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Abstract
Background
Bacterial vaginitis (BV) and Trichomonas vaginitis are the most frequently recurring infectious diseases in women. Therefore, accurate tests for post-treatment follow-up are required. A multiplex PCR assay allows for the simultaneous detection of multiple pathogens in a single specimen. In this study, we assessed the clinical implications of multiplex PCR detection of fastidious microorganisms causing vaginitis.
Methods
A total of 216 vaginitis patients who presented to Chung-Ang University Yongsan Hospital with more than one positive result on multiplex PCR (Trichomonas vaginalis (TV), Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Mycoplasma genitalium (MG), Mycoplasma hominis (MH)) were retrospectively enrolled in this study. Each patient's clinical symptoms, initial treatment and follow-up for BV, and other related test results were also retrospectively reviewed.
Results
The most commonly reported symptom was abnormal discharge, followed by pruritis (73.1%), lower abdominal pain (38.4%), urination difficulties (13%), and others such as fever. According to the multiplex PCR results, there were 116 cases (35.8%) of MH, 86 cases (26.5%) of UU, 62 cases (19.1%) of CT, and 84 cases (38.9%) were mixed infections. Among those patients with single infections, treatment changed for 63 cases (65.6%) while treatment remained unchanged for 17 (17.7%) after PCR results were reported.
Conclusion
The diagnosis of BV using multiplex PCR is clinically effective and the results of which can be incorporated in antibiotic selection for patients with multiple sexually transmitted diseases (STD). Multiplex PCR may be especially helpful in the diagnosis of patients in whom the differentiation of STD pathogens is difficult using traditional methods.
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Table 1.
Clinical symptom and physical examination of patients (including overlapping results, N=216)
| Clinical symptoms | Number (%) |
|---|---|
| Abnormal vaginal discharge, pruritis | 158 (73.1) |
| Lower abdominal pain | 83 (38.4) |
| Urination difficulties | 28 (13) |
| Dyspareunia | 15 (6.9) |
| Fever | 13 (6.0) |
| No symptom | 16 (7.4) |
Table 2.
The numbers of microorganisms in positive results (including overlapping results, N=216)
Table 3.
The numbers of single, double and multiple positive microorganism results
Table 4.
Prescribed drugs for 216 patients at first (before PCR results reported, including overlapping results)
| Prescribed drugs for treatment | Patients numbers (%) |
|---|---|
| No treatment prescription | 56 (22.6) |
| Cefazodone, Ceftrizine∗ | 45 (18.1) |
| Doxycycline | 39 (15.7) |
| Metronidazole | 39 (15.7) |
| Levofloxacin 3rd generation cephalosporin† | 23 (9.3) 16 (6.5) |
| Cefditoren, Ceftriaxone† | |
| Ciprofloxacin | 16 (6.5) |
| Fluconazole | 12 (4.8) |
| Amoxicillin | 2 (0.8) |
| Total | 248 (100) |
Table 5.
The treatment change of each microorganism single positive patients (after PCR results reported)
| Single positive microorganism | No. | No. (%∗) of treatment prescribed at first | No. (%†) of treatment change after PCR results |
|---|---|---|---|
| MH | 59 | 45 (76.3) | 25 (55.6) |
| UU | 32 | 20 (62.5) | 19 (95) |
| CT | 25 | 19 (76.0) | 12 (63.2) |
| MG | 8 | 5 (62.5) | 3 (60.0) |
| TV | 6 | 5 (83.3) | 2 (40.0) |
| NG | 2 | 2 (100) | 2 (100) |
| Total | 132 | 96 | 63 |
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