DEDICATION

This work is dedication to God Almighty.

 ACKNOWLEDGEMENT
I Thank my husband who has always being there for
me both nlorally and finically. My mum and my
sister and brother who have been so helpful to me
are not left out as well/Ireally appreciate all their
support.
 TABLE OF CONTENTS
Title page
Dedication
Acknowledgment
Table of contents
List of figure
List of table
Abstract
CHAPTER ONE
1.0 Introduction.
1.1 Aims and Objectives.
1.2 Statement of problem.
CHAPTER TWO.
2.0 Literature Review.
2.1 Causative Pathogens.
2.2 Epidemiology.
2.3 Routes of Infection.
2.4 Pathogenesis.
2.5 Clinical Features.
2.6 Diagnosis.
2.7 Treatment.
2.8 Prevention and Control.
2.9 Contraceptives.
CHAPTER THREE.
3.0 Materials and Methods.
3.1 Equipment.
3.2 Study Area.
3.3 Study Population.
3.4 Sample Collection.
3.5 Processing and Identification.
CHAPTER FOUR.
4.0 Result.
CHAPTER FIVE.
5.0 Discussion and Conclusion.
5.1 Discussion.
5.2 Conclusion.
References.
LIST OF FIGURES.
Incidence Of UTI among women studied:
…………………………………………………..

Incidence Of VTI by age distribution among women

studied:………………………………………………………
LIST OF TABLES:
Incidence of UTI among women studied:………………..

Incidence of UTI by age distribution among women

studied:…………………………………………………………

Incidence of UTI on various birth control devices

studied:………………………………………………………….

Organisms isolated among women studied:

…………….
ABSTRACT:
Urinary tract infections (UTI) in women using
birth control devices was studied over a period of
four months (October-January) in the family planning
of ESUT Teaching Hospital Enugu. Two hundred
samples were collected for the work; one hundred
samples each from women using birth control
devices and non-users. The appearance of each
sample was noted and examined using standard
microscopic and cultural methods. Gram staining and
relevant biochemical test were done for the
identification of isolates that were significant. Urinary
tract infections were fond in thirty four percent (34%)
of women using birth control devices while the
incidence was fourteen percent (14%) in non-users.
The incidence was high among women using
intrauterine devices, the result revealed that 61.4%
of urinary tract infections recorded in women using
birth control devices was as a result of intrauterine
devices, this was followed by injections with 20% of
the infections recorded. Predominant organism
isolated was Esherichia Coli. UTI was high in age
bracket of 26-47 years among women studied.
 CHAPTER ONE

1.0 INTRODUCTION

1.1 THE EFFECT OF CONTRACEPTIVE DEVICES IN THE

URINARY TRACT

Urinary Tract Infections (UTI) is invasion and

multiplication of pathogens in the urinary tract leading to

establishment of disease (Pattison et, al 1995). Urinary tract

includes the kidneys, bladder, ureter and urethra, which are

involved in production and temporarily storage and

elimination of urine. Infection is indicated when the presence

of bacteria in a “clean catch” urine is equal or greater than

one hundred thousand organism per ml of urine, seeded in a

media and incubated over night at temperature of 370c

(Buckley et, al 1978).

Birth control measures include use of contraceptives or

any measure designed to prevent conception.

Contraceptives can be inform of synthetic hormones

(chemical formulations) packaged into injections or pills or it

can be inform of barrier substances designed to prevent

spermatozoa from entering the vagina (mechanical form)

examples include condom, intrauterine devices etc. Several

studies have demonstrated that the use of contraceptives

predisposes women to risk of urinary tract infection (Remis

et, al. (1987) estimated that 6% of UTI indiaphragm use

perse. In a study of young women presenting with acute

urinary symptoms, those using diaphragms were more likely

to have increased vaginal fluid pH alteration in normal

vaginal flora, and increased rate of colonization with E coli,

all of which have been associated with a predisposition to

UTI.

Hooton, et, al (1994) in their study revealed that the

use of diaphragm plus spermicide was associated with

increased rate of vaginal colonization with E. coli as well as

other gram negative uropathogens, group B streptococci and

candida Spp and a decreased rate of lactobacilli colonization.

Similar trends were seen in users of spermicide alone. In a

prospective study of two group of women aged 18-40 from a

health centre, the following were identified as independent

risk factors for urinary tract infection: recent diaphragm and

spermicide use, recent intercourse and a history of recurrent

UTI. The association between diaghragm and spermicide use

was strong and showed a dose response effect in both

groups of women.

A study of women experiencing a first UTI, found that

condom use in the receding two weeks was associated with

a 42% increased risk of UTI compared to use of oral

contraceptives or no birth control (Foxman et al. 1995). This

risk persisted after adjustment for other confounding factors.

Women who used condoms five or more times in the

proceeding two weeks had a five-fold increased risk of UTI. It

was not specified if the condoms were spermicide-coated.

More recently, condom coated with the spermicide – Nonoxyl

– 9 have been linked to an increased risk of UTI. Use of a

coated condom two or more times per week during the

previous mouth was associated with an odds ratio for UTI of

5.65. The risk of UTi with spermicide – coated condoms

exceeded that observed with diaphragm plus spermicide,

however only 7% of the study group was using the later

contraceptive method . in a multivariate analysis the use of

non-coated condoms did not confer an increased risk of UTI

(BOYKO et, al. 1996).

Much of the risk of UTI with barrier methods of condom

appears to be conferred by the concomitant use of

spermicide Nonoxyl-9, The most commonly used spermicidal

agent is bactericidal to lactobacilli, but not to uropathogens

and increases adherence of E coli to uroepithehal cells. (MC

Groarty et al. 1990).

1.2 OBJECTIVES OF THE STUDY

This project aims to determine

i. The prevalence rate of urinary tract infections among

women using birth control devices.

ii. The effects of various types of birth control devices on

UTI in women users.

1.3 STATEMENT OF THE PROBLEM

Certain birth control measures have been shown to

increase the risk of Urinary Tract Infection. This infection can

spread to different organs of the urinary tract.

14 SIGNIFICANCE OF THE STUDY

 The importance of this study is to educate women using

birth control devices to know the effect of these devices as

well as the control and preventive measures.

1.5 LIMITATION OF THE STUDY

This project is limited to the urinary tract infection

cause by birth control devices only.

 CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 HISTORICAL BACKGROUND

Urinary tract infection (UTI) is a significant causes of

morbidity and a frequent reason for seeking medical

attention among individuals of different backgrounds. It does

not discriminate against age or gender. In women, about

fifty percent will suffer at least one episode during their

reproductive years and a significant condition occurs when

bacteria gain access and multiply in the urinary tract that

ought to be sterile and thus leads to presence of bacteria in

urine (bacteruria). (Pattison, et 1996).

The infection is indicated when uncontaminated urine

(i.e. clean catch) cultural in a media yield a pathogenic

bacterium with colony count greater than 105 org/per ml. It

can be symptomatic or asymptomatic in an individual.

 This infection can spread to different organs of the

urinary tract. It can infect one organ or two or more in

combination. When the kidney is infected the condition is

known as pyelonephritis which is characterized with fever,

chills, mid-back pain and often nausea. But when ureter,

bladder or urethra is infected conditions known as uretritis,

cystitis and urethristis results respectively.

The incidence of UTI is more in females than males due

to the closeness of the women’s urethra to sources of

bacteria from anus and, vaginal area. Sexual intercourse is

often an initiating factor for triggering the infection. (Nester,

et al 2001).

Certain methods of contraception have been shown to

increase the risk of UTI, most importantly the use of

diaphragm plus spermicide and spermicide-coated condoms.

(Hooton et, al 1994). Other conditions such as systemic

illnesses that alter immune system, situations that hinders

natural flow of urine can also be implicated in the infection.

2.1 CAUSATIVE PATHOGENS

Escherichia Coli is the commonest urinary pathogen

causing 60-90% of the infections (Cheesbrough, 2000). This

organism is the agent implicated in uncomplicated cystitis,

pyclonephritis and relatively few 0 sero groups (02, 04, 08,

018ab) of E. coli are the cause of these uncomplicated

infections. These sero groups of E. coli implicated is

collectively know as uropathogenic E coli clones.

Other organisms such as Pseudomonas, klebsiella

species, and Proteus species have also been implicated but

are mainly associated with nosocomial UTI (Nester et, al

2001) and this often follows catheterication or

gynaecological surgery. Proteus infections are also

associated with renal stones (Cheesbrough, 2000).

 Recent studies have clearly demonstrated

Staphylococcus saprohyticus as a pathogen of urinary tract

infections especially in sexually active young women

(Hooton et al, 1994). Staphylococcus aureus is also another

pathogen implicated, it’s presence in urine often indicates

metastatic infection of the kidney following bacterimia.

Ascending cystitis or pyelonephritis can be due to the

organism (i.e. Staph aureus) (Demuth et al 1989) Neisseria

gonorrhoeae is another pathogen of UTI, this mainly colonize

the anterior urinary tract resulting in urethritis. Candida

urinary infection which is caused by fungi, (Candida Spp) is

usually ofund in diabetic patients and those with

immonosuppression or those taken much of antibacterial

agent.

Adenoviruses (especially type II) cause epidemic

haemorrhagic cystistis in children.

2.2 EPIDEMIOLOGY

Research has shown that the incidence of UTI is higher

in males than females in the first year of life. Between ages

1-5 years, the prevalence of bacteruria in girls rise to 4.5%

whereas in boys it falls to 0.5% (Lipsky, 1989). The infection

in young boys often is associated with cogenital anomalies of

the urinary tract about one third and half of UTI in girls in the

first 5 years of life are associated with vesico ureteral reflux

(Lipsly, 1989).

In late adolescence, the occurrence of UTI increases in

young women approximately 20% of young women have at

least one episode of acute dysuria each year, most due to

bacterial infections (Hooton et al 1994).

It is also noted that during this period of life UTI are fifty

times more common in women than in men major risk

factors in women of this age group appear to be sexual

intercourse and birth control deceives risk used (Foxman et,

al 1995).

In later years of life the incidence of urinary tract

infection increases sharply in both sexes.

2.4 ROUTES OF INFECTION

There are three possible routes by which bacteria can

invade and spread within the urinary tract these are

ascending, Haematogenous and lymphatic pathways.

Ascending route: in this route bacteria can be forced

into the bladder by massage of the urethra which has been

found to be colonized by bacteria in woman and presumably

sexual intercourse, catheterication of the bladder will also

result in cystitis in about 1% of ambulatory patients and

infection will develop within 3 or 4 days in the patients

(nester et al, 2001).

 Haematogenous route: certain bacteria in bacteriaemic

conditions often gain access into the kidney which has blood

filtration as one of its physiological functions and results in

pyelonephritis.

Lymphatic route: evidence for a significant roel for

renal lymphatics in the pathogenesis of pyelonephritis is

unimpressive and consists of the demonstration of lymphatic

connection between the ureters and kidneys in animals and

the fact that increased pressure in the bladder can cause

lymphatic flow to be directed towards the kidney (Murphy et

al 1960).

2.4 CLINICAL FEATURES

The clinical presentation of urinary tract infection

depends on the age of patient and site of infection in the

urinary tract.
 In urethritis there is usually burning urethra during

urination this is because the bacteria and infected urine in

the urethra cause inflammation but are flushed out when

“fresh” urine through the urethra on its way out of the

bladder.

Cystitis may show up as burning on urination, often in

the “middle” of urination. However it may have no

symptoms other than fever, abdominal pain, or even just a

funny smell or colour appearance (cloudy, dark, even blood-

tinged) to your urine. Since the kidneys are located in the

back just below the bottom ribs, pyelonephritis may appears

as pain in the back or flank(s) or in the abdomen. Fever but

not always comes along with the pain. In addition, there can

be nausea and vomiting including frequency and urgency of

urination.

2.5 DIAGNOSIS
 The diagnosis of a urinary tract infection involves a visit

to the laboratory where the urine will be tested. In this

testing procedure a sample of urine is collected in a sterile

container – usually mid portion (midstream urine) of urinary

passage is collected this is done using “clean catch” method

in which the genital area is washed before collection and this

method helps to eliminate bacteria and other microorganism

from the skin from contaminating the urine, thus making the

testing inaccurate. The urine is then centrifuged and the

resulting cells, which accumulate at the bottom of the test

tube, are examined under a microscope. In the presence of

infection, one usually finds bacteria, white blood cells or red

blood cells (Cheesbrough, 2000). In addition the urine can be

cultured in a media and if bacteria are grown. They can be

tested with, different antibiotics for effective treatment.

Other microorganisms that cannot be cultivated by using

routine culture methods, for example Chlamydia and

mycoplasma can be detected only with special tests or

culture techniques. Other diagnostics test and procedures

may include; Inotravenous pyelogram (IVP), an opaque dye

is injected into the vein and x-rays are taken which visualize

the baldder, kidneys, and ureters. Cystoscopy in which

flexible tube and a viewing device are inserted through the

urethra in order to see bladder is also used. Renal ultrasound

is another diagnostic method, in this a transducer is passed

over the kidneys, radiating sound waves that bounce off of

the kidneys, transmitting a picture on a screen.

2.6 TREATMENT

In general treatment for urinary tract infections will be

properly administered after careful consideration of

individual symptoms and medical profile and this use of

antibacterial drugs such as peflacine, Ciprofloxacine,

Augumentin etc can be used, other medication can also be

used for non bacterial infection or a heating pad to relieve

pain.

1.7 PREVENTION AND CONTROL

Studies have shown that the incidence of urinary tract

infection is increasing annually, Taloro reveals that about

10million doctor’s visit in USA is as a result of urinary tract

infection. Therefore effort should be made to prevent the

infection and following measures should be adopted for

effective prevention and control about 6.8 glasses of water

should taken regularly and individuals should be encouraged

to urinate when they feel urinating since anything that

hinders natural flow of urine increases chances of UTI, use of

alcohol and caffeine on daily basis should be minimal. Daily

use of min-pads or panty liners that may cause irritation of

meatus should be avoided. Underwear with a cotton crotch

should be worn while bubble baths and clothing that is right

or retains moisture should be avoided. Use of additional

lubrication during intercourse should avoided and urinate

within 10-20 minutes after intercourse, after urination or

bowel movements females should wipe from front to back to

avoid introducing bacteria into the meatus. Wash the vagina

and meatus with warm water, but avoid direct soap

applications since this can cause external irritation and

increase inflammation of the external urinary /genital tissue

(Toloro, 1996).

1.8 CONTRACEPTIVES

Contraceptives are agent(s) or any measure designed

to prevent conception. These can be in form of synthetic

hormones (i.e. chemical formulations) packaged into

injections or pills or barrier substances deigned to prevent

spermatozoa from entering the vaginal and are know as

Barrier contraceptives (mechanical form) examples include

condom, intrauterine devices etc.

History reveals that contraceptives have been in use by

women for more than 3,000 years, Ancient Egyptians,

Greeks and Romans use mixture of herbs, trees resins, and

honey or oil, which are poured into the vaginas. Some

African women used hollowed out Okra pods pouch, some

what like the modern female condom. (Dance, 2002).

Today, millions of women and men rely on modern

forms of contraceptives both to prevent pregnancy and to

protect themselves against sexually transmitted diseases

such as gonorrhea and especially human immunodeficiency

virus.

These contraceptive devices or agents will achieve the

desired goal only if they are properly used, although there

are some side effects and reported cases of failure but their

efficacy is more when two of the agents are combined than

when one is used for the purpose of this study, only

contraceptives applicable to women will be considered while

summary will be made on male contraceptive devices.

Billings Method or Natural Family Planning

This method of birth control involves the use of signs

during the menstrual cycle. These signs reveals the fertile

period in women and during this fertile period sexual

intercourse is avoided. The fertile period is characterized by

these signs Basal body temperature which goes up slightly

when an egg is released, cervical secretions, feel of the

cervix which normally feels softer, opens slightly and moist

during fertile period, calendar calculations is also use to

ascertain this fertile time i.e. when it starts and ends.

Lactational Ammenorrhea method is common among

mothers with infants under six months. Lactation at times

leads to cessation of menstrual bleeding and this is evidence

that ovulation has not taken place; during this period

pregnancy cannot occur.

Natural family planning has no physical or hormonal

side effects, very little or no cost, no effect on breast-feeding

or breast milk but has some advantages. Since it does not

protect against sexually transmitted infections does not work

well as modern family methods, if using periodic abstinence,

requires 8 to 16 days without vaginal intercourse each

month, requires careful daily records, may be difficult to use

when there is fever or a vaginal infection. (Robert et al,

2003).

Intrauterine Contraceptive Device (IUCD)

This is made of flexible plastic or metal. It has a short

string, which is not felt during sexual intercourse. This device

stops the sperm from meeting the ovum and also prevents
the ovum from implantation in the uterus. It is about 994 +%

effective, it works for intercourse. Fertility returns some after

removal and can be used while breast-feeding. It has the

following disadvantages menstrual changes which become

less overtime, some pain and bleeding may occur right after

insertion, does protect against sexually transmitted

diseases, required a trained health provider for insertion and

removal. Different types are available they include the loop

(Lippes Loop), Copper T etc.

Oral Contraceptives

These can be made up to one substance like progestin

only or combination with an estrogen. The pills are taken

daily at some time on different days. Depending on packets,

some contain 28 pills, 21 of it is “active” pills which contain

hormones while 7 is “reminder” pills of different colour and

do not contain hormones. It functions to stop ovulation and

thickens cervical mucus, making it difficult for perm to pass

through. It is very effective when used correctly, monthly

periods are regular; lighter monthly bleeding and fever,

menstrual camps, it can prevent iron deficiency anemia, it

helps to prevent Ectopic pregnancies, ovarian cancer,

Endometrial cancer, pelvic inflammatory disease, benign

breast disease and ovarian cyst, it can cause Nausea, mild

headaches, slight weight gain and does not protect against

sexually transmitted diseases.

Injection Contraceptive

This method involves the use of prevent pregnancy.

The most common preparation in used is Depo-provera and

it is progestin based. It functions by stopping mainly

ovulations and also thickens cervical mucus, making it

difficult for sperm to pass through. It is convenience, it has

long-term pregnancy prevention but reversible. One injection

prevents pregnancy for at least 3 months; it prevents ectopic

pregnancies, endometrial cancer, uterine fibroids and

ovarian cancer. It may help to prevent iron deficiency

anemia, may make seizures less frequent in women with

epilepsy and makes sickle cell crisis less frequent and

painful. It may cause headaches, breast tenderness.

Norplant

This method can prevent conception at least for five

years. It consists of a set of six small, plastic capsules of

which each is about the size of a small matchstick. The

capsules are placed under the skin of a women’s upper arm.

A Norplant capsule contain a progestin, similar to the natural

hormone but does not contain oestrogen. It is released

slowly and steady from all the six capsules. They stop

ovulation and thicken cervical mucus, making it difficult for

sperm to pass through. It help to prevent iron deficiency

anemia, ectopic pregnancies, endometrial cancer and make

sickle cell crises less frequent and less painful. Nursing

mothers starting six weeks after childbirth can use it since it

does not affect quantity and quality of breast milk. It may

cause headaches, dizziness, breast tenderness, skin rash.

(Robert et al, 2003).

Vaginal Methods

These are contraceptives that a women places in her

vaginal shortly before sex. There are several vaginal

methods.

Spermicides; including foaming tablets or suppositories,

melting suppositories foam, melding film, jelly and cream.

Diaphragm; a soft rubber cup that covers the cervix-

should be used with spermicidal jelly or cream.

Cervical cap: this is like the diaphragm but smaller. Not

widely available in Africa.

 Spermicides kill sperm or make sperm unable to move

toward the egg. Diaphragms and cervical caps block sperm

from entering the uterus and tubes, where sperm could meet

an egg. It is safe and helps to prevent some sexually

transmitted disease, no side effects from hormones, no

effect in breast-milk and can be stopped at any time. It’s

major disadvantages is that it can cause irritation to women

or her partner, it can make urinary tract infections more

common.

Other methods include female sterilization and condom.

Female sterilization provides permanent contraception for

women who will not want more children. It is also known as

voluntary surgical contraception (VSC), tubal ligation (TL),

tying the tubes, minilap, and “the operation” here the

fallopian tubes are blocked or cut off and this prevent, the

women’s egg from meeting the sperm cells. Female condom

is not common in Nigeria.

 CHAPTER THREE

MATERIALS AND METHODS

3.1 EQUIPMENT

Binoccular Microscope (Olympus)

Refrigerator and incubator

Centrifuge

Slide and cover slips

Test tubes

Test tube racks

Universal container

Platinum wire loop of 0.002ml capacity

Busen burner

MEDIA: The following solid media were used

Cystein lactose Electrolyte Deficient agar (CLED)

(oxiod)

Blood agar (oxoid)

 REAGENTS

Oxidase regent

Tryptone water

Kovac’s reagent

Hydrogen peroxide solution

Citrate identification tablets

Urease tablet

Litmus milk

Methyl violet, lugol iodine, Acetone and Neutral red

Plasma

Physiological saline

3.2 STUDY AREA

Enugu is a city in south-each of Nigeria: it is the capital

of Enugu state. it is densely populated and relatively

developed with such basic amenities as pipe borne,

electricity, transportation and communication services.

3.3 STUDY POPULATION

Women used mainly in this study were those attending

family planning clinic of University of Nigeria Teaching

Hospital Enugu (UNTH). UNTH is a tertiary Health institution

of Federal Republic of Nigeria. Patients from Enugu State and

her neighboring states attend this institution for their health

needs.

3.4 SAMPLE COLLECTION

Two hundred samples were collected. One hundred

samples each from users and non users respectively.

Questionnaires were first issued to obtain information such

as age, type of contraceptive being used by women, the

number of years in use, marital status, menstrual status and

whether the individual was using any antibiotics. After

obtaining their informed consent, a labeled and wide

mouthed universal container was given to each of the

women. They were advised to wash the vaginal area and

collect mid stream urine to avoid contamination. The next

day, the samples were collected and sent t laboratory where

they were processed immediately.

3.5 PROCESSING AND IDENTIFICATION

i) Macroscopic Examination

Each sample was examined visually for colour and

turbidity and all the findings recorded appropriately.

ii) Microscopic Examination

Each sample was examined as a wet preparation.

Wet preparation

- 10ml of well mixed sample urine was aseptically

transferred to a labeled test tube.

 - The 10ml of urine sample was centrifuged at

1000rpm for 5 minutes.

- Supernatant fluid was discarded completely,

inverting the tube.

- The sediment was remixed by gently tapping of the

bottom of the bottom of the tube and one drop was

transferred to a slide and covered with a cover slip.

- The preparation was examined microscopically using

x10 and x40 objective with the condenser iris closed

sufficiently to give good contrast.

iii) Culture

- Each sample was mixed by inverting gently for five

times.

- A sterile platinum wire loop was used to inoculate a

loopful of urine on a quarter plate of CLED agar and

blood agar respectively.

 - The two plates were incubated aerobically at

temperature of 370c overnight.

Colonies of organism were identified based on their cultural

characteristics. Gram staining and relevant biochemical test

were done on significant colonies.

v) Gram staining and biochemical tests

The isolated organisms which counts were significant were

identified by Gram-staining and biochemical tests as

appropriate.

a) Gram staining

- A colony of test organism was emulsified in a drop of

physiological saline and a thin smear was made on

microscopic slide.

- The smear was heat fixed.

- The dried fixed smear was covered with methyl violet

for 1 minute.
- Then washed off with water

- It was then covered with Lugol’s iodine for 1 minute

- Then washed off with water

- It was then decolorize rapidly with acetone and wash off

with water.

- The smear was covered with neutral red stain for 2

minutes

- Then washed off with water and the back of the slide

was wiped off, and place in a draining rack for the smear to

air-dry.

- The smear was examine microcopically, with x 100 oil

immersion and findings recorded.

The following biochemical tests were done for

identification of bacteria isolated.

a) Indole test

- the test organism was inoculated into a test tube

containing 3ml of sterile tryptone water.

- This was incubated at 370c overnight.

- 0.5ml of Kovac’s reagent was added and shook

gently.

- Ared colour in the surface layer was observed within

10 minutes in some of the colony tested.

b) Catalase test:

- A drop of 3% Hydrogen Peroxide solution was placed

on a slide.

- A loopful of the test organism was immersed in the

solution.

- Immediate bubbling was used to confine the

organism as positive.

c) Coagulate test:

- A drop of physiological saline was placed on two

different slides.

- A colony of test organism was emulsified to make

two thick suspensions.

- A loopful of plasma was added to one of the

suspensions and mix gently. Clumping was seen

within 10 secnds and was used to confirm the

organism.

d) Citrate Utilization test:

- Loopful of test organism was used to prepare

suspension of test organism in 0.25ml sterile

physiological saline in a small tube.

- Citrate tablet was added.

- This was incubated overnight at 37oc.

- Red colour indicates positive.

e) Urease test:

- test organism was emulsified to form dense milk

suspension in 0.25ml of physiological saline in a

tube.

- Urease tablet, was added and the tube incubate at

37oc for upto 4 hours.

 - Purple colour indicates positive organism.

f) Litmus milk decolourization test:

- 0.5 ml sterile milk was inoculated with test organism

in a test tube.

- This was incubated at 37oc for 4 hours.

- White colour was used to confirm the organism.

g) Oxidase test:

- 3 drops of freshly prepared oxidase reagent was

added on filter paper.

- A loopful of test organism was smeared on the filter

paper.

- Development of a blue-purple colour indicates

positive test.

CHAPTER FIVE

DISCUSSION AND CONCLUSION

5.0 DISCUSSION

The prevalence of urinary tract infections was found

to be high in women using birth control devices when

compared with non-users. From the result it was observed

that 34% of women using birth control devices urinary tract

infection. This is more than the infection (Table 1 and fig.1).

This high prevalence rate could be attributed to the use of

these agents or devices. Some of these devices were found

to increase the PH of the vagina which results in bactericidal

action against normal flora such as lactobacilli and this

encourages the colonization of the vagina with Escherichia

coli which finds their way into the tract where they multiply

and cause infection (Lidefelt et, al 1991). Coitus is

associated with increase in vaginal colonization with E. coli

(Buckley et, al 1978). Most women using these devices

indulges in sex more often since these devices offers some

degree of protection and thus contributes to urinary teact

infection.

Some of these agents were found to push some of

these pathogens into the tract during insertion or sexual

intercourse. All these factors contribute to high prevalence

rate of UTI among users of contraceptives.

It was observed that some contraceptives agents or

devices used recorded incidence of urinary tract infections in

users more than others. For instance it was found out that

51.4% of intrauterine devices users had the infection,

followed by injection users with 20%, Norplant 14.3%, Oral

pills3% and vaginal tablets 2.9% each (Table III). It could be

deduced that some devices such as intrauterine devices

could push in bacteria or other pathogens into the tract

during the insertion of the device. This is because the

vaginal area is surrounded by the potential sources of

bacteria such as anus and perineum. Some of these agents

such as injections and other chemical agents packaged as

contraceptives increases vaginal PH which favors the

colonization of vagina with Escherichia coli (Pattison et, al

1995).

The predominant organism isolated was Escherichia

coli which was found to constitute 48.6% and 50% of all

organisms isolated among users and non-users respectively.

This agrees with previous work done on urinary tract

infections by Demuth et, al 1989, in which Escherichia coli

was implicated as the cause of 60-90% of all cases of UTI

recorded. Staphylococcus aureus constitute 17.1% and

28.6% respectively among users and non-users. The least

percentage of 5.7% and 7.1% were Pseudomonas

aeuroginosa and Enterococcus faecalis in users and non-

users respectively.

Other organisms and their percentages of occurrence

were shown in Table IV.

 The infection was also found to be high in women of

age bracket 37-47. This was in agreement with earlier work

done by Lipsky B.A in 1989 in which he observed that

catheler such as intrauterine devices used in women of age

bracket 30-50 years will increase chances of urinary tract

infection.

5.1 CONCLUSSION

The result of this study suggests that there is need to

further investigate the effects of birth control devices among

women using these devices in a developing country such as

Nigeria.

Birth control devices are continually being

incriminated in studies. Pathogens implicated in these

infections can damage important organs of the urinary

system, thereby resulting in serious infections which may be

fatal unless diagnosed early.

 The high prevalence of urinary tract infection among

women using birth control devices seems to highlight the

need for periodical laboratory diagnosis for the infection. The

primary aim of this periodical laboratory diagnosis should be

to ensure early and optimal management of the condition. In

Nigeria for instance where there is no epidemiological data

on the infection. This will be an important course of

population based epidemiological data.

In family planning clinics, women should be taught

the need or improved personal hygiene since the vaginal

area is surrounded by potential sources of pathogens.

Aseptically procedure should be observed during insertion of

these agents, women should be advised to clean the vaginal

area with warm water which has been found to reduce the

colonization of vagina with bacteria before insertion into

uterus (Stapleton, et, al 1990).