RESUMEN
Despite a high prevalence of sexually transmitted Chlamydia trachomatis infections in Brazil and other countries in South America, very little is known about the distribution of C. trachomatis genovars. In this study, we genotyped C. trachomatis strains from urine or endocervical specimens collected from 163 C. trachomatis-positive female and male youths, and female adults, residing in two different regions of Brazil, the city of Goiânia located in the central part of Brazil, and the city of Vitória in the south-east region. C. trachomatis strains were genotyped by amplifying and sequencing the ompA gene encoding the chlamydial major outer-membrane protein, which is genovar specific. We found nine different C. trachomatis genovars: E (39.3%), F (16.6%), D (15.9%), I (8.6%), J (7.4%), G (4.9%), K (3.1%), H (2.4%) and B (1.8%). The distribution of the C. trachomatis genovars in the two regions of Brazil was similar, and there was no statistically significant association of serovars with age, gender, number of sexual partners or clinical symptoms. The overall distribution of C. trachomatis genovars in Brazil appears similar to that found in other regions of the world, where E, D and F are the most common. This supports the notion that, during the last few decades, the overall distribution of C. trachomatis genovars throughout the world has been relatively stable.
Asunto(s)
Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/clasificación , Chlamydia trachomatis/aislamiento & purificación , Adolescente , Adulto , Proteínas de la Membrana Bacteriana Externa/genética , Técnicas de Tipificación Bacteriana , Brasil/epidemiología , Cuello del Útero/microbiología , Chlamydia trachomatis/genética , Femenino , Genotipo , Humanos , Masculino , Tipificación Molecular , Prevalencia , Orina/microbiología , Adulto JovenRESUMEN
BACKGROUND: Sexually transmitted infections constitute the main health risk among adolescents. In developing countries the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among female adolescents from a Health Sector of the city of Goiânia, Brazil, and validated cervicitis diagnosis using World Health Organization/Ministry of Health risk score and gynecological examination. METHODS: A cross-sectional community-based sample of 914 15- to 19-year-old female teenagers was randomly selected and referred to the local Family Health Program. Of these, 472 (51.6%) were sexually active and gynecological examinations were carried out for 427. Endocervical samples were collected to perform the polymerase chain reaction for C. trachomatis and N. gonorrhoeae. Performance of risk score, the presence of mucopurulent discharge, friability, ectopia and pain during cervical maneuver were compared with the presence of C. trachomatis or N. gonorrhoeae or both. RESULTS: The prevalence of C. trachomatis and N. gonorrhoeae was 14.5% and 2.1%, respectively. The risk score had a specificity of 31.9% (95% confidence interval, 21.2 to 44.2) and a positive predictive value of 20.8% (95% confidence interval, 13.5 to 29.7). Friability was the component of the gynecological examination that presented the best performance with a sensitivity of 43.5%, specificity of 81.0%, and 30.6% of positive predictive value. CONCLUSION: The prevalence of infection by C. trachomatis and N. gonorrhoeae was high among these sexually active adolescents. The syndromic approach is clearly inadequate for screening and treating these infections in this population. Therefore, the implantation of other strategies to control these infections among adolescents is urgently required.
Asunto(s)
Chlamydia trachomatis/aislamiento & purificación , Gonorrea/diagnóstico , Investigación sobre Servicios de Salud , Linfogranuloma Venéreo/diagnóstico , Tamizaje Masivo/métodos , Neisseria gonorrhoeae/aislamiento & purificación , Adolescente , Brasil , Estudios Transversales , Femenino , Gonorrea/patología , Gonorrea/fisiopatología , Humanos , Linfogranuloma Venéreo/patología , Linfogranuloma Venéreo/fisiopatología , Examen Físico , Reacción en Cadena de la Polimerasa/métodos , Valor Predictivo de las Pruebas , Prevalencia , Medición de Riesgo , Sensibilidad y Especificidad , Población Urbana , Adulto JovenRESUMEN
Estudo transversal de base populacional, com seleção aleatória sistemática de adolescentes do gênero feminino, sexualmente ativas, com idade entre 15 e 19 anos. Os dados foram obtidos por meio de entrevista confidencial