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Fishy smell in women may cause premature Births

By Vision Reporter

Added 29th August 2010 03:00 AM

GETRUDE had been married for barely three years when her husband started acting up. He would return home drunk every night and order her out of the house shouting that she smelt like fish. However much she bathed, she always had the foul smell.

GETRUDE had been married for barely three years when her husband started acting up. He would return home drunk every night and order her out of the house shouting that she smelt like fish. However much she bathed, she always had the foul smell.

By Arthur Baguma
GETRUDE had been married for barely three years when her husband started acting up. He would return home drunk every night and order her out of the house shouting that she smelt like fish. However much she bathed, she always had the foul smell.

After getting two miscarriages, Gloria Nyamata is having a second thought about conceiving again.

Her first pregnancy was normal and all antenatal visits showed that everything was going on well until she developed complications and suffered a miscarriage in her ninth week of pregnancy.

Two years, later she conceived but again in the 12th week she got another miscarriage.

For Abby it was a pre-term birth that came unexpected. Having taken regular antenatal checkups and precaution, she could not believe she still got a premature birth.

There may be several explanations for miscarriages but the three women’s woes were caused by abnormal bacteria in the vagina.

“A healthy woman needs lacto bacillus bacteria that produce acid to keep the vagina normal,” explains Prof. Donders, a gynaecologist and researcher working with the Mulago hospital Obstetrics and Gynaecology department.

“Certain conditions affect the balance of these bacteria and cause bacterial vaginosis, which causes a fishy smell” he adds.

According to Dr. Andabati Ganzaga, a member of the research team, the core of the issue is that women harbouring the wrong composition of bacteria in the vagina end up with increased risks for acquiring sexually transmitted infections.

These include chlamydia, gonorrhoea, herpes genitalis, HIV and HPV (the latter causing cervix cancer and condylomata).

As a result, the condition of abnormal vaginal bacteria is associated with an increased risk for cervix cancer, HIV transmission, ectopic pregnancies, miscarriages and preterm birth.

Hence, if one could find a simple method to screen for this condition and improve it, we might be able to improve women’s health dramatically in the long run.

Testing for BV
Most health workers send women to a laboratory, but Prof. Donders says this is not necessary.

He says the lab takes too much time and is logistics heavy. Instead, his team at Mulago hospital are using a PH test to determine whether a woman who has BV symptoms actually has the type that requires medication.

In a laboratory, a woman is given a strip attached to a slide on which she smears her vaginal fluids. The strip shows her vaginal PH immediately. A woman with a normal PH does not need treatment.

The strip changes to easily recognisable colours of yellow, orange or red corresponding to low, intermediate or increased risks for the above conditions
Dr. Donders explains that to get proper diagnostic workout, the women will first test themselves, followed by a microsocopy exam of the vaginal fluid in the positive cases.

Specimens for the women with abnormal results are then identified and studied with the microscope to identify the infections and then treat the women.

In order to be efficient, the microscopy needs to be performed at the same location, so the patient will have a proper diagnosis and treatment proposal before leaving the hospital.

“We might be able to improve female health dramatically in the long run. Even if a small improvement from 10% to 15% of the affected could be achieved, the beneficial effects for the public health can be enormous,” Donders, the lead researcher said.

He said this would not only save lives and disease sufferings, but also save money as expensive treatments like taking care of cancer patients or pre-term babies, can be replaced by preventive measures at low cost.

Symptoms of BV
Donders explains that a woman notices a foul smelling discharge after intercourse.

“This is the most striking indication of the onset of Bacterial Vaginosis,” he adds.
The symptoms are exhibited depending on the advancement of this condition and the woman’s state of health. Others include:
Stomach cramps
Irritation, itching, and painful swelling of the nether region.
Large volumes of vaginal discharge that smell that gradually increase.

However, it should be emphasized that self-medicating with over-the-counter products cannot only accelerate this medical condition, but it can lower the woman’s overall immunity to bacteria and other viruses as well.
It is imperative that a health care provider is consulted immediately.

Mulago studies improved testing of BV in pregnant women
Studies conducted at Mulago hospital in 2009 showed that 24% of the women tested had BV and 42% were found with abnormal vaginal bacteria (AVF). These are the ones that would qualify for treatment.

With the old testing method, all the women, those with BV and AVF would be treated, yet the ones with BV do not need the treatment.

Research findings show that if a woman has abnormal vaginal bacteria, she increases her risk of premature birth by over 2.5%. “If you have AVF you can easily be infected after a caesarian section or an abortion and this may lead to infertility,” stated the research findings.

“Abnormal vaginal bacteria cause premature births which contribute to the high infant mortality rates. Pre-term babies also often have complications which are very costly for hospitals to manage,” says Dr. Josaphat Byamugisha, the head of Mulago hospital’s department of obstetrics and gynaecology says.

To be more effective, Mulago hospital department of obstetrics and gynaecology received a special microscope to screen for abnormal BV bacteria.

The microscope, the second in the teaching hospital, is part of a study project worth 15,000 euros (over sh42m) funded by Femicare, a Belgium NGO supporting and performing clinical research on bacterial vaginosis, at Mulago Hospital.

“This microscope will help us to do a lot of things that we were not able to do for mothers in the past. It will save time and money,” says John Lule, an associate professor at Mulago School of Health Sciences.

The first phase of this research was done last year at Mulago hopsital leading to a first treatment study to be launched last week. If successful a larger scale project will follow to help as many women across Africa.

Fishy smell in women may cause premature Births

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