Profile of Microorganisms Causing Vaginal Discharge in Reproductive Women at Dr. Pirngadi Hospital in Medan

: Leucorrhoea or Fluor albus is the discharge of other fluid than blood from vaginal canal out of the ordinary, either smelling or not, and accompanied by local itching. Two factors cause leucorrhoea, namely endogenous factors such as vagina abnormalities and the exogenous factor which are infection and non-infection. This study aims to define the profile of microorganisms causing vaginal discharge in reproductive women. This is a descriptive study with a cross-sectional method conducted at the Skin and Genital Polyclinic of the Sexually Transmitted Infectious Disease Division and the Obstetrics and Gynecology Clinic of Pirngadi Hospital, Medan. Subjects that have met the inclusion and exclusion criteria were included in the study. Vaginal discharge samples were examined for gram staining, KOH staining, bacterial and fungal cultures and wet preparations for parasites. Out of a total of 50 subjects, the majority of the subject are aged 31-40 years, with a history of high school education and working women. The most types of vaginal discharge are pathological (84%) and the most common cause of the vaginal discharge is a fungal infection by Candida sp (90%) followed by bacterial infection by Staphylococcus aureus (64.8%) and Klebsiella (20.3%).


INTRODUCTION
Leucorrhoea is one of the problems that many women complain of from young to old age. According to WHO, problems regarding poor reproductive health of women account for 33% of the total burden of disease affecting women worldwide. 1 Whitish or fluor albus or known as leukorrhea. Vaginal discharge is an unusual discharge, other than blood, from the vaginal canal, whether smelling or not and accompanied by local itching. The driving factors for leucorrhoea are endogenous factors from inside the body and exogenous factors from outside the body. Endogenous factors include abnormalities in the vagina, exogenous factors can be divided into two namely infections and non-infection. Infection factors can be due to bacteria, fungi, parasites, viruses, while non-infectious factors are the entry of foreign objects into the vagina either intentionally or not, clean the vagina less cleanly, the area around the vagina is moist, decreased body condition, Buletin Farmatera Fakultas Kedokteran (FK) Universitas Muhammadiyah Sumatera Utara (UMSU) http://jurnal.umsu.ac.id/index.php/buletin_farmatera activity that is too tired and endocrine or hormonal abnormalities. 2,3 In 2007 4 This research was conducted to look at the profile of microorganisms that cause vaginal discharge in women of reproductive age at Dr. Pirngadi Medan.

METHODS
This research is a descriptive study conducted by the cross-sectional method. The study was conducted from January 2019 to March 2019.
The inclusion criteria of the study were women with vaginal discharge who came to the Dermatovenereology clinics for the Sexually Transmitted Diseases Division and Obstetrics and Gynecology Clinic Dr. Pirngadi Kota Medan, productive women who suffer from vaginal discharge, women of reproductive age who are married, women of reproductive age who are pregnant and are willing to participate in research by signing an informed consent. Exclusion criteria were women of reproductive age who were menstruating and women of reproductive age who suffered from physiological vaginal discharge.
Gram staining, KOH staining, bacterial and fungal culture and wet preparations for parasites were examined.
Data collection is done by filling out the questionnaire directly from the research subject. The subject of the research will first be taken his data, then anamnesis will be carried out, and fill out the questionnaire questions after which the sampling will be examined.
Data analysis was performed by compiling data in the form of a frequency distribution table.

RESULTS
The total number of subjects in this study was 50 people with the majority aged 31-40 years, 32 people (64%), with a high school education level of 18 people (36%) and most of the subjects were employed, 38 people (76%) as seen in tables 1 to 3. The most types of vaginal discharge suffered by research subjects are pathological vaginal discharge as much as 84%, with symptoms of vaginal discharge that are often complained of is the color of vaginal discharge such as milky white, sour smell, lumpy, leaving itching and many.

DISCUSSION
Khuzaiyah et al, who examined the characteristics of women with vaginal discharge found that 61.2% of research subjects suffering from vaginal discharge were in the age group of 20-35 years. Attitudes and knowledge possessed by women of childbearing age are one of the important factors that can affect the health of reproductive organs. Likewise, the level of education in the same study found that 34.7% of junior high school level was the most suffering from vaginal discharge, followed by 32.7% of high school education level.5 This is consistent with this study where the majority of women who suffer from vaginal discharge are in their 30s and are at the level of high school education. Epidemiological research states that pathological leucorrhoea can strike women of any age starting from young women, healthy reproductive women, and older women who do not know the economic status, education level, and socioculture. Although this case can be found more in women who have low levels of education and socioeconomic status. 6 The study also found that the majority of women who suffer from vaginal discharge are already working. For women who work, time is everything so they are more likely to prioritize consuming practical food so that the fulfillment of daily nutrition becomes unbalanced. Poor eating patterns by consuming too much fast food and drinks that do not meet the nutritional intake that is not balanced can lead to vaginal discharge. Women who work also usually will have a workload that is too heavy or a lack of balance between activities at work and activities at rest and can trigger stress. Stress that occurs will trigger the onset of stress hormones that can have negative consequences. In some women who have a stress load that is too heavy will be able to trigger vaginal discharge. Some experts argue that vaginal discharge that occurs in women who work is caused by increased production of stress hormones. 7 Some things can be done to deal with vaginal discharge conditions such as cleaning intimate organs with a cleanser that does not interfere with the stability of the pH around the vagina where one of them is cleaning products made from milk-based ingredients that can maintain pH balance while increasing normal flora growth and suppress the growth of hostile bacteria, avoid the use of powder on female organs with the aim that the vagina is fragrant and dry all day, always dry the vaginal area before dressing, using dry underwear, using underwear that absorbs sweat, using non-tight clothing, changing pads when menstruating, using pantyliner when necessary only and not too long. 8,9 This study found that the most types of vaginal discharge suffered by research subjects were a pathological vaginal discharge that is equal to 84%. This is by Adawiyah's study, which stated that the most Buletin Farmatera Fakultas Kedokteran (FK) Universitas Muhammadiyah Sumatera Utara (UMSU) http://jurnal.umsu.ac.id/index.php/buletin_farmatera research subjects suffered pathological vaginal discharge as much as 53.3% . 10 Young women who came to the health facility complained of discharge (discharge) from the vagina (vaginal discharge), mostly due to cleanliness ( bad hygiene), there are foreign objects in the vagina (spiral) and experience sexual abuse. in women of reproductive age who suffer from vaginal discharge is most likely caused by an infection, and the most frequently encountered is the emergence of infection due to the use of oral contraceptives after giving birth. In older women, most likely caused by malignancy, especially cervical cancer. 11 Based on the symptom frequency distribution table in this study, it was found that most of the research subjects experienced vaginal discharge that experienced discoloration, odor changes, large amounts and leaving stains on underwear, consistency of lumps of whiteness, as well as having accompanying symptoms in the form of itching and burning or feeling sore. In the vagina there are various kinds of bacteria, 95% of the vaginal bacteria are Lactobacillus and the rest are harmful bacteria or are bacteria that can cause disease. In the vaginal environment with a balanced condition, pathogenic bacteria will not interfere. Maintaining the acidity of the pH to remain normal is an important role for normal flora bacteria in the vagina. With this level of acidity, Lactobacillus will flourish and pathogenic bacteria in the vagina will die. in certain circumstances, the pH level can change to high or become lower than normal pH. If the pH level in the vagina becomes higher than 4.2 (less acidic), the fungus will be able to grow and develop, resulting in the Lactobacillus bacteria will become defeated and die from pathogenic bacteria. 12,13 In this study, it was found that bacteria that caused the most leucorrhoea were Staphylococcus aureus, followed by Klebsiella spp and Escherichia coli. The Staphylococcus aureus colony is round, smooth, raised and shiny, and is gray to dark brown in yellow. This bacterium has a coagulase that can coagulate plasma containing oxalate or citrate so that it has the potential to become an invasive pathogen. Staphylococcus aureus produces catalase which converts hydrogen peroxide to water and oxygen. Staphylococcus aureus can cause bacterial vaginitis characterized by reduced hydrogen peroxide produced by Lactobacillus. Based on the literature, one type of Klebsiella spp that can cause bacterial vaginitis is a type of Klebsiella pneumonia. This bacterium is present in the airways and feces in about 5% of normal individuals, where the symptoms of vaginitis are inflammation of the vaginal mucosa, burning, irritation, and discomfort. Escherichia coli is a normal flora in the gastrointestinal. This bacterium has a K antigen in the form of polysaccharide which is a virulence factor. The K antigen causes E. coli to attach bacteria to epithelial cells before invading the digestive tract and urinary tract, and these bacteria have bacteriocin in the form of colicin. E. coli found in vaginal secretions can occur due to contamination by rectal microorganisms and can cause bacterial vaginitis also due to reduced hydrogen peroxide produced by Lactobacillus. 14,15 The most common cause of vaginal discharge caused by fungi in this study is Candida spp. which is the fungus that most often causes opportunistic infections in humans. Candida spp. is a potential pathogen and can produce toxins that can interfere with