Vaginal ecology in Cameroonian urban areas: study of the flora of douala city inhabitants

Abstract

Introduction: The vaginal flora consists of bacilli of Doderleïn (various species of lactobacilli) which constitute a biofilm on the mucosa. These bacteria play a protective role by inhibiting the growth, adhesion or expansion of other microorganisms. To do this, various mechanisms are deployed, including the secretion of organic acids, antimicrobial substances, competition for nutrients and receptor sites as well as steric exclusion. This balance is sometimes called into question by the use of oral medications and antiseptics for vaginal cleansing, oral contraception, diseases such as the Human Immunodeficiency Virus (HIV) or diabetes. Objective: The objective of this work was to study the vaginal flora of women residing in the city of Douala. Methodology: we carried out in three health structures in the city of Douala a transverse analytical study for seven (7) months in women aged at least 21 years. We randomly included 540 women who gave their written and signed consent. The variables of interest were socio-demographic, clinical and microbiological variables. Gram staining was used and read using an optical microscope for the identification of microorganisms and the classification of flora consisting of bacteria from vaginal secretions. The statistical tests used for the comparison of the numbers were chi-square and the exact fisher test with a significance threshold of 5% (p<0.05) Results: A total of five hundred and forty (540) women had their samples collected. The majority age group was that of 30-40 years with 28.30% of cases. The mean age was 42.58 years (+/- 13.37). Four types of vaginal flora have been identified, in particular Type 4 (complete disappearance of the Döderlein flora with the appearance of abundant, polymorphic replacement flora and presence of clues-cells) with 36.30% of cases; Type 3 (rare, minority lacto-bacillary flora with the appearance of a substitution flora with a dominant morphology) at 32.20%; Type 1 (mainly Döderlein flora: lactobacilli) at 17.20%; Type 2 (Döderlein flora present and predominant but with a substitution flora without dominant morphology) at 14.30%. The factors associated with the flora imbalance were scented soaps (OR=1.84; 95% CI=1.77-2.73; P=0.001), antiseptic products (OR=2.04; 95% CI=1, 05-5.67; P=0.004) and the risk increased by combining them (OR=4.04; 95% CI=3.92-6.49; P=0.001) 95% CI=1.77-2.73; P=0.001), Oral contraception, HIV infection and diabetes also altered the flora. In addition, the presence of yeasts and mycelial filaments also favoured the degradation of the flora. On the other hand, drinking water appeared as a protective factor (OR=0.19; 95% CI=0.043-0.84; P=0.028). Conclusion: the vaginal flora of women residing in Douala is mainly degraded in a cumulative percentage of 68.50% and represented by types 4 and 3.