Burden of genital warts in Colombia: an observational study / Carga das verrugas genitais na Colômbia: um estudo observacional

Introduction: Genital warts are benign lesions caused by sexual transmission of human papillomavirus types 6 and 11, with significant impact on healthcare resource use and patients' quality of life. Objective: To describe the epidemiology of genital warts in adults visiting a physician office for any reason, physician practice patterns, and healthcare resource use and costs in Colombia. Methods: Participants were a convenience sample of 53 physicians in 5 specialties: primary care (15), gynecology (24), urology (12), proctology (1), and dermatology (1). Physicians completed a survey and daily log of all patients 18-60 years old seen over 10 days in their practices in 2016-2017. The physician survey recorded genital warts consultation and management patterns. The daily log recorded patient demographic information and genital warts diagnosis. Results: Among 6,393 patients logged by physicians, the genital warts prevalence was 2.03% (95%CI 1.69­2.38) and incidence 1.30% (95%CI 1.02­1.58). Primary care physicians referred most of their genital warts cases for treatment (female: mean 63.3%, SD=44.8; male: mean 58.3%, SD=43.8). Treatment of non-resistant episodes (<6-month duration) lasted an average of 37.4 days (SD=29.4) and required an average of 4.0 (SD=1.9) office visits for females and 3.0 (SD=1.7) for males. The overall mean cost of an episode of care was USD558.13 (SD=507.30). Conclusion: Genital warts cases reported by most participant physicians were mainly direct-consult, but patients were typically treated by specialists. Much of the genital warts health care utilization and costs reported could be prevented by immunization with the quadrivalent or nonavalent HPV vaccine.

Introdução: As verrugas genitais são lesões benignas, de transmissão sexual, causadas pelo papilomavírus humano tipos 6 e 11 e que causam impacto significativo no uso de recursos de saúde e na qualidade de vida dos pacientes. Objetivo: Descrever a epidemiologia das verrugas genitais em adultos que buscaram atendimento médico ambulatorial por qualquer motivo, incluindo padrões de prática médica, uso de recursos de saúde e custos na Colômbia. Métodos: foi utilizada uma amostra de conveniência composta por 53 médicos em 5 especialidades: clínico geral (15), ginecologia (24), urologia (12), proctologia (1) e dermatologia (1). Os médicos completaram um questionário e registros diários de todos os pacientes com idade entre 18 e 60 anos atendidos durante 10 dias em seus consultórios em 2016-2017. O questionário registrou os padrões de prática médica e de tratamento de verrugas genitais. Os registros diários continham informações demográficas do paciente e o diagnóstico de verrugas genitais. Resultados: Entre 6.393 atendimentos médicos, a prevalência das verrugas genitais foi de 2,03% (IC95% 1,69­2,38) e a incidência de 1,30% (IC95% 1,02­1,58). Os clínicos gerais encaminharam a maioria dos pacientes com verrugas genitais para tratamento (mulheres: média de 63,3%, DP=44,8; homens: média de 58,3%, DP=43,8). O tratamento dos casos não-persistentes (<6 meses de duração) durou em média 37,4 dias (DP=29,4) e requereu uma média de 4,0 (DP=1,9) consultas para mulheres e 3,0 (DP=1,7) para homens. O custo médio geral do tratamento foi de US$ 558,13 (SD=507,30). Conclusão: Os casos de verrugas genitais relatados pela maioria dos médicos participantes derivaram-se principalmente de atendimentos primários e os pacientes foram tratados geralmente por especialistas. Grande parte da utilização de recursos e custos relacionados a verrugas genitais poderia ser evitada pela imunização com a vacina papilomavírus humano 4-valente ou 9-valente.

Conocimiento y creencias sobre infección por clamidia en población joven. Revisión narrativa / Knowledge and beliefs about chlamydia infection in a young population. Narrative review

RESUMEN Introducción: La Chlamydia trachomatis es una de las infecciones de transmisión sexual más comunes en la población menor de 25 años, causante de graves problemas para la salud pública y la calidad de vida de las personas. Objetivo: Describir el conocimiento y creencias en la población joven entre 15 y 25 años, en relación a la infección por Clamidia, enmarcado en el contexto chileno e internacional. Métodos: Revisión narrativa que incluye 14 artículos cualitativos y cuantitativos de los últimos 10 años, en idioma inglés y español. Resultados: Existe desconocimiento sobre la infección por Clamidia, en cuanto a las características clínicas, el medio de transmisión y las pruebas diagnósticas, lo que genera que la población joven subestime el riesgo percibido y aumente conductas sexuales riesgosas. Por otro lado, se observa que el conocimiento aumenta de forma proporcional a la edad de la población, nivel educacional e historia previa de ITS. Conclusión: El déficit de conocimientos frente a las conductas sexuales de riesgo en la población joven favorece a un aumento en la prevalencia la infección por Clamidia, por lo cual es de suma importancia realizar nuevos estudios con el fin de aportar datos para potenciar programas de salud orientados a la concientización de los jóvenes frente a esta infección para así lograr disminuir la incidencia de esta enfermedad y sus complicaciones.

SUMMARY Introduction: Chlamydia trachomatis is one of the most common sexually transmitted infections in the population under 25 years old, causing serious problems for public health and the people's quality of life. Objective: Describe the knowledge and beliefs in the young population between 15 and 25 years old, related to Chlamydia infection in the Chilean and international context. Methods: Narrative review that includes qualitative and quantitative articles of the last 10 years, published in English and Spanish. Results: There is a lack of knowledge about Chlamydia infection, in the clinical characteristics, the transmission, and in the diagnostic tests, which causes the young population to underestimate the perceived risk and increase risky sexual behaviors. On the other hand, it is observed that knowledge increases proportionally to the population's age, educational level, and previous history of STIs. Conclusion: The lack of knowledge about risky sexual behavior in young population increase the prevalence of Chlamydia infection, due to this generates risky behaviors in the population, due to this, it is very important to conduct new studies in order to provide data to promote health programs oriented to raising awareness of young people against this infection and thus achieve to reduce the incidence of this disease and complications.

Incidence, psychosocial burden, and economic impact of genital warts in Mexico / Incidencia, carga psicosocial e impacto económico de las verrugas genitales en México

Abstract: Objective: To estimate the burden of genital warts (GW) in Mexico. Materials and methods: We estimated the annual incidence of GW based on data reported by specialist physicians. We also assessed GW treatment practices, the average cost of treatment, and the psychosocial burden of GW among patients. Results: The annual incidence of GW in Mexico was estimated to be 547 200 cases. Treatment procedures vary by specialist and patient gender. The estimated annual cost was $195 million USD. The psychosocial impact of GW was slightly greater in males than females. Conclusions: This is the first evaluation of the burden of GW in Mexico. Our data suggest that GW are common, with significant health-related costs and psychosocial impact.

Resumen: Objetivo: Estimar la carga por verrugas genitales (VG) en México. Material y métodos: Estimamos la incidencia anual de VG, con base en información proporcionada por médicos especialistas y el manejo de las VG, así como el costo promedio del tratamiento y la carga psicosocial de las VG. Resultados: La incidencia anual de VG en México fue de 547 200 casos. Los tratamientos variaron según la especialidad y el sexo del paciente. El costo anual por VG fue de $195 millones de dólares estadounidenses. El impacto psicosocial de las VG es ligeramente mayor en hombres que en mujeres. Conclusiones: Esta es la primera evaluación de la carga de VG en México. Los datos sugieren que las VG son frecuentes, tienen costos relacionados con salud e impactos psicosociales significativos.

Prevalencia de la infección genital por Chlamydia trachomatis en mujeres que asisten al Instituto Nacional de Perinatología de la Ciudad de México / Prevalence of genital Chlamydia trachomatis infection in women attending in the National Institute of Perinatology from Mexico City

Resumen Introducción: La infección endocervical por Chlamydia trachomatis es considerada una de las principales causas de infertilidad en todo el mundo. Durante el embarazo puede conducir a complicaciones graves como la ruptura prematura de membranas y los partos prematuros. Objetivo: Determinar la prevalencia de infección genital por C. trachomatis en mujeres embarazadas e infértiles de la Ciudad de México. Métodos: La detección de C. trachomatis fue mediante reacción de polimerasa en cadena tiempo real (RPC-TR) con el kit comercial COBAS® TaqMan CT Test v2,0 (Roche Molecular System). Resultados: Se analizaron 2.352 muestras; 102 fueron positivas (4,3%). La prevalencia por edad mostró que las adolescentes embarazadas (15 a 19 años) fueron las de mayor riesgo de infección (10,9%, RR = 3,23 [IC 95%: 1,79-5,84]), seguido de mujeres jóvenes de 20 a 24 años, con prevalencia de 5,6% (RR = 1,65 [IC 95%: 0,82-3,34]). Discusión: Los resultados indican que la prevalencia está dentro del rango reportado en el concierto mundial. Sin embargo, las adolescentes embarazadas tuvieron mayor prevalencia que las mujeres infértiles. Conclusión: Es imperioso realizar un rastreo sistemático de infección por C. trachomatis en mujeres bajo 24 años de edad, y en mujeres embarazadas para disminuir los casos de infertilidad y las complicaciones perinatales.

Background: Endocervical infection by Chlamydia trachomatis is considered one of the leading causes of infertility worldwide. During pregnancy, it can lead to serious complications such as premature rupture of membranes and premature births. Aim: To determine the prevalence of genital infection by C. trachomatis in pregnancy and infertile women from Mexico City. Methods: The detection of C. trachomatis was performed by real-time PCR with the commercial kit COBAS® TaqMan CT Test v2.0 (Roche Molecular System). Results: We analyzed 2,352 endocervical swabs; 102 were positive (4.3%). Age prevalence showed that pregnant adolescents (15 to 19 years of age) had the highest risk of infection (10.9%, RR = 3.23 [95% IC: 1.79-5.84]), followed by young women aged 20 to 24 years, with a prevalence of 5.6% (RR = 1.65 [95% IC: 0.82-3.34]). Discussion: The results indicate that the prevalence is within the range reported worldwide. However, pregnant adolescents were those with a higher prevalence than infertile women were. Conclusion: A systematic screening of C. trachomatis infection in women younger than 24 years of age, and in pregnant women is necessary to reduce the incidence of infertility and perinatal complications.

Demanda del servicio de ginecología infanto-juvenil en la atención primaria de salud (1996-2011) / Demand for infant-juvenile gynecology service in the primary health care from 1996 to 2011

Introducción: los servicios multidisciplinarios de la ginecología infanto-juvenil tienen la finalidad de promover la salud sexual y reproductiva de niñas y adolescentes, estrategia en la cual la atención primaria de salud juega un papel fundamental. Objetivo: determinar la demanda de un servicio de Ginecología Infanto-Juvenil de alcance municipal en un área de atención primaria de salud. Métodos: estudio descriptivo retrospectivo realizado en el municipio Plaza de la Revolución desde julio/1996 hasta diciembre/2011. Se trabajó con 3 091 usuarias que correspondió al universo de los casos vistos. Se analizó el motivo de consulta, acompañamiento y procedencia a partir de la revisión de la historia clínica individual. La información se procesó mediante análisis de frecuencia, media y rango. Resultados: asistieron a consulta en el período estudiado 605 (19,6 por ciento) niñas y 2 486 (80,4 por ciento) adolescentes. En las niñas la causa más frecuente de demanda fue la infección genitourinaria baja, 338 (77,9 por ciento) asociada a condiciones higiénicas inadecuadas. Las adolescentes concurrieron de manera reiterada para recibir orientación anticonceptiva, 325 (23,1 por ciento), casi siempre después de iniciadas las relaciones sexuales, seguido en orden descendente por infección genitourinaria baja y trastornos menstruales. Conclusiones: la demanda del Servicio de Ginecología Infanto-Juvenil se caracteriza por una tendencia al incremento de manera progresiva con predominio de las adolescentes sobre los casos pediátricos. En las primeras es creciente la demanda relacionada con el comportamiento sexual. La atención sistematizada en estos servicios contribuye a mejorar la salud sexual y reproductiva de la población infanto-juvenil(AU))

Introduction: infant-juvenile gynecology is aimed at promoting sexual and reproductive health in girls and adolescents in which the primary health care plays a key role. Objective: to characterize the demand for infant-juvenile gynecology services in a municipal primary health area Methods: retrospective and descriptive study conducted in Plaza of the Revolution municipality from July 1996 to December 2011. The sample was 3 091 patients who made up the universe of cases attended to at the service. Reason for consultation, support, and origin from the review of the medical history of the service individually were analyzed based on the checking of the individual medical history. Information was processed through frequency mean and range analysis. Results: in the studied period, 605 girls (19.6 percent) and 2 486 adolescents (80.4 percent) went to the gynecological service. The main reason for consultation in girls was low genital urinary sepsis, accounting for 338 cases (77.9 percent) and associated to inappropriate hygienic conditions. The teenagers went to the service more frequently to receive contraceptive counseling, amounting to 325 (23.1 percent); this occurred just after having their first sexual intercourse followed by lower genitourinary infection and menstrual disorders. Conclusions: the demand for infant-gynecological service is characterized by growing trends in which adolescents prevail over pediatric patients. Adolescents increasingly demand this service in terms of sexual behavior counseling. Systematic care provided in these services would contribute to improve sexual and reproductive health of the infant and adolescent populations(AU)

Dolor pélvico ginecológico: caracterización de egresos hospitalarios en Chile, 2001-2012 / Gynecologic pelvic pain: characterization of hospital discharges in Chile, 2001-2012

Introducción: se define dolor pélvico como aquél que se presenta en la región abdominal baja o pélvica, que puede ser agudo o crónico, y representa un frecuente motivo de consulta y hospitalización ginecológica. Mientras la valoración del dolor pélvico agudo está orientada a disminuir el riesgo de morbimortalidad a través de su identificación etiológica oportuna, en el caso del dolor pélvico crónico aún existe controversia respecto de su definición y criterios de inclusión etiológicos. Si bien existen amplias variaciones en las estimaciones de prevalencia de dolor pélvico, existe consenso que el dolor pélvico crónico tiene importantes repercusiones, tanto a nivel individual como del sistema de salud. En Chile no existen estudios que hayan cuantificado la prevalencia de dolor pélvico. Se presenta una descripción demográfica y epidemiológica de los egresos hospitalarios por dolor pélvico de causa ginecológica en Chile, desde los años 2001 al 2012, con el fin de aportar cifras iniciales sobre la magnitud de esta problemática de salud de la mujer. Materiales y métodos: Estudio descriptivo del universo de egresos hospitalarios por dolor pélvico en mujeres de 12 años y más, ocurridos en Chile entre los años 2001 y 2012, a partir de las bases de datos nacionales del Ministerio de Salud de Chile. Se seleccionaron los códigos CIE-10, correspondientes a dolor pélvico y perineal, y dolor relacionado con órganos genitales femeninos y con el ciclo menstrual. A partir de las variables disponibles, se realizó un análisis descriptivo sociodemográfico y epidemiológico, realizando inferencia estadística con nivel de significancia de 5%...

Introduction: pelvic pain is defined as the one presenting in lower abdomen or pelvis, which may be acute or chronic, and it represents a frequent reason for gynecologic consultations and hospitalization. While acute pelvic pain valuation is oriented to diminish morbidity and mortality through its opportune etiological identification, in chronic pelvic pain, there is still controversy about its definition and optimal inclusion criteria. While there are wide variations in prevalence estimates of pelvic pain, there is consensus in that chronic pelvic pain has important effects at an individual and health system level. In Chile there are not studies that quantify pelvic pain prevalence. Our work presents a demographic and epidemiological description of hospital discharges by gynecological pelvic pain in Chile, from 2001 to 2012, in order to provide initial figures on the extent of this health issue in women. Materials and methods: Descriptive study of hospital discharges by pelvic pain in women 12 years old and older in Chile between 2001 and 2012, from the national databases of the Chilean Health Ministry. We selected ICD-10 codes corresponding to pelvic and perineal pain, and pain related to female genitalia and the menstrual cycle. With the available variables, we made a sociodemographic and epidemiological analysis, conducting statistical inference with a significance level of 5%...

Verrugas anogenitales y sospecha de abuso sexual infantojuvenil / Anogenital warts and suspicion of child sexual abuse

El presente trabajo se refiere a las lesiones por verrugas anogenitales producidas por el virus de papiloma humano (HPV) en niños. Describe el diagnóstico, la epidemiología, los modos de transmisión, los diagnósticos diferenciales y su relación con el cáncer a largo plazo; también, la presencia de verrugas anogenitales como indicador de abuso sexual infantojuvenil. Finalmente, incluye sugerencias para el pediatra en el manejo de estos pacientes y sus familias.

This article deals with anogenital warts (AGW) injuries caused by human papiloma virus (HPV) in children. Diagnosis, epidemiology, modes of transmission, differential diagnosis, relationship between AGW and cancer are descript. Also, it remarks the presence of AGW as indicator of child sexual abuse. Finally, it includes suggestions for the management of patients and their families by the paediatrician.

Malignant and benign lesions of female genital tract - an experience at a tertiary care hospital in Bahawalpur - Pakistan

Frequencies and incidence rates of site - specific cancer and other pathological lesions are reported regularly in different studies, but mostly not by the histological type within site. This study reviews 3 years data of female genital tract tumours from 2008 - 2011, at Quaid-e- Azam Medical College / Victoria Hospital, Bahawalpur. Data of the surgical specimens of uterus, ovary, vulva, vagina and cervix submitted to the Department of Pathology was reviewed and analysed for the type of specimen, tissue of origin, different diagnosed histological types and finally the behaviour of tumour i.e. benign or malignant. A total of 1373 surgical specimens of female genital tract were submitted in 3 years, out of which 101 [7.4%] were malignant. Twenty nine percent and 28% of the neoplasms were from cervix and vagina respectively followed by vulva [17%], and then ovary and uterus [12% each]. Squamous cell carcinoma was the most common invasive malignancy of the cervix [86%], vulva [77%], and vagina [71%]. Adenocarcinoma was the most frequent malignancy in the uterus [53%] and ovary [61%]. The 73% of the burden of benign disease was contributed by uterine lesions, 3/4th of them being leiomyoma and endometrial hyperplasia. Squamous cell carcinoma was the most frequent malignant tumour of the cervix, vagina and vulva. Adenocarcinoma was the most common malignancy in ovary and uterine corpus. Epidemiologic studies may provide more definite information by considering the effect of these subtypes in examining risk factors

Aspectos ginecológicos e obstétricos de pacientes atendidas nos serviços público e privado de saúde: há diferenças? / Gynecological and obstetrics aspects of patients treated in public and private health services: are there any differences?

OBJETIVO: Avaliar os aspectos epidemiológicos e clínicos de pacientes ginecológicas atendidas nas redes privada e pública de saúde. MÉTODOS: Estudo de corte transversal, no qual foram estudados prontuários de 243 pacientes (122 pacientes no serviço público e 121 no privado), de janeiro de 2007 a janeiro de 2008. Excluíram-se os prontuários de pacientes grávidas, com sangramento genital, histórico de uso de cremes ou géis vaginais em intervalos inferiores há 15 dias e pacientes que tiveram relação sexual em prazo inferior a cinco dias da consulta avaliada. A análise dos dados foi realizada com recursos de processamento estatístico do software Stata, versão 9.2, considerando-se o nível de significância de 5 por cento. RESULTADOS: A média de idade das pacientes foi de 27±12 anos entre pacientes da rede pública, e de 25,9±10,4 anos na rede particular, não havendo diferença estatística entre estas médias (F=0,5 e p=0,4). As pacientes da rede pública apresentaram escolaridade mais baixa (p<0,001), eram preferencialmente do lar (p<0,001), iniciaram vida sexual mais precocemente, tiveram maior número de parceiros (p<0,001), de gestações (p<0,001) e de partos (p=0,004) e utilizavam principalmente a camisinha como método contraceptivo (p=0,013). Não houve diferença estatística em relação aos antecedentes de doenças sexualmente transmissíveis, ao diagnóstico de candidíase, vaginose bacteriana, tricomoníase ou neoplasia. CONCLUSÕES: As pacientes da rede pública de saúde apresentam maior número de gestações e partos. São, em geral, donas de casa, com baixa escolaridade, iniciam vida sexual mais precocemente e com maior número de parceiros. Entretanto, não houve diferença entre os grupos quando se avaliaram doenças mamárias, infecções ginecológicas ou neoplasias de colo uterino, o que sugere que o nível socioeconômico não é o único elemento no determinismo da doença e, por isso, outras variáveis devem ser avaliadas.

PURPOSE: To evaluate the epidemiological and clinical aspects of gynecological patients seeking care in the private and public health networks. METHODS: In this cross-sectional study we analyzed the records of 243 patients (122 public service patients and 121 private service ones), from January 2007 to January 2008. We excluded records of pregnant patients with vaginal bleeding, history of using vaginal creams or gels at intervals of less than 15 days and patients who had sexual intercourse within less than five days before their visit and with incomplete clinical data. Data were analyzed statistically using the Stata software, version 9.2, with a 5 percent level of significance. RESULTS: The mean age of the patients attending the public health service was 27±12 years-old and 25.9±10.4 years-old for patients attending the private health service, with no statistical difference between means (F=0.5 and p=0.4). Patients attending the public health service had lower education (p<0.001), they were preferentially housewives (p<0.001), began sexual life early, had a greater number of partners (p<0.001), of pregnancies (p<0.001) and of deliveries (p=0.004), and mainly used the condom as a contraceptive method (p=0.013). There was no statistical difference between groups regarding the history of sexual transmitted diseases, diagnosis of candidiasis, bacterial vaginosis, trichomoniasis, or neoplasia. CONCLUSIONS: Patients attending the public health service have a higher number of pregnancies and births. They are usually housewives with low educational level, their sex life begins early, and they have more partners. However, there was no difference between groups when evaluating breast diseases, gynecological infections, or cancer of the cervix, which suggests that socioeconomic status is not the only element in the determination of the disease and, therefore, other variables should be evaluated.

Relación del bajo peso al nacer con la sepsis vaginal: its relation to the low-birth weight / Vaginal sepsis: its relation to the low-birth weight

INTRODUCCIÓN: El bajo peso al nacer constituye uno de los principales problemas obstétricos actuales pues está relacionado con más del 75 por ciento de la mortalidad perinatal. Las infecciones del tracto genital se asocian a numerosas complicaciones como aborto espontáneo, elevada morbimortalidad, bajo peso al nacer, endometritis posparto y secuelas en los neonatos sobrevivientes. OBJETIVO: Conocer la relación del bajo peso al nacer con la sepsis vaginal en el área de salud del policlínico Este del municipio Camagüey, durante el trienio 2007-2009. MÉTODOS: Se realizó un estudio descriptivo, transversal, acerca de la relación del bajo peso al nacer con la sepsis vaginal en el área de salud. El universo estuvo conformado por los 1 151 nacidos vivos en el periodo y se tomó como muestra los 55 niños que nacieron con peso inferior a 2 500 g, independientemente de la edad gestacional, aplicándoles a las madres un cuestionario (previo consentimiento informado) que contenía las variables: presencia de sepsis, tipo de germen, rotura prematura de membranas y modificaciones cervicales durante el embarazo. RESULTADOS: El 72,72 por ciento de las madres tuvieron en algún momento del embarazo sepsis vaginal, el germen más frecuente fue la trichomonas vaginalis con el 50,90 por ciento; el 52,5 por ciento de las gestantes aunque tenían sepsis vaginal no presentaron modificaciones cervicales. CONCLUSIONES: Las tres cuartas partes de las gestantes tuvieron sepsis vaginal, más de la mitad de las gestantes que tuvieron sepsis vaginal presentaron rotura prematura de membranas

INTRODUCTION: The low-birth weight is one of the major current obstetric problems since it is related to with more than the 75 percent of the perinatal mortality. The genital tract infections are associated with many complications including the spontaneous abortion, a high morbidity and mortality, the low-birth weight, postpartum endometritis and the sequelae in surviving neonates. OBJECTIVE: To know the relationship between the low-birth weight and vaginal sepsis in a health area of the East polyclinic of Camag³ey municipality from 2007-2009. METHODS: A cross-sectional and descriptive study was conducted to know the relationship between the low-birth weight and vaginal sepsis in the above mentioned health area. Universe included 1 151 newborns during the period taking like sample a group of 55 children weighing less than 2 500 g, independently of the gestational age, applying to mothers a questionnaire (previous informed consent) including the following variables: presence of sepsis, type of germen, an premature rupture of membranes and cervical modifications during pregnancy. RESULTS: The 72.72 percent of mothers had during any moment of pregnancy vaginal sepsis, the more frequent germ was the Trichomonas vaginalis with the 50.90 percent; the remainder 52.5 percent although despite the presence of vaginal sepsis had not cervical modifications. CONCLUSIONS: The three quarter of pregnant women had vaginal sepsis, more than half with this type of sepsis also had a premature rupture of membranes

Factores de riesgo asociados a alteraciones histológicas del aparato genital en pacientes del primer nivel de atención / Risk factors associated with histological alterations of the female genital tract in patients attending a first-level medical care facility

Objetivo: Determinar los factores de riesgo para las alteraciones histológicas del aparato genital en población abierta. Material y métodos: Estudio de casos y controles anidado en una cohorte. Se incluyeron pacientes de la consulta externa que acudieron de forma espontánea al programa de prevención y control de cáncer cervicouterino. Se estudiaron 1933 pacientes, de las cuales 88 fueron diagnosticadas con alteración celular y fueron pareadas con 88 sin alteraciones. El análisis estadístico se realizó con Anova de una vía para la comparación entre grupos y la asociación de las variables con riesgo relativo para un intervalo de confianza de 95 % y p < 0.05. Resultados: El grupo de pacientes consideradas como casos tuvo edad promedio de 36.1 ± 1.6 y el de controles de 35.8 ± 2.1 años. Los diagnósticos obtenidos en el grupo de casos mostró mayor frecuencia de ectropión, infección por virus del papiloma humano y NIC1. Los factores de riesgo analizados solo demostraron diferencia estadística en el número de gestas mayor a dos (RR = 2.33) y el inicio de vida sexual menor a 19 años (RR = 1.14), para padecer algún problema histológico del aparato genital. Conclusiones: La prevención del cáncer cervicouterino se puede realizar por detección oportuna, orientada a evitar o disminuir factores de riesgo, por lo que utilizar preservativo, posponer el inicio de la vida sexual y limitar el número de parejas, son medidas que debe conocer la población general.

BACKGROUND: We undertook this study to determine risk factors for histological alterations of the female genital tract in an open population who attend a first-level care medical facility. METHODS: We conducted a case/control cohort study that included patients from outpatient consultation who responded to a cervical cancer control and prevention program. We studied 1933 patients; 88 patients (cases) had cellular alterations and were matched with 88 patients without alterations (controls). Statistical analysis was carried out with one-way ANOVA for comparison between groups and association of variables with relative risk for 95% confidence interval; p <0.05. RESULTS: Mean age of the case group was 36.1 +/- 1.6 years and the control group had a mean age of 35.8 +/- 2.1 years. Diagnoses obtained in the case group showed a greater frequency of ectropion, human papilloma virus infection and CIN1. Risks factors analyzed in these patients showed statistical differences in number of gestations >2 (RR = 2.33) and the early initiation of sexual activity (<19 years) (RR = 1.14) for experiencing histological problems of the female genital tract. CONCLUSIONS: Prevention of cervical cancer can be accomplished through timely and opportune detection in order to avoid the disease or to decrease risk factors by using condoms, delaying initiation of sexual activity and limiting the number of sexual partners. These are all strategies that the general population should be aware of.

Perspectives on sexual and reproductive health among women in an ancient mining area in Brazil / Perspectiva de la salud sexual y reproductiva en mujeres de una antigua zona minera de Brasil

The purpose of this study was to describe the reproductive profile and frequency of genital infections among women living in the Serra Pelada, a former mining village in the Pará state,Brazil. A descriptive study of women living in the mining area of Serra Pelada was performed in 2004 through interviews that gathered demographics and clinical data, and assessed risk behaviors of 209 randomly-selected women. Blood samples were collected for rapid assay for HIV; specimens were taken for Pap smears and Gram stains. Standard descriptive statistical analyseswere performed and prevalence was calculated to reflect the relative frequency of each disease. Of the 209 participants, the median age was 38 years, with almost 70% having less thanfour years of education and 77% having no income or under 1.9 times the minimum wage of Brazil. About 30% did not have access to health care services during the preceding year. Risk behaviors included: alcohol abuse, 24.4%; illicit drug abuse, 4.3%; being a sex worker, 15.8%; and domestic violence, 17.7%. Abnormal Pap smear was found in 8.6%. Prevalence rates of infection were: HIV, 1.9%; trichomoniasis, 2.9%; bacterial vaginosis, 18.7%; candidiasis, 5.7%;Chlamydial-related cytological changes, 3.3%; and HPV-related cytological changes, 3.8%. Women living in this mining area in Brazil are economically and socially vulnerable to health problems. It is important to point out the importance of concomitant broader strategies that include reducing poverty and empowering women to make improvements regarding their health.

El propósito de este estudio fue describir el perfil reproductivo y la frecuencia de infecciones genitales en mujeres que viven en la población minera Serra Pelada en el Estado de Pará, Brasil. Se realizó un estudio descriptivo de las mujeres que vivían en la zona minera de Serra Pelada en 2004 mediante entrevistas en las que se recabarondatos demográficos y clínicos y se examinaron las conductas de riesgo de 209 mujeres seleccionadas aleatoriamente. Se tomaron muestras de sangre para pruebas rápidas de detección de anticuerpos contra el VIH y muestras de tejido para análisis citológico y tinción de Gram. Se calculó la prevalencia y se utilizaron pruebas estadísticas descriptivas estándares para caracterizar la frecuencia relativa de cada enfermedad. La mediana de la edad de las 209 participantes fue de 38 años; 70% tenía menos de cuatro años de escolaridad y 77% no tenía ingresos o estos eran inferiores a 1,9 veces elsalario mínimo en Brasil. Alrededor de 30% no tuvo acceso a servicios de salud durante el año previo. Entre las conductas de riesgo estaban: consumo de bebidas alcohólicas (24,4%) y de drogas ilícitas (4,3%), ser trabajadora sexual (15,8%) y violencia doméstica (17,7%). Se encontraron resultados anormales a la prueba citológica en8,6% de las participantes. Las prevalencias de infección fueron: 1,9% de VIH, 2,9% de tricomoniasis, 18,7% de vaginosis bacteriana y 5,7% de candidiasis; 3,3% presentó alteracionescitológicas asociadas con la infección por clamidia y 3,8% alteraciones citológicas asociadas con el virus de papiloma humano. Las mujeres de esta zona minera de Brasil son económica y socialmente vulnerables a problemas de salud. Es importante señalar la importancia de estrategias concomitantes más amplias que abarquen la reducción de la pobreza y el empoderamiento de las mujeres para lograr mejoras en su salud.

Aspectos epidemiológicos e clínicos de pacientes ginecológicas atendidas na Faculdade de Medicina de Barbacena / Epidemiologic and clinical aspects of gynecology patients under medical assistance in Barbacena Faculty of Medicine

Objetivos: avaliar os aspectos clínicos e epidemiológicos de pacientes ginecológicas atendidas na Faculdade de Medicina de Barbacena no período de agosto de 2003 a maio de 2004. Métodos: trata-se de estudo transversal a partir de inquérito e exame clínico. Resultados: foram estudadas 252 pacientes cuja idade variou de sete a 73 anos e média de 33,3 ± 13,2 anos, sendo a maior freqüência de pacientes casadas (56,3 por cento), donas de casa (46,8 por cento) e que cursaram até o primeiro grau do Ensino Fundamental(65,9 por cento). A média de idade do início da vida sexual foi de 18,3 ± 2,9 anos, com variação de 13,0 a 32,0 anos. Em relação ao número de parceiros sexuais atualmente, observou-se média de 0,8 ± 0,5, sendo que a relação sexual com parceiro fixo (73,8 por cento) foi a mais freqüente. Dos métodos contraceptivos atuais, a laqueadura tubárea foi citada por21,8 por cento das pacientes. Em relação aos motivadores dessas consultas destacaram-se:exame de rotina (29,1 por cento), corrimento vaginal (24,9 por cento), alterações do ciclo menstrual(20,4 por cento), dor abdominal e pélvica (11,9 por cento), prurido vaginal e vulvar (9,5 por cento), sintomas do climatério (5,9 por cento) e pré-natal (4,2 por cento). Pelo exame citológico, rastrearam-se oito casos com alguma alteração epitelial escamosa (4,2 por cento). Conclusão: as pacientes aqui estudadas eram jovens, casadas e com baixo nível intelectual e econômico, sendo de importância o seu atendimento gratuito e acadêmico.

Prevalence of reproductive tract infections amongst ever married women and sociocultural factors associated with it.

A community-based study was carried out to assess the prevalence of reproductive tract infections (RTIs) among ever married rural women aged 15 -45 years at village Naila during 2002. Six hundred houses were surveyed and all the eligible women residing in these houses were interviewed by MPWs and Interns and were offered medical examinations at rural health training centre, Naila. At least one symptom related to RTIs was found in 471(55%) out of 859 women. Only 50% (432/859) women gave consent for their gynaecological and microbiological examinations. Out of 432 women examined 61% (263/432) had at least one type of RTIs. Out of 263 cases, 43% had cervicitis, 26% had bacterial vaginitis, 14% had fungal infection, 8% had trichomonas vaginitis, 22% had pelvic inflammatory disease and 19% had cervical erosion. Prevalence of RTI was significantly associated with age, personal hygiene, material used for menstrual blood, gravida status, type of attendance at child birth, invasive contraceptives, gynaecological surgery but caste, literacy status and place of deliveries were not significantly associated with RTI status in the present study.

Obstetric history and reproductive tract infections among married female (15-44 yrs.) in rural area of district Meerut, U.P.

The prevalence of RTIs in 600 married females (15-44 yrs.) representing 12 subcentre villages of Daurala block of Meerut was 35.3%. The reproductive tract infections were significantly associated with place of last delivery (P< 0.001), person conducted the last delivery (P< 0.001) and in women had history of abortions (P< .005).

Prevalence and risk factors for reproductive tract infections among women in rural Vietnam.

The objective of this study was to estimate prevalence and risk factors of reproductive tract infections (RTIs) among women in Haiphong, Vietnam. In October 1998, 197 women aged 18-49 were recruited into a community-based, cross-sectional study. Of the 197 women, 95 (49.5%) were diagnosed with > or = 1 endogenous reproductive tract infections (RTI) and 7 (3.6%) with > or = 1 sexually transmitted disease (STD). In three separate multivariate analyses, age <30 years (OR = 2.5; 95% CI = 1.1, 5.8), residential mobility (OR = 2.3; 95% CI = 1.1, 4.9), self reported genital itch/discharge (OR = 2.1; 95% CI = 1.1, 4.1), and reported belief that RTI symptoms were shameful (OR = 2.5; 95% CI = 1.2, 5.0) were associated with bacterial vaginosis (BV); low education was associated with candida (OR = 2.6; 95% CI = 1.0, 6.7); > or = 1 abortion was associated with > or = 1 STD (OR = 9.2; 95% CI = 1.1, 427). The prevalence of STDs was low but the prevalence of endogenous infections was high. Abortion is a proxy for other factors, such as high risk sexual behavior in either the woman or her partner. Given the low prevalence STD in this area of Vietnam, clinical case management of women presenting with RTI symptoms should focus on treatment of the more common endogenous infections, candida and BV.

An overview of reproductive health of women in Bajhang district.

Reproductive health is not merely an absence of disease or disorder, rather it is a condition in which reproductive process is accomplished in a state of complete physical, mental and social well being according to WHO. Reproductive morbidity encompasses obstetric morbidity including conditions during pregnancy, delivery and the post-partum period; and gynecological morbidity including conditions of the reproductive tract such as reproductive-tract infections, cervical cell changes, genital prolapse, malignancies and infertility. The first step towards achieving the needs of women as consumers and providers is to do baseline research so that the nature and magnitude of the problem is assessed. Bajhang is one of the poorest, most deprived and remotest districts in the Far Western development region of Nepal. The status of all women is very low and their situation is very difficult. This study was conducted during a gynecological camp for a period of six days from 10th-15th March, 2003, in the district hospital of Bajhang at Chainpur. All women who attended the gynecological camp were included in the study. The 6 days period, total 530 women had attended the camp. Among them 273 (51.5%) had gynecological problems. Uterovaginal prolapse was the leading morbidity found in 97 women (18.3%) followed by subfertility (14.2%) and reproductive tract infections(13.9%). Only 22.0% women were using family planning methods. This study shows that a large number of women are seeking help for gynecological problems, hence emphasizing the importance of research in this area. Such studies have a pronounced impact in settings where no information on gynaecological morbidities exists and where there is an absence of consensus on the extent of such morbidity. This study not only gives us a baseline data about the most prevalent gynaecological problems in the remote area, it may help us in planning future reproductive health programs also.

Non healing genital ulcer in a young woman. A case Report

A case of a young married female is reported here, who was treated with various topical and systemic medicines for non healing ulcer over labia majora. A faint scaly rash was noted over her face in addition to genital ulcer. On suspicion of secondary syphilitic rash, serological tests for syphilis were carried out which confirmed the diagnosis. She was then treated accordingly. The genital ulcer and the rash, both settled in about four weeks

Prevalence and determinants of reproductive tract infections among women.

Reproductive tract infections (RTIs) are one of the most common health problems in women during reproductive age. There are gaps in the knowledge regarding the prevalence and determinants of these infections among women. A cross-sectional study was conducted at Primary Health Centre, Palam. Three hundred currently married women from antenatal and gynae clinic were interviewed followed by clinical examination and microbiological investigations. The prevalence of RTIs was 37.0 % based on symptoms and 36.7 % by laboratory investigations, including 26.3% candidiasis, 18.0% vaginitis, 15.7% trichomoniasis and 14.3% bacterial vaginosis. Factors which were found to be significantly associated with reproductive tract infections in women were not cleaning genitals daily, last delivery being domiciliary, history of anal intercourse, last delivery conducted by dai, relative/neighbour, not bathing daily, not bathing daily during menstruation and history of abortions. Strength of association of these factors was further analysed using the odd ratio with 95% confidence interval.