[Factors of risk of bacterial vaginosis]. / Factores de riesgo asociados a vaginosis bacteriana.

OBJECTIVES: To recognise factors in the host that might condition the appearance of the bacterial vaginosis (BV) syndrome, whether gynae-obstetrical factors, habits of sexual conduct, hygiene, or other factors. DESIGN: Cross-sectional, observational study. SETTING: The study was conducted from January 2002 to June 2003 in the Primary Care Dr. Jose Castro Villagrana Community Health Centre at Tlalpan, Mexico City. PARTICIPANTS: 968 patients with an active sexual life who had not taken antibiotics for at least 15 days before the study and who were not menstruating at the moment of taking a swab, 859 of whom had a diagnosis of cervico-vaginitis and 109 had no symptoms. MAIN MEASUREMENTS: Confidential questionnaire and a cervical-vaginal culture. The Amsel criteria were used to make the diagnosis of bacterial vaginosis. RESULTS: There was 32.9% prevalence of BV. There was a statistically significant association with factors such as age, start of active sexual life, the number of sexual relations per week, the number of sexual partners, and pregnancy. CONCLUSIONS: Bacterial vaginosis is the main cause of infectious processes in the vagina. Its appearance appears to be linked to factors involving sexual transmission. Interventions to reduce its prevalence and complications are recommended.

Factores de riesgo asociados a vaginosis bacteriana / Factors of risk of bacterial vaginosis

Objetivos. Reconocer factores del huésped, ya sea ginecoobstétricos, de conducta sexual, de hábitos higiénicos y otros que condicionen la aparición del síndrome de vaginosis bacteriana. Diseño. Estudio transversal y observacional. Emplazamiento. El estudio se realizó entre enero de 2002 y junio del 2003 en el Centro de Salud Comunitario en Atención Primaria a la Salud Dr. José Castro Villagrana en Tlalpan, México DF. Participantes. Un total de 968 pacientes con vida sexual activa que no habían tomado antibióticos al menos 15 días antes del estudio y que no estuvieran en el período menstrual en el momento de la toma de la muestra, de las que 859 tenían un diagnóstico de cervicovaginitis y 109 estaban asintomáticas. Mediciones principales. Cuestionario confidencial y un cultivo cervicovaginal. El diagnóstico de vaginosis bacteriana se realizó según los criterios de Amsel. Resultados. La prevalencia de vaginosis bacteriana fue del 32,9 por ciento. Se ha encontrado una asociación estadísticamente significativa con factores como la edad, el inicio de vida sexual activa, el número de relaciones sexuales por semana, el número de parejas sexuales y el embarazo. Conclusiones. La vaginosis bacteriana es la causa principal asociada a procesos infecciosos en la vagina y su aparición parece estar relacionada con factores afines a la transmisión sexual. Por ello, se sugiere intervenir en los pacientes para disminuir su prevalencia y complicaciones (AU)

[Is the Papanicolaou smear useful as aid for diagnosing some sexually transmitted infections?]. / ¿Es útil la tinción de Papanicolaou como auxiliar del diagnóstico de algunas infecciones de transmisión sexual?

OBJECTIVE: We undertook this study to assess the validity of cytologic diagnosis of sexually transmitted infections like: bacterial vaginosis (BV), tricomoniasis and candidiasis using the Papanicolaou (Pap) smear. DESIGN: Prospective, descriptive transverse study. SETTING: The present study was carried out in the Health Center Dr. José Castro Villagrana in Tlalpan, México, D.F. from January 1997, to February 2000. PARTICIPANTS: Routine Pap smears and vaginal secretion smears were collected from two hundred and seventy one patients ranged from age 16-66 years, with cervicovaginitis diagnosis. MEASUREMENTS AND MAIN RESULTS: Of the 271 patients, 92 (33.9%) had bacterial vaginosis diagnosed by Amsel criteria, 47 (17.3%) had candidiasis by culture and 5 (1.8%) had tricomoniasis by wet smear. The Bethesda system for diagnosing BV on Pap smear had 66% sensitivity and a specificity of 86%. The respective positive predictive and negative predictive value were 79% and 84%. Therefore, compared to the Candida culture, cervical cytologic test results had a sensitivity of 21% and specificity of 99%. The predictive positive predictive and negative predictive values were 90% and 85%. CONCLUSIONS: Specificity tended to be higher than sensitivity, in other words cytology tended to be more efficient in identifying women without sexually transmitted infection than in identifying those with infection. In summary, the Pap smear should not be used in lieu of more effective diagnostic test for sexually transmitted disease, and treatment should not be based on cytologic findings alone.

¿Es útil la tinción de Papanicolaou como auxiliar del diagnóstico de algunas infecciones de transmisión sexual? / Is the Papanicolaou smear useful for diagnosing some sexually transmitted infections?

Objetivo. Validar si la tinción de Papanicolaou es útil para el diagnóstico de tres de las patologías mayormente asociadas a infecciones de transmisión sexual (ITS): vaginosis bacteriana (VB), candidiasis y tricomoniasis. Diseño. Estudio prospectivo, descriptivo y transversal. Emplazamiento. El estudio se realizó en la Unidad de Atención Primaria Dr. José Castro Villagrana, Tlalpan, México, DF, entre enero de 1997 y febrero de 2000.Participantes. A 271 pacientes de 16-66 años (media, 32,2) con diagnóstico de cervicovaginitis se les realizó toma de muestra cervical para tinción de Papanicolaou (Pap) y toma de muestra vaginal para pruebas de laboratorio de rutina. Mediciones y resultados principales. La prevalencia de VB diagnosticada por criterios de Amsel fue de 33,9 por ciento, de candidiasis por cultivo de 17,3 por ciento y de tricomoniasis por fresco del 1,8 por ciento. Para VB utilizando el sistema Bethesda para interpretar el Pap se obtuvo 66 por ciento de sensibilidad y 86 por ciento de especificidad y valores predictivos positivo y negativo (VPP y VPN) del 79 por ciento y 84 por ciento, respectivamente. Para candidiasis se obtuvo 21 por ciento de sensibilidad, 99 por ciento de especificidad, VPP y VPN de 90 por ciento y 85 por ciento, respectivamente. Conclusiones. El Pap tiene baja sensibilidad y elevada especificidad para detectar ITS, por lo tanto parece más adecuado para excluir que para diagnosticar dichas infecciones. Tanto los métodos de laboratorio, como los criterios para diagnosticar ITS no son uniformes, por lo que el Pap no debe usarse en lugar de una prueba diagnóstica más efectiva y el tratamiento no debe basarse en los hallazgos citológicos (AU)

Treatment of urinary tract infection by Gardnerella vaginalis: a comparison of oral metronidazole versus ampicillin.

Treatment options for bacterial vaginosis are numerous, however for urinary tract infection (UTI) by Gardnerella vaginalis have been not reported. Our purpose was to compare the efficacy and treatment complications of oral metronidazole versus oral ampicillin for treatment of this condition in a prospective randomized, nonblinded study. Fifty-seven women who had symptoms of UTI and a positive culture for G. vaginalis were enrolled in the study. Only forty-five subjects were considered valuable: 25 treated with oral metronidazole 500 mg twice daily for 7 days, and 20 with oral ampicillin 2 g for 10 days. Positive culture was defined as the presence of 10(4) or 10(5) UFC/ml of G. vaginalis in pure culture in HBT media. The clinical and bacteriological cure rates were 92% and 96% respectively for metronidazole and 90% in both for ampicillin. Chi-squared analysis reveals no statistical significance between two treatments. Adverse events were common in-patients treated with metronidazole whereas relatively few side effects were experienced in-patients treated with ampicillin. Ampicillin is effective, safe and well-tolerated therapy for UTI by G. vaginalis. In contrast oral metronidazole is effective but no safe and bad-tolerated therapy for the same condition.