Resistance Pattern of Isolates From Bacterial Vaginosis in Sex Workers in Nairobi, Kenya

Abstract

Background Bacterial vaginosis (BV) is a lower genital tract infection characterized by the presence of thin, white, homogeneous, fishy-smelling vaginal discharge. This discharge is present in the absence of signs of vaginal irritation. It is also characterized by a disruption of the normal vaginal equilibrium. BV accounts for 40% to 50% of all gynecologic conditions encountered by primary health care physicians. Its prevalence is reported to be generally high among women who are sexually active than those who are not. Some antimicrobials have been associated with marked evidence of resistance among vaginal anaerobic bacteria. Since the prevalence of BV in women of reproductive age is shown to be high in Kenya, there is need to investigate the antimicrobial susceptibility pattern of anaerobic bacteria isolated from BV in female sex workers in Nairobi, Kenya. Broad objective The goal of this study was to determine the susceptibility of vaginal anaerobic bacterial isolates from female sex workers with bacterial vaginosis in Nairobi, Kenya. Study design This was a cross-sectional study. High Vaginal Swab (HVS) specimen was obtained from Female Sex Workers (FSW) attending Sex Workers Operating Point (SWOP) clinics and sociodemographic data obtained using questionnaires. Methodology Structured questionnaires were used to collect the socio-demographic features of the participants. These included age, educational level and residence of the participants. It was also used to elicit information on participants’ knowledge and attitude towards their reproductive health. Vaginal secretions were taken using sterile swabs at the SWOP clinic and cultured for isolation of Gardnerella vaginalis, Mobiluncus species, Ureaplasma urealyticum, Peptostreptococcus species. and Bacteroides species in an anaerobic environment at the University of Nairobi, Institute of Tropical and Infectious diseases laboratory. Susceptibility test was done using the disc diffusion and agar dilution technique. Data analysis The data collected was edited, coded and analyzed using SPSS version 21. Descriptive statistics was used to analyze socio-demographic features while odds ratio was used to determine the risk factors associated with bacterial vaginosis. Chi square was used to determine the difference in response to the antimicrobials used to treat bacterial vaginosis. Results Out of 160 participants enrolled in to the study, 18.4% were confirmed to have Bacterial vaginosis. Contraceptive use was found to be common among the participants (68.5%), 51.6% practiced douching while only 18% indicated that they smoked. BV was found to be inversely related to number sexual partners and contraceptive use (Pearson correlation -0.033 and -0.045 respectively) while douching and smoking were directly related to BV condition (Pearson correlation 0.099 and 0.044 respectively). Bacteroides dominated the isolates at 16.3% while Morbiluncus was at 3.1%. There was a significant difference in the antimicrobials used to treat BV (P˂0.001). Most of the isolates were sensitive to clindamycin while majority were resistant to metronidazole. Conclusion Hormonal contraceptives were negatively associated with BV while smoking and douching were directly associated with the condition in FSW in Nairobi. Bacteroides sp was the most commonly isolated organism from samples collected from FSW in Nairobi. Clindamycin was the most effective drug for treating BV in FSW in Nairobi, Kenya.