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Research Article | DOI: https://doi.org/10.31579/2690-4861/969
1Second Degree Specialist in Comprehensive General Medicine, Assistant Professor, Master in Comprehensive Care for Women, Research Associate.
2First-degree specialist in Comprehensive General Medicine, First-year resident in Ophthalmology.
3Specialist First- year in Comprehensive General Medicine, Second- year Resident in General Surgery.
4Fourth Year Resident in Pediatric Surgery.
5First and Second Degree Specialist in General Surgery, Specialist in Aesthetic Medicine and Medical Laser. Assistant Professor, Assistant Researcher, and Consulting Professor in General Surgery.
*Corresponding Author: Elisa Puentes Rizo, Department of General Surgery, The Affiliated Bozhou Hospital of Anhui Medical University, China.
Citation: Elisa P. Rizo, Alejandro A. Puentes, Aguilar Puentes RA, Mariam M. Tejera, López Rodríguez PR, (2025), Characterization of Vaginal Infection in Pregnant Women. "José Antonio Céspedes Argote" Polyclinic , 2020-2022, International Journal of Clinical Case Reports and Reviews, 31(3); DOI:10.31579/2690-4861/969
Copyright: © 2025, Elisa Puentes Rizo. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 08 September 2025 | Accepted: 20 September 2025 | Published: 07 November 2025
Keywords: pregnancy; vaginal infection; primary care
Introduction: Vaginal infection is a worldwide disease that has become a health problem due to its increasing incidence. It es one of the most common medical complications associated with pregnancy.
Objective: To characterizes vaginal infection in pregnant women.
Methods: Between January 2020 and December 2022, an observational, descriptive, cross-sectional study was conducted in 195 pregnant women.
Result: We found 116 pregnant women (59.5%) with vaginal infection. The mean age of the group was 23.6 ± 7.05 years, and black skin color represented 45.6%. 100% of those with only completed primary education had vaginal infection, as well as 67.8% of those who were not married, and 61.2% of those who were single. 67.6% had the infection at 12 weeks of pregnancy or less. Prenatal care was inadequate in 40.5% of these women, and 72.2% had vaginal infections. 62.6% had unprotected sexual intercourse, and 52.8% practiced inadequate hygiene. 9.5% had mixed infections, and of these, 72.7% responded unfavorably to treatment. Only 8.6% presented neonatal infection as a complication.
Conclusions: Among pregnant women with vaginal infections, those with low educational levels, young gestational age, and unprotected sexual intercourse predominated. Mixed infections responded unfavorably in a greater number of pregnant women. The most common complication was premature rupture of membranes.
Pregnancy is an event traditionally celebrated in all societies around the world. During pregnancy, the birth of a healthy child is expected; however, for many families, the reproductive process can be grim and dangerous, with morbidity and consequences for both mother and child. [1]One of the main diseases that occur during pregnancy is vaginal infections, which have become a medical problem due to the expansion of their rate, establishing quite possibly the most frequent unexpected problems related to pregnancy and the damage caused to the new being. [2]
During pregnancy, hormonal changes alter the vaginal flora, making vaginal and cervical infections a common disorder, often difficult to eradicate, causing recurrences and potentially triggering adverse effects. [3, 4]Vaginal infection is characteristic of the lower genital tract in women of reproductive age and accounts for one-third of all vulvovaginal infections, although it can occur in women of any age, whether or not they are sexually active. This is a major cause of concern for women and primary care physicians, as most have had a vaginal infection at least once in their lives. [5,6In medical practice, this condition is a common problem, with a worldwide incidence of 7 to 20% of women per year.[ 7] Pregnant women are not exempt from suffering from vaginal infections. Several studies declare that some coexist with them and sometimes they go unnoticed. However, this constitutes a serious problem, since they represent a risk factor for complications such as premature rupture of the membranes, preterm labor and their consequences, even the birth of a low-birth-weight baby. [7,8]There are certain predisposing factors for the development of vaginal infections, including poor hygiene habits, multiple sexual partners, diabetes, congenital malformations, frequent use of antibiotics, and immune deficiency, among others. [7, 8, 9]In clinical practice, it is sometimes not always possible to determine the etiologic agent or triggering factors through history taking and examination. Furthermore, empirical treatment may not be adequate, resulting in relapses and recurrences, which pose a problem for both the woman and the clinician.In research conducted worldwide, it has been found that 90% of vaginal infections are caused by three groups of etiological agents: a group of anaerobic bacteria that produce vaginosis, yeasts of the genus Candida spp ., and those caused by the protozoan Trichomonas vaginalis . Statistics have increased in recent years, going from a prevalence of less than 5-10% in 2005 to 7-20% of cases per year in 2015. This type of disease affects women regardless of race, socioeconomic status, educational level, or other factors. ,[9,10]Studies show that sub-Saharan Africa has a high prevalence of vaginal infections, especially in areas affected by the human immunodeficiency virus (HIV). In North America, one in three women has this condition; in Latin America, Chile reports up to 32%, while in adolescents in Brazil, prevalences of over 30% are reported. In Peru, a study in Lima reported a prevalence of 23% among women who attended gynecological clinics. [10,11]Vaginitis, in particular, is among the ten most common reasons for consultations in general medicine and accounts for 15–20% of consultations in gynecological practices. Approximately 75% of all women will experience a vaginal yeast infection at least once in their lives, of which 40–50% are recurrent. [6 , 11, 12, 13]The prevalence of vaginal candidiasis during pregnancy is higher than that of the general population (28% to 38%). A prevalence of pathogenic flora of 49.3% has been observed in both symptomatic and asymptomatic pregnant women. [11,12,13,14] In the United States, it is the most common cause of infectious diseases, with an estimated 5 to 7 million cases per year. Bacterial vaginosis is reported in up to 25% of pregnant women, yeast infections in up to 45%, and trichomoniasis in 3 to 5%. 15Published studies report figures as diverse as 18.2% in Japan, 24.2% in Argentina, and 22.6% in Mexico for bacterial vaginosis. Research in Colombia and Haiti has found a high incidence of 54.6% and 60%, respectively. [16] Regarding fungal infections, the incidence in studies conducted in Colombia is 12.5%, 18% in Spain, 19% in Peru, 23% in New Guinea, and others such as Jamaica with 30.7%. ,17.18In Cuba, there are reports indicating that cervicovaginal infections occur at an incidence of 7-20% per year. Furthermore, pregnant women, in the first and third trimesters, are the most frequently affected by vaginal infections. Around 22.5% are caused by Trichomonas , while, with percentages between 48.3 and 53.7%, fungal vaginal infections are 19%, respectively. In our country, the development of preventive medicine with the participation of the family doctor and nurse in gynecological and obstetric care , together with the substantial technical and organizational changes to improve the quality of care for the mother-child binomial, have forced us to look for more dynamic ways that favor the performance of the health team.The main objective of our study is to characterize the Vaginal infection in pregnant women in the health area of the Polyclinic before mentioned in the period indicated.
Methods
An observational, descriptive, cross-sectional study was carried out with the aim of characterizing vaginal infection in pregnant women at the “José Antonio Céspedes Argote” Polyclinic in the period from 2020 to 2022. The universe was made up of all pregnant patients (195) with a microbiological study registered in the obstetric card. No Sampling techniques were applied, working with all patients who met the aforementioned criteria. Inclusion criteria: Pregnant patients with a microbiological study registered in the obstetric card belonging to the "José Antonio Céspedes Argote" Polyclinic in the Arroyo Naranjo municipality in Havana between January 2020 and December 2022, Agree to participate in the study, an attitude that must be expressed by signing the informed consent, and have a stable residence in the health area. Exclusion criteria: Presenting any mental disability that prevents them from performing adequately in the study. The variables used were age, infection vaginal, skin color , education, marital status, occupation, trimester of pregnancy ,previous vaginal infection , quality of prenatal care, sexual partners, protected sexual intercourse, use of tampons or pads, Inadequate use of underwear :, vaginal hygiene, microbiological findings, complications, response to treatment. Methods were used to obtain the information theorists Induction-Deduction , Historical -Logical and Analysis-Synthesis . Empirical Methods: Documentary Analysis Statistical Method : Calculation of absolute frequencies, percentages, arithmetic mean, median, standard deviation and X 2 (Chi-Square). Preparation of statistical and contingency tables With the information obtained, an automated database was created using the Statistical program. Package for Social Sciences ( SPSS) 19.0 for Windows, where all statistical processing was performed. The study was approved by the Scientific Council and the relevant Medical Research Ethics Committee. Informed consent was obtained from the patient or legal guardian, as appropriate, after being previously informed of the research purposes.
Table 1 shows the sociodemographic characterization of the patients in the study, whether or not they were positive for vaginal infections.
| General Characteristics | Present | Absent | Total | P | |||
| No. | %to | No. | %to | No. | %b | ||
| Vaginal infection | 116 | 59.5 | 79 | 40.5 | 195 | 100 | |
| Age (x) ( SD) 23.6 +/- 7.05 | |||||||
| Age groups (in years) | |||||||
| Under 15s | 23 | 88.5 | 3 | 11.5 | 26 | 13.3 | 0.000 |
| 16 - 25 | 58 | 65.2 | 31 | 34.8 | 89 | 45.6 | |
| 26 - 35 | 30 | 46.9 | 34 | 53.1 | 64 | 32.8 | |
| Over 35 | 5 | 31.3 | 11 | 68.8 | 16 | 8.2 | |
| Skin Color | |||||||
| White | 28 | 63.8 | 13 | 31.7 | 41 | 21.0 | 0.433 N/S |
| Mestiza | 37 | 56.9 | 28 | 42.7 | 65 | 33.3 | |
| Black | 51 | 57.3 | 39 | 42.7 | 89 | 45.6 | |
| Schooling | |||||||
| Primary | 19 | 100 | 0 | 0.0 | 19 | 9.7 | 0.000 |
| Secondary | 47 | 61.8 | 29 | 38.2 | 76 | 39.0 | |
| Upper secondary | 30 | 57.7 | 22 | 42.3 | 52 | 26.7 | |
| University | 20 | 41.7 | 28 | 58.3 | 48 | 24.6 | |
| Occupation | |||||||
| Linked | 57 | 52.8 | 51 | 47.2 | 108 | 55.4 | 0.033
|
| Disconnected | 59 | 67.8 | 28 | 32.2 | 87 | 44.6 | |
| Marital status | |||||||
| Single woman | 41 | 61.2 | 26 | 38.8 | 67 | 34.4 | 0.075 N/S |
| Married | 16 | 42.1 | 22 | 57.9 | 38 | 19.5 | |
| Divorcee | 9 | 56.3 | 7 | 43.8 | 16 | 8.2 | |
| Stable union | 50 | 67.6 | 24 | 32.4 | 74 | 37.9 | |
a.- Calculated from the total number of patients in each row; b.- Calculated from the grand total; (x): mean; SD: standard deviation. N/S: Not significant. Age group: x 2 = 19.76. Skin color: g (2); x 2 = 1.67. Education: g (3); x 2 = 19.50. Occupation: x 2 = 4.52. Marital status: g (3); x 2 = 6.91.
Table 1: Sociodemographic characteristics and vaginal infection behavior in pregnant women. “José Antonio Céspedes Argote” Polyclinic, 2020-2022
Source: Data Collection Form
195 pregnant women were studied, of which 116 (59.5%) presented a vaginal infection at some point during pregnancy.The mean age of the group was 23.6±7.05 years. The majority of the patients studied were between 16 and 25 years old (89 patients; 45.6%), however, vaginal infection was most common in the group under 15 years of age, with 88% of those affected. This finding was statistically significant.Black patients accounted for 45.6% of the total, with 89 pregnant women. White patients accounted for 21.0%. In this group, vaginal infections had the highest percentage of cases, with 28 cases, representing 63.8% of the group. There was no association between these variables.Among patients with secondary or university education, at least 5 out of 10 studied patients had vaginal infections. However, 100% of those who had only completed primary school had vaginal infections. The association between these variables is statistically significant.Pregnant women who were employed or studying (affiliated) accounted for more than 50%, and were less affected by vaginal infections: 52.8% compared to 67.8% of those who were not employed. This represents a significance level of 5%.Regarding marital status, 37.9% and 34.4% of patients were in a stable relationship and single, respectively. In both groups, at least 6 out of 10 patients studied had a vaginal infection. However, this was not statistically significant.
Table 2 shows the obstetric risk factors analyzed and their distribution according to the presence of vaginal infection.
It is noteworthy that less than 20% of vaginal infections occurred in women 25 weeks or older (37 patients). At least 6 out of 10 patients with pregnancies of 12 weeks or less had vaginal infections. A statistically significant association was found between these variables. multigravid patients, representing 53.3% of the total. There was little difference in the percentage of patients with vaginal infection compared to nulliparous women, which was reflected in the lack of association between these variables analyzed. In contrast, the categories of previous vaginal infection were associated with the presence of vaginal infection, with a significance level of 5%. More than half of pregnant women with a previous infection experienced a similar event during the study period. The association between the quality of prenatal care and vaginal infection was also highly significant in the study group. Those with good or fair care predominated (59.5% of the total). It was notable that more than 70% of those with poor prenatal care were diagnosed with vaginal infection.
| Obstetric risk factors | Present | Absent | Toral | P | |||
| N=116 | %to | N = 79 | %to | N=195 | %b | ||
| Gestation period (in weeks) | |||||||
| 12 or less | 73 | 67.6 | 35 | 32.4 | 108 | 55.4 | 0.000 |
| 13 to 24 | 21 | 42.0 | 29 | 58.0 | 50 | 25.6 | |
| 25 or more | 22 | 59.5 | 15 | 40.5 | 37 | 19.0 | |
| Pregnancy | |||||||
| Nulliparous | 56 | 61.5 | 35 | 38.5 | 91 | 46.7 | 0.585 N/S |
| Multigravida | 60 | 57.7 | 31 | 32.3 | 96 | 49.2 | |
| Previous vaginal infection | |||||||
| Yeah | 51 | 51.5 | 48 | 48.5 | 99 | 50.8 | 0.021 |
| No | 65 | 67.7 | 31 | 32.3 | 96 | 49.2 | |
| Quality of prenatal care . | |||||||
| Good | 28 | 40.6 | 41 | 59.4 | 69 | 35.4 | 0.000 |
| Regular | 31 | 66.0 | 16 | 34.0 | 47 | 24.1 | |
| Bad | 57 | 72.2 | 22 | 27.8 | 79 | 40.5 | |
a.- Calculated from the total number of patients in each row; b.- Calculated from the overall total. N/S: Not significant. Gestational age: g (2); x 2 =9.28. Gravidity: x 2 =0.29. Previous vaginal infection: x 2 =5.30. Quality of prenatal care: g (2); x 2 =16.31. Source: data collection form.
Table 2: Obstetric risk factors in pregnant women according to the presence of vaginal infection. “José Antonio Céspedes Argote” Polyclinic , 2020-2022.
The risk factors related to the sexual behavior of the patients analyzed are shown in Table 3. Although just over 25% of patients had only one sexual partner, the difference in the presence of vaginal infection was negligible. However, it was more frequent in those with more than one sexual partner. No statistical association was found between the variables.
This was not the case for the analysis of protected sexual intercourse, which was highly significant. 62.6% of pregnant women reported unprotected sexual intercourse, and 72.1% of these reported vaginal infections.
| Sexual Conduct | Present | Absent | Total | P | |||
| N=116 | %to | N= 79 | %to | n)196 | %vb | ||
| Sexual partners | |||||||
| Only | 27 | 52.9 | 24 | 47.1 | 51 | 25.2 | 0.268 N/S |
| Several | 89 | 61.8 | 55 | 38.2 | 144 | 73.8 | |
| Protected sexual relations | |||||||
| Yeah | 28 | 38.4 | 45 | 61.6 | 73 | 37.4 | 0.000 |
| No | 88 | 72.1 | 34 | 27.9 | 122 | 62.6 | |
a.- Calculated from the total number of patients in each row; b.- Calculated from the overall total. N/S: Not significant. Sexual partners: x 2 = 1.22. Protected sexual intercourse: x 2 = 21.61. Source: data collection form.
Table 3: Sexual behavior of pregnant women according to the presence of vaginal infection. “José Antonio Céspedes Argote” Polyclinic, 2020-2022
Table 4 lists the health and hygiene risk factors of the pregnant women studied.
Vaginal tampons or pads were used in 42.1% of pregnant women (82 cases). However, the highest incidence of these patients was observed among those who did not use them, at 64.6%. These variables were not correlated in the statistical analysis, with p > 0.05.
A similar statistical result was obtained after analyzing the relationship between improper use of underwear and vaginal infections. Inappropriate use was reported in over 50% of cases, but more cases were reported in the group where the use was correct.
It was however statistically proven that proper hygiene was related to the absence of vaginal infection with 65.2% of patients who cleaned themselves properly and did not develop vaginal infection.
| Obstetric risk factors | Present | Absent | Total | p | |||
| N=116 | %to | N=79 | %to | N=195 | % b | ||
| Use of vaginal plug or pad | |||||||
| Yeah | 43 | 52.4 | 39 | 47.6 | 82 | 42.1 | 0.088 N/S |
| No | 73 | 64.6 | 40 | 35.4 | 113 | 57.9 | |
| Improper use of underwear | |||||||
| Yeah | 60 | 57.7 | 44 | 42.3 | 104 | 53.3 | 0.585 N/S |
| No | 56 | 61.5 | 35 | 38.5 | 91 | 46.7 | |
| Vaginal Hygiene | |||||||
| Appropriate | 32 | 34.8 | 60 | 65.2 | 92 | 47.2 | 0.000 |
| Inappropriate | 84 | 81.6 | 19 | 18.6 | 103 | 52.8 | |
a.- Calculated from the total number of patients in each row; b.- Calculated from the overall total. N/S: Not significant. Use of a vaginal tampon or pad: x 2 = 2.91. Improper use of underwear: x 2 = 2.98. Vaginal hygiene: x 2 = 44.10. Source: data collection form.
Table 4: Hygiene factors in pregnant women according to the presence of vaginal infection. “José Antonio Céspedes Argote” Polyclinic , 2020-2022
Table 5 shows the results of the microbiological studies and the response to treatment of the 116 patients diagnosed with vaginal infection.
Candida infection predominated albicans (40 pregnant women; 34.5%), followed by vaginal Gardnerella infections (31 cases; 26.7%). The Other category included microbiological results from swabs that corresponded to Escherichia coli. coli (4 patients), Group B Streptococcus or Streptococcus agalactiae (5 cases) where the percentage was less than 5.
Gardnerella infections were vaginalis, where the highest percentages of unfavorable outcomes were recorded in the group, with 72.7% and 64.5%, respectively. An association between these variables was established at a significance level of 5%.
| Microbiological results | Favorable Response | Unfavorable Response | Total | P | |||
| No. | %to | No. | %to | No. | % b | ||
| Gardnerella vaginalis | 11 | 35.5 | 20 | 64.5 | 31 | 26.7 | 0.000 |
| Vaginal Trichomonas | 21 | 84.0 | 4 | 16.0 | 25 | 21.6 | |
| Candida Albicans | 27 | 67.5 | 13 | 32.5 | 40 | 34.5 | |
| Mixed | 3 | 27.3 | 8 | 72.7 | 11 | 9.5 | |
| Others | 6 | 66.7 | 3 | 33.3 | 9 | 7.8 | |
| Total | 68 | 58.6 | 48 | 41.4 | 116 | 100 | |
a.- Calculated from the total number of patients in each row; b.- Calculated from the overall total. Microbiological result: g (4); x 2 = 19.46. Others: Escherichia coli, Group B streptococcus or Streptococcus agalactiae. Source: data collection form
Table 5: Microbiological outcome and treatment response in pregnant women with vaginal infection. “José Antonio Céspedes Argote” Polyclinic, 2020-2022.
Table 6 lists the complications and their absolute frequencies and percentages. A clear predominance of premature rupture of membranes and abortion/preterm delivery was observed (69 pregnant women; 59.5%). Fewer than 10% presented neonatal infection as a complication
| Complications | N=116 | % |
| Premature rupture of membranes | 35 | 30.2 |
| Abortion/premature birth | 34 | 29.3 |
| Puerperal infection | 15 | 12.9 |
| Underweight / CIUR | 22 | 19.0 |
| Neonatal infection | 10 | 8.6 |
IUGR: Intrauterine growth restriction. Source: data collection form.
Table 6: Complications in pregnant women with vaginal infection. “José Antonio Céspedes Argote” Polyclinic, 2020-2022 .
Pregnancy is one of the situations that physiologically increases the secretion of the vestibular and endocervical glands and, therefore, the amount of vaginal content. Therefore, it is necessary to distinguish between normal losses that should not worry us (white, milky, odorless or with a slight odor) and those that may indicate an infection (color other than white and with a bad odor). 20 Syndromic management, a strategy outlined by the Ministry of Public Health, represents an alternative that guarantees the solution of more than 95% of cases in all units of the National Health System. , 21 . In the current study, 116 patients presented vaginal infection, which represented more than half of the pregnant women analyzed. This corresponds to what was reported by Alves D. et al and by Castillo Pacheco 1,22 with an incidence of 54.3% in their series. In the present investigation, the data regarding the age of the patients analyzed showed a mean of 23.6 ± 7.05 years and a predominance of pregnant women between 16 and 25 years of age corresponded to similar studies such as the one mentioned above and the. 7 Rojas- JiménezS,Lopera -ValleJ . ,23 with a predominance of patients under 25 years of age., Various studies have shown that younger women are more likely to have pathological vaginal discharge during pregnancy. 1,22, 23, In the study, the presence of vaginal infections by age group showed, however, that the highest number of cases was found in those under 15 years of age. This finding was also associated with a high degree of statistical significance. Adolescence is considered a stage of rebellion and consolidation of personality traits such as individual responsibility, which many of these patients lack, and they not only end up pregnant (even without physical or psychological preparation for facing such a large responsibility) but also experience complications such as vaginal infections. In the current series, patients with black and mixed-race skin predominated, although the highest percentage of infections was found in white women (63.8%). No other research has been found that addresses the race of pregnant women. Low educational levels lead to inappropriate behavior, as lack of knowledge leads to promiscuity, unprotected sexual practices, failure to comply with the measures recommended by medical personnel, frequent change of partner, and infidelity leading to genital infections [24]. González N. et al 25 and Rodríguez Batista MD., et al 2 6. propose that the level of education is a vital factor in the acquisition of knowledge about the appearance of a genital infection. García Piña DL and Proenza Fernández L. 27 when distributing pregnant women according to the level of education found an overwhelming predominance of completed pre-university with 837 patients (39.2%) followed by completed secondary technical school with 629 patients (29.4%) and only 15 patients (0.7%) had completed primary school. However, the most relevant was that of the 19 patients who had only completed primary school, 100% had a vaginal infection. On the other hand, the demographic characteristics described, with a significant number of pregnant adolescents, explain why the distribution according to level of education was considered according to the highest academic level completed. Regarding occupation, the decision was made for educational purposes and to facilitate understanding to use the categories of employed (students or workers) and unemployed (non-employed). Despite this, the variable in question was considered important. A collateral analysis, equally valid, would explain that women of childbearing age who are not engaged in an activity that requires time (study or work) have more free time and therefore the "possibility" of "becoming pregnant." In addition, the lack of time available to those "employed" could influence the time spent on personal care, leaving them relatively vulnerable to hygiene and health behaviors. The association between these variables in the present study was statistically significant. There was a higher percentage of vaginal infections among unemployed pregnant women. Regarding the marital status of the patients analyzed, it was found that at least 6 out of 10 single women, as well as those in a stable relationship, had vaginal infections. The lowest percentage was among married women (42%). Although the results did not demonstrate an association with the presence of vaginal infection, the data are consistent with those of López-Torres L. et al. 28 who found in their research that the prevalence of BV is higher in unmarried women. These researchers believe that marital status plays a role because some patients do not have a stable partner, which is why they are more likely to acquire vaginal infections. However, it is not a significant factor, unlike the age of the pregnant woman, since in the case of single adolescents , the risk multiplied considerably. 28 Gestational age was one of the variables associated with a statistical significance of 95% in the study. Pregnant women with 12 weeks or less predominated in the study, with an incidence of at least 6 out of 10 with vaginal infection. Taking into account the trimester of pregnancy in which the vaginal infection occurs may be of interest to the healthcare team, since the treatment method and the complications that may occur vary from one trimester to the next. The appearance of vaginal infection in the first trimester can occur because they frequently begin with pregnancy, since it is a condition that predisposes to the appearance of infections and also because it is likely that they had this problem before pregnancy, the latter is the most successful cause, if one takes into account that there are risk factors such as poor hygiene conditions, inappropriate sexual behavior, unprotected sexual relations, frequent changes of partners, among others. In agreement and with similar results to those obtained in the current series of cases. There is the study by Rosada Navarro Y., Álvarez Ramírez R. 29 where it is shown that 40.1% were diagnosed during the first trimester of pregnancy with 51 cases, while 37.1% were diagnosed during the third trimester demonstrating its highest incidence in these trimesters. More than half of those studied were multigravid patients , but of the 91 nulliparous patients, 61.5% had vaginal infection. Although the difference between the two was less than 5 percentage points and no statistically significant association was found, López Figallo GL. 33 in his thesis on vaginal discharge and risk factors for premature rupture of membranes in pregnant adolescents reports that multiparous pregnant women predominated with a total of 62 pregnant women for 71.3%, data that does not coincide with the results obtained from the research because, as explained, nulliparous women were those who presented a higher percentage of vaginal infections . A history of previous vaginal infection was associated with the presence of this entity during pregnancy. Of the pregnant women who had previously presented it, 4 out of 10 did not present vaginal infection, while 6 out of 10 without this history were diagnosed with vaginal infection. The results of this research coincided with the findings of other researchers. 30,31 The lead researcher agrees that the quality of prenatal care is an influential factor not only because of the possibility of establishing an early diagnosis, but also because it ensures adequate follow-up and the assessment and prevention of potential complications. Risk indicates only a probability; that is, there is no certainty that a situation will occur, but the likelihood of suffering harm during the reproductive process will be higher for those who present one or more of the risk factors. This is a fundamental element for health administrators to consider when developing the interventions they deem necessary to avoid or at least reduce a risk factor; isolated facts should not be taken into account when developing intervention policies. In this sense, inappropriate sexual behavior is one of the most studied elements related to vaginal infections in pregnant women. It was significant that the number of sexual partners was not associated with the presence of vaginal infections, while unprotected sexual intercourse was. In 2017, Chacón O'Farrill and Cires Alfaro 2 published an educational intervention study on vaginal discharge syndrome in pregnant women. They evaluated the level of knowledge of these women and identified that 49% of their cases did not adequately associate sexual behavior and hygiene-health risk factors with the development of vaginal infection. Between 2017 and 2018, Miranda Guerra AJ et al. 6 published a study conducted with 182 pregnant women in the town of Santa Fe, Playa municipality, in a maternity home in Havana. to study the main characteristics of those with vaginal infections. Monilial infection predominated , and low birth weight was the most affected indicator of the Maternal and Child Program. González N. et al. 25 In 2019 in Cuba, they prepared their study: Risk factors associated with vaginal infection in pregnant women, where they sought to verify the relationship between both variables. The previous history of sexually transmitted infection (OR 2.25), more than three pregnancies (OR 3.20), previous abortions (9.88) and not using condoms during sexual intercourse (OR 5.35) were found to be significant.
Reports carried out by Cutié and 32 others , in women who attended the gynecology consultation at ISMM, Dr. Luis Díaz Soto where they came to the conclusion that promiscuity, early initiation of sexual relations and non-use of condoms favor the appearance of these entities. Similar results have been reported by other authors 34,35 , who suggest that these infections will continue to increase in the coming years despite educational measures, and that the difficulty in detecting asymptomatic individuals is one of the causes. In the study by Cires Pujol M et al 34 , in their treatment guidelines for vaginal infections , they consider proper vulvovaginal hygiene and safe sexual intercourse to be important risk factors for preventing vaginal infections. The literature reviewed indicates that, in counseling, the physician will convey messages encouraging pregnant women and their partners to adhere to the instructions, such as: not having sexual relations until cured; the importance of using a condom to avoid reinfections and as a preventive measure against premature birth (highlighting the role of prostaglandins present in semen); teaching the correct use of condoms and providing some; and the importance of adherence to treatment and to sexual partners. ,35 The study by Rosada Navarro Y., Álvarez Ramírez R. 29 in a polyclinic in Granma coincided with the results obtained in the present series with 45.6% of patients who adequately performed vulvovaginal hygiene (47.2% in the current series). Despite having found a high number of women with good hygiene techniques, the 52.8% who do not have it is still worrying, since poor hygiene techniques can eliminate the normal protective vaginal flora against other pathogens, and the use of products marketed for intimate hygiene sometimes makes this area more vulnerable to vaginal infection. However, the use of inappropriate underwear or a sanitary tampon or pad was not associated with the presence of infection in this investigation. Regarding the highest incidence according to the causative agents, we have in first place monilia or candida, because it is transmitted so simply by washing with contaminated water. Furthermore, pregnant women are predisposed to this type of infection due to hormonal changes and variability in vaginal pH and the temporary immunosuppression that occurs in women during this period, a fact that favors the proliferation of this fungal infection, which is usually opportunistic. 29 These results coincide with the studyof vulvovaginal candidiasis in women over 12 years of age in Mexico 36 and Castillo Pacheco MC. 22 where a high positivity was obtained for the different etiological agents and specifically monilia . The study by Rojas-Jiménez S et al. 23 in a high-complexity clinic in Medellín, Colombia showed that after performing the laboratory study, the most frequent microbiological diagnosis made by the treating physician was vulvovaginal candidiasis in 12 (41.4%) cases, followed by bacterial vaginosis in 7 (24.1%). Furthermore, in two patients, the study was reported as normal by the attending physician, but was pathological according to the institution's management guidelines. On the other hand, in three cases, the microbiological diagnosis was not reported in the medical history. When analyzing the discharge studies according to institutional guidelines, the most frequent diagnosis continued to be vulvovaginal candidiasis, with a higher percentage (55.2%), followed in this case by mixed infection (27.6%). Of the 45 patients treated, in the study by Rojas-Jiménez S et al. 23 , 24 (53.3%) received targeted treatment with mono- or polytherapy after the germ was identified in the microbiological examination. An adequate therapeutic response was achieved in 85.7% of these patients. Regarding the response to treatment, the results achieved coincided with those reported by Soberón F RM., Evaristo S. ,38 where the largest number of pregnant women have a satisfactory evolution and only a few do not achieve it with the therapeutic plan in their home environment, but with more energetic measures prescribed by the family doctor and the obstetrician of the area. It also coincides with Miranda Guerra AJ. and 6 others where 81.3% of satisfactory evolution was achieved. In the research, in addition, the response to treatment was related to the microbiological result and with a high level of statistical significance (p = 0.001) it was relevant how mixed infections were those with the worst response to treatment. Machado D, et al. 37 in 2017 with the aim of determining the prevalence of vaginal colonization by Gardnerella v. and bacterial vaginosis (BV) in Portuguese pregnant women and identifying risk factors for colonization was 3.88% and 67.48%, respectively. Previous preterm birth and G. vaginalis colonization were factors with very high ORs, but only statistically significant for a 90% CI. Preventing complications and achieving a pregnancy with the lowest number of adverse events is the main objective of the personalized and detailed care offered to pregnant women in our country. Efforts are increasing daily to achieve this goal. The indicators of the Maternal and Child Program, in addition to evaluating health status, reflect the degree of social development of a given country or region. Complications secondary to a vaginal infection may compromise compliance with some of these indicators. The study by Rosada Navarro Y., Álvarez Ramírez R. 29 observed few obstetric conditions in the patients in the study (41), with only 11 neonatal sepsis with a predominance of respiratory location associated with respiratory difficulty in the newborn, hyaline membrane disease and congenital bronchopneumonia mainly. 10 puerperal infections that are mostly due to infections of the episiotomy after delivery and 7 cases of prematurity and low birth weight respectively, which was due to the fact that a timely diagnosis was not made in some cases, others received treatments that did not resolve the problem during pregnancy or were reinfected , which caused immature births with a septic birth canal and consequently newborns with sepsis. In the present investigation and in contrast to what was found by these researchers, premature rupture of membranes (30.2%) and abortion or preterm delivery (29.3%) predominated. Neonatal and puerperal infections were the least common complications. This reinforces López's point . Figallo GL 33. on the significant role of Vaginal Discharge as a risk factor for Premature Rupture of Membranes in pregnant women. as well as that reported by Kraus et al 24 and by Montoya BJ, Avila VMA, Vadillo OF, Hernández GC, Peraza GF, Olivares MS. 39 Cervicovaginal infection as a risk factor for preterm delivery and Premature Rupture of Membranes. The development of increasingly preventive medicine capable of anticipating the onset of adverse events is, as mentioned, a strategy to follow. In this regard, it is vitally important to understand the characteristics of obstetric patients and their conditions throughout pregnancy, identifying early risk factors that could compromise the integrity of the maternal-fetal relationship.
More than half of the pregnant women had vaginal infections, and this group was predominantly adolescent, black , with low levels of education, unmarried, and in a stable relationship. The first trimester of pregnancy, previous vaginal infections, quality of prenatal care, unprotected sexual intercourse, and inadequate vaginal hygiene were the factors significantly associated with vaginal infections in the study group. Monilial infection predominated, although mixed infections responded unfavorably to treatment in a greater number of pregnant women. The most frequent complications were premature rupture of membranes and abortion or preterm delivery.
The authors declare that there is no conflict of interest.
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Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
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My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
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"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
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Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
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Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
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Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
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Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
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I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
