Concordance Between Clinical and Laboratory Diagnosis of Abnormal Vaginal Discharge in Chilean Women / Concordância entre o diagnóstico clínico e laboratorial de corrimento vaginal anormal em mulheres chilenas

Abstract Objective To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota. Methods Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women>18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of Trichomonas vaginalis and Candida albicans. The Cohen kappa coefficient was used in the concordance analysis. Results Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant (p=0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa=0.21; p=0.003) and candidiasis (Kappa=0.22; p=0.001), and slight for trichomoniasis (Kappa=0.14; p=0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests. Conclusion The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms.

Resumo Objetivo Determinar a concordância entre o diagnóstico clínico de mulheres com corrimento vaginal anormal (AVD) e os resultados laboratoriais por meio da detecção molecular e observação da microbiota vaginal. Métodos Estudo transversal realizado em 2018 em Temuco, Chile. Participaram 25 parteiras de 12 centros de saúde. Um total de 125 mulheres>18 anos, voluntárias, foramrecrutadas. A amostra do fórnice vaginal posterior foi obtida por especuloscopia. Foram observadas características da secreção e da genitália externa e interna. A coloração de Gram foi usada para observar a microbiota vaginal, blastoconídios e pseudo-hifas, e a reação em cadeia da polimerase foi usada para a detecção de Trichomonas vaginalis e Candida albicans. O coeficiente kappa de Cohen foi usado na análise de concordância. Resultados De um total de 125 mulheres com AVD, 85,6% consultaram espontaneamente e 14,4% foram diagnosticados clinicamente durante um check-up de rotina. A concordância absoluta foi significativa (p=0,0012), com concordância de 13,6%. A concordância relativa foi significativa, mas razoável para vaginose bacteriana (Kappa =0,21; p=0,003) e candidíase (Kappa=0,22; p=0,001), e leve para tricomoníase (Kappa=0,14; p=0,009). O percentual de coincidência dos diagnósticos (solteiros ou mistos) por laboratório e parteiras foi: vaginose bacteriana 63,2% (12/19), candidíase 36,5% (27/74) e tricomoníase 12,5% (4/32). Houve 20% de coinfecção. Umtotal de 36% dos diagnósticos clínicos de AVD tiveram exames laboratoriais negativos. Conclusão As condições de vulvovaginite candidíase e tricomoníase parecem ser sobrediagnosticadas, e a vaginose bacteriana parece ser subdiagnosticada pelo diagnóstico clínico quando comparado com o diagnóstico laboratorial. A baixa concordância obtida mostra a importância de complementar o diagnóstico clínico comestudo laboratorial de AVD, principalmente emmulheres com falha de tratamento e / ou coinfecções com sinais e sintomas inespecíficos e variáveis.

Diagnóstico de la Tricomonas vaginalis en la mujer / Diagnosis of Trichomonas vaginalis in women

OBJETIVO: revisar los diferentes métodos de diagnóstico de la tricomoniasis vaginal disponibles hasta el presente. MATERIALES Y MÉTODOS: se revisó la bibliografía latinoamericano e internacional a través de los sitios electrónicos de Pub-Med y Scielo. RESULTADOS: la Tricomonas vaginalis es considera como la enfermedad de transmisión sexual no viral, curable más frecuente y prevalente en el mundo. Se revisan los diferentes de métodos para diagnosticar la presencia de la tricomonas vaginalis en pacientes femeninos con síntomas y signos de la infección producida por el protozoario flagelado. CONCLUSIONES: se revisaron los diferentes métodos de diagnostico de la infección producida por la Tricomonas vaginalis en pacientes femeninas, desde los clásicos hasta los más actuales que emplean alta tecnología.

OBJECTIVE: to review the different diagnostic methods of Trichomonas vaginal available at the present time. MATERIAL AND METHOD: it was reviewed the Latin-American and international bibliography using the Pub-Med and Scielo web sites. RESULTS: Trichomonas vaginalis is considered the most common and prevalent sexual transmitted disease curable and non-viral worldwide. It was reviewed the different methods to diagnose the presence of Trichomonas vaginalis in female patients with symptoms and signs of infection produces by the flagellate protozoa. CONCLUSION: Different methods of diagnosis of the infection produced by Trichomonas vaginalis, since the classics to the most current methods that use high technology, were reviewed.

Prevalencia de disfunción vaginal en mujeres de la ciudad de Bahía Blanca (Argentina) / Vaginal dysfunction prevalence in women of the city of Bahía Blanca (Argentina) / A prevalência de disfunção vaginal em mulheres da cidade de Bahía Blanca (Argentina)

La disfunción vaginal (vaginosis/vaginitis) es la patología genital hoy reconocida más prevalente. El objetivo del trabajo fue generar información sobre la prevalencia de Disfunción vaginal y los factores de riesgo asociados en mujeres sintomáticas y asintomáticas. Se incorporó además la detección de C. trachomatis y N. gonorrhoeae. Se consolida la validez del Balance del Contenido Vaginal (BACOVA) en el diagnóstico integral de disfunción vaginal y de la amplificación génica en la detección de C. trachomatis. Se estudiaron 295 mujeres que asistieron al Hospital Municipal de Bahía Blanca. La mayor prevalencia correspondió a vaginosis bacteriana (21,36%), luego levaduras (13,90%), T. vaginalis (3,73%) y C. trachomatis (3,05%). No se detectó ningún caso de gonococia. Los factores de riesgo encuadran en el marco de valores de la región centro sur del país, pero se debe destacar la frecuencia significativa de alteraciones de la función vaginal (68,87%) y la infección por clamidias (4,35%) detectadas en mujeres asintomáticas. Esto impone la necesidad de revisar y optimizar la política de cumplimiento de las Normas Ministeriales de prevención y control con la aplicación de una metodología de laboratorio normatizada en el protocolo de control de mujeres en edad fértil, embarazadas o no.

Vaginal dysfunction (vaginosis/vaginitis) is the most prevalent genital pathology recognized today. The objective of the work was to generate information on the prevalence of vaginal dysfunction and the associated risk factors in symptomatic and asymptomatic women. The detection of C. trachomatis and N. gonorrhoeae was also incorporated. The validity of the Vaginal Content Balance (BACOVA) in the comprehensive diagnosis of vaginal dysfunction and of gene amplification in the detection of C. trachomatis is consolidated. A total of 295 women who attended the Municipal Hospital of Bahía Blanca were studied. The highest prevalence corresponded to bacterial vaginosis (21.36%), then yeasts (13.90%), T. vaginalis (3.73%) and C. trachomatis (3.05%). No cases of gonorrhea were detected. The risk factors fit within the framework of values of the south central region of the country, but the significant frequency of alterations of vaginal function (68.87%) and chlamydial infection (4.35%) detected in asymptomatic women should be noted. This imposes the need to review and optimize the compliance policy of the Ministerial Standards of prevention and control, with the application of a standardized laboratory methodology, in the control protocol for women of childbearing age, pregnant or not.

A disfunção vaginal (vaginose/vaginite) é a patologia genital mais prevalente hoje reconhecida. O objetivo do trabalho foi gerar informações sobre a prevalência de disfunção vaginal e os fatores de risco associados em mulheres sintomáticas e assintomáticas. A detecção de C. trachomatis e N. gonorrhoeae também foi incorporada. A validade do Equilíbrio do Conteúdo Vaginal (BACOVA) no diagnóstico integral da Disfunção Vaginal e da amplificação gênica na detecção de C. trachomatis está consolidada. Estudamos 295 mulheres que freqüentaram o Hospital Municipal de Bahía Blanca. A maior prevalência correspondeu à vaginose bacteriana (21,36%), depois leveduras (13,90%), T. vaginalis (3,73%) e C. trachomatis (3,05%). Nenhum caso de gonorreia foi detectado. Os fatores de risco enquadram-se no quadro de valores da região centro-sul do país, mas deve-se notar a frequência significativa de alterações da função vaginal (68,87%) e infecção por clamídia (4,35%), detectadas em mulheres assintomáticas. Isso impõe a necessidade de rever e otimizar a política de compliance das Normas Ministeriais de prevenção e controle, com a aplicação de metodologia laboratorial padronizada, no protocolo de controle para mulheres em idade fértil, gestantes ou não.

Prevalence of Trichomonas vaginalis and Human papillomavirus in female sex workers in Central Veracruz, Mexico / Prevalencia de Trichomonas vaginalis y virus del papiloma humano en mujeres trabajadoras sexuales en el centro de Veracruz, México

Female sex workers (FSWs) have been considered a key population for sexually transTrichomonas mitted infections (STIs); therefore, they are periodically screened as a requirement to obtain a work card. However, there is insufficient epidemiological data on STIs among FSWs in Mexico. The detection of Trichomonas vaginalis is limited to microscopic studies and the molecular screening of Human papillomavirus (HPV) is only done to women 35 years of age and older. The objective of this study was to determine the prevalence of T. vaginalis and HPV infections in FSWs in the city of Orizaba, Veracruz, Mexico. Samples from 105 FSWs were obtained by cervical swab and analyzed. The identification of T. vaginalis and HPV was performed by molecular methods. HPV DNA was identified in 5.71% of the samples with the presence of HPV16, HPV18, and HPV58. A percentage of 25.7% samples were positive for T. vaginalis for optical microscopy and 23.8% for PCR. The results of the study indicate the need to incorporate more sensitive methods for the timely diagnosis of STIs as well as comprehensive health promotion programs directed to the most vulnerable groups among FSWs.

Las mujeres trabajadoras sexuales (MTS) han sido consideradas una población clave para las infecciones de transmisión sexual (ITS), por ello son examinadas periódicamente como requisito para obtener una tarjeta de trabajo. Sin embargo, no existen datos epidemiológicos suficientes sobre las ITS en las MTS en México. La detección de Trichomonas vaginalis se limita a los estudios microscópicos, y el cribado molecular del virus del papiloma humano (Human papillomavirus: HPV) solo se realiza en las mujeres de 35 años o mayores. El objetivo de este estudio fue determinar la prevalencia de T. vaginalis e infecciones por HPV en las MTS de la ciudad de Orizaba, Veracruz, México. Se analizaron 105 muestras de las MTS, obtenidas mediante frotis cervical. La identificación de T. vaginalis y HPV se realizó por métodos moleculares. El ADN del HPV se identificó en el 5,71% de las muestras, con la presencia de HPV16, HPV18 y HPV58. El 25,7% de las MTS fueron positivas para T. vaginalis por microscopia óptica el 23,8% por PCR. Los resultados del estudio indican la necesidad de incorporar métodos más sensibles para el diagnóstico oportuno de ITS y programas integrales de promoción de la salud en los grupos más vulnerables, entre las MTS.

Avaliação da abordagem sindrômica do corrimento vaginal para o diagnóstico de tricomoníase / Evaluation of syndromic approach of vaginal discharge flowchart to diagnosis of trichomoniasis

A infecção por Trichomonas vaginalis é a doença sexualmente transmissível não viral mais prevalente no mundo. Entre os diferentes métodos para seu diagnóstico, estão os fluxogramas previstos pela abordagem sindrômica. Objetivo: Avaliar o fluxograma de corrimento vaginal para o diagnóstico de tricomoníase em mulheres atendidas em equipe de saúde da família. Métodos: Estudo transversal feito com amostra consecutiva de população ambulatorial, composta por mulheres em idade fértil, exceto gestantes e menores de idade. As participantes responderam a um questionário onde foram registradas as queixas ocorridas nas últimas quatro semanas. Também foram examinadas e submetidas à medição do pH vaginal e teste das aminas. A cultura em meio específico foi considerada como padrão-ouro. Resultados: Dez por cento das mulheres infectadas pela T. vaginalis estavam assintomáticas; entre as infectadas, a dispareunia foi significativamente maior do que entre as mulheres negativas. O esquema proposto pela abordagem sindrômica tem baixa especificidade e acurácia. Conclusão: O diagnóstico de tricomoníase embasado apenas na queixa de corrimento tem baixa acurácia; o resultado do teste das aminas melhora a especificidade do diagnóstico da infecção por Trichomonas vaginalis, independentemente do valor do pH vaginal.

Trichomonas vaginalis infection is the most prevalent non-viral sexually transmitted disease in the world. Among the different methods for diagnosis, the World Health Organization and Ministry of Health of Brazil proposes the use of flowcharts in the syndromic approach. Objective: To evaluate the syndromic approach of vaginal discharge to diagnosis of T. vaginalis infection. Methods: Transversal study with sample of outpatient population consisting of women in reproductive age. After exclusion of pregnant women and minor girls, the final sample consisted of women between 18 and 49 years old. The participants answered a questionnaire where the complaints were registered. They were examined, had the vaginal pH assessed and sample tested with 10% KOH solution to verify the exhalation of amine odor (whiff test). After this proceeding, a vaginal secretion sample was inoculated in a specific T. vaginalis culture medium. The culture results were used as the gold standard to evaluate the syndromic approach flowchart. The algorithm was evaluated according sensitivity, specificity, accuracy, and predictive values. Results: Among women with T. vaginalis infection, 10% were asymptomatic; among them, dyspareunia was significantly higher, if compared to women with no infection. Flowchart proposed by the syndromic approach had low specificity and accuracy, leading to unnecessary treatment in two-third of women. Conclusion: The diagnosis of trichomoniasis based only on the discharge complaint had low accuracy; the whiff test result improves the specificity of diagnosis of T. vaginalis infection, regardless of the vaginal pH value

Frequency of human immunodeficiency virus [HIV] in Trichomonas vaginalis infected women in Badagry, Lagos, Nigeria

Background: The interaction between HIV and Trichomonas vaginalis infection has been widely studied in most developed countries but with scanty information in sub-Saharan Africa. While many of these studies have examined the prevalence of T. vaginalis infection in HIV positive individuals, no study in Nigeria has shown the effect of T. vaginalis on HIV transmission. Therefore, the study aimed to determine the occurrence of HIV in T. vaginalis infected women

Methods: A descriptive study was conducted among women attending STI clinic at the General Hospital, Badagry, Lagos, Nigeria. A total number of 201 [T. vaginalis infected] women were screened for HIV using rapid diagnostic test kits

Results: The frequency of HIV in T. vaginalis infected women was 35.8%

Conclusion: The study showed that T. vaginalis infection in women may be a high risk factor of HIV infection

Trichomonas vaginalis e sua associação com o câncer cervical: uma revisão sistemática / Trichomonas vaginalis associated with cervical cancer: a systematic review

A correlação entre Trichomonas vaginalis (T. vaginalis) e o desenvolvimento do câncer cervical foi estabelecida. Uma revisão sistemática baseada em artigos originais (padrão ouro) foi conduzida a partir de duas importantes bases eletrônicas: PubMed e MEDLINE. A partir das bases de dados Medical Subject Headings (MeSH) e Descritores em Ciências da Saúde (DeCS) os seguintes termos "T. vaginalis & uterine cervical neoplasms" e "T. vaginalis & signal transduction" foram buscados. Critérios de inclusão e exclusão foram estabelecidos considerando as características específicas de cada artigo visando garantir a qualidade dos artigos selecionados (testes de relevância 1 e 2). Com relação aos efeitos patogênicos de T. vaginalis, o teste de relevância 1 selecionou 13 artigos de ambas as bases, PubMed e MEDLINE, enquanto o teste de relevância 2 finalizou com 8 artigos. Os estudos selecionados demonstraram correlação entre T. vaginalis e neoplasia cervical, apontando os efeitos citopatogênicos do parasito e enfatizando a importância das vias de sinalização, tais como as proteínas mitógenoativadas (MAPK).(AU)

A correlation between Trichomonas vaginalis (T. vaginalis) and the development of cervical cancerwas investigated. A systematic review based on original articles (the gold standard) was conducted by performing a search of two major electronic databases, PubMed and MEDLINE. The search was performed by using the exploded MeSH and DeCS terms "T. vaginalis & uterine cervical neoplasms" and "T. vaginalis & signal transduction". Inclusion and exclusion criteria were assessed using specific characteristics to determine whether the quality of each article was high enough to warrant selection (the first and second tests of relevance). With reference to the cytopathogenic effects of T. vaginalis, the first test of relevance selected13 articles from both databases, PubMed and MEDLINE, whereas the second test of relevance selected8 articles. The studies selected showed a correlation between T. vaginalis and cervical neoplasia, demonstrating the cytopathogenic effects of the parasite and highlighting the importance of cell signaling pathways such as the mitogen-activated protein kinase (MAPK) pathway.(AU)

Secreção vaginal anormal: Sensibilidade, especificidade e concordância entre o diagnóstico clínico e citológico / Abnormal vaginal secretion: sensitivity, specificity and concordance between clinical and cytological diagnosis

OBJETIVOS: Estimar a prevalência da vaginose bacteriana (VB), candidíase e tricomoníase e comparar os achados do exame físico da secreção vaginal com o diagnóstico microbiológico, obtido pelo estudo citológico do esfregaço vaginal, pelo do método de Papanicolaou. MÉTODOS: Estudo de corte transversal que incluiu 302 mulheres com idade entre 20 a 87 anos, submetidas à entrevista e exame ginecológico para avaliação da secreção vaginal e coleta de esfregaço citológico, no período de junho de 2012 a maio de 2013. Para avaliar a acurácia das características da secreção vaginal em relação ao diagnóstico microbiológico do esfregaço citológico foi empregado as análises de sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN), com seus respectivos IC95%. Para avaliar o grau de concordância entre as características clínicas da secreção vaginal e os achados microbiológicos no exame citológico, foi aplicado o índice kappa (k). RESULTADOS: A prevalência da VB, candidíase e tricomoníase foi de 25,5, 9,3 e 2,0%, respectivamente. A sensibilidade, especificidade, valor o VPP e o VPN das características clínicas da secreção vaginal para o diagnóstico citológico de VB foram de 74, 78,6, 54,3, e 89,9%, respectivamente. A sensibilidade, a especificidade, o VPP e o VPN das características clínicas da secreção vaginal para o diagnóstico citológico de candidíase foram de 46,4, 86,2, 25,5 e de 94%, respectivamente. O grau de concordância entre a avaliação clínica da secreção vaginal e o diagnóstico microbiológico de VB, candidíase e tricomoníase, avaliados pelo índice kappa foi de 0,47, 0,23 e 0,28, respectivamente. CONCLUSÃO: A causa mais frequente de secreção vaginal anormal foi VB. A avaliação clínica da secreção vaginal apresentou sensibilidade, VPP e grau de concordância moderado a fraco, comparado ao diagnóstico microbiológico, o que indica a necessidade de avaliação complementar do achado clínico de secreção vaginal anormal. .

PURPOSE: To estimate the prevalence of bacterial vaginosis (BV), candidiasis and trichomoniasis and compare the findings of physical examination of the vaginal secretion with the microbiological diagnosis obtained by cytology study of a vaginal smear using the Papanicolaou method. METHODS: A cross-sectional study of 302 women aged 20 to 87 years, interviewed and submitted to a gynecology test for the evaluation of vaginal secretion and collection of a cytology smear, from June 2012 to May 2013. Sensitivity analyses were carried out and specificity, positive predictive value (PPV) and negative predictive value (NPV) with their respective 95%CI were determined to assess the accuracy of the characteristics of vaginal secretion in relation to the microbiological diagnosis of the cytology smear . The kappa index (k) was used to assess the degree of agreement between the clinical features of vaginal secretion and the microbiological findings obtained by cytology. RESULTS The prevalence of BV, candidiasis and trichomoniasis was 25.5, 9.3 and 2.0%, respectively. The sensitivity, specificity, PPV and NPV of the clinical characteristics of vaginal secretion for the cytological diagnosis of BV were 74, 78.6, 54.3 and 89.9%, respectively. The sensitivity, specificity, PPV and the NPV of the clinical characteristics of vaginal secretion for the cytological diagnosis of candidiasis were 46.4, 86.2, 25.5 and 94%, respectively. The correlation between the clinical evaluation of vaginal secretion and the microbiological diagnosis of BV, candidiasis and trichomoniasis, assessed by the kappa index, was 0.47, 0.23 and 0.28, respectively. CONCLUSION The most common cause of abnormal vaginal secretion was BV. The clinical evaluation of vaginal secretion presented amoderate to weak agreement with the microbiological diagnosis, indicating the need for complementary investigation of the clinical findings of abnormal vaginal secretion. .

Involvement of PI3K/AKT and MAPK Pathways for TNF-alpha Production in SiHa Cervical Mucosal Epithelial Cells Infected with Trichomonas vaginalis

Trichomonas vaginalis induces proinflammation in cervicovaginal mucosal epithelium. To investigate the signaling pathways in TNF-alpha production in cervical mucosal epithelium after T. vaginalis infection, the phosphorylation of PI3K/AKT and MAPK pathways were evaluated in T. vaginalis-infected SiHa cells in the presence and absence of specific inhibitors. T. vaginalis increased TNF-alpha production in SiHa cells, in a parasite burden-dependent and incubation time-dependent manner. In T. vaginalis-infected SiHa cells, AKT, ERK1/2, p38 MAPK, and JNK were phosphorylated from 1 hr after infection; however, the phosphorylation patterns were different from each other. After pretreatment with inhibitors of the PI3K/AKT and MAPK pathways, TNF-alpha production was significantly decreased compared to the control; however, TNF-alpha reduction patterns were different depending on the type of PI3K/MAPK inhibitors. TNF-alpha production was reduced in a dose-dependent manner by treatment with wortmannin and PD98059, whereas it was increased by SP600125. These data suggested that PI3K/AKT and MAPK signaling pathways are important in regulation of TNF-alpha production in cervical mucosal epithelial SiHa cells. However, activation patterns of each pathway were different from the types of PI3K/MAPK pathways.

Evaluación de la disfunción vaginal en mujeres embarazadas sintomáticas y asintomáticas mediante la utilización de los estados vaginales básicos (EVB) y su comparación con el estudio microbiológico convencional / Evaluation of vaginal dysfunction in symptomatic and asymptomatic pregnant women by using the analysis of basic vaginal states (BVS) and its comparison with the conventional microbiological study

Durante el embarazo se producen frecuentemente infecciones del tracto genital inferior asociadas a complicaciones maternas y perinatológicas. El objetivo del trabajo fue evaluar la disfunción vaginal mediante el análisis de los estados vaginales básicos (EVB) por la metodología del balance del contenido vaginal (BACOVA) y compararlo con el estudio microbiológico convencional en el diagnóstico de candidiasis, tricomonosis y vaginosis bacteriana (VB). Entre 2010 y 2012 se estudiaron 1238 pacientes embarazadas; 1046 eran asintomáticas (A) y 192 sintomáticas (S). La prevalencia del EVB I fue del 59,5 % y 26 %, respectivamente. El EVB II se observó en 19,7 % de las mujeres A y en 17,2 % de las S. El EVB III se detectó solamente en las A, en 0,4 %. El EVB IV se observó en 14,4 % de las A y en 38 % de las S. El EVB V se detectó en 6 % de las A y en 18,8 % de las S. En las mujeres A, las levaduras se asociaron a los EVB I y II en el 55,5 % y 23,2 % de los casos, respectivamente; entre las S, alcanzaron el 32,4 % y 31 % de los casos, en igual orden. Las tricomonas se asociaron al EVB I en el 50 % de las A, al EVB IV en el 44,4 % de las S y al EVB V en el 33,3 % de las S. La sensibilidad del BACOVA para detectar levaduras fue 80,4 % en las A y 85,5 % en las S; para detectar tricomonas, del 40 % y 75 %, y para detectar VB, del 100 % en los dos grupos. La especificidad del BACOVA fue 100 % para todos los patógenos en las A y en las S. El estudio de los EVB resultó útil para orientar el diagnóstico a la disfunción vaginal, independientemente de la sintomatología, por lo que se sugiere este estudio como parte del control prenatal. Durante el embarazo se producen frecuentemente infecciones del tracto genital inferior asociadas a complicaciones maternas y perinatológicas. El objetivo del trabajo fue evaluar la disfunción vaginal mediante el análisis de los estados vaginales básicos (EVB) por la metodología del balance del contenido vaginal (BACOVA) y compararlo con el estudio microbiológico convencional en el diagnóstico de candidiasis, tricomonosis y vaginosis bacteriana (VB). Entre 2010 y 2012 se estudiaron 1238 pacientes embarazadas; 1046 eran asintomáticas (A) y 192 sintomáticas (S). La prevalencia del EVB I fue del 59,5 % y 26 %, respectivamente. El EVB II se observó en 19,7 % de las mujeres A y en 17,2 % de las S. El EVB III se detectó solamente en las A, en 0,4 %. El EVB IV se observó en 14,4 % de las A y en 38 % de las S. El EVB V se detectó en 6 % de las A y en 18,8 % de las S. En las mujeres A, las levaduras se asociaron a los EVB I y II en el 55,5 % y 23,2 % de los casos, respectivamente; entre las S, alcanzaron el 32,4 % y 31 % de los casos, en igual orden. Las tricomonas se asociaron al EVB I en el 50 % de las A, al EVB IV en el 44,4 % de las S y al EVB V en el 33,3 % de las S. La sensibilidad del BACOVA para detectar levaduras fue 80,4 % en las A y 85,5 % en las S; para detectar tricomonas, del 40 % y 75 %, y para detectar VB, del 100 % en los dos grupos. La especificidad del BACOVA fue 100 % para todos los patógenos en las A y en las S. El estudio de los EVB resultó útil para orientar el diagnóstico a la disfunción vaginal, independientemente de la sintomatología, por lo que se sugiere este estudio como parte del control prenatal.

Infections of the lower genital tract associated to maternal and perinatal complications frequently occur during pregnancy. The aim of this study was to evaluate vaginal dysfunction through the analysis of basic vaginal states (BVS) using the methodology of balance of the vaginal content (BAVACO) and to compare it with the microbiological study of candidiasis, trichomoniasis and bacterial vaginosis (BV). Pregnant patients (1238) were examined from 2010 to 2012. In asymptomatic (A) (n: 1046) and symptomatic pregnant women (S) (n: 192) BVS I was 59.5% and 26% of the patients, respectively. BVS II was observed in 19.7% of A and in 17.2% of S. BVS III was only detected in A in 0.4%. BVS IV was observed in 14.4% of A and in 38% of S. BVS V was detected in 6% of A and in 18.8% of S. Yeasts were associated to BVS I and II in 55.5% and 23.2% of A, respectively; and in 32.4% and 31% of S, respectively. Trichomonas were associated to BVS I in 50% of A, to IV in 44.4% of S and to V in 33.3% of S. BAVACO susceptibility to detect yeasts was 80.4% and 85.5% in A and S, respectively; 40% and 75% in A and S, respectively, to detect trichomonas and 100% in A and S to detect BV. BAVACO specificity was 100% for all pathogens in A and S. The study of BVS proved useful as a guide to evaluate vaginal dysfunction, regardless of symptomatology. Therefore, this study is recommended as prenatal control. Infections of the lower genital tract associated to maternal and perinatal complications frequently occur during pregnancy. The aim of this study was to evaluate vaginal dysfunction through the analysis of basic vaginal states (BVS) using the methodology of balance of the vaginal content (BAVACO) and to compare it with the microbiological study of candidiasis, trichomoniasis and bacterial vaginosis (BV). Pregnant patients (1238) were examined from 2010 to 2012. In asymptomatic (A) (n: 1046) and symptomatic pregnant women (S) (n: 192) BVS I was 59.5% and 26% of the patients, respectively. BVS II was observed in 19.7% of A and in 17.2% of S. BVS III was only detected in A in 0.4%. BVS IV was observed in 14.4% of A and in 38% of S. BVS V was detected in 6% of A and in 18.8% of S. Yeasts were associated to BVS I and II in 55.5% and 23.2% of A, respectively; and in 32.4% and 31% of S, respectively. Trichomonas were associated to BVS I in 50% of A, to IV in 44.4% of S and to V in 33.3% of S. BAVACO susceptibility to detect yeasts was 80.4% and 85.5% in A and S, respectively; 40% and 75% in A and S, respectively, to detect trichomonas and 100% in A and S to detect BV. BAVACO specificity was 100% for all pathogens in A and S. The study of BVS proved useful as a guide to evaluate vaginal dysfunction, regardless of symptomatology. Therefore, this study is recommended as prenatal control.

Prevalencia de resultado positivo de la citología para vaginosis bacteriana, candidiasis y tricomoniasis en una Empresa Social del Estado de Medellín (Colombia), 2010-2012 / Prevalence of positive cytology results for bacterial vaginosis, candidiasis and trichomoniasis in a Social State Institution in Medellín, Colombia, 2010-2012

Objetivo: determinar la prevalencia del resultado positivo de la citología para vaginosis bacteriana, candidiasis y tricomoniasis vaginal, y su distribución según edad, método de planificación y sector de residencia.Materiales y métodos: estudio de corte transversal en especímenes citológicos obtenidos de mujeres atendidas entre los años 2010-2012 en Metrosalud, red de instituciones de la que hacen parte cincuenta centros de salud y unidades hospitalarias de primer nivel en Medellín (Colombia). Se incluyó toda la población de mujeres del régimen subsidiado atendida en la institución, se excluyeron las citologías con muestras insatisfactorias por ausencia de células, exceso de eritrocitos o leucocitos, y extendido defectuoso. Se usó fuente de información secundaria. Los datos se almacenaron y analizaron en SPSS 21®, con medidas de resumen y frecuencias absolutas y relativas.Resultados: se incluyeron 206.035 registros. La prevalencia de vaginosis bacteriana fue 18 %, candidiasis 4,7 % y tricomoniasis 0,8 %. Los subgrupos con mayor prevalencia de infecciones fueron los adolescentes, con 22,8 % de vaginosis bacteriana, 9,2 % de candidiasis y 1,0 % para tricomoniasis; y quienes usan el dispositivo intrauterino (DIU) con 25,6, 5,1 y 1,2 % respectivamente.Conclusión: se halló una elevada prevalencia de las infecciones estudiadas, principalmente en adolescentes y usuarias del DIU; esta información resulta útil para los tomadores de decisiones en salud y para evaluar la pertinencia de estructurar programas de tamización de infecciones del tracto genital aunados a la tamización del cáncer cérvico-uterino.

Objective: To determine the prevalence of positive cytology results for bacterial vaginosis, candidiasis and vaginal trichomoniasis, and distribution by age, birth control method and place of residence. Materials and methods: Cross-sectional study of cytology samples from women seen between 2010 and 2012 at Metrosalud, a network of institutions comprising 50 healthcare centres and level I hospitals in Medellín, Colombia. All the female population under the subsidized insurance regime was included, and inadequate samples due to absence of cells, excess red or white blood cells, and defective smear were excluded. A secondary source of information was used. Data were stored and analysed using the SPSS 21®, with summary measurements and absolute and relative frequencies. Results: Overall, 206,035 records were included. The prevalence of bacterial vaginosis was 18 %, and the prevalence of candidiasis and trichomoniasis was 4.7 % and 0.8 %, respectively. The subgroups with the highest prevalence of infections were adolescents with 22.8 % bacterial vaginosis, 9.2 % candidiasis and 1.0 % trichomoniasis. Among women using the intrauterine device (IUD), the prevalence was 25.6 %, 5.1 % and 1.2 %, respectively.Conclusion: A high prevalence of the infections studied was found, mainly among adolescents and IUD users. This information is useful for healthcare decision-making and for evaluating the relevance of structuring screening programs for genitourinary tract infections together with screening for cervical and uterine cancer.

Perfil clínico, microbiológico y epidemiológico de la vulvovaginitis en gestantes atendidas en el Hospital de Tingo María. Enero-Diciembre 2012 / Clinical, microbiological and epidemiological profile of vulvovaginitis in pregnant women at the Hospital of Tingo Maria. January-December 2012

Las infecciones del tracto genital inferior son frecuentes en pacientes en todos los grupos de edad, pero afectan principalmente a pacientes en edad reproductiva. La presentación clínica varía de infecciones asintomáticas hasta un compromiso local y sistémico importante. Los principales agentes etiológicos son: Gardnerella vaginalis, Candida albicans y Trichomonas. En el embarazo estas infecciones afectan la unidad feto-placentaria, llevando a complicaciones como ruptura prematura de membranas, parto pretérmino y recién nacido de bajo peso, e incluso maternas, como corioamnionitis e infección puerperal. Objetivo: Determinar las características clínicas, microbiológicas y epidemiológicas de la vulvovaginitis en las gestantes que acuden a recibir atención prenatal en el Hospital de Tingo María. Diseño: Estudio descriptivo, retrospectivo. Material y métodos: El estudio se realizó con gestantes que asistieron al Consultorio Materno Perinatal del Hospital de Tingo María, en el periodo de Enero a diciembre del 2012. Se evaluaron 410 gestantes en distintos trimestres de gestación, a quienes se les realizó un hisopado vaginal para luego ser extendidos en una lámina; a las muestras se les realizó las siguientes pruebas: Preparación en fresco con SSF 0.9 por ciento, Test Aminas, identificación del puntaje de Nugent y células clave. Las muestras fueron procesadas en el Laboratorio del Programa de PCITS del Hospital de Tingo María. Resultados: Al realizar el examen físico de las muestras tomadas se encontró que el 60 por ciento de las gestantes presentaron flujo vaginal escaso, mientras que el 40 por ciento presentaban flujo vaginal abundante. Al evaluar el olor de la secreción vaginal, se encontró que 75.12 por ciento de las gestantes no presentaba mal olor en su secreción vaginal, mientras que el 24.88 por ciento sí tenía mal olor. En cuanto al color de la secreción, un 83.66 por ciento presentaron color blanquecino y un 16.34 por ciento color amarillento. Durante el...

The lower genital tract infections are common in patients in all age groups, but mainly affect patients of reproductive age. The clinical presentation varies from asymptomatic infections to tics local and systemic compromise important. The main causative agents are: Gardnerella vaginalis, Candida albicans and Trichomonas. These infections in pregnancy affect fetal-placental unit, leading to complicated as premature rupture of membranes, preterm delivery and low birth weight, and even maternal, as chorioamnionitis and puerperal infection. Objective: To determine the clinical and microbiological characteristics of vulvovaginitis in pregnant women attending antenatal care at the Hospital of Tingo Maria. Design: A descriptive, retrospective study. Material and methods: The study was conducted with pregnant women who attended the Maternal Perinatal Clinic Hospital of Tingo Maria, in the period from January to December 2012. We evaluated 410 pregnant women in different trimesters of pregnancy, who have performed a vaginal swab then be extended in a sheet, the samples were subjected to the following tests: Preparing fresh with SSF 0.9 per cent, Test Amines, Nugent score and clue cells. Samples were processed in the Laboratory PCITS Program Tingo Maria Hospital. Results: Upon physical examination of the samples was found to be 59.76 per cent of pregnant women had vaginal scarce, while 40.24 per cent had heavy vaginal discharge. In assessing the odor of vaginal discharge, it was found that 75.61 per cent of pregnant women had no bad odor in vaginal discharge, while 24.39 per cent did have a bad odor. As for the color of the discharge a whitish showed 82.93 per cent and 17.07 per cent yellow. During the clinical examination for assessment of pruritus, the 64.63 per cent reported not present the symptoms, while 35.37 per cent had pruritus. Microbiological analysis, through the direct smear for identification of Candida albicans, was positive in 48.78 per cent and...

Trichomonas vaginalis and associated factors among women living with HIV/AIDS in Amazonas, Brazil

OBJECTIVES: Our goal was to determine the prevalence of Trichomonas vaginalis and its associated factors among women living with HIV attending an AIDS clinic in Manaus, Amazonas, Brazil. METHODS: Cross-sectional study among women attending an AIDS clinic in Manaus between March and December 2010 for gynecological examination were invited to participate. Enrolled patients answered a face-to-face interview including demographic, behavioral and clinical data. They also underwent a gynecological evaluation and cervical scrape samples were collected for wet mount, Gram stain, culture and cytological analysis. A blood sample was obtained to determine TCD4+ lymphocytes and viral load. RESULTS: A total of 341 (91.2%) women participated in the study. The prevalence of T. vaginalis was 4.1% (95% CI: 2.0-6.2%). Median age was 32 (interquartile range 27-38) years and median years of schooling was 9.0 (interquartile range 4-11). A total of 165 (53.2%) HIV women were classified as patients with AIDS. In multivariate analyses, squamous intraepithelial lesions in cytology [OR = 2.46 (95% CI: 1.31-4.63, p = 0.005)] and anal sex practice [OR = 3.62 (95% CI: 1.08-12.19, p = 0.037)] were associated with T. vaginalis. CONCLUSIONS: These results highlight that HIV-infected women should be screened for T. vaginalis. The control of this infection may have an impact on preventing reproductive complications among these women.

Prevalence of bacterial vaginosis in Grenadian women of reproductive age / Prevalencia de la vaginosis bacteriana en mujeres granadinas en edad reproductiva

OBJECTIVES: To determine the prevalence of bacterial vaginosis (BV) among Grenadian women of reproductive age using the routinely collected Pap smear data for the period January 2009 to December 2011. METHODS: A retrospective review of a cross-section of Pap smears was obtained for women between the ages of 15 and 49 years, using the national centralized data bank at the General Hospital in St George's, Grenada. Women aged younger or older than the sample group, as well as those who were reported as being menopausal or hysterectomized were excluded from the study. Demographic and laboratory data were collected and descriptive statistics reported. RESULTS: The prevalence of BV was 19.5% for the three-year period among the 2677females included in the analysis with the 20-29-year age group having the largest percentage of infection (43.6%). An increase in the trend of prevalence between 2009 (16.1%) and 2011 (21.4%) was also observed. Candida vaginalis and Trichomonas vaginalis were present in 3.6% and 0.85%, respectively. Additionally, atypical cells of unknown significance and cervical dysplasia were documented in 5.3% and 1.8% of the smears, respectively. CONCLUSION: Practicing physicians in Grenada need to consider increased screening for BV in women who may present with non-specific symptoms. Further research is necessary to determine the predisposing factors in Grenadian women and associations with the disease and to assist in the development of national education programmes to alter behavioural practices that could result in the acquisition and persistence of BV among women of reproductive age in Grenada.

OBJETIVOS: Determinar la prevalencia de vaginosis bacteriana (VB) entre mujeres granadinas de edad reproductiva utilizando datos de pruebas de Papanicolaou rutinariamente recolectados durante el período de enero de 2009 a diciembre de 2011. MÉTODOS: Se realizó una revisión retrospectiva de una muestra representativa de Papanicolau de mujeres entre las edades de 15 a 49 años, usando el Banco Nacional de Datos centralizados en el Hospital General de Saint George, Granada. Las mujeres de edad más jóvenes o mayores que el grupo de muestra, así como aquellas que se registraron como menopáusicas o histerectomizadas fueron excluidas del estudio. Datos demográficos y del laboratorio fueron recogidos, y se reportó la estadística descriptiva. RESULTADOS: La prevalencia de BV fue de 19,5% para el período de tres años entre las 2677 hembras incluyeron en el análisis, presentando el grupo de edad de 20-29 años el mayor porcentaje de infección (43,6%). También se observó un aumento en la tendencia de la prevalencia entre 2009 (16,1%) y 2011 (21,4%). Candida vaginalis y Trichomonas vaginalis estuvieron presentes en 3,6% y 0,85%, respectivamente. Además, se documentaron las células anormales de significación desconocida y displasia cervical en 5,3% y 1,8% de los frotis, respectivamente. CONCLUSIÓN: Los médicos en ejercicio en Granada necesitan considerar el aumento del tamizaje para la detección de BV en mujeres que puedan presentarse con síntomas no específicos. Se necesita continuar las investigaciones a fin de determinar los factores de predisposición en las mujeres Granadinas y las asociaciones con la enfermedad. Asimismo, es necesario ayudar al desarrollo de programas nacionales de educación encaminados a modificar aquellas conductas que podrían conducir a la adquisición y la persistencia delaBV entre las mujeres de edad reproductiva en Granada.

Prevalencia de infecciones de transmisión sexual en mujeres embarazadas atendidas en un hospital público de Chile / Prevalence of sexually transmitted infections in pregnant women attending a public hospital in Chile

Introduction: The epidemiologic rates of gonorrhea have declined steadily in Chile, while the incidence of infections with Trichomonas vaginalis and Chlamydia trachomatis is not well known. Aim: Since these sexually transmitted infections (STIs) are associated with adverse pregnancy outcomes and perinatal infections, this study aimed to update their prevalence in a public hospital in the Metropolitan Region of Chile. Patients and Methods: Between April and October 2010 and April and October 2011, pregnant women attending the antenatal Service, Hospital San Borja Arriarán, were randomly selected for detection of T. vaginalis, N. gonorrhoeae and C. tra-chomatis by culture in modified Diamond's broth, Thayer-Martin agar, and by omp1 gene amplification by nested PCR, respectively. We excluded pregnant women who received antibiotics within the past 30 days. Results: Two hundred and fifty five cervicovaginal samples were analyzed. C. trachomatis was detected in 15 (5.9%) and T. vaginalis in 6 (2.4%). N. gonorrhoeae was not found. Conclusion: The results show low prevalence of C. tracho-matis and T. vaginalis and absence of N. gonorrhoeae. These rates have remained stable at this medical center since the 1990s, with a slight increase in C. trachomatis.

Introducción: Las tasas epidemiológicas de gonorrea han disminuido constantemente en Chile, mientras que la incidencia de infecciones por Trichomonas vaginalis y Chlamydia trachomatis no es bien conocida. Estas infecciones de transmisión sexual (ITSs) están asociadas con resultados adversos del embarazo e infecciones peri-natales. Objetivo: Actualizar su prevalencia en un hospital público de la Región Metropolitana de Chile. Pacientes y Métodos: Entre abril y octubre de 2010 y desde abril a octubre de 2011, fueron seleccionadas al azar mujeres embarazadas atendidas en el Servicio de atención prenatal del Hospital San Borja Arriarán para detección de T. vaginalis, N. gonorrhoeae y C. trachomatis, por cultivo en caldo Diamond modificado, cultivo en Thayer-Martin y mediante amplificación del gen omp1, por RPC anidada, respectivamente. Se excluyeron mujeres embarazadas que recibieron antimicrobianos los 30 días previos. Resultados: Se analizaron 255 muestras cérvico-vaginales. C. trachomatis fue detectada en 15 (5,9%) de las mujeres embarazadas. T. vaginalis se aisló en 6 (2,4%) de ellas, mientras que N. gonorrhoeae no se encontró en las gestantes. Conclusión: Los resultados muestran prevalencia baja de C. trachomatis y de T. vaginalis y ausencia de N. gonorrhoeae, proporción que se mantiene estable en este establecimiento desde la década de 1990s, con leve aumento de C. trachomatis.

Clinical and laboratory evidence of Trichomonas vaginalis infection among women of reproductive age in rural area.

Background: Vaginitis is a commonly encountered complaint and one of the most frequent reasons for patient visit to obstetrician-gynaecologists. Three vaginal infections are frequent causes of a vaginal discharge: (1) bacterial vaginosis, (2) vulvovaginal candidiasis and (3) trichomonas vaginitis. Differences in the clinical presentation are helpful in diagnosis. Characteristic signs and symptoms for these three vaginal infections are distinct, but on many occasions, they are overlapping. The aim of the present study was to find the prevalence and correlation between the clinical spectrum and laboratory evidence of Trichomonas vaginalis infection by simple, reliable, confirmatory and specific method, i.e. microscopic examination of wet mount preparation and acridine stain of vaginal fluid. Materials and Methods: Irrespective of HIV status, a total of 156 women with vaginal discharge were studied for establishing diagnosis of genital tract infection. The cases of bacterial vaginosis and vulvovaginal candidiasis were excluded from the study. Vaginal speculum assisted high vaginal swabs were collected from women with discharge, during collection vagina was inspected for obvious signs. Results: Of the 156 women with vaginal discharge, 19 (12.06 %) showed T. vaginalis infection. All the women belonged to active reproductive age group, i.e. 20-40 years. Itching dysuria, and offensive, malodorous, thin, yellowish vaginal discharge were the main and consistent complaints. Only in 2 (1.52%) cases, vaginal speculum examination revealed erythema and punctuate haemorrhage, the so-called "strawberry' vagina. The pH was recorded to be >4.5. Conclusion: Clinical differentiation of various forms of infectious vaginitis is unreliable. The prevalence of T. vaginalis infection at 12.06% was found among rural young women of reproductive age using simple and reliable screening wet mount microscopy.

Tratamento das vulvovaginites na gravidez / Treatment of vulvovaginitis in pregnancy

As vulvovaginites constituem causa frequente de queixa pré-natal. Entre as mais comuns, destacam-se a candidíase, a vaginose bacteriana e a tricomoníase. Permanece polêmico se o rastreamento e o tratamento dessas afecções seriam medidas eficazes contra o parto prematuro. Esta revisão teve como objetivo avaliar as principais opções terapêuticas dessas vulvovaginites durante a gestação, com base nas melhores evidências científicas disponíveis. A literatura recomenda, para tratamento durante a gravidez, o uso tópico de imidazólicos durante sete dias nos casos de candidíase. O metronidazol é boa opção para o tratamento da vaginose bacteriana (via oral ou vaginal por sete dias) e também para os casos de tricomoníase (via oral, dose única e tratamento do parceiro). Nas gestações de alto risco para o parto pré-termo, sobretudo no segundo trimestre, o uso do metronidazol merece cautela, visto poder aumentar este risco

The vulvovaginitis is frequent cause of complaints prenatal. Among the most common, stand out as candidiasis, bacterial vaginosis and trichomoniasis. It remains controversial whether screening and treatment of these conditions would be effective against premature birth. This review aimed to evaluate the main therapeutic options for these vulvovaginitis during pregnancy based on the best available scientific evidence. The literature recommends for treatment during pregnancy, topical imidazole for seven days in cases of candidiasis. Metronidazole is a good choice for the treatment of bacterial vaginosis (orally or vaginally for seven days) and also in case of trichomoniasis (orally, single dose and partner’s treatment). In pregnancies at high risk for preterm delivery, especially in the second quarter, the use of metronidazole merits caution, since it may increase this risk

Comparison of resistant and susceptible strains of Trichomons vaginalis to metronidazole using PCR method

Metronidazole is drug of choice recommended by WHO for treatment of trichomoniasis, however, some reports claims drug resistance in Trichomonas vaginalis isolates recently. The objective of this study was to determine the minimum lethal concentration [MLC] of metronidazole in resistant and sensitive strains, as well as genetic patterns of these stains by PCR method. From February 2006 to March 2007, in a cross sectional study, clinical and wet mount examination of vaginal smear along with culture were performed on 683 women attending to public and private outpatient clinics in Hamadan. Trichomoniasis marked based on major clinical symptoms. Diagnosis confirmed using wet mount microscopically and culture in Diamond medium. A serial concentration of metronidazole was provided and all isolated Trichomonas strains [resistant and sensitive] tested by standard method. Finally, all sensitive and resistant strains examined by PCR technique. Only 15/683, [2.2%] of patients clinically diagnosed trichomonal vaginitis were positive for T. vaginalis by wet smear and culture. The minimum lethal concentration [MLC] for clinically sensitive isolates was 25 micro g/ml; however, this concentration for resistant isolates was 200 micro g/ml after 24 h and 100 micro g/ml after 50 h. The results of PCR examination of DNA from sensitive and resistant isolates had same pattern. The lanes appeared by two primers were 98 bp and 261 bp for both clinically sensitive and resistant strains. Resistance to metronidazole in T. vaginalis has not relation to genetic variations and might be related to some physiologic pathways of organism

Importancia del estudio del balance del contenido vaginal (BACOVA) en el control preventivo de las trabajadoras sexuales / Importance of studying the balance of vaginal content (BAVACO) in the preventive control of sex workers

El objetivo de este trabajo fue estudiar a un grupo de 229 trabajadoras sexuales de Comodoro Rivadavia (Chubut), atendidas en centros públicos de salud de dicha ciudad, mediante la aplicación del método conocido como balance del contenido vaginal (BACOVA). Este método comprende el estudio morfológico de la microbiota vaginal, como así también de la reacción infamatoria. Incluye el análisis del contenido vaginal en fresco y por tinciones de Gram y de Giemsa, de modo de integrar la exploración de todo el panorama biológico. El 35,37 % de estas mujeres presentó microbiota normal (MN); el 15,72 %, microbiota intermedia (MI); el 23,14 %, vaginosis bacteriana (VB) y el 10,48 %, vaginitis microbiana inespecífca (VMI). Los casos de vaginitis por levaduras y por Trichomonas vaginalis comprendieron el 8,30 % y 6,99 % de las mujeres, respectivamente. Se observó el desplazamiento de la MN hacia una MI, que se correspondió con el predominio de bacterias corineformes. Por otra parte, no se reconoció un marcado desequilibrio del contenido vaginal ante la colonización e infección por levaduras o por T. vaginalis: el 48 % de los casos de estas vaginitis convencionales no presentaron reacción infamatoria vaginal (RIV). El 24,89 % de los casos de MN presentaron una signifcativa RIV, y en más del 50 % de las mujeres se diagnosticaron disfunciones vaginales en ausencia de sintomatología. Estos resultados se podrían asociar a un incremento del riesgo gineco-obstétrico, lo que afecta la salud sexual y reproductiva de la población estudiada.

The aim of this work was to study the vaginal microenvironment in sex workers from Comodoro Rivadavia, Chubut. For that purpose, BAVACO procedures were applied. A total of 229 female sex workers attended public health centers. Vaginal secretions were analyzed by Gram and Giemsa stains. The following results were obtained: normal microbiota 35.37 %, intermediate microbiota 15.72 %, bacterial vaginosis 23.14 %, microbial nonspecifc vaginitis, Donders'"aerobic vaginitis" 10.48 %, yeast vulvovaginitis 8.30 %, and trichomoniasis 6.99 %. The intermediate microbiota was characterized by a decrease in the number of lactobacilli and the presence of diphtheroid bacilli cell types. The population studied shared increased values of vaginal dysfunctions. These results are considered risk factors for obstetric and gynecologic diseases.