Factors associated with Trichomonas vaginalis infection in reproductive-aged women attending cervical screening in southeast of Brazil

ABSTRACT Background: Sexually Transmitted Infections (STIs) can be caused by viruses, bacteria, and parasites. The World Health Organization estimated more than 300 million new global cases of curable STIs among individuals of reproductive age. Infection by Trichomonas vaginalis is one of the most prevalent curable STL Despite the current treatments available, the diagnosis of T. vaginalis can be difficult, and the resistance to the treatment increased concern for the healthcare system. Objectives: The aim of this study was to determine the prevalence and factors associated with Trichomonas vaginalis infection among women of reproductive age attending community-based services for cervical screening. Patients and methods: A total of 1477 reproductive-aged women attending 18 Primary Health Care Units in Botucatu, Brazil, from September to October 2012, were enrolled. A structured questionnaire was used for individual face-to-face interviews for obtaining data on sociodemographic, gynecologic, and obstetrics history, sexual and hygiene practices, among others. Cervicovaginal samples were obtained for detection of T. vaginalis by culture using Diamond's medium and microscopic vaginal microbiota classification according to Nugent. A multivariable logistic regression analysis was carried out to estimate Odds Ratios (OR) and 95% Confidence Intervals (95% CI) for the association between participants' sociodemographic, behavioral factors, and clinical factors with T. vaginalis infection. Results: Median age of study participants was 33 years (ranging from 18 to 50). The overall prevalence of T. vaginalis infection was 1.3% (n = 20). Several factors were independently associated with T. vaginalis infection, such as self-reporting as black or Pardo for ethnicity (OR = 2.70; 95% CI 1.03-7.08), smoking (OR=3.18; 95% CI 1.23-8.24) and having bacterial vaginosis (OR = 4.01; 95%CI = 1.55-10.38) upon enrollment. A protective effect of higher educational level (having high school degree) was observed (OR = 0.16; 95% CI 0.05-0.53). Conclusions: Our data suggest that screening programs to correctly detect T. vaginalis infection can be helpful to guide prevention strategies to the community. Our study supports an association between abnormal vaginal microbiota and T. vaginalis infection.

Prevalence of bacterial vaginosis and factors associated among women who have sex with women / Prevalência de vaginose bacteriana e fatores associados em mulheres que fazem sexo com mulheres / Prevalencia de vaginosis bacteriana y factores asociados en mujeres que tienen sexo con mujeres

ABSTRACT Objective: to describe the prevalence of bacterial vaginosis and factors associated among women who have sex with women. Method: cross-sectional, descriptive and analytical study with 150 women. The vaginal microbiota profile was analyzed by microscopic examination of vaginal swabs according to the Gram method. Endocervical samples were collected with cytobrush for the investigation of endocervicitis by Chlamydia trachomatis. The polymerase chain reaction was used to diagnosis Human Papillomavirus infection. Socio-demographic data, sexual behavior and clinical history were obtained through an interview. Logistic regression was performed to identify risk factors independently associated with bacterial vaginosis. Results: among the 150 participants, 71 (47.3%) presented some alteration in the vaginal microbiota, 54 (36.0%) bacterial vaginosis and 12 (8.0%) Flora II. The variable independently associated with bacterial vaginosis was the use of sexual accessories [2.37(1.13-4.97), p=0.022]. Conclusion: the high prevalence of bacterial vaginosis among women who have sex with women indicates the need for screening this population and association between use of sexual accessories and this disease suggests the possibility of transmission of sexual fluids between the partners during the sexual act, which demonstrates the need for educational actions on sexual and reproductive health.

RESUMO Objetivo: descrever a prevalência de vaginose bacteriana e fatores associados em mulheres que fazem sexo com mulheres. Método: trata-se de estudo transversal, descritivo e analítico com 150 mulheres. O padrão de microbiota vaginal foi analisado por microscopia do conteúdo vaginal corado pelo método de Gram. Amostras de secreção endocervical foram coletadas com cytobrush para a pesquisa de endocervicites por Chlamydia trachomatis e para infecção por Papilomavírus Humano por meio de reação em cadeia da polimerase. Dados sociodemográficos, de comportamento sexual e de história clínica foram obtidos por entrevista. Regressão logística foi realizada para identificar fatores de risco independentemente associados à vaginose bacteriana. Resultados: dentre as 150 participantes, 71 (47,3%) tinham alguma alteração da microbiota vaginal, 54 (36,0%) vaginose bacteriana e 12 (8,0%) Flora II. A variável independentemente associada com vaginose bacteriana foi o uso de acessórios sexuais [2,37(1,13-4,97), p=0,022]. Conclusão: a elevada prevalência de vaginose bacteriana entre mulheres que fazem sexo com mulheres aponta a necessidade de rastreio nessa população. O uso de acessórios sexuais associado a esse agravo sugere a possibilidade de transmissão de fluidos sexuais entre as parceiras durante o ato sexual, o que demonstra necessidade de ações de educação em saúde sexual e reprodutiva.

RESUMEN Objetivo: describir la prevalencia de la vaginosis bacteriana y los factores asociados en mujeres que tienen sexo con mujeres. Método: se trata de un estudio transversal, descriptivo y analítico realizado entre 150 mujeres. El patrón de microbiota vaginal se analizó por microscopía del contenido vaginal teñido por el método de Gram. Se recolectaron muestras de secreción endocervical con un citocepillo para investigar la endocervicitis por Chlamydia trachomatis y la infección por el Virus del Papiloma Humano mediante la reacción en cadena de la polimerasa. De la entrevista se obtuvieron datos sociodemográficos, de comportamiento sexual y del historial clínico. Se llevó a cabo una regresión logística para identificar factores de riesgo asociados independientemente a la vaginosis bacteriana. Resultados: entre las 150 participantes, el 71 (47,3%) tenía alteración de la microbiota vaginal, el 54 (36,0%), vaginosis bacteriana y el 12 (8,0%), Flora II. La variable asociada independientemente a la vaginosis bacteriana se debió al uso de accesorios sexuales [2,37(1,13-4,97), p=0,022]. Conclusión: la prevalencia elevada de vaginosis bacteriana entre mujeres que tienen sexo con mujeres señala la necesidad de estudiar dicha población, y el uso de accesorios sexuales asociado a este agravante sugiere la posibilidad de transmisión de fluidos sexuales entre las compañeras durante el acto sexual, razón por la cual deben llevarse a cabo acciones de educación en salud sexual y reproductiva.