DefinePK

Abstract

Introduction


Vaginal discharge is one of the most common symptoms of gynecological morbidity.1 Vaginitis is the most prevalent cause followed by cervicitis2, however vaginal secretions also increase physiologically during mid-cycle and pregnancy. Sexually Transmitted Diseases (STDs) and Reproductive Tract Infections (RTIs) often present with vaginal discharge.3 Presence of an STD increases the likelihood of contacting HIV as these diseases facilitate HIV transmission.2,4-6 In order to restrain HIV and AIDS, control of other STDs is imperative.2,7 Though STD infection rates are similar in both sexes, women bear the major burden of complications and serious sequelae.4,5,8 Hence, STD management in women is particularly important.9 The two important components of STD control program are case identification and appropriate management. STD case identification is extremely difficult in most parts of the world as these diseases are considered social problems and are frequently surrounded by prejudices and poor information.8,10 Social barriers in STD control are particularly pronounced in rural sectors of developing countries where the majority of population lives.11 Because of fear and shame victims commonly hide their conditions. In India and Nepal STDs remained one of the commonest disease next to Malaria and Pulmonary Tuberculosis12 and its incidence is increasing in Nepal.13 Vaginal discharge was the most frequently reported symptom in gynecology. STD and ante-natal clinics14,15 in Nepal. In these patients it is usually difficult to differentiate between physiological and pathological discharges only on the basis of history and clinical examination. Pathological discharge can be caused by more than twenty different organisms.4,16 WHO recommends algorithms for the treatment of this symptom in developing countries. These algorithms are poor predictors of an STD.10 If the management is based on these algorithms then patients having only one etiology are treated for several diseases. Laboratory test can sometimes be required to identify the specific micro-biological agent which can be treated effectively with specific anti-microbial agents.5,17-19 Given the general poor correlation observed between client symptoms, clinical signs and laboratory findings, the identification of appropriate, simple and low cost diagnostic test will be an effective strategy for better management of vaginal discharge and hence STDs. This study was conducted to know Nepalese women's perceptions about vaginal discharge and STDs in the context of causes, routes of transmission, characteristics of normal and abnormal discharge and health seeking practices so that services can be geared towards patients needs. The study also aimed to correlate client symptoms, clinical signs and laboratory findings so that appropriate test can be identified for vaginal discharge management in the local context.