In present study, the overall prevalence of vaginal infections (15.4 %) was coherent with reports in Kerkuk-Iraq (13.2 %) [14] and India (14.7 %) [15]. However, it was lower compared to reports in Vietnam (49.5 %) [1], Iran (27.6 %) [16] and Thandalam (44 %) [17]. This variation might be methodology difference in isolation and identification of etiologies of vaginal infections. For instance, in this study culture method was not possible to identify BV. Moreover, environmental factors and difference on the actual study participants might also explain the above discrepancy.
In this study, candidiasis followed by BV and trichomoniasis were the leading vaginal infections. This was coherent with a study conducted in Vietnam [1], Bangladesh [18] and Nepal [19] where candidiasis followed by BV was the most prevalent. However, it differs from a study done in India [15] where trichomoniasis was the most prevalent. This study also differs from findings in Shandong [20] where BV was the most prevalent. Comparison was not possible in Ethiopian context owing to lack of reproductive tract infections data in women of reproductive age.
In this study, the prevalence of vaginal infection was significantly higher in non-pregnant compared to pregnant women (p = 0.03) which might be due to lowering of immunity in non-pregnant women due to use of steroid drugs as contraceptive. However, significant difference was not found in the proportion of vaginal infections between asymptomatic women and women who had symptoms of vaginitis. This finding was comparable to a study conducted in Nepal [19]. This showed that vaginitis symptoms have multiple etiologies. However, this finding infers the strong recommendation to all women in reproductive age for vaginal infection screening regardless of symptoms of vaginitis and pregnancy status.
The prevalence of candidiasis in the present study (8.3 %) was consistent with reports from kerkuk-Iraq (8 %) [14] and Lebanon (8.8 %) [21]. However, it was higher than a study in India (1.96 %) [15]. In contrast, the prevalence of candidiasis was lower than studies from Vietnam (25.3–34 %), Hanol Vietnam (11.1 %) and Brazil (12.5 %) [1, 22, 23]. This variation could be the difference in study participants as the present study included pregnant, non-pregnant, symptomatic and asymptomatic women in reproductive age.
In this study, prevalence of BV (2.8 %) was in agreement with studies conducted in Hanol Vietnam (3.5 %) and Tribhuvan (2.5 %) [22, 24]. However, it was lower than reports from Addis Ababa, Ethiopia (19.4 %), Tanzania (28.5 %), Brazil (20 %), Iran (26.2 %) and Peru (27 %) [16, 23, 25–27]. This lower prevalence of BV might be associated with the method we used to identify BV. Because, we used only two criteria’s of Amles (wet mount and Gram stain) to identify BV.
The prevailing prevalence of trichomoniasis was comparable to studies carried out in Kerkuk-Iraq (2.9 %), Thandalam (2.1 %), Shandong (2.9 %) and USA (2.8 %) [14, 17, 20, 28]. However, it was higher than a study in Sudan (0.5 %), Vietnam (0.4 %), Turkey (1.1 %) and Hanol Vietnam (1.3 %) [1, 2, 22, 29]. In contrast, the prevalence was lower than studies carried out in Jimma, Ethiopia (4.98 %) [9], Brazil (4.1 %) [23] and India (18.8 %) [30]. The observed difference could be due to variation in pregnancy status, personal hygiene practice, environment, immunity, socioeconomic and cultural factors of the study participants. Moreover, the detection of trichomoniasis by conventional wet mount method in the present study might reduce the actual prevalence.
The distribution of trichomoniasis in the present study was relatively higher among age groups of 20–29 years compared to others. This was comparable to a study done in Kerkuk-Iraq [14]. This might be because this age group constituted the majority of study participants. Moreover, it might be due to the ability of the parasite to alter at the vaginal environment for its survival. On the other hand, peak candidiasis was observed in women of age 30–39 years. This finding conforms to a study finding in Shandong [20]. This is due to the fact that women at this age are more prone to vaginitis related to frequent sexual activities with husbands, pregnancy, weakening of immunity and oral contraceptive use.
In the present study, women aged > 40 years of age had highest proportion of BV. This result conforms to studies conducted in Shandong [20], Indonesia [31] and Bangladesh [32]. It is true that in age ≥ 40 years, the level of estrogen is declining which causes elevated vaginal pH. This condition is not optimal for lactobacilli species growth but very conducive for the growth of microorganisms causing BV.
In this study, all trichomoniasis cases were detected only from married women. This was in line with a study conducted in Nepal [19]. This strengthens the significant role of sexual intercourse in predisposing women to trichomoniasis. Similarly candidiasis was higher in married women compared to others. Similar finding was reported in India [15]. This might be because the married women are more likely to get pregnant and pregnancy is known to be a risk factor for candidiasis. In this study, the highest proportion of BV was noticed among non-pregnant women than pregnant women. This was consistent with reports from Addis Ababa, Ethiopia [25] and Thai women [33]. This could be due to increased coital frequency in non-pregnant compared to pregnant women resulting in reduction in the physiological barrier of the vagina, leads to over growth of normal commensals.
In the present study, all cases of BV and higher proportion of trichomoniasis were detected in women coming from rural area. Moreover, the highest proportion of BV was found in those women with agricultural occupation. This was consistent with a study done in Nepal [19]. The explanation might be because of poor hygiene practices, lack of time to keep their proper health, poor living standard, ignorance and difficulty in accessibility towards immediate health care facilities.
The prevalence of N. gonorrhoeae (1 %) in this study was comparable with a study conducted in kerkuk -Iraq (0.8 %), Lebanon (1 %) and Shandong (0.1 %) [14, 20, 27]. Moreover, Group B Streptococcus vaginal colonization (1.5 %) in women of reproductive age conforms to a study conducted in South India (2.3 %) [34]. However, it was lower than reports from other part of Ethiopia (20.9 %), Argentina (7.6 %) and Japan [35–37]. This inconsistency might be associated with difference among study participants.
Although, bacterial vaginal infections are one of the major causes of frequent antibiotic use in women of reproductive age, the level of antibiotic resistance in vaginal isolate was not studied before in Ethiopia. Thus, this study presents the antibiogram of the most predominant vaginal isolates. In this study, E.coli showed high level of resistance (73–83 %) to tetracycline and amoxycillin and moderate resistance (60 %) to cotrimoxazole. This was consistent with a report in Dessie and Bahir Dar, Ethiopia [38, 39], where 86–90 % and 60–67 % resistance levels of amoxicillin and cotrimoxazole, respectively were noticed. However, in this study E.coli and pseudomonas spp demonstrated low level of resistance to ciprofloxacin, norfloxacin and gentamycin. This was coherent with reports from Ethiopia and Pakistan [38, 40].
In the present study, S. aureus revealed a high level of resistance to amoxicillin. In contrast, S. aureus exhibited low levels of resistance (32.4–34.5 %) to ciprofloxacin, gentamycin and norfloxacin. These were consistent with studies from Ethiopia and Pakistan [38, 40].
In the present study, N.gonorrhoeae showed 25–50 % resistance rate against ciprofloxacin, tetracycline, ampicillin and erythromycin. This was coherent with studies in Nepal [41], Port Elizabeth [42], and Saudi Arabia [43] where 37.5–42.5 %, 50–94 %, 25 % and 50 % resistance of ciprofloxacin, tetracycline, ampicillin and erythromycin, respectively were noticed. Group B Streptococcus revealed 20 % resistance rate against ciprofloxacin, norfloxacin, erythromycin and clindamycin. This was consistent with previous studies in Ethiopia, Uganda and South India [34, 35, 44].
This study was not without limitations thus detecting candidiasis and BV using culture method may be more accurate than microscopic examination but was not possible due to the limitations of laboratory setups. Some of the information was obtained by interview, hence the possibility of recall bias. The study looked at current infection; addition of serology test would have given a broader profile of the infection to include past infection and inability to easily detect some causes of abnormal vaginal discharge due to Chlamydia, U.urealyticum and other organisms like viruses by the tools used. Moreover, this is a hospital based study and the occurrence of infection and antibiotic sensitivity may not be representative of the community. However, these data provided comprehensive information on vaginal infections and antimicrobial susceptibility profiles of aerobic bacteria isolates highlight the urgent need for more detailed study in specific group in women of reproductive age using advanced laboratory technique.