Chlamydia infection in patients with and without cervical intra-epithelial lesions tested by real-time PCR vs. direct immunofluorescence

This study compares the detection rates of Chlamydia trachomatis by two techniques, direct immunofluorescence (IMF) and real time polymerase chain reaction (PCR), in patients with and without intra-epithelial cervical lesions (SIL) in Recife. We conducted a transversal study involving 35 women with SIL and 35 without SIL attended at Ambulatório Especializado da Mulher, Recife, Brazil. They were tested for Chlamydia trachomatis using two techniques, direct IMF or real time PCR. The rates of Chlamydia trachomatis detection were compared and the association with intra-epithelial cervical lesions was determined using the chi-square test at a 5 percent level of significance. Concordance between the tests was evaluated using kappa. The global prevalence of Chlamydia infection was 47.1 percent by direct IMF and 58.6 percent by real time PCR. A significant association was observed between Chlamydia diagnosis and presence of intra-epithelial cervical lesions, with about 80 percent positive results by direct IMF and 77.1 percent by real time PCR. However, the detected rate of infection with Chlamydia trachomatis was significantly greater in patients without intra-epithelial cervical lesions tested by real time PCR (40 percent) when compared to direct IMF (14.3 percent). The concordance between the tests was weak, with a kappa coefficient of 0.4. Both real time PCR and direct IMF detected elevated rates of Chlamydia infection in patients with intra-epithelial cervical lesions (80 percent) but the tests were discordant when patients without cervical lesions were tested, possibly because sensitivity of real time PCR is greater.

Microbial and cytopathological study of intrauterine contraceptive device users.

CONTEXT: Intrauterine contraceptive device (IUCD) is a commonly used birth-spacing method which is fitted into maternal system. Clinical, microbial and cytopathological monitoring of women using these devices are important for ascertaining their side effects, risk of genital tract infection and carcinogenic potential. AIMS: To study clinical, microbial and cytopathological changes in IUCD users in a tertiary care hospital. DESIGN: Prospective analytic. SETTING: Tertiary hospital. MATERIAL AND METHODS: women visiting Family Planning clinic for follow up (IUCD users, n=100) or for IUCD insertion (controls, n=50) were enrolled in the study. Each subject underwent detailed history, general physical, systemic, and per local examination. Vaginal discharge was subjected to pH testing, KOH and wet mount examination, gram staining, and for culture and sensitivity. Bacterial vaginosis was defined using Nugent criteria. Cervical smears were examined and reported as per Bethesda system. STATISTICAL ANALYSIS: The information was entered into Microsoft Excel spreadsheet. The results were analyzed using EPI Info version-6 and Stata statistical software version 7 packages. Two-tailed t-test, chi2 test with Yates correction and two-tailed Fisher Exact tests were applied. RESULTS: Most women used CuT 200 (92%). Median duration of use was 2 years. Chief complaints of IUCD users included backache (54%), vaginal discharge (46%), pain lower abdomen (34%), dyspareunia (22%), menorrhagia (18%) and dysmenorrhea (14%). Mean hemoglobin was lower in IUCD users than controls (11.2+/-1.7 versus 11.9+/-1.8 g/dL, p 0.02). Proportion of women with anemia was higher in IUCD users than in controls (29% versus 16%, p 0.12). Cervical erosion was significantly increased in study group as compared the controls (20% versus 0%, p=0.00) whereas only insignificant increase in vaginitis (6% versus 0%, p=0.17). Trichomonas vaginalis and fungal hyphae positivity and gram stain findings and bacterial vaginosis rate were not significantly different in two groups. Vaginal discharge bacterial culture revealed comparable results in two groups. Cytological findings were predominantly inflammatory. None of cases revealed Actinomycosis infection. High-grade squamous intraepithelial lesion (n=2) and low grade squamous intraepithelial lesion (n=1) cytological finding were present in IUCD users compared to none in controls. None of the cases had any malignant transformation. CONCLUSION: IUCD use results in lower hemoglobin concentration and cervical erosion. Women using IUCD requires a regular follow up, clinical examination, counseling and further investigation if required.

Infección cervicovaginal como factor de riesgo para parto pretérmino / Cervicovaginal infection as a risk factor for premature labor

OBJECTIVE: To identify the possible association between cervicovaginal infections (CVI) and preterm delivery. DESIGN: Cohorts. REFERENCE FRAME: Instituto Nacional de PerinatologÝa, Hospital Central Militar and Hospital General Regional No. 1, IMSS, Culiacßn, Sinaloa, MÚxico. PATIENTS: Four hundred and sixty eight patients attending prenatal control and delivery care. INTERVENTIONS: Fresh smears, Gram stain, and cervicovaginal sample culture from samples obtained during the following gestational stages: First sample at 16-24 weeks, second sample at 25-32 weeks, and third sample at 33-42 weeks. The following microorganisms were studied: Candida albicans, Gardnerella vaginalis, Ureaplasma urealyticum, Streptococcus agalactiae, Mycoplasma hominis, Neisseria gonorrhoeae, Listeria monocytogenes, and Chlamydia trachomatis. In case of a positive culture, the specific treatment was indicated. MEASUREMENTS: Positive or negative culture for each of the studied pathogens, and the presence or absence of a preterm delivery for each of the patients included in the study. RESULTS: Three hundred and ninety eight were still present at the end of the study, of which 156 had a CVI and 242 had no CVI. No differences between both groups were observed concerning preterm delivery. Significant relative risks were: In the first stage, Ureaplasma urealyticum and Mycoplasma hominis with RR = 9.0 (6.81, 11.8); in the second stage, Ureaplasma urealyticum with RR = 6.2 (3.30, 11.7) and Escherichia coli with RR = 3.4 (1.33, 8.6); in the third stage, Ureaplasma urealyticum with RR = 9.19 (6.93, 12.1). The logistic regression analysis identified Ureaplasma urealyticum during the second stage with OR = 16.6 (2.9, 93.7), statistically significant with p = 0.001. The survival analysis showed differences between the two groups concerning pregnancy duration (p < 0.001). CONCLUSIONS: There is a difference in the duration in pregnancy in patients with CVI and without CVI. Ureaplasma urealyticum is consistently associated with preterm delivery.

Infección cervico vaginal en la pielonefritis aguda del embarazo: relación con los resultados del tratamiento antibiótico y con la contractilidad uterina anormal / Cervix-vaginal infection in acute pyelonephritis in pregnancy: it relation with the results of antibiotic treatment and with abnormal uterine contractility

Antecedentes. La embarazada desarrolla fácilmente infecciones de la vía urinaria por cambios funcionales y por ubicación del meato uretral. En la pielonefritis aguda del embarazo no es muy conocida la participación de la infección del tracto genital inferior en los resultados del tratamiento antibiótico y en la presencia de contracción uterina del aborto y parto prematuro. Objetivos. Conocer la microbiología de la vía uterina y del tracto genital en la pielonefritis aguda del embarazo y su relación con los resultados del tratamiento y con la existencia de contracción uterina. Diseño del estudio. Embarazada entre 12 y 34 semanas de gestación con el diagnóstico de pielonefritis aguda se enrolaron. Se tomaron muestras de orina y cervicovaginales para cultivo. Recibieron randomizadamente cefuroxima o cefradina. Se observó la contracción uterina. En el seguimiento se pidieron cultivos de orina como controles. Resultados. 97 mujeres cumplieron con los criterios de inclusión. Escherichia coli se aisló del urocultivo en el 94,8 por ciento de los casos. La vaginosis bacteriana se presentó en el 32,0 por ciento y la infección cervicovaginal en el 57,7 por ciento de las pacientes. En la infección cervicovaginal E. coli se aisló en el 65,2 por ciento. El fracaso en la erradicación de la bacteria de la vía urinaria, se asoció con infección cervicovaginal (76,9 por ciento vs 52,9 por ciento, p< 0.05) y con leucocitos aumentados en la muestra cervical (76,9 por ciento vs 47,1 por ciento, p< 0,01). La contracción uterina se asoció significativamente con: infección cervicovaginal (p < 0,01), vaginosis bacteriana (p < 0,001) y con hallazgo en la muestra cervical de : leucocitos aumentados (p < 0,01), flora polimicrobiana (p < 0,001), aislamiento de E. coli (p < 0.001) y disminución de Lactobacillus sp (p < 0.01). Conclusiones: La infección del tracto genital inferior existente en la pielonefritis aguda del embarazo se relaciona con el fracaso de la terapia antimicrobiana en la erradicación de la bacteria de la vía urinaria y con contracción uterina presente

Enfermedades infecciosas del cérvix uterino, vagina y vulva: prevencion, diagnóstico y tratamiento / Infectious diseases of the uterine cervix, vagina and vulva: prevention, diagnosis and treatment

Las enfermedades infecciosas inflamatorias del cérvix uterino, vagina y vulva se encuentran entre las patologías con mayor frecuencia en la práctica clínica cotidiana; forman parte de los 12 motivos principales de demanda de consulta en medicina familiar en el Instituto Mexicano del Seguro Social (IMSS). La cérvico-vaginitis de origen infeccioso se asocia con incremento en la frecuencia de parto pretérmino secundario a ruptura prematura de membranas amnióticas durante el embarazo y con enfermedad inflamatoria pélvica crónica, esterilidad de origen tubario y carcinoma cérvico-uterino. Todas estas patologías impactan en forma desfavorable la salud de las mujeres en edad reproductiva y dan lugar a secuelas de alto costo social y económico. En virtud de lo anterior, en el presente trabajo se efectúa la revisión y síntesis de los factores de riesgo, las medidas preventivas y los criterios más aceptados para el diagnóstico y tratamiento de los tipos más frecuentes de cérvico-vaginitis infecciosas, con el fin de contribuir a su difusión y a la utilización de protocolos actualizados y uniformes por parte del personal médico familiar y ginecoobstetra de nuestra institución

Análise dos achados citológicos, histológicos e polimerase chain reaction (PCR) em mulheres com diagnóstico de infecçäo do trato genital por papilomavírus humano (HPV) / Analysis of citologic, histologic and polimerase chain reaction (PCR) findings in women with a diagnosis of human papillomavirus genital tract infection (HPV)

As alteraçöes histopatológicas do colo uterino associadas ao Papillomavírus Humano (HPV) säo bastante prevalentes. Dentre os métodos utilizados para a identificaçäo da infecçäo pelo HPV estäo a Citologia, Histologia e os métodos de Biologia Molecular. Este é um estudo transversal onde o desfecho clínico de interesse é a infecçäo pelo HPV e os fatores em estudo säo os diferentes mótodos diagnósticos, sendo avaliada a concordância entre e Citologia, Histologia e o método de Polimerase Chain Reaction (PCR). Foram analisados exames citológicos e histológicos de 216 mulheres que consultaram no HCPA. Em 25 destas mulheres foi realizado PCR. O exame citológico indicava infecçäo em 37 por cento da amostra, enquanto a Histologia em 91 por cento. A PCR evidenciou DNA viral em todas as amostras estudadas, tendo uma concordância de 100 por cento com o histológico e 20 por cento com o citológico. A concordância entre o citológico e a biópsia foi de 40 por cento. Os resultados permitem estimar a concordância diagnóstica entre tais métodos, o que ainda näo havia sido feito em nosso meio

Tratamiento de la infección cervical subclínica por el virus del papiloma humano (VPH) con asa diatérmica. Eficacia a corto plazo / Loop electrosurgical excision procedure for cervical subclinical papilomavirus infection: short term effectiveness

A partir del conocimiento de la infección subclínica por VPH se han intentado múltiples tratamientos, con diversos resultados. El objetivo de esta comunicación es establecer la utilidad del asa diatérmica como procedimiento de consultorio en el tratamiento de la infección cervical subclínical por VPH. Durante el periodo comprendido de enero de 1992 a dicimebre de 1993, 49 pacientes portadores de infección cervical por VPH fueron tratadas en la Clínica de Colposcopia Privada mediante asa diatérmica. La edad fue entre 20 y 49 años, con una media de 36.1, siendo la mayoría multíparas. Los conos obtenidos fueron satisfactorios para estudio histopatológico y los márgenes de excisión se encontraron libres de infección por VPH. El procedimiento quirúrgico fue bien tolerado en 45 pacientes (91.8 por ciento) y sólo 4 pacientes (8.1 por ciento) se quejaron de molestias moderadas. Cinco pacientes (10.2 por ciento) presentaron sangrado genital tardío y 3 (6.1 por ciento) infección cervical. La base media del cono cervical fue de 1.43 cm, con un rango de 1.0 a 3.0 cm. La tasa de éxito fue de 98 por ciento ya que solo en un caso se confirmó falla en el tratamiento. Se concluye que los resultados a corto plazo son satisfactorios

Detection of human papilloma virus types 16 & 18 DNA in cervical lesions of Indian women using in situ hybridization.

Fifty one biopsies from women with malignant lesions of the uterine cervix and 9 biopsies fron non-malignant lesions were examined for the presence of HPV 16 and 18 DNA sequences by in situ hybridization method using 35S-labelled DNA probes. HPV 16 DNA sequences were detected in 82.4 per cent biopsies from women with malignant lesions, whereas HPV 18 DNA was detected in only 3 biopsies which were also positive for HPV 16 DNA. Two biopsies from non-malignant lesions were positive for HPV 16 DNA only. Data were also analysed according to the histologic type of cancer. It was observed that no significant correlation existed between HPV types and different histologic types of cervical cancer.

Lower urinary tract symptoms and female genital tract infection

Fifty female patients with lower urinary tract symptoms with symptoms of genital infection were studied bacteriologically and vaginal and cervical swabs were examined. 36.4% had monilial vaginitis and monilial cevicitis in 27.37% Mixed monilial and trichomonoas vagintis in 22.7% and trichomonoas vaginitis in 13.6%. Fifty six per cent had significant bacteriurea with E. Coli infection in 89.3%. Forty four per cent had pyuria but insignificant bacteriuria. In the latter group 86% had positive vaginal swabs and no growth in 14%, cervical swabs were positive in 22%. The aetiology of lower urinary symptoms is discussed