الفهرس 
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Abstract
Part I: Study of abnormal vaginal discharge in Assiut Women’s Hospital:
Abnormal vaginal discharge is one of the most distressing problems daily faced by the gynecologist. However, it is usually pathological and because it is so frequent some ladies tend to consider it part of their daily life. The current study was a cross sectional study evaluating abnormal vaginal discharge and its common predisposing and etiological factors, different types of vulvovaginal infection and possible common reproductive hazards. Furthermore, the study discussed the common habit of vaginal douching, its possible relation to abnormal vaginal discharge and common risk factors.
There are three types of infections that commonly cause abnormal vaginal discharge during reproductive period; bacterial vaginosis” BV” (replacement of the normal vaginal flora by an overgrowth of anaerobic microorganisms, myco-plasmas, and Gardnerella vaginalis), trichomoniasis (T. vaginalis), and candidiasis usually caused by Candida albicans.
The study included an interview administered questionnaire consists of 24 questions. The questionnaire was administered by trained clinic nurse and asking about the demographic questions, obstetric history, use of internal vaginal douching, contraceptive method, chronic diseases, history of vaginitis, and its expected health hazards including; preterm labor, ectopic pregnancy, pelvic inflammatory disease.
In this study about 326 women; those only with a history strongly suggesting vaginal infection, participated in the questionnaire. We found that VVC was the most common type of vulvovaginal infections.
In conclusion, abnormal vaginal discharge is a big problem in Upper Egypt. Vaginal douching is a common practice and together with vulvovaginal infection it may predispose to many reproductive health hazards including PID, and preterm delivery.
Part Π: RCT comparing once daily in-situ MTZ (0.8%) versus twice daily (0.8%) conventional vaginal gel:
BV is one of the most common vaginal infections among women of child-bearing age and representing up to 25% of women attending gynecologic clinics (Sweet, 2000). Studies in Europe and the USA have found a prevalence between 4.9% and 36.0% (Morris et al. 2001). BV is a causative factor of many health hazards including premature rupture of the amniotic membrane (McDonald et al. 2007), late pregnancy miscarriage (Donati et al. 2010), chorio-amnionitis (Fahey et al. 2008), post-partum endometritis (Sweet 1995; Hillier et al. 1996; Pellati et al. 2008), as well as failure of in vitro fertilization and embryo transfer (Fredricks et al. 2005; Livengood et al. 2009).
The second part of the study is randomized controlled trial comparing conventional MTZ vaginal gel (Tricho gel 0.8%, Sedico, Egypt) twice daily for 5 days versus in situ MTZ (0.8%) vaginal gel once daily for 5 days demonstrating the efficacy of treatment options. Both types of gels have nearly the same cure rate after one week of starting treatment; however, less recurrence of BV have been seen with the in situ MTZ versus conventional gel.
In conclusion, once daily in situ MTZ gel (0.8%) is as effective as twice daily conventional gel of same concentration after the end of one week of treatment. Less recurrence rates after four weeks of treatment were encountered with in situ gel with nearly the same side effects.