Associação entre Vaginose Bacteriana e Anormalidades Citológicas nos Exames Citopatológicos Analisados em um Laboratório Escola de Goiânia-GO / Association Between Bacterial Vaginosis and Cytological Abnormalities in Cytopathological Exams Analyzed in a Laboratory School of Goiânia-GO / Asociación entre Vaginosis Bacteriana y Anormalidades Citológicas en Exámenes Citopatológicos Analizados en una Escuela de Laboratorio de Goiânia-GO

Introdução: A Gardnerella vaginalis facilita a infecção pelo papilomavírus humano (HPV). Objetivo: Verificar a associação entre anormalidades citológicas e presença de Gardnerella vaginalis nos esfregaços cervicovaginais encaminhados ao Laboratório Clínico da Pontifícia Universidade Católica de Goiás (LAC/PUC Goiás) estratificadas por faixa etária. Método: Estudo transversal realizado no LAC/PUC Goiás entre janeiro de 2013 a dezembro de 2015. Para análises estatísticas, a variável idade foi categorizada em ≤39 anos e >40 anos, utilizando o programa IBM SPSS Statistics (Version 2.0, 2011®) para o teste de qui-quadrado (X²), com intervalo de confiança de 95% e valor p<0,05. Resultados: Foram analisados 4.558 exames citopatológicos, a maioria com presença de Lactobacillus spp. (46,97%). A prevalência dos agentes patogênicos foi a Gardnerella vaginalis (79,6%), seguida de Candida spp. (16,8%), Trichomonas vaginalis (2,2%), Herpes simplex (0,4 %) e Chlamydia trachomatis (0,1%). As anormalidades citológicas foram observadas em 9,1%, sendo atypical squamous cells of undetermined significance (ASC-US) 2,57%, low grade squamous intraepithelial lesion (LSIL) 1,78%, atypical squamous cells of undetermined significance cannot exclude high grade squamous intraepithelial lesion (ASC-H) 3,52%, high grade squamous intraepithelial lesion (HSIL) 1,08%, atypical endocervical cells, favor neoplastic (AGC-NEO) 0,22% e carcinoma 0,02%. Houve uma associação significante entre anormalidades citológicas graves e mulheres ≥40 anos, OR 3,01 (IC 95% 2,0-4,58) (p<0,0001). Mulheres ≤40 anos mostraram significância à presença de Gardnerella vaginalis (p<0,0004). Conclusão: Uma elevada prevalência de Gardnerella vaginalis foi encontrada associada com as anormalidades citológicas, principalmente em mulheres sexualmente ativas.

Introduction:Gardnerella vaginalis facilitates human papillomavirus (HPV) infection. Objective: To verify the association between cytological abnormalities and the presence of Gardnerella vaginalis in cervicovaginal smears sent to the Clinical Laboratory of the Pontifical Catholic University of Goiás (LAC/PUC Goiás) stratified by age range. Method: Cross-sectional study carried out at LAC/PUC Goiás from January 2013 to December 2015. For statistical analysis, the variable age was categorized as ≤39 years and >40 years, using the IBM SPSS Statistics program (Version 2.0, 2011®) for the chi-square test (X²), with a 95% confidence interval and p<0.05. Results:4,558 cytopathological exams were analyzed, most of them with the presence of Lactobacillus spp (46.97%). The prevalence of pathogens was Gardnerella vaginalis (79.6%), followed by Candida spp. (16.8%), Trichomonas vaginalis (2.2%), Herpes simplex (0.4%) and Chlamydia trachomatis (0.1%). Cytological abnormalities were observed in 9.1%, being atypical squamous cells of undetermined significance (ASC-US) 2.57%, low grade squamous intraepithelial lesion (LSIL) 1.78%, atypical squamous cells of undetermined significance cannot exclude high intraepithelial lesion (ASC-H) 3.52%, high grade squamous intraepithelial lesion (HSIL) 1.08%, atypical endocervical cells, neoplastic favor (AGC-NEO) 0.22% and carcinoma 0.02%. There was a significant association between severe cytological abnormalities and women >40 years old OR 3.01 (95% CI 2.0-4.58) (p<0.0001). Women ≤40 years old showed the presence of Gardnerella vaginalis (p<0.0004). Conclusion:A high prevalence of Gardnerella vaginalis was found and its association with cytological abnormalities, especially in sexually active women.

Introducción:Gardnerella vaginalis facilita la infección por el virus del papiloma humano (VPH). Objetivo: Verificar la asociación entre anormalidades citológicas y la presencia de Gardnerella vaginalis en frotis cervicovaginales enviadas al Laboratorio Clínico de la Pontificia Universidad Católica de Goiás (LAC/PUC Goiás) estratificadas por grupo de edad. Método: Estudio transversal realizado en LAC/PUC Goiás desde enero de 2013 hasta diciembre de 2015. Para el análisis estadístico, la edad variable se clasificó como ≤39 años y >40 años, utilizando el programa IBM SPSS Statistics (Versión 2.0, 2011®) para la prueba de chi-cuadrado (X²), con un intervalo de confianza del 95% y p <0,05. Resultados: Se analizaron 4.558 exámenes citopatológicos. La prevalencia de Lactobacillusspp. con 46,97%. Los patógenos como Gardnerella vaginalis fueron 79,6%, Candidaspp. 16,8%, Trichomonas vaginalis 2,2%, Herpes simplex 0,4%, y Chlamydia trachomatis 0,1%. Se observaron anormalidades citológicas en 9,1%, con células escamosas atípicas de significado indeterminado (ASC-US) 2,57%, lesión intraepitelial escamosa de bajo grado (LSIL) 1,78%, células escamosas atípicas de significación indeterminada no pueden excluir lesión intraepitelial (ASC-H) 3,52%, lesión intraepitelial escamosa de alto grado (HSIL) 1,08%, células endocervicales atípicas, favor neoplásico (AGC-NEO) 0,22% y carcinoma 0,02%. Hubo una asociación significativa entre anormalidades citológicas severas y mujeres >40 años OR 3,01 (IC 95% 2,0-4,58) (p<0,0001). Las mujeres ≤40 años mostraron la presencia de Gardnerella vaginalis (p<0,0004). Conclusión: Se encontró una alta prevalencia de Gardnerella vaginalis y su asociación con anomalías citológicas, especialmente en mujeres sexualmente activas.

Posible papel de Bacteroides fragilis enterotoxigénico en la etiología de la vaginitis infecciosa / Possible role of enterotoxigenic Bacteroides fragilis in the etiology of infectious vaginitis

La vaginitis es un trastorno ginecológico frecuente producido por distintas causas, algunas de las cuales permanecen desconocidas. Bacteroides fragilis es el anaerobio más importante en bacteriología clínica. Algunas cepas son enterotoxigénicas y se asocian con síndromes intestinales y extraintestinales. Recientemente han sido aisladas de pacientes con vaginitis. En este trabajo se planteó investigar la posible asociación de B. fragilis enterotoxigénico con la vaginitis infecciosa. Fueron procesadas 265 muestras de exudado vaginal. 202 de mujeres sintomáticas y 63 mujeres sanas. La identificación de los microorganismos se realizó por métodos convencionales. En 31,2% de las pacientes sintomáticas se identificaron: Gardnerella vaginalis, Candida albicans, Mobiluncus, Mycoplasma hominis, Ureaplasma urealyticum y Streptococcus agalactiae. En 27 pacientes sintomáticas y en 5 mujeres sanas se identificó B. fragilis. Estas cepas fueron cultivadas en medio líquido e incubadas durante 48 h a 36° C en anaerobiosis. La toxicidad en los sobrenadantes se ensayó en células HT-29. 18 cepas de B. fragilis aisladas de pacientes sintomáticas fueron enterotoxigénicas, ya que indujeron alteraciones en la monocapa celular y en las células. No se identificó en mujeres sanas (P<0,05). 77,7% de las cepas de B. fragilis enterotoxigénicas no se encontraron asociadas con otros patógenos específicos. Este hecho sugiere que pudiera ser un agente causante de vaginitis, ya que el efecto de la enterotoxina sobre la E-cadherina del epitelio vaginal podría facilitar la invasión y su posible papel patógeno en la vagina. Esta es la primera investigación que asocia a Bacteroides fragilis enterotoxigénico como posible causa de vaginitis infecciosa.

Vaginitis is a common gynecologic disorder. It is due to several causes, some even unknown. Bacteroides fragilis is the most important anaerobe in clinical bacteriology, some strains of this group are notable for being enterotoxigenic and they have been associated with intestinal and extraintestinal syndromes. They have recently been isolated from patients with vaginitis. The purpose of this study was to investigate a possible association of enterotoxigenic B. fragilis with infectious vaginitis. 265 samples of vaginal exudate were processed, 202 from symptomatic patients and 63 healthy women. The identification of the microorganisms was carried out by conventional methods. In 31.2% of symptomatic patients were identified: Gardnerella vaginalis, Mobiluncus, Candida albicans, Mycoplasma hominis, Ureaplasma urealyticum and Streptococcus agalactiae. B. fragilis was identified in 27 symptomatic patients and 5 healthy women. These strains were cultivated in liquid medium and incubated during 48 h at 36°C in anaerobe chambers. Supernatant activity was assayed in HT-29 cells. Eighteen B. fragilis strains isolated from symptomatic patients were enterotoxigenic, because induced alterations in target cell morphology. It was not identified in healthy women (P<0.05). 77.7% of enterotoxigenic B. fragilis strains were not associated with other specific pathogens. This fact suggests that enterotoxigenic B. fragilis could be a cause for vaginitis. The effect of enterotoxin on E-cadherin of vaginal epithelium could facilitate invasion and its possible pathogenic role in the vagina. This is the first report that associates enterotoxigenic Bacteroides fragilis as a possible cause of infectious vaginitis.

Biotypes and virulence factors of Gardnerella vaginalis isolated from cases of bacterial vaginosis.

The present study was conducted to correlate the biotypes of Gardnerella vaginalis strains isolated from cases of bacterial vaginosis and their virulence factors. Thirty-two strains of G. vaginalis isolated from cases of bacterial vaginosis were biotyped. Adherence to vaginal epithelial cells, biofilm production, surface hydrophobicity, phospholipase C and protease activity were tested on these isolates. Biotype 1 was the most prevalent (8; 25%), followed by biotype 2 (7; 21.9%) and biotypes 5 and 8 (5; 15.6%). We did not find any statistical correlation between G. vaginalis biotypes and its virulence factors. Virulence factors expressed by G. vaginalis were not associated with a single biotype.

Prevalência de gardnerella e mobiluncus em exames de colpocitologia em Tomé-Açu, Pará / Prevalence of gardnerella and mobiluncus in vaginal cytology examinations in Tome-Açu-Pará

Objetivo: a Gardnerella vaginalis, isoladamente ou associada ao Mobiluncus sp., é um dos principais agentes causadores de infecções em mulheres em idade reprodutiva, seja pela falta de hábitos de higiene adequados, número de parceiros sexuais ou desequilíbrios da microflora vaginal. Assim, buscou-se verificar a prevalência de G vaginalis e/ou Mobiluncus sp., associadas às condições sócio-culturais em mulheres atendidas no Hospital de Quatro Bocas de Tomé-Açu - Pará, através de exame preventivo de câncer de colo do útero. Método e Resultados: analisados materiais cervico-vaginais e informações sócio-culturais de 156 mulheres, com faixas etárias de 17 e 73 anos, período de outubro de 2003 a julho de 2004, para o diagnóstico de prevenção de câncer ginecológico. Todas as amostras foram processadas de modo convencional e analisadas no Laboratório de Citopatologia da Universidade Federal do Pará por três observadores (estudo cego). Como resultados verificou-se que das 156 mulheres pesquisadas , a maior prevalência estava associada à G vaginalis (48,15%), faixa etária de 21 a 30 anos, ou pela associação G vaginalis e Mobiluncus sp (36,36%). Em relação ao grau de escolaridade e ocupação, a maior prevalência ocorreu em mulheres com r grau incompleto (47,37%), com atividades do lar (21,05%) e comércio (22,81%). Conclusões: estes dados reforçam pesquisas que relacionam a prevalência de G vaginalis e/ou Mobiluncus sp, em mulheres com vida sexual e menor grau de escolaridade.

Objective: gardnerella vaginalis, alone or associated to Mobiluncus sp., is one of the main etiological agents ofinfection in women of reproductive age, due to lack of appropriate hygiene habits, number of sexual partners ar imbalance of the vaginal microbiota. Therefore, our objective was to assess the prevalence of bacterial vaginosis caused by G vaginalis and/or Mobiluncus sp., and associate this to the sociocultural conditions in women attended ai Hospital de Quatro Bocas in Tomé-Açu - Pará - Brazil, through gynecological cancer screening. Methods and Results: cervico-vaginal smears and socio-cultural information of 156 women aged 17 to 73 were analyzedfor diagnosis and prevention of gynecological cancer from October 2003 to July 2004. Ali samples were processed in the conventional way and analyzed at Universidade Federal do Pará's Laboratory of Cytopathology by three observers (a blind study). Among ali 156 women, the largest prevalence was associated to G vaginalis (48,15%) in 21 to 30- year-old women, ar to the association of G vaginalis and Mobiluncus sp (36,36%). As for the occupation and instruction degree, the infection was most prevalent in women with incomplete primary school (47,37%), housewives (21,05%) and market workers (22,81 %). Conclusions: our data reaffirm previous researches that relate the prevalence ofbacterial vaginosis caused by G vaginalis and /or Mobiluncus sp. to low instruction degree in sexually active women.

Vaginosis bacteriana en estudiantes universitarias de Antofagasta / BacteriaI vaginosis in university students of Antofagasta

The bacterial vaginosis (VE) is a clinical entity that one has proposed as sexually transmitted disease (ETS), which still is in discussion, provided that the principal agents etiologic (Gardnerella vaginalis and Mobiluncus spp), also are a part of the normal vaginal flora. VE's prevalence was investigated according to the Nugent's microbiological and Amsel's clinical criteria between 190 university students of Antofagasta city who consult spontaneously, during April and October, 2006. Other agents (bacteria, fungi and parasites) isolated of the vaginal secretion were diagnosed by means of standardized methods. One found a prevalence of 19% (36/190) of VE and 38% (72/190) of other pathologies: Candida albicans 76% (55/72); bacteria, predominating over Enterobacteriaceas 15% (21/72) and Trichomonas vaginalis 3% (2/72). One concludes that the high indicators of VE and other infectious pathologies of ETS's type in this group of women who begin in the sexual activity it needs of major educational support, special1y the related ones to the entity bacterial vaginosis, who still is not very frequently studied in these groups.

La vaginosis bacteriana (VB) es una entidad clínica que se ha propuesto como enfermedad de transmisión sexual (ETS), lo cual aún está en discusión, dado que los principales agentes etiológicos (Gardnerella vaginalis y Mobiluncus spp), también son parte de la flora normal vaginal. Se investigó la prevalencia de VB, según los criterios microbiológico de Nugent y clínico de Amsel en 190 estudiantes universitarias de la ciudad de Antofagasta que consultan espontáneamente, durante abril y octubre del 2006. Otros agentes patógenos (bacterias, hongos y parásitos) aislados de la secreción vaginal fueron diagnosticados mediante técnicas estandarizadas. Se encontró una prevalencia del 19% (36/190) de VB y 38% (72/190) de otras patologías causadas por: Candida albicans 76% (55/72); bacterias, predominando Enterobacteriaceas 15% (21/72); Y Trichomonas vaginalis 3% (2/72). Se concluye que los elevados indicadores de VB y de otras patologías infecciosas del tipo de las ETS, en este grupo de mujeres que se inician en la actividad sexual, requiere de mayor apoyo educativo y profiláctico, especialmente las relacionadas con la entidad vaginosis bacteriana, la cual aún no es muy frecuentemente estudiada en estos grupos etarios.

Freqüência de Gardnerella vaginalis em esfregaços vaginais de pacientes histerectomizadas / Frequency of Gardnerella Vaginalis in vaginal smears of hysterectomized women

OBJETIVO: Avaliar a freqüência de Gardnerella vaginalis em esfregaços cérvico-vaginais de pacientes com histerectomia prévia comparados com os esfregaços de pacientes não histerectomizadas. MÉTODOS: Realizamos um estudo retrospectivo no Laboratório de Anatomia Patológica da Unoeste, sendo revisados 39.447 laudos de citologia cérvico-vaginal. Destes, 1934 pacientes eram histerectomizadas totais e 37.513 não histerectomizadas. Dentre as pacientes não histerectomizadas foram coletados os dados apenas das pacientes com Gardnerella vaginalis (n=755). RESULTADOS: Com relação à microbiota vaginal das pacientes histerectomizadas, houve um predomínio de lactobacilos (60 por cento dos casos); Gardnerella vaginalis ocorreu em 7,08 por cento dos casos, com predomínio entre 41 a 50 anos (38 por cento). Entre as pacientes não histerectomizadas, 755 (2 por cento dos casos) apresentavam Gardnerella vaginalis e a maioria estava na faixa etária abaixo de 40 anos (62 por cento). CONCLUSÃO: A chance de uma mulher histerectomizada ter Gardnerella vaginalis é 3,71 vezes maior. Nas pacientes histerectomizadas, Gardnerella vaginalis predomina naquelas entre 41 e 50 anos, enquanto nas não histerectomizadas predomina em mulheres abaixo de 40 anos. A manutenção do pH vaginal é importante para a prevenção de infecções por Gardnerella vaginalis e pacientes histerectomizadas devem tomar medidas de prevenção contra esta infecção.

OBJECTIVE: This work intended to evaluate the frequency of Gardnerella vaginallis in cervicalvaginal smears of hysterectomized women when compared to smears of non-hysterectomized women. METHODS: A retrospective study was conducted in the laboratory of pathology of the Western São Paulo University - Unoeste and 39.447 cervical/vaginal cytology reports were reviewed. Of these, 1934 women were totally hysterectomized and 37,513 were non-hysterectomized. Only data from Gardnerella vaginalis patients were collected (n=755) among the non-hysterectomized patients. RESULTS: There was a predominance of Lactobacillus species (60 percent of the cases) in the vaginal microbiota of hysterectomized patients with an incidence of Gardnerella vaginalis in 7.08 percent of the cases with a prevalence among the 41 to 50 year old age group (38 percent). Among non-hysterectomized patients, 755 (2 percent) had Gardnerella vaginalis and most patients were under 40 years of age (62 percent). CONCLUSION: Hysterectomized women are more than 3.71 times more likely to have Gardnerella vaginalis. Gardnerella vaginalis predominated in the 41 to 50 year old age group of hysterectomized women, and in the group of non-hysterectomized women with less than 40 years of age. Maintenance of the vaginal pH is important to prevent Gardnerella vaginalis infections and hysterectomized patients must take preventive care against this infection.

Actividad sialidasa en mujeres con vaginosis bacteriana / Sialidase activity in women with bacterial vaginosis

La vaginosis bacteriana (VB) es un síndrome caracterizado por el sobrecrecimiento bacteriano deflora endógena Gram negativa, que desplaza a la flora lactobacilar normal. Dentro de las enzimasbacterianas, las sialidasas han sido consideradas factores de virulencia de muchos microorganismos patógenosque colonizan las distintas mucosas. Su presencia en fluidos vaginales puede estar correlacionada con VB. Elpropósito de este estudio fue comprobar la actividad de dicha enzima en mujeres con este síndrome y sin evidenciaclínica de infección genital. Se estudiaron 112 mujeres (51 fueron pacientes con VB y 61 mujeres conflora colonizante habitual). Para la cuantificación de la actividad sialidasa se empleó la técnica basada en lahidrólisis enzimática de un derivado ácido del ácido metoxifenil acetil murámico. En la población estudiada seencontró que ambos grupos mostraron valores comprendidos entre 0.5 a 5.1 nmoles de metoxifenol, mientrasque 11 de 52 pacientes con VB (21.17%), registraron valores superiores a 5.1 nmoles. La presencia de actividadsialidasa solamente no es índice de VB, excepto para valores mayores de 5.5 nmoles de metoxifenol, producidosen la reacción enzimática.

Bacterial vaginosis (VB) is a syndromecharacterized by overgrowth of endogenous Gram negative bacterial flora and the lack of the normalflora. Within bacterial enzymes, sialidases have been considered a virulence factor of many pathogenic microorganismscolonizing the different mucous membranes. Their presence in vaginal discharges can be correlatedwith VB. The aim of this study was to detect the activity of this enzyme in women with this syndrome andwithout clinical evidence of genital infection. Out of a total 112 women studied, 51 were patients with VB andthe other 61 women presented normal vaginal flora. For the quantification of enzyme activity, the technique basedon the enzymatic hydrolysis of a derivative acid of the acetyl metoxifenil muramic acid was used. In the studiedpopulation both groups shared values from 0.5 to 5.1 nmoles of metoxifenol, whereas only 11 out of 52 patientswith VB (21.17%), registered more than 5.1 nmoles. The presence of sialidase activity is not enough to confirmVB, except for values greater than 5.5 nmoles of the metoxifenol produced in the enzymatic reaction.

Vulvovaginites: estudo das variaçoes de pH vaginal e microflora associada / Vulvovaginitis: vaginal pH changes and associated microflora

PURPOSE: To establish a correlation between pH vaginal and the microflora associated in carriers of vulvovaginites. METHODS: In the present study, the cytopathological examination and the vaginal flow in a group of 65 sexually active women had been carried through, 20 and 72 years, taken care of in the Laboratório de Citologia Clínica do Departamento de Análises Clínicas e Toxicológicas da Universidade Federal do Rio Grande do Norte, for determination of microorganisms in cervicovaginal sample and of pH in the vaginal flow. RESULTS: Associating pH vaginal with the presence of vulvovaginitis, it was evidenced that the Candida sp. occurred more frequently in pH 4.0, Trichomonas vaginalis in pH 6.0, Gardnerella vaginalis in pH 5.0, coconuts in pH 5.0, bacilli in pH 4.0 and cocos/bacilos in pH 6.0. It was observed that all the patients had presented at least one type of ethiological agent of vulvovaginiti and an associated microflora. CONCLUSION: The joint accomplishment of the cytological examinations and the determination of pH revealed important for directing the microflora associated with the vulvovaginiti, suggesting, of this form, that pH vaginal plays preponderant role how much to the presence of the infectious agents in the vaginal ecosystem.

Biotipos y susceptibilidad antimicrobiana de Gardnerella vaginalis / Biotypes and antimicrobial susceptibility of Gardnerella vaginalis

Se determinaron los biotipos y susceptibilidad a ampicilina, clindamicina, eritromicina, ciprofloxacina y tetraciclina de 63 cepas de Gardnerella vaginalis aisladas de pacientes con vaginosis bacteriana. Las cepas se distribuyeron en los 8 biotipos del esquema de clasificación de Piot, siendo los biotipos 1 y 2 los más frecuentes (44,4 por ciento). Todas las cepas fueron susceptibles a ampicilina y resistentes a ciprofloxacina. Cuatro cepas (6,4 por ciento) presentaron resistencia a clindamicina y dos (3,2 por ciento) a eritromicina. Treinta y una cepas (49,2 por ciento) fueron resistentes a tetraciclina. Se estudió la base genética de la resistencia a tetraciclina en ocho cepas resistentes, demostrándose la presencia del determinante tet (M) en todas ellas.

Parto prematuro con membranas intactas: microbiología del líquido amniótico y tracto genital inferior y su relación con los resultados materno neonatales / Premature labor with intact membranes: relationship of amniotic fluid and lower genital tract microbiology with maternal and neonatal outcomes

Background: The prevalence of idiopathic spontaneous premature labor or without an evident clinical cause, has not been reduced with tocolytic treatments, suggesting that premature labor has multiple causes and infections play a not well-defined role. Aim: To perform microbiological studies of the amniotic fluid and of the lower genital tract in women with idiopathic premature labor and intact membranes, relating these findings with maternal and neonatal outcomes. Patients and methods: Women with pregnancies between 24 and 34 weeks, with premature labor and without an evident clinical cause were enrolled. Amniotic fluid and genital tract samples were obtained for traditional microbiological cultures. This information was related with delivery events and neonatal outcome. Results: Sixty-three patients were included. The overall frequency of microbial invasion of amniotic cavity was 23.8 percent and of cervical or vaginal infection was 63.5 percent (in 39.7 percent there was only cervical or vaginal infection without involvement of the amniotic sac). Absence of infection was documented in 36.5 percent of women. Compared to patients without infection, women with microbial invasion of amniotic cavity had a higher rate of prematurity (73.3 percent p < 0.05), a higher rate of prematurity of less than 34 weeks (60 percent p < 0.01), a higher frequency of preterm rupture of membranes (40 percent p < 0.001), a shorter admission-to-delivery interval (median 3.0 days p < 0.01) and lower gestational age at delivery (median 33 weeks p < 0.01). Clinical chorioamnionitis and endometritis (20 percent p < 0.01) was observed only in patients with amniotic cavity infections. Severe asphyxia (26.7 percent p < 0.05) and neonatal admission to Intensive Care Units (46.7 percent p < 0.05) were more frequent and neonatal weight was less in the offspring of women with microbial invasion of amniotic cavity (2020 g median p < 0.01). Conclusions: In preterm labor with intact membranes, intraamniotic infection is the most frequent cause of prematurity and is associated with a higher prevalence of maternal and neonatal problems

Incidence of Gardnerella vaginalis, Candida sp and human papilloma virus in cytological smears

CONTEXT: In spite of the wide-ranging literature on the microbiology of normal and abnormal flora of the vagina, there are few studies on the relationship between human papilloma virus (HPV) and other vaginal microorganisms. OBJECTIVE: To analyze the frequency of infection by human papilloma virus (HPV) and other agents like Candida sp., Gardnerella vaginalis and Trichomonas vaginalis in cytological smears. DESIGN STUDY: Retrospective study SETTING: A public tertiary referral center. SAMPLE: An analysis of 17,391 cytologies from outpatients seen between January 1997 and August 1998. The control group was made up of patients in the same age group and same period with no cytological evidence of HPV infection. Patients with a diagnosis of cervical intraepithelial neoplasia (CIN) II or III were excluded from this analysis. MAIN MEASUREMENTS: The diagnosis of HPV infection was made in accordance with the criteria of Schneider et al. and the diagnosis of Gardnerella vaginalis was made with a finding of clue cells. RESULTS: 390 (2.24 per cent) had alterations consistent with infection by HPV, sometimes associated with CIN I. The results showed that Gardnerella vaginalis was the most frequent agent in women with HPV infection (23.6 per cent versus 17.4 per cent; P <0.05), while in the control group the most frequent agent was Candida sp. (23.9 per cent versus 13.8 per cent; p <0.001). CONCLUSION: In spite of this study being based solely on cytological criteria, in which specific HPV and Gardnerella diagnostic tests were not used, the cytological smear is widely used in clinical practice and the data presented in this investigation show that there is an association between Gardnerella vaginalis and HPV infection. It remains to be established whether the microorganisms favor each other

Evaluación de los criterios de Nugent y Amsel para el diagnóstico de vaginosis bacteriana / Evaluation of Nugent and Amsel criteria for the diagnosis of bacterial vaginosis

Background: Bacterial vaginosis (BV) is a common disease in reproductive-age women and is associated to important gynecologic and obstetric complications. Aim: To study the occurrence of BV in apparently healthy women attending family planning clinics, using Amsel and Nugent diagnostic criteria. Material and methods: Two hundred thirty nine women consulting for symptoms associated to cervicovaginitis, were studied. A sample from the lateral walls of the vagina was obtained with a sterile swab for microscopic analysis, Gram stain and amine test. Results: According to Amsel and Nugent criteria a 31.1 percent and 31.8 percent BV prevalence was observed. The sensitivity and specificity of Nugent criteria, compared with Amsel criteria were 83.3 percent and 92.1 percent, respectively. Conclusions: The high prevalence of BV found in this study suggests that this vaginal infection should be diagnosed with standardized methods. Nugent criteria are economic easy to perform and sensitive and we propose that they should be used in local health centers

Gardnerella vaginallis: a cofactor in cervical neoplasia?

Gardnerella vaginalis has been associated with cervical lesions. This agent produces nitrosamines that are transformed into carcinogenic derivatives by the cell metabolism. On the other hand, it seems that G. vaginalis can act synergistically with oncogenic agents, such as papillomarivus. The present paper, a five-year study, reports a significantly higher incidence of G. vaginallis infection (p<0.01) in patients whose PAP smears showed features of CIN. Comparing the incidence of this agent in the three grades of CIN cases, a higher incidence in the CIN I group (p<0.001) was observed. We emphasize the importance of PAP and clinical follow-up in patients with G. vaginalis infection in order to search for CIN features.

Cervicovaginal aerobic microflora of women with spontaneous abortion or preterm delivery in Araraquara-Brazil

Microbiological routine exams of endocervix and vaginal specimens of 22 women with clinical history of recent spontaneous abortion or premature rupture of membranes were accomplished. "Chlamydia thachomatis", "Streptococcus pyogenes", "Streptococcus agalactie", "Candida" sp and "Gardnerela vaginalis" were recovered from 54.5 (per cent) (12) of the women. "Ureoplasma urealyticum" was frequently isolated (45.5 (per cent)) but 5 out of 22 qualitative investigation on genital microflora in pregnant women, since it is likely to influence onm pregnancy outcome.

Cervical cytology in women with bacterial vaginosis.

398 symptomatic cases of vaginitis and 43 asymptomatic healthy women were subjected to cervical cytology and microbiological investigations for detection of Bacterial vaginosis, G. vaginalis, T. vaginalis, C. albicans and M. hominis. Cervical inflammatory changes were reported in 81.4% of cases and 60.4% of controls (p < 0.05) and were significantly associated with Bacterial Vaginosis and G. vaginalis infection (p < 0.01). Cervical inflammation was detected in all cases of Trichomonasis.

Biotypes of Gardnerella vaginalis isolated from urinary tract

Tomando como base el esquema propuesto por Benito y col. (1986) conservando las mismas pruebas bioquímicas pero cambiando las tablas de interpretación, se biotipificaron 73 cepas de Gardnerella vaginalis aisladas de vías urinarias de 41 mujeres que acudieron a consulta ginecológíca al Centro de Salud "Dr. José Castro Villagrana" en Tlalpan, México, D.F. De éstas, 33 cepas correspondieron a 16 mujeres con sintomatología de infección de vías urinarias y 40 cepas correspondieron a 25 mujeres sin sintomatología. Con base en la tabla de interpretación propuesta, se encontraron 30 biotipos diferentes, siendo los biotipos 1H (8.2 por ciento), 5G (9.6 por ciento) y 7G (9.6 por ciento), los más frecuentemente aislados mostrando diferencias significativas. No se encontró ningún biotipo asociado mayormente a cuadros con sintomatología de infección de vías urinarias; mientras que los biotipos antes mencionados se asocian con significancia estadística (p< 0.01) a la ausencia de sintomatología

Consideraciones sobre el aislamiento en exudados vaginales de Streptococcus morbillorum / The isolation of Streptococcus morbillorum from vaginal exudates

De el estudio de 195 exudados vaginales enviados por el Servicio de Ginecologia de este hospital, durante el periodo 1988-1990, hemos seleccionado aquellos en los que el cultivo fue positivo para estreptococos, 58 (30 por ciento) de los cuales 26 (44.8 por ciento) correspondia a Streptococcus morbillorum, 9 (15.5 por ciento) a Gardnerella vaginalis, 5 (8.6 por ciento) a Enterococcus faecalis-durans, y a Streptococcus agalactiae, 3 (5.1 por ciento) a Streptococcus mitis y Styreptococcus milleri, 2 (3.4 por ciento) a Streptococcus bovis y Streptococcus cremoris y 1 (1.7 por ciento) a Streptococcus salivarius, Streptococcus equinus y Strptococcus sanguis II respectivamente. En todos los casos se observó antecedentes de actuacción medicoquirurjica en el tracto genital, y en el 52,8 por ciento de los casos fuè concomitante con el diagnostico clinico-micologico de candidiasis vaginal. La identificacción bacteriologica se realizó mediante el sistema API 20 STREP (sistema api bioMérieux GmbH, Nüttingen, Alemania) dando un patron tipico ("excelente identificacción") para el Streptococcus morbillorum.

Infección por Gardnerella vaginalis en parejas heterosexuales: estudio ultraestructural en células de descamación del epitelio estratificado / Gardnerella vaginalis infection in heterosexual couples: ultrastructural al study in descamation cells of stratified epithelium

La vaginosis bacteriana es una de las infecciones más frecuentes en la edad reproductiva de la mujer. La flora normal de lactobacilos es sustituída por concentraciones relativamente elevadas de Gardnerella vaginalis (GV), bacteroides anaerobios, Mobiluncus y Mycoplasma. El objetivo de este trabajo es hacer un análisis morfológico de los posibles mecanismos de adhesión y penetración de GV en la pareja heterosexual tanto en el epitelio escamoso de la pared vaginal como en el líquido seminal. Para cumplir con nuestro objetivo se estudiaron 10 parejas con cultivo de GV que tenían de 3 a 4 días de abstenencia sexual. Las mujeres presentaron al menos 3 de los 4 criterios de Amsel. Se obtuvieron muestras de las paredes laterales de la vagina y de líquido seminal, éstas se dividieron en dos partes: 1) para realizar cultivos para GV, Ureaplasma urealyticum y Mycoplasma hominis, y 2)para un análisis ultraestructural. Las muestras fueron procesadas con las técnicas habituales para microscopía electrónica. En las células vaginales se encontraron bacterias semejantes a GV en forma libre, adherencias a la membrana plasmática y dentro del citoplasma celular. En el líquido seminal se encontraron numerosas células ureterales de descamación que presentaron, al igual que en la mujer, bacterias en forma libre, adherida a la membrana plasmática y dentro del citoplasma. En 4 casos se encontraron bacterias semejantes a mycoplasma y un caso con partículas que sugieren citomegalovirus. En este trabajo se concluye que: 1) el varón presenta células uretrales semejantes a células guía" de la vagina de la mujer 2) la GV coloniza el epitelio ureteral del varón, 3) el varón es capaz de infectar y/o reinfectar a la mujer

Evaluation of clinical criteria versus direct microscopic examination and culture in diagnosis of bacterial vaginosis

Thirty two cases completed the study of bacterial vaginosis of which 10 [31.3%] were diagnosed as B.V. depending on the clinical criteria of Amsel et al., [1983 Gram stained smears and culture. The properatin of B.V. among IUD users was statistically significantly higher than that of B.V. among non-IUD users [p< 0.005]. The pH of vaginal secretion [> 4.5] in this study showed 100% sensitivity, 45.5% specificity. However, the presence of clue cells in wet mout examination of vaginal fluid showed 70% sensitivity and 81.8% specificity. The sensitivity and specificity for the detection of fishy odour on addition of 10% KOG and vaginal discharge were 60%, 86.4% and 70% respectively. Compared with clinical criteria for diagnosis of B.V. Gram stained smears were 100% sensitive and 72.2% specific. The isolation of G. Vaginails and Gram stained smears of vaginal fluid were equally sensitive and specific