Melanosis of the vagina and human papillomavirus infection, an uncommon pathology: Case Report / Melanosis de la vagina e infección por virus del papiloma humano, una patología poco común: Reporte de un Caso

Benign melanotic lesions of the vagina are uncommon and only a few cases have been reported in the literature. A 34-year-old woman was referred because of a Vaginal Intraepithelial Neoplasia 1 biopsy result. On the gynecological examination, two different hyperpigmented areas were noted in the vagina. The colposcopic visualization of the cervix and vagina found an aceto-white lesion at the right lateral wall of the upper third of the vagina. Biopsies from three areas were taken. Histological study reported a melanosis of the vagina and HPV infection. An immunohistochemical panel of epithelial markers was performed in vaginal samples, such as Cytokeratin AE1/AE3 and epithelial membrane antigen, mesenchymal marker: vimentin; melanocytic makers: protein S-100 and HMB45 (Human Melanoma Black); proliferating cell marker: proliferating cell nuclear antigen (PCNA), and P-53 oncoprotein. High Risk (16, 18, 31, 45) and Low Risk (6, 11) HPV types were studied by In Situ Hybridization using the same vaginal samples. CK, EMA and Vimentin were 2+. Melanocytic markers, HMB45 and S100, and PCNA were 1+ in basal cell layer. P-53 was negative. The melanotic tissue and acetowhite lesion were positives to HPV Types 6,11. In conclusion, melanosis of the vagina is a uncommon benign pathology. Usually, melanosis is present in women over 40 years old. We present a case of melanosis of the vagina in a young woman infected with low-risk HPV types and review the literature.

Las lesiones melanóticas de la vagina son infrecuentes. y Solo pocos casos han sido reportados. Se presenta el caso de una mujer de 34 años quien es referida con diagnóstico de una Neoplasia Intraepitelial Vaginal 1. Al examen ginecológico, se encontraron dos áreas hiperpigmentadas en la vagina. La exploración colposcópica del cuello uterino y vagina reveló la presencia de una lesión aceto-blanca en la pared lateral derecha del tercio superior de la vagina. Muestras de biopsias fueron tomadas en dichas áreas. El estudio histológico reportó una melanosis de la vagina y una infección por el virus del Papiloma Humano (VPH). Se realizó un panel de estudio inmunohistoquímico de marcadores epiteliales en las muestras vaginales: tales como citoqueratina AE1/AE3 y antígeno epitelial de membrana; marcador mesenquimal: vimentin; marcadores melanóticos: proteina S-100 y HMB45 (Human Melanoma Black); marcadores de proliferación celular: antígeno de proliferación nuclear (PCNA), y la oncoproteína P-53. Se realizó Hibridización In Situ para establecer los tipos de alto (16, 18, 31, 45) y bajo (6, 11) riesgo de VPH en las muestras vaginales. Los marcadores CK, EMA y Vimentin fueron 2+. Los marcadores melanótico, el HMB45 y el S100, y el PCNA fueron 1+ en la capa basal. P-53 fue negativo. El tejido melanótico y la lesión acetoblanca fueron positivos al VPH 6,11. En conclusión, la melanosis vaginal es una patología poco frecuente. Usualmente, se ha reportado en mujeres mayores de 40 años. Presentamos un caso de una melanosis de la vagina infectada con un tipo de VPH de bajo riesgo en una mujer joven y una revisión de la literatura.

Prevalência e susceptibilidade aos antimicrobianos de Staphylococci isolados de vagina de ovelhas sadias / Prevalence and antimicrobial susceptibility of Staphylococci isolated from the vagina of healthy ewes

Os objetivos deste estudo foram: identificar as espécies de Staphylococcus sp. da vagina de ovelhas sem sinal de infecção e determinar sua susceptibilidade in vitro aos antimicrobianos. Swabs estéreis foram usados para coletar as amostras da vagina de 24 ovelhas da raça Santa Inês, do mesmo rebanho, classificadas como livres de doenças genitais após um histórico e exame físico detalhados. Procedimentos bacteriológicos padronizados, como por exemplo, o isolamento em meio de cultura seletivo e crescimento das amostras em aerobiose, foram utilizados para identificação dos isolados. Espécies de Staphylococcus coagulase-positivo (CoPS) representaram 60% dos isolados e foram significantemente mais resistentes do que as espécies de Staphylococcus coagulase-negativo. A resistência aos antibióticos foi frequentemente observada, e 66,6% dos isolados demonstraram resistência à pelo menos uma droga. Ciprofloxacina foi o agente antimicrobiano mais eficiente, não apresentando nenhuma cepa resistente, enquanto a Penicilina G foi a droga menos efetiva (40% de resistência). Esse estudo confirma a presença de amostras estafilocócicas na vagina de ovelhas, com predominância de CoPS que apresentaram resistência a diversos antibióticos testados. Este trabalho contribui para um melhor esclarecimento sobre o papel dos staphylococci na vagina das ovelhas e sua susceptibilidade aos antimicrobianos, colaborando para um tratamento de vaginite mais eficiente, que pode ser causada por este gênero bacteriano.

The aims of this study were identify the species of Staphylococcus sp. from the vagina of healthy ewes and determine their in vitro susceptibility to antibiotics. Sterile cotton swabs were used to collect samples from the vagina of 24 ewes. Standard bacteriological procedures were conducted. Coagulase-positive Staphylococcus species (COPS) represented 60% of the isolates and were significantly more resistant to antibiotics than coagulase-negative isolates. Resistance to antibiotics was frequently observed, and 66.6% of the isolates showed resistance to at least one tested drug. Ciprofloxacin was the most active antimicrobial agent (100%), while Penicillin G was the less effective (40% of resistance). This study confirms the presence of Staphylococcal isolates in the vagina of ewes, with predominance of CoPS isolates resistant to various antibiotics. This study contributes to a better knowledge about the role of Staphylococcus species in the ewe’s vagina and their antimicrobial susceptibility, collaborating for a better treatment of the vaginitis determined by these bacteria.

Corrimento vaginal referido entre gestantes em localidade urbana no Sul do Brasil: prevalência e fatores associados / Self-reported vaginal discharge among pregnant women in an urban area in Southern Brazil: prevalence and associated factors

Por intermédio de delineamento transversal, buscou-se determinar a prevalência e identificar fatores associados à ocorrência de corrimento vaginal referido entre gestantes da cidade de Rio Grande, Rio Grande do Sul, Brasil. Utilizando-se de questionário padrão, foram investigadas características sócio-econômicas, demográficas, reprodutivas, condições de moradia, assistência recebida e ocorrência de corrimento vaginal referido entre estas gestantes. Para as comparações entre proporções utilizou-se teste do qui-quadrado e para análise multivariada regressão de Poisson. Dentre as 339 gestantes estudadas, 51,6 por cento referiram corrimento vaginal na gestação. As seguintes variáveis mostraram-se significativamente associadas à ocorrência de corrimento vaginal referido: idade (razão de prevalências: RP= 1,49), estado civil (RP = 1,31), ocorrência de infecção urinária (RP = 1,56), hiperglicemia na gestação atual (RP = 1,48), uso de dispositivo intra-uterino (RP = 2,35), ocorrência prévia de parto prematuro (RP = 1,37) e utilização de anticoncepcional oral como fator de proteção (RP = 0,79). Este estudo mostrou prevalência elevada de corrimento vaginal referido entre as gestantes estudadas e permitiu identificar aquelas com maior risco de adoecer por esta causa, o que pode contribuir para a adoção de medidas preventivas.

The purpose of this study was to determine the prevalence and risk factors associated with self-reported vaginal discharge among pregnant women in the city of Rio Grande, South Brazil. Using a cross-sectional design, a standard interview was applied to pregnant women at home by previously trained interviewers, covering the following: demographic, reproductive, and socioeconomic data, household conditions, health care, and illnesses during pregnancy, including vaginal discharge. The chi-square test was used to compare proportions, and Poisson regression was used in the multivariate analysis. Among the 339 pregnant women interviewed, 52 percent reported vaginal discharge. The following variables were significantly associated with the outcome: age (prevalence rate, PR = 1.49), marital status (PR = 1.31), urinary tract infection (PR = 1.56), hyperglycemia (PR = 1.48), use of an intrauterine device (PR = 2.35), and history of preterm delivery (PR = 1.37), with oral contraception showing a protective effect (PR = 0.79). Prevalence of self-reported discharge was high among this group of pregnant women. Several risk factors were also identified for the disease under study. These findings can contribute to the implementation of preventive interventions.

Corrimento vaginal / Genital discharge

Os autores fazem uma revisão bibliográfica sobre as causas mais comuns do corrimento vaginal, com ênfase nas três principais etiologias vivenciadas na prática médica, objetivando a abordagem de aspectos como patogenia, manifestações clínicas, diagnóstico e tratamento

Asociación de la citología cervico-vaginal inflamatoria con la lesión intraepitelial cervical en pacientes de una Clínica de Salud Sexual y Reproductiva en Bogotá, Colombia 1999- 2003 / Association between the cervico-vaginal inflammatory citology and the intraepithelial cervical lesion in patients from a Sexual and Reproductive Health Clinic in Bogotá, Colombia, 1999-2003

OBJETIVOS: El cáncer de cervix es la neoplasia más frecuente de la mujer en Colombia. La citología cervical es la prueba de tamizaje para las lesiones intra-epiteliales-LIE, predecesoras del cáncer de cervix. La lesión intraepitelial podría manifestarse por la presencia de células inflamatorias. El objetivo del presente trabajo fue evaluar el papel de la citología inflamatoria como marcador de LIE. MATERIALES Y MÉTODOS: Estudio de corte transversal, para establecer las características operativas de la citología cervical en pacientes de la consulta de colposcopia de la Clínica Piloto Profamilia de Bogotá, entre Enero de 1999 y Diciembre de 2003. Se compararon pacientes que presentaron patología de LIE con quienes presentaron patología benigna del cervix. Se evaluó la sensibilidad y especificidad de la citología en diferentes puntos de corte, al compararla con la biopsia como patrón de oro. RESULTADOS: La prevalencia de LIE de bajo grado fue del 48,7 por ciento y la prevalencia de LIE de alto grado fue del 9,7 por ciento. La citología mostró mejor desempeño al considerar la citología atipia epitelial de significado indeterminado-AESI como anormal. La citología inflamatoria severa mostró similar asociación a la LIE que a la AESI. CONCLUSIONES: La exclusión de las atipias epiteliales de significado indeterminado como punto de corte, reduce la sensibilidad de la prueba de tamizaje. Se recomienda incluir la lectura inflamatoria en el informe citológico estratificado por severidad, hasta que se aclaresu real utilidad para el diagnóstico de la lesión intraepitelial.

open evaluation of fluconazole as a single dose oral treatment for vaginal infections with candida

The clinical and mycological efficacy of single-dose oral treatment with Fluconazole 150mg was evaluated in 29 patients with vaginal candidiasis confirmed by microscopic and culture examination. Clinical and mycological evaluations were done at 5-9 days after treatment and again at 4-6 weeks after treatment. Fluconazole produced rapid relief of signs and symptoms [erythema, excoriation, erosion, discharge, pruritis and burning/irritation] and this relief persisted in 80 to 90% of patients 4-6 weeks after treatment. At 5-9 days post treatment, 93% of patients were clinically cured or improved while 76% of patients were mycologically cured. At long term follow-up visit 4-6 weeks after treatment, 100% of patients were found clinically cured or improved while 97% were determined candida-free on microscopic/culture examination. Overall therapeutic response [combining clinical and mycological response to treatment] at the end of the study was rated excellent or good in 93% of the patients. Toleration of the drug was exceptional as no side effect was reported by the patients during the study. Results of this study suggest that fluconazolc as a single dose oral treatment is effective in providing both short-term and long-term control of vaginal candidiasis clinically as well as mycologically, with no problem of toleration

Vaginite enfisematosa: apresentaçäo de um caso / Emphysematous vaginitis: report of a case

A case vaginitis emphysematosa is presented, wich, with only more 170 cases in the world literature, is the second to be described in Brazilian literature, is thes second to be described in Brazilian literature. This case is associated with idiophatic trombocitopenic purpura, cardiovascular disease and Trichomonas vaginalis vaginitis. The clinical aspects of this vaginitis can suggest that vlood stagnation in vaginal and cervical wall have great importance in the genesis of this situation

Vaginitis enfisematosa: caso clínico / Emphysematous vaginitis: a clinical case

1. Se presenta un caso de vaginitis enfisematosa. 2. Se realiza descripción macroscópica y microscópica de las lesiones encontradas. 3. Se revisan diversas teorías acerca de su patogenia, probable agente etiológico y análisis de la naturaleza del gas. 4. Se comenta acerca de vaginitis enfisematosa como hallazgo radiológico. 5. Es el primer caso que se describe en el Servicio de Obstetricia, Ginecología y Neonatología del Hospital Salvador, Santiago, Chile