Cervicitis necrótica por co-infección de virus herpes simplex 2 y Mycoplasma genitalium / Necrotic cervicitis for co-infection of herpes simplex virus 2 and Mycoplasma genitalium

Resumen Las cervicitis es una condición frecuente causada principalmente por agentes de transmisión sexual. Su presentación clínica varía desde cuadros asintomáticos hasta procesos inflamatorios extensos, que incluso asemejan un tumor maligno. Presentamos el caso de una adolescente que presentó úlceras genitales, síntomas generales y cérvix necrótico con aspecto tumoral. Los estudios de laboratorio confirmaron una co-infección por virus herpes simplex 2 (HSV-2) y Mycoplasma genitalium. El estudio histológico descartó una neo- plasia. Evolucionó favorablemente al tratamiento antimicrobiano, con recuperación progresiva del aspecto del cérvix. La cervicitis en raras ocasiones se presenta con compromiso necrótico. La co-infección por HSV-2 y M. genitalium, en este caso, pudo ser el determinante del daño cervical y la necrosis. Una evaluación acuciosa y estudio con exámenes diagnósticos de alta sensibilidad y especificidad permitieron hacer un diagnóstico y tratamiento adecuado.

Abstract Cervicitis is a frequent condition caused mainly by sexually trans- mitted agents. The clinical spectrum varies from absence of symptoms to extensive inflammatory processes that may simulate a malignant neoplasm. We present a clinical case of an adolescent with genital ulcers and systemic disease. Speculoscopy revealed a tumoral-looking cervix. Laboratory studies confirm infection with herpes simplex virus 2 (HSV-2) and Mycoplasma genitalium, together with a histological study that ruled out neoplasia. It progresses favorably to antimicrobial treatment, with recovery of the appearance of the cervix. Cervicitis rarely presents with necrotic involvement. Co-infection with HSV-2 and M. genitalium infection may have been the determinant of cervical damage and the necrotic appearance. A thorough evaluation and study with highly sensitive and specific diagnostic tests allowed an adequate diagnosis and treatment.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecções que causam cervicite / Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause cervicitis / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infecciones que causan cervicitis

As infecções que causam cervicite são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo apresenta aspectos epidemiológicos e clínicos das infecções que causam cervicite, bem como recomendações sobre a triagem, diagnóstico e tratamento das pessoas acometidas e suas parcerias sexuais. Além disso, discutem-se estratégias para as ações de vigilância, prevenção e controle desses agravos para os profissionais de saúde e gestores envolvidos no manejo programático e operacional das infecções sexualmente transmissíveis. A ampliação do acesso aos testes para diagnóstico e o tratamento precoce são cruciais para o controle da disseminação dos patógenos causadores de cervicite.

Infections that cause cervicitis are a topic presented in the "Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections", published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with experts. This article presents epidemiological and clinical aspects of infections that cause cervicitis, as well as recommendations on screening, diagnosis and treatment of affected people and their sexual partnerships. In addition, it discusses strategies for surveillance, prevention and control of these infections for health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections. Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cevicitis.

Las infecciones que causan cervicitis son uno de los temas que integran el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. El documento fue desarrollado en base a evidencia científica y validado en discusiones con expertos. Este artículo presenta aspectos epidemiológicos y clínicos de las infecciones que causan cervicitis, así como recomendaciones sobre el cribado, diagnóstico y tratamiento de las personas afectadas y sus parejas sexuales. Además, se discuten estrategias de vigilancia, prevención y control de estas enfermedades para los profesionales y gestores de salud involucrados en el manejo programático y operativo de las infecciones de transmisión sexual. Ampliar el acceso a las pruebas de diagnóstico y a un tratamiento precoz es crucial para controlar la propagación de los agentes patógenos que causan cervicitis.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecções que causam cervicite / Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause cervicitis / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infecciones que causan cervicitis

Resumo As infecções que causam cervicite são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo apresenta aspectos epidemiológicos e clínicos das infecções que causam cervicite, bem como recomendações sobre a triagem, diagnóstico e tratamento das pessoas acometidas e suas parcerias sexuais. Além disso, discutem-se estratégias para as ações de vigilância, prevenção e controle desses agravos para os profissionais de saúde e gestores envolvidos no manejo programático e operacional das infecções sexualmente transmissíveis. A ampliação do acesso aos testes para diagnóstico e o tratamento precoce são cruciais para o controle da disseminação dos patógenos causadores de cervicite.

Abstract Infections that cause cervicitis are a topic presented in the "Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections", published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with experts. This article presents epidemiological and clinical aspects of infections that cause cervicitis, as well as recommendations on screening, diagnosis and treatment of affected people and their sexual partnerships. In addition, it discusses strategies for surveillance, prevention and control of these infections for health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections. Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cevicitis.

Resumen Las infecciones que causan cervicitis son uno de los temas que integran el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. El documento fue desarrollado en base a evidencia científica y validado en discusiones con expertos. Este artículo presenta aspectos epidemiológicos y clínicos de las infecciones que causan cervicitis, así como recomendaciones sobre el cribado, diagnóstico y tratamiento de las personas afectadas y sus parejas sexuales. Además, se discuten estrategias de vigilancia, prevención y control de estas enfermedades para los profesionales y gestores de salud involucrados en el manejo programático y operativo de las infecciones de transmisión sexual. Ampliar el acceso a las pruebas de diagnóstico y a un tratamiento precoz es crucial para controlar la propagación de los agentes patógenos que causan cervicitis.

Brazilian protocol for sexually transmitted infections, 2020: infections that cause cervicitis

Abstract Infections that cause cervicitis are a topic presented in the "Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections", published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with experts. This article presents epidemiological and clinical aspects of infections that cause cervicitis and recommendations on screening, diagnosis, and treatment of affected people and their sexual partnerships. Also, it discusses strategies for surveillance, prevention, and control of these infections for health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections. Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cervicitis.

Comparação da Quantidade de Células de Langerhans em Neoplasias Intraepiteliais Cervicais e Cervicites Crônicas / Comparison of the Quantity of Langerhans Cells in Cervical Intraepithelial Neoplasia and Chronic Cervicitis / Comparación de la Cantidad de Células de Langerhans en Neoplasias Intraepiteliales Cervicales y Cervicites Crónicas

Introdução: O câncer cervical é atribuído ao papilomavírus humano (HPV) cuja infecção, na maioria das vezes, sofre regressão espontânea. A menor porção de casos que evoluem para lesão precursora de baixo e alto graus e invasora pode ter relação com uma falha na atividade das células de Langerhans em eliminar o vírus. Objetivo: Determinar se há redução do número de células de Langerhans em colos uterinos acometidos por neoplasias intraepiteliais cervicais (NIC), graus I e III, comparado ao grupo controle (cervicites crônicas), por imuno-histoquímica, possibilitando correlacionar a ação do sistema imune com o desenvolvimento dessas lesões. Método: Foram analisados 40 casos de cervicite crônica, NIC I e III, com diagnóstico anatomopatológico entre janeiro de 2014 e dezembro de 2015, buscando-se comparar a quantidade de núcleos marcados positivamente como célula de Langerhans pela proteína S-100 por imuno-histoquímica, quantificando-os em áreas padronizadas. Resultados: Dos 40 casos avaliados, 17 foram cervicite crônica, 13 NIC I e 10 NIC III. Na análise comparativa do número de células em cada grupo a média, desvio-padrão e mediana foram maiores no grupo cervicite crônica e menores no grupo NIC III. O valor de p encontrado para a variação do número de células de Langerhans, entre os grupos, foi significativo (p=0,0442); mas, ao comparar os grupos de NIC com o controle, só o grupo NIC III teve variação significativa (p=0,0209). Conclusão:Há diminuição significativa do número de núcleos de células de Langerhans marcados em lesões do tipo NIC III em comparação a cervicites crônicas.

Introduction: Cervical cancer is attributed to human papillomavirus (HPV), whose infection mostly undergoes spontaneous regression. The smaller part of cases that evolve to low and high-grade lesions or invasive lesions may be related to failure of Langerhans cell activity to eliminate the virus. Objective: To determine if there is reduction of Langerhans' cells in cervix uterus affected by cervical intraepithelial neoplasms (CIN) grades I and III compared to control group (chronic cervicitis) by immunohistochemistry, granting the correlation of the immune system action with the development of these lesions. Method: It were analyzed 40 cases of chronic cervicitis, CIN I and III with anatomopathological diagnosis between January 2014 and December 2015, attempting to compare the amount of positively labeled Langerhans cells nuclei by S-100 protein by immunohistochemistry, quantifying them in standard areas. Results: Of the 40 evaluated cases, 17 were chronic cervicitis, 13 CIN I and 10 CIN III. The comparative analysis of the number of cells in each group showed that the mean, standard deviation and median number of Langerhans cells per area were higher in the chronic cervicitis group and lower in the CIN III group. The p value found in the variation of the Langerhans cells number among the groups was significant (p=0.0442). However, when comparing the CIN groups directly with the control group, only the CIN III group had a significant variation (p=0.0209). Conclusion: There is a significant decrease in the number of marked Langerhans cell nuclei in CIN III type lesions compared to chronic cervicitis.

Introducción: El cáncer cervical puede atribuirse al virus del papiloma humano (VPH) cuya infección a menudo sufre regresión espontánea. El menor número de casos que evolucionan a lesiones precursoras de bajo y alto grado o invasivas puede estar relacionado con una falla en la actividad de las células de Langerhans para eliminar el virus. Objetivo: Determinar si hay reducción del número de células de Langerhans en colos uterinos acometidos por neoplasias intraepiteliales cervicales (NIC) grados I y III comparado al grupo control (cervicitis crónicas), por medio de inmunohistoquímica, posibilitando correlacionar la acción del sistema inmune con estas lesiones. Método: Se analizaron 40 casos de cervicitis crónica, NIC I y III, con diagnóstico anatomopatológico entre enero de 2014 y diciembre de 2015, comparando la cantidad de núcleos marcados positivamente como célula de Langerhans por la proteína S-100 por inmuno-histoquímica, cuantificándolos. Resultados: De 40 casos, 17 fueron cervicitis crónica, 13 NIC I y 10 NIC III. En el análisis comparativo del número de células en cada grupo la media, desviación estándar y mediana fueron mayores en el grupo cervicite crónica y menores en el NIC III. El valor de p encontrado para la variación del número de células de Langerhans entre los grupos fue significativo (p=0,0442), pero al comparar los grupos de NIC con el control sólo el grupo NIC III tuvo variación significativa (p=0,0209). Conclusión: Hay disminución significativa del número de núcleos marcados de células de Langerhans en lesiones de tipo CIN III en comparación con cervicitis crónica.

Cervical tuberculosis masquerading as cancer cervix: A report of three cases.

Summary: Tuberculosis is still frequently observed in third world countries like Africa and Asia. Here we report three cases of genital tuberculosis with variable presentations. First case was a lady of reproductive age group who presented with polymenorrhea and post-coital bleeding with unhealthy cervix. Histopathology of cervical tissue revealed tubercular cervicitis. Second and third cases presented with different complaints like discharge per vaginum, post-coital bleeding and pain in lower abdomen with growth over the cervix. Cervical biopsy was inconclusive of tuberculosis but endometrial tissue sampling for TB PCR was positive. This shows that newer diagnostic marker test can help us to detect secondary genital tuberculosis.

Perinatal morbidity and mortality associated with chlamydial infection: a meta-analysis study

OBJECTIVE: To evaluate the effect of Chlamydia trachomatis infection during pregnancy on perinatal morbidity and mortality. METHODS: Systematic review and meta-analysis in an electronic database and manual, combining high sensitivity specific descriptors seeking to answer the research objective. The articles considered to be of high methodological quality (score above 6 on the Newcastle-Ottawa Scale) were assessed by meta-analysis. RESULTS: Summary estimates of 12 studies were calculated by means of Mantel-Haenszel test with 95 percent confidence interval. It was observed that Chlamydia infection during pregnancy increased risk of preterm labor (relative risk (RR) = 1.35 [1.11, 1.63]), low birth weight (RR = 1.52 [1.24, 1.87]) and perinatal mortality (RR = 1.84 [1.15, 2.94]). No evidence of increased risk was associated with Chlamydia infection in regard to premature rupture of membranes (RR = 1.13 [0.95, 1.34]), abortion and postpartum endometritis (RR = 1.20 [0.65, 2.20] and 0.89 [0.49, 1.61] respectively). CONCLUSION: The diagnosis and treatment of Chlamydia cervicitis during pregnancy can reduce perinatal morbidity and mortality associated with this infection. However, clinical trials are needed to confirm these findings.

[ incidence of co-occurrence of chlamydial cervicitis with bacterial vaginosis]

Bacterial vaginosis is caused by an imbalance in normal vaginal bacterial flora mainly caused by the introduction of pathogenic bacteria. Failure to properly treat this condition cannot only induce abortion but also increase the chance of acquiring other serious infections such as AIDS, gonorrhea and chlamydiosis. Chlamydia trchomatis is one of the causative agents of cervicitis of which 70% is totally asymptomatic. Untreated cases can lead to salpengititis, pelvic inflammatory diseases, infertility, pelvic area pains and other complications. The purpose of this study was to determine the co-occurrence of these two conditions. A total of 137 patients were examined for both Chlamydial cervicitis and for bacterial vaginosis. Gram stain was used to detect bacterial vaginosis and anti-chlamydial antibodies were titered by microimmunofluoresence [MIF] assay. According to the MIF results, 10 patients [7.3%] had elevated anti-chlamydial IgG and 3 patients [2.2%] showed high IgM titers. Gardnerella vaginalis was detected in 6 patients [4.7%] as the causative agent of vaginosis. There were 3 cases of co-occurrence of chlamydial cervicitis and bacterial vaginosis [30%]. Due to the fact that bacterial vaginosis can provide the pre-disposing conditions for cervicitis and its chronicity and the similarity of the cilinical singns of these two conditions, Infections with Chlamydia are often overlooked. It therefore seems necessary to check any patient with bacterial vaginosis for chlamydial co-infection

Nuevos paradigmas y desafíos en la prevención y control del cáncer de cuello uterino en América Latina / New paradigms and challenges in cervical cancer prevention and control in Latin America

El cáncer de cuello uterino sigue siendo un problema de salud pública en Latinoamérica. El uso de la citología para la detección de lesiones pre-cancerosas no ha tenido mayor impacto en las tasas de incidencia y mortalidad, que aún se mantienen altas en la región. La disponibilidad de nuevas técnicas de tamizaje para la detección de lesiones pre-cancerosas y de vacunas altamente eficaces que previenen casi todas las lesiones relacionadas con VPH-16 y VPH-18 en mujeres no expuestas previamente al virus representan una gran oportunidad para la prevención del cáncer de cuello uterino en la región. En este manuscrito resumimos la evidencia científica y la experiencia de la región en i) el uso de pruebas de VPH y de la inspección visual después del ácido acético (IVAA) en tamizaje primario, y ii) la implementación de programas de vacunación en adolescentes. Finalmente enumeramos una serie de recomendaciones adecuadas para distintos escenarios. La factibilidad de implementar un programa nacional de prevención de cáncer de cuello uterino exitoso y sostenible en países latinoamericanos dependerá de las prioridades de salud, la infraestructura y personal de salud disponible, determinadas luego de un riguroso análisis situacional local.

Cervical cancer continues to be a significant health problem in Latin America. The use of conventional cytology to detect precancerous cervical lesions has had almost no major impact on reducing cervical cancer incidence and mortality rates, which are still high in the region. The availability of new screening tools to detect precancerous lesions provide great opportunities for cervical cancer prevention in the region, as do highly efficacious HPV vaccines able to prevent nearly all lesions associated with HPV-16 and -18 when applied before viral exposure. This paper summarizes the scientific evidence and regional experiences related to: i) the use of HPV testing and visual inspection after the application of acetic acid (VIA) in primary screening and ii) the implementation of adolescent HPV vaccination programs. Finally, we outline a number of recommendations for different resource settings. The feasibility of implementing successful and sustainable national cervical cancer prevention programs in Latin American countries in the region will depend on health priorities and the availability of infrastructure and health personnel-as determined by rigorous local situational analysis.

Rastreamento universal para cervicite clamidiana: uma revisão sistemática / Universal screening for chlamydial cervicitis: a systematic review

A revisão sistemática teve como objetivo avaliar a efetividade dos testes de ácido nucleico no rastreio da C. trachomatis. A maioria dos estudos foi localizada via internet, entretanto, alguns deles foram encontrados em revistas que abordavam o tema e mediante contato com especialistas. Os artigos foram selecionados após criteriosa avaliação crítica da força de evidência científica, obedecendo às regras da Associação Médica Brasileira e do Conselho Federal de Medicina, além dos critérios de Irwig, para análise qualitativa dos artigos. A revisão incluiu todos os estudos publicados a partir de 1990 que avaliavam testes de ácido nucleico em mulheres sexualmente ativas, assintomáticas e que tivessem sido submetidas à avaliação clinica e a testes moleculares. Os testes de ácido nucleico que utilizavam sondas de RNA e amplificação de DNA (PCR) foram comparados à cultura (padrão-ouro) com o intuito de determinar se seriam método de diagnóstico adequado para o rastreio da infecção. Após análise qualitativa, foram selecionados 12 estudos, mas não foi possível realizar avaliação quantitativa dos mesmos devido à heterogeneidade dos dados. A efetividade e os benefícios dos testes de ácido nucleico justificam estudos de custo-efetividade, com o intuito de avaliar o impacto do rastreio universal na redução das complicações advindas da infecção clamidiana

This systematic review aims at evaluating the effectiveness of the nucleic acid test for detection of C. trachomatis. Most of the studies were searched electronically and key journals were hand-searched. Further studies were identified in the internet and by contacting experts in the field. The articles were selected after careful critical evaluation of the strength of scientific evidence, according to the rules of the Brazilian Medical Association and the Federal Council of Medicine, besides the Irwig's criteria for qualitative analysis of article The review included all studies published from 1990 onward that evaluated nucleic acid tests in asymptomatic, young and sexually active women that have been subjected to clinical evaluation and molecular testing. The nucleic acid tests taken with the use of probes of RNA and amplification (PCR) were compared to culture (gold standard) in order to determine if a method of diagnosis would be appropriate for screening of infection. After the qualitative analysis, we selected 12 studies; it has not been possible to perform their quantitative evaluation due to the heterogeneity of data. The effectiveness and benefits of DNA testing justify the cost-effectiveness studies in order to assess the impact of universal screening in reducing the complications that arise from chlamydial infection

Infección por Chlamydia trachomatis en mujeres consultantes en Maracaibo, Venezuela / Chlamydia trachomatis infection in females consulting health centres in Maracaibo, Venezuela

Objetivo Evaluar la prevalencia de infecciones por Chlamydia trachomatis en un grupo de mujeres sintomáticas y asintomáticas que asistieron a control en servicios de ginecología en centros de salud de Maracaibo, estado Zulia. Métodos Se incorporaron al estudio 168 pacientes que asistieron a dos centros de salud de Maracaibo. Se llevó a cabo evaluación ginecológica basada en examen pélvico, de áreas profundas de la vagina y cuello uterino. Las pacientes fueron clasificadas en grupos etarios y de acuerdo a la presencia de manifestaciones clínicas. Para investigar C. trachomatis, se aplicaron dos ensayos de amplificación de ADN del plásmido endógeno y del gen OMP1, a partir de hisopados endocervicales. Resultados Se evaluaron 168 pacientes, 81 (48,2 por ciento) sintomáticas y 87 (51,8 por ciento) asintomáticas. Se encontró una prevalencia de 7,7 por ciento en la población total evaluada. La prevalencia fue de 9,9 por ciento y 5,8 por ciento para las pacientes sintomáticas y asintomáticas, respectivamente (p>0,05). El grupo de pacientes de 18-28 años exhibió la más alta prevalencia (13,7 por ciento) (p=0,0322). Las manifestaciones clínicas predominantes fueron secreción mucopurulenta (35,8 por ciento) y cervicitis (21 por ciento). C. trachomatis fue detectada en 7,1 por ciento pacientes con secreción mucopurulenta y 23,5 por ciento casos de cervicitis, pero no se demostró asociación significativa entre infección y manifestaciones clínicas individuales (p>0,05). Conclusión Se encontró una mediana prevalencia de infecciones por C. trachomatis en la población evaluada, exhibiendo mayor frecuencia en mujeres jóvenes. Este microorganismo debería ser investigado en mujeres jóvenes sexualmente activas, independientemente de su condición sintomática o asintomática.

Objective Evaluating Chlamydia trachomatis infection prevalence in a group of symptomatic and asymptomatic females attending gynaecology services in health centres in Maracaibo in the state of Zulia in Venezuela. Methodology 168 patients attending two health centres in Maracaibo were included in this study. Gynaecological evaluation was based on examining the pelvis, deep areas of the vagina and the cervix. Patients were classified into groups according to age and the presence of clinical manifestations. Two DNA amplification assays of endogenous plasmid and the omp1 gene taken from endocervical swabs were used for investigating C. trachomati. Results 168 patients were evaluated; 81 (48,2 percent) were symptomatic and 87 (51,8 percent) asymptomatic, A 7,7 percent prevalence (p>0.05) was found in the total population (9,9 percent prevalence for symptomatic patients and 5,8 percent for asymptomatic ones). The 18- 28 year old patient group exhibited the highest prevalence (13,7 percent) (p=0.0322). The predominant clinical manifestations were mucopurulent secretion (35,8 percent) and cervicitis (21 percent). C. trachomatis was detected in 7,1 percent of patients having mucopurulent secretion and 23,5 percent of cervicitis cases; however, no significant association between infection and individual clinical manifestations was shown (p>0.05). Conclusion Medium C. trachomatis infection prevalence was found In the population being assessed here, the highest frequency being exhibited in young females. This microorganism should be investigated in sexually-active young women, regardless of their symptomatic or asymptomatic status.

Prevalencia de infección cervical por Chlamydia trachomatis en mujeres de la Región Metropolitana / Prevalence of cervical infection by Chlamydia trachomatis among Chilean women living in the Metropolitan Región

Background: Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) worídwide. In women, chlamydia infections are 75 percent asymptomatic and can lead to pelvic inflammatory disease, infertility, and ectopic pregnancy. Infants exposed to the microorganism at birth also have a high risk to develop conjunctivitis and pneumonía. Aim: To determine the prevalence of C trachomatis in women in the Metropolitan área of Santiago (Chile). Patients and methods: Cervical specimens were collected from 403 women attending three gynecological outpatient settings from Apríl 2003 to June 2005. These included one public hospital (n =100), a prívate medical center (n =268), and a clinic for adolescents (n =35). Mean ages ofeach group of patients were 35.6±8,2, 33.4±8.1 and 16.9±4.2 years, respectively. The diagnosis of C trachomatis was performed by the amplification byPCRofa 517-base pair segment of the cryptic plasmid on specimens extracted by a commercial procedure. Positive specimens were conñrmed by nested PCRs targeting the ompl gene. The presence of vaginal infections and its association with C trachomatis was investigated in a subset of 223 women ofthe prívate center. Residís: C trachomatis was detected in the cervix of 19 out of 403 women, resulting in a prevalence of 4.7 percent. The distribution of positive cases among different age groups was not significantly different. Women presenting with bacterial vaginosis had a significantly higher prevalence of C trachomatis infection (p <0.01). Conclusions: This study found a high prevalence of C trachomatis among gynecologic patients that should prompt preventive strategies.

Program issues in delivering targeted STI services through the public sector in the Greater Mekong region.

This review discusses the delivery of targeted STI services for both female sex workers (FSWs) and other high-risk groups through the public sector in the Greater Mekong region. Vaginal discharge algorithms for the general population are also discussed. High STI rates that justify targeted interventions have been reported recently amongst FSW in Cambodia, Lao PDR and Vietnam. Such interventions need to take into account the different patterns of sex work in the three countries. In Cambodia, there are large numbers of brothel-based FSWs although this pattern is changing as more brothels are closed by the authorities. In Lao PDR, services targeted towards reducing the burden of HIV/STI in FSW/service women are probably best delivered through NGO-led clinics. In Vietnam, commune based district health centers appear to offer better services for FSW than STI clinics. Male clients of FSW are an important group to target, but reaching such a heterogeneous population is difficult. Provision of quality STI drugs to those places where men present with STI symptoms should be a priority. The optimal way to manage STIs in FSWs is still unclear in this region. Clinical and laboratory specialists are keen to promote laboratory tests for STIs but there is an over reliance on direct staining techniques. In areas with high STI prevalences, periodic presumptive treatment could offer an effective option to reduce STI levels in high-risk groups until syndromic management algorithms are evaluated for local use. Social patterns of sex work are changing continually and require close monitoring in the future so that services can be adapted to these changes.

Cervicite por Chlamydia trachomatis em mulheres sexualmente ativas atendidas em um serviço privado de ginecologia na cidade de Fortaleza / Chlamydia trachomatis cervicitis in sexual actives women from a private gynecologic service in Fortaleza city

Introdução: A infecção por Chlamydia trachomatis geralmente é assintomática, acomete mulheres jovens sexualmente ativas e, quando não tratada adequadamente, pode ocasionar complicações como doença inflamatória pélvica, infertilidade e gravidez ectópica. Objetivos: Avaliar a freqüência de cervicite por Chlamydia trachomatis em serviço privado, na cidade de Fortaleza e correlacionar a infecção com achados clínicos.Métodos: Foram utilizadas amostras colhidas de 214 mulheres sexualmente ativas, atendidas em serviços de ginecologia geral na cidade de Fortaleza, processadas através do método de Captura Híbrida (Digene ®) para detecção de DNA-Chlamydia trachomatis. Resultados: Foram encontrados 6,08 de mulheres com positividade para C. trachomatis. A faixa etária com maior prevalência foi 26-30 anos. A infecção ocorreu em pacientes assintomáticas em 6,2 dos casos e, dentre as pacientes em que havia suspeita clinica, em 5,7. Por outro lado, nos casos positivos, 61,63 não apresentavam queixas. Conclusão: A freqüência de cervicite por C. trachomatis em mulheres jovens sexualmente ativas não teve relação com sintomas ou achados clínicos, ressaltando a necessidade de um rastreio a fim de realizar o tratamento adequado, evitando possíveis complicações bastante dispendiosas, tanto para as mulheres quanto para a sociedade.

Subclinical infection of the genital tract with Neisseria meningitidis

We report the isolation of Neisseria meningitidis, characterized as B:NT:P1.7, from a female patient's genital tract in an outpatient clinic for HIV care. The gynecology clinic, as part of the follow up, collects specimens from all patients with HIV infection for routine exams and for early laboratory detection of sexually transmitted diseases . A Gram-negative diplococcus was isolated from the cervix of a heterosexual patient with AIDS. Based on this and other reported cases, urogenital infection with N. meningitidis can no longer be considered uncommon. The rising incidence of N. meningitidis isolated from this and similar sites has significant medical and diagnostic implications.

A report of two unsuspected cases of cervical tuberculosis.

Tuberculosis of the uterine cervix is an uncommon disease. Two cases of unsuspected cervical tuberculosis are reported. In Case 1, the patient presented with primary infertility. In Case 2, the patient had procidentia with decubitus ulcer and purulent vaginal discharge. In both the cases, the patients had secondary amenorrhoea. The differential diagnoses and role of other diagnostic aids are discussed.

Follicular cervicitis: a case report.

Chronic follicular cervicitis (CFC) is a benign inflammatory condition which can be easily diagnosed with a fair degree of assurance on pap stained cervical smears, thus preventing the need for cervical biopsy. We report a case of CFC in a postmenopausal woman.

Microbial flora of women with chronic cervicitis.

The present study comprised 50 patients of chronic cervicitis attending gynaecological clinic of Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. The aim of the study was to isolate some of the common sexually transmitted disease (STD) pathogens in chronic cervicitis. Cervical swabs were taken from the patients. The swabs were analysed by various microbiological techniques. Most (78%) of the patients harboured infection, no growth of any organism was found in 22% cases. Ureaplasma urealyticum was the predominant organism isolated in 56% of cases. It was isolated singly in 38% of cases. Various other organisms isolated singly were Chlamydia trachomatis in 2% of cases, candida species in 2% of cases, Staphylococcus epidemidis in 4% of cases, lactobacillus in 4% of cases, and Staphylococcus aureus in 2% of cases. Multiple organisms were isolated in 26% of cases.