ABSTRACT
This study was carried out to examine the bacteria that cause vaginal infection in female students. Vaginal infection with bacterial vaginosis, candiasis and trichomoniasis are a global health problem for women. Other specific objectives are to determine the bacterial load, to ascertain the associated bacterial isolates and to determine the frequency of occurrence of the bacterial isolates and to determine the susceptibility pattern of the isolates to some antibiotics. This study was conducted using selected 20 female students of Michael Okpara University of Agriculture, Umudike, Abia State aged 16 to 29 years. Vaginal swabs were obtained twice weekly. The bacterial isolates from the samples were examined for appearance based on shape, elevation, edge and pigmentation. The higher number of bacterial growth observed in this study suggested an infection process by organism E. coli and S. aureus. The most effective chemotherapeutic agents observed against E. coli in this study were ciprofloxacin which had (17s) and tarivid (17s) which is 100%, for S. aureus ciprofloxacin and tarivid had 11s which was 100% also, the least activity in E. coli was penicillin, colistin, gentamycin. The result obtained from this study have revealed a high vaginal infection among female students of Michael Okpara University, therefore the study recommended that the use of condoms or total abstinence should be encouraged among the female undergraduates and the females should always clean from forward to backward after using the toilet so as not to transfer the microorganism from the bowel to the vagina.
TABLE OF
CONTENTS
Cover page
Title Page i
Certification ii
Declaration iii
Dedication iv
Acknowledgements v
Table of Contents vi
List of Tables viii
List of Figures ix
Abstract x
CHAPTER ONE: INTRODUCTION
1.1
Background of the Study
1.2
Statement of the Problem
1.3 Aim and Objectives
1.4 Scope of Study
1.5 Significance of Study
1.6 Limitations of the Study
1.7 Key Definition of Terms
CHAPTER TWO: LITERATURE REVIEW
2.1
Vaginal Infection
2.1.1 Pathophysiology
2.1.2 Etiology
2.1.3 Epidemiology
2.1.4 Prognosis
2.2 Causes of Vaginal Infection
2.3 Prevention of Vaginal
Infection
2.4 Symptoms of Vaginal
Infection
2.5 Diagnosis of Vaginal Infection
2.6 Empirical Review
CHAPTER
THREE: MATERIALS AND METHODS
3.1 Materials Used
3.2 Methods
3.2.1 Population of the Study
3.2.2 Sample Collection
3.2.3 Microbiological Analysis
3.2.4 Identification of Bacterial Isolates
3.2.4.1 Gram Reaction
3.2.4.2 Catalase Test
3.2.4.3 Coagulase Test
3.2.4.4 Urease Test
3.2.4.5 Oxidase Test
3.2.4.6 Indole Test
3.2.4.7 Citrate Utilization
3.2.4.7 Motility Test
CHAPTER
FOUR
4.1 Results
CHAPTER
FIVE
5.1 Discussion
5.2 Conclusion
5.3 Recommendations
REFERENCES
TLIST OF
TABLES
Table Title
Page
1.1 Bacterial Count (Cfu/ml)
on chocolate agar 26
1.2 Bacterial Count (Cfu/ml)
on macconkey 27
2 Microbiology
Identification of Isolates from Samples Cultured 28
3 Sensitivity
test on the Isolate
30
LIST
OF FIGURES
Figure Title Page
1 Frequency of occurrence
of the isolate from the samples
29
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Vaginal infections with
bacterial vaginosis, candidiasis and trichomoniasis are a global health problem
for women (Go et al., 2006). Vaginitis is the inflammation and infection
of vagina commonly encountered in clinical medicine (Hacer et al., 2012).
Diverse spectrums of pathogenic agents were observed in the vaginal micro
flora. Of these, bacterial vaginosis, candidiasis and trichomoniasis are
responsible for majority of vaginal infections in women of reproductive age (Spinillo et al.,
1997). Abnormal vaginal discharge, itching, burning sensation,
irritation and discomfort are frequent complaints among patients attending
obstetrics and gynecology clinics. However, a number of vaginal infections
present with few or no symptoms.
Candida vaginitis (CV) is one
of the most frequent infections in women of reproductive age. Approximately
75 % of adult women will have at least one episode of vaginitis by candida
during their life time (Adeyba et al., 2003). Unfortunately,
about 40 – 50 % of women who had a first episode is likely to present a
recurrence and 5 % may present a form of “recurring” characterized by at
least three or more episodes of infection per year.
Trichomonal vaginitis (TV) is
the most common sexually transmitted disease (Prospero,
2014). It is caused by a parasitic protozoan T.
vaginalis. Globally, TV affects approximately 57–180 million
people, with the majority living in developing countries. However, in most
cases TV is asymptomatic. In women, TV affects more frequently between 20 and
40 years old and is quite rare before puberty and postmenopausal age.
The symptoms of TV are mainly
characterized by vaginal discharge with gray or greenish-yellow fluid rather
frothy, foul-smelling, intense itching, edema cervix redness, the sensation of
itching, dyspareunia and postcoital bleeding, pelvic pain and urinary symptoms.
Gonococcal infections are the
second most common prevalent sexually transmitted bacterial infections causing
substantial morbidity worldwide each year. Gonorrhoea is a potent amplifier of
the spread of sexually transmitted human immuno deficiency virus (HIV). Various
studies across the world have shown that women with BV are more likely to be
co-infected with, T. vaginalis, N.gonorrhoeae and HIV (Lamichhane,
2014). Aerobic vaginitis has
been identified for a smaller proportion of women whose microbiota
(lactobacilli) is dominated by facultative anaerobic or aerobic bacteria
especially S. aureus, group B
streptococci, E.coli and
Klebsiella spp.
Bacterial vaginosis (BV) is
the most common cause of abnormal vaginal discharge among women of reproductive
age. The prevalence of BV is about 30 % in women of reproductive age (Prospero, 2014). BV is characterized by raised
vaginal pH and milky discharge in which normal vaginal flora (Lactobacilli) is
replaced by a mixed flora of aerobic, anaerobic and microaerophilic species.
Anaerobic organisms like Gardnerella vaginalis, Prevotella spp., Mycoplasma hominis, Mobiluncus spp. colonize vagina predominantly in
BV.
The
prevalence of vaginal infections, particularly BV, is high in many countries in
Sub-Saharan Africa. For example, 20% to 50% of women of reproductive age are
affected in Zimbabwe (van De Wijgert et
al., 2000). It is characterized by a disorder of the vaginal ecosystem
characterized by a change in the vaginal flora from the normally predominant
lactobacillus to one dominated by sialidase enzyme- producing organisms.
The
vagina is a complicated environment containing a number of microbial species in
variable quantities and relative proportions (Mumtaz, et al., 2008). A complex and intricate balance of microorganisms
maintains the normal vaginal flora and changes with a multitude of events in
the patient‟s life (Cook, et al.,
2001). The dominant microbial species is Lactobacillus, which maintains the
generally acidic vaginal pH (Khan and Khan, 2004).
The
presence in the vagina of other bacteria such as Gardnerella vaginalis,
group B streptococci and Esherichia coli termed commensal bacteria (Laren and
Monif, 2001) is not synonymous with infection (Cook, et al., 2001). According to Hammill (1989), the incidence of E. coli in the vagina of normal,
pre-menopausal, non- pregnant, asymptomatic women is about 21%. However,
vaginal E. coli may also cause
symptomatic infections such as vaginitis or tubo-ovarian abscess and is
associated with life-threatening neonatal sepsis (Percival-Smith, 1983).
According
to Larsen and Monif (2001), G. vaginalis
was isolated from the vaginal samples obtained from 150 of 446 women who
visited a student health center and who were free of clinically overt disease.
During the past several decades, the many published survey of vaginal flora
specimens obtained from asymptomatic women have clearly shown that Candida
albicans may be present without the typical symptoms of yeast vaginitis (Glover
and Larsen, 1998). Bacteria that are normal constituents of the vaginal flora
of the host have the potential to cause symptoms of disease, but they
apparently require some alteration in the microenvironment to do so (Larsen and
Monif, 2001).
Other
microorganisms such as Neisseria
gonorrhoeae, Streptococcus pyogenes, Streptococcus pneumonia, Haemophilus
influenza, listeria monocytogenes and
Trichomonas vaginalis are not ordinarily part of the flora of the female
genital tract, but they bring the potential for disease to the
vaginal/endocervical area by virtue of their inherent biological properties,
(Larsen and Monif, 2001). Although the presence of these properties do not
guarantee that disease will occur.
The
frequent cause of vaginal discharge is an infection or colonization with
different microorganisms (Mylonas and Friese, 2007). Vaginitis, whether
infectious or not, poses one of the most common problems that lead women to
seek out an obstetrician or gynecologist (Adad et al., 2001; Mumtaz et al.,
2008), in approximately 10 million office visit annually (Kent, 1991; Donder et al., 2002). The tradition of
diagnosis of vaginitis which involves patient’s symptoms, clinical findings
observed during vaginal examination, and laboratory analysis of vaginal fluid
and treatment can be elusive, leading to lack of relief from the symptoms
(Schaaf, et al., 1990; Bornstein et al., 2001).
Although
some pathologic conditions causing vaginitis are well defined like bacterial
vaginosis, vulvovaginal candidiasis, and trichomoniasis yet, 7-72% of women
with vaginitis may remain undiagnosed and such forms of abnormal vaginal flora
neither considered as normal, nor can be called bacterial vaginosis have been
termed as „intermediate flora‟ and its management probably differ from that of
bacterial vaginosis (Vigneswaran and McDonald, 1994; Mumtaz et al., 2008).
1.3 Aim and Objectives
The
main aim of this study is to examine the bacteria that causes vagina infection
in female students in Michael Okpara University of Agriculture, Umudike. Other
specific objectives include:
•
To determine the bacterial load
•
To ascertain the associated bacterial species
•
To determine the frequency of occurrence of the bacteria
isolates
•
To determine the susceptibility pattern of the isolates to
some antibiotics.
1.4 SCOPE
OF STUDY
This
study is limited to the bacteriological study and examination of vaginal
infection of female students in Michael Okpara University of Agriculture,
Umudike. The study will cover selected amount of female students in Michael
Okpara University of Agriculture, Umudike and it will specifically cover
vaginal infections and how they can be examined.
1.5 SIGNIFICANCE
OF STUDY
This
study will provide knowledge mainly on the bacteriological examination of
vaginal infections. It will help to assess among others, the various causes, characteristics
and effects of vaginal infections of female students of MOUAU.
This
study will enlighten students on proper ways of preventing and protecting
themselves from vaginal infections as well as provide treatments to the
students who are already have vaginal infections.
The
result from this study will be helpful to medical personnel to counsel and
direct patients and students on the effects of vaginal infection and ways to
avoid them.
1.6 LIMITATIONS OF THE STUDY
The
researcher encountered some problems as a graduating student in the course of
completing this project work. The actual limitation of the study is the
financial constraints as well as time constraints due to other academic
pressure.
1.7 KEY
DEFINITION OF TERMS
Bacteriology: This
is a branch of medical science that studies bacteria in relation to disease
Examination: This
is a careful search, investigation or inquiry, scrutiny by study or experiment
Infection: The
state of being infected, contaminated, or the effect of prevailing disease or
epidemic.
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