Vaginal washing fluid C-reactive protein levels in women with recurrent or treatment resistant vaginitis

Abstract

Objective: The aim of this study is to evaluate the C-reactive protein (CRP) levels in vaginal washing fluid (VWF) in women with a history of recurrent and/or treatment resistant vaginitis. Methods: This prospective case control study was conducted in the gynecology clinic of the current hospital. A total of 64 women (33 with a history of recurrent and/ or treatment resistant vaginitis as study group and 31 healthy women as control group) were enrolled in the study. The recorded parameters were; age, presenting symptom, educational level, socioeconomic status, frequency of vaginal douching (VD), peripheral blood leukocyte count, CRP levels in VWF, vaginal culture, fresh vaginal smear and urinalysis. Results: The study group had statistically significantly lower educational level and socioeconomic status than the control group (p<0.05). The mean levels of peripheral blood leukocyte count and leukocyte count on the fresh vaginal smear, leukocyturia and VWF CRP levels were statistically significantly higher in the study group (p<0.05). In patients who had ≥ 3 times a week VD had also statistically significantly higher VWF CRP levels (p=0.012). Conclusion: According to this study, recurrent and/or treatment resistant vaginitis is more common in women who have lower socioeconomic status/educational level and who perform more frequently VD, and VWF CRP levels may be a good marker for the diagnosis of disease. J Clin Exp Invest 2015; 6 (1): 5-9 Key words: C-reactive protein, recurrent vaginitis, treatment resistant vaginitis, vaginal washing fluid

Keywords

• C-reactive protein, recurrent vaginitis, treatment resistant vaginitis, vaginal washing fluid

Tekrarlayan veya tedaviye dirençli vajinit olgularında vajinal yıkama sıvısında C-reaktif protein düzeyleri

Abstract

Amaç: Bu çalışmanın amacı tekrarlayan ve/veya tedaviye dirençli vajinit öyküsü olan olgularda vajinal yıkama sıvısı C-reaktif protein (CRP) düzeylerinin değerlendirilmesidir.Yöntemler: Bu prospektif vaka kontrollü çalışma hastanemizin jinekoloji kliniğinde yapılmıştır. Toplam 64 kadın (33 tekrarlayan ve/veya tedaviye dirençli vajinit öyküsü olan kadın çalışma grubu ve 31 sağlıklı kadın kontrol grubu) çalışmaya dâhil edilmiştir. Kaydedilen parametreler; yaş, başvuru şikâyeti, eğitim düzeyi, sosyoekonomik durum, vajinal duş (VD) sıklığı, periferik kan lökosit sayısı, vajinal sıvı CRP düzeyi, vajinal kültür, taze vajinal yayma ve idrar tetkikidir.Bulgular: Çalışma grubu istatistiksel olarak anlamlı düzeyde daha düşük eğitim düzeyi ve sosyoekonomik duruma sahipti (p<0,05). Periferik kanda ve taze vajinal sürüntüdeki ortalama lökosit sayısı, lökositüri ve vajinal yıkama sıvısı CRP düzeyleri çalışma grubunda istatistiksel anlamlı olarak daha yüksekti (p<0,05). Ayrıca haftada ≥ 3 kez VD yapanlarda vajinal yıkama sıvısı CRP düzeyleri istatistiksel olarak anlamlı yüksekti (p=0,012). Sonuç: Bu çalışmaya göre düşük sosyoekonomik durumu olan ve sık VD yapan kadınlarda tekrarlayan ve/veya tedaviye dirençli vajinit daha sık görülürken, bu hastalığın tanısında vajinal yıkama sıvısı CRP düzeyleri iyi bir belirteç olabilir

Keywords

• C-reaktif protein, tekrarlayan vajinit, tedaviye dirençli vajinit, vajinal yıkama sıvısı

References

1. Ramírez SA, Pereiro MJ, Toribio J. Recurrent vulvovaginitis:
2. diagnostic assessment and therapeutic management.
3. Actas Dermo-Sifiliográficas 2008;99:190-198.
4. Sivaranjini R, Jaisankar T, Thappa D.M, et al. Spectrum of
5. vaginal discharge in a tertiary care setting. Trop Parasitol
6. ;3:135-139.
7. Guzel AI, Kuyumcuoglu U, Celik Y. Vaginal douching practice
8. and related symptoms in a rural area of Turkey. Arch

9. Gynecol Obstet 2011;284:1153-1156.
10. Shaaban OM, Youssef AE, Khodry MM, et al. Vaginal
11. douching by women with vulvovaginitis and relation
12. to reproductive health hazards. BMC Women’s Health
13. ;13-23:1-6.
14. Pepys MB, Hirschfield GM. C-reactive protein: a critical
15. update. J Clin Invest 2003;111:1805–1812.
16. Ni CY, Jia WX, Yi WM, et al. Practicability of using vaginal
17. fluid markers in detecting premature rupture of membranes.
18. Ann Clin Biochem. 2003;40:542-545.
19. Torbé A, Czajka R. Are vaginal fluid procalcitonin levels
20. useful for the prediction of subclinial infection in patients
21. with preterm premature rupture of membranes? J Obstet
22. Gynaecol Res 2005;31:464-470.
23. Celik Y. Biostatistics, principles of research.2nd edition. Diyarbakir:
24. Dicle University Press. 2007.
25. Pavlova S.I, Tao L. In vitro inhibition of commercial douche
26. products against vaginal microflora. Infect Dis Obstet
27. Gynecol 2000;8:99-104.
28. Brotman RM, Klebanoff MA, Nansel TR, et al. A longitudinal
29. study of vaginal douching and bacterial vaginosis-a
30. marginal structural modeling analysis. Am J Epidemiol
31. ;168:188-196.
32. Sutton M, Sternberg M, Koumans EH, et al. The prevalence
33. of Trichomonas vaginalis infection among reproductive-age
34. women in the United States, 2001-2004.
35. Clin Infect Dis 2007;45:1319-1326.
36. Heng L.S, Yatsuya H, Morita S, et al. Vaginal douching in
37. Cambodian women: its prevalence and association with
38. vaginal candidiasis. J Epidemiol 2009;20:70-76.
39. Klebanoff MA, Nansel TR, Brotman RM, et al. Personal
40. hygienic behaviours and bacterial vaginosis. Sex
41. Transm Dis 2010;37:94–99.
42. Eckert LO, Hawes SE, Stevens CE, et al. Vulvovaginal
43. candidiasis: clinical manifestations, risk factors, management
44. algorithm. Obstet Gynecol 1998;92:757–765.
45. Corsello S, Spinillo A, Osnengo G, et al. An epidemiological
46. survey of vulvovaginal candidiasis in Italy. Eur J
47. Obstet Gynecol Reprod Biol 2003;110:66-72.
48. Seña AC, Bachmann LH, Hobbs MM. Persistent and recurrent
49. Trichomonas vaginalis infections: epidemiology,
50. treatment and management considerations. Expert Rev
51. Anti Infect Ther 2014;12:673-685.
52. Schwebke JR, Muzny CA, Josey WE. Role of Gardnerella
53. vaginalis in the Pathogenesis of Bacterial Vaginosis:
54. A Conceptual Model. J Infect Dis 2014;[Epub ahead of
55. print].
56. Hillier S.L, Nugent R.P, Eschenbach D.A, et al. Association
57. between bacterial vaginosis and preterm delivery
58. of a low-birthweight infant. The Vaginal Infections and
59. Prematurity Study Group. N Engl J Med 1995;333:1737–
60. -
61. Martin HL, Richardson BA, Nyange PM, et al. Vaginal
62. lactobacilli, microbial flora, and risk of human immunodeficiency
63. virus type 1 and sexually transmitted disease
64. acquisition. J Infect Dis 1999;180:1863–1868.
65. Wiesenfeld HC, Hillier SL, Krohn MA, et al. Bacterial
66. vaginosis is a strong predictor of Neisseria gonorrhoeae
67. and Chlamydia trachomatis infection. Clin Infect Dis
68. ;36:663–668.
69. Vodstrcil LA, Hocking JS, Law M, et al. Hormonal contraception
70. is associated with a reduced risk of bacterial
71. vaginosis: a systematic review and meta-analysis. PLoS
72. One 2013;8:1-32.
73. Thompson D, Pepys MB, Wood SP. The physiological
74. structure of human C-reactive protein and its complex
75. with phosphocholine. Structure 1999;7:169-177.
76. Witkin S.S, Jeremias J, Ledger W.J. Recurrent vaginitis
77. as a result of sexual transmission of IgE antibodies. Am
78. J Obstet Gynecol 1988;159:32-36.
79. Nawrot U, Grzybek H.K, Zielska U, et al. The study of
80. cell-mediated immune response in recurrent vulvovaginal
81. candidiasis. FEMS Immunol Microbiol 2000;29:89-94.
82. Fidel PL. History and new insights into host defense
83. against vaginal candidiasis. Trends Microbiol
84. ;12:220-227.
85. Weissenbacher TM, Witkin SS, Gingelmaier A, et al.
86. Relationship between recurrent vulvovaginal candidosis
87. and immune mediators in vaginal fluid. Eur J Obstet Gynecol
88. Reprod Biol 2009;144:59-63.
89. Lev SA, Nyirjesy P, Tarangelo N, et al. Hyaluronan in
90. vaginal secretions: association with recurrent vulvovaginal
91. candidiasis. Am J Obstet Gynecol 2009;201:206.e1-
92. -
93. Babula O, Lazdane G, Kroica J, et al. Relation between
94. recurrent vulvovaginal candidiasis, vaginal concentrations
95. of mannose-binding lectin and a mannose-binding
96. lectin gene polymorphism in Latvian women. Clin Infect
97. Dis 2003;37:733-737.
98. Babula O, Lazdāne G, Kroica J, et al. Frequency of interleukin-4
99. (IL-4) –589 gene polymorphism and vaginal
100. concentrations of IL-4, nitric oxide and mannose-binding
101. lectin in women with recurrent vulvovaginal candidiasis.
102. Clin Infect Dis 2005;40:1258-1262.