title: Increased vaginal pH in Ugandan women: what does it indicate?
abstract: Abnormal vaginal flora (AVF), indicative of bacterial vaginosis (BV) and/or aerobic vaginitis (AV), amongst other abnormalities, is a risk factor for multiple complications in pregnant as well as non-pregnant women. Screening for such conditions could help prevent these complications. Can self-testing for increased vaginal pH reliably detect BV and other high-risk microflora types, and is this more accurate than performing Gram stain-based Nugent score when screening for high-risk microflora? A total of 344 women presenting at different outpatient clinics in Mulago Hospital and Mbuikwe Outpatient clinics in Kampala, Uganda, were asked to test themselves by introducing a gloved finger into the vagina and smearing it on a microscopy slide, on which a pH strip was attached. Self-assessed categories of normal (pH 3.6-4.4), intermediate (4.5-4.7) or high pH (>4.7) were compared with demographic and with centralised microscopic data, both in air-dried rehydrated wet mounts (Femicare), as well as in Gram-stained specimens (Nugent). AVF was present in 38 %, BV in 25 % and AV in 11 % of patients. High pH and AVF is correlated with human immunodeficiency virus (HIV), infertility, frequent sex, but not vaginal douching. Screening for raised pH detects 90 % of AVF cases, but would require testing over half of the population. As AV and non-infectious conditions are frequent in women with AVF and high pH, Nugent score alone is an insufficient technique to screen women for a high-risk vaginal microflora, especially in infertile and HIV-infected women.
authors.affiliation: Femicare vzw, Clinical Research for Women, Gasthuismolenstraat 31, 3300, Tienen, Belgium. gilbert.donders@femicare.net.|Department of Obstetrics and Gynecology, Antwerp University Hospital, Edegem, Belgium. gilbert.donders@femicare.net.|Department of Obstetrics and Gynecology, General Hospital H Hart, Tienen, Belgium. gilbert.donders@femicare.net.
authors.forename: G G G
authors.initials: GG
authors.lastname: Donders
authors.affiliation: Department of Obstetrics and Gynecology, Mulago University Hospital, Kampala, Uganda.
authors.forename: A
authors.initials: A
authors.lastname: Gonzaga
authors.affiliation: Department of Pathology, Botucatu Medical School, UNESP-Universidade Estadual Paulista, Botucatu, Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Marconi
authors.affiliation: Femicare vzw, Clinical Research for Women, Gasthuismolenstraat 31, 3300, Tienen, Belgium.|MS, Faculty of Medicine, University of Leuven, Leuven, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Donders
authors.affiliation: Femicare vzw, Clinical Research for Women, Gasthuismolenstraat 31, 3300, Tienen, Belgium.|MS, Faculty of Medicine, University of Leuven, Leuven, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Michiels
authors.affiliation: MS, Faculty of Medicine, Ghent University, Ghent, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: Eggermont
authors.affiliation: Femicare vzw, Clinical Research for Women, Gasthuismolenstraat 31, 3300, Tienen, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Bellen
authors.affiliation: Department of Obstetrics and Gynecology, Mulago University Hospital, Kampala, Uganda.
authors.forename: J
authors.initials: J
authors.lastname: Lule
authors.affiliation: Department of Obstetrics and Gynecology, Mulago University Hospital, Kampala, Uganda.
authors.forename: J
authors.initials: J
authors.lastname: Byamughisa
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008875:Middle Aged; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology; D014621:Vagina / Q000737:chemistry* / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000453:epidemiology; D055815:Young Adult