Prevalencia de disfunción vaginal en mujeres de la ciudad de Bahía Blanca (Argentina) / Vaginal dysfunction prevalence in women of the city of Bahía Blanca (Argentina) / A prevalência de disfunção vaginal em mulheres da cidade de Bahía Blanca (Argentina)

La disfunción vaginal (vaginosis/vaginitis) es la patología genital hoy reconocida más prevalente. El objetivo del trabajo fue generar información sobre la prevalencia de Disfunción vaginal y los factores de riesgo asociados en mujeres sintomáticas y asintomáticas. Se incorporó además la detección de C. trachomatis y N. gonorrhoeae. Se consolida la validez del Balance del Contenido Vaginal (BACOVA) en el diagnóstico integral de disfunción vaginal y de la amplificación génica en la detección de C. trachomatis. Se estudiaron 295 mujeres que asistieron al Hospital Municipal de Bahía Blanca. La mayor prevalencia correspondió a vaginosis bacteriana (21,36%), luego levaduras (13,90%), T. vaginalis (3,73%) y C. trachomatis (3,05%). No se detectó ningún caso de gonococia. Los factores de riesgo encuadran en el marco de valores de la región centro sur del país, pero se debe destacar la frecuencia significativa de alteraciones de la función vaginal (68,87%) y la infección por clamidias (4,35%) detectadas en mujeres asintomáticas. Esto impone la necesidad de revisar y optimizar la política de cumplimiento de las Normas Ministeriales de prevención y control con la aplicación de una metodología de laboratorio normatizada en el protocolo de control de mujeres en edad fértil, embarazadas o no.

Vaginal dysfunction (vaginosis/vaginitis) is the most prevalent genital pathology recognized today. The objective of the work was to generate information on the prevalence of vaginal dysfunction and the associated risk factors in symptomatic and asymptomatic women. The detection of C. trachomatis and N. gonorrhoeae was also incorporated. The validity of the Vaginal Content Balance (BACOVA) in the comprehensive diagnosis of vaginal dysfunction and of gene amplification in the detection of C. trachomatis is consolidated. A total of 295 women who attended the Municipal Hospital of Bahía Blanca were studied. The highest prevalence corresponded to bacterial vaginosis (21.36%), then yeasts (13.90%), T. vaginalis (3.73%) and C. trachomatis (3.05%). No cases of gonorrhea were detected. The risk factors fit within the framework of values of the south central region of the country, but the significant frequency of alterations of vaginal function (68.87%) and chlamydial infection (4.35%) detected in asymptomatic women should be noted. This imposes the need to review and optimize the compliance policy of the Ministerial Standards of prevention and control, with the application of a standardized laboratory methodology, in the control protocol for women of childbearing age, pregnant or not.

A disfunção vaginal (vaginose/vaginite) é a patologia genital mais prevalente hoje reconhecida. O objetivo do trabalho foi gerar informações sobre a prevalência de disfunção vaginal e os fatores de risco associados em mulheres sintomáticas e assintomáticas. A detecção de C. trachomatis e N. gonorrhoeae também foi incorporada. A validade do Equilíbrio do Conteúdo Vaginal (BACOVA) no diagnóstico integral da Disfunção Vaginal e da amplificação gênica na detecção de C. trachomatis está consolidada. Estudamos 295 mulheres que freqüentaram o Hospital Municipal de Bahía Blanca. A maior prevalência correspondeu à vaginose bacteriana (21,36%), depois leveduras (13,90%), T. vaginalis (3,73%) e C. trachomatis (3,05%). Nenhum caso de gonorreia foi detectado. Os fatores de risco enquadram-se no quadro de valores da região centro-sul do país, mas deve-se notar a frequência significativa de alterações da função vaginal (68,87%) e infecção por clamídia (4,35%), detectadas em mulheres assintomáticas. Isso impõe a necessidade de rever e otimizar a política de compliance das Normas Ministeriais de prevenção e controle, com a aplicação de metodologia laboratorial padronizada, no protocolo de controle para mulheres em idade fértil, gestantes ou não.

Prevalence of Candida spp. in cervical-vaginal samples and the in vitro susceptibility of isolates

Abstract Vulvovaginal candidiasis (VVC) is an infection of the genital mucosa caused by different species of the genus Candida. Considering the lack of data on this topic in the south of Brazil, this study aimed to assess the prevalence of Candida spp. in the cervical-vaginal mucosa of patients treated at a university hospital in southern Rio Grande do Sul, as well as the etiology and the susceptibility of the isolates against fluconazole, itraconazole, miconazole and nystatin. Samples were collected at the gynecology clinic of the Federal Hospital of the University of Rio Grande, and the isolates were identified using phenotypic and biochemical tests. The susceptibility analysis was performed according to the CLSI M27-A2 protocol. Of the 263 patients included, Candida spp. was isolated in 27%, corresponding to a prevalence of approximately 15% for both VVC and colonization. More than 60% of the isolates were identified as Candida albicans; C. non-albicans was isolated at a rate of 8.6% in symptomatic patients and 14.3% in asymptomatic patients. The prevalence of resistance against fluconazole and itraconazole was 42% and 48%, respectively; the minimal inhibitory concentration of miconazole ranged from 0.031 to 8 µg/mL, and that of nystatin ranged from 2 to >16 µg/mL. The high rate of resistance to triazoles observed in our study suggests the necessity of the association of laboratory exams to clinical diagnosis to minimize the practice of empirical treatments that can contribute to the development of resistance in the isolates.

Susceptibilidad antifúngica de aislados vaginales de Candida spp / Antifungal susceptibility of Candida spp. vaginal isolates

Introducción: la vulvovaginitis constituye una de las principales afecciones ginecológicas, y su causa más frecuente es la candidiasis. Candida albicans se considera el agente etiológico más importante de esta entidad; sin embargo, estudios recientes revelan un incremento en la incidencia de otras especies del género. Algunas de estas tienen la particularidad de presentar resistencia a los tratamientos usuales con antimicóticos. Objetivo: evaluar la susceptibilidad antifúngica de aislados vaginales de pacientes cubanas con sospecha de candidiasis vulvovaginal que se obtuvieron en el 2015. Métodos: a 28 aislados pertenecientes al género Candida, se les realizó las pruebas de susceptibilidad in vitro con la galería ATBTM Fungus 3 frente a diferentes antifúngicos (5-fluorocitosina, anfotericina B, fluconazol, itraconazol y voriconazol). Resultados: todos los aislados fueron sensibles a la anfotericina B y uno de C. albicans se informó resistente a los azoles estudiados. Todas las especies diferentes de C. albicans fueron susceptibles al voriconazol (CMI≤ 1 mg/L). Conclusiones: el estudio de patrones de susceptibilidad en aislados de Candida provenientes de mujeres con vulvovaginitis permite profundizar en cómo abordar la terapéutica de esta afección; el fluconazol resultó el tratamiento de elección. Los resultados alertan sobre la emergencia de C. glabrata, C. krusei, C. parapsilosis, C. tropicalis, C. inconspicua y C. lusitaniae como agentes causales de la candidiasis vulvovaginal(AU)

Introduction: vulvovaginitis is one of the main gynecological diseases frequently caused by candidiasis. Candida albicans is considered as the most important etiological agent for the disease; however, recent students have revealed an increased incidence of other species of the genus. Some of them may show particular resistence to usual antimycotic treatments. Objective: to evaluate the antifungal susceptibility of vaginal isolates from Cuban female patients suspected of vulvovaginal candidiasis in 2015. Methods: twenty eight Candida genus isolates underwent in vitro susceptibility tests with ATBTM Fungus 3 using several antifungal agents (5 fluorocytosine, anphotericin B, fluconazole, itraconazole and vorixonazole). Results: all isolates were susceptible to B anphotericin and one C. albicans isolate was reported as resistant to the studied azoles. All the species other thanC. albicans were susceptible to voriconazole (CMI≤ 1mg/L). Conclusions: the study of susceptibility patterns in Candida isolates from women with vulvovaginitis allow delving into the different ways of approaching the therapeutics of this disease; fluconazole was the treatment of choice. The results show emergence of C. glabrata,C. krusei, C. parapsilosis, C. tropicalis, C. inconspicua and C. lusitaniae as causative agents of vulvovaginal candidiasis(AU)

O papel dos parceiros sexuais sintomáticos e assintomáticos nas vulvovaginites recorrentes / The role of the symptomatic and asymptomatic sexual partners in the recurrent vulvovaginitis

OBJETIVO: Identificar as espécies predominantes e o papel dos parceiros sexuais na manutenção das vulvovaginites recorrentes por Candida spp. MÉTODOS: Entre agosto de 2007 e março de 2012, foi efetuado estudo prospectivo de 830 pacientes com idades variáveis entre 18 e 65 anos e vaginites fúngicas. Foram excluídos pacientes com diabetes mellitus, síndrome da imunodeficiência adquirida (AIDS), em uso de corticoterapia, antibioticoterapia, hormonoterapia, imunossupressão, duchas vaginais, dispositivos intrauterinos (DIUs) ou espermicidas. A identificação das espécies de Candida foi feita por métodos fenotípicos e genotípicos. O teste do χ2 foi usado para correlacionar a Candida spp. nos parceiros masculinos e a recorrência nas vaginites. RESULTADOS: O agente fúngico foi isolado em um total de 40 mulheres, sendo 24 com vaginites recorrentes, e em 15 dos seus parceiros sexuais, dos quais 10 eram assintomáticos, e 5, sintomáticos. Houve concordância das espécies encontradas no casal em 100% das recorrências. C. albicans (62,4 e 60%), C. glabrata (29,1 e 33,3%) e C. guilliermondii foram as espécies identificadas. Candida tropicalis (4,1%) foi isolada de apenas uma paciente. Nas 16 mulheres restantes que tinham vaginites não complicadas, C. albicans foi isolada em todas. C. glabrata foi isolada em apenas dois de seus parceiros assintomáticos. CONCLUSÃO: Houve predominância de C. albicans; parceiros sintomáticos ou assintomáticos podem ter papel importante como reservatório e fonte de transmissão de leveduras, principalmente nos quadros de vulvovaginites recorrentes. .

PURPOSE: To identify the predominant species and the role of sexual partners in the maintenance of recurrent vulvovaginitis by Candida spp. METHODS: A prospective study of 830 patients aged 18 to 65 years with yeast vaginitis was performed between August 2007 and March 2012. Patients with diabetes mellitus, AIDS or taking corticosteroids, antibiotics or hormone therapy and immunosuppressed patients, patients using vaginal douches, spermicides or intrauterine devices were excluded from the study. Candida species were identified by phenotypic and genotypic methods. The chi-square test was used to correlate the presence of Candida spp. in male partners with the recurrence of vaginitis. RESULTS: The fungal agent was isolated from a total of 40 women, 24 with recurrent vaginitis and from 15 of their sexual partners, 10 of whom were asymptomatic while 5 were symptomatic. There was agreement of the species found in the couple in 100% of recurrences. C. albicans (62.4 and 60%), C. glabrata (29.1 and 33.3%) and C. guilliermondii species were identified. Candida tropicalis (4.1%) was isolated from only one patient. Candida albicans was isolated from the remaining 16 women who had uncomplicated vaginitis. C. glabrata was isolated from only two of the asymptomatic partners. CONCLUSION: There was a predominance of C. albicans and symptomatic or asymptomatic partners can play an important role as a reservoir and source of transmission of yeast, especially in cases of recurrent vulvovaginitis. .

Secreção vaginal anormal: Sensibilidade, especificidade e concordância entre o diagnóstico clínico e citológico / Abnormal vaginal secretion: sensitivity, specificity and concordance between clinical and cytological diagnosis

OBJETIVOS: Estimar a prevalência da vaginose bacteriana (VB), candidíase e tricomoníase e comparar os achados do exame físico da secreção vaginal com o diagnóstico microbiológico, obtido pelo estudo citológico do esfregaço vaginal, pelo do método de Papanicolaou. MÉTODOS: Estudo de corte transversal que incluiu 302 mulheres com idade entre 20 a 87 anos, submetidas à entrevista e exame ginecológico para avaliação da secreção vaginal e coleta de esfregaço citológico, no período de junho de 2012 a maio de 2013. Para avaliar a acurácia das características da secreção vaginal em relação ao diagnóstico microbiológico do esfregaço citológico foi empregado as análises de sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN), com seus respectivos IC95%. Para avaliar o grau de concordância entre as características clínicas da secreção vaginal e os achados microbiológicos no exame citológico, foi aplicado o índice kappa (k). RESULTADOS: A prevalência da VB, candidíase e tricomoníase foi de 25,5, 9,3 e 2,0%, respectivamente. A sensibilidade, especificidade, valor o VPP e o VPN das características clínicas da secreção vaginal para o diagnóstico citológico de VB foram de 74, 78,6, 54,3, e 89,9%, respectivamente. A sensibilidade, a especificidade, o VPP e o VPN das características clínicas da secreção vaginal para o diagnóstico citológico de candidíase foram de 46,4, 86,2, 25,5 e de 94%, respectivamente. O grau de concordância entre a avaliação clínica da secreção vaginal e o diagnóstico microbiológico de VB, candidíase e tricomoníase, avaliados pelo índice kappa foi de 0,47, 0,23 e 0,28, respectivamente. CONCLUSÃO: A causa mais frequente de secreção vaginal anormal foi VB. A avaliação clínica da secreção vaginal apresentou sensibilidade, VPP e grau de concordância moderado a fraco, comparado ao diagnóstico microbiológico, o que indica a necessidade de avaliação complementar do achado clínico de secreção vaginal anormal. .

PURPOSE: To estimate the prevalence of bacterial vaginosis (BV), candidiasis and trichomoniasis and compare the findings of physical examination of the vaginal secretion with the microbiological diagnosis obtained by cytology study of a vaginal smear using the Papanicolaou method. METHODS: A cross-sectional study of 302 women aged 20 to 87 years, interviewed and submitted to a gynecology test for the evaluation of vaginal secretion and collection of a cytology smear, from June 2012 to May 2013. Sensitivity analyses were carried out and specificity, positive predictive value (PPV) and negative predictive value (NPV) with their respective 95%CI were determined to assess the accuracy of the characteristics of vaginal secretion in relation to the microbiological diagnosis of the cytology smear . The kappa index (k) was used to assess the degree of agreement between the clinical features of vaginal secretion and the microbiological findings obtained by cytology. RESULTS The prevalence of BV, candidiasis and trichomoniasis was 25.5, 9.3 and 2.0%, respectively. The sensitivity, specificity, PPV and NPV of the clinical characteristics of vaginal secretion for the cytological diagnosis of BV were 74, 78.6, 54.3 and 89.9%, respectively. The sensitivity, specificity, PPV and the NPV of the clinical characteristics of vaginal secretion for the cytological diagnosis of candidiasis were 46.4, 86.2, 25.5 and 94%, respectively. The correlation between the clinical evaluation of vaginal secretion and the microbiological diagnosis of BV, candidiasis and trichomoniasis, assessed by the kappa index, was 0.47, 0.23 and 0.28, respectively. CONCLUSION The most common cause of abnormal vaginal secretion was BV. The clinical evaluation of vaginal secretion presented amoderate to weak agreement with the microbiological diagnosis, indicating the need for complementary investigation of the clinical findings of abnormal vaginal secretion. .

Infecciones vaginales en un Centro de Salud Familiar de la Región Metropolitana, Chile / Vaginal infections in a Family Health Clinic in the Metropolitan Region, Chile

Background: Vaginal infections are a frequent cause for consultation, but their prevalence and etiology vary in different populations. Objectives: To determine the prevalence and etiologies of vaginal infection in women attending a family health center in the Metropolitan Region of Chile. Methods: The microbiological diagnosis was made by wet mount and Gram stain. Diagnosis of trichomoniasis was performed by wet mount, culture and polymerase chain reaction. Results: 101 women aged 15-54, not selected by signs or symptoms of vaginal infection, 46 of them pregnant were included. In 47 women (46.5%), vaginal infections were diagnosed. An association was observed between age and frequency of vaginal infection. The proportion of infections among pregnant and non-pregnant women was similar. The most frequent infections were bacterial vaginosis (16.8%), vulvovaginal candidiasis (11.9%) and co-infections (6.9%). We found 5.9% of intermediate microbiota cases, 3% of trichomoniasis and 2% of aerobic vaginitis. Symptoms of vaginal infection had poor agreement with microbiological findings. Otherwise physical signs had good agreement with the presence of infection, but low to moderate concordance with a specific etiology. Conclusions: We found a high prevalence of vaginal infections in the study population. It is necessary to improve the definitions and criteria of microbiological diagnosis of co-infections and intermediate microbiota, for them to be diagnosed in the clinical practice. More descriptive questionnaires are recommended to enhance the usefulness of clinical examination.

Introducción: Las infección vaginales constituyen un motivo frecuente de consulta, pero su prevalencia y etiología varían en distintas poblaciones. Objetivos: Determinar la prevalencia y tipos de infección vaginal en mujeres atendidas en un centro de salud familiar de la Región Metropolitana. Métodos: El diagnóstico microbiológico fue efectuado mediante examen microscópico al fresco y tinción de Gram y para tricomoniasis examen al fresco, cultivo y reacción de la polimerasa en cadena. Resultados: Se incluyeron 101 mujeres de 15-54 años, no seleccionadas por signos ó síntomas, 46 de ellas embarazadas. En 47 mujeres (46,5%) se diagnosticaron infecciones vaginales. Se observó asociación entre edad y frecuencia de infección vaginal. La proporción de infecciones entre gestantes y no gestantes fue similar. Las infecciones más frecuentes fueron vaginosis bacteriana (16,8%), candidiasis vulvo-vaginal (11,9%) y co-infecciones (6,9%). Se observó 5,9% casos de microbiota intermedia, 3% de tricomoniasis y 2% de vaginitis aeróbica. Los síntomas de infección vaginal tuvieron mala concordancia con los hallazgos microbiológicos. A su vez, los signos físicos tuvieron buena concordancia con la existencia de infección, pero escasa a moderada concordancia con una etiología específica. Conclusiones: Se encontró alta frecuencia de infecciones vaginales. Es necesario mejorar las definiciones y criterios de diagnóstico microbiológico de las co-infecciones y microbiota intermedia, para ser diagnosticadas en la práctica clínica. Se recomienda emplear cuestionarios más descriptivos para mejorar la utilidad del examen clínico.

Evaluación de la disfunción vaginal en mujeres embarazadas sintomáticas y asintomáticas mediante la utilización de los estados vaginales básicos (EVB) y su comparación con el estudio microbiológico convencional / Evaluation of vaginal dysfunction in symptomatic and asymptomatic pregnant women by using the analysis of basic vaginal states (BVS) and its comparison with the conventional microbiological study

Durante el embarazo se producen frecuentemente infecciones del tracto genital inferior asociadas a complicaciones maternas y perinatológicas. El objetivo del trabajo fue evaluar la disfunción vaginal mediante el análisis de los estados vaginales básicos (EVB) por la metodología del balance del contenido vaginal (BACOVA) y compararlo con el estudio microbiológico convencional en el diagnóstico de candidiasis, tricomonosis y vaginosis bacteriana (VB). Entre 2010 y 2012 se estudiaron 1238 pacientes embarazadas; 1046 eran asintomáticas (A) y 192 sintomáticas (S). La prevalencia del EVB I fue del 59,5 % y 26 %, respectivamente. El EVB II se observó en 19,7 % de las mujeres A y en 17,2 % de las S. El EVB III se detectó solamente en las A, en 0,4 %. El EVB IV se observó en 14,4 % de las A y en 38 % de las S. El EVB V se detectó en 6 % de las A y en 18,8 % de las S. En las mujeres A, las levaduras se asociaron a los EVB I y II en el 55,5 % y 23,2 % de los casos, respectivamente; entre las S, alcanzaron el 32,4 % y 31 % de los casos, en igual orden. Las tricomonas se asociaron al EVB I en el 50 % de las A, al EVB IV en el 44,4 % de las S y al EVB V en el 33,3 % de las S. La sensibilidad del BACOVA para detectar levaduras fue 80,4 % en las A y 85,5 % en las S; para detectar tricomonas, del 40 % y 75 %, y para detectar VB, del 100 % en los dos grupos. La especificidad del BACOVA fue 100 % para todos los patógenos en las A y en las S. El estudio de los EVB resultó útil para orientar el diagnóstico a la disfunción vaginal, independientemente de la sintomatología, por lo que se sugiere este estudio como parte del control prenatal. Durante el embarazo se producen frecuentemente infecciones del tracto genital inferior asociadas a complicaciones maternas y perinatológicas. El objetivo del trabajo fue evaluar la disfunción vaginal mediante el análisis de los estados vaginales básicos (EVB) por la metodología del balance del contenido vaginal (BACOVA) y compararlo con el estudio microbiológico convencional en el diagnóstico de candidiasis, tricomonosis y vaginosis bacteriana (VB). Entre 2010 y 2012 se estudiaron 1238 pacientes embarazadas; 1046 eran asintomáticas (A) y 192 sintomáticas (S). La prevalencia del EVB I fue del 59,5 % y 26 %, respectivamente. El EVB II se observó en 19,7 % de las mujeres A y en 17,2 % de las S. El EVB III se detectó solamente en las A, en 0,4 %. El EVB IV se observó en 14,4 % de las A y en 38 % de las S. El EVB V se detectó en 6 % de las A y en 18,8 % de las S. En las mujeres A, las levaduras se asociaron a los EVB I y II en el 55,5 % y 23,2 % de los casos, respectivamente; entre las S, alcanzaron el 32,4 % y 31 % de los casos, en igual orden. Las tricomonas se asociaron al EVB I en el 50 % de las A, al EVB IV en el 44,4 % de las S y al EVB V en el 33,3 % de las S. La sensibilidad del BACOVA para detectar levaduras fue 80,4 % en las A y 85,5 % en las S; para detectar tricomonas, del 40 % y 75 %, y para detectar VB, del 100 % en los dos grupos. La especificidad del BACOVA fue 100 % para todos los patógenos en las A y en las S. El estudio de los EVB resultó útil para orientar el diagnóstico a la disfunción vaginal, independientemente de la sintomatología, por lo que se sugiere este estudio como parte del control prenatal.

Infections of the lower genital tract associated to maternal and perinatal complications frequently occur during pregnancy. The aim of this study was to evaluate vaginal dysfunction through the analysis of basic vaginal states (BVS) using the methodology of balance of the vaginal content (BAVACO) and to compare it with the microbiological study of candidiasis, trichomoniasis and bacterial vaginosis (BV). Pregnant patients (1238) were examined from 2010 to 2012. In asymptomatic (A) (n: 1046) and symptomatic pregnant women (S) (n: 192) BVS I was 59.5% and 26% of the patients, respectively. BVS II was observed in 19.7% of A and in 17.2% of S. BVS III was only detected in A in 0.4%. BVS IV was observed in 14.4% of A and in 38% of S. BVS V was detected in 6% of A and in 18.8% of S. Yeasts were associated to BVS I and II in 55.5% and 23.2% of A, respectively; and in 32.4% and 31% of S, respectively. Trichomonas were associated to BVS I in 50% of A, to IV in 44.4% of S and to V in 33.3% of S. BAVACO susceptibility to detect yeasts was 80.4% and 85.5% in A and S, respectively; 40% and 75% in A and S, respectively, to detect trichomonas and 100% in A and S to detect BV. BAVACO specificity was 100% for all pathogens in A and S. The study of BVS proved useful as a guide to evaluate vaginal dysfunction, regardless of symptomatology. Therefore, this study is recommended as prenatal control. Infections of the lower genital tract associated to maternal and perinatal complications frequently occur during pregnancy. The aim of this study was to evaluate vaginal dysfunction through the analysis of basic vaginal states (BVS) using the methodology of balance of the vaginal content (BAVACO) and to compare it with the microbiological study of candidiasis, trichomoniasis and bacterial vaginosis (BV). Pregnant patients (1238) were examined from 2010 to 2012. In asymptomatic (A) (n: 1046) and symptomatic pregnant women (S) (n: 192) BVS I was 59.5% and 26% of the patients, respectively. BVS II was observed in 19.7% of A and in 17.2% of S. BVS III was only detected in A in 0.4%. BVS IV was observed in 14.4% of A and in 38% of S. BVS V was detected in 6% of A and in 18.8% of S. Yeasts were associated to BVS I and II in 55.5% and 23.2% of A, respectively; and in 32.4% and 31% of S, respectively. Trichomonas were associated to BVS I in 50% of A, to IV in 44.4% of S and to V in 33.3% of S. BAVACO susceptibility to detect yeasts was 80.4% and 85.5% in A and S, respectively; 40% and 75% in A and S, respectively, to detect trichomonas and 100% in A and S to detect BV. BAVACO specificity was 100% for all pathogens in A and S. The study of BVS proved useful as a guide to evaluate vaginal dysfunction, regardless of symptomatology. Therefore, this study is recommended as prenatal control.

Associação entre cultura de secreção vaginal, características sociodemográficas e manifestações clínicas de pacientes com diagnóstico de candidíase vulvovaginal / Association between vaginal secretion culture, socio-demographic characteristics and clinical manifestations of patients with vulvovaginal candidiasis

OBJETIVO: Investigar a etiologia, o perfil epidemiológico de pacientes com candidíase vulvovaginal (CVV) e possíveis fatores predisponentes. MÉTODOS: Secreção vaginal das pacientes foi semeada em ágar Sabouraud e amostras de leveduras foram isoladas e identificadas por Polymerase Chain Reaction (PCR). Dados demográficos, clínicos e fatores predisponentes foram obtidos por meio de questionário. Para análise estatística, foram utilizados os testes t de Student, Fischer e do χ², com auxílio do software Statistical Package for the Social Sciences (SPSS), com nível de significância de 5%. RESULTADOS: Foram avaliadas 69 pacientes, com idade entre 15 e 52 anos, predominando mulheres brancas (79,7%), com escolaridade de nível superior completo (58%), casadas (56,5%) e com vida sexual ativa (97,1%). Dentre elas, 34,8% eram gestantes, 7,2% diabéticas, 1,4% soropositivas para AIDS e 36,2% usavam anticoncepcional oral. Antibioticoterapia recente foi citada por 13% das pacientes, uso de antifúngico por 5,8% e de antitricomonas por 1,4%. Uso de corticosteroides foi relatado por 2,9% das participantes e de antineoplásicos, por 1,4%. Fluxo vaginal e prurido foram as principais queixas apresentadas, respectivamente, por 97,1 e 73,9% das pacientes, seguido de ardência (63,8%) e hiperemia (63,8%). Quando presente, o fluxo foi majoritariamente branco (88,1%) ou grumoso (86,6%). O diagnóstico foi confirmado pela cultura em 55 (79,7%) pacientes, sendo 4 casos de infecção mista. A espécie prevalente foi C. albicans, seguida por um caso de C. glabrata, que foi encontrada em mais duas pacientes em associação com C. albicans. Nas outras duas infecções polimicrobianas, C. lusitaniae foi isolada com C. albicans. CONCLUSÕES: Embora a positividade da cultura tenha sido alta e os dados clínicos de CVV sejam característicos, a sintomatologia não é patognomônica. C. albicans é a espécie prevalente, mas deve-se atentar para a ocorrência de outras espécies na etiologia de CVV, como a emergência de C. lusitaniae.

PURPOSE: To investigate the etiology and the epidemiological profile of patients with vulvovaginal candidiasis (VVC) and predisposing factors. METHODS: Vaginal secretions were streaked in Sabouraud agar and yeast samples were isolated and identified by Polymerase Chain Reaction (PCR). Demographic and clinical data were obtained with a questionnaire. For statistical analysis, the Student's t-test, the χ² and Fischer tests were applied as needed using the Statistical Package for Social Sciences (SPSS) software, with the level of significance set at 5%. RESULTS: Sixty-nine patients aged from 15 to 52 years were evaluated. They were predominantly white (79.7%), with higher education (58%), married (56.5%) and sexually active (97.1%). Among them, 34.8% were pregnant, 7.2% diabetic, 1.4% seropositive for AIDS, and 36.2% were using oral contraceptives. Recent antibiotic therapy was mentioned by 13% of the patients, and antifungal or anti-trichomonas therapy was mentioned by 5.8 and 1.4% of the patients, respectively. Corticosteroid use was reported by 2.9% and antineoplastic by 1.4%. Vaginal discharge and itching were the main complaints (97.1 and 73.9%), followed by burning (63.8%) and erythema (63.8%). When present, the vaginal flow was predominantly white (88.1%) or lumpy (86.6%). The diagnosis was confirmed by culture in 55 (79.7%) patients, with mixed infections in 4 patients. The most prevalent species was C. albicans, followed by C. glabrata (one monoinfection and two mixed infections with C. albicans). C. lusitaniae and C. albicans were also identified in mixed infections (two patients). CONCLUSION: Despite the high culture positivity and clinical data characteristic of VVC, the symptoms were not pathognomonic. C. albicans is the most prevalent species, but other species are also involved in VVC etiology, such as the emergence of C. lusitaniae.

Etiología de la candidiasis vulvovaginal recidivante en la Atención Primaria de Salud en Santa Catarina, Brasil / Etiology of recurrent vulvovaginal candidiasis in the National Health System in Santa Catarina, Brazil / Etiologia da candidíase vulvovaginal recorrente na Atenção Primária à Saúde em Santa Catarina, Brasil

El objetivo del presente trabajo fue destacar las características epidemiológicas que puedan subsidiar la Atención Primaria de Salud (APS) en mujeres portadoras de candidiasis vulvovaginal (CVV) y candidiasis vulvovaginal recidivante (CVVR), a partir de estudios realizados en tres municipios del sur de Brasil. A través del examen micológico de la secreción vaginal de 300 mujeres con sospecha clínica de CVV o CVVR se identificaron las especies prevalentes de Candida, correlacionándose los hallazgos con los principales factores de riesgo mencionados en la literatura. Fueron confirmadas levaduras en 90 (30%) casos, resultando las especies más frecuentes C. albicans (61,1%), C. krusei (16,7%), C. tropicalis (6,7%), C. glabrata (4,4%) y Candida spp. (11,1%). En los casos de CVVR, C. albicans fue la especie más encontrada, con una prevalencia superior a la observada en la CVV. C. krusei apareció como la segunda especie más prevalente en todas las muestras, resaltando la importancia del diagnóstico a nivel de especie, dada la resistencia intrínseca al fluconazol. Las informaciones epidemiológicas del estudio son útiles para que los gestores de la Atención Primaria de Salud (APS) y los profesionales de la Salud puedan tener subsidios adicionales para actuar preventivamente en el caso de candidiasis vulvovaginales.

The main purpose of this work was to highlight epidemiological characteristics serving as subsidies to health promotion activities for vulvovaginal candidiasis (VVC) and recurrent vulvovaginal candidiasis (RVVC) by the national health system, in three cities in southern Brazil. Through the mycological examination of vaginal secretions of 300 women with clinical suspicion of VVC or RVVC, Candida-prevalent species were identified and they were correlated with the main risk factors mentioned in the literature. Yeasts were confirmed in 90 (30%) cases, resulting in C. albicans 61.1%, C. krusei 16.7%, C. tropicalis 6.7%, C. glabrata 4.4% and others 11.1%. C. albicans was the species most commonly found in cases of RVVC, with levels higher than the prevalence of the species in the VVC. C. krusei prevailed as the second most prevalent species in both samples, emphasizing the importance of diagnosing the species level, due to its intrinsic resistance to fluconazole. The epidemiological information of the study is useful for managers of the National Health Care System, as well as direct health professionals, who can have new subsidies to act preventively against vulvovaginal candidiasis.

O objetivo do presente trabalho foi destacar as características epidemiológicas que possam subsidiar a Atenção Primária à Saúde (APS) em mulheres portadoras de candidíase vulvovaginal (CVV) e candidíase vulvovaginal recorrente (CVVR), a partir de estudos realizados em três municípios do sul do Brasil. Através do exame micológico da secreção vaginal de 300 mulheres com suspeita clínica de CVV ou CVVR foram identificadas as espécies prevalentes de Candida, correlacionando os achados com os principais fatores de risco mencionados na literatura. Foram detectadas leveduras em 90 (30%) dos casos, resultando as espécies mais frequentes C. albicans (61,1%), C. krusei (16,7%), C. tropicalis (6,7%), C. glabrata (4,4%) e Candida spp. (11,1%). Nos casos de CVVR, C. albicans foi a espécie mais encontrada, com uma prevalência superior à observada nos casos de CVV. C. krusei apareceu como a segunda espécie mais prevalente em todas as amostras, ressaltando a importância do diagnóstico em nível de espécie, devido à resistência intrínseca ao fluconazol. As informações epidemiológicas deste estudo são úteis para que os gestores da Atenção Primária à Saúde (APS) e os profissionais da Saúde Pública possam ter subsídios adicionais para atuar preventivamente nos casos de candidíases vulvovaginais.

A six-year epidemiological survey of vulvovaginal candidiasis in cytopathology reports in the state of Rio Grande do Sul, Brazil

Candidíase Vulvovaginal (CVV) é uma infecção vaginal comum. O constante aumento da incidência da doença pode estar associado a fatores como idade, infecção por HIV, diabetes, uso de métodos hormonais de contracepção e alterações citopatológicas. O objetivo deste estudo foi avaliar a prevalência de Candida sp. em amostras de secreção vaginal no estado do Rio Grande so Sul, no período de 2005 a 2010. Trata-se de um estudo retrospectivo e observacional, por meiodo qual foram avaliados 121.328 relatórios médicos de citopatologia num período de seis anos. Foram constatados 8.582 (7,1por cento) casos positivos de Candida sp.. A idade média das pacientes era de 35 anos. Mais da metade das pacientes (53por cento) usavam anticoncepcional oral e, em 49por cento dos casos, verificou-se a existência de alterações no colo do útero. A continuidade da investigaçãoepidemiológica é necessária para o acompanhamento das tendências ao longo dos anos e para uma melhor compreensão dos fatores que predispõem à CVV no Brasil.

Importancia del estudio del balance del contenido vaginal (BACOVA) en el control preventivo de las trabajadoras sexuales / Importance of studying the balance of vaginal content (BAVACO) in the preventive control of sex workers

El objetivo de este trabajo fue estudiar a un grupo de 229 trabajadoras sexuales de Comodoro Rivadavia (Chubut), atendidas en centros públicos de salud de dicha ciudad, mediante la aplicación del método conocido como balance del contenido vaginal (BACOVA). Este método comprende el estudio morfológico de la microbiota vaginal, como así también de la reacción infamatoria. Incluye el análisis del contenido vaginal en fresco y por tinciones de Gram y de Giemsa, de modo de integrar la exploración de todo el panorama biológico. El 35,37 % de estas mujeres presentó microbiota normal (MN); el 15,72 %, microbiota intermedia (MI); el 23,14 %, vaginosis bacteriana (VB) y el 10,48 %, vaginitis microbiana inespecífca (VMI). Los casos de vaginitis por levaduras y por Trichomonas vaginalis comprendieron el 8,30 % y 6,99 % de las mujeres, respectivamente. Se observó el desplazamiento de la MN hacia una MI, que se correspondió con el predominio de bacterias corineformes. Por otra parte, no se reconoció un marcado desequilibrio del contenido vaginal ante la colonización e infección por levaduras o por T. vaginalis: el 48 % de los casos de estas vaginitis convencionales no presentaron reacción infamatoria vaginal (RIV). El 24,89 % de los casos de MN presentaron una signifcativa RIV, y en más del 50 % de las mujeres se diagnosticaron disfunciones vaginales en ausencia de sintomatología. Estos resultados se podrían asociar a un incremento del riesgo gineco-obstétrico, lo que afecta la salud sexual y reproductiva de la población estudiada.

The aim of this work was to study the vaginal microenvironment in sex workers from Comodoro Rivadavia, Chubut. For that purpose, BAVACO procedures were applied. A total of 229 female sex workers attended public health centers. Vaginal secretions were analyzed by Gram and Giemsa stains. The following results were obtained: normal microbiota 35.37 %, intermediate microbiota 15.72 %, bacterial vaginosis 23.14 %, microbial nonspecifc vaginitis, Donders'"aerobic vaginitis" 10.48 %, yeast vulvovaginitis 8.30 %, and trichomoniasis 6.99 %. The intermediate microbiota was characterized by a decrease in the number of lactobacilli and the presence of diphtheroid bacilli cell types. The population studied shared increased values of vaginal dysfunctions. These results are considered risk factors for obstetric and gynecologic diseases.

Detección de Chlamydia trachomatis, esporos micóticos y Trichomonas vaginalis en mujeres en edad fértil que acuden a los Hospitales San Pablo y Regional de San Lorenzo / Chlamydia trachomatis, fungal spores and Trichomonas vaginalis detection of childbearing age women who attend to San Pablo Hospital and Regional of San Lorenzo

Introducción: Las infecciones vulvo-cérvico-vaginales constituyen la causa más común por la que las mujeres en edad fértil acuden al Ginecólogo. Los agentes etiológicos involucrados incluyen a Chlamydia trachomatis, Trichomonas vaginalis, Cándida albicans, entre otros. La sospecha de vulvo-cervico-vaginitis debe orientar a la realización de estudios de secreción vaginal y muestreo endocervical a fin de detectar el agente causal, establecer un tratamiento específico y disminuir la prevalencia de los mismos así como las complicaciones. Objetivos: Determinar la prevalencia de esporos micóticos, Trichomonas vaginalis y Chlamydia trachomatis en mujeres en edad fértil. Materiales y Métodos: Estudio observacional, descriptivo, de corte transversal y prospectivo, con cuestionario realizado a mujeres en edad fértil que acudieron a los hospitales Materno Infantil San Pablo y Regional de San Lorenzo entre los meses de diciembre de 2010 a febrero de 2011. Resultados: De las 148 pacientes estudiadas, se observó una prevalencia de 27,7% de esporos micóticos, 2% de Trichomonas vaginalis y 4,1% de Chlamydia trachomatis. De las pacientes estudiadas, la mayoría tenían entre 25 a 29 años (26%). Conclusión:La prevalencia de esporos micóticos fue 27,7%, Trichomonas vaginalis 2% y Chlamydia trachomatis 4,1%.

Introduction: the vulvo cervicovaginal infections are the most common reason that women of childbearing age go to the gynecologist. The ethiological agents involved are Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, among others. The suspicion of cervico-vulvo-vaginitis should guide the studies of vaginal discharge and endocervical sampling to detect the causative agent, to stablish specific treatment and reduce the prevalence of these infections and the complications. Objective: to determine the prevalence of fungal spores, Trichomonas vaginalis and Chlamydia trachomatis in women of childbearing age. Materials and Methods: observational, descriptive, cross-sectional and prospective study performed in women of childbearing age who attended the San Pablo Hospital and Regional of San Lorenzo between the months of December 2010 to February 2011. Results: 148 patients were studied, there was a 27.7% prevalence of fungal spores, 2% Trichomonas vaginalis and 4.1% Chlamydia trachomatis. Of the patients studied, most were between 25 to 29 years (26%). Conclusion: the prevalence of fungal spores was 27.7%, Trichomonas vaginalis 2% and Chlamydia trachomatis 4.1%.

Abnormal Vaginal Flora in Low-Risk Pregnant Women Cared for by a Public Health Service: prevalence and Association with Symptoms and Findings from Gynecological Exams / Alteração de flora vaginal em gestantes de baixo risco, atendidas em serviço público de saúde: prevalência e associação à sintomatologia e achados do exame ginecológico / Alteración de la flora vaginal en gestantes de bajo riesgo atendidas en servicio público de salud: prevalencia y asociación a la sintomatología y hallazgos del examen ginecológico

This study identifies the prevalence of vaginal flora alterations in low-risk pregnant women and their association with reported symptoms and gynecological exams. This quantitative, descriptive, cross-sectional study was conducted in public primary care service units in Botucatu, SP, Brazil from 2006 to 2008 with 289 pregnant women from a stratified sample obtained by sampling by care unit. Tests of vaginal content were performed using Gram’s method and testing for Trichomonas vaginalis using Diamond’s medium. The prevalence of altered vaginal flora was 49.5 percent, of which bacterial vaginosis (20.7 percent), vaginal candidiasis (11.8 percent) and intermediate flora (11.1 percent) were the most frequent, not considering associations. Results revealed a high prevalence of vaginal flora alterations with little relation to symptoms, but in agreement with findings from the gynecological exams. Considering undesirable maternal and perinatal outcomes and feasible laboratory practices, the establishment of a routine for diagnosing vaginal flora alterations in low-risk pregnant women is suggested.

Objetivou-se identificar a prevalência das alterações de flora vaginal em gestantes de baixo risco, sua associação à sintomatologia referida e exame ginecológico. É estudo quantitativo, descritivo e transversal, desenvolvido no serviço público de atenção básica de Botucatu, SP, no período de 2006 a 2008, com 289 gestantes, amostradas de forma estratificada por unidade. Realizou-se exame do conteúdo vaginal, utilizando-se coloração pelo método de Gram e pesquisa de Trichomonas vaginalis em meio líquido de Diamond. Desconsiderando-se as associações, a prevalência de flora vaginal alterada foi de 49,5 por cento, sendo as mais frequentes: vaginose bacteriana (20,7 por cento), candidíase vaginal (11,8 por cento) e flora intermediária (11,1 por cento). Os dados apontam elevada prevalência das alterações de flora vaginal, com pouca associação à sintomatologia, mas associação com achados do exame ginecológico. Considerando-se as repercussões maternas e perinatais indesejáveis e a prática laboratorial exequível, sugere-se o estabelecimento de rotina para diagnóstico das alterações de flora vaginal em gestantes de baixo risco.

Se tuvo por objetivo identificar la prevalencia de las alteraciones de flora vaginal en gestantes de bajo riesgo, su asociación a la sintomatología referida y examen ginecológico. Estudio cuantitativo, descriptivo y transversal, desarrollado en el servicio público de atención básica de Botucatu/SP, en el período de 2006 a 2008, con 289 gestantes, el muestreo fue realizado de forma estratificada por unidad. Se realizó examen del contenido vaginal utilizándose coloración por el método de Gram e investigación de Trichomonas vaginalis en medio líquido de Diamond. Desconsiderándose las asociaciones, la prevalencia de flora vaginal alterada fue de 49.5 por ciento, siendo las alteraciones más frecuentes: vaginitis bacteriana (20.7 por ciento), candidiasis vaginal (11.8 por ciento) y flora intermediaria (11.1 por ciento). Los datos apuntan elevada prevalencia de las alteraciones de flora vaginal, con poca asociación a la sintomatología, pero con asociación a hallazgos del examen ginecológico. Considerándose las repercusiones maternas y perinatales indeseables y la práctica de laboratorio ejecutable, se sugiere el establecimiento de rutina para diagnóstico de las alteraciones de flora vaginal en gestantes de bajo riesgo.

Prevalence of condom use and associated factors in a sample of university students in southern Brazil / Prevalência e fatores associados ao uso de preservativos masculinos entre universitários no Sul do Brasil

This article focuses on the frequency of condom use and associated factors in university students, based on a cross-sectional study of 633 students in 2006. Associations were investigated using a logistic regression model with 5 percent significance. Condom use prevalence was 60 percent. Having candidiasis was a protective factor for condom use in both sexual initiation (OR = 0.49; 95 percentCI: 0.31-0.79) and the most recent sexual intercourse (OR = 0.39; 95 percentCI: 0.24-0.65). Condom use was associated with single marital status (OR = 2.89; 95 percentCI: 1.60-5.23) and having a sex partner froim the health field (OR = 0.50; 95 percentCI: 0.34-0.75). Condom use was high in all sexual relations in this sample of university students. Single marital status and having a sex partner from a health-related course were positively associated with condom use in the most recent intercourse. Self-reported genital candidiasis was protective for condom use during early sexual activity and in the most recent sexual relation. Belonging to the health field did not show a significant impact on the use of male condoms.

Este estudo verificou a freqüência e fatores associados ao uso de preservativos em universitários, por meio de estudo transversal com 633 estudantes, em 2006. Para avaliar associação foi utilizado o modelo de regressão logística em nível de 5 por cento de significância. A prevalência do uso de preservativos foi de 60 por cento. Ter candidíase foi um fator de proteção tanto para uso de preservativos na primeira (OR = 0,49; IC95 por cento: 0,31-0,79) quanto na última relação sexual (OR = 0,39; IC95 por cento: 0,24-0,65). O uso de preservativos na última relação sexual foi associado à relação marital não-estável (OR = 2,89; IC95 por cento: 1,60-5,23) e parceiro(a) pertencer à área da saúde (OR = 0,50; IC95 por cento: 0,34-0,75). Concluindo, a freqüência do uso de preservativos, em todas as relações sexuais, entre os estudantes universitários é alta. A relação marital não-estável e possuir parceiro do curso da área da saúde relacionaram-se positivamente ao uso de preservativos durante a última relação sexual. Relato de ter candidíase genital demonstrou proteção para uso de preservativos no início da atividade sexual e na última relação sexual. Pertencer à área da saúde não influenciou significativamente o uso de preservativos masculinos.

Candidíase vulvovaginal na gravidez / Vulvovaginal candidiasis in pregnancy

A candidíase vulvovaginal (CVV) é a segunda causa entre as vulvovaginites, podendo ser ainda mais freqüente durante a gravidez. O objetivo deste estudo foi avaliar a freqüência de CVV em gestantes atendidas no Programa Integrado da Saúde da Mulher da Secretaria de Saúde do Município de Toledo - PR. Foi aplicado questionário para 82 gestantes, o qual forneceu os principais dados, como: idade, presença de doença de base, uso de medicamento, influência da gestação na candidíase, sintomas e tratamento. Das entrevistadas, 32 (39 porcento) apresentaram episódios de CVV pelo menos uma vez na vida: 24 semanas antes da gestação, seis durante a gravidez e duas antes e durante o período gestacional. Observou-se predomínio de mulheres adultas jovens com pico entre 31 e 35 anos. Aparentemente, a gestação influenciou o desenvolvimento da CVV, pois 19 porcento das mulheres a manifestaram pela primeira vez no período gestacional. Fica clara, porém, a importância das medidas educativas e preventivas para o controle da CVV.

Infecciones durante la gestación en el Hogar Materno de Los Arabos. 2005 / Infections during pregnancy at Los Arabos Maternity House. 2005

Se realizó un estudio observacional descriptivo transversal en el Hogar Materno de Los Arabos durante el año 2005, creándose un sitio centinela para el estudio de las infecciones durante la gestación, con el objetivo de conocer la incidencia de las infecciones, su manejo y repercusión perinatal. El universo de estudio estuvo constituido por 306 pacientes que ingresaron en el año 2005 y la muestra por 91 pacientes que se extraen por muestreo sistemático en fase. La muestra se operacionaliza según las variables seleccionadas, ingreso por trimestre, tipos de diagnóstico y tratamiento, positividad microbiológica, clasificación de gérmenes. Las variables se procesan mediante análisis descriptivos de por cientos. La incidencia de infecciones en el estudio fue del 29,7 por ciento (91 pacientes) correspondiéndole al III trimestre la mayor incidencia con un 19,2 por ciento (59 pacientes) del total de ingresos. El diagnóstico utilizado se basó en métodos clínicos con flujo, gramas de tratamientos preestablecidos y métodos de laboratorio con antibiograma específico de tratamientos. La positividad de las pruebas diagnósticas muestra que la cituria con un 42,1 por ciento es el examen que más frecuentemente se altera, seguida por el exudado vaginal 21,8 por ciento, urocultivo 15,6 por ciento, y exudado uretral 12,5 por ciento, positividad esta que se incrementa en el tercer trimestre (62,5 por ciento). Los análisis microbiológicos indican que la vaginosis bacteriana, la candidiasis y las infecciones por E. Coli son las más frecuentes de las sepsis con un 16,6 por ciento, las Klebsiellas y Estafilococos 14,2 por ciento y las Tricomonas 9,5 por ciento. Las infecciones del aparato urinario son las más frecuentes en la gestación (69,2 por ciento) contra el 27,6 por ciento del aparato genital. El ampicillín combinado con Ácido Nalidíxico fue el tratamiento más utilizado en las infecciones urinarias.

We carried out a transversal, descriptive, observational study at Los Arabos Maternity House during 2005, and created a sentinel site to study infections during pregnancy with the objective of knowing the infections incidence, manage and perinatal repercussion. The study universe was 306 patients admitted in 2005 and the sample was 91 patients selected by systematic sampling in phase. The sample was analyzed according to the selected variables: trimestrial admission, kind of diagnosis and treatment, microbiologic positiveness, germs classification. The variables were processed by percentage descriptive analysis. The infection incidence found in the study was 29, 7 % (91 patients) with bigger incidence in the 3rd Semester: 19, 2 % (59 patients) of the admission total. The applied diagnosis was based on clinical methods with flow, pre-established treatment grams and laboratory methods with treatment specific antibiograms. The positiveness of the diagnostic tests shows that cyturia, with 42,1 %, is the test that is most frequently altered , followed by the vaginal exudates 21,8 %, urine cultures 15,6 %, and urethral exudates 12,5 %. The last one increases during the last trimester (62, 5 %). Microbiologic analyses indicate that bacterial vaginosis, candidiasis and Escherichia Coli infections are the most common sepsis with 16,6 %, Klebsiella and Staphylococcus 14,2 % and Trichomonas 9,5 %. The urinary tract infections are the most frequent during pregnancy (69,2 %) against 27,6 % of the genital tract. The most used treatment in urinary infections was ampicillin combined with Nalidixic acid. Azitromicine and Metronidazole (tablets) were the most used drugs in vaginal infections, combined with Clotrimazole (ovules). Medicine based on evidences and the practice of highly beneficial actions favour the perinatal results.

Sexually transmitted infections, bacterial vaginosis, and candidiasis in women of reproductive age in rural Northeast Brazil: a population-based study

Population-based data on sexually transmitted infections (STI), bacterial vaginosis (BV), and candidiasis reflect the epidemiological situation more accurately than studies performed in specific populations, but such data are scarce. To determine the prevalence of STI, BV, and candidiasis among women of reproductive age from a resource-poor community in Northeast Brazil, a population-based cross sectional study was undertaken. All women from seven hamlets and the centre of Pacoti municipality in the state of Ceará, aged 12 to 49 years, were invited to participate. The women were asked about socio-demographic characteristics and genital symptoms, and thereafter examined gynaecologically. Laboratory testing included polymerase chain reaction (PCR) for human papillomavirus (HPV), ligase chain reaction (LCR) for Chlamydia trachomatis and Neisseria gonorrhoeae, ELISA for human immunodeficiency virus (HIV), venereal disease research laboratory (VDRL) and fluorescent treponema antibody absorption test (FTA-ABS) for syphilis, and analysis of wet mounts, gram stains and Pap smears for trichomoniasis, candidiasis, and BV. Only women who had initiated sexual life were included in the analysis (n = 592). The prevalences of STI were: HPV 11.7 percent (95 percent confidence interval: 9.3-14.7), chlamydia 4.5 percent (3.0-6.6), trichomoniasis 4.1 percent (2.7-6.1), gonorrhoea 1.2 percent (0.5-2.6), syphilis 0.2 percent (0.0-1.1), and HIV 0 percent. The prevalence of BV and candidiasis was 20 percent (16.9-23.6) and 12.5 percent (10.0-15.5), respectively. The most common gynaecological complaint was lower abdominal pain. STI are common in women in rural Brazil and represent an important health threat in view of the HIV pandemic.

A prospective study of genital infections in Hamedan, Iran.

A prospective study of genital infections was conducted in a university-affiliated teaching hospital in Hamedan City, Iran. A total of 540 women were recruited and divided into two equal groups: (1) the case group with vaginitis (N=270) and, (2) the asymptomatic control group (N=270). Participants were interviewed about the occurrence of any vaginal or urethral discharge. Two vaginal swabs were obtained for pH testing, KOH and wet mount examination, Gram staining and culture at the time of speculum examination. In the case group, the prevalence of candidiasis, trichomoniasis, and bacterial vaginosis was 17.2, 18.1, and 28.5%, respectively. Measurement of vaginal pH in the clinic was the single most useful clinical finding for directing empirical therapy. No single specimen was found ideal for all pathogens; a cervical swab is better for Trichomonas vaginalis but a vaginal swab is needed for candida and bacterial vaginosis. To achieve STD control in this and similar populations, public health programs must target asymptomatic infections.