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Recent Trends in Infectious Diseases Original Research

Lower Genital Tract Infections in Pregnant Women: Epidemiology and Risk Factors Associated in Dakar, Senegal

  1. Ndeye Safietou Ngom Bacteriology-Virology Laboratory, National University Hospital Center Aristide Le Dantec,
  2. Gora Lo Bacteriology-Virology Laboratory, National University Hospital Center Aristide Le Dantec,
  3. Assane Dieng Gynecological and obstetrical clinic, National University Hospital Center Aristide Le Dantec,
  4. Doudou Georges Massar Niang Immunology Unit, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University
  5. Serigne Mbaye Lo Ndiaye Bacteriology-Virology Laboratory, National University Hospital Center Aristide Le Dantec,
  6. Alioune Tine Bacteriology-Virology Laboratory, National University Hospital Center Aristide Le Dantec,
  7. Awa ba-Diallo Bacteriology-Virology Laboratory, National University Hospital Center Aristide Le Dantec,
  8. Omar Gassama Gynecological and obstetrical clinic, National University Hospital Center Aristide Le Dantec,
  9. Halimatou Diop-Ndiaye Bacteriology-Virology Laboratory, National University Hospital Center Aristide Le Dantec,
  10. Makhtar Camara Bacteriology-Virology Laboratory, National University Hospital Center Aristide Le Dantec,

Abstract

Vaginal infections are responsible for many problems in women of childbearing age and significantly influence pregnancy outcomes. This study sought to ascertain the prevalence of lower genital tract infections and the risk factors associated with them in pregnant women under observation at the Nabil Choucair Health Centre in Dakar, Senegal. This nine-month cross-sectional study, which involved women between 34 and 38 weeks gestation (WG), was carried out from July 2020 to March 2021. The vaginal samples were analyzed using the humid montage method, Gram coloration (Nugent criteria), and culture in a specific medium. The data was analyzed using SPSS version 25 and the chi-two test to determine the strength of the association. A significance level of p < 0.05 was set for the statistical tests. Microbiological confirmation of infection was found in 227 pregnant women, resulting in an overall prevalence of 59.1% (227/384). In the series, the median gestational age was 36 WG. Only 55.9% (215/384) of patients reported infection-related symptoms. With 42.7% (164/384) of these infections being vulvovaginal candidiasis, it was the most frequent, followed by bacterial vaginosis (29.2%; 112/384) and Trichomonas vaginal (1.3%; 5/384). Mixed infections were recorded at 24.8% (n = 94), with a Gardnerella vaginalis/Candida spp. co-infection rate estimated at 13.80% (n = 53). Other germs found in mixed infections included Group B Streptococcus (GBS; 8.07%; n = 31) and Escherichia coli (0.78%; n = 3). Clinical symptoms (p = 0.018), bleeding from ectocervical contacts (p = 0.005), and unfavorable pregnancy outcomes (p = 0.020) were significantly correlated with the occurrence of lower genital tract infections. Our findings show a high prevalence of vaginal infections during pregnancy. Vaginal sampling during pregnancy should be included in the prenatal surveillance program to reduce the disease burden and complications associated with lower genital tract infections.

Keywords

References (47)

  1. Bagga R, Arora P. Genital Micro-Organisms in Pregnancy. Frontiers in Public Health. 2020;8. doi:10.3389/fpubh.2020.00225
  2. Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SSK, McCulle SL, et al. Vaginal microbiome of reproductive-age women. Proceedings of the National Academy of Sciences. 2010;108(supplement_1):4680-4687. doi:10.1073/pnas.1002611107
  3. Bonet M, Brizuela V, Abalos E, Cuesta C, Baguiya A, Chamillard M, et al. Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study. The Lancet Global Health. 2020;8(5):e661-e671. doi:10.1016/s2214-109x(20)30109-1
  4. Maternal and neonatal mortality in Senegal: 315 deaths per 100,000 live births | Fonds Francais Muskoka (ffmuskoka.org) https://news.un.org/fr/story/2019/09/1052012.
  5. https://microbiologiemedicale.fr/diagnostic-infections-vaginales/ consulted on 16/06/2023.
  6. Owen, M. K., & Clenney, T. L. (2004). Management of vaginitis. American family physician, 70(11), 2125–2132.
  7. Salinas AM, Osorio VG, Endara PF, Salazar ER, Vasco GP, Vivero SG, et al. Bacterial identification of the vaginal microbiota in Ecuadorian pregnant teenagers: an exploratory analysis. PeerJ. 2018;6:e4317. doi:10.7717/peerj.4317
  8. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. Journal of Clinical Microbiology. 1991;29(2):297-301. doi:10.1128/jcm.29.2.297-301.1991
  9. Aagaard K, Riehle K, Ma J, Segata N, Mistretta TA, Coarfa C, et al. A Metagenomic Approach to Characterization of the Vaginal Microbiome Signature in Pregnancy. PLoS ONE. 2012;7(6):e36466. doi:10.1371/journal.pone.0036466
  10. Domeika M, Zhurauskaya L, Savicheva A, Frigo N, Sokolovskiy E, Hallén A, et al. Guidelines for the laboratory diagnosis of trichomoniasis in East European countries. Journal of the European Academy of Dermatology and Venereology. 2010;24(10):1125-1134. doi:10.1111/j.1468-3083.2010.03601.x
  11. Froböse NJ, Bjedov S, Schuler F, Kahl BC, Kampmeier S, Schaumburg F. Gram Staining: a Comparison of Two Automated Systems and Manual Staining. Journal of Clinical Microbiology. 2020;58(12). doi:10.1128/jcm.01914-20
  12. Matheson A, Mazza D. Recurrent vulvovaginal candidiasis: A review of guideline recommendations. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2017;57(2):139-145. doi:10.1111/ajo.12592
  13. Matheson A, Mazza D. Recurrent vulvovaginal candidiasis: A review of guideline recommendations. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2017;57(2):139-145. doi:10.1111/ajo.12592
  14. Franco-Duarte R, Černáková L, Kadam S, S. Kaushik K, Salehi B, Bevilacqua A, et al. Advances in Chemical and Biological Methods to Identify Microorganisms—From Past to Present. Microorganisms. 2019;7(5):130. doi:10.3390/microorganisms7050130
  15. De La Rosa M, Villareal R, Vega D, Miranda C, Martinezbrocal A. Granada medium for detection and identification of group B streptococci. Journal of Clinical Microbiology. 1983;18(4):779-785. doi:10.1128/jcm.18.4.779-785.1983
  16. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. Journal of Clinical Microbiology. 1991;29(2):297-301. doi:10.1128/jcm.29.2.297-301.1991
  17. Diadhiou M, Ba Diallo A, Barry MS, Alavo SC, Mall I, Gassama O, et al. Prevalence and Risk Factors of Lower Reproductive Tract Infections in Symptomatic Women in Dakar, Senegal. Infectious Diseases: Research and Treatment. 2019;12. doi:10.1177/1178633719851825
  18. Konadu DG, Owusu-Ofori A, Yidana Z, Boadu F, Iddrisu LF, Adu-Gyasi D, et al. Prevalence of vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis in pregnant women attending antenatal clinic in the middle belt of Ghana. BMC Pregnancy and Childbirth. 2019;19(1). doi:10.1186/s12884-019-2488-z
  19. Dickson, S. N., Denis, Z., Jules-Clement, N. A., Anna, L. N., Che Denis Nchang, Neville MvoNgum, Weledji Elroy Patrick, and NgoweNgowe Marcelin, “The Epidemiology of Trichomonas vaginalis, Gardnerella vaginalis and Candida albicans Co- Infections in Women Attending the Yaounde University Teaching Hospital.” American Journal of Epidemiology and Infectious Disease, vol. 3, no. 2 (2015): 28-31. doi:10.12691/ajeid-3-2-2.
  20. V Majigo M, Kashindye P, Mtulo Z, Joachim A. Bacterial vaginosis, the leading cause of genital discharge among women presenting with vaginal infection in Dar es Salaam, Tanzania. African Health Sciences. 2021;21(2):531-537. doi:10.4314/ahs.v21i2.7
  21. Yasin J, Ayalew G, Dagnaw M, Shiferaw G, Mekonnen F. Vulvovaginitis Prevalence Among Women in Gondar, Northwest Ethiopia: Special Emphasis on Aerobic Vaginitis Causing Bacterial Profile, Antimicrobial Susceptibility Pattern, and Associated Factors. Infection and Drug Resistance. 2021;Volume14:4567-4580. doi:10.2147/idr.s337205
  22. Konaté A, Yavo W, Kassi FK, Djohan V, Angora EK, Barro-Kiki PC, et al. Aetiologies and contributing factors of vulvovaginal candidiasis in Abidjan (Cote d’Ivoire). Journal de Mycologie Médicale. 2014;24(2):93-99. doi:10.1016/j.mycmed.2013.11.006
  23. Fanou, B. A., Klotoe, J. R., Dougnon, V., Monteiro, A., Koudokpon, C. H., & Loko, F. (2022). Prevalence and factors associated with vulvovaginal candidiasis in women admitted to the Zone Hospital of Mènontin (Bénin). The Pan African medical journal, 42, 215. https://doi.org/10.11604/pamj.2022.42.215.28984
  24. Bitew A, Abebaw Y. Vulvovaginal candidiasis: species distribution of Candida and their antifungal susceptibility pattern. BMC Women's Health. 2018;18(1). doi:10.1186/s12905-018-0607-z
  25. Elfeky, D.S., Gohar, N.M., El-Seidi, E.A., Ezzat, M., & AboElew, S.H. (2016). Species identification and antifungal susceptibility pattern of Candida isolates in cases of vulvovaginal candidiasis. Alexandria Journal of Medicine, 52, 269 - 277.
  26. Anh DN, Hung DN, Tien TV, Dinh VN, Son VT, Luong NV, et al. Prevalence, species distribution and antifungal susceptibility of Candida albicans causing vaginal discharge among symptomatic non-pregnant women of reproductive age at a tertiary care hospital, Vietnam. BMC Infectious Diseases. 2021;21(1). doi:10.1186/s12879-021-06192-7
  27. Sylla K, Sow D, Lakhe NA, Tine RC, Dia M, Lelo S et al. Vulvo-vaginal candidiasis in the Parasitology-Mycology laboratory of the Centre Hospitalier Universitaire de Fann, Dakar (Senegal). Rev Cames Santé. 2018;5(2): 21-27 G. PubMed| Google Scholar.
  28. Osman Mohamed A, Suliman Mohamed M, Hussain Mallhi T, Abdelrahman Hussain M, Ali Jalloh M, Ali Omar K, et al. Prevalence of vulvovaginal candidiasis among pregnant women in Africa: A systematic review and meta-analysis. The Journal of Infection in Developing Countries. 2022;16(08):1243-1251. doi:10.3855/jidc.15536
  29. Sy, O., Diongue, K., Ahmed, C. B., Ba, O., Moulay, F. C., Lo, B., & Ndiaye, D. (2018). Vulvovaginal candidiasis in pregnant women in the Mère et Enfant Hospital center in Nouakchott, Mauritania. Journal de mycologie medicale, 28(2), 345–348. https://doi.org/10.1016/j.mycmed.2018.02.006.
  30. Sangaré I, Sirima C, Bamba S, Zida A, Cissé M, Bazié WW, et al. Prevalence of vulvovaginal candidiasis in pregnancy at three health centers in Burkina Faso. Journal de Mycologie Médicale. 2018;28(1):186-192. doi:10.1016/j.mycmed.2017.08.006
  31. Djohan V, Angora KE, Vanga-Bosson AH, Konaté A, Kassi KF, Kiki-Barro PCM, et al. Recurrent vulvo-vaginal candidiasis in Abidjan (Côte d’Ivoire): Aetiology and associated factors. Journal de Mycologie Médicale. 2019;29(2):127-131. doi:10.1016/j.mycmed.2019.04.002
  32. Leli, C., Mencacci, A., Meucci, M., Bietolini, C., Vitali, M., Farinelli, S., D' Alò, F., Bombaci, J. C., Perito, S., & Bistoni, F. (2013). Association of pregnancy and Candida vaginal colonization in women with or without symptoms of vulvovaginitis. Minerva ginecologica, 65(3), 303–309.
  33. Schuster HJ, de Jonghe BA, Limpens J, budding A. AE, Painter RC. Asymptomatic vaginal Candida colonization and adverse pregnancy outcomes, including preterm birth: a systematic review and meta-analysis. Am J Obstet Gynecol 2020;2(3):100163.
  34. Sule-Odu, A. O., Akadri, A. A., Oluwole, A. A., Osinupebi, O. A., Andu, B. A., Akiseku, A. K., & Lawal, A. I. (2020). Vaginal Candida infection in pregnancy and its implications for fetal well-being. African journal of reproductive health, 24(3), 33–40. https://doi.org/10.29063/ajrh2020/v24i3.4
  35. Mtibaa L, Fakhfakh N, Kallel A, Belhadj S, Belhaj Salah N, Bada N, et al. Vulvovaginal candidiasis: Etiology, symptomatology and risk factors. Journal de Mycologie Médicale. 2017;27(2):153-158. doi:10.1016/j.mycmed.2017.01.003
  36. Bonneton M, Huynh BT, Seck A, Bercion R, Sarr FD, Delarocque-Astagneau E, et al. Bacterial vaginosis and other infections in pregnant women in Senegal. BMC Infectious Diseases. 2021;21(1). doi:10.1186/s12879-021-06767-4
  37. Kamga YM, Ngunde JP, Akoachere JFKT. Prevalence of bacterial vaginosis and associated risk factors in pregnant women receiving antenatal care at the Kumba Health District (KHD), Cameroon. BMC Pregnancy and Childbirth. 2019;19(1). doi:10.1186/s12884-019-2312-9
  38. Abdul-Aziz M, Mahdy MAK, Abdul-Ghani R, Alhilali NA, Al-Mujahed LKA, Alabsi SA, et al. Bacterial vaginosis, vulvovaginal candidiasis and trichomonal vaginitis among reproductive-aged women seeking primary healthcare in Sana’a city, Yemen. BMC Infectious Diseases. 2019;19(1). doi:10.1186/s12879-019-4549-3
  39. Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, et al. The Prevalence of Bacterial Vaginosis in the United States, 2001–2004; Associations With Symptoms, Sexual Behaviors, and Reproductive Health. Sexually Transmitted Diseases. 2007;34(11):864-869. doi:10.1097/olq.0b013e318074e565
  40. Tine RC, Sylla K, Ka R, Dia L, Sow D, Lelo S, et al. A Study ofTrichomonas vaginalisInfection and Correlates in Women with Vaginal Discharge Referred at Fann Teaching Hospital in Senegal. Journal of Parasitology Research. 2019;2019:1-8. doi:10.1155/2019/2069672
  41. Abdullahi, B. and Danyaya, R. (2021): Prevalence of Candida Albicans and Trichomonas vaginalis Infection among Women Presenting With Vaginitis in Jama'a Hospital, Samaru, Zaria, Nigeria BJMLS. 6(2):69 – 77.
  42. Abdul-Aziz M, Mahdy MAK, Abdul-Ghani R, Alhilali NA, Al-Mujahed LKA, Alabsi SA, et al. Bacterial vaginosis, vulvovaginal candidiasis and trichomonal vaginitis among reproductive-aged women seeking primary healthcare in Sana’a city, Yemen. BMC Infectious Diseases. 2019;19(1). doi:10.1186/s12879-019-4549-3
  43. Zenebe MH, Mekonnen Z, Loha E, Padalko E. Prevalence, risk factors and association with delivery outcome of curable sexually transmitted infections among pregnant women in Southern Ethiopia. PLOS ONE. 2021;16(3):e0248958. doi:10.1371/journal.pone.0248958
  44. Rowley J, Vander Hoorn S, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bulletin of the World Health Organization. 2019;97(8):548-562P. doi:10.2471/blt.18.228486
  45. Van Gerwen OT, Muzny CA. Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection. F1000Research. 2019;8:1666. doi:10.12688/f1000research.19972.1
  46. Fanou, B. A., Klotoe, J. R., Dougnon, V., Monteiro, A., Koudokpon, C. H., & Loko, F. (2022). Prevalence and factors associated with vulvovaginal candidiasis in women admitted to the Zone Hospital of Mènontin (Bénin)]. The Pan African medical journal, 42, 215. https://doi.org/10.11604/pamj.2022.42.215.28984.
  47. Sylla K, Sow D, Lakhe NA, Tine RC, Dia M, Lelo S et al. Vulvo-vaginal candidiasis in the Parasitology-Mycology laboratory of the Centre Hospitalier Universitaire de Fann, Dakar (Senegal). Rev Cames Santé. 2018;5(2): 21-27 G.