November 15, 2024
dr kalu

By Dr Anuma Kalu Ulu

For full disclosure, I will start by stating that I shall be calling body parts freely no matter where they are located without recourse to the sanctimonious, a politically-correct nuance expected of a writer like me in Nigeria. Over here in USA, we call a spade a spade. This is because I have been rail-roadeded in the past by girls who reach me from Nigeria seeking for medical advice and who either by piety or bashfulness or a combination of both, euphemistically referred to their vaginas as something akin to their anuses, making me give them wrong treatment until I caught on with the programme. In this article, there will not be such ambivalence!

Toilet infection in Nigeria erroneously refers to a group of infections that manifests with itchy vaginal discharge and is medically called vaginitis in other climes. Vaginitis generally is inflammation of the vagina as may be caused by infections with Gardnerella vaginalis, staphylococcus, gonorrhea, streptococcus and chlamydia; Viruses like herpes; irritation from chemicals in douching, fungal infection (candidiasis) ; protozoal infection, e.g., Trichomonas vaginalis; tumours of the cervix or vagina; foreign bodies like tampons; or vulval atrophy in the elderly. It is the pervasively mistaken belief that it is contracted from sharing dirty toilets with infected persons as in schools and other public toilets and in the ‘villages’ that makes sufferers too shy to admit to it lest they be perceived as being dirty. As such, a lot of people suffer in silence or try outrageous remedies and the few that venture to seek medical advice from people like me, always tell me it is their phantom roommate or friend who has the infection, yet when I ask for colour, consistency and other details, they are quick to supply these graphically without recourse to the facade of a reported speech. My intention here is not to ridicule anybody but to teach you that it is okay to admit to having the infection, as the cause has nothing to do with being dirty, and it is even easily treatable. Here in the USA, a young female with these symptoms will come to my emergency room, tell me exactly what symptoms she has, and will be examined by me with speculum and all that, and a high vaginal swab will be taken to be examined in the lab as wet prep and result will be back within 10 minutes showing either of or a combination of 3 organisms, and pt will be treated appropriately. Try that in Nigeria, for a young girl sufferer to even come forward with such an admission, let alone be examined there, ‘akuko’!!
It may be seem like this is a female issue but guys should not stop reading here because we may not show symptoms but could act as storage depot to re-infect treated female partners who may have had unprotected sex with us prior to their treatment. A case can be made for treating male partners who have had unprotected sex with infected females the first time the woman is diagnosed but this is not strictly done, but in recurrent infections of the same female after treatment, then the male partner has to be treated too.
I shall concentrate on the main causes from the above causative agents which span 3 different classes of organisms viz bacteria especially Gardnerella vaginalis ( called bacterial vaginosis or BV), a protozoan called Trichomonas vaginalis which causes trichomoniasis and finally a fungus of the candida specie especially Candida albicans which causes candidiasis or yeast infection. In the USA, BV is the most common vaginitis but in Nigeria yeast is the most common so much so that most people do not know that there are other causes of toilet infection ( there I go too!) except candida. I shall take each of them separately.

BV is characterized by vaginal itching and frothy discharge although 50% may be asymptomatic and causes include new or multiple sexual partners, cigarette smoking and douching with resulting bacterial shift. Although sexual activity may play a role, women who have never had sexual intercourse can also be affected. Presence of clue cells in wet prep exam is diagnostic. It is treated with metronidazole ( flagyl) at 500mg by mouth 2x/day for 7days although it can also be treated with tinidazole or even clindamycin. Untreated cases can result in miscarriage or even premature birth in pregnant females. It is recommended to treat the male partner also to avoid re-infection from these asymptomatic males.

Trichomoniasis is characterized by itchy frothy yellowish-green vaginal discharge although 50% could be asymptomatic and it is definitely diagnosed on saline wet preps when multiple flagella of the protozoan are seen. It is treated with flagyl (metronidazole) 500mg by mouth 2x/day for 7days or just one dose of flagyl 2grams (2000mg) by mouth. Since about 60% of male partners of infected females carry the organism although asymptomatic, they also need to be treated as above to avoid
re-infection. Flagyl will need to be avoided in early pregnancy.

The poster child for toilet infections in Nigeria is candidiasis as caused chiefly by Candida albicans although other candida species have been implicated. It presents with itchy thick white curdy vaginal discharge and is made possible due to a distortion in the urogenital normal flora or a change in the immunity of the infected. Antibiotic therapy which destroys the normal bacteria flora, leaving the fungus to grow unopposed; and steroid therapy, which decreases white blood cell function thereby rendering the patient less immune, are the chief causes candidiasis, and not being dirty! It is also common during pregnancy because of increased estrogen levels and in diabetes mellitus, due to high blood sugar, since the fungus grows well on sugar. So candida lives normally in the urogenital and alimentary tracts because it thrives in warm moist areas but is held in check by commensal bacteria in these places. When a female takes antibiotics for anything else like pneumonia, etc, these antibiotics also kill the commensal bacteria thus leaving the fungus or candida unchecked, resulting in vaginal candidiasis. This is why in the USA, most girls on antibiotics for anything else are given 150mg of fluconazole once by mouth to prevent candidiasis. Those who are familiar with my practice in Nigeria know that I am big on this method of treatment too. It is also common in chronic diseases like kidney failure patients, diabetes mellitus, AIDS patients, patients who have received transplants, cancer patients especially those receiving chemotherapy as well as a host of other chronic diseases. Treatment is simple, just fluconazole (diflucan) 150mg by mouth once or in pregnant patients an insertion clotrimnazole vaginal preparations once nightly for 7days. A usually asymptomatic partner can also reinfect a treated female, so he will need to be treated too with the one time fluconazole.

In conclusion, toilet infection should not carry the stigma that it carries at present and sufferers should step forward to be treated. In places where no wet prep test is immediately available, a young female with itchy vaginal discharge should just cover all bases by taking 150mg of fluconazole together with 2000mg of flagyl (10 tabs of the 200mg or 5 tabs of the 400mg in Nigeria) all at once and this should take care of the above 3 causes. When i send down the flagyl from the USA, it is 8tabs of the 250mg or 4 tabs of the 500mg, since that is thee type we have here, so that those i have been treating do not get it mixed up.
I hope that we learn one or two things from the above.

537 thoughts on “The Medical Iconoclastic Series: The Misnomer called Toilet Infection in Nigeria

  1. I am getting enlightened medically every week by this weekly medical series by Dr Anuma Kalu Ulu. Thank you sir for the good work. I am happy to be one of those benefiting from your vast knowledge. Thank u sir

  2. My chief more kudos on this subject as this exposition is an eye opening information on bacteria infections,which is very common in our country Nigeria. You even gave prescriptions on the treatment More grace sir..

  3. A very detailed expository piece.
    I must confess you are a skilled wordsmith who deeply understands patterns and how to bluntly correct misconceptions.
    From awareness to preventive tips and finally to treatment.
    You simply nailed it!!

  4. As usual Dr Anuma delves right into the heart of the topic in a simplistic learnt way causing his audience to be simulated and hungry for more knowledge. This article like the other I have read is on point and informative. God bless you Sir….I salute you!!

  5. Doc, thanks so much for this information every week, particularly this infections of a thing is common here,I now know their prescription,I will also pass this information around my vicinity.
    Thanks you sir.

  6. i am glad i get to read this every week.the need to be medically enlightened can never be over emphasized. thank you sir for this really

  7. I am getting more educated here medically every week I must confess especially this one of infections Thank you very much sir

  8. This page has been educational & has exposed lot of things that people are not aware of & have helped a lot of families that have been mislead by the doctors we have here in Nigeria & this young man have giving many reason to live again. I pray that The Almighty God gives him the strength to finish the good work he has started ??

  9. Hmmmm!! Dr. For free “Dr. Anuma” . You are indeed a Nigerian Health Problems Micro-Macroscopia . All your articles on health challenge here are very issues of urgent concerns affecting us here in Nigeria. You don’t just discuss it but you also proffer remedy. Struggle for quality living don’t have shame . Dr. Akwaala nkwa n’ihu Akpukpo. He have said all, is our choice to enjoy healthy live or die in shame. Ndi kezahia go and threats as prescribed or better die alone.

  10. Hmmmm!! Toilets infection? Dr. For free “Dr. Anuma” . You are indeed a Nigerian Health Problems Micro-Macroscopia . All your articles on health challenge here are very issues of urgent concerns affecting us here in Nigeria. You don’t just discuss it but you also proffer remedy. Struggle for quality living don’t have shame . Dr. Akwaala nkwa n’ihu Akpukpo. He have said all, is our choice to enjoy healthy live or die in shame. Ndi kezahia go and threats as prescribed or better die alone.

  11. I remember scouring through my textbooks looking for toilet infections, and my disappointment at discovering it is a colloquial term. I remember learning for the first time it was possible to administer 2g of flagyl for trichomoniasis. That was at my first Dr Anuma outreach program, where I also saw more medical supplies than most government hospitals in Nigeria can muster. More power to you sir, and God bless you.

  12. Thanks doc for all these free teachings,I really look forward to them
    as every new week comes with yet another powerful topic!

    God bless

  13. I strongly believe that by this piece, sufferers of bacterial infections would be emboldened to state their case properly before a medic without pretentiously doing so on behalf of a phantom friend. The causative agents of this ailment has been been duly x-rayed thereby expunging the entrenched dogmatic belief that dirty habits is responsible. Appropriate prescriptions has been auspiciously offered for a definitive cure of this infections by the the medical iconoclast himself. I commend the sole effort of Dr.Ulu for his unbridled passion for an infections – free and healthy society.

  14. Every Educative! You nailed it Doctor Ulu. Especially on this toilet infection that so many of us down here in Nigeria have suffered. Keep doing what you know best how to do. Thanks for the weekly articles, your teachings which has imparted so much on us, and for showing us way forward on health issue.

  15. Thank you very much sir for this great enlightenment on this wonderful topic for this week.
    I have really learnt a lot from it.
    Thanks once again Doctor.

  16. ‘The Misnomer Called Toilet Infection In Nigeria’……My take : I have said it for the repeated times, that Dr Anuma Kalu Ulu is a very big gift to our generation and the yet unborn. He made us to know that in medical situations and circumstances, a spade is called spade. It is true in Nigeria most females refers to their vaginas as anuses. The Doctor Emeritus made it clear that there will be no such Misnomer in this Article and he did. Dr Anuma said that vagnities generally is inflammation of the vagina and may caused by infections with Gardneralla vaginally, staphylococcus, gonorrhea, streptococcus and chlamydia. Viruses like herpes, irritation from chemicals including fungal infection, protozoal infection. The young Dr said that it is erroneously believed that it is contracted from sharing dirty toilet with infected persons as in public toilets. He as well said, though cause has nothing to do with being dirty and it is easily treatable. He remarked in US girls (sufferers )will willingly open up and allow examinations to be carried out and will be promptly treated, as against what obtains here in Nigeria. He also said males may not show symptoms of this, but are storage depot that infect their partners, through unprotected sex. The Dr emphasized male partners should also be treated. He said that it is caused by 3 agents, viz bacterial, protozoan and fungus. Dr Ulu said in US, BV is the most common, while yeast is the most common in Nigeria. The Dr was down to earth in the medications for the treatments. He went ahead to explain that it also common during pregnancy and in diabetes millions. It is as well common in kidney failure and AIDS patients as well as patients who have received transplants and cancer patients including other chronic diseases. He strongly and warmly warned that sufferers should step forward to be treated including their partners. The Dr did not only discuss this Article but also anchored it by proffering solution to it all. Dr Anuma Kalu Ulu should be strongly commended and appreciated by all human and elements of goodwill all over the world.

    1. Once again, sir Darlington has provided the most indepth analysis of the original article written by me, and i thank him again for his commitment to the cause and his unshaken belief that good will come out of this. He is one of those who who would usually reach me to know why it is being delayed, assuming the article didn’t come out in time, every Monday

  17. Another brain stunner from the master. Bottomline; openness about one’s health status can save a lot of headaches. Thanks Dr. Ulu for this

  18. Am so much delighted for this week article,i have learned alot,if one want a lawyer to hear him out from his mistakes you must tell him the whole truth,and leave the case for him,in the same way if one want to be well treated open up don’t justify ur sickness, thinking that it will make one less important or a dirty person no,thanks alot sir,Doc Anuma ulu for that upbulding information we appreciate pls keep it up.

  19. Thanks doc for letting us no all this, many people are really suffering from infections, I wish they will read this article, for them to be save from their ignorant , u are really educating us more & more, kudos for u sir

  20. Wow this is another wonderful teaching on misnomer, I learnt a lot. Toilet infection is very common here in Nigeria, I strongly believe that this we us to understand more better, and help us to protect ourselves, and know the way forward. Tnx Sir for this wonderful teaching and God bless……..

  21. Thanks so much Sir,l always talk great pleasure reading your masterful deliveries.On seeing the topic, l knew it’s a must read!I had to share the information with a friend. Sir, you didn’t just write, you also did “free consultation”,Prescribing drugs and giving dosage.l had to screenshot it, so as to share with others.I need no lawyer to tell me you are a “Genius “.You made it look easy and effortless.You have made my Mondays eventful! I ache to read next week’s article.

  22. Thank you Sir for this mind-blowing article…. Candida albicans is a normal floral of the vaginal region. However this fungus can become opportunistic when there is an abnormal change(as listed above) in the body…. You are really helping me not to forget my course!!!!!

  23. Sir, the way you write is wonderful! You always make me to create a mental picture of what you write!You make one visualize what one reads.Sir, if you were a lecturer, you would have produced so many Doctors, cos no serious students should fail your course .More power to your elbow

  24. Each publication comes with numerous schoolings and this is no less.
    With such a busy day as mine. The inherent benefits make it difficult to look away.
    I am aware it takes a lot of commitment to ensure this piece is available every Monday to your numerous fans.
    I therefore laud and embolden you to sustain until ours becomes that healthy society we pant for.
    A very warm regard to you Dr.

  25. Wow, what a wonderful article sir, may God keep strengthing you for us not to be misled in this kind of knowledge….God bless you for this…..

  26. Of course I learnt a lot! How well can I thank you for your numerous aids, you are just too good, thank you so much Sir, God bless you.

  27. Thanks so much Doc for this particular article. This infection thing is really a confusing topic among a lot of us but I’m more enlightened now. May God bless you as you take out your time to educate us.

  28. This is very educating. I have been learning a lot from ur article. Indeed u are a genius. More of this Sir. U don’t know how many lives ur have healed.

  29. These weekly informative articles be steadily dealing with health ignorance on every level. There’s always a lot to learn on this platform

  30. This topic is on point. A lot of people suffer in silence because of the #sensitive nature of this constant medical condition. Thanks for enlightening us Doc.

  31. One thing is certain and it is that knowledge is power. God has blessed us with this medical icon to Him alone be the praise! God bless you Doc.

  32. This is highly educative. Here in our demography (Africa), individuals simply allow symptoms to grow critically because of trivial issues like closure. They neglect the need for quick examination and thereafter succinct treatment. I would use this to educate some rural communities in my area in my next outreach program for my debate club.

  33. This series is really getting hotter and interesting, like I said before you are getting closer to the people Dr Ulu. Your yearly routine door to door medical care will be easier this time around because education is power. Individuals are learning, people are also learning and many homes are benefiting. Well-done Miller.

  34. I have learnt so much from this.
    Treatment is simple, just fluconazole (diflucan) 150mg by mouth once or in pregnant patients an insertion clotrimnazole vaginal preparations once nightly for 7days. That’s all I need to know. Thanks doc for exposing all this to me.

  35. Thanks for this explanations about toilet infections, the truth is that most ladies surfer this most times and our men also carry it without knowing and thus distribute it to uninfected ladies
    Now my question is what can cause itching in the virgina of a young girl of 10yrs and what treatment is best for her age
    Thank you and God bless you sir

  36. This is another powerful article by our amiable Dr. Anuma, The issue of toilet infection is of great concern to almost every home, you didn’t just educate us on the causes you also gave solutions to it and i know it will be of great benefit to as many that will come across this article and at the same time reduce it in our society. Thanks Dr.

  37. This article is getting more interesting by the week. Sir, I strongly believe that this information will be an eye opener especially to the women. Kudos

  38. From one interesting & educative article to other. You are blessing to our generation. I wish you become minister for health in the nearest future in Nigeria. May God richly bless and keep you as you continue to impart knowledge to our generation .

  39. This has changed my perspective on toilet infection ,now I know smoking too can cause infection,uuh,am learning, thus they say, learning is a continuous process… You’re not stingy with your knowledge oo ?, am getting enlighten in each article.. ..well done

  40. Here in Nigeria.We are in thick darkness in the aspect of medicals.Most of the doctors here are after their pockets not giving us the right knowledge for the right health predicaments.Sir what a true Intense Knowledge on The Misnomer (Toilet infection) especially we female folks in Nigeria the rate at which our doctors prescribe antibiotics for us is so alarming and the doses are so high ,we thinking our system will be cleared not knowing we are destroying our bacteria flora that is why reoccurance Candidiasis and Trichomonas Vaginalis is high in our System. Thanks for this true Intense knowledge. Doctors like you is what we need in our Country. Sir you are the SAVIOUR of our TIME

  41. Thanks for calling a spade a spade, my people. Let us not die in silence, say exactly what is wrong with us then we have deliver our soul from destruction.

  42. By all means thanks for this, this article is one which we tend to shy away from most times…. To say the least.., I’ve been enlightened by this. Thank you sir.

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