Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: doença inflamatória pélvica / Brazilian Protocol for Sexually Transmitted Infections 2020: pelvic inflammatory disease / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: enfermedad inflamatoria pélvica

O tema doença inflamatória pélvica está contemplado no Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. A doença inflamatória pélvica é a infecção aguda do trato genital superior feminino decorrente da ascensão canalicular de microrganismos cervicovaginais endógenos e, principalmente, os de transmissão sexual. Entre os agentes etiológicos envolvidos, destacam-se Chlamydia trachomatis e Neisseria gonorrhoeae. As sequelas mais importantes são dor pélvica crônica, infertilidade e gravidez ectópica. O diagnóstico clínico apresenta-se como a abordagem prática mais importante. O tratamento com antibióticos deve ser iniciado imediatamente diante da suspeição clínica. Descrevem-se orientações para gestores e profissionais de saúde sobre testes diagnósticos, tratamento preconizado, seguimento, aconselhamento, notificação, manejo de parcerias sexuais e de populações especiais. Com a maior disponibilidade da técnica de biologia molecular no Brasil, recomenda-se o rastreio de C. trachomatis e N. gonorrhoeae como estratégia preventiva da doença.

Pelvic Inflammatory Disease is a topic included 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. Pelvic inflammatory disease is an acute infection of the upper female genital tract due to canalicular spread of endogenous cervicovaginal microorganisms, in particular sexually transmitted organisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The most important sequels are chronic pelvic pain, infertility and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment should start immediately upon clinical suspicion. The article contains guidance for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling of sexual partnerships and special populations. In view of increased availability of the molecular biology technique in Brazil, C. trachomatis and N. gonorrhoeae screening is recommended as a disease prevention strategy.

El tema de la enfermedad inflamatoria pélvica está incluido en el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral para Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. La enfermedad inflamatoria pélvica es una infección aguda del tracto genital superior femenino resultante del ascenso canalicular de microorganismos cervicovaginales endógenos y, principalmente, los de transmisión sexual. Entre los agentes etiológicos involucrados, se destacan Chlamydia trachomatis y Neisseria gonorrhoeae. Las secuelas más importantes son: dolor pélvico crónico, infertilidad y embarazo ectópico. El diagnóstico clínico es el enfoque práctico más importante. El tratamiento con antibiótico debe iniciarse inmediatamente ante la sospecha clínica. Se describen pautas para gestores y profesionales de la salud sobre pruebas de diagnóstico, tratamiento, seguimiento, asesoramiento, notificación, manejo de parejas sexuales y poblaciones especiales. Con la mayor disponibilidad de la técnica de biología molecular, se recomienda el cribado de C. trachomatis y N. gonorrhoeae como estrategia preventiva para la enfermedad.

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)

Proctitis infecciosa por Chlamydia Trachomatis / Infectious proctitis by Chlamydia Trachomatis

Introducción: Las infecciones transmisibles sexualmente (ITS) son motivo de consulta frecuente, encontrándose Chlamydia trachomatis (CT) entre las prevalentes. Este germen provoca proctitis de diversa gravedad según el biovar involucrado. Los casos más floridos suelen ser ocasionados por el biovar LGV, responsable de la entidad linfogranuloma venéreo. Se desconocen la prevalencia de CT como causa de proctitis en Argentina y los biovares implicados. Con el objetivo de estudiar estas variables, se diseñó un protocolo para detectar y genotipificar CT en pacientes con proctitis infecciosa. Pacientes y métodos: Se incluyeron pacientes mayores de 18 años con cuadro de proctitis infecciosa atendidos en un centro público y otro privado. Se excluyeron pacientes con enfermedad inflamatoria intestinal y radioterapia pelviana. El estudio fue aprobado por un Comité de Ética y los pacientes firmaron un consentimiento informado. En las muestras de hisopado anal se realizó detección y tipificación molecular de CT. Resultados: Entre 31de agosto de 2017 y 31 de mayo de 2018, se incluyeron 56 pacientes (1 mujer, 53 hombres, 2 mujeres trans), 79% HIV+. En 29 casos (52%) se detectó CT. Todos eran hombres que tienen sexo con hombres (HSH) y refirieron practicar sexo anal u oral receptivo no protegido. La mediana de edad de este subgrupo fue de 31 años; 83% HIV+ en tratamiento antirretroviral y mediana de CD4 637 cel/mm3. La coinfección con otras ITS fue del 41% (siendo las más frecuentes HPV, gonococia y sífilis). Los motivos de consulta más frecuentes fueron proctorragia, pujo y tenesmo, proctalgia y secreción. Las manifestaciones clínicas fueron variadas: proctitis, úlcera perianal, tumor endoanal/rectal y absceso/fístula. El 86% de las proctitis correspondió al biovar LGV, siendo 62% moderadas a graves. La mediana de tiempo de evolución hasta el diagnóstico fue 21 días. Los casos más prolongados correspondieron a cuadros clínicos y endoscópicos más graves. La duración del tratamiento se adecuó al biovar involucrado. Todos los pacientes respondieron favorablemente; sin embargo, las dos fístulas perianales requirieron resolución quirúrgica. Conclusiones: Proctitis, úlceras y fístulas son manifestaciones inespecíficas; el hallazgo clínico y endoscópico per se no son suficientes para definir la etiología; sólo una anamnesis minuciosa permite presumir una ITS como agente causal. La tipificación logra definir el biovar, dato fundamental para adecuar el tratamiento, cortar la cadena de transmisión y contar con datos epidemiológicos a nivel local. Como resultado de esta investigación, el Ministerio de Salud de Nación proyectó la emisión de una alerta sobre la presencia de LGV en nuestro medio. Tipo de estudio: Observacional, transversal, analítico, multicéntrico.

Introduction: Sexually transmitted infections (STI) are a frequent reason for consultation, being Chlamydia trachomatis (CT) among the most prevalent ones. It causes proctitis of varying severity depending on the biovar involved. The most severe cases are usually caused by the LGV biovar, responsible for the entity called lymphogranuloma venereum. The prevalence of CT as a cause of proctitis in Argentina and the biovars involved are unknown. In order to study these variables, a protocol was designed to detect and genotype CT in patients with infectious proctitis. Patients and methods: Patients over 18 years old with infectious proctitis were attended in a public and private center. Patients with inflammatory bowel disease and pelvic radiation therapy were excluded. The study was approved by an Ethics Committee and the patients signed an informed consent. The detection and molecular typing of CT was performed in anal swab samples. Results: Between 31-08-2017 and 31-05-2018, 56 patients were included (1 woman, 53 men, 2 trans women), 79% HIV +. In 29 cases (52%) CT was detected. All were MSM and reported to practice unprotected receptive oral or anal sex. The median age of this subgroup was 31 years; 83% HIV + on antiretroviral treatment and median CD4 637 cel / mm3. The coinfection with other STIs was present 41% (the most frequent were HPV, gonococcal and syphilis). The most frequent symptoms were bleeding, tenesmus, proctalgia and secretion. The clinical manifestations were varied: proctitis, perianal ulcer, endoanal / rectal tumor and abscess / anal fistula. 86% of the proctitis corresponded to the LGV biovar, being 62% moderate to severe. The median time of evolution until the diagnosis was 21 days. The most prolonged cases corresponded to more severe clinical and endoscopic symptoms. The duration of the treatment was adapted to the biovar involved. All patients responded favorably; however, the two perianal fistulas required surgical resolution. Conclusions: Proctitis, ulcers and fistulas are nonspecific manifestations; the clinical and endoscopic findings per se are not sufficient to define the etiology; only a meticulous anamnesis allows us to presume an STI as a causative agent. The typification allows to define the biovar, a fundamental data to adapt the treatment, stop chain of transmission and provides local epidemiological data. As a result of this investigation, the Ministry of Health of the Argentina issued an alert about the presence of LGV in our country. Type of study: Observational, cross-sectional, analytical, multicenter study.

Detección de Chlamydia trachomatis en muestras de exudado endocervical mediante una prueba de diagnóstico rápido y dos técnicas de reacción en cadena de la polimerasa / Detection of Chlamydia trachomatis in endocervical swab using rapid test and two reaction techniques polymerase chain

Introducción: Chlamydia trachomatis es el principal agente bacteriano que produce infecciones de transmisión sexual.Objetivo: detectar la presencia de C. trachomatis utilizando una prueba de diagnóstico rápido y compararla con la reacción en cadena de la polimerasa (RCP).Métodos: se procesaron 50 muestras de exudado endocervical, de mujeres sintomáticas del municipio 10 de Octubre. A las muestras se les aplicó la prueba Chlamy-check-1, un ensayo de RCP del gen del plásmido críptico y una RCP en tiempo real (RCP-TR) de la proteína mayor de la membrana externa (MOMP) de C. trachomatis, que fue utilizada como referencia. Se calculó, sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN).Resultados: de las muestras estudiadas, 44 resultaron positivas por la prueba rápida, mientras que por la RCP del plásmido críptico solo 3 muestras (6 porciento) amplificaron. Al aplicar la RCP-TR, 4 muestras (8 porciento) se confirmaron como positivas, coincidiendo 3 por los tres métodos de diagnóstico. Al evaluar la prueba Chlamy-check-1 frente a la prueba de referencia se observó una sensibilidad de 100 porciento, mientras que la especificidad fue de 13 porciento, así como un VPP de 9,1 porciento y VPN de 100 porciento. Por el contrario, la RCP del plásmido críptico mostró una sensibilidad y especificidad de 75 y 100 porciento, respectivamente; un VPP de 100 porciento y VPN de 97,9 porciento.Conclusiones: se obtuvo diferencia entre los porcentajes de positividad detectados con la prueba rápida, y las técnicas de RCP. La baja especificidad de la prueba rápida indica la necesidad de realizar estudios de evaluación de este estuche diagnóstico.

Introduction: Chlamydia trachomatis is the leading bacterial agent that causes sexually transmitted infections.Objective: to detect the presence of C. trachomatis using a rapid test and compare it with the chain reaction (PCR).Methods: 50 endocervical exudates taken from symptomatic women were processed in Diez de October municipality. The samples were applied the Chlamy-check-1 test, a PCR assay of the cryptic plasmid gene and a real-time PCR (RT-PCR) of major outer membrane protein (MOMP) of C. trachomatis which was used as reference. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive value were calculated.Results: 44 samples were positive by the rapid test, whereas only three samples (6 percent) amplified by cryptic plasmid PCR. Applying RT-PCR, 4 samples (8 percent) were confirmed as positive, 3 samples matched with three diagnostic methods. In assessing the Chlamy-check-1 versus the reference test, 100 percent of sensitivity was observed, while the specificity was 13 percent> Also PPV was 9.1percent and NPV was 100 percent. On the contrary, the cryptic plasmid PCR had 75 and 100 percent of sensitivity and specificity respectively, 100 percent PPV and 97.9 percent NPV.Conclusions: the difference was obtained between the percentages of positivity detected with both the rapid test, and CPR techniques. The low specificity of the rapid test indicates the need for further studies to evaluate this diagnostic kit.

Infección por Chlamydia trachomatis como cofactor en la etiología del cáncer cervical / Chlamydia trachomatis: a cofactor in the etiology of cervical cancer

Se ha demostrado que la infección por el virus del papiloma humano es una condición necesaria pero no suficiente para el desarrollo del cáncer de cuello de útero, ya que solo un pequeño número de las mujeres expuestas progresan a neoplasia cervical. El objetivo de este estudio fue revisar la literatura científica reciente acerca del papel de Chlamydia trachomatis como cofactor en el establecimiento del virus del papiloma humano y en el desarrollo del cáncer de cuello de útero. Entre los cofactores propuestos se incluyen otras infecciones de transmisión sexual, hábito de fumar, hormonas, deficiencias nutricionales, obesidad y respuesta genético-inmunológica del individuo. Chlamydia trachomatis es la más común de las infecciones de transmisión sexual de origen bacteriano y se ha asociado con el desarrollo del cáncer de cuello de útero en muchos estudios poblacionales y de casos y controles. Sin embargo, todavía es necesario esclarecer algunos aspectos de la relación causa-efecto entre la infección por Chlamydia trachomatis, la persistencia del virus del papiloma humano y la progresión a cáncer. La prevención de la infección por Chlamydia trachomatis puede ser importante en la reducción de este tipo de neoplasia, fundamentalmente en mujeres jóvenes.

It has been shown that human papillomavirus presence is a necessary condition for the development of cervical cancer. However, it is not sufficient and only a small number of exposed women will progress to cervical neoplasia. Proposed cofactors include other sexually transmitted infections, smoking habit, hormones, nutritional deficiencies, obesity and host genetic/immunologic responses. Chlamydia trachomatis is the most common bacterial sexually transmitted infection and it has been associated with the development of cervical cancer in many case-controlled and population based studies. However, it is still necessary to elucidate some aspects of cause/effect relationship between Chlamydia trachomatis infection, human papillomavirus persistence and progression to cervical cancer. This article aims to review the current scientific literature upon the role of Chlamydia trachomatis as a cofactor in the development of invasive cervical cancer and HPV establishment. Prophylaxis against Chlamydia trachomatis could be important in reducing the incidence of cervical cancer, mainly in young women.

Abordagem atual da doença inflamatória pélvica / Current approaches to pelvic inflammatory disease

A doença inflamatória pélvica (DIP) é um processo inflamatório de natureza infecciosa que pode atingir estruturas e órgãos do trato genital superior. Devido à sua importância epidemiológica e de suas graves complicações, este artigo atualiza e propõe uma abordagem sistemática da DIP. Os principais agentes etiológicos são a Neisseria gonorrhoeae,Chlamydia trachomatis e outros agentes etiológicos de uretrites, cervicites, vulvovaginites e vaginoses, em geral, polimicrobiana, o que é a base de sua terapêutica. A mulher deve ser investigada para DIP quando apresenta, especialmente, desconforto abdominal, dor lombar, dispareunia e nódoas ou manchas ao exame ginecológico, previamente a procedimentos transcervicais. A classificação clínico-laparoscópica deDIP pode ser dividida em: a) estágio I (endometrite/salpingite sem peritonite); estágio II (salpingite aguda com peritonite); estágio III (salpingite aguda com oclusão tubária ou abscesso tubo-ovariano); estágio IV (abscesso tubo-ovariano roto). A definição do estágio orienta a conduta e o tratamento, pois em formas leves (estágio I) o tratamento e seguimento podem ser feitos ambulatorialmente, enquanto para os casos moderadosou graves a internação hospitalar está indicada para início do tratamento por via endovenosa e monitorização da resposta ao tratamento. O tratamento suportivo, retirada de dispositivo intrauterino (DIU), abstinência sexual e repouso também são indicados, além de orientações sobre as implicações da doença e abordagem do parceiro.

Pelvic inflammatory disease (PID) is an inflammatory process of infectious nature that can affect structures and organs of the upper genital tract. Considering this disease's epidemiological relevance and severe complications, this article provides an update and proposes a systematic approach to PID. The main etiological agents are Neisseria gonorrhoeae, Chlamydia trachomatis and other etiological agents of urethritis, cervicitis, vulvovaginitis and vaginoses. These are generally of polymicrobial origin, which determines the treatment basis for pelvic inflammatory diseases.Women must be checked for PID when experiencing abdominal discomfort, backache, dyspareunia, or presenting with stains during gynecological examination and prior to transcervical procedures. The clinical and laparoscopic classification of PID can be divided into: a) stage I (endometritis/salpingitis without peritonitis), stage II (acute salpingitis with peritonitis), stage III (acute salpingitis with tubal occlusion or tube-ovarian abscess), and stage IV (tube-ovarian abscess rupture). Defining the stage guides procedures and treatment, given that in mild forms (stage I) the treatment and follow-up can be performed in the ambulatory environment while moderate to severe cases require hospitalization so that intravenous treatment and treatment outcome monitoring can be started. Supportive treatment, removal of intrauterine device (IUD), sexual abstinence and rest are also indicated, as well as counseling on the implications of the disease and partner approach.

Infecção por Chlamydia trachomatis e anticorpos contra proteína de choque térmico 60 (HPS60) associados a fator de infertilidade tubária / Chlamydia trachomatis and antibodies against heat shock protein 60 (HPS60) associated with tubal factor infertility

Chlamydia trachomatis é uma bactéria transmitida sexualmente e uma frequente causa de doença inflamatória pélvica (DIP) que, com sua evolução, pode levar à gravidez ectópica ou a fator de infertilidade túbaria (TFI). Hipóteses sugerem que reações imunes à proteína de choque térmico 60 (HPS60) de Chlamydia trachomatis induz à DIP e à consequente infertilidade. A revisão sistemática foi conduzida utilizando artigos científicos das bases de dados MEDLINE, PubMed e Scopus, com estudos que associavam o aumento do TFI à presença de anticorpos contra HPS60 em mulheres portadoras da bactéria. Foram incluídos 12 estudos. As evidências de 11 estudos caso-controle sugerem a confirmação da associação do TFI com maior produção de anticorpos contra HPS60 de Chlamydia trachomatis. Inversamente ao resultado, foi encontrado um estudo do tipo ensaio clínico controlado randomizado em que os anticorpos contra HPS60 da Chlamydia não foram significamente associados a sequelas por doença inflamatória pélvica. Nossos achados confirmam uma associação entre TFI e anticorpos para HSP60 da Chlamydia trachomatis, mas enfatizamos a necessidade de mais estudos com ensaio clínico controlado e randomizado.

Chlamydia trachomatis is a sexually transmitted bacteria and a common cause of pelvic inflammatory disease (PID); its evolution can lead to ectopic pregnancy or tubal infertility factor (TFI). Hypotheses suggest that immune reactions to heat shock protein 60 (HPS60) of Chlamydia trachomatis induces DIP and, thus, infertility. A systematic review was conducted of scientific articles using MEDLINE, PubMed and Scopus, with studies that linked the increase in the TFI HPS60 presence of antibodies in women with the bacterium. We included 12 studies. Evidence from 11 case-control studies suggest confirmation of the TFI association with increased production of antibodies against HPS60 Chlamydia trachomatis. In contrast to the result, we found a type study randomized controlled trial in which the antibodies of Chlamydia HPS60 were not significantly associated with sequelae of pelvic inflammatory disease. Our findings confirm an association between TFI and antibodies to HSP60 of Chlamydia trachomatis, but emphasize the need for more studies with randomized controlled trial.

Clinical Features of Fitz-Hugh-Curtis Syndrome in the Emergency Department

PURPOSE: Fitz-Hugh-Curtis Syndrome (FHCS) is a clinical entity characterized by inflammation of the liver capsule associated with genital tract infection. The aim of this study is to provide physicians with clinical suggestions for diagnostic approaches based on a series of patients who were diagnosed with FHCS. MATERIALS AND METHODS: We conducted a retrospective study of patients who were diagnosed with FHCS after presenting to the emergency department (ED). The symptoms, physical examinations, laboratory findings, radiological findings, and progress of the patients were reviewed. RESULTS: During the four-year study period, a total of 82 female patients received a final diagnosis of FHCS in the ED. Chlamydia trachomatis was identified as a pathogen in 89% of the patients. Their clinical characteristics and laboratory findings were described. Fifty-two patients (63.4%) were admitted to the hospital. All of the admitted patients improved after treatment combining antibiotic therapy with conservative care. CONCLUSION: FHCS should be considered as a differential diagnosis for female patients of childbearing age with right upper abdominal pain. Timely diagnosis using biphasic computed tomography (CT) with arterial and portal phases may help ensure adequate medical treatment as well as avoid invasive procedures.

Infecções genitais por Chlamydia trachomatis em mulheres / Genital infections for Chlamydia trachomatis in women

Os autores apresentam uma revisão da literatura sobre cervicovaginites causadas por Chlamydia trachomatis e discorrem sobre a epidemiologia, a teraia e o seguimento das pacientes. Atualmente mulheres que após o tratamento apresentam resultados positivos para C. trachomatis são consideradas como reinfectadas. Contudo, discutem estudos que mostram evidências de reemergência de infecções latentes persistentes em mulheres tratadas, ressaltando a importância do seguimento dessas paciente.

The authors present a literature review about cervicovaginitis caused by Chlamydia trachomatis and discuss the epidemiology, therapy and follow-up of the patients. Nowadays, women previously treated for chlamydial infection and presenting positive tests are considered reinfected. However, the authors discuss studies showing evidence of latent infection that persists after treatment, and therefore emphasize the importance of treatment follow-up.

Acute epididymo-orchitis - is empirical therapy for Chlamydia trachomatis justified?

In sexually active males, the commonest organisms causing acute epididymo-orchitis are Chlamydia trachomatis and Neisseria gonnorhoae. The peak incidence is seen during 20's. The aim of our study was to prove that in majority of cases of acute epididymo-orchitis, the bacterial pathogens cannot be isolated. The reason being that the pathogen responsible in majority of cases is Chlamydia trachomitis which cannot be isolated by routine bacteriological techniques. We reviewed the cases of acute epididymo-orchitis and studied the percentage of patients in which bacterial pathogens were isolated. The clinical and microbiological data of patients from Aug. 2003 to Sep. 2005 was reviewed. The clinical diagnosis of acute epididymo-orchitis was confirmed by scrotal ultrasonography. Midstream urine sample were processed by using standard culture techniques. Patients were followed for a period of three months. There were total 97 patients, with median and interquartile range of 20 and 17-25 years respectively. At the time of presentation the median duration of symptoms was 4.5 days, while median hospital stay was 5 days. Scrotal pain was the main presenting symptom. Pyuria was noticed in 41 [43%] patients and in only 12 [14%] of these the bacterial pathogens were isolated. Main organisms being Escherichia coli and Klebsiella pneumoniae. We have concluded that Chlamydia trachomatis can not be isolated by routine bacteriological techniques. Currently available diagnostic methods are cumbersome and expensive. Therefore there is a need to develop simpler techniques, which can be made available in moderately equipped laboratories; in order to facilitate the detection of Chlamydia trachomatis. Presently the patients in whom the causative organisms can not be isolated can safely be treated for Chlamydia trachomatis

Management of trachomatous cicatricial entropion of the upper eye lid: Our modified technique

Management of trachomatous cicatricial entropion of the upper eye lid presents a difficult problem. Many surgical approaches have been developed to address it. We report the functional and cosmetic results of our modified surgical technique we have developed in the management of trachomatous cicatricial entropion of the upper eye lid. 45 lids of 43 patients having trachomatous cicatricial entropion of upper eye lids were operated by our modified surgical technique in which we combine bilamellar tarsal margin rotation procedure with blepharoplasty. The technique and results were evaluated in a follow up period of up to 40 months. In all 45 upper eye lids, the normal eyelashes rotated away from the surface of the eye and were no longer in contact of the eye ball in all position of gaze. All eyes had adequate lid closure and regular lid margin. No eye had any overhanging baggy fold of skin at operation site. Three eyes had conjuctival granuloma which was excised under local anaesthesia Three eyes needed Diode laser ablation to treat isolated cilia posterior to normal lash line. Three eyes had mild over correction which regressed without any surgical intervention. One lid had segmental necrosis of distal part of eye lid which recovered spontaneously in following days. Our modified technique of combining bilamellar tarsal rotation procedure [BTR] with blepharoplasty appears to be an effective surgical technique in the management of the trachomatous cicatricial entropion of the upper eye lid. It achieves successful anatomical correction along with more acceptable cosmetic appearance

Infecciones en la mujer embarazada transmisibles al feto / Vertically transmissible infections to the fetus in the pregnant woman

La mujer embarazada está expuesta a contraer una variedad de infecciones, tanto bacterianas, como virales y parasitarias, muchas de las cuales implican un riesgo de afectar también al feto y recién nacido. La transmisión de infecciones de la madre al hijo (transmisión vertical) puede ocurrir tanto durante el embarazo como durante el parto y aún después del parto. Este artículo resume ciertas medidas preventivas de probada eficacia contra algunas de estas infecciones, como son la vacunación pre- embarazo contra rubéola, varicela, hepatitis B, difteria-tétanos; o contra influenza durante el embarazo, el estudio serológico de algunas infecciones que cuentan con medidas de prevención de transmisión al hijo (VIH, sífilis, hepatitis B en no vacunadas) y medidas generales para prevenir la toxoplasmosis. Además revisa con mayor detalle las siguientes infecciones: Streptococcus b hemolítico Grupo B, Listeria monocytogenes, Chlamydia trachomatis, herpes genital, varicela y parvovirus. Para cada una de éstas se indican algunos aspectos epidemiológicos, frecuencia y momento de la transmisión vertical, los riesgos para la madre y para el hijo, las medidas terapéuticas para la infección materna y en especial, las medidas preventivas de la transmisión vertical.

Prevalencia de chlamdia trachomatis en conjuntivitis neonatal determinada mediante las técnicas de inmuno-fluorescencia y amplificación génica / Indirect fluorescence and genic amplification for the determination of chlamydia trachomatis prevalence in neonatal conjunctivitis

Backgrund: Chlamydia trachomatis is one of the most common identifiable infectious agents in neonatal conjunctivitis. It also causes pneumonitis, that is preceded by conjunctivitis in one third of cases. Aim: To asses the prevalence of Chlamydia trachomatis in newborns with conjunctivitis. Patients and methods: In 162 newborns, coming from 14 Primary Health Centers from Santiago de Chile, C. trachomatis was detected by indirect fluorescence and two polymerase chain reaction (PCR 1 and 2), wich amplified different sequences from the common endogenous plasmid. Those patients with positive indirect fluorescence and PCR 2 were definedas infected: Results: The prevalence of C. trachomatis was 8 percent, and the distribution of the positive cases was similar in the different Health Centers. Other isolates were: S. aureus (9.8 percent), S. pneumoniae (8 percent), S. viridans (6.2 percent) y H. influenzae (5.5 percent). Conclusions: The prevalence of C. trachomatis in neonatal conjunctivitis in Chile is similar to that of developed countries. Therefore, C. trachomatis should be considered in the election of antimicrobials for the treatment of neonatal conjunctivitis, to avoid ocular and respiratory complications

Chlamydia trachomatis y ureaplasma urealyticum / Chlamydia trachomatis and ureaplasma urealyticum

La etiología de la uretitis no gonocóccica trasciende las infecciones por chlamydia trachomatis y ureaplasma urealyticum. otros agentes etiológicos comunes son responsables de aproximadamente 20 por ciento de los casos y en un tercio no se precisa una etiología. Por esta situación se requiere de una nueva terminología para caracterizar mejor esta entidad. Test de amplificación genómica aplicados a la secreción uretral u orina son nuevas herramientas para un diagnóstico precoz de chlamydia trachomatis. El diagnóstico precoz es muy importante para evitar complicaciones y secuelas, especialmente infertilidad en mujeres, mediante un tratamiento oportuno y adecuado. Azitromicina, 1g oral, en dosis única es un avance significativo en el tratamiento de la uretritis causada por clamidias

Infección y parto prematuro: enlace epidemiológico y bioquímico / Infection and preterm birth: epidemiological and biochemical linkage

Esta revisión define parto prematuro e infección intrauterina (origen, vías y estadios). Resumimos las asociaciones epidemiológicas entre parto prematuro y los diferentes microorganismos. Se discute la interacción entre productos bacterianos y el sistema monocitomacrófago del huésped, los atributos de las citoquinas proinflamatorias y el papel desempeñado en el mecanismo del parto y el síndrome de respuesta inmune fetal

Detection of chlamydia trachomatis DNA by polymerase chain reaction in urine of women with tubal infertility as diagnosed by hysterosalpingography and laparoscopy

This study included 30 women with tubal infertility and 14 women with other causes of infertility documented by laparoscopy. The presence of C. trachomatis DNA in first void urine was determined using PCR assay and the presence of C. trachomatis-specific IgG in serum samples was also investigated using microimmunofluorescence [MIF] technique. C. trachomatis-specific IgG was present in 14 of 30 women with tubal infertility compared with seven of 14 with other causes of infertility. In conclusion, there was a strong association between the presence of C. trachomatis DNA and the development of chlamydial- associated infertility

Mecanismos inespecíficos en la eliminación de Chlamydia trachomati: aspectos microbiológicos y fagocitosis / Inespecific mechanisms to eliminate Chlamydia trachomatis: fhagocytosis and microbiologic aspects

Chlamydia trachomatis es uno de los patógenos más frecuentes en las infecciones de transmisión sexual, es causante de una serie de padecimientos y está asociada a otros. Sin embargo, poco se conoce acerca de los mecanismo de evación de la respuesta inmune inespecífica, tal es el caso de fagocitosis, mediante la cual dicho microorganismo puede crecer y evadir los mecanismos de la respuesta inmune específica. Por ello es esencial tener un conocimiento sobre los mecanismos que modulan la respuesta inmune inespecífica contra C. trachomatis para el desarrollo de vacunas. El objetivo de esta revisión bibliográfica es analizar aspectos sobre fagocitosis en la infección por Chlamydia