Clinically Recorded Etiology and Aerobic Culture Findings in Women with Vaginal Symptoms in Benghazi, Libya: A Cross-Sectional Study
DOI:
https://doi.org/10.54361/LJMR.20.3.93Keywords:
aerobic vaginitis, diagnostic stewardship, group A Streptococcus, Libya, vulvovaginal candidiasisAbstract
Background: Vulvovaginal candidiasis and bacterial vaginosis account for most gynecological consultations for abnormal vaginal discharge. Treatment in low-resource settings often proceeds on bedside microscopy or clinical impression, and Libyan data on how closely such diagnosis tracks culture are scarce. To describe recorded etiology, symptoms, hygiene practices, awareness, and treatment-seeking among women attending gynecology clinics in Benghazi, and to compare etiologies recorded at consultation against organisms recovered by culture in an independent sample. Methods: This cross-sectional study ran for three months at two facilities in Benghazi. A structured Arabic questionnaire was administered to 119 women aged 18 and older, whose working diagnosis rested on potassium hydroxide wet mount microscopy. Fifty routine culture reports from the same facilities were drawn at random from laboratory records; Sabouraud dextrose agar was used in parallel with bacteriological media. Associations were tested by chi-square, Fisher exact test, and logistic regression. The arms were not linked individually. Results: Fungal infection was recorded most often (70 of 119, 58.8%), then bacterial infection (31, 26.1%), urinary tract infection (8, 6.7%), mixed infection (5, 4.2%), and Trichomonas vaginalis (5, 4.2%). Abnormal discharge (72.3%) and pruritus (58.8%) predominated. Culture differed: Streptococcus pyogenes was the leading isolate (11 of 50, 22.0%), ahead of Candida spp. (9, 18.0%). Twenty-two women (18.5%) used unprescribed intravaginal antibiotics. Prior infection was independently associated with fungal etiology (adjusted odds ratio 4.22, 95% CI 1.77 to 10.08). Pregnancy was associated with bacterial rather than fungal etiology (2.60, 1.11 to 6.12) and lower symptom burden (0.38, 0.17 to 0.85). Physician consultation was associated with improvement (8.17, 2.43 to 27.48). Only 44 women (37.0%) reported prior awareness, tracking previous infection (3.27, 1.41 to 7.63). Conclusion: Fungal etiology was recorded far more often than culture recovered Candida, and group A streptococcus was the most frequent isolate. Because the arms were independent samples, these are divergent distributions rather than demonstrated diagnostic error. Low fungal recovery is less likely to reflect a culture artifact, though variation in routine laboratory practice cannot be excluded, and the gap runs opposite to the sensitivity of microscopy against culture. These findings, although based on an unlinked ecological comparison, nonetheless argue for culture alongside microscopy where capacity allows, and for health education reaching women before a first episode.
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