Diagnosis of lower genital tract infection in pregnancy: Routine mid-trimester high vaginal swab followed by gram staining, seems to be the best strategy

Vidyashree Ganesh Poojari, Akhila Vasudeva, Samantha Dawson, Geetha Kaipa, Vandana Eshwara, Chaitanya Tellapragada, Pratap Kumar

Research output: Contribution to journalArticle

Abstract

Background: Screening of lower genital tract infection (LGTI) in mid-trimester prevents preterm birth (PTB). There is no consensus on best screening methods for LGTI-symptoms, speculum findings, a point of care tests or high vaginal swab microscopy. Aim: To know diagnostic accuracy of screening of lower genital tract infection (LGTI) in mid-trimester by clinical symptom/signs and point of care tests (viz Amsel’s criteria) as against the gold standard microscopic tests using gram stain. Settings and Design: Prospective observational study in a tertiary care hospital over two years. The study population included 228 antenatal women between 18th-24th weeks. Materials and Methods: Symptoms of vaginal discharge were noted. Speculum examination was performed on all, to detect the type of discharge. High vaginal swabs were collected, subjected to the point of care tests (Amsel’s criteria) as well as gram staining. Microscopy (Eg: Nugent’s crite-ria) was taken as the gold standard, to which other methods were compared. Results: Thirty women (13.5%) were symptomatic. Among 198 that were asymptomatic, 91(45.92%) had LGTI. Speculum examination showed discharge in 221 (96.9%), but gram staining showed LGTI in only 104 (45.61%), among whom 45 (19.7%) had partial Bacterial vaginosis (BV), 14(6.1%) had full BV, and 40(17.5%) had candidiasis. The commonest discharge was homogenous thin white, suggestive of BV but 51% among them had normal vaginal flora (NVF); whereas 27% of those labelled physiological discharge were positive for BV. The appearance of discharge and gram stain thus did not correlate well. Amsel’s criteria had poor diagnostic accuracy compared to Nugent’s, although negative predictive value were high. Conclusion: There is a high prevalence of LGTI, especially BV among asymptomatic pregnant women at mid-trimester, best detected with a routine high vaginal swab and gram staining rather than relying on symptoms/speculum findings/point of care tests. Such testing may guide appropriate treatment for reducing the risk of PTB.

Original languageEnglish
Pages (from-to)277-283
Number of pages7
JournalCurrent Women's Health Reviews
Volume15
Issue number4
DOIs
Publication statusPublished - 01-01-2019

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Reproductive Tract Infections
Bacterial Vaginosis
Point-of-Care Systems
Staining and Labeling
Surgical Instruments
Pregnancy
Premature Birth
Microscopy
Vaginal Discharge
Candidiasis
Tertiary Healthcare
Tertiary Care Centers
Signs and Symptoms
Observational Studies
Pregnant Women
Prospective Studies
Population

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynaecology

Cite this

@article{5437881f9b0840d38dcad7355abbc47c,
title = "Diagnosis of lower genital tract infection in pregnancy: Routine mid-trimester high vaginal swab followed by gram staining, seems to be the best strategy",
abstract = "Background: Screening of lower genital tract infection (LGTI) in mid-trimester prevents preterm birth (PTB). There is no consensus on best screening methods for LGTI-symptoms, speculum findings, a point of care tests or high vaginal swab microscopy. Aim: To know diagnostic accuracy of screening of lower genital tract infection (LGTI) in mid-trimester by clinical symptom/signs and point of care tests (viz Amsel’s criteria) as against the gold standard microscopic tests using gram stain. Settings and Design: Prospective observational study in a tertiary care hospital over two years. The study population included 228 antenatal women between 18th-24th weeks. Materials and Methods: Symptoms of vaginal discharge were noted. Speculum examination was performed on all, to detect the type of discharge. High vaginal swabs were collected, subjected to the point of care tests (Amsel’s criteria) as well as gram staining. Microscopy (Eg: Nugent’s crite-ria) was taken as the gold standard, to which other methods were compared. Results: Thirty women (13.5{\%}) were symptomatic. Among 198 that were asymptomatic, 91(45.92{\%}) had LGTI. Speculum examination showed discharge in 221 (96.9{\%}), but gram staining showed LGTI in only 104 (45.61{\%}), among whom 45 (19.7{\%}) had partial Bacterial vaginosis (BV), 14(6.1{\%}) had full BV, and 40(17.5{\%}) had candidiasis. The commonest discharge was homogenous thin white, suggestive of BV but 51{\%} among them had normal vaginal flora (NVF); whereas 27{\%} of those labelled physiological discharge were positive for BV. The appearance of discharge and gram stain thus did not correlate well. Amsel’s criteria had poor diagnostic accuracy compared to Nugent’s, although negative predictive value were high. Conclusion: There is a high prevalence of LGTI, especially BV among asymptomatic pregnant women at mid-trimester, best detected with a routine high vaginal swab and gram staining rather than relying on symptoms/speculum findings/point of care tests. Such testing may guide appropriate treatment for reducing the risk of PTB.",
author = "Poojari, {Vidyashree Ganesh} and Akhila Vasudeva and Samantha Dawson and Geetha Kaipa and Vandana Eshwara and Chaitanya Tellapragada and Pratap Kumar",
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Diagnosis of lower genital tract infection in pregnancy : Routine mid-trimester high vaginal swab followed by gram staining, seems to be the best strategy. / Poojari, Vidyashree Ganesh; Vasudeva, Akhila; Dawson, Samantha; Kaipa, Geetha; Eshwara, Vandana; Tellapragada, Chaitanya; Kumar, Pratap.

In: Current Women's Health Reviews, Vol. 15, No. 4, 01.01.2019, p. 277-283.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Diagnosis of lower genital tract infection in pregnancy

T2 - Routine mid-trimester high vaginal swab followed by gram staining, seems to be the best strategy

AU - Poojari, Vidyashree Ganesh

AU - Vasudeva, Akhila

AU - Dawson, Samantha

AU - Kaipa, Geetha

AU - Eshwara, Vandana

AU - Tellapragada, Chaitanya

AU - Kumar, Pratap

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Screening of lower genital tract infection (LGTI) in mid-trimester prevents preterm birth (PTB). There is no consensus on best screening methods for LGTI-symptoms, speculum findings, a point of care tests or high vaginal swab microscopy. Aim: To know diagnostic accuracy of screening of lower genital tract infection (LGTI) in mid-trimester by clinical symptom/signs and point of care tests (viz Amsel’s criteria) as against the gold standard microscopic tests using gram stain. Settings and Design: Prospective observational study in a tertiary care hospital over two years. The study population included 228 antenatal women between 18th-24th weeks. Materials and Methods: Symptoms of vaginal discharge were noted. Speculum examination was performed on all, to detect the type of discharge. High vaginal swabs were collected, subjected to the point of care tests (Amsel’s criteria) as well as gram staining. Microscopy (Eg: Nugent’s crite-ria) was taken as the gold standard, to which other methods were compared. Results: Thirty women (13.5%) were symptomatic. Among 198 that were asymptomatic, 91(45.92%) had LGTI. Speculum examination showed discharge in 221 (96.9%), but gram staining showed LGTI in only 104 (45.61%), among whom 45 (19.7%) had partial Bacterial vaginosis (BV), 14(6.1%) had full BV, and 40(17.5%) had candidiasis. The commonest discharge was homogenous thin white, suggestive of BV but 51% among them had normal vaginal flora (NVF); whereas 27% of those labelled physiological discharge were positive for BV. The appearance of discharge and gram stain thus did not correlate well. Amsel’s criteria had poor diagnostic accuracy compared to Nugent’s, although negative predictive value were high. Conclusion: There is a high prevalence of LGTI, especially BV among asymptomatic pregnant women at mid-trimester, best detected with a routine high vaginal swab and gram staining rather than relying on symptoms/speculum findings/point of care tests. Such testing may guide appropriate treatment for reducing the risk of PTB.

AB - Background: Screening of lower genital tract infection (LGTI) in mid-trimester prevents preterm birth (PTB). There is no consensus on best screening methods for LGTI-symptoms, speculum findings, a point of care tests or high vaginal swab microscopy. Aim: To know diagnostic accuracy of screening of lower genital tract infection (LGTI) in mid-trimester by clinical symptom/signs and point of care tests (viz Amsel’s criteria) as against the gold standard microscopic tests using gram stain. Settings and Design: Prospective observational study in a tertiary care hospital over two years. The study population included 228 antenatal women between 18th-24th weeks. Materials and Methods: Symptoms of vaginal discharge were noted. Speculum examination was performed on all, to detect the type of discharge. High vaginal swabs were collected, subjected to the point of care tests (Amsel’s criteria) as well as gram staining. Microscopy (Eg: Nugent’s crite-ria) was taken as the gold standard, to which other methods were compared. Results: Thirty women (13.5%) were symptomatic. Among 198 that were asymptomatic, 91(45.92%) had LGTI. Speculum examination showed discharge in 221 (96.9%), but gram staining showed LGTI in only 104 (45.61%), among whom 45 (19.7%) had partial Bacterial vaginosis (BV), 14(6.1%) had full BV, and 40(17.5%) had candidiasis. The commonest discharge was homogenous thin white, suggestive of BV but 51% among them had normal vaginal flora (NVF); whereas 27% of those labelled physiological discharge were positive for BV. The appearance of discharge and gram stain thus did not correlate well. Amsel’s criteria had poor diagnostic accuracy compared to Nugent’s, although negative predictive value were high. Conclusion: There is a high prevalence of LGTI, especially BV among asymptomatic pregnant women at mid-trimester, best detected with a routine high vaginal swab and gram staining rather than relying on symptoms/speculum findings/point of care tests. Such testing may guide appropriate treatment for reducing the risk of PTB.

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