Prevalência de Chlamydia trachomatis e fatores de risco associados à infecção detectada em amostra endocervical / Prevalence of Chlamydia trachomatis and risk factors associated with infection detected in endocervical sample

OBJETIVO: Foi avaliar a prevalência de Chlamydia trachomatis e os fatores de risco associados à infecção em amostras endocervicais de mulheres atendidas em ambulatório de Ginecologia e Obstetrícia. MÉTODOS: Amostras de secreção endocervical de 200 mulheres atendidas em Hospital Universitário foram avaliadas para diagnosticar C. trachomatis com uso da reação em cadeia da polimerase (PCR) utilizando primers CT05/CT06 que amplificam 281 pares de bases da principal proteína de membrana externa de C. trachomatis. Todas as participantes responderam a um questionário pré-codificado e autoaplicável. Os dados foram analisados no programa do software SPSS 17.0; para a análise multivariada foi utilizada a regressão de Poisson. RESULTADOS: Das 200 mulheres que foram incluídas no estudo, a prevalência de infecção por C. trachomatis foi de 11% (22 pacientes) e destas 55 (27,5%) foram positivas para o HPV. Os fatores de risco associados à infecção por C. trachomatis foram: ter 8 anos ou menos de escolaridade (p<0,001), renda familiar de até 1 salário mínimo (p=0,005), primeira relação sexual com 15 anos ou menos (p=0,04) e ser portadora do vírus HIV (p<0,001). Após a análise multivariada, apenas as variáveis escolaridade igual ou inferior a oito anos (RP 6,0; IC95% 1,26 - 29,0; p=0,02) e presença do HIV (RP 14,1; IC95% 3,4 - 57,5; p<0,001) permaneceram significantes. CONCLUSÕES: A prevalência de C. trachomatis em amostras endocervicais pelo método de PCR foi de 11%. Os fatores associados à maior infecção por C. trachomatis foram menor escolaridade e ser portar o vírus HIV.

PURPOSE: It was to determine the prevalence of Chlamydia trachomatis and the risk factors associated with infection in endocervical specimens from women seen in outpatient Obstetrics and Gynecology. METHODS: Samples of endocervical secretion of 200 women treated at the University Hospital of the Federal University of Rio Grande were analyzed for the presence of C. trachomatis by polymerase chain reaction (PCR) using primers that amplify CT05/CT06 281 base pairs of the main outer membrane protein of C. trachomatis. All participants completed a pre-coded and self-report questionnaire. Data were analyzed with the SPSS 17.0 software; for multivariate analysis it was used Poisson regression. RESULTS: Of the 200 women who were included in the study, the prevalence of infection with C. trachomatis was 11% (22 patients) and these 55 (27.5%) were positive for HPV. Risk factors associated with infection by C. trachomatis were: 8 years or less of schooling (p<0.001), family income below the poverty level (p=0.005), first intercourse at age 15 or less (p=0.04) and being a carrier of the virus HIV (p<0.001). After multivariate analysis, only the variables of schooling or less than eight years (PR 6.0; 95%CI 1.26 - 29.0; p=0.02) and presence of HIV (RP 14.1; 95%CI 3.4 - 57.5; p<0.001) remained statistically significant. CONCLUSIONS: The prevalence of C. trachomatis in endocervical specimens by PCR was 11%. The factors associated with a higher infection by C. trachomatis were lower education and being HIV positive.

Co-infections associated with human immunodeficiency virus type 1 in pregnant women from southern Brazil: high rate of intraepithelial cervical lesions

Human immunodeficiency virus type 1 (HIV-positive) pregnant women require specific prophylactic and therapeutic approaches. The efficacy of established approaches is further challenged by co-infection with other sexually transmitted diseases (STDs). The objective of this study was to determine the prevalence of co-infections in pregnant women infected with different HIV-1 subtypes and to relate these findings, together with additional demographic and clinical parameters, to maternal and infant outcomes. Blood samples from pregnant women were collected and tested for syphilis, hepatitis B virus (HBV) and hepatitis C virus (HCV). Human papillomavirus (HPV) diagnosis was evaluated by the presence of alterations in the cervical epithelium detected through a cytopathological exam. Medical charts provided patient data for the mothers and children. Statistical analyses were conducted with STATA 9.0. We found a prevalence of 10.8 percent for HCV, 2.3 percent for chronic HBV, 3.1 percent for syphilis and 40.8 percent for HPV. Of those co-infected with HPV, 52.9 percent presented high-grade intraepithelial lesions or in situ carcinoma. Prematurity, birth weight, Apgar 1' and 5' and Capurro scores were similar between co-infected and non-co-infected women. The presence of other STDs did not impact maternal and concept outcomes. More than half of the patients presenting cervical cytology abnormalities suggestive of HPV had high-grade squamous intraepithelial lesions or cervical cancer, evidencing an alarming rate of these lesions.

Alta prevalência de usuários que não retornam ao Centro de Testagem e Aconselhamento (CTA) para o conhecimento do seu status sorológico: Rio Grande, RS, Brasil / High prevalence of users who did not return to the Testing and Counseling Center (TCC) for knowing their serological status: Rio Grande, RS, Brazil

Os Centros de Testagem e Aconselhamento (CTA) constituem importantes fontes de informações epidemiológicas, que quando bem gerenciadas e atualizadas, permitem o conhecimento e a análise das características da população atendida por esses serviços. Esse estudo descreve o perfil dos usuários do CTA de Rio Grande (RS) que foram submetidos à sorologia anti-HIV entre os anos de 2001 e 2004. Variáveis demográficas relativas ao comportamento e práticas das pessoas que procuraram o serviço foram analisadas, mediante consulta ao banco de dados SISCTA-2002/RG. A soropositividade para HIV-1 foi de 1,1 por cento; 2,4 por cento; 2,3 por cento e 1,7 por cento de 2001 a 2004, respectivamente. Nos anos de 2003 e 2004, 37,7 por cento e 36 por cento, respectivamente, dos pacientes HIV-1+ não retornaram ao CTA para conhecimento dos exames anti-HIV ou confirmatório. Os resultados analisados parecem refletir algumas tendências da epidemia em Rio Grande e no país. É importante ressaltar a alta porcentagem de pacientes HIV-1 positivos que não procuram o resultado do seu teste. Em termos de saúde pública essa situação pode colocar em risco os esforços para o controle da epidemia.

The Testing and Counseling Centers are important sources of epidemiological information. This study describes a research conducted with the users of the Testing and Counseling Center of Rio Grande-RS submitted to anti-HIV test during the period 2001-2004. Demographic and behavioral factors of individuals attended in the service were analyzed using the database SISCTA-2002/RG. HIV-1 seropositivity between 2001 and 2004 was of 1,1 percent; 2,4 percent; 2,3 percent and 1,7 percent, respectively. In 2003 and 2004, 37,7 percent and 36 percent of the HIV-1 positive patients did not return to the Testing and Counseling Center for getting the result of their serological anti-HIV or confirmatory tests. These results seem to reflect some tendencies of the HIV epidemic in Rio Grande and in Brazil. It is important to emphasize the high percentage of HIV-1 positive patients who do not return for getting the result of their test. In terms of public health this risk behavior may jeopardize the efforts for controlling the epidemic.