Nongonococcal And Nonchlamydial Microbial Isolates From High Vaginal Swabs Of Nigerian Women Diagnosed With Pelvic Inflammatory Disease

摘要

High vaginal swabs from 1451 Nigerian women clinically diagnosed with pelvic inflammatory disease (PID) were investigated for nongonococcal and nonchlamydial microbial infections using standard techniques. Bacteria were isolated from 623(42.9%, 95% CI., 40.4-45.4%) women, comprising 474(76.1%) monobacterial and 149(23.9%) polybacterial isolates. Trichomonas vaginalis and Candida albicans were isolated from 124(8.5%, 95% CI., 7.1-9.9%) and 611(42.1%, 95% CI., 39.6-44.6%) women respectively. Predominant bacterial isolates were Escherichia coli (34.9%, 95% CI., 29.2-40.6%) and Staphylococcus aureus (27.1%, 95% CI., 24.0-30.2%), while least bacterial isolates were Streptococcus species (5.1%, 95% CI., 3.5-6.7%) and Gardnerella vaginalis (4.3%, 95% CI., 2.9-5.7%). Individuals aged 36-40 years were significantly more infected with bacteria (χ2 =107.97, P<0.05) and C. albicans (χ2 =55.90, P<0.05). While prevalence of T. vaginalis was significantly higher among individuals aged 26-30 years (χ2 =27.46, P<0.05). Routine screening and treatment of women for lower genital tract infections to minimize their role in PID is recommended Introduction Pelvic inflammatory disease (PID) is the most important complication of the female genital tract, causing major medical, social and economic problems worldwide [1]. PID comprises a spectrum of inflammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis [2,3]. PID is a polymicrobial infection due to the ascending of normal endogenous microorganisms from the lower genital tract into the upper genital tract or the infection by microorganisms related to sexually transmitted diseases (STD) as Chlamydia trachomatis and Neisseria gonorrhoeae [4,5]. Complications of PID are common and difficult to treat and include tubo-ovarian abscess, ectopic pregnancy, recurrent PID and infertility [5]. Overall, such complications are estimated to occur among 15%-20% of women with PID, and are associated with great emotional stress and can have a major effect on a woman's reproductive health [6]. Approximately 12% of women are infertile after a single episode of PID, almost 25% after two episodes, and over 50% after three or more episodes [7]. Despite advances in defining its aetiology, pathogenesis and availability of many powerful antimicrobial drugs, PID consumes a significant portion of the medical resources of numerous countries [8]. In US for instance, at least 5.5 billion dollars are spent on PID annually and more than a million women are diagnosed with PID each year and for every four women who have PID, one will suffer a complication [1,9].Often the PID rates are highest in developing countries where medical resources are most severely limited and the number of women with unrecognized PID is estimated to be far higher [8,10]. It is estimated that in developing countries PID is related to 94% of all sexually transmitted infections (STI) related morbidity [11]. There is paucity of information on PID in sub-Saharan Africa and available statistics in the sub-region are rather focal [12,13]. This is largely attributed to the fact that clinical diagnosis of PID is at best difficult and imprecise, and laboratory criteria are neither highly specific nor sensitive [2,3]. Although it is well established that gonococcal (Neisseria gonorrhoeae) and chlamydial (Chlamydia trachomatis) microorganisms are the major pathogens causing acute PID, currently, there is a rising incidence of nongonococcal and nonchlamydial PID worldwide [13,14,15]. The nongonococcal and nonchlamydial microorganisms have been reported to be responsible for higher frequency of PID in some areas[14,16]. However, the natural genital flora of females is so varied that determining actual causative agents is difficult. The objective of this study therefore was to investigate the spectrum of nongonococcal and nonchlamydial genital microorganisms implicated in