40 J I M D C 2 0 1 7 40
Op e n Ac c e ss
F u l l L e n g t h A r t i c l e
Frequency of Candidiasis, Trichomoniasis and Pyogenic
Infection Causing Pelvic Inflammatory Diseases
Shazia Azhar1, Mamoona Shafiq2, Summayah Niazi3
1Assiatant Professor, Medical Technology, Baqai Institute of Medical Technology, Baqai Medical University Karachi
2 Associate Professor, Dept. of Physiology, Islamabad Medical and Dental College, Islamabad
3Assistant Professor, Dept. of Physiology, Fazaia Medical College, Islamabad.
A B S T R A C T
Objective: To determine the frequency of Candida, Trichomonas and Pyogenic infection, in Pelvic inflammatory
diseases (PID)
Patients and Methods: This cross-sectional study was carried out in Gynecology OPD of Abbasi Shaheed Hospital
Karachi and Baqai Hospital Karachi from November 2013 to January 2014. The study included 100 females of 20-40
years and above with history of vaginal discharge, low back pain, itching, bleeding. The subjects were divided on the
basis of various socioeconomic status (poor, middle, rich) groups. Females who were pregnant or had recent history of
abortion were excluded from the study. For assessment, Pap smear, wet preparation and high vagina swab was
collected from cervix and vagina.
Results: In our study Candida albican 35%, Trichomonas infection 30% and pyogenic infection 35% were seen in
various age groups. Majority of the cases were between 20-40 years. It was also observed that trichomoniasis was
observed in lower and middle class females and not in upper class females.
Conclusion: Trichomonas, Candida and Pyogenic infections were found to be most commonly associated with pelvic
inflammatory diseases. A relatively higher frequency of Candidiasis, and Pyogenic infections were observed in upper
and middle class, whereas high frequency of trichomoniasis was found in lower and middle class women.
Key words: Candidiasis, Pelvic inflammatory disease, Pyogenic Infection, Trichomoniasis.
Author`s Contribution
1Conception, Synthesis and Planning of the
research,2 Active participation in active
methodology & Interpretation, analysis
and discussion, 1,3Active participation in
active methodology
Address of Correspondence
Dr. Mamoona Shafiq
E-mail: dr_mamoona78@hotmail.com
Article info.
Received: Aug 8, 2016
Accepted: Feb 4, 2017
Cite this article: Azhar S, Shafiq M, Niazi S. Frequency of Candidiasis, Trichomoniasis and
Pyogenic Infection Causing Pelvic Inflammatory Disease.JIMDC. 2017; 6(1):40-43.
Funding Source: Nil
Conflict of Interest: Nil
I n t r o d u c t i o n
Pelvic inflammatory disease (PID) is an infectious and
inflammatory disorder of the upper female genital tract,
including the uterus, fallopian tubes, and adjacent pelvic
structures. Infection and inflammation may spread to the
abdomen, including perihepatic structures. PID is initiated
by infection that ascends from the vagina and cervix into
the upper genital tract. Vaginitis is defined as a spectrum
of condition that cause vaginal and sometimes vulvar
symptoms, such as itching, burning, irritation, odor, and
vaginal discharge. The most common causes of vaginitis
and cervicitis are candidiasis, trichomoniasis and bacterial
vaginosis.1 The symptomatic infection by these etiological
agents arises when there is an excessive proliferation of
these microorganism in the vaginal flora, ceasing the
colonization and starting to achieve outright adherence to
the vaginal cells, consequently causing infection.2 In
O R I G I N A L A R T I C L E
mailto:dr_mamoona78@hotmail.com
41 J I M D C 2 0 1 7 41
candidiasis infective patient presents with thick, fetid
vaginal secretions which may have granular appearance
and an itchy vulva..3 The vagina becomes hyperemic and
the vulva becomes erythematous, and there may be
excoriation and dyspareunia.4 A patient with
trichomoniasis presents with intense frothy yellow-
greenish vaginal discharge, irritation and pain in the vulva,
perineum and thighs, along with dyspareunia and
dysuria.5 Trichomonas vaginalis is a flagellate protozoan
considered to be sexually transmittable and usually seen
in low socioeconomic class.6 In Bacterial vaginosis foul-
smelling vaginal secretion, is associated with a high
incidence of endometritis and pelvic inflammatory disease
following abortion and late miscarriages, premature
rupture of membranes, and preterm birth.7 Among women
with bacterial vaginosis, no overall increased risk of
developing pelvic inflammatory disease has been found.8
Bacterial vaginosis is also associated with both
symptomatic and asymptomatic conditions. Bacterial
vaginosis have been strongly linked with an increased risk
of human immunodeficiency virus transmission.9 Clinical
manifestations of PID vary widely, however: Many
patients exhibit few or no symptoms, whereas others have
acute, serious illness. The most common presenting
complaint is lower abdominal pain. Many women report
an abnormal vaginal discharge. For situations where on-
site microscopy is not available, the World Health
Organization has developed algorithm for management of
vaginal discharge.10
P a t i e n t s a n d M e t h o d s
This cross-sectional study was carried out in 100 females
(20 years and above) attending Gynae OPD of Abbasi
Shaheed Hospital and Baqai Hospital Karachi from
November 2013 to January 2014. Patients with history of
discharge, low back pain, itching were included in the
study. Patients were also asked for history of bleeding,
pregnancy and medication. Patients with present
pregnancy and abortion were excluded from the study.
For the assessment of Pap smear, wet preparation and
high vagina swab was collected from cervix and vagina.
Wet preparation in normal saline for the identification of
trichomonas was also done. High vaginal swab was
inoculated in Maconkey`s agar for the isolation of type of
bacteria. In our study, we found the colonies of E. coli
which showed indole positivity, pink rod were shows in
gram staining. Pap staining was used to find out the
Candida albican and cell morphology. All values were
entered on SPSS version 10 for evaluation of frequency
of etiological agents in the study population. Moreover,
their frequency was also assessed in various
socioeconomic groups.
R e s u l t s
Among total of 100 cases, 35 cases were found to have
candidiasis, 30 cases trichomoniasis, and 35 cases were
found to have pyogenic infection. Our study also showed
that Candidiasis was found in 57% of cases in 20-40
years’ age group. whereas it was 43% in 50 years and
above. Trichomoniasis was found in 100% cases between
20-40 years. None of the females 50 years and above
were found to be infected with it (table1 & 2).
Pyogenic infection was found in 94 in 20-40% years and
6% of cases in age groups of 50 years and above. Our
data was also categorized according to socioeconomically
Table 1. Demographic characteristics of participants
(n=100)
Variables Number
Age limits
20-30years
31-40yrs
41yrs & above
No
58
25
17
Marital status
Married
Unmarried
60
40
Education
Educated
Uneducated
60
40
Occupation
House wife
Working ladies
60
40
Socioeconomic
status
According to area
poor
middle
rich
40
30
30
Family life cycle
Satisfactory
Unsatisfactory
60
40
42 J I M D C 2 0 1 7 42
status into poor, middle and rich classes (Table 3); we
found in poor class 40% cases had infection whereas in
middle class and upper class it was seen in 30% cases
each. Frequency of various infections in different
socioeconomic groups is shown in table 3; as shown in
table no case of trichomoniasis was found in upper class.
D i s c u s s i o n
Pelvic inflammatory disease comprises a spectrum of
inflammatory disorders of the upper female genital tract,
including any combination of endometritis, salpingitis,
tubo-ovarian abscess, and pelvic peritonitis.11
Microorganisms that comprise the vaginal flora (e.g.,
anaerobes, G. vaginalis, Haemophilus influenzae, enteric
Gram-negative rods, and Streptococcus agalactiae) have
been associated with PID.12 In addition, cytomegalovirus
(CMV), M. hominis, U. urealyticum, and M.
genitalium have also been found to be associated with
some PID cases.13-16 Sexually transmitted organisms,
especially N. gonorrhoeae and C. trachomatis, are
implicated in many cases. Screening and treating sexually
active women for chlamydia reduces their risk for
PID.17 According to epidemiological studies three main
causes of vaginitis all over the world are; candidiasis,
trichomoniasis and pyogenic infections.18 These
etiological agents are associated with a high incidence of
endometritis and pelvic inflammatory disease. Our study
also correlates with another study which was conducted
on infection and infertility in India, and it revealed that
candidiasis, trichomoniasis, and pyogenic infections are
the most common opportunistic infections in the female
genital system.19 They also reported 35% candidiasis,
30% trichomoniasis infection and 35% other pyogenic
infections in their study. They isolated other pyogens like
sp.Staphylococci, Chlamydia, and Nesisseria
gohorrhoeae sp, species, besides Escherichca coli, a
finding which is not comparable with our study. Many
cases of PID go unrecognized. Reason being as some of
the cases are asymptomatic, others are not diagnosed
because the patient or the health-care provider fails to
recognize and investigate for mild or nonspecific
symptoms or signs (e.g., abnormal bleeding, dyspareunia,
and vaginal discharge) and thus many cases remain
undiagnosed. It has also been observed that even women
with mild or asymptomatic PID might be at risk for
infertility, so it is very much important that all cases with
even mild and nonspecific symptoms be investigated
meticulously. Another study was also conducted on
sexually transmitted diseases, and it revealed that
trichomonas infection was frequently observed in poor
and middle class, because of poor hygiene.20 This theory
correlates with our study as we also observed that poor
class and middle class are most commonly infected with
trichomonas infections due to improper hygiene.
C o n c l u s i o n
Trichomonas, candida and pyogenic infections were
found to be most commonly associated with pelvic
inflammatory diseases and trichomoniasis was more
frequently observed in poor and middle class females due
to poor hygenic.
R e f e r e n c e s
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2. Hughes JP, Baeten JM, Lingappa JR, et al. Determinants
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Table 2. Frequency of etiological agents in various age
groups (n=100)
Etiological
agents
20-30years
(n=58) n(%)
30-40yrs
(n=25) n(%)
50 yrs &
(n=17) n(%)
Candida
albicans (n=35)
10 (28.5) 10(28.5) 15(43)
Trichomoniasis
(n=30)
20(6.7) 10(33) __
Pyogenic
(n=35)
28(80) 5(14) 2(6)
Table 3. Frequency of etiological agents in various
socioeconomic groups (n=100)
Etiological
agents
Lower class
(n=40) n(%)
Middle class
(n=30) n(%)
Upper class
(n=30) n(%)
Candida
albicans (n=35)
10 (28.5) 10 (28.5) 15 (43)
Trichomoniasis
(n= 30)
20 (67) 10 (33) ---
Pyogenic
(n= 35)
10 (28.5) 10 (28.5) 15 (43)
43 J I M D C 2 0 1 7 43
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