High prevalence detection of Chlamydia trachomatis by polymerase chain reaction in endocervical samples of infertile women attending university hospital in Manaus-Amazonas, Brazil.

BACKGROUND: We established for the first time the prevalence of Chlamydia trachomatis infection among infertile women in Manaus Amazonas Brazil using the polymerase chain reaction (PCR) technique. METHODS: 106 women were studied at a public university hospital fertility clinic for infertility problems correlated with chlamydia infection. Social-economic and clinical information was obtained before medical examination to obtain samples for the amplification of C. trachomatis DNA plasmid. RESULTS: The prevalence of chlamydial infection among infertile women was 52.8, and 51.8% of the positive participants were older than 30 years of age (p = 0.8697). Of the 56 women positive for C. trachomatis, 31 (55.4%) had never given birth, while 9 (16%) had a pregnancy resulting in fetal death. Our findings also revealed that these patients had a low socio-economic status and high unemployment (p = 0.0274), and a significant association of 5% (p < 0.05) of chlamydial infection with family income. CONCLUSIONS: Due to the high prevalence of C. trachomatis, concerns about effects on reproductive health and fertility are undertaken. Therefore, we believe it is extremely necessary to implement large-scale PCR-based screening as part of routine clinical detection programs concerning preventive effects of chlamydial infection among this population.

Performance of p16INK4a immunocytochemistry as a marker of anal squamous intraepithelial lesions.

BACKGROUND: Protein p16(INK4a) immunocytochemistry (ICCp16) has the potential to reveal lesions at risk of progression to anal cancer. This study examined measures of diagnostic validity of ICCp16 in HIV-positive patients treated at the Tropical Medicine Foundation of Amazonas in the coloproctology outpatient clinic. METHODS: One hundred ninety HIV-positive patients were consecutively enrolled in 2007 and 2008. All patients underwent anal cytologic sampling to perform ICCp16 in conventional and GluCyte (Synermed International, Westfield, Indiana and S¸ao Paulo, Brazil) smears and also for genotyping of human papillomavirus (HPV). Patients were then subjected to anal biopsies monitored by high-resolution anoscopy. Hematoxylin-eosin and immunoperoxidase p16 (clone 6H12) stains were performed in slides with biopsied and cytological specimens, respectively. HPV genotyping on anal scrapings was performed by a polymerase-chain reaction (PCR)-based method. The immunochemical findings were compared with histopathological and PCR results in contingency tables and analyzed by nonparametric tests. Measures of diagnostic validity of ICCp16 were calculated. Statistical significance was set at P ≤ .5. RESULTS: There was no statistically significant association between the immunochemical results (conventional or GluCyte smears) and histopathological or HPV genotyping findings (P > .05). In the best scenario, ICCp16 presented 31% sensitivity and 81% specificity for the diagnosis of anal squamous intraepithelial lesion (ASIL) and 30% and 66%, respectively, for the diagnosis of infection with high-risk HPV. CONCLUSIONS: There was no association between ICCp16 results and histopathological findings nor between ICCp16 and HPV genotyping. ICCp16 showed poor sensitivity and moderate specificity for the diagnosis of ASIL or high-risk HPV.