Epidemiology and management of bacterial vaginosis in Dakar, Senegal.

BACKGROUND: In Africa, vulvovaginal infections represent a public health issue due to their frequency and complications. Recent studies have shown a significant shift in bacterial ecology, which is increasingly dominated by bacterial vaginosis. The PETAL study aimed to determine the epidemiological, clinical, and microbiological profile of vulvovaginal infections in Dakar (Senegal), to assess the predictive etiological value of the syndromic approach by comparing it with microbiological results, and to evaluate the clinical and microbiological efficacy and the tolerance of treating bacterial vaginosis with the Neomycin-Polymyxin B-Nystatin (NNP) combination (Polygynax®). METHODS: This monocentric, prospective, single-arm and observational study was conducted at the Gynecology-Obstetrics Department of Institut d’Hygiène Social Hospital in Dakar. Women with suspected vulvovaginal infection underwent a clinical exam and vaginal bacteriological sampling. Based on the WHO syndromic approach, an initial diagnosis was made, and patients received NNP treatment (one vaginal capsule daily for 12 days). Clinical and microbiological outcomes were assessed on Day 15 after treatment. Consistency between the syndromic and microbiological diagnoses was evaluated using Cohen’s Kappa test. RESULTS: Women included in this study were on average 32 years old, mostly married (87.0%) and unemployed (52.2%). Among the 224 patients analyzed, 78.6% had positive bacteriological results at Day 0. Bacterial vaginosis was confirmed in 68.7% of cases, either alone (44.6%) or associated with candidiasis (22.8%) or trichomoniasis (1.3%). Isolated candidiasis accounted for 9.8%. High mixed-infection rates highlight diagnostic challenges. The syndromic approach showed strong consistency with microbiological diagnosis for bacterial vaginosis (sensitivity: 100%; specificity: 96.1%), but lower agreement for candidiasis (sensitivity: 100%; specificity: 78%) and mixed infections (sensitivity: 59.3%; specificity: 100%). Clinical remission was achieved in 91.4% of cases and bacteriological cure in 73.3% of vaginosis cases. The treatment was well tolerated (98.5%). CONCLUSIONS: Vulvovaginal infections in Dakar are largely dominated by bacterial vaginosis. In cases of isolated vaginosis, the syndromic approach showed very good consistency with the bacteriological diagnosis, while it seems less suitable for identifying mixed infections, which account for one-third of cases. In this context, the NNP combination could be an appropriate, effective, and well-tolerated treatment for the management of bacterial vaginosis.