Vaginitis: Review on Drug Resistance.

Female genital tract infections have a high incidence among different age groups and represent an important impact on public health. Among them, vaginitis refers to inflammation of the vulva and/or vagina due to the presence of pathogens that cause trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. Several discomforts are associated with these infections, as well as pregnancy complications and the facilitation of HIV transmission and acquisition. The increasing resistance of microorganisms to drugs used in therapy is remarkable, since women report the recurrence of these infections and associated comorbidities. Different resistant mechanisms already described for the drugs used in the therapy against Trichomonas vaginalis, Candida spp., and Gardnerella vaginalis, as well as aspects related to pathogenesis and treatment, are discussed in this review. This study aims to contribute to drug design, avoiding therapy ineffectiveness due to drug resistance. Effective alternative therapies to treat vaginitis will reduce the recurrence of infections and, consequently, the high costs generated in the health system, improving women's well-being.

Atypical Squamous Cells in Liquid-Based Cervical Cytology: Microbiology, Inflammatory Infiltrate, and Human Papillomavirus-DNA Testing.

OBJECTIVE: The aim of this study was to assess the correlation between atypical squamous cells (ASC) and inflammatory infiltrate and vaginal microbiota using cervical liquid-based cytological (SurePath®) and high-risk human papillomavirus (HR-HPV) tests. STUDY DESIGN: A cross-sectional study was conducted using a 6-year database from a laboratory in Fortaleza (Brazil). Files from 1,346 ASC cases were divided into subgroups and results concerning inflammation and vaginal microorganisms diagnosed by cytology were compared with HR-HPV test results. RESULTS: An absence of specific microorganisms (ASM) was the most frequent finding (ASC of undetermined significance, ASC-US = 74%; ASC - cannot exclude high-grade squamous intraepithelial lesion, ASC-H = 68%), followed by bacterial vaginosis (ASC-US = 20%; ASC- H = 25%) and Candida spp. (ASC-US = 6%; ASC-H = 5%). Leukocyte infiltrate was present in 71% of ASC-US and 85% of ASC-H (p = 0.0040), and in these specific cases HR-HPV tests were positive for 65 and 64%, respectively. A positive HR-HPV test was relatively more frequent when a specific microorganism was present, and Candida spp. was associated with HR-HPV-positive results (p = 0.0156), while an ASM was associated with negative HR-HPV results (p = 0.0370). CONCLUSION: ASC-US is associated with an absence of inflammation or vaginosis, while ASC-H smears are associated with Trichomonas vaginalis and inflammatory infiltrate. A positive HR-HPV is associated with Candida spp. in ASC cytology.

Impact of a progesterone-releasing intravaginal device and inflammatory reaction on ovarian activity in embryo-recipient anestrus mares.

This study aimed to correlate the inflammatory reaction (IR) caused by a progesterone-releasing intravaginal device (P4) with ovarian activity and pregnancy rate (PR) in embryo-recipient anestrus mares (to decrease the spring transitional period). 50 animals were assigned to three groups: GP4 (P4 group; n = 16), GP4OH (P4 + oxytetracycline hydrochloride and hydrocortisone sprayed onto the device; n = 14), and GNP4 (no intravaginal P4; n = 20). The administration protocol for GP4 was: Day 0, 750 mg P4 + ovarian examination by ultrasonography (US) + vaginal sample collection; Day 8, US; Day 11, P4 removal + 7.5 mg PGF2α + US + second vaginal sample collection; Days 13 to 16, US; Days 17 to 21, US + 750 IU hCG to mares with follicles 35 mm or more in diameter; Days 19 to 23 US (ovulation check); Days 24 to 28, embryo transfer + intravenous flunixin meglumine; and Days 30, US pregnancy diagnosis. The GP4OH and GNP4 mares received the same administration protocol as GP4, except that no P4 device was administered to the GNP4 group on Day 0. Although neutrophil-mediated IR occurred in the GP4 and GP4OH groups, the IR was significantly reduced in GP4OH as compared with that in GP4 (P < 0.0001). From Day 0 to Day 17, the GP4 and GP4OH mares developed a greater number of follicles per animal than did the GNP4 mares (P < 0.05), and the average diameter of the follicles was larger in the GP4 and GP4OH mares. The ovulation rates in GP4, GP4OH, and GNP4 mares were, respectively, 43.7%, 64.3%, and 30.0%, and ovulation occurred at 6.8, 6.5, and 23 days after P4 removal (P < 0.05). On Day 17, endometrial edema was verified in 50%, 64.2%, and 35.0% of the GP4, GP4OH, and GNP4 mares, and the PRs after embryo transfer were 80%, 100%, and 66.6%, respectively. Although intravaginal devices caused IR in both the device-recipient groups (P = 0.0001), IR and vaginitis had no negative impact on follicle diameter, ovulation rate, period to ovulation after the removal of P4, endometrial edema, or PR. In addition, P4 reactivated the ovarian function and the IR eliminated a large percentage of bacteria (Bacillus spp., Enterobacter spp., Proteus spp., Pseudomonas spp., and Staphylococcus spp.), especially in GP4; the application of oxytetracycline hydrochloride and hydrocortisone on the devices reduced the severity of vaginitis.

Vaginal microbial communities from synchronized heifers and cows with reproductive disorders.

AIM: To evaluate changes in the resident microbial population in the cranial vaginal mucosa induced by a progesterone-releasing intravaginal device (PRID) compared to the vaginal microbiota of cows with reproductive disorders. METHODS AND RESULTS: Vaginal discharge was evaluated by clinical examination and a Vaginitis Diagnosis Score was performed by exfoliative cytology. All samples classified as positive and some classified as negative by clinical evaluation were later diagnosed as positive for vaginitis by cytological analysis. Bacterial diversity profiles were performed by PCR-DGGE and clustered according to the reproductive health status of the specimens, revealing a correspondence between the structures of the communities in the vagina and the clinical profile. Representative bands from each group were sequenced and identified as Ruminococcus sp., Dialister sp., Escherichia sp./Shigella sp., Virgibacillus sp., Campylobacter sp., Helcoccoccus sp., Staphylococcus sp., Bacillus sp., Actinopolymorpha sp., Exiguobacterium sp., Haemophilus sp./Histophilus sp., Aeribacillus sp., Porphyromonas sp., Lactobacillus sp. and Clostridium sp. CONCLUSION: Our results contribute to the knowledge of the vaginal microbiome in synchronized heifers showing positive or negative clinical vaginitis. SIGNIFICANCE AND IMPACT OF THE STUDY: This study contributes to the understanding of a dynamic vaginal colonization by bacterial consortiums during the synchronization with a widely used PRID protocol. Also, the results reveal the presence of well-known metritis-related pathogens as well as emerging uterine opportunistic pathogens. The provided information will allow to carry out further studies to elucidate functional roles of these native micro-organisms in the bovine reproductive tract.

Epidemiology, species distribution, antifungal susceptibility, and ERG11 mutations of Candida species isolated from pregnant Chinese Han women.

The widespread use of antifungal agents has led to increasing azole resistance in Candida species. A major azole-resistance mechanism involves point mutations in the ERG11 gene, which encodes cytochrome P450 lanosterol 14a-demethylase. In this study, vaginal swabs were obtained from 657 pregnant Chinese Han women and cultured appropriately. The open reading frame of the obtained fungal species were amplified by PCR and sequenced; additionally, the ERG11 gene of the isolated Candida species was amplified and sequenced, and the antifungal susceptibility of the isolated species was determined. The vaginal swabs of 124 women produced fungal cultures; five species of Candida were isolated from the patients, among which Candida albicans was predominant. Twelve C. albicans isolates (13.8%) were resistant to fluconazole and 2 (2.2%) were resistant to itraconazole. Seventeen mutations, including 9 silent and 8 missense mutations, were identified in the ERG11 gene of 31 C. albicans isolates. Our findings suggest that infection caused by C. albicans and non-C. albicansis common in Chinese Han women of reproductive age. Moreover, the relationship between Candida infection and certain epidemiological factors emphasizes the need to educate women about the precise diagnosis and punctual treatment of vaginitis.

Diagnóstico microbiológico de vaginitis en mujeres de edad fértil / Microbiological diagnosis of vaginitis in women of childbearing age

Se realizó un estudio descriptivo transversal en el laboratorio de microbiología del Hospital General Docente Dr Agostinho Neto, en el período enero-junio de 2014, con el objetivo de diagnosticar el agente etiológico que desencadenaba la sepsis vaginal en cada una de las mujeres en edad fértil. El universo de estudio estuvo formado por 160 pacientes, de ellas 80 procedentes de la Consulta de Patología de Cuello y, 80, procedentes de la Consulta de Infertilidad. Se analizaron las variables, procedencia y gérmenes aislados según tipo de consulta. Se realizó encuesta previa, se tuvo en cuenta criterios de exclusión para el estudio. Entre los principales resultados se obtuvo que, de las muestras analizadas el 85,6 por ciento resultaron positivas, las pacientes procedentes de la consultas de infertilidad mostraron un 97,5 por ciento de positividad, de las muestras analizadas, entre los gérmenes estuvo la Clamidia trachomatis, Escherichia coli y de Micoplasma hominis y Ureaplasma urealyticum(AU)

A cross-sectional descriptive study was conducted in the microbiology laboratory of the General Teaching Hospital Dr Agostinho Neto, in the from January to June 2014, in order to diagnose the etiological agent that triggered the vaginal sepsis in each of the women of childbearing age. The study group consisted of 160 patients, of which 80 from the Consultation and Cervical Pathology, 80 from the Consultation of Infertility. Variable were analyzed as: provenance and seeds isolated by type of query. Previous survey was conducted. It was considered exclusion criteria for the study. Among the main results obtained of the samples 85,6 percent were positive, patients from the infertility clinics showed 97,5 percent positivity, of the samples, including Chlamydia trachomatis bacteria was Escherichia coli and Mycoplasma hominis and Ureaplasma urealyticum(AU)

Influencia de la sepsis vaginal endógena sobre la calidad del moco cervical en mujeres infértiles / Influence of endogenous vaginal sepsis on the quality of the cervical mucus in sterile women

Se realizó un estudio descriptivo y observacional de 150 mujeres infértiles atendidas en el Hospital Universitario Ginecoobstétrico Provincial Ana Betancourt de Mora de Camagüey, desde el 1 de junio de 2012 hasta el 31 de mayo de 2013, con vistas a determinar la influencia de la sepsis vaginal endógena sobre la calidad del moco cervical en estas pacientes, para lo cual se confeccionó un modelo de registro que recogía los aspectos siguientes: datos personales, antecedentes de infecciones vaginales, evaluación del moco cervical, hallazgos microbiológicos y técnicas de aseo genital; también se aplicó una encuesta para verificar los conocimientos que poseían al respecto. En la serie predominaron las féminas de piel blanca, las mayores de 35 años, los resultados microbiológicos positivos, así como la levadura y la vaginosis como diagnósticos más comunes; asimismo, el moco cervical resultó no adecuado en todos los casos y fue evidente el nivel de desconocimiento de las pacientes acerca del tema(AU)

A descriptive and observational study of 150 sterile women assisted in Ana Betancourt de Mora University Gynecoobstetrical Provincial Hospital in Camagüey was carried out from June 1, 2012 to May 31, 2013, with the objective of determining the influence of the endogenous vaginal sepsis on the quality of the cervical mucus in these patients, for which a registration model was made which included the following aspects: personal data, history of vaginal infections, evaluation of the cervical mucus, microbiological findings and techniques for genital washing; a survey was also applied to verify the knowledge they had in this respect. White skin females, those older than 35 years, positive microbiological results, as well as yeast and vaginosis as the most common diagnosis prevailed in the series; also, the cervical mucus was not adequate in all the cases, and the ignorance level of the patients about the topic was evident(AU)

Photodynamic therapy has antifungal effect and reduces inflammatory signals in Candida albicans-induced murine vaginitis.

BACKGROUND: Vaginal candidiasis (VC) is a disease that affects thousands of women of childbearing age, mainly caused by Candida albicans fungus. Photodynamic therapy (PDT) uses photosensitizing substances that are nontoxic in the dark, but able to produce reactive oxygen species when they are subjected to a light source. In this work our purpose was to investigate PDT effects on fungal burden and inflammatory cells in a murine model of C. albicans-induced vaginal candidiasis. METHODS: Female BALB/c mice 6-10 weeks were estrogenized and maintained in this state during all experiment. After 72h, mices were inoculated intravaginally (IV) with 20µL of 2×10(5)C. albicans cells suspension. Mice were separated into 5 groups after five days: H (healthy), PBS (control), laser, MB (methylene blue) and PDT. PDT and MB groups received IV 20µL solution with 1mM of MB, others received PBS. PDT and laser groups were irradiated with a red laser (100mW, 660nm) in one (36J, 6min) or two sessions (18J, 3min). After the end of treatment, mice were submitted to microbiological and histomorphometric analysis with ImageJ software. Data were plotted by mean values and standard deviations of CFU/mL and percentage of inflammatory cells area. ANOVA and Bonferroni post-test were used and data were considered significant when p<0.05. RESULTS: PDT significantly reduced C. albicans after the two tested protocols, however, percentage area of inflammatory cells was significantly reduced just with two sessions of PDT. CONCLUSIONS: PDT with MB and red laser is a promising therapy for VC. It is able to reduce fungal infection in biofilm and inflammatory signals associated with VC in a murine model of vaginitis.

Virulence genes and antimicrobial susceptibility of Escherichia coli taken from women with vaginitis in Talca, Chile.

INTRODUCTION: Vaginitis is one of the most common reasons women visit a gynecologist. Escherichia coli has been isolated from women with vaginitis, but its role as a vaginal infection aetiological agent is controversial. This study aimed to detect virulence genes and determine the antimicrobial susceptibility of E. coli strains isolated from monomicrobial and polymicrobial cultures collected from women with vaginitis. METHODOLOGY: The presence of the following virulence genes: papC, hly, iucC, afa, fimH, neuC, sfa/foc, cnf1, usp, and ibeA in two E. coli groups was determined by PCR. The antibacterial susceptibility of strains was tested. RESULTS: A higher percentage (93.3%) of isolated strains from monomicrobial cultures with virulence genes in relation to polymicrobial cultures (56.7%) was found. The most frequent virulence genes in both groups were hly (p = 0.0357), fimH (p = 0.000), and cfn1 (p = 0.000). In addition, E. coli isolated from monomicrobial cultures showed 5 genetic combinations compared to the 10 observed in the polymicrobial cultures. An increased number of strains were sensitive to cefotaxime, moxifloxacin, and ciprofloxacin. A high resistance to trimethoprim-sulfamethoxazole was observed. CONCLUSIONS: Most of the E. coli strains isolated from monomicrobial cultures and some from polymicrobial cultures showed virulence genes. A better understanding of the virulence and antibacterial susceptibility of E. coli strains isolated from patients with vaginitis can contribute to improved diagnosis and treatment of this disease.

[Diagnosis of vaginitis-vaginosis by hibridization with DNA strands]. / Diagnóstico de vaginitis-vaginosis mediante hibridación con sondas de ADN.

BACKGROUND: Vaginal infections lie among the most common causes women ask for medical advice. In order of frequency bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis are responsible for 90% of vaginitis/vaginosis. OBJECTIVE: To evaluate a DNA hybridization test for simultaneous molecular detection of Gardnerella vaginalis, Candida species and Trichomonas vaginalis, as an alternative to conventional microbiological methods. MATERIAL AND METHODS: Cohort, cross-sectional, and comparative study of 1,003 vaginal samples from symptomatic women from our health-care area. Two swabs were obtained from each woman, one for routine microbiological diagnosis of vaginal infection (wet mount, Gram stain, and mycological culture) and the other for the DNA hybridization test (Affirm VPIII, Becton Dickinson). This method detects clinically significant levels of G. vaginalis (2 x 10(5) CFU/ml), Candida spp. (1 x 10(4) cells) and T. vaginalis (5x103 trichomonads). RESULTS: Out of the 1,003 women studied, 30.6% tested positive for bacterial vaginosis, 23.3% for vulvovaginal candidiasis, and 0.5% for trichomoniasis. The Affirm VPIII method turned out positive in 27.5%, 27.4% and 0.5% of cases, respectively. No statistically significant differences were found between the molecular technique and conventional methods for microbiological diagnosis of vaginitis/ vaginosis (p < 0.05). CONCLUSION: The Affirm VPIII test correlated well with wet mount, Gram stain and mycological culture. Although its cost is relatively high, it is fast, reproducible, easy, and can be done in either clinical laboratories or Gynecology offices, which permits prescribing a specific early treatment.

Chlamydial infection in a high risk population: association with vaginal flora patterns.

PURPOSE: This study aimed to determine the frequency of Chlamydia trachomatis (CT) infection among high risk Brazilian women and evaluate its association with vaginal flora patterns. METHODS: This was a cross-sectional study, performed in an outpatient clinic of Bauru State Hospital, São Paulo, Brazil. A total of 142 women were included from 2006 to 2008. Inclusion criteria was dyspareunia, pain during bimanual exam, presence of excessive cervical mucus, cervical ectopy or with three or more episodes of abnormal vaginal flora (AVF) in the previous year before enrollment. Endocervical CT testing was performed by PCR. Vaginal swabs were collected for microscopic assessment of the microbial flora pattern. Gram-stained smears were classified in normal, intermediate or bacterial vaginosis (BV), and recognition of Candida sp. morphotypes. Wet mount smears were used for detection of Trichomonas vaginalis and aerobic vaginitis (AV). RESULTS: Thirty-four of 142 women (23.9%) tested positive for CT. AVF was found in 50 (35.2%) cases. The most frequent type of AVF was BV (17.6%). CT was strongly associated with the presence of AV (n = 7, 4.9%, P = 0.018), but not BV (n = 25, 17.6%, P = 0.80) or intermediate flora (n = 18, 12.7%, P = 0.28). CONCLUSIONS: A high rate of chlamydial infection was found in this population. Chlamydia infection is associated with aerobic vaginitis.

Therapeutic efficacy of posaconazole against Candida glabrata in a murine model of vaginitis.

The frequency of mucosal infections caused by Candida glabrata has increased significantly. Candida glabrata infections are often resistant to many azole antifungal agents, especially fluconazole. The purpose of this study was to compare the efficacies of posaconazole (PSC) and fluconazole (FLC) in the treatment of experimental C. glabrata vaginitis caused by isolates with different FLC susceptibilities. A battery of 36 vaginal isolates of C. glabrata was tested against PSC and FLC to determine their in vitro susceptibilities. The 48-h geometric mean MICs for all isolates tested were 0.156 and 4.238 µg ml(-1) for PSC and FLC respectively. Two strains of C. glabrata for which FLC MICs were different were selected for in vivo study. The treatment regimens for the vaginal murine infection model were PSC or FLC at 10 or 20 mg kg(-1) of body weight/day and 20 mg kg(-1) twice a day. Regimens with PSC at 20 mg kg(-1) once or twice a day were effective in reducing the load of both the FLC-susceptible and -resistant isolates of C. glabrata. FLC at 20 mg kg(-1) twice a day was effective in reducing the load of both the isolates of C. glabrata. PSC displayed a more effective in vivo activity than FLC in the treatment of murine C. glabrata vaginitis.

Validation of an immunologic diagnostic kit for infectious vaginitis by Trichomonas vaginalis, Candida spp., and Gardnerella vaginalis.

FemPure is a kit for the rapid diagnosis of vaginitis by Trichomonas vaginalis, Candida spp., and Gardnerella vaginalis, based on aggregation of latex particles joined to specific antibodies. The validation of the method involved the parameters specificity, detection limit, robustness, clinical sensitivity, and clinical specificity. Also, samples analyzed in parallel by the validated test and other recognized tests conducted by external laboratory were included. The method was specific for the 3 infectious agents, and no cross-reaction with other microorganisms usually present in vaginal exudates. The detection limit > or =1 x 10(6) CFU/mL for Candida albicans and G. vaginalis avoids the detection of concentrations considered normal flora, whereas T. vaginalis was detected until 1 x 10(5) cells/mL. Values of clinical sensitivity > or =80% and clinical specificity > or =90% and concordance > or =90% were found between samples evaluated in parallel by different methods. Robustness showed that the test can be used in laboratories with different management systems; its simple implementation without equipment allows the use in primary health care areas.

Molecular identification and susceptibility testing of Trichosporon isolates from a Brazilian hospital.

In this study the molecular identification and susceptibility profile of 21 clinical isolates, from a Brazilian hospital, belongs to six different species of Trichosporon were described. Trichosporon asahii was the predominant species and corresponded to 43% of isolates. Eighty three percent of the strains isolated from deep sites were identified as T. asahii, while only 17% belong to a non-T. asahii species (Trichosporon inkin). In general, the MICs were high and independent of the species of Trichosporon as well as the clinical origin of strain. Amphotericin B and fluconazole were less effective against Trichosporon spp. and high MIC values of voriconazole, posaconazole and ravuconazole were observed. Fifty-six percent (5/9) of T. asahii strains were isolated from deep sites, whereas 8% (1/12) of non-T. asahii species were isolated from those sites. A total of 89% of T. asahii isolates exhibited resistance to amphotericin B in vitro.

Prevalencia de infección cervical por Chlamydia trachomatis en mujeres de la Región Metropolitana / Prevalence of cervical infection by Chlamydia trachomatis among Chilean women living in the Metropolitan Región

Background: Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) worídwide. In women, chlamydia infections are 75 percent asymptomatic and can lead to pelvic inflammatory disease, infertility, and ectopic pregnancy. Infants exposed to the microorganism at birth also have a high risk to develop conjunctivitis and pneumonía. Aim: To determine the prevalence of C trachomatis in women in the Metropolitan área of Santiago (Chile). Patients and methods: Cervical specimens were collected from 403 women attending three gynecological outpatient settings from Apríl 2003 to June 2005. These included one public hospital (n =100), a prívate medical center (n =268), and a clinic for adolescents (n =35). Mean ages ofeach group of patients were 35.6±8,2, 33.4±8.1 and 16.9±4.2 years, respectively. The diagnosis of C trachomatis was performed by the amplification byPCRofa 517-base pair segment of the cryptic plasmid on specimens extracted by a commercial procedure. Positive specimens were conñrmed by nested PCRs targeting the ompl gene. The presence of vaginal infections and its association with C trachomatis was investigated in a subset of 223 women ofthe prívate center. Residís: C trachomatis was detected in the cervix of 19 out of 403 women, resulting in a prevalence of 4.7 percent. The distribution of positive cases among different age groups was not significantly different. Women presenting with bacterial vaginosis had a significantly higher prevalence of C trachomatis infection (p <0.01). Conclusions: This study found a high prevalence of C trachomatis among gynecologic patients that should prompt preventive strategies.

[Prevalence of cervical infection by Chlamydia trachomatis among Chilean women living in the Metropolitan Region]. / Prevalencia de infección cervical por Chlamydia trachomatis en mujeres de la Región Metropolitana.

BACKGROUND: Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) worldwide. In women, chlamydia infections are 75% asymptomatic and can lead to pelvic inflammatory disease, infertility, and ectopic pregnancy. Infants exposed to the microorganism at birth also have a high risk to develop conjunctivitis and pneumonia. AIM: To determine the prevalence of C trachomatis in women in the Metropolitan area of Santiago (Chile). PATIENTS AND METHODS: Cervical specimens were collected from 403 women attending three gynecological outpatient settings from April 2003 to June 2005. These included one public hospital (n=100), a private medical center (n=268), and a clinic for adolescents (n=35). Mean ages of each group of patients were 35.6+/-8,2, 33.4+/-8.1 and 16.9+/-4.2 years, respectively. The diagnosis of C trachomatis was performed by the amplification by PCR of a 517-base pair segment of the cryptic plasmid on specimens extracted by a commercial procedure. Positive specimens were confirmed by nested PCRs targeting the ompl gene. The presence of vaginal infections and its association with C trachomatis was investigated in a subset of 223 women of the private center. RESULTS: C trachomatis was detected in the cervix of 19 out of 403 women, resulting in a prevalence of 4.7%. The distribution of positive cases among different age groups was not significantly different. Women presenting with bacterial vaginosis had a significantly higher prevalence of C trachomatis infection (p<0.01). CONCLUSIONS: This study found a high prevalence of C trachomatis among gynecologic patients that should prompt preventive strategies.

Frequency of cervical intraepithelial neoplasia and infectious agents for vaginitis in menstrual cycle phase.

OBJECTIVE: The study objective was to verify differences in the diagnosis of infectious agents and CIN in cytological smears in the proliferative and secretory phases of the menstrual cycle. METHODS: A retrospective study was carried out at the Federal University of "Triângulo Mineiro". Presence of Candida albicans, Trichomonas vaginalis, clue cells, Doderlein bacilli, cytolytic flora, coccoid bacillus, CIN and HPV were collected from the vaginal cytology tests, cervical and endocervical in healthy women of reproductive age from 1994 to 2004 (about 14,000 in total). The cytologies were divided into two groups: proliferative and secretory phase. Chi-square and Fisher's exact tests were used for statistical analysis with the significance level set at less than 0.05. RESULTS: The frequency of cytolysis and candidiasis was higher in the secretory phase of the menstrual cycle (p < 0.0001). When the presence of CIN associated with vulvovaginitis was evaluated, there was no significant difference in cytologies with CIN between the first and the second phases of the menstrual cycle. CONCLUSION: Frequency of the cytolytic flora and Candida albicans is influenced by the phase of the menstrual cycle, but CIN is not.

[Diagnostic criteria for cervicovaginitis and its congruency with the Mexican official norm to prevent and control vaginal infections]. / Criterios para el diagnóstico de cervicovaginitis aplicados en el primer nivel de atención. Corrrelación con la norma oficial mexicana.

OBJECTIVE: to analyze currently used criteria to diagnose and treat cervicovaginitis in primary care and its congruency with the Mexican Official Norm (MON). METHODOLOGY: a cross sectional study was conducted to analyze 227 cases with cervicovaginitis. The information was obtained from the clinical charts and the variables were related to the criteria for diagnosis and treatment stated by MON. RESULTS: the mean age of patients was 31.5 years (SD 7.7). The cervicovaginitis cases were more frequent in the group of 31-35 years of age (21.4%). The etiology was ascertained in 20.7%; 48.5% of clinical charts had registered the clinical information (symptoms and signs); 25.1% were given specific treatment; in 20.7% of cases treatment was given to the sexual partner, regardless of the etiology. 24.7% had registered preventive actions; 10.6% had gynecological examination; 26.9% had laboratory exams and 27.3% of cases were followed up. CONCLUSIONS: little correspondence exists between the MON criteria and the clinical information registered in the clinical charts. This was found in less than thirty percent of cases. The gynecological examination and use of laboratory exams were infrequent, and there were a low percentage of cases in which the etiology was reported and related to the drug treatment.

Accuracy of a self-collection kit for the microbiological study of the vaginal content.

Diagnosis of vaginal discharge is frequently performed in an empirical way, leading to inadequate treatment. This study tested the accuracy of a self-collection kit for microbiological study of the vaginal content. One hundred and forty-two women of Family Health Program units in Niterói and Piraí cities were enrolled in order to have their vaginal content studied. A brief explanation and a self-collection kit were provided in order to sample the vaginal content. The self-collection kit was composed of one empty plastic tube, two glass slides, a long handle cytobrush, an identification card and guideline notes. The vaginal sample was applied on the glass slides by the women and stained by Gram technique. A second sampling was done by the medical personnel. The microbiological diagnosis in a blinded analysis was made under optical microscopy. A validation diagnosis test was done taking the medical collection results as a gold standard. A total of 106 women had followed the protocol and were included in the study. Microbiological analysis was unsatisfactory in 12 cases (6 cases of self-collection material and 6 cases of medical collection). The microbiological analyses in the self-collection and in the medical collection material were respectively: bacterial vaginosis in 21.7% and 17.9%, non bacillar flora in 10.3% and 11.3%, vaginal trichomoniasis in 5.66% and 5.6%, candidiasis in 3.78% and 2.8% and a normal microbiota in 52.8% and 56.6%. The Kappa coefficient suggested a "very good correlation" of the microbiological results between the two methods of collection (K=0.7945). The self-collection kit provides samples for microbiological analysis of the vaginal microbiota as good as medical collection.