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Bacterial agents in vulvovaginitis and vaginal discharge: a 10-year retrospective study in the Netherlands

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

Abstract

Vulvovaginitis is a common problem in the GP’s practice. Causes are bacterial vaginosis (BV), Candida infection and sexually transmitted infections (STIs). Only if empirical treatment fails, a vaginal swab is sent in for culture and BV detection. However, without culture essential, bacterial pathogens may escape diagnosis. Many molecular BV assays have recently appeared on the marketplace, all quite differing in price and targets. However, for years, the Nugent score has been the gold standard for BV detection. We analysed retrospectively 10 years of microbiology results of vulvovaginal swabs, focusing on less frequently reported bacterial pathogens, and assessed the characteristics of BV diagnostics. Vulvovaginal swabs sent in between 2010 and 2020 from > 11,000 GP patients with vulvovaginitis associated symptoms, but negative STI tests, were analysed. First cultures and repeat cultures after at least 6 months were included in four age groups: < 12, 12–17, 18–51 and > 51 years. Candida species and BV were most frequently found, with the highest prevalence in premenopausal women. Haemophilus influenzae, beta-haemolytic streptococci, Streptococcus pneumoniae and Staphylococcus aureus were isolated in 5.6% of all cultures, with the highest percentages in children and postmenopausal women. If empirical treatment of vulvovaginitis fails, bacterial culture should be performed to detect all potentially pathogenic microorganisms to obtain a higher rate of successful diagnosis and treatment, avoiding unnecessary antimicrobial use and costs. For BV detection, molecular testing may seem attractive, but Nugent scoring still remains the low-cost gold standard. We recommend incorporating the above in the appropriate guidelines.

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Authors and Affiliations

  1. Laboratory of Clinical Microbiology and Infectious Diseases, Isala Hospital, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands

    Marjan J. Bruins, Claudy Oliveira dos Santos & Gijs J. H. M. Ruijs

  2. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    Roger A. M. J. Damoiseaux

Authors
  1. Marjan J. Bruins
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  2. Claudy Oliveira dos Santos
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  3. Roger A. M. J. Damoiseaux
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  4. Gijs J. H. M. Ruijs
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Contributions

All authors contributed to the design of the study, analysis and interpretation of the data and drafting and revising the manuscript. All authors approved of the final submitted version.

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Correspondence to Marjan J. Bruins.

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All procedures performed in our study involving human participants were in accordance with the ethical standards of our institution and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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The authors declare no competing interests.

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Bruins, M.J., dos Santos, C.O., Damoiseaux, R.A.M.J. et al. Bacterial agents in vulvovaginitis and vaginal discharge: a 10-year retrospective study in the Netherlands. Eur J Clin Microbiol Infect Dis 40, 2123–2128 (2021). https://doi.org/10.1007/s10096-021-04265-8

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  • DOI: https://doi.org/10.1007/s10096-021-04265-8

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