Factores asociados a Chlamydia trachomatis en mujeres con vaginitis atendidas en atención primaria en salud / Factors associated with Chlamydia trachomatis in women with vaginitis attending in primary health care

INTRODUCCIÓN: Chlamydia trachomatis es reconocida como el agente causal de una de las infecciones de transmisión sexual (ITS) más común y curable. En mujeres, puede ser gatillante de enfermedad inflamatoria pélvica, un factor de riesgo para infertilidad o adquisición de otras ITS. OBJETIVO: Determinar C. trachomatis en mujeres con diagnóstico clínico de vaginitis asociando factores sociodemográficos, sexuales, clínicos y microbiota vaginal. PACIENTES Y MÉTODOS: Participaron 121 mujeres voluntarias > 18 años, con diagnóstico clínico de vaginitis y descarga vaginal anormal, atendidas en servicios de atención primaria en salud (APS) en Temuco-Chile. Se tomó muestra de flujo vaginal, determinándose C. trachomatis por una reacción de polimerasa en cadena convencional y microbiota vaginal por tinción de Gram. Se colectaron datos clínicos, sociodemográficos y sexuales mediante encuesta. RESULTADOS: Rango de edad 18-61 años. La frecuencia de C. trachomatis fue 14,9%. Se asoció C. trachomatis a mayor número de parejas sexuales en los últimos 5 años (p = 0,001), relaciones sexuales oral más anal (p = 0,055) y juguetes sexuales (p = 0,027). Asociación no significativa hubo con vaginosis bacteriana 31,2% (p = 0,091) e inicio de la actividad sexual < 18 años 20,6% (p = 0,07). CONCLUSIONES: Sería beneficioso incorporar en la semiología ginecológica de las mujeres atendidas en servicios de APS, los factores encontrados como favorecedores de infección por C. trachomatis, pues ello podría ayudar al manejo de esta ITS.

BACKGROUND: Chlamydia trachomatis is recognized as the causative agent of one of the most common and curable sexually transmitted infections (STIs). In women, it can be a trigger for pelvic inflammatory disease, a risk factor for infertility or acquisition of other STIs. AIM: To determine CT in women with vaginitis and associate it with sociodemographic, sexual, clinical, and vaginal microbiota factors. Methods: 121 female volunteers > 18 years of age, with a clinical diagnosis of vaginitis and abnormal vaginal discharge, attending in primary health care services (PHC) in Temuco-Chile were recluted. A vaginal discharge sample was taken, determining C. trachomatis by polymerase chain reaction and vaginal microbiota by Gram stain. Clinical, sociodemographic and sexual data were collected by survey. RESULTS: Age range was 18-61 years. The frequency of C. trachomatis was 14.9%. C. trachomatis was associated with a higher number of sexual partners in the last 5 years (p = 0.001), oral plus anal sex (p = 0.055) and sex toys (p = 0.027); there was a non-significant association with bacterial vaginosis 31.2% (p = 0.091) and initiation of sexual activity < 18 years 20.6% (p = 0.07). CONCLUSIONS: It would be beneficial to incorporate in the gynecological semiology of the women attended in PHC services, the factors found to favor C. trachomatis infection, as this could help the management of this STI.

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.