LETTER TO EDITOR
|Year : 2017 | Volume
| Issue : 2 | Page : 188-189
Department of Dermatology, PGI, Chandigarh, India
|Date of Web Publication||23-Oct-2017|
Former Professor & Head, Department of Dermatology, PGI, Chandigarh, H.No.81, Sector-16/A, Chandigarh-160015
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar B. Author Reply. Indian J Sex Transm Dis 2017;38:188-9
I read with interest the article, “Epidemiology and clinico-investigative study of organisms causing vaginal discharge” by Venugopal et al. (Indian J Sex Transm Dis. 2017; 38:69-75).
There has been an attempt to correlate the clinical symptomatology with the laboratory findings and the statement by the authors – lamenting the discordance (discordance is not the exact opposite of concordance) more appropriate would have been “lack of concordance” knowing fully well that in any disease, the correlation between the two parameters is never hundred percent. Moreover, if the authors have introduced the term nonspecific vaginitis, this is more likely to happen more often (lack of correlation between the clinical features and microbiology).
There is a problem with the figures and percentages. [Table 2] summarizes that the total number of patients is 128 (total number studied – 100) and the percentages are 60 cases 40% and so on? The diagnosis is clinical, but subsequently, it is stated that nonspecific vaginitis was in those patients where no organism was identified.
[Table 1] summarizes that the total number of patients – in age-wise distribution – is 97 only.
[Table 4] shows the distribution of patients according to age group and at wide variance from the figures given in [Table 1].
[Table 3] shows the percentage of isolation of organisms. The percentage should have been calculated for 77 patients who were positive for an organism and not from the total of 100 patients. The figure for 13 patients with trichomoniasis jumps to 25. What happened to the bulk of sixty patients with nonspecific vaginitis – did the authors make enough efforts to isolate a pathogen before labeling it as nonspecific? No cause for mucopurulent discharge in 23 patients.
To make a diagnosis of gonococcal infection on the basis of Gram-stained smear alone is not an accepted scientific practice.
In conclusion – the authors mention about “prevention” should be undertaken but have not explained what they mean by this.
The authors should have mentioned in the introduction about reproductive tract infections (RTIs) being different from sexually transmitted infections and RTIs being the most common cause of vaginal discharge.
On speculum examination, the condition of the cervix and any endocervical discharge though is written as recorded but is not provided in the results.
The higher prevalence of BV was observed in a study on sex workers from Bangladesh; the high prevalence maybe due to frequent sexual intercourse and subsequent frequent washing with water and disinfectant. No scientific basis for this statement. Geographical variation and systemic differences have been mentioned as a cause for less number of cases of bacterial vaginosis seen as compared to some other studies. This “hypothesis” is not scientific. Other predisposing factors for the causation of candidal vaginitis, for example, antibiotic or steroid usage, diabetes mellitus or prediabetic stage/obesity, local hygiene, and use of tight-fitting noncotton undergarments have to be taken into consideration.
Many demographic details have been given such as literacy, age, and employment, but because of such a small number, no significance can be attached to them. It is being made out that all these infections are directly proportional to increased sexual activity, which is not exactly true because the infections can be seen even in sexually inactive women.
Mention should have been made of the marital status of the patients and use of condom by the partner if some variables for susceptibility were being considered.
Label of nonspecific vaginitis should be given only after complete investigations to rule out any causative infection of the cervix as well – not fair to put this label on clinical examination.
Last line under conclusion – “as the Clinical diagnosis alone leads to false interpretation,” this is not borne out by the facts of the presentation. There was more than 90% concordance between the clinical diagnosis and laboratory confirmation (Bacterial vaginosis 27/30, candidiasis 22/25 and trichomoniasis 25/25).
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