Cultural and biomedical meanings of the complaint of leukorrhea in South Asian women.
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Among women in South Asia, the complaint of vaginal discharge (often called leukorrhea) is extraordinarily common. From a biomedical perspective, this symptom suggests that reproductive tract infection (RTI) is prevalent in the subcontinent; however, several recent studies provide evidence that the prevalence of RTI is relatively low. Women who do not have RTI frequently report the symptom of vaginal discharge. An anthropological perspective on the cultural meanings of leukorrhea can shed light on this puzzling phenomenon. According to Ayurvedic concepts of health and illness, genital secretions are considered a highly purified form of dhatu, or bodily substance, and loss of this precious substance is thought to result in progressive weakness or even death. Many South Asian women who complain of vaginal discharge also report a variety of somatic symptoms such as dizziness, backache and weakness. The link between unexplained gynaecological symptoms and mental health concerns has been explored by both psychiatrists and anthropologists in South Asia. Leukorrhea may represent a culturally shaped "bodily idiom of distress", in which concerns about loss of genital secretions reflect wider issues of social stress. Problems may arise when a symptom with deep cultural meaning is interpreted in a purely biomedical framework. In the syndromic approach to the treatment of sexually transmitted infections (STIs), health workers are trained to treat women presumptively based on history and a risk assessment, but without clinical or laboratory confirmation of infection. A recent evaluation of this approach demonstrates that many women who complain of vaginal discharge do not have RTI, and are inappropriately treated with antibiotics. It seems likely that women are over-reporting vaginal discharge because of its deep cultural meanings, meanings that need to be understood within an anthropological rather than biomedical framework. (+info)
Vulvovaginitis and vaginal discharge in general practice.
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Ninety-four patients with vulvovaginitis and vaginal discharge were assessed clinically and had vaginal swabs taken in an effort to establish a definite diagnosis. A high incidence of fungous infection was found while there was a surprisingly low incidence of Trichomonal vaginitis. These findings vary markedly from recent surveys in other countries (Delaha et al. (1964); Gray and Barnes, 1965; Desai et al., 1966). (+info)
A study of leucorrhoea in reproductive age group women of Nagpur City.
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A community based cross-sectional study was conducted in reproductive age group women in an urban community of Nagpur, to assess the prevalence of leucorrhoea and the factors influencing the same in these women. The study participants included 506 females, out of which 149 were unmarried and 357 were married. Detailed history and clinical examination was done in all the females including gynecological examination in all the married females. Leucorrhoea was present in 139 (27.47%) females. Leucorrhoea was found significantly more in married females as compared to unmarried (p < 0.001), pregnant as compared to non-pregnant (OR = 2.10, 95% C.I. = 1.02-4.32), and women of lower socioeconomic status (p < 0.001), women with high parity (p < 0.001). Use of Cu-T was not associated with Leucorrhoea (p > 0.05). (+info)
Virulence of transparent and opaque colony types of Neisseria gonorrhoeae for the genital tract of mice.
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The virulence of transparent (Tr) and opaque (Op) colony types of Neisseria gonorrhoeae in the genital tract of female mice was evaluated at two stages of oestrous. Isogenic pairs of Tr and Op variants were isolated from N. gonorrhoeae strain 57-120. Both variants exhibited a T2 morphology, but only the Op variant possessed protein II (P.II) in outer-membrane fractions. When administered by intravaginal inoculation Op gonococci were highly infective only for mice in late pro-oestrous, whereas Tr gonococci were virulent for mice at both late pro-oestrous and dioestrous. Gonococci recovered from the uterus were of both Tr and Op phenotypes in equal proportions when mice were infected at dioestrous with Tr cells. In contrast, greater than 90% of recovered colonies were of Op phenotype when mice were infected at late pro-oestrous with either Op or Tr cells. These results indicate that the virulence of gonococci for the genital tract of female mice differs from that for the chicken embryo. Furthermore, gonococcal survival in the female genital tract might be attributable to phase variation from Tr to Op phenotypes. (+info)
Screening for cervical Chlamydia trachomatis infections in two Dutch populations.
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Endocervical cultures for Chlamydia trachomatis and Neisseria gonorrhoeae were taken from 492 women attending an outpatient clinic for sexually transmitted diseases (group I) and 560 women seeking legal abortion (group II). Possible risk factors for C trachomatis infection were evaluated by multivariate analysis. The prevalence rates for C trachomatis and N gonorrhoeae were 7.3% and 2.5% in group I and 9.4% and 0.4% in group II. From multivariate analysis it was found that age (p less than 0.01), number of sexual partners (p less than 0.01), abnormal vaginal discharge (p less than 0.01), and endocervical mucopus (p = 0.02) were independently associated with chlamydial infection in group I. In the abortion clinic age (p = 0.03) and endocervical mucopus (p = 0.03) were the only significant independent predictors of C trachomatis. In all women vaginal discharge was collected for Gram staining. A significant higher number of polymorphonuclear cells was seen in the smears of C trachomatis positive women (group I: p = 0.04; group II: p = 0.03). In group II there was also a significant association between C trachomatis and Gardnerella type bacterial flora (p = 0.02) and the presence of comma-shaped rods (p = 0.04). Screening for C trachomatis infection may help to decrease the incidence of (post-abortal) pelvic inflammatory disease. Because screening in abortion clinics is not always possible, decreasing the incidence of postabortal pelvic inflammatory disease could be achieved by using prophylactic antibiotics. Selective use of prophylaxis in high risk patients can minimise costs and the incidence of side effects. (+info)
Towards developing a diagnostic algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae cervicitis in pregnancy.
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C trachomatis and N gonorrhoeae are major causes of maternal and neonatal morbidity and mortality in developing countries. To identify characteristics predictive of cervical infection, we examined pregnant women attending an antenatal clinic in Nairobi, Kenya. C trachomatis was isolated from 14/178 (8%), and N gonorrhoeae from 17 (10%); cervical infection with either pathogen was present in 28 (16%). Two characteristics were independently predictive of cervical infection by logistic regression analysis; the presence of either endocervical mucopus or induced endocervical bleeding, relative risk 4.2 (95% confidence interval (CI) 2.2 to 8.0) and having more than one sexual partner during pregnancy, relative risk 3.3 (95% CI 1.4 to 7.6). A screening programme for cervical infection which tested women with one or both risk markers would have a sensitivity of 68% (95% CI 51 to 85%) and a positive predictive value of 0.35 (95% CI 0.22 to 0.47). In countries where resources are limited, diagnostic algorithms incorporating clinical signs and behavioural characteristics may be useful in identifying pregnant women at high risk of cervical infection. (+info)
Correlation of leukorrhea and Trichomonas vaginalis infection.
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Detection of HIV p17 antigen in lymphocytes but not epithelial cells from cervicovaginal secretions of women seropositive for HIV: implications for heterosexual transmission of the virus.
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Human immunodeficiency virus (HIV) has been isolated from cervicovaginal secretions from infected women and is thought to be cell associated. To identify which cells harbour viral antigen, we used monoclonal antibodies to OKT4 and a monoclonal antibody directed against HIV p17 core antigen to perform indirect immunofluorescence assays of genital secretions from 17 HIV seropositive and 17 HIV seronegative women with leucorrhoea. OKT4 positive lymphocytes were detected in all tested samples. HIV p17 antigen was detected in the genital fluid lymphocytes in nine out of 14 seropositive subjects from whom lymphocytes were available. No viral antigen was detected in genital fluid lymphocytes of seronegative subjects, nor in any cervicovaginal epithelial cells. This study shows that lymphocytes are the major source of HIV in cervicovaginal secretions of infected women. Conditions that increase the lymphocyte population in the female genital tract, such as sexually transmitted disease (STD), chronic inflammation of the cervix, and menstruation, may facilitate the transmission of HIV during sexual intercourse. (+info)