الفهرس 
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Abstract
Bacterial vaginosis (BV) is the most common vaginal infection worldwide and is associated with important public health issues, such as preterm labor and the acquisition and transmission of sexually transmitted infection (STIs) and human immunodeficiency virus (HIV)
The purpose of this study was to detect prevlance of bacterial vaginosis among chronic copper IUD users.
The study was conducted at family planning clinic, gynecology department, Al Amiriyah general hospital, Alexandria on female patients between 18-40 years coming for routine check up on their IUD and fulfilled the following inclusion criteria:
Ages eligible for study: 18 Years to 40 years.
IUD user since at least 1 year.
sexually active female
Non-pregnant women.
Women who presented with abnormal vaginal discharge.
Women who presented with abnormal vaginal odour.
Women who presented with Pruritus vulvae.
Patients who fulfilled the inclusion criteria and were accepted to participate in the study were recruited and an informed consent were obtained from them were examined: General examination: including vital signs (pulse, blood pressure and temperature) and examination of the head, neck, chest, heart and limbs. Abdominal examination for: organomegaly, masses and ascites. Local examination: Inspection of vulva, urethra, and perineum to detect the presence of any discharge or local inflammatory signs. A vaginal speculum, lubricated with water only was inserted and the presence of vaginal discharge was evaluated.
Samples of the vaginal discharge were obtained with two dry cotton-wool tipped swabs from the lower third of the vaginal wall:
The first swab was spread on clear glass slide for wet mount preparation; the slide was examined by microbiologist for detection of clue cells.
Vaginal PH was measured directly in the discharge on the removed speculum by dipping a pH indicator strip with a scale graded from 1-14 including distinct color key for each value.
Amine test (Whiff test) was performed after removal of the speculum by adding two drops of 10% potassium hydroxide (KOH) to the posterior lip of the speculum. The release of fishy odor means positive amine test.
Wet mount preparation for examination of clue cells, measuring of Vaginal PH and application of Amine test (Whiff test) were performed to fulfill Amsel criteria.
The second swab was spread on a clear glass slide for gram staining; the slides were left to dry in air then transferred to the microbiologist. Slides were fixed by heating and stained by gram stain. This was assessed using Nugent’s criteria.
The results of the study were as follows:
In the current study, it was found that age group above 30 years old had the highest prevalence of BV and there was a statistically significant association between diagnosis of BV and this age group.
The study showed that there was (22%) of cases had a positive result by Amsel criteria method, (22%) of cases had a positive result by Gram stain score, while nugent score was (7-10) in (37%) of cases.
In the current study,there was no significant association between BV and menstrual cycle.
In the current study, there was no association between use of vaginal douches and BV.
In the present study, There was a highly significant association between presence of Foul-smelling discharge (either as a symptom or as a sign) and diagnosis of BV this may be explained by that the increase in pH rapidly releases amines, for example trimetylamine (TMA), which are dissolved in the discharge as an acid when the pH is low.
There was a significant agreement between diagnosis of BV based on Amsel criteria and diagnosis of BV based on Nugent’s score.
The results in this study show that the isolated organisms were the pathogenic bacteria E.coli (17%), followed by K.pneumonia (14%) and S.aurous (12%), then B.subtilis, P. mirabilis, A.israelii is 10%, 10%, 3% respectively from all positive results.
In this study, the relationship between the duration of use of IUD and positive Amsel criteria was as follows: during the first year, more than 10 (45.5%) of users had positive Amsel criteria. The negative Amsel criteria (no growth results) reached up to 36 (46.2%) among the IUD users, most of them were during the first year of use. The percent of positive Amsel criteria decrease with increasing duration of use.
Also in the current study presence of foul smelling vaginal discharge had a highly statistically significant relation with Amsel criteria. There was a statistically significant relationship between pruritis and Amsel criteria and this could be attributed to presence of mixed infection as presence of pruritis is pathognomonic to candidal infection.
According to the current study, asymptomatic women were 26%, women complained of pelvic pain were 13% while who complained of vaginal dysparaunia were 18% and there were no statistically significant relationship between them and Amsel criteria.