Vaginal Discharge in the Prostitutes of the Group Yèrêlon of Bobo-Dioulasso : Epidemiological , Clinical and Etiological Aspects

The authors report a cross-sectional descriptive study over 6 years, from December 8, 2003 to October 27, 2009, involving 911 women involved in the sex trade within the Yèrêlon group in Bobo-Dioulasso. Objectives: To describe the epidemiological, clinical and etiological aspects of vaginal discharge in women in the Yèrêlon group of the city Bobo-Dioulasso. Results: Frequency of vaginal discharge was 48.89%. The mean age was 28.4 years with extremes of 16 and 54 years. Single, divorced and widowed women accounted for 78.8% of the study population. Women who never attended school and those with primary education accounted for 74.3% of the study population. HIV serology was positive in 38.4% of cases. The main symptoms were genital itching, dyspareunia and urinary signs. The main germs identified in the laboratory were Candida albicans, Trichomonas vaginalis and Gardenerella vaginalis. Conclusion: vaginal discharge was found in 48.89% of women in the Yèrêlon group of Bobo-Dioulasso. The clinical study of the discharge and the laboratory results allowed a diagnosis and a better management of the leucorrhea in the group Yèrêlon.


Introduction
Leucorrhea is non-bloody female genital discharge.It can be pathological, in this case translating a genital infection.If the vaginal discharge is usually mild, it may https://doi.org/10.4236/ojog.2017.78088Open Journal of Obstetrics and Gynecology have an impact on the couple's sexual and emotional life, and also could have dramatic consequence, such as ectopic pregnancy or infertility [1].
Like other sexually transmitted infections (STIs), vaginal discharge promotes sexual transmission of the human immunodeficiency virus [2].
Sex workers have multiple partners, and this behavior promotes the spread of HIV and STIs.We undertook this study on the vaginal discharge in women of the Yèrêlon group in order to study the epidemiological, clinical and etiological aspects.

Materials and Methods
A cross-sectional, descriptive study over a 6 years period, from December 8, 2003 to October 27, 2009 was carried out, in Bobo-Dioulasso, as part of a research project called Yèrêlon on the prevention and management of sexually transmitted infections and the human immunodeficiency virus in professional sex workers and women infected with HIV from the Associations of People Living with HIV.

1) Inclusion and non-inclusion criteria
Inclusion criteria -be a woman aged 18 years and over; -be sexually active; -agree to participate in HIV testing and testing.
Non-inclusion criteria -to be pregnant; -refusal of screening Of HIV.

2) Conduct of the study
The visits included conducting a behavioral questionnaire, an Information-Education-Communication (IEC) session, counseling for HIV testing, a medical examination with genital specimens (vaginal specimen culture and sensitivity) and blood tests (serology Syphilis and HIV serology).The visit ended with a distribution of condoms and possibly drugs.
For the collection of data, a behavioral questionnaire, a follow-up register and a laboratory record were used.The variables studied were: Socio-demographic and behavioral characteristics-Clinical characteristics of the discharges and specimen's laboratory results.
Data were entered and analyzed with the software Epi Info 2000.

2) Epidemiological characteristics a) Socio-demographic characteristics
The mean age was 28.4 years with extremes of 16 and 54 years.The age group 20 -29 years represented 47.1% of the (429/911).According to the marital status, Open Journal of Obstetrics and Gynecology singles, divorced and widows accounted for 78.8% of the population (718/911), Married 17% (155) and concubines 6.4% (58).Sex workers accounted for 23.2% of the population, while occasional prostitution was of the order of 76.8% of the group.The women out of school and those with primary education accounted for 74.42% (678/911).
For the distribution according to religion, Catholics accounted for 53.2% of the population, Muslim 46.3% and animists 0.5%.Table 1 (below) gives the distribution of women from the Yèrêlon cohort according to socio-demographic characteristics.

b) Past obstetrical history
The mean gravity was 2 with extremes of 0 and 15.The mean parity was 2 with extremes of 0 and 10.Pauciparous accounted for 52.1% of the population.

c) Contraceptive methods used by women.
There is a diversity of contraceptive methods used by women in the Yèrêlon group.
A contraceptive method was used by 60% of women (547/911).The proportion of women using condoms alone as a contraceptive method was 43.3% (395/911).
Combined oral contraception was used by 8, 7% of women (79/911) as shown in Table 2.
The associations were as follows: Gardenerella vaginalis and Trichomonas vaginalis in 44 cases; Gardenerella vaginalis and Candida albicans in 15 cases; A combination of Candida albicans and Trichomonas vaginalis in 1 case; And Gardenerella vaginalis, Trichomonas vaginalis and Candida albicans in 6 cases.
The Figure 2 below shows the distribution of vaginitis according to the etiology.
e) Gonorrhea The 724 endocervical swabs were examined directly and a culture in search of Neisseria gonorrhoeae was found to be negative.
f) Factors associated with vaginal discharge Table 5 below gives the prevalence of vaginal discharge syndrome (VDS) according to socio-demographic characteristics and women's past medical history.

Epidemiological characteristics of women
Most studies of sexually transmitted infections show that the majority of patients are between the ages of 20 and 35 [3]- [9].Open Journal of Obstetrics and Gynecology  The mean age in our series was 28.4 years.It is identical to that of Desai [6] in India, which was 28.5 years and superior to those of Wang [10] in China, Cornier [5] in Bulgaria and Reed [11] in Indonesia which were respectively 23.5 years, 23.9 years and 25.8 years.
In terms of educational level, most studies show that the majority of women engaged in sex work (occasional prostitution, or professional sex workers ) are out of school or just have the level of primary education [6] [10] [11].The data In terms of marital status, the percentages are disparate.Wang [10] in China reported 14% of singles and 52% of or concubines.Reed [11] in Indonesia reported 12% of singles and 70% of divorced and Desai [6] in India found 41.7% of singles and 59.3% of married.

Frequency of vaginal discharge
The prevalence of vaginal discharge in our study was 48.8%.Most data from the literature show high frequencies for vaginal discharge in this target population.It was found frequencies of 51.7%, 90% and 94% respectively in the studies of Desai in India [6], Gaye-Diallo in Senegal [9] and Fonck in Kenya [1].

Prevalence of genital infections
Many studies on sex workers show a high prevalence of genital infections [1].
Lack of hygiene, promiscuity, non-use of condoms, the existence of genital tract lesions and high-risk practices during sexual intercourse are factors that promote the transmission of STIs and HIV [1] [6] [12] [13].
Our rate of 50.4% is higher than those of Reed [11] in Indonesia and Wang [10] in China, which were 39% and 41% respectively.Higher rates were reported by Nguyen [9] in Vietnam and Fonck [1] in Kenya, which were 75.9% and 94%, respectively.Ulcerations in the genital tract increased the risk of HIV infection, and seropositive women developed precancerous cervical lesions more rapidly (CIN2, CIN3) [1].
Indeed, the decline in immunity is recognized as a factor favoring opportunistic infections such as genital candidiasis [16] [17].
True sex workers had a higher prevalence of vaginal discharge syndrome than occasional sex workers and other women in the population.This difference was statistically significant [p < 0.0078, 95% CI (1.11 -2.07)].
With relation to age, couple life, condom use or pill use, and the practice of vaginal douching, there was no statistically significant difference.Wang and al noted no association between the practice of vaginal douching and vaginal discharge in sex workers in China.Similarly, Demba [14] and al found no signifi-Open Journal of Obstetrics and Gynecology cant difference between the practice of vaginal douching and the occurrence of bacterial vaginosis.
The use of vaginal douching is a relatively widespread practice among sex workers [1] [10] [13].Different products were used for the genital cleaning (lemon juice, diluted bleach, diluted permanganate, soap, antiseptics).These various products used can disrupt the ecosystem of the vagina with consequences of vaginal irritations and infections.The frequent and regular practice of the vaginal douching represents for these women a means of prevention of the genital infections [19].
Condoms are effective means of fighting STIs and HIV when its use is optimal.Condom users accounted for 43.3% of the population.

Conclusions
At the end of this study in the Yèrêlon group of the city Bobo-Dioulasso, the prevalence of vaginal discharge syndrome was 48.8%.The main germs found in vaginal discharge were Gardenerella vaginalis, Candida albicans and Trichomonas vaginalis.Infections were mixed in 14.4% of cases.
Improving the situation requires preventive measures, diagnosis and management of vaginal discharge in women infected with HIV and sex workers.

Figure 1 .
Figure 1.Distribution of vaginal discharge by origin.

Figure 2 .
Figure 2. Distribution of vaginitis according to etiology.

Table 1 .
Socio-demographic characteristics of women in the Yèrêlon group.

Table 3
below lists the products and Tablets used by women for vaginal

Table 2 .
Distribution of women by contraceptive method used.

Table 3 .
Products and solutions used by women in the Yèrêlon group for the vaginal douching.
6Open Journal of Obstetrics and Gynecology

Table 5 .
Prevalence of vaginal discharge syndrome according to socio-demographic characteristics and women's past medical history.
study confirm this trend, where school dropped out and primary school level accounted for 74.3% the population.They engage in risky behaviors that are rooted in poverty, ignorance and easy gain.