Factors associated with Trichomonas vaginalis infection in reproductive-aged women attending cervical screening in southeast of Brazil

ABSTRACT Background: Sexually Transmitted Infections (STIs) can be caused by viruses, bacteria, and parasites. The World Health Organization estimated more than 300 million new global cases of curable STIs among individuals of reproductive age. Infection by Trichomonas vaginalis is one of the most prevalent curable STL Despite the current treatments available, the diagnosis of T. vaginalis can be difficult, and the resistance to the treatment increased concern for the healthcare system. Objectives: The aim of this study was to determine the prevalence and factors associated with Trichomonas vaginalis infection among women of reproductive age attending community-based services for cervical screening. Patients and methods: A total of 1477 reproductive-aged women attending 18 Primary Health Care Units in Botucatu, Brazil, from September to October 2012, were enrolled. A structured questionnaire was used for individual face-to-face interviews for obtaining data on sociodemographic, gynecologic, and obstetrics history, sexual and hygiene practices, among others. Cervicovaginal samples were obtained for detection of T. vaginalis by culture using Diamond's medium and microscopic vaginal microbiota classification according to Nugent. A multivariable logistic regression analysis was carried out to estimate Odds Ratios (OR) and 95% Confidence Intervals (95% CI) for the association between participants' sociodemographic, behavioral factors, and clinical factors with T. vaginalis infection. Results: Median age of study participants was 33 years (ranging from 18 to 50). The overall prevalence of T. vaginalis infection was 1.3% (n = 20). Several factors were independently associated with T. vaginalis infection, such as self-reporting as black or Pardo for ethnicity (OR = 2.70; 95% CI 1.03-7.08), smoking (OR=3.18; 95% CI 1.23-8.24) and having bacterial vaginosis (OR = 4.01; 95%CI = 1.55-10.38) upon enrollment. A protective effect of higher educational level (having high school degree) was observed (OR = 0.16; 95% CI 0.05-0.53). Conclusions: Our data suggest that screening programs to correctly detect T. vaginalis infection can be helpful to guide prevention strategies to the community. Our study supports an association between abnormal vaginal microbiota and T. vaginalis infection.

Prevençäo de aderências pélvicas: estudo experimental em ratas com diferentes modalidades terapêuticas / Pelvic adhesion prevention: experimental study on rats with different therapeutic agents

OBJETIVOS: avaliar o grau de aderências pélvicas em funçäo do tempo e da utilizaçäo de diferentes substâncias empregadas na sua profilaxia. MATERIAL E MÉTODOS: estudo prospectivo com 120 ratas Wistar, albinas, virgens, 3 a 4 meses de idade, pesando aproximadamente 250 gramas, divididas aleatoriamente em 10 grupos de 12 animais cada: controle, sem lesäo; lesöes e sem tratamento; lesöes + soluçäo fisiológica 0,9 por cento; lesöes + Ringer-lactato; lesöes + dextrano 70 a 32 por cento; lesöes + Ringer-lactato/heparina; lesöes + Ringer-lactato/dexametasona; lesöes + Ringer-lactato/hidrocortisona/dexametasona/ampicilina; lesöes + Ringer-lactato/albumina e lesöes + carboximetilcelulose 1 por cento. Após anestesiados os animais, realizaram-se dois tipos de lesöes nos cornos uterinos (escarificaçäo e eletrocauterizaçäo), seguidos de tratamento profilático intraperitoneal com as soluçöes citadas. No 7º, 14º e 28º dia pós-operatório, momentos M1, M2 e M3, respectivamente, avaliaram-se quatro ratas de cada grupo quanto à presença de aderências. Os métodos empregados na quantificaçäo das aderências encontradas basearam-se na classificaçäo de Cohen, com escores variando de 0 a 4+ de acordo com a quantidade, características e localizaçäo das aderências. Foram usadas provas paramétricas para análise da variância e Kruskal-Wallis. RESULTADOS: os melhores tratamentos para prevençäo de aderência pélvica em ratas foram: Ringer-lactato/dexametasona (predomínio do escore 1+), dextrano 70 a 32 por cento (predomínio do escore 2+) e Ringer-lactato/hidrocortisona/dexametasona/ampicilina (predomínio do escore 2+). O período pós-operatório, representado pelo momento M3, e a técnica cirúrgica, predominantemente com escore 0, influíram na adesiólise e manutençäo de aderências pélvicas em ratas. CONCLUSÖES: a prevençäo de aderências pélvicas em ratas inicia-se no processo cirúrgico de baixo dano tecidual; o uso de substâncias profiláticas (soluçöes) tem eficácia variada, sendo que algumas mostraram-se mais eficazes que outras