Table 1: Distribution of complaints (n=258).

Table 2: Distribution of vaginal culture results.

Table 3: Comparison of complaints between patients with growth of Gardnerella vaginalis in vaginal culture and other patients.

Chi square test was used.

Table 4: Comparison of some mean values of patients with growth of Gardnerella vaginalis in vaginal culture and other patients.

Mann-Whitney U test was used. SD: Standard deviation.

4.Discussion
Nowadays, recurrent vaginal discharge has become a common problem affecting women’s health. This condition may occur due to the interaction of many factors and therefore, the evaluation of risk factors for recurrent vaginal discharge is of great importance in terms of developing accurate diagnosis and effective treatment strategies^5-7. In this study, some distinguishing factors regarding the causative agent in women with pre-diagnosis of recurrent vaginitis were examined. The distribution of causative microorganisms in vaginitis cases varies according to age, the region where the study was conducted and the population^4-7. In the study conducted by Kaymak et al¹², normal vaginal flora was grown in 36% of the vaginal cultures and in the study conducted by Duran et al¹³, normal vaginal flora was grown in 59% of the samples and the vaginitis agent could not be detected. Similarly, in the present study, no agent was detected in 46.5% of the vaginal cultures and they were evaluated as normal vaginal flora. These findings show that the agent may not be detected by culture in approximately one-third of the vaginal cultures of patients presenting with a pre-diagnosis of recurrent vaginitis. Kaymak et al¹² reported that the most common pathogens in which growth was detected were candida species at a rate of 42% and gardnerella at a rate of 9%. Celik et al¹⁴. found that gardnerella was the most common pathogen in cervicovaginal pap smear screenings. Kesli et al¹⁵. and Duran et al¹³. found G. vaginalis growth in 13% of patients with suspected vaginitis in their studies. Tosun et al¹⁶. reported the G. vaginalis detection rate as 23% in patients with suspected vaginitis. In the present study, candida species growth was seen in 37.6% of the cultures and gardnerella vaginalis growth was seen in 7.8%. In addition, escherichia coli and trichomonas vaginalis growth was detected less frequently. These findings show that candida species are dominant in recurrent vaginitis, but gardnerella causes vaginitis to a significant extent. Kaymak et al¹². and Celik et al¹⁴. found no difference in mean age between the groups they studied according to the vaginitis agents. Ortayli et al¹⁷. found the mean age to be similar between patients diagnosed with bacterial vaginosis and the control group without vaginitis. In the present study, no significant difference was found in mean age between patients with G. vaginalis growth and the group with other agents. These findings show that cases of bacterial vaginosis caused by gardnerella are seen at similar ages to other vaginitis cases and that patient age is not a determinant in the differential diagnosis.

It has been reported that the most common complaints in vaginitis cases are discharge, burning and odor from the genital area^9-13. Ortayli et al¹⁷. found that the rate of patients with discharge or odor complaints in patients diagnosed with bacterial vaginosis was significantly higher than in the control group not diagnosed with vaginitis. Kaymak et al12. reported that there was no difference in the distribution of complaints according to the vaginitis agents. In the present study, it was determined that the most common complaints at presentation were discharge (73.3%), itching (18.2%) and burning (14.3%), with lower rates of pain and odor complaints. As expected, these findings show that discharge is the most prominent complaint in patients presenting with a preliminary diagnosis of vaginitis. In addition, no significant difference was found in the distribution of complaints between patients in whom G. vaginalis grew and the group in whom other agents grew. These findings indicate that complaints in patients presenting with a preliminary  diagnosis of recurrent vaginitis may not contribute significantly to the differential diagnosis of bacterial vaginosis caused by gardnerella.

Ortayli et al¹⁷. found that the mean gravida and parity numbers were similar between patients with bacterial vaginosis and the control group without vaginitis. In the present study, no significant difference was found in terms of mean parity and gravida between patients with G. vaginalis growth and the group with other factors. This finding shows that the number of pregnancies or births is not directly related to the factor causing recurrent vaginitis.Some limitations of the present study include the fact that the number of patients with gardnerella-caused vaginitis was not very high but we consider that this situation may affected the statistical analysis minimally.

The findings obtained from the present study show that the most common factor in patients presenting with a preliminary diagnosis of recurrent vaginitis was candida species and that the distribution of complaints, age and number of pregnancies do not provide important information in the differential diagnosis of bacterial vaginosis caused by gardnerella. If the patient does not get better despite the usual treatment of vaginitis and frequently relapses, treatment should be planned according to the vaginal culture result. This sentence is not compatible with the content of this study. Therefore, we would like to remove this sentence.

Conflict of interests
None to declare.

Funding
None to declare.

5.References
1.Buchta V. Vaginal microbiome. Vaginální mikrobiom. Ceska Gynekol, 2018;83:371-379.
2.https://link.springer.com/chapter/10.1007/978-3-319-31248-4_6
3.https://www.annualreviews.org/content/journals/10.1146/ annurev-micro-092611-150157
4.https://www.mayoclinicproceedings.org/article/S0025- 6196(21)00879-X/fulltext
5.https://academic.oup.com/mmy/article-abstract/56/suppl_1/ S26/4925975?redirectedFrom=fulltext
6.Sobel JD. Bacterial vaginosis. Annu Rev Med, 2000;51: 349-56.
7.https://journals.lww.com/jaapa/fulltext/2017/12000/bacterial_ vaginosis a_practical_review.3.aspx
8.https://www.ejog.org/article/S0301-2115(19)30602-5/abstract
9.https://journals.lww.com/nursing/abstract/2021/03000/ recurrent_bacterial_vaginosis.14.aspx
10.https://journals.asm.org/doi/10.1128/cmr.00075-15
11.https://www.aerzteblatt.de/int/archive/article/231184
12.Kaymak Y, Pasaoglu A, Erhan M, Celik B. Investigation of vaginal discharge agents in patients attending an outpatient clinic with the complaint of vaginitis. Gazi Med J, 2005;16: 114-20.
13.Duran N, Çulha G, Çetin M, Zeteroğlu Ş, Güngören A, Hakverdi AU. Genital enfeksiyon şüphesi olan adölesan ve yetişkin kadınlarda enfeksiyon etkenleri. Tıp Araştırmaları Dergisi, 2005;3: 13-19.
14.Celik A, Atilgan R, Aygün HB, Özkan ZS, Can B, et al. An Evaluation About the Frequency of Trichomonas Vaginalis, Candida and Gardnerella Vaginalis at The Serviko-Vaginal Pap Smear Examination According to Age. Fırat Medical Journal, 2013;18: 44-47.
15.https://turkiyeparazitolderg.org/articles/doi/tpd.2012.43 .
16.Tosun I, Karaoğlu AS, Ciftçi H, Buruk CK, Aydin F, et al. Biotypes and antibiotic resistance patterns of Gardnerella vaginalis strains isolated from healthy women and women with bacterial vaginosis. Mikrobiyol Bul, 2007;41: 21-27.
17.Ortayli N, Amca B, Say L, Özgür S, Nalbant H. Frequency of bacterial vaginosis and related factors. T Klin J Gynecol Obst,