Low-dose secnidazole in the treatment of bacterial vaginosis.

OBJECTIVE: To determine whether bacterial vaginosis could be cured with a single 1-g oral dose of secnidazole. MATERIAL AND METHODS: A total of 80 women were recruited at the outpatient gynecologic clinic of Manuel Noriega Hospital, Maracaibo, Venezuela. Diagnosis and patient enrollment were based on the Amsel criteria. The participants were randomized to 2 groups. In group 1 (n=44) participants received a single 1-g oral dose and in group 2 (n=32) participants received a single 2-g oral dose of secnidazole. Clinical cure was defined as the absence of the characteristic symptoms (a bad odor and a grossly abnormal discharge) and at least 2 of the following: vaginal pH less than 4.5, no fish odor on addition of KOH, and no Gardnerella vaginalis or clue cells on wet-mount examination. Cytologic cure was defined as an absence of G. vaginalis on a Papanicolaou (Pap) smear. RESULTS: Clinical cure was experienced by 95.5% of the women who received the 1-g oral dose and by 97.4% of the women who received the 2-g oral dose of secnidazole. There was no significant difference between the groups in the clinical resolution of bacterial vaginosis. Following treatment, results were negative for G. vaginalis in 94.7% of the women. In group 1, 41 women (93.2%), and in group 2, 31 women (96.9%) had cytologic cure. The Pap smear revealed G. vaginalis in 3 of the women in group 1 and 1 of the women in group 2 (P=0.47). Twenty-seven women (35.5%) reported mild side effects. More women had adverse effects in group 1 (n=16) than in group 2 (n=11) but this difference was not statistically significant. CONCLUSION: This clinical study showed that a single 1-g oral dose of secnidazole is effective to cure bacterial vaginosis associated with G. vaginalis.

Smoking as a risk factor for preinvasive and invasive cervical lesions in female sex workers in Venezuela.

OBJECTIVES: To determine whether the number of cigarettes smoked per day and years of smoking were risk factors for preinvasive and invasive cervical lesions in Venezuelan female sex workers. METHODS: The clinical history of 438 female sex workers (FSWs) was taken and each received a gynecological examination, a Pap smear, and a colposcopic examination. A colposcopically-guided cervical biopsy was taken when the epithelium appeared abnormal. RESULTS: The FSWs' mean age was 32.16+/-8 years. Age at first sexual intercourse was 15.9+/-2 years, parity was 4.1+/-2.3, live births were 3+/-3, and age at first delivery was 16.6+/-4.7 years. Cervical biopsies were performed in 84 FSWs. Sixty-four of them (76.2%) had preinvasive or invasive lesions and 47 (73.4%) were current smokers (Relative Risk) (RR), 1.26; 95% confidence interval (CI), 1.02-1.55; P<0.03]. FSWs who smoked more than 20 cigarettes per day had an increased RR to get a premalignant or malignant cervical lesion (RR, 1.27; 95% CI, 1.02-1.52; P<0.03). There was no statistically significant difference between FSWs who smoked 20 cigarettes or more per day and FSWs who smoked less than 20 cigarettes per day (RR, 1.36; 95% CI, 0.81-2.29; P<0.25). FSWs who had been smoking for 5 years or more were at risk to develop preinvasive or invasive cervical lesions (RR, 1.37; 95% CI, 1.01-1.86; P<0.04). CONCLUSIONS: The risk for FSWs to develop preinvasive or invasive cervical lesions increased with the number of cigarettes they smoked per day and their years of smoking.

Cyto-colpo-histological Study in Sexual Workers.

OBJECTIVE: To determine the false-negative, false-positive, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) rates of Pap smears and colposcopy in sexual workers. MATERIALS AND METHODS: Four hundred thirty-eight prostitutes were given a gynecological examination, Pap smear, and colposcopic examination of the cervix. A cervical biopsy was taken under colposcopic guidance when there was abnormal epithelium. RESULTS: There were 81 premalignant and malignant lesions. Twenty-two Pap smear reports were abnormal: 17 CIN1, four CIN2, and one CIN3. Pap smears had a 14.4% false-negative rate, 0.9% false-positive rate, sensitivity 22.2%, specificity 98.8%, NPV 84.4%, and PPV 81.8%. Eighty-four biopsies were taken from abnormal colposcopic findings, and 96.4% were reported as premalignant and malignant lesions. Colposcopy had a 0.8% false-positive rate, sensitivity 100%, specificity 99.2%, NPV 100%, and PPV 96.4%. CONCLUSIONS: Pap smear had a low-sensitivity and colposcopy had a high sensitivity and specificity.