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Increased vaginal pH in Ugandan women: what does it indicate?

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Abnormal vaginal flora (AVF), indicative of bacterial vaginosis (BV) and/or aerobic vaginitis (AV), amongst other abnormalities, is a risk factor for multiple complications in pregnant as well as non-pregnant women. Screening for such conditions could help prevent these complications. Can self-testing for increased vaginal pH reliably detect BV and other high-risk microflora types, and is this more accurate than performing Gram stain-based Nugent score when screening for high-risk microflora? A total of 344 women presenting at different outpatient clinics in Mulago Hospital and Mbuikwe Outpatient clinics in Kampala, Uganda, were asked to test themselves by introducing a gloved finger into the vagina and smearing it on a microscopy slide, on which a pH strip was attached. Self-assessed categories of normal (pH 3.6–4.4), intermediate (4.5–4.7) or high pH (>4.7) were compared with demographic and with centralised microscopic data, both in air-dried rehydrated wet mounts (Femicare), as well as in Gram-stained specimens (Nugent). AVF was present in 38 %, BV in 25 % and AV in 11 % of patients. High pH and AVF is correlated with human immunodeficiency virus (HIV), infertility, frequent sex, but not vaginal douching. Screening for raised pH detects 90 % of AVF cases, but would require testing over half of the population. As AV and non-infectious conditions are frequent in women with AVF and high pH, Nugent score alone is an insufficient technique to screen women for a high-risk vaginal microflora, especially in infertile and HIV-infected women.

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Author contributions

GD, JL, JB and AG participated in the design of the study.

FD, TM, NE and AG conceived the study, participated in its design and coordination, and helped to draft the manuscript.

CM, GD and GB performed the microscopic examinations and helped to draft the manuscript.

All authors read and approved the final manuscript.

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Correspondence to G. G. G. Donders.

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Funding

Femicare, a non-profit organisation based in Tienen, Belgium, supporting clinical research for women.

Conflict of interest

None of the authors declares any conflict of interest.

Ethical approval

The study was approved by the ethical committee of the Kampala University Hospital in November 2008.

Informed consent

Written informed consent was signed by all patients before engaging in the study.

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Donders, G.G.G., Gonzaga, A., Marconi, C. et al. Increased vaginal pH in Ugandan women: what does it indicate?. Eur J Clin Microbiol Infect Dis 35, 1297–1303 (2016). https://doi.org/10.1007/s10096-016-2664-2

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  • DOI: https://doi.org/10.1007/s10096-016-2664-2

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