Síndrome de ovario poliquístico: diagnóstico en la adolescencia / Polycystic ovary syndrome: diagnosis during adolescence

La sospecha de Síndrome de Ovario Poliquístico es un motivo de consulta frecuente durante la adolescencia, esto probablemente está dado por la sobreposición de las características fisiológicas de este período con los criterios diagnósticos tradicionalmente usados para definir este síndrome, tales como ciclos menstruales irregulares, hiperandrogenismo y morfología ecográfica de ovario poliquístico. Es por esto que parece importante discutir si los criterios diagnósticos de Síndrome de Ovario Poliquístico aplicados en mujeres adultas pueden extrapolarse a los primeros años postmenarquia. En este artículo se discute el diagnóstico de Síndrome de Ovario Poliquístico en la adolescencia, sus controversias y su manejo.

The suspicion of polycystic ovary syndrome is a common complaint during adolescence, and is probably given by the overlap of physiological characteristics of this period of life with the diagnostic criteria traditionally used to define this syndrome, such as irregular menstrual cycles, hyperandrogenism and polycystic ovarian morphology. This is why it seems important to discuss whether these diagnostic criteria for polycystic ovary syndrome in adults can be extrapolated to the early years postmenarche. This article will discuss the diagnosis of polycystic ovary syndrome in adolescence, their controversies and their management.

Experiencia con un método de autotoma de muestra vaginal para la detección de infección por Chlamydia trachomatis y Neisseria gonorrhoeae en mujeres jóvenes / Screening of Neisseria gonorrhoeae and Chlamydia trachomatis using techniques of self collected vaginal sample in young women

Chlamydia trachomatis and Neisseria gonorrhoeae are responsible for 3-10% of sexually transmitted diseases in adolescents. 75% are asymptomatic. International standards recommend annual screening for C. trachomatis in sexually active women under 26 years. Self-collected vaginal swab is one of the less invasive screening methods, it is well accepted by patients and rarely used in our country. Aim: To determine the frequency of C. trachomatis and N. gonorrhoeae by a self-sampling method of vaginal swab and its acceptability in a group of adolescents and young adults. Patients and Methods: Women 18 to 25 years old. Vaginal samples were processed by nucleic acid amplification tests, Gen Probe APTIMA Combo2. Data were collected on sexual behavior and perception of self-sampling by survey. Results: We studied 344 patients with an average age of 21.7 years. Detection of C. trachomatis was positive in 7.9% women and it was not found in any of the patients studied for N. gonorrhoeae. 98% considered self-sampling instructions easy to understand, 87.5% felt comfortable taking the sample. Conclusions: Prevalence of C. trachomatis in the study population was similar to that described in other national and international studies. N. gonorrhoeae was not found in this series, which is consistent with literature reports. The self-sampling technique of vaginal sample was well accepted by the patients. However, they were anxious about the quality of the sample. According to our results, it is important to emphasize the importance of annual detection of these pathogens and that self-sampling technique is a valid alternative.

Chlamydia trachomatis y Neisseria gonorrhoeae son causantes de 3 a 10% de las infecciones de transmisión sexual en adolescentes. Las normas internacionales recomiendan su detección anual en mujeres sexualmente activas menores de 26 años. La adherencia a este tamizaje en mujeres jóvenes está limitada por el temor al examen ginecológico y alto costo del examen. Objetivo: Determinar la frecuencia de detección de C. trachomatis y N. gonorrhoeae por un método de auto-toma de muestra vaginal y su aceptabilidad en un grupo de adolescentes y jóvenes adultas. Pacientes y Método: Se incluyeron mujeres de 18 a 25 años atendidas en Clínica Las Condes y el Servicio de Salud Estudiantil de la Universidad de Chile, que fueron instruidas para autotoma de muestra vaginal. Luego de dar su consentimiento, las muestras fueron estudiadas mediante reacción de polimerasa en cadena para la detección de C. trachomatis y N. gonorrhoeae. Se recopilaron datos sobre conductas sexuales y percepción de la autotoma mediante encuesta. Se determinó la relación entre estos factores y la aceptabilidad del método. Resultados: Se reclutaron 344 mujeres, con una edad promedio de 21,7 años. La detección de C. trachomatis fue de 7,9% y no se encontró muestra positiva para N. gonorrhoeae. El reporte de flujo vaginal por la paciente se asoció a 1,5 veces mayor riesgo de C. trachomatis. El 98% consideró las instrucciones de la autotoma fáciles de entender, 87,5% se sintió cómoda al tomar la muestra. Conclusiones: La prevalencia de C. trachomatis en la población estudiada fue similar a lo descrito en otras series nacionales e internacionales; no se encontró N. gonorrhoeae en esta serie, lo que coincide con lo reportado en el extranjero. La técnica de autotoma de muestra vaginal fue bien aceptada por las pacientes; sin embargo, manifestaron ansiedad acerca de la seguridad de una toma adecuada. De acuerdo a nuestros resultados, es importante insistir en la detección anual de estos patógenos siendo la técnica de autotoma una alternativa válida.

A rational approach to the diagnosis of polycystic ovarian syndrome during adolescence / Uma abordagem racional do diagnóstico da síndrome dos ovários policísticos na adolescência

Polycystic ovarian syndrome (PCOS) is a lifelong disorder characterized by hyperandrogenism and ovulatory dysfunction, with a wide spectrum of clinical symptoms and signs. Three different sets of diagnostic criteria have been established in order to define this disease in adult women, but there is controversy regarding the use of these criteria in adolescence. During puberty, the adult criteria for ovulatory dysfunction does not seem applicable, because an irregular menstrual pattern and a decreased ovulatory rate is a physiologic event during this period of life. Also, a higher prevalence of polycystic ovarian morphology (PCOM) may be observed during this period, so PCOM is not a useful criterion to define PCOS in young women. These findings suggest that a key factor to diagnose to PCOS during adolescence is hyperandrogenism. In addition, since PCOM is not clearly associated with hyperandrogenism during this period of life, the term "polycystic ovarian syndrome" during adolescence creates confusion and may be misleading.

A síndrome dos ovários policísticos (SOP) é uma desordem que afeta pacientes por toda a vida e é caracterizada por hiperandrogenismo e disfunção ovariana, com um amplo leque de sintomas e sinais clínicos. Três diferentes conjuntos de critérios diagnósticos foram estabelecidos para definir essa doença em mulheres adultas, mas existem controvérsias relacionadas ao uso desses critérios na adolescência. Durante a puberdade, o critério de disfunção ovariana usado em adultos não parece aplicável, porque um padrão menstrual irregular e uma menor taxa de ovulação são eventos fisiológicos nesse período da vida. Além disso, uma maior prevalência de morfologia ovariana policística (MOP) pode ser observada nesse período, de forma que a MOP não é um critério útil para se definir a SOP em mulheres jovens. Esses achados sugerem que o hiperandrogenismo é um fator-chave para o diagnóstico da SOP na adolescência. Além disso, como a MOP não está claramente associada com o hiperandrogenismo durante esse período da vida, o termo "síndrome dos ovários policísticos" durante a adolescência cria confusão e pode ser errôneo.