Prevalencia de la infección por Chlamydia trachomatis y su potencial impacto perinatal en pacientes chilenas / Prevalence of Chlamydia trachomatis infection and a potential perinatal impact in Chilean patients

Resumen Chlamydia trachomatis es la infección de transmisión sexual bacteriana más frecuente en el mundo. Según datos de la Organización Mundial de la Salud, su prevalencia se estima alrededor de 4,2% en mujeres. Es una infección silente; sin embargo, puede desarrollar complicaciones en la fertilidad o durante el embarazo. El objetivo de esta revisión es describir la prevalencia de C. trachomatis en estudios recientes en Chile, que utilicen para su detección reacción de polimerasa en cadena (RPC), revisar las posibles complicaciones perinatales asociadas, conocer las recomendaciones de tamizaje en gestantes en otros países y discutir la necesidad de incluir en nuestro país un programa de tamizaje prenatal.

Abstract Chlamydia trachomatis is the most frequent bacterial sexually transmitted disease around the world. Estimated prevalence by WHO is 4,2% for women. Most cases are asymptomatic, but complications in fertility and during pregnancy are possible. The aim of this review is to describe the prevalence of C. trachomatis in Chilean studies using polymerase chain reaction (PCR) for detection, to describe the possible perinatal complications, to know recommendations about pregnancy screening in other countries, and to discuss the possibility of implementing in Chile.

Factores asociados a Chlamydia trachomatis en mujeres con vaginitis atendidas en atención primaria en salud / Factors associated with Chlamydia trachomatis in women with vaginitis attending in primary health care

INTRODUCCIÓN: Chlamydia trachomatis es reconocida como el agente causal de una de las infecciones de transmisión sexual (ITS) más común y curable. En mujeres, puede ser gatillante de enfermedad inflamatoria pélvica, un factor de riesgo para infertilidad o adquisición de otras ITS. OBJETIVO: Determinar C. trachomatis en mujeres con diagnóstico clínico de vaginitis asociando factores sociodemográficos, sexuales, clínicos y microbiota vaginal. PACIENTES Y MÉTODOS: Participaron 121 mujeres voluntarias > 18 años, con diagnóstico clínico de vaginitis y descarga vaginal anormal, atendidas en servicios de atención primaria en salud (APS) en Temuco-Chile. Se tomó muestra de flujo vaginal, determinándose C. trachomatis por una reacción de polimerasa en cadena convencional y microbiota vaginal por tinción de Gram. Se colectaron datos clínicos, sociodemográficos y sexuales mediante encuesta. RESULTADOS: Rango de edad 18-61 años. La frecuencia de C. trachomatis fue 14,9%. Se asoció C. trachomatis a mayor número de parejas sexuales en los últimos 5 años (p = 0,001), relaciones sexuales oral más anal (p = 0,055) y juguetes sexuales (p = 0,027). Asociación no significativa hubo con vaginosis bacteriana 31,2% (p = 0,091) e inicio de la actividad sexual < 18 años 20,6% (p = 0,07). CONCLUSIONES: Sería beneficioso incorporar en la semiología ginecológica de las mujeres atendidas en servicios de APS, los factores encontrados como favorecedores de infección por C. trachomatis, pues ello podría ayudar al manejo de esta ITS.

BACKGROUND: Chlamydia trachomatis is recognized as the causative agent of one of the most common and curable sexually transmitted infections (STIs). In women, it can be a trigger for pelvic inflammatory disease, a risk factor for infertility or acquisition of other STIs. AIM: To determine CT in women with vaginitis and associate it with sociodemographic, sexual, clinical, and vaginal microbiota factors. Methods: 121 female volunteers > 18 years of age, with a clinical diagnosis of vaginitis and abnormal vaginal discharge, attending in primary health care services (PHC) in Temuco-Chile were recluted. A vaginal discharge sample was taken, determining C. trachomatis by polymerase chain reaction and vaginal microbiota by Gram stain. Clinical, sociodemographic and sexual data were collected by survey. RESULTS: Age range was 18-61 years. The frequency of C. trachomatis was 14.9%. C. trachomatis was associated with a higher number of sexual partners in the last 5 years (p = 0.001), oral plus anal sex (p = 0.055) and sex toys (p = 0.027); there was a non-significant association with bacterial vaginosis 31.2% (p = 0.091) and initiation of sexual activity < 18 years 20.6% (p = 0.07). CONCLUSIONS: It would be beneficial to incorporate in the gynecological semiology of the women attended in PHC services, the factors found to favor C. trachomatis infection, as this could help the management of this STI.

Sexually transmitted infections among women living with HIV in a Brazilian city

ABSTRACT Background: Clinical improvements following highly active antiretroviral therapy (HAART) may increase high-risk behaviors resulting in sexually transmitted infections (STI). Optimism related to the success of HAART in slowing disease progression, reducing viral load, and improving health status might be important factors for increasing sexual risk behaviors such as less use of condoms. Objective: To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, hepatitis B and C, high-risk HPV, and cervical cytological abnormalities among women living with HIV (WLHIV) who attended a Reference Center for STI/AIDS in Brazil. Methods: A cross-sectional study was conducted among 151 WLHIV attending an STI Clinic in Vitória city, Brazil. A structured questionnaire, including demographic, behavioral, and clinical information, was used for data collection. Serological tests for HIV, syphilis, hepatitis C and B, CD4 counts, and viral load determination were performed. Cervical samples were collected for cytology and real-time PCR for HPV, Chlamydia, and Neisseria gonorrhoeae. Results: In this study, 59% of women had at least one diagnosed STI at the time of the first clinic visit; 31% had clinical forms of anogenital HPV, 10% syphilis, 8%Neisseria gonorrhoeae, 5.0% trichomoniasis, 3% Chlamydia trachomatis, 1% hepatitis B, and 1% hepatitis C; 6.7% of the women presented with cervical cytological abnormalities. Furthermore, 46.3% of women had HR-HPV, and 17.6% had HPV 16/18. Only 5% of the women had a CD4 count <200 cells/mm3, 61.6% had undetectable HIV viral load, and 81.3% were currently on HAART. Conclusion: A high prevalence of STI and HR-HPV infections were observed among HIV-infected women in this investigation. Prevention programs need to focus on counseling WLHIV and their regular partners with focused interventions such as couples counseling and education programs.

Infecções sexualmente transmissíveis em mulheres afrodescendentes de comunidades quilombolas no Brasil: prevalência e fatores associados / Sexually transmissible infections in African-descendant women in maroon communities in Brazil: prevalence and associated factors / Enfermedades de transmisión sexual en mujeres afrodescendientes de comunidades quilombolas en Brasil: prevalencia y factores asociados

Resumo: O objetivo do estudo foi estimar a prevalência de infecções sexualmente transmissíveis (IST) e fatores associados sobre mulheres quilombolas no Brasil. Trata-se de estudo transversal de base populacional com mulheres quilombolas no período de março de 2017 a janeiro de 2019. Utilizou-se um questionário com informações sociodemográficas, comportamentais e clínicas. Foi realizado exame ginecológico para coleta de células cervicais para citologia oncótica e para detecção de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis e papilomavírus humano (HPV), por meio de teste de reação em cadeia pela polimerase. Foi realizado teste rápido para HIV e sífilis. O desfecho principal foi definido como a infecção por um ou mais agentes infecciosos de transmissão sexual. Para a análise, utilizou-se o teste do qui-quadrado e regressão logística hierárquica. De um total de 380 mulheres, 352 (92,6%) foram incluídas no estudo. A prevalência de, pelo menos, uma IST foi de 18,5% (IC95%: 14,76-22,85). A maior prevalência foi de 11,1% por HPV, seguido de 6,3% por T. vaginalis e de 4,3% por C. trachomatis. Não houve nenhum caso de N. gonorrhoeae. Para o HIV, a prevalência foi de 0,3%, e de sífilis foi de 4,3%. A citologia cervicovaginal estava alterada em 7,7%. A detecção de uma ou mais IST foi significativamente associada a idade entre 25 e 44 anos (OR = 2,33; IC95%: 1,05-5,18), a consumo de álcool (OR = 1,96; IC95%: 1,06-3,64), a resultado alterado da citologia (OR = 3,96; IC95%: 1,65-9,48) e a vaginose bacteriana (OR = 3,61; IC95%: 2,01-6,47). Em mulheres quilombolas houve elevada prevalência de uma ou mais IST, o que torna importante a elaboração de estratégias de prevenção direcionadas a essas mulheres.

Abstract: The study aimed to estimate the prevalence of sexually transmissible infections (STIs) and associated factors in women in quilombola (maroon) communities in Brazil. This was a population-based cross-sectional study of quilombola women from March 2017 to January 2019. A questionnaire was used with sociodemographic, behavioral, and clinical information. A gynecological examination was performed for the collection of uterine cervical cells for oncotic cytology and the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and human papillomavirus (HPV) via polymerase chain reaction. Rapid tests for HIV and syphilis were performed. The main outcome was defined as infection with one or more sexually transmissible pathogens. The analysis used chi-square test and hierarchical logistic regression. From a total of 380 women, 352 (92.6%) were included in the study. Prevalence of at least one STI was 18.5% (95%CI: 14.76-22.85). The highest prevalence was for HPV, with 11.1%, followed by 6.3% for T. vaginalis and 4.3% for C. trachomatis. There were no cases of N. gonorrhoeae. Prevalence was 0.3% for HIV and 4.3% for syphilis. Cervical-vaginal cytology was altered in 7.7% of the women. Detection of one or more STIs was significantly associated with age 25 to 44 years (OR = 2.33; 95%CI: 1.05-5.18), alcohol consumption (OR = 1.96; 95%CI: 1.06-3.64), altered cervical cytology (OR = 3.96; 95%CI: 1.65-9.48), and bacterial vaginosis (OR = 3.61; 95%CI: 2.01-6.47). Quilombola women showed high prevalence of one or more STIs, emphasizing the importance of organizing prevention strategies targeted to these women.

Resumen: El objetivo del estudio fue estimar la prevalencia de enfermedades de transmisión sexual (ETS) y sus factores asociados en mujeres quilombolas en Brasil. Estudio transversal de base poblacional con mujeres quilombolas durante el período de marzo de 2017 a enero de 2019. Se utilizó un cuestionario con información sociodemográfica, comportamental y clínica. Se realizó un examen ginecológico, a fin de recoger células cervicales para la citología oncótica, así como para la detección de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, y virus del papiloma humano (VPH) mediante un test de reacción en cadena de la polimerasa. Se realizó un test rápido para VIH y sífilis. El resultado principal, se definió como infección por uno o más agentes infecciosos de transmisión sexual. Para el análisis, se utilizó el test de chi-cuadrado y regresión logística jerárquica. De un total de 380 mujeres, 352 (92,6%) se incluyeron en el estudio. La prevalencia de por lo menos una ETS fue de 18,5% (IC95%: 14,76-22,85). La mayor prevalencia fue por VPH 11,1%, seguida de 6,3% por T. vaginalis y 4,3% por C. trachomatis. No hubo casos de N. gonorrhoeae. Para el VIH, la prevalencia fue de 0,3% y de sífilis fue de 4,3%. La citología cérvico-vaginal estaba alterada en un 7,7%. La detección de una o más ETS estuvo significativamente asociada con la edad entre 25 a 44 años (OR = 2,33; IC95%: 1,05-5,18), el consumo de alcohol (OR = 1,96; IC95%: 1,06-3,64), resultado alterado de la citología (OR = 3,96; IC95%: 1,65-9,48) y vaginosis bacteriana (OR = 3,61; IC95%: 2,01-6,47). Las mujeres quilombolas presentaron una elevada prevalencia por una o más ETS, por lo que es importante la elaboración de estrategias de prevención dirigidas a estas mujeres.

Comparison of two methods for detection of Chlamydia trachomatis and Ureaplasma urealyticum in male reproductive tract / 北京大学学报(医学版)

OBJECTIVE@#To investigate the value of clinical application of simultaneous amplification and testing of RNA (SAT-RNA) for detecting Chlamydia trachomatis (CT) and Ureaplasma urealyticum (UU) by comparing with the polymerase chain reaction testing of DNA (PCR-DNA) method.@*METHODS@#Specimens from both urethra swab and the first avoid urine which should be at least one hour after the previous urination were collected from 163 men who were scheduled for in vitro fertilization and embryo transfer (IVF-ET) treatment due to female factors at Center for Reproductive Medicine, Shengjing Hospital of China Medical University during the period of April 2016 to April 2017. Among the 163 men, 109 simultaneously provided semen that was collected after 3-7 days of sexual abstinence for the testing. Urine and semen specimens were detected for CT and UU with SAT-RNA, while urethra swab specimens were detected for CT and UU with standard PCR-DNA. Detection results of the SAT-RNA were compared with those of the PCR-DNA method.@*RESULTS@#The positive rate of UU in the urethra swab detected with PCR-DNA and that of UU in the urine with SAT-RNA were 47.24% and 47.85%, respectively, and the coincidence rate was 93.25%. In addition, the positive and negative coincidence rates were 93.51% and 93.02%, respectively, and the concordance between the two methods was very good (Kappa=0.865). On the other hand, the positive rate of CT in the swab specimen tested with PCR-DNA was 3.07% and that of CT in urine with SAT-RNA was 4.29%, and the coincidence rate was 97.55%. Moreover, the positive and negative coincidence rates were 80.00% and 98.10%, respectively, and the concordance between the two methods was good (Kappa=0.654). Regarding SAT-RNA detection of UU in the urine and semen specimen of the 109 patients, the positive rates of UU in the urine and semen specimens were 50.46% and 44.95%, respectively; and the coincidence rate between the two specimens was 88.99%. In addition, the positive coincidence rate and the negative coincidence rate was 93.88% and 85.00%, respectively, and the concordance between the two specimens was good (Kappa=0.780). Similarly, SAT-RNA detection of CT in the urine and semen specimens showed the positive rate was 5.50% and 3.67%, respectively; and the two specimens showed 98.17% coincidence rate. The positive and negative coincidence rates were 100.00% and 98.10%, respectively, and the concordance was also good (Kappa=0.791).@*CONCLUSION@#SAT-RNA detection of CT and UU in the urine specimen showed good concordance with the PCR-DNA detection of CT and UU in the urethra swab specimen. In addition, the concordance was also good between the urine and semen specimens detected with SAT-RNA. These results indicate that, as a less invasive and equally accurate procedure, SAT-RNA may be more suitable for clinical application.

High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in Western French Guiana

ABSTRACT The purpose of this study was to estimate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in western French Guiana and to analyze associated factors with both infections. A retrospective study was conducted in a sexually transmitted infections clinic in 2017. Women (n = 338) were tested by real-time polymerase chain reaction for vaginal, anal and throat CT and NG infections. Men (n = 192) were evaluated using urine specimens. Socio-demographic and sexual behaviour data were collected by nurses with a structured questionnaire. The prevalence of CT and NG infections among women were 24.3% and 13.3%, respectively, and 12.0% and 7.3% among men. Women aged under 25 years had a higher risk of CT and NG infections than women aged 35 years or more. Another risk factor for CT infection was low educational level, and occasional unprotected sex for NG infection. CT and NG infections were associated with reporting symptoms among men. Very high prevalences of CT and NG infections among women and men were found, which suggest that a large-scale screening strategy should be implemented in French Guiana.

Incidência de Chlamydia trachomatis em gestantes diagnosticadas com sífilis / Chlamydia trachomatis incidence on syphilis diagnosed pregnant women

De acordo com a Organização Mundial da Saúde, a cada ano, mais de 376 milhões de pessoas são infectadas pelas doenças sexualmente transmissíveis, das quais 127,2 milhões são por Chlamydia trachomatis. As infecções genitais não tratadas na gestação, principalmente as assintomáticas, podem acarretar complicações, tais como: endometrite puerperal e síndrome de Fitz-Hugh-Curtis. A pesquisa científica foi realizada com o objetivo de identificar a presença de Chlamydia trachomatis na secreção endocervical de gestantes sifilíticas, estabelecendo o perfil das gestantes a partir de informações dos possíveis sinais e sintomas durante a gravidez e hábitos gestacionais. Adotou-se como caminho metodológico a pesquisa quantitativa, descritiva, bibliográfica e laboratorial. Como resultados finais, 54% das gestantes foram diagnosticadas com Chlamydia trachomatis e 67% eram assintomáticas. Correlacionamos também que as altas taxas de infecção estão associadas com a falta de conhecimento sobre infecções sexualmente transmissíveis e suas formas de prevenção.(AU)

According to the World Health Organization, each year, more than 376 million people are infected with sexually transmitted diseases, of which 127.2 million are Chlamydia trachomatis, it is a asymptomatic disease, meaning there are no symptoms. Genital infections can lead to complications such as: puerperal endometritis and Fitz-Hugh- -Curtis syndrome. The scientific research was carried out to identify the presence of Chlamydia trachomatis in the endocervical secretion of syphilitic pregnant women. This research established a profile of pregnant women infected with Chlamydia trachomatis using information about possible signs and symptoms during pregnancy and gestational habits. It provides a methodological way to quantify and describe the laboratory research. The results showed, 54% of the pregnant women were diagnosed with Chlamydia trachomatis of which 67% were asymptomatic. We also correlate that high rates of Chlamydia trachomatis infection are associated with lack of knowledge about sexually transmitted infections and their forms of prevention.(AU)

Conocimiento y creencias sobre infección por clamidia en población joven. Revisión narrativa / Knowledge and beliefs about chlamydia infection in a young population. Narrative review

RESUMEN Introducción: La Chlamydia trachomatis es una de las infecciones de transmisión sexual más comunes en la población menor de 25 años, causante de graves problemas para la salud pública y la calidad de vida de las personas. Objetivo: Describir el conocimiento y creencias en la población joven entre 15 y 25 años, en relación a la infección por Clamidia, enmarcado en el contexto chileno e internacional. Métodos: Revisión narrativa que incluye 14 artículos cualitativos y cuantitativos de los últimos 10 años, en idioma inglés y español. Resultados: Existe desconocimiento sobre la infección por Clamidia, en cuanto a las características clínicas, el medio de transmisión y las pruebas diagnósticas, lo que genera que la población joven subestime el riesgo percibido y aumente conductas sexuales riesgosas. Por otro lado, se observa que el conocimiento aumenta de forma proporcional a la edad de la población, nivel educacional e historia previa de ITS. Conclusión: El déficit de conocimientos frente a las conductas sexuales de riesgo en la población joven favorece a un aumento en la prevalencia la infección por Clamidia, por lo cual es de suma importancia realizar nuevos estudios con el fin de aportar datos para potenciar programas de salud orientados a la concientización de los jóvenes frente a esta infección para así lograr disminuir la incidencia de esta enfermedad y sus complicaciones.

SUMMARY Introduction: Chlamydia trachomatis is one of the most common sexually transmitted infections in the population under 25 years old, causing serious problems for public health and the people's quality of life. Objective: Describe the knowledge and beliefs in the young population between 15 and 25 years old, related to Chlamydia infection in the Chilean and international context. Methods: Narrative review that includes qualitative and quantitative articles of the last 10 years, published in English and Spanish. Results: There is a lack of knowledge about Chlamydia infection, in the clinical characteristics, the transmission, and in the diagnostic tests, which causes the young population to underestimate the perceived risk and increase risky sexual behaviors. On the other hand, it is observed that knowledge increases proportionally to the population's age, educational level, and previous history of STIs. Conclusion: The lack of knowledge about risky sexual behavior in young population increase the prevalence of Chlamydia infection, due to this generates risky behaviors in the population, due to this, it is very important to conduct new studies in order to provide data to promote health programs oriented to raising awareness of young people against this infection and thus achieve to reduce the incidence of this disease and complications.

Prevalence of HIV/STIs and correlates with municipal characteristics among female sex workers in 13 Mexican cities / Prevalencia de VIH/ITS y correlaciones con carácterísticas municipales entre trabajadoras sexuales en 13 ciudades mexicanas

Abstract: Objective: To identify correlates of HIV/STI prevalence among 13 cities with varying sizes of female sex worker (FSW) populations and municipal characteristics in Mexico. Materials and methods: FSWs underwent interviews and testing for HIV, syphilis, gonorrhea and chlamydia. Logistic regression explored variations in HIV/STI prevalence. Results: Among FSWs (n=1 092), prevalence across 13 sites was: HIV: 0.4% (range: 0%-1.4%): syphilis: 7.8% (range: 0%-17.2%); chlamydia: 15.3% (range: 5.7%-32.2%); gonorrhea: 2.9% (range 0%-13.8%), and any HIV/STI: 23% (range: 9.9%-46%). Municipalities with high human development scores and a lower municipal marginalization index had higher odds of combined HIV/STI prevalence. After controlling for site-specific variability in municipal characteristics, greater risk of HIV/STIs was associated with lower education, having a spouse diagnosed or treated for an STI, unaffordability of condoms, and having non-Mexican clients. Conclusions: Prevalence of HIV/STIs varies across Mexican municipalities indicating the need for surveillance to identify hotspots for targeted resource allocation.

Resumen: Objetivo: Identificar correlaciones de la prevalencia de VIH / ITS entre 13 ciudades con diferentes tamaños de población de trabajadoras sexuales y características municipales en México. Material y métodos: Las trabajadoras sexuales fueron entrevistadas y recibieron pruebas de VIH, sífilis, gonorrea y clamidia. La regresión logística exploró las variaciones en la prevalencia del VIH/ITS. Resultados: Entre las trabajadoras sexuales (n = 1 092), la prevalencia en 13 sitios fue: VIH: 0.4% (rango: 0-1.4%): sífilis: 7.8% (rango: 0-17.2%); clamidia: 15.3% (rango: 5.7-32.2%); gonorrea: 2.9% (rango 0-13.8%) y cualquier VIH/ITS: 23% (rango: 9.9-46%). Los municipios con altos puntajes de desarrollo humano y menor índice de marginación municipal tuvieron una mayor probabilidad de prevalencia combinada de VIH/ITS. Después de controlar la variabilidad específica del sitio en las características municipales, el mayor riesgo de VIH / ITS se asoció con menor educación, tener un cónyuge diagnosticado o tratado para una ITS, imposibilidad de conseguir condones y tener clientes no mexicanos. Conclusiones: La prevalencia de VIH/ITS varía entre los municipios mexicanos, lo que indica la necesidad de una vigilancia para identificar hotspots para la asignación selectiva.

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.

Prevalencia de la infección genital por Chlamydia trachomatis en mujeres que asisten al Instituto Nacional de Perinatología de la Ciudad de México / Prevalence of genital Chlamydia trachomatis infection in women attending in the National Institute of Perinatology from Mexico City

Resumen Introducción: La infección endocervical por Chlamydia trachomatis es considerada una de las principales causas de infertilidad en todo el mundo. Durante el embarazo puede conducir a complicaciones graves como la ruptura prematura de membranas y los partos prematuros. Objetivo: Determinar la prevalencia de infección genital por C. trachomatis en mujeres embarazadas e infértiles de la Ciudad de México. Métodos: La detección de C. trachomatis fue mediante reacción de polimerasa en cadena tiempo real (RPC-TR) con el kit comercial COBAS® TaqMan CT Test v2,0 (Roche Molecular System). Resultados: Se analizaron 2.352 muestras; 102 fueron positivas (4,3%). La prevalencia por edad mostró que las adolescentes embarazadas (15 a 19 años) fueron las de mayor riesgo de infección (10,9%, RR = 3,23 [IC 95%: 1,79-5,84]), seguido de mujeres jóvenes de 20 a 24 años, con prevalencia de 5,6% (RR = 1,65 [IC 95%: 0,82-3,34]). Discusión: Los resultados indican que la prevalencia está dentro del rango reportado en el concierto mundial. Sin embargo, las adolescentes embarazadas tuvieron mayor prevalencia que las mujeres infértiles. Conclusión: Es imperioso realizar un rastreo sistemático de infección por C. trachomatis en mujeres bajo 24 años de edad, y en mujeres embarazadas para disminuir los casos de infertilidad y las complicaciones perinatales.

Background: Endocervical infection by Chlamydia trachomatis is considered one of the leading causes of infertility worldwide. During pregnancy, it can lead to serious complications such as premature rupture of membranes and premature births. Aim: To determine the prevalence of genital infection by C. trachomatis in pregnancy and infertile women from Mexico City. Methods: The detection of C. trachomatis was performed by real-time PCR with the commercial kit COBAS® TaqMan CT Test v2.0 (Roche Molecular System). Results: We analyzed 2,352 endocervical swabs; 102 were positive (4.3%). Age prevalence showed that pregnant adolescents (15 to 19 years of age) had the highest risk of infection (10.9%, RR = 3.23 [95% IC: 1.79-5.84]), followed by young women aged 20 to 24 years, with a prevalence of 5.6% (RR = 1.65 [95% IC: 0.82-3.34]). Discussion: The results indicate that the prevalence is within the range reported worldwide. However, pregnant adolescents were those with a higher prevalence than infertile women were. Conclusion: A systematic screening of C. trachomatis infection in women younger than 24 years of age, and in pregnant women is necessary to reduce the incidence of infertility and perinatal complications.

Documento: Chlamydia trachomatis: fundamentos de la importancia del cribado en el sistema público de salud / Document: Chlamydia trachomatis: fundamentals of the importance of screening in the public health system

Resumen La infección de transmisión sexual por Chlamydia trachomatis, tiene una alta prevalencia en Chile y otras latitudes, y se asocia a graves riesgos para la salud reproductiva de quienes se infectan. El cribado con autotoma de la muestra y detección mediante amplificación de ácidos nucleicos es la forma más eficaz de control sanitario. Hasta ahora, en Chile, el diagnóstico y manejo epidemiológico de C. trachomatis no se realiza en la salud pública. El Ministerio de Salud de Chile está haciendo importantes avances para iniciar esta implementación. La Sociedades Médicas se comprometen a participar en este proceso para lograr el eficaz control de esta infección en nuestra población.

The sexually transmitted infection caused by Chlamydia trachomatis has a high prevalence in Chile and other latitudes and is associated with serious risks to the reproductive health of those who become infected. Screening with self- collected samples and detection by amplification of nucleic acids is the most effective form of sanitary control. Until now, in Chile, the diagnosis and epidemiological management of C. trachomatis is not carried out in public health. The Ministry of Health of Chile is making important progress to start this implementation. The Medical Societies are committed to participate in this process to achieve effective control of this infection in our population.

Prevalence of Chlamydia trachomatis and Neisseria gonorrhea and associated factors among women living with Human Immunodeficiency Virus in Brazil: a multicenter study

Abstract Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) cause infections in the female genital tract, increasing susceptibility to and infectiousness of HIV. The objectives of the present study were to determine the prevalence and associated factors of CT and GC infection among HIV-infected women in Brazil. Methods: Cross-sectional study conducted from March to December 2015, including HIV-infected women attending referral centers in nine states of Brazil, aged 18-49 years, nonpregnant. An interview was conducted including socio-demographic, epidemiological and clinical characteristics. After the interview, gynecological examination was conducted to collect cervical cytology and vaginal secretion to C. trachomatis and N. gonorrhoeae tests through molecular biology. Results: A total of 802 (89.1%) women participated. The prevalence of CT was 2.1% (17/802) and CG was 0.9% (7/802). The prevalence of a positive test for both CT and/or GC was 2.7%. The factors associated with positive CT/GC test in the multivariate logistic regression analysis were abnormal Papanicolau smear (OR 4.1; 95% CI: 1.54-11.09) and the presence of abnormal cervical discharge (OR 2.6; 95% CI: 1.02-6.71). Among 377 women who reported previous STI 245 (65.0%) reported using condom more frequently after being diagnosed. 62 (16.4%) discovered the STI after the partner told he was infected; 157 (41.6%) had STI symptoms and looked for care, and 158 (41.9%) discovered it in a routine consultation for another reason. Conclusions: The control of STI represents a unique opportunity to improve reproductive health of women living with HIV. STI diagnosis can change their behavior and reduce the sexual transmission of HIV and bacterial STI.

Chlamydia trachomatis infection in young pregnant women in Southern Brazil: a cross-sectional study / Infecção por Chlamydia trachomatis em gestantes jovens no Sul do Brasil: um estudo transversal / Infección por Chlamydia trachomatis en gestantes jóvenes en el sur de Brasil: un estudio transversal

Abstract: This study estimated the prevalence of Chlamydia trachomatis infection during pregnancy in a sample of women up to 29 years of age in the city of Pelotas, Rio Grande do Sul State, Brazil, and investigated socio-demographic risk factors such as maternal age, marital status, maternal schooling, and family income. C. trachomatis infection was diagnosed with PCR using BD ProbeTecTM CT/GC Amplified DNA Assay. Socio-demographic, behavioral, and reproductive data were collected using structured questionnaires. All collections were performed by previously trained medical students. The study included a stratified probabilistic sample from four maternity hospitals in the city. The sample included 562 pregnant women, and prevalence of C. trachomatis infection was 12.3% (95%CI: 9.6-15.0). No significant association was identified between C. trachomatis infection and any of the target variables, including obstetric outcomes such as history of preterm delivery. Our findings in terms of low treatment adherence, only 43% of the women and 9.7% of partners, associated with high C. trachomatis prevalence, reinforce the need to implement routine screening for C. trachomatis during prenatal care. The attempt to diagnose and treat this infection after delivery, as in this study, limits the possibility of success.

Resumo: Este estudo estimou a prevalência de Chlamydia trachomatis durante a gestação entre mulheres de até 29 anos e investigou fatores de risco sociodemográficos, como idade materna, estado civil, escolaridade materna e renda familiar, para a infecção na cidade de Pelotas, Rio Grande do Sul, Brasil. Infecção por C. trachomatis foi diagnosticada por PCR utilizando BD ProbeTecTM CT/GC Amplified DNA Assay system. Dados sociodemográficos, comportamentais e reprodutivos foram coletados através de questionários estruturados. Todas as coletas foram realizadas por estudantes de medicina treinados. Amostra probabilística estratificada de quatro maternidades da cidade foi estudada. A amostra constou de 562 gestantes e a prevalência de infecção por C. trachomatis foi de 12,3% (IC95%: 9,6-15,0). Não foi identificada associação significativa entre infecção por C. trachomatis e as variáveis investigadas, incluindo desfechos obstétricos como parto pretermo. Nossos achados de baixa adesão ao tratamento, de apenas 43% entre as mulheres e de 9,7% entre os parceiros, associados a alta prevalência, reforçam a necessidade de implementar rastreamento de rotina para C. trachomatis durante a assistência pré-natal. A tentativa de diagnosticar e tratar esta infecção depois do parto, como feito neste estudo, limita a possibilidade de sucesso.

Resumen: Este estudio estimó la prevalencia de Chlamydia trachomatis durante la gestación, entre mujeres de hasta 29 años, e investigó factores de riesgo sociodemográficos como: edad materna, estado civil, escolaridad materna y renta familiar, para esta infección en la ciudad de Pelotas, Rio Grande do Sul, Brasil. La infección por C. trachomatis fue diagnosticada mediante PCR, utilizando BD ProbeTecTM CT/GC Amplified DNA Assay system. Los datos sociodemográficos, comportamentales y reproductivos se recogieron a través de cuestionarios estructurados. Todas las recogidas de datos se realizaron por parte de estudiantes de medicina entrenados. Se estudió la muestra probabilística estratificada de cuatro maternidades de la ciudad. La muestra constó de 562 gestantes y la prevalencia de infección por C. trachomatis fue de un 12,3% (IC95%: 9,6-15,0). No se identificó una asociación significativa entre infección por C. trachomatis y las variables investigadas, incluyendo desenlaces obstétricos como el parto pretérmino. Nuestros hallazgos de baja adhesión al tratamiento, solamente un 43% entre las mujeres y un 9,7% entre los compañeros, asociados a la alta prevalencia, refuerzan la necesidad de implementar una exploración de rutina para C. trachomatis durante la asistencia prenatal. La tentativa de diagnosticar y tratar esta infección después del parto, como se realizó en este estudio, limita la posibilidad de éxito.

Anogenital infection by Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected men and women in Salvador, Brazil

ABSTRACT Background: Infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae are the most common bacterial sexually transmitted infections throughout the world. These sexually transmitted infections are a growing problem in people living with HIV/AIDS. However, the presence of these agents in extra genital sites, remains poorly studied in our country. The objective of this study was to estimate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae anal and genital infection in people living with HIV/AIDS followed in a reference center in Salvador, Brazil. Methods: Cross-sectional study, from June 2013 to June 2015. Proven HIV-infected people attending this reference center were invited. Clinical and epidemiological data were obtained through interview with standardized form. Chlamydia trachomatis and Neisseria gonorrhoeae screening was performed using qPCR (COBAS 4800® Roche). Results: The frequency of positive cases of Chlamydia trachomatis and Neisseria gonorrhoeae was 12.3% in total, 9.2% cases amongst women and 17.1% amongst men. We found 14.0% of positive cases in anus and 3.1% in genital region in men, while 5.6% and 3.6%, in women, respectively. Among men, anal infection was associated with age <29 years (p = 0.033), report of anal intercourse (p = 0.029), pain during anal intercourse (p = 0.028). On the other hand, no association between genital infection and other variables were detected in bivariate analysis. Among women, we detected an association between Chlamydia trachomatis genital infection and age <29 years (p < 0.001), younger age at first sexual intercourse (p = 0.048), pregnancy (p < 0.001), viral load >50 copies/mL (p = 0.020), and no antiretroviral use (p = 0.008). Anal infection in women was associated with age <29 years old (p < 0.001) and pregnancy (p = 0.023), and was not associated with report of anal intercourse (p = 0.485). Conclusion: Missed opportunities for diagnosis in extra genital sites could impact on HIV transmission. The extra genital sites need to be considered to break the HIV and bacterial sexually transmitted infections chain-of-transmission.

La prevalencia actual de infección genital por Chlamydia trachomatis en adolescentes y mujeres jóvenes chilenas asintomáticas justifica la vigilancia periódica / The current prevalence of Chlamydia trachomatis infection among teenagers and young asymptomatic Chilean women justifies the periodic surveillance

Introduction: Chlamydia trachomatis infection constitutes the most common sexual transmitted disease (STD) among young women. International studies demonstrate that prevalence changes over time and also according to places. Aims: To estimate the prevalence of this infection among asymptomatic Chilean women (15 to 24 years old) and correlating with risk factor occurrence. Methods: Transversal cohort study to identify C. trachomatis infection through a diagnostic kit designed to detect and amplify cryptic plasmid DNA by quantitative PCR from endocervical sample. Results: 181 women were screened during the period of study. The overall prevalence estimate was 5.5% and founding significant estimate variations (0% to 14.6%) between recruiting centers. There was difference in number of sexual partners (4.1 vs 2.5; p<0.05) between positive and negative women. No difference was observed in age of first coitus, STD history, the use of barrier method or socioeconomic level. However, the probability of being carrier increases as greater is the number of sexual partners, especially when the use of barrier method is low. The latest is not related to the socioeconomic level. Conclusions: One of 12 to 18 women at this age range will have asymptomatic infection. The current prevalence and its variability substantiates the C. trachomatis screening and periodic surveillance.

Introducción: La infección por Chlamydia trachomatis constituye la infección de transmisión sexual (ITS) más común en población femenina joven. Estudios internacionales demuestran que su prevalencia cambia con el tiempo y en diferentes lugares. Objetivos: Estimar la prevalencia de esta infección en mujeres jóvenes chilenas (15 a 24 años), asintomáticas, y correlacionarla con factores de riesgo. Métodos: Estudio de corte transversal para detección de C. trachomatis mediante kit diagnóstico basado en amplificación de ADN plasmidial críptico y uso de RPC cuantitativa en secreción endocervical. Resultados: En el período de estudio fueron tamizadas 181 mujeres. La prevalencia global fue 5,5%, observándose variaciones significativas (0% hasta 14,6%) entre centros. Hubo diferencia en el número de parejas (4,1 vs 2,5; p = 0,04) entre infectadas o no. No hubo diferencia en edad de inicio de actividad sexual, historia de ITS, uso de preservativo o nivel socio-económico. Sin embargo, el riesgo de infección asintomática aumenta a mayor número de parejas sexuales y cuando el uso de método de barrera es infrecuente durante el coito, independiente del nivel socio-económico. Conclusiones: Una de cada 12 a 18 mujeres a esta edad presenta infección asintomática de C. trachomatis. La prevalencia actual y su variabilidad justifican el tamizaje y la vigilancia periódica de C. trachomatis.

Infección por Chlamydia trachomatis en pacientes de una institución de salud de Bogotá y Medellín, 2012-2015 / Chlamydia trachomatis infection in patients of a health institution of Bogota and Medellin, 2012-2015

Introduction: Chlamydia trachomatis presents clinical consequences and it is barely studied in Colombia. Objective: To compare the C. trachomatis infection in Bogotá and Medellín with specific frequencies by gender and age group, between 2012-2015. Methods: Descriptive study of multiple groups, with 1,660 people in Bogotá and 1,087 in Medellin. Anti-Chlamydia trachomatis test with recombinant antigens MOMP, TARP and CPAF was applied; 100% sensitivity and 99.6% specificity. It was estimated and compared the frequency of infection by gender and age group, by hypothesis testing, confidence intervals and prevalence ratios. Results: The largest proportion were women and people between 30-39 years. The frequency of positive IgG in Bogotá was 15.6% (95% CI = 13.4 to 17.8) in Medellin 16.9% (95% CI = 13.4 to 20.4), while the frequency of positive IgM was 0% in Medellin and 0.2% (95% CI = 0.01-1.0) in Bogotá; it was higher in women. In Bogotá, the frequency was higher in younger than 30 years and lower in older than 50. Discussion: The high frequency of infection, its greater occurrence in women, the differences found in the age groups, the low number of investigations in Colombia and clinical risks associated with C. trachomatis, show the need to improve surveillance, screening and research in this infection.

Introducción: Chlamydia trachomatis presenta graves consecuencias clínicas y es poco estudiada en Colombia. Objetivo: Comparar la infección por C. trachomatis en Bogotá y Medellín, y sus frecuencias específicas según sexo y grupo etario, 2012-2015. Material y Métodos: Estudio descriptivo de grupos múltiples, con 1.660 personas de Bogotá y 1.087 de Medellín. Se aplicó serología anti-Chalmydia trachomatis con antígenos recombinantes MOMP, TARP y CPAF; sensibilidad 100% y especificidad 99,6%. Se estimó y comparó la infección según sexo y grupo etario, mediante pruebas de hipótesis, intervalos de confianza y razones de prevalencia. Resultados: La mayor proporción correspondió a mujeres y personas entre 30-39 años. La frecuencia de historia de infección, según IgG, en Bogotá fue 15,6% (IC 95% = 13,4-17,8), en Medellín 16,9% (IC 95% = 13,4-20,4), mientras que con IgM fue 0% en Medellín y 0,2% (IC 95% = 0,01-1,0) en Bogotá; siendo mayor en las mujeres. En Bogotá, la frecuencia de infección fue más elevada bajo 30 años de edad y más baja sobre 50. Discusión: La elevada frecuencia de infección, la mayor ocurrencia en las mujeres, las diferencias halladas en los grupos etarios, el bajo número de investigaciones en Colombia y los riesgos clínicos asociados con C. trachomatis, evidencian la necesidad de mejorar la vigilancia, tamización e investigación en esta infección.

Prevalence and factors associated with Chlamydia trachomatis infection among women with HIV in São Paulo

Abstract: INTRODUCTION: This study aimed to estimate the prevalence and risk factors associated with Chlamydia trachomatis (CT) infection among women with HIV in São Paulo. METHODS: This cross-sectional study included women with HIV who were receiving care from sixteen public health services in São Paulo (October 2013 to March 2014). All participants answered a questionnaire regarding their sociodemographic, behavioral, and clinical characteristics. A urine sample was tested for CT and Neisseria gonorrhoeae (NG) using the polymerase chain reaction. The chi-square test and a logistic regression model were used to test the associations with CT or NG infections. RESULTS: We evaluated 853 women and ultimately included 836 (98%) women. The mean age was 40.5 ± 0.34 years, and the prevalences of CT and NG infections were 1.8% and 0.5%, respectively. CT infection was associated with CD4+ T-cell counts of <350 cells/mm3 [adjusted odds ratio (ORadj): 24.5], age of 18-25 years (ORadj: 23.2), the non-use of condoms during the last 6 months (ORadj: 10.2), a self-reported history of a sexually transmitted infection (ORadj: 9.4), and having two or more sexual partners during the last year (ORadj: 6.1). CONCLUSIONS: Although we observed a low prevalence of CT infection among women with HIV, younger age was associated with a high risk of infection. Therefore, it may be appropriate to include screening for CT as part of the routine care for this population.

Virus papiloma humano y Chlamydia trachomatis según número de parejas sexuales y tiempo de actividad sexual en estudiantes universitarias en la Región de La Araucanía, Chile / Human papilloma virus and Chlamydia trachomatis by number of sexual partners and time of sexual activity on university students in the Region of La Araucanía, Chile

Introducción: El virus papiloma humano (VPH) y Chlamydia trachomatis son las infecciones de transmisión sexual (ITS) más frecuentes, en adolescentes y jóvenes, con factores de riesgo: vida sexual activa y múltiples parejas. Chlamydia trachomatis puede favorecer el ingreso de VPH y éste el desarrollo del cáncer cérvico uterino. Ambas infecciones pueden dejar secuelas en la salud sexual y reproductiva. Objetivo: Determinar frecuencias VPH y C trachomatis en estudiantes universitarias asinto-máticas bajo 25 años, asociándolas con número de parejas sexuales (n°PSx) y tiempo de actividad sexual (TASx). Material y Método: Se procesaron 151 muestras/exo y endo cervicales para VPH y C. trachomatis, mediante reacción de polimerasa en cadena convencional y en tiempo real. Resultados: La frecuencia fue: VPH 21,8%, C. trachomatis 11,2% y co-infección 4,6%. De las jóvenes con infección por VPH, 80,6% presentó VPH alto riesgo oncogénico. El n°PSx se asoció fuertemente a VPH. Entre las jóvenes con co-infección VPH/C. trachomatis, 71,4% tenían tres o más PSx. Según TASx, C. trachomatis fue más frecuente (64,7%) entre 3-5 años que VPH. Conclusión: Se observó alta prevalencia de VPH y C trachomatis. Mujeres jóvenes con co-infección VPH/C. trachomatis podrían ser un grupo de alto riesgo con necesidad de mo-nitorear sus infecciones. Es sugerida la implementación de programas universitarios en educación, orientación y prevención en ITS.

Background: Human papilloma virus (HPV) and Chlamydia trachomatis are the most prevalent sexually transmitted infections (STIs), among teenagers and young people, with risk factors: active sex life and multiple partners. Chlamydia trachomatis infection may favor HPV infection and this, the development of cervical cancer. Both infections can lead to consequences on sexual and reproductive health. Objective: To determine frequency of HPV and C. trachomatis in asymptomatic university women less than 25 years, associating them with number of sexual partners (n°SxP) and time of sexual activity (TSxA). Material andMethods: 151 cervical samples for HPV and C. trachomatis, were processed by conventional and in real time reaction polymerase chain. Results: HPV 21, 8%, C. trachomatis 11, 2% and co-infection (HPV/C.trachomatis), 4.6%. Aimong HPV +, 80, 6% showed high risk HPV. The n°SxP was strongly associated with HPV. Aimong young coinfected HPV/C. trachomatis, 71.4% had 3 or more PSx. Chlamydia trachomatis was more frequent (64,7%) that HPV within range of 3-5 years according to the TSxA, Discussion: A high prevalence of HPV and C. trachomatis was observed. Young women with coinfection HPV/C. trachomatis could be a high-risk group need to monitor their infections. It suggests the implementation of university programs in education, counseling and prevention in sexual health.

Association of human papillomavirus and Chlamydia trachomatis with intraepithelial alterations in cervix samples

The influence of different infectious agents and their association with human papillomavirus (HPV) in cervical carcinogenesis have not been completely elucidated. This study describes the association between cytological changes in cervical epithelium and the detection of the most relevant aetiological agents of sexually transmitted diseases. Samples collected from 169 patients were evaluated by conventional cytology followed by molecular analysis to detect HPV DNA, Chlamydia trachomatis, herpes simplex virus 1 and 2,Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, andTreponema pallidum, besides genotyping for most common high-risk HPV. An association between cytological lesions and different behavioural habits such as smoking and sedentariness was observed. Intraepithelial lesions were also associated with HPV and C. trachomatis detection. An association was also found between both simple and multiple genotype infection and cytological changes. The investigation of HPV and C. trachomatisproved its importance and may be considered in the future for including in screening programs, since these factors are linked to the early diagnosis of patients with precursor lesions of cervical cancer.