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.

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.

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. .

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.

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.

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.

Prevalencia de Trichomonas vaginalis en trabajadores sexuales / Trichomonas vaginalis prevalence in sex workers

La tricomoniasis es una infección de transmisión sexual (ITS) que se asocia a vaginitis, uretritis, cervicitis y enfermedad inflamatoria pélvica pudiendo producir infertilidad tubárica. El objetivo de este trabajo, de tipo retrospectivo longitudinal, fue determinar la prevalencia de Trichomonas vaginalis en una población de trabajadores sexuales en Mendoza, Argentina. Se estudió en forma retrospectiva una población de 720 personas asistidas por el Programa Provincial de ITS de Mendoza. Entre febrero de 2007 y junio de 2009 se procesaron 1692 muestras con un muestreo por reposición. La distribución por sexo fue de 687 mujeres y 33 varones con edades comprendidas entre 15 y 65 años. La prevalencia de tricomoniasis determinada en esta población en riesgo fue de 7.6% para las mujeres, sin encontrarse infecciones en el grupo de los hombres. La prevalencia hallada en este grupo en riesgo muestra una población con alta vulnerabilidad para contraer otras ITS de mayor gravedad. En otro sentido, sugiere una importante falta de adhesión al uso de barreras mecánicas para prevenir infecciones de transmisión sexual. Este trabajo justifica la elaboración de una guía de procedimientos para el manejo de la infección por tricomonas en el marco del Programa de Salud Reproductiva (PROSAR).

Trichomoniasis is a sexually transmitted infection (STI) usually associated to vaginitis, urethritis, cervicitis and pelvic inflammatory disease, which can cause infertility. The aim of this retrospective longitudinal study was to determine Trichomonas vaginalis prevalence in a population of male and female sex workers in Mendoza, Argentina. A cohort of 720 people who attended the STI Program in this province was retrospectively analyzed. From February 2007 up to June 2009, 1692 samples were processed using a reposition sampling method. The age and sex distribution of the population was: 687 women/33 men, from 15 to 65 years old. Trichomoniasis prevalence determined for this population at risk was 7.6% in women only, men did not present infection. The high prevalence shown for this risk group suggests a great vulnerability of this population to contract other more serious STIs. In another sense, it also shows a remarkable lack in the use of mechanical barriers to prevent sexually transmitted diseases (STDs). The present research justifies the elaboration of standardized procedures guide to diagnose T. vaginalis within the framework of the Reproductive Health Program (PROSAR).

Detección de Chlamydia trachomatis, esporos micóticos y Trichomonas vaginalis en mujeres en edad fértil que acuden a los Hospitales San Pablo y Regional de San Lorenzo / Chlamydia trachomatis, fungal spores and Trichomonas vaginalis detection of childbearing age women who attend to San Pablo Hospital and Regional of San Lorenzo

Introducción: Las infecciones vulvo-cérvico-vaginales constituyen la causa más común por la que las mujeres en edad fértil acuden al Ginecólogo. Los agentes etiológicos involucrados incluyen a Chlamydia trachomatis, Trichomonas vaginalis, Cándida albicans, entre otros. La sospecha de vulvo-cervico-vaginitis debe orientar a la realización de estudios de secreción vaginal y muestreo endocervical a fin de detectar el agente causal, establecer un tratamiento específico y disminuir la prevalencia de los mismos así como las complicaciones. Objetivos: Determinar la prevalencia de esporos micóticos, Trichomonas vaginalis y Chlamydia trachomatis en mujeres en edad fértil. Materiales y Métodos: Estudio observacional, descriptivo, de corte transversal y prospectivo, con cuestionario realizado a mujeres en edad fértil que acudieron a los hospitales Materno Infantil San Pablo y Regional de San Lorenzo entre los meses de diciembre de 2010 a febrero de 2011. Resultados: De las 148 pacientes estudiadas, se observó una prevalencia de 27,7% de esporos micóticos, 2% de Trichomonas vaginalis y 4,1% de Chlamydia trachomatis. De las pacientes estudiadas, la mayoría tenían entre 25 a 29 años (26%). Conclusión:La prevalencia de esporos micóticos fue 27,7%, Trichomonas vaginalis 2% y Chlamydia trachomatis 4,1%.

Introduction: the vulvo cervicovaginal infections are the most common reason that women of childbearing age go to the gynecologist. The ethiological agents involved are Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, among others. The suspicion of cervico-vulvo-vaginitis should guide the studies of vaginal discharge and endocervical sampling to detect the causative agent, to stablish specific treatment and reduce the prevalence of these infections and the complications. Objective: to determine the prevalence of fungal spores, Trichomonas vaginalis and Chlamydia trachomatis in women of childbearing age. Materials and Methods: observational, descriptive, cross-sectional and prospective study performed in women of childbearing age who attended the San Pablo Hospital and Regional of San Lorenzo between the months of December 2010 to February 2011. Results: 148 patients were studied, there was a 27.7% prevalence of fungal spores, 2% Trichomonas vaginalis and 4.1% Chlamydia trachomatis. Of the patients studied, most were between 25 to 29 years (26%). Conclusion: the prevalence of fungal spores was 27.7%, Trichomonas vaginalis 2% and Chlamydia trachomatis 4.1%.

[Detection of drug resistance gene in trichomonas vaginalis by PCR]

Trichomoniasis is a worldwide protozoan parasitic disease. Considering the importance of the disease in public health and the controversial ideas about the prevalence of drug resistance, this study was designed to determine the prevalence of metronidazole resistance gene in trichomonas vaginalis [T. vaginalis] with PCR-RFLP method in Tehran and in Kashan. In this descriptive study 140 samples of T. vaginalis in patients with T. vaginalis infections were collected and assessed microscopically. Then they were isolated and examined by culturing in dorset's medium, DNA extraction and PCR amplification. The PCR products were analyzed using RFLP and suspected samples were sequenced. All but 7 samples were T. vaginalis positive by PCR. Sixty-two samples [44.4%] were examined by microscopic, culture and PCR techniques; 12 samples [8.5%] by microscope and PCR, 56 samples [40%] by culture and PCR and other 3 samples [2.1%] were positive only by PCR. Two samples [1.5%] were also examined for detection of mutation in 18S rRNA gene with RFLP in Tehran. This study shows that T. vaginalis infections in the female population living in Tehran are metronidazole-resistant. Since metronidazole is considered as the drug choice for T. vaginalis infections, more studies are recommended for identification of the drug resistance mechanisms and prevention of the disease

Abnormal Vaginal Flora in Low-Risk Pregnant Women Cared for by a Public Health Service: prevalence and Association with Symptoms and Findings from Gynecological Exams / Alteração de flora vaginal em gestantes de baixo risco, atendidas em serviço público de saúde: prevalência e associação à sintomatologia e achados do exame ginecológico / Alteración de la flora vaginal en gestantes de bajo riesgo atendidas en servicio público de salud: prevalencia y asociación a la sintomatología y hallazgos del examen ginecológico

This study identifies the prevalence of vaginal flora alterations in low-risk pregnant women and their association with reported symptoms and gynecological exams. This quantitative, descriptive, cross-sectional study was conducted in public primary care service units in Botucatu, SP, Brazil from 2006 to 2008 with 289 pregnant women from a stratified sample obtained by sampling by care unit. Tests of vaginal content were performed using Gram’s method and testing for Trichomonas vaginalis using Diamond’s medium. The prevalence of altered vaginal flora was 49.5 percent, of which bacterial vaginosis (20.7 percent), vaginal candidiasis (11.8 percent) and intermediate flora (11.1 percent) were the most frequent, not considering associations. Results revealed a high prevalence of vaginal flora alterations with little relation to symptoms, but in agreement with findings from the gynecological exams. Considering undesirable maternal and perinatal outcomes and feasible laboratory practices, the establishment of a routine for diagnosing vaginal flora alterations in low-risk pregnant women is suggested.

Objetivou-se identificar a prevalência das alterações de flora vaginal em gestantes de baixo risco, sua associação à sintomatologia referida e exame ginecológico. É estudo quantitativo, descritivo e transversal, desenvolvido no serviço público de atenção básica de Botucatu, SP, no período de 2006 a 2008, com 289 gestantes, amostradas de forma estratificada por unidade. Realizou-se exame do conteúdo vaginal, utilizando-se coloração pelo método de Gram e pesquisa de Trichomonas vaginalis em meio líquido de Diamond. Desconsiderando-se as associações, a prevalência de flora vaginal alterada foi de 49,5 por cento, sendo as mais frequentes: vaginose bacteriana (20,7 por cento), candidíase vaginal (11,8 por cento) e flora intermediária (11,1 por cento). Os dados apontam elevada prevalência das alterações de flora vaginal, com pouca associação à sintomatologia, mas associação com achados do exame ginecológico. Considerando-se as repercussões maternas e perinatais indesejáveis e a prática laboratorial exequível, sugere-se o estabelecimento de rotina para diagnóstico das alterações de flora vaginal em gestantes de baixo risco.

Se tuvo por objetivo identificar la prevalencia de las alteraciones de flora vaginal en gestantes de bajo riesgo, su asociación a la sintomatología referida y examen ginecológico. Estudio cuantitativo, descriptivo y transversal, desarrollado en el servicio público de atención básica de Botucatu/SP, en el período de 2006 a 2008, con 289 gestantes, el muestreo fue realizado de forma estratificada por unidad. Se realizó examen del contenido vaginal utilizándose coloración por el método de Gram e investigación de Trichomonas vaginalis en medio líquido de Diamond. Desconsiderándose las asociaciones, la prevalencia de flora vaginal alterada fue de 49.5 por ciento, siendo las alteraciones más frecuentes: vaginitis bacteriana (20.7 por ciento), candidiasis vaginal (11.8 por ciento) y flora intermediaria (11.1 por ciento). Los datos apuntan elevada prevalencia de las alteraciones de flora vaginal, con poca asociación a la sintomatología, pero con asociación a hallazgos del examen ginecológico. Considerándose las repercusiones maternas y perinatales indeseables y la práctica de laboratorio ejecutable, se sugiere el establecimiento de rutina para diagnóstico de las alteraciones de flora vaginal en gestantes de bajo riesgo.

Tricomoníase: prevalência no gênero feminino em Sergipe no biênio 2004-2005 / Trichomoniasis: prevalence in the female gender in 2004-2005 in Sergipe State, Brazil

A tricomoníase é uma protozoose causada pelo Trichomonas vaginalis, que desencadeia uma ampla variedade de manifestações clínicas, podendo estar associada à transmissão do vírus da imunodeficiência humana, câncer cervical, infertilidade, entre outros. No Brasil, a incidência varia entre 20 e 40 por cento. A via primária de transmissão é pelo contato sexual e o diagnóstico laboratorial pode ser realizado através da Reação de Polimerase em Cadeia (PCR), isolamento em meios de cultura e exame do conteúdo vaginal à fresco e/ou corados pelos métodos de Giemsa e Papanicolau. Esse último possui limitações na detecção de patologias consideradas DST, a exemplo da tricomoníase. Esse artigo trata da prevalência de tricomoníase em mulheres usuárias dos laboratórios conveniados ao Ministério da Saúde, na faixa etária de 19 a 44 anos, que foram submetidas ao teste de Papanicolau, em 2004-2005, no Estado de Sergipe. Os resultados revelaram que, em 206.034 usuárias, 7.349 apresentaram tricomoníase, sendo que 3.788 em 2004 e 3.498 em 2005. Observou-se que a prevalência estimada em Sergipe, no biênio estudado, não corrobora com a realidade brasileira, fato esse que pode estar atrelado ao diagnóstico executado.

Trichomoniasis is a disease caused by the protozoan Trichomonas vaginalis, which initiates a wide variety of clinical manifestations. It may be associated with human immunodeficiency virus, cervical cancer, infertility and other diseases. Its incidence ranges from 20 percent up to 40 percent in Brazil. The primary channel of transmission is by sexual contact and laboratorial diagnostic may be performed by chain polymerase reaction (CPR), culture medium isolation, fresh vaginal content exam and/or colored by Giemsa and Papanicolau methods. The later has limitations in the detection of pathologies considered sexually transmissible, like Thricomoniasis. This work deals with prevalence of Thricomoniasis in users of laboratories associated with the Ministry of Health, in the age group from 19 up to 44 years old which were submitted to Papanicolau test in 2004-2005 in Sergipe state, Brazil. Results have revealed that among 206,034 users, 7,349 have shown Thricomoniasis, being 3,788 in 2004 and 3,498 in 2005. It could be observed that the estimated prevalence in Sergipe in the biennium studied did not corroborate with the Brazilian reality, which may be attributed to the diagnostic executed.

Inquérito preliminar de Trichomonas vaginalis em população feminina e fatores de risco associados em Unidade de Atendimento Público no município de Uberlândia-MG / Survey of Trichomonas vaginalis in women attended in public health care facilities and risk factors for infection, in Uberlândia, Minas Gerais state, Brazil

Trichomonas vaginalis é o agente etiológico da tricomonose, sendo transmitido sexualmente ou por meio de fômites contaminados. O objetivo deste estudo foi determinar a prevalência do parasito, identificando os possíveis fatores de risco associados à infecção. Amostras de secreções vaginais de 157 mulheres procedentes da Unidade de Atendimento Integrado, em Uberlândia-MG, foram coletadas e questionários epidemiológicos foram aplicados com o intuito de se conhecer variáveis socioeconômicas e hábitos comportamentais. Foram coletadas duas amostras individuais de cada paciente, as quais foram analisadas por meio de exame direto a fresco, cultura e Papanicolaou. Do total, nove (5,7por cento) mulheres apresentaram o parasito, sendo encontrada maior prevalência da infecção entre as casadas, negras, morenas ou pardas e com idade média de 37 anos, apesar de não ser estatisticamente significante (p maior que 0,05). A baixa escolaridade, a fase do ciclo menstrual e a presença de sinais clínicos foram variáveis associadas à infecção (p menor que 0,05). Na comparação entre os métodos diagnósticos, o exame direto a fresco e a cultura mostraram concordância de 100por cento e apresentaram sensibilidade maior do que o Papanicolaou. Esses fatores constituem informações importantes no estudo socioepidemiológico envolvendo o parasito e são fundamentais para o controle da doença.

Prevalencia por diagnóstico inmunológico de Candida spp, Trichomonas vaginalis y Gardnerella vaginalis en mujeres embarazadas a nivel primario del sistema de salud / Prevalence by immunologic diagnosis of Candida spp, Trichomonas vaginalis and Vardnerella vaginalis in pragnants at primary level of health system

OBJETIVO: determinar la prevalencia de Candida spp, Trichomonas vaginalis y Gardnerella vaginalis en la población de mujeres embarazadas de cuatro áreas primarias de salud de la provincia La Habana a través de un método inmunológico con partículas de látex, FemPure. MÉTODOS: se tomaron muestras de exudado vaginal a todas las mujeres embarazadas con o sin síntomas de vaginitis en los consultorios especializados de Obstetricia de cuatro áreas primarias de salud de la provincia La Habana con o sin síntomas de vaginitis a través de un método inmunológicocon partículas de látex. Se siguió la metodología planteada por el instructivo técnico del fabricante y a los 3 min de iniciada la reacción se leyeron los resultados. RESULTADOS: los intervalos de confianza (95 %) observados fueron para Candida spp de 21,9 a 29,2 %, para Trichomonas vaginalis de 14,5 a 20,9 % y para Gardnerella vaginalis de 22,10 a 29,40 %, 56,72 % de las muestras fueron negativas y 1,81 % dieron reacción al control negativo clasificándose como inespecíficas. Además 18,26 % de las muestras dieron positivas a más de un germen incluyendo a 26 que dieron positivas a los tres microorganismos. Hubo diferencias (p<0,0001) entre las prevalencias de los tres gérmenes en las diferentes localidades siendo lo más llamativo que la candidiasis fue más del doble en Güines que en Santa Cruz y Jaruco. CONCLUSIONES: con este diagnosticador que cumple con los requisitos de sencillez, objetividad y rapidez se pudo, a nivel primario de salud, estudiar a gran número de embarazadas e indicar el mismo día de la consulta el tratamiento etiológico para cada caso, lo cual benefició a estas mujeres y contribuyó a evitar las complicaciones de la vaginitis infecciosa

OBJECTIVE: to determine the prevalence of Candida ssp, Trichomonas vaginalis and Gardnerella vaginalis in pregnant women from four primary health areas of La Habana province using a immunologic method with particles of FemPure latex. METHODS: we took samples of vaginal exudates in all pregnant women with or without vaginitis seen in specialized Obstetrics consulting rooms from four health primary areas of La Habana province with or without vaginitis using the above mentioned method. Methodology proposes by manufacturer technical instructor and at three minutes of started the reaction results were read. RESULTS: confidence intervals (95 percent) observed were: for Candida ssp of 21.9 to 29.2 percent, for Trichomonas vaginalis of 14.5 to 20,9 percent and for Gardnerella vaginalis of 22.10 to 29.40 percent. The 56.72 percent of samples were negative and the 1.81 percent were reactive to negative control classifying as non-specific. Also, the 18.26 percent of samples were positive to more than germ including 26 positives to the three microorganisms. There were differences (p 0.0001) among the prevalences of the three germs in distinct localities where candidiasis was twice more in G³ines municipality than in Santa Cruz and Jaruco municipalities. CONCLUSIONS: using this diagnostic method fulfilling the simplicity, objectivity and speed criteria, at primary health level, it was possible to study more pregnants and at same day to suggest the etiologic treatment to each case for the good of these women contributing to avoid the infectious vaginitis complications

Há aumento de dst no carnaval? Série temporal de diagnósticos em uma clínica de DST / Is there increase of std during carnival? Time series of diagnoses in a STD clinic

OBJETIVO: As doenças sexualmente transmissíveis (DST) são causas frequentes de procura por serviços de saúde. As campanhas de mídia sobre DST/Aids apoiam-se na hipótese de que há maior exposição às práticas de risco para DST na época do Carnaval. Nosso objetivo é estudar a distribuição temporal dos atendimentos de primeira vez em uma clínica de DST no período de janeiro de 1993 a dezembro de 2005, visando verificar se há um aumento sazonal após o Carnaval. MÉTODOS: Selecionamos 2.646 prontuários com diagnóstico de gonorreia, sífilis e tricomoníase de pacientes que procuraram o Setor de DST da Universidade Federal Fluminense em Niterói, Rio de Janeiro, Brasil. Na análise estatística, utilizamos observação da média padronizada do número de atendimentos para os 13 anos, mês a mês, ano a ano, observação da série suavizada pelo método Lowess e pelo método determinístico da média móvel. RESULTADOS: Os meses de julho e agosto concentraram o maior número de diagnósticos de gonorreia e sífilis e os de junho e julho, os de tricomoníase. A gonorreia apresentou um valor máximo em maio, tendendo a se reduzir até agosto. Com relação à sífilis, observou-se um número de diagnósticos constantes entre maio e agosto, havendo menor número em janeiro e fevereiro com pico em novembro. O comportamento sazonal para a tricomoníase exibiu um máximo de diagnóstico em julho com tendência consistente de redução até o mês de dezembro, e elevação a partir de janeiro. CONCLUSÃO: O Carnaval não influencia no aumento da ocorrência de gonorréia, sífilis e tricomoníase em pacientes atendidos em uma clínica de DST em Niterói, Rio de Janeiro.

OBJECTIVE: Sexually Transmitted Diseases (STD) are often the cause for search for medical assistance. Media campaigns on STD/Aids presume that exposure to sexual risk practices during Carnival is greater than in other periods of the year. The objective here is to study the temporal distribution of first consultations in a STD clinic, from January, 1993, to December, 2005, to verify whether there is a seasonal increase of STD after Carnival. METHODS: Two thousand, six hundred and fifty six (2,656) records of patients who had received a diagnosis of gonorrhea, syphilisor trichomoniasis were selected. These patients at the time had looked for assistance at the STD Division of the Universidade Federal Fluminense, in Niterói, State of Rio de Janeiro, Brazil. The standardized mean of the number of consultations during those 13 years, month by month, and year by year was observed in the statistical analysis and also smoothed series by the Lowess method and by the deterministic method of the variable mean was considered. RESULTS: July and August showed an increased number of diagnoses for gonorrhea and syphilis, while in June and July there was a concentration of trichomoniasis diagnoses. Gonorrhea presented its highest value in May, tending to a reduction until August. A constant number of syphilis diagnoses was noted between May and August, with a decreased number in January and February, reaching a peak in November. The seasonal behavior of trichomoniasis showed the greatest number of diagnoses in July, with a consistent reduction tendency until December, and an increase from January on. CONCLUSION: The Carnival period has no influence on the increase of gonorrhea, syphilis and trichomoniasis diagnoses in patients observed in a STD clinic in Niterói, Rio de Janeiro.

Prevalence of vulvovaginitis and bacterial vaginosis in patients with koilocytosis / Prevalência de vulvovaginte e vaginose bacteriana em pacientes com coilocitose

CONTEXT AND OBJECTIVE: Empirical discussion regarding an association between koilocytosis and vulvovaginitis often occurs. Thus, the objective of this study was to assess the prevalence of microorganisms associated with bacterial vaginosis and vulvovaginitis in women with and without koilocytosis. DESIGN AND SETTING: Analytical cross-sectional study including two cohorts of women (with and without koilocytosis) who attended a cancer hospital in the city of Goiânia, state of Goiás. METHODS: A total of 102 patients entered the study. The whiff test, Gram and Papanicolaou staining and bacterial and fungal culturing were performed. The results were observed using univariate analysis. The odds ratio and confidence interval (CI) of the variables were calculated; P-values < 0.05 were considered significant. RESULTS: The prevalence of bacterial colonization was similar in patients with and without koilocytosis. The odds ratio for candidiasis was 1.43 (CI 1.05-1.95) and the odds ratio for trichomoniasis was 1.78 (CI 1.49-2.12), in patients with koilocytosis. CONCLUSIONS: The prevalence of candidiasis and trichomoniasis seems to be higher in patients with koilocytosis.

CONTEXTO E OBJETIVO: Existe uma discussão empírica sobre a associação de coilocitose e vulvovaginite. Assim, o objetivo deste estudo foi saber a prevalência de microorganismos associados à vaginose bacteriana e à vulvovaginite em mulheres com e sem coilocitose. DESENHO E LOCAL: Estudo transversal analítico, que incluiu duas coortes de mulheres, com e sem coilocitose, atendidas em um hospital de referência de câncer, na cidade de Goiânia, estado de Goiás. MÉTODOS: Um total de 102 pacientes entrou no estudo. Foram feitos os testes whiff, Gram e Papanicolaou, além de cultura para bactérias e fungos. Utilizou-se análise univariada, com o cálculo do risco relativo e do intervalo de confiança (IC). Considerou-se significativo quando valor de P < 0,05. RESULTADOS: A prevalência de colonização bacteriana foi similar em pacientes com e sem coilocitose. O risco relativo para candidíase observado em mulheres com coilocitose foi de 1,43 (IC 1,05-1,95) e, para tricomoníase, 1,78 (IC 1,49-2,12). CONCLUSÃO: A prevalência de candidíase e de tricomoníase parece ser maior nas pacientes com coilocitose.

Investigación de Trichomonas vaginalis durante el embarazo mediante diferentes metodologías / Investigation of Trichomonas vaginalis through different methodologies during pregnancy

Los objetivos del trabajo fueron conocer la prevalencia de tricomonosis en pacientes embarazadas y evaluar la utilidad de diferentes metodologías para su diagnóstico. Se estudiaron prospectivamente 223 mujeres embarazadas. Trichomonas vaginalis se investigó utilizando distintos exámenes microscópicos, cultivo en medio sólido y medio líquido. Se evaluó la sensibilidad y especificidad de la microscopía considerando a los cultivos en ambos medios como método de referencia. La prevalencia del parásito obtenida por cultivo (medio líquido más medio sólido) fue de 4,5% (10/223) siendo la detección por examen en fresco, coloración de May-Grunwald Giemsa, fresco con solución acética formolada (SAF)/azul de metileno y por cultivo en medio sólido y líquido de 1,3%, 1,8%, 1,8% y 4,5% respectivamente. La sensibilidad del examen en fresco fue 30%, para el May-Grunwald Giemsa y el SAF/azul de metileno fue 40%. Utilizando conjuntamente los tres exámenes microscópicos, la sensibilidad se elevó al 50% y la especificidad fue 100% para todos los exámenes microscópicos. El cultivo en medio líquido detectó el 100% de los casos positivos , mientras que el medio sólido sólo el 50%. Por la baja sensibilidad de la microscopía para T. vaginalis, en embarazadas asintomáticas recomendamos la utilización del cultivo en medio líquido durante el embarazo, para instaurar un tratamiento precoz.

The aim of this study was to conduct a survey regarding the prevalence of trichomoniasis in pregnant patients and to evaluate the utility of different diagnostic methods. Two hundred and twenty three vaginal swab specimens from pregnant women were prospectively examined. Trichomonas vaginalis was investigated by various microscopic examinations, solid culture medium and liquid culture medium. The sensitivity and specificity of microscopy were evaluated by considering both culture media as the "gold standards". The prevalence of T. vaginalis obtained by both culture media (liquid plus solid media) was 4.5% (10/223). The prevalence of T. vaginalis obtained by direct smear, May-Grunwald Giemsa staining, sodium acetate-acetic acid-formalin (SAF)/Methylene blue staining-fixing technique, solid medium and liquid medium was 1.3%, 1.8%, 1.8% and 4.5%, respectively. The sensitivity of the direct smear was 30 %, but for the May- Grunwald Giemsa staining and the SAF/Methylene blue staining-fixing technique was 40%. Considering the three microscopic examinations altogether, the sensitivity rose to 50% and the specificity was 100% for all of them. The solid medium detected only 50% of the positive cases; the liquid medium detected 100%. Due to the low sensitivity obtained with microscopy in asymptomatic pregnant patients, we recommend the use of the liquid medium during pregnancy, in order to provide an early treatment.

A prospective study of genital infections in Hamedan, Iran.

A prospective study of genital infections was conducted in a university-affiliated teaching hospital in Hamedan City, Iran. A total of 540 women were recruited and divided into two equal groups: (1) the case group with vaginitis (N=270) and, (2) the asymptomatic control group (N=270). Participants were interviewed about the occurrence of any vaginal or urethral discharge. Two vaginal swabs were obtained for pH testing, KOH and wet mount examination, Gram staining and culture at the time of speculum examination. In the case group, the prevalence of candidiasis, trichomoniasis, and bacterial vaginosis was 17.2, 18.1, and 28.5%, respectively. Measurement of vaginal pH in the clinic was the single most useful clinical finding for directing empirical therapy. No single specimen was found ideal for all pathogens; a cervical swab is better for Trichomonas vaginalis but a vaginal swab is needed for candida and bacterial vaginosis. To achieve STD control in this and similar populations, public health programs must target asymptomatic infections.