COMPARISON OF PERMANENT STAINING METHODS FOR THE LABORATORY DIAGNOSIS OF TRICHOMONIASIS

Trichomonas vaginalis is the etiologic agent of trichomoniasis, the most common non-viral sexually transmitted disease (STD) in the world. The diagnosis is based on wet mount preparation and direct microscopy on fixed and stained clinical specimens. The aim of this study was to compare the performance of different fixing and staining techniques used in the detection of T. vaginalis in urine. The smears were fixed and submitted to different methods of permanent staining and then, the morphological aspects of the parasites were analyzed and compared. The Papanicolaou staining with ethanol as the fixative solution showed to be the best method of permanent staining. Our data suggest that staining techniques in association with wet mount examination of fresh specimens contribute to increase the sensitivity in the diagnosis of trichomoniasis.

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.

Comparative study between different methods for diagnosing vaginal trichomoniasis

This study, started in 1st of October 1991 and ended in 30th of September 1992, included 300 cases presenting to Obstetric and Gynecological Outpatient Clinic at Al-Zahraa University Hospital. Different methods for diagnosing Trichomonas vaginalis such as Wetmount smear culture, Papanicolaou stain and colposcopic examination, were done to the cases aiming to point out the most sensitive method of diagnosis. 46% [138 out of 300 cases] had positive T. vaginalis by culture method. The wet mount examination had 38% [114 out of 300 cases] positive cases for T. vaginalis. It gave 8% false -ve results compared with culture results. The Papanicolaou modified stain showed 12.3% positive T-V, which made this method not sensitive and having a false -ve results. The colposcopic abnormal finding was found in 75% of cases giving a high false +ve results compared with culture results. The highest rate of infection with T. vaginalis was among infertility cases [62%] followed by intrauterine contraceptive device [IUCD] users [55.7%], and grand multipara [50%]

Candidiasis vaginal: diagnóstico y tratamiento en la práctica ginecológica / Candidiasis, vaginal: diagnosis and treatment in the practice

El tratamiento efectivo de las Candidiasis vaginal se ha convertido en un problema social y terapéutico, porque es una enfermedad muy molesta aunque no compromete la vida, compromete la felicidad de la vida conyugal. El uso de los conazoles en cualquiera de sus formas en el presente, es una solución. Pero el problema de las recurrencias frustran severamente los resultados, por lo que es necesario controlar, tratar los factores predisponentes para el fracaso o la recurrencia. Se debe tener en cuenta que el factor sexual en la que está envuelta la pareja, deberá ser considerado en la terapéutica paralela, así como todos los cuidados para evitar la infectación. Con el avance de la farmacología anti fungicida, deberemos considerar que mientras no consiga la forma de crear defensa en la vagina contra la Candida, ésta seguirá invadiéndola. Por lo tanto, es buena técnica de utilizar de manera profiláctica tratamiento local, de preferencia, o en el futuro, la dosis única oral para prevenir reinfecciones