RESUMEN
OBJECTIVES: To assess low abdominal pain, yellow vaginal discharge, other symptoms and signs, and demographic and behavioural variables as predictors for cervical or vaginal infection. METHODS: A cross sectional study of women attending gynaecology and family planning clinics in Lima, Peru was undertaken. 630 consecutive eligible female patients with chief or elicited complaints of yellow vaginal discharge, low abdominal pain, or both were interviewed and examined, together with a comparable reference group without these complaints. Vaginal specimens were tested for trichomoniasis and bacterial vaginosis. Endocervical specimens were tested for Neisseria gonorrhoeae and Chlamydia trachomatis using the ligase chain reaction. RESULTS: Infections found included chlamydial infection in 69 women (10.9%), gonorrhoea in 10 (1.6%), and either infection in 77 (12.2%); trichomoniasis in 46 (7.3%), bacterial vaginosis in 189 (30%), and either infection in 209 (33.2%). Cervical infection with C trachomatis and/or N gonorrhoeae was independently associated with history of a new sex partner within the last 3 months, more than one sex partner within the last year, use of condoms never or in less than 50% of sex acts, history of sex partner with STD within the last year; with symptoms of persistent low abdominal pain and of yellow vaginal discharge; and with signs of profuse and yellow vaginal discharge, cervical ectopy, easily induced endocervical bleeding, or brown cervical secretion. Using these findings, an algorithm was created that had a positive predictive value (PPV) of 36% for cervical infection among women reporting chief or elicited complaint of this abnormal vaginal discharge and a PPV of 25% among those without a complaint. A chief complaint of yellow vaginal discharge had a PPV of 50% for trichomoniasis or bacterial vaginosis. Among women without a chief complaint of yellow vaginal discharge, clinical findings of yellow vaginal discharge had a PPV of 55%. CONCLUSIONS: Where economic and technical constraints preclude testing, clinical findings and risk assessment are helpful in detecting vaginal and cervical infections. Several demographic, behavioural, clinical, and laboratory variables were predictive of infection in this population.
Asunto(s)
Dolor Abdominal/microbiología , Infecciones por Chlamydia/diagnóstico , Gonorrea/diagnóstico , Enfermedades del Cuello del Útero/microbiología , Excreción Vaginal/microbiología , Adolescente , Adulto , Algoritmos , Infecciones por Chlamydia/terapia , Estudios Transversales , Femenino , Gonorrea/terapia , Humanos , Perú , Estudios Prospectivos , Medición de Riesgo , Sensibilidad y Especificidad , Parejas SexualesRESUMEN
OBJECTIVES: This study examined the prevalences of antibodies to Treponema pallidum, Chlamydia trachomatis, and herpes simplex virus type 2 in a sample of Peruvian adults. METHODS: Among adults seeking health certification in Lima, Peru, 600 were randomly selected to undergo interviews and serologic testing. RESULTS: Men's reported mean lifetime number of partners (10.6) far exceeded women's (1.1), yet antibody to sexually transmitted infection pathogens among sexually experienced participants was 2.8 times more prevalent among women than among men. Among men, female sex workers accounted for 37% of recent partners, and only sex with female sex workers while using condoms less than half of the time was independently associated with antibody (odds ratio = 3.6, 95% confidence interval = 1.5, 8.8). among women, number of partners was associated with any sexually transmitted infection antibody, while intercourse before 18 years of age was associated with C trachomatis antibody. At every level of perceived risk, sexually transmitted infection antibody was more frequent among women. CONCLUSIONS: Men having unprotected sex with female sex workers had the greatest risk of acquiring infections and (by inference) of transmitting them to women.
Asunto(s)
Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Herpes Genital/epidemiología , Conducta Sexual , Sífilis/epidemiología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Perú/epidemiología , Prevalencia , Estudios Seroepidemiológicos , Distribución por Sexo , Factores Sexuales , Encuestas y Cuestionarios , Salud UrbanaRESUMEN
Four hundred female sex workers attending a sexually transmitted disease clinic in Lima, Peru, were interviewed for demographic information and medical, contraceptive, and sexual practice histories. Cervical cultures were done for Neisseria gonorrhoeae and Chlamydia trachomatis, and serum was tested for antibodies to human immunodeficiency virus, human T cell lymphotropic virus type I (HTLV-I), Treponema pallidum, C. trachomatis, herpes simplex virus type 2 (HSV-2), and Haemophilus ducreyi. The prevalence of HTLV-I increased with duration of prostitution from 3.6% (< 3 years) to 9.3% (3-6 years) to 15.9% (> 6 years; P < .01). After adjustment for duration of prostitution, reduced risk of HTLV-I was significantly correlated with condom use for more than half of all sexual exposures for > 3 years (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.13-0.89). Further adjusting for condom use, HTLV-I seropositivity was associated with C. trachomatis (OR, 3.7; 95% CI, 1.4-13.2) and with antibody to HSV-2 (OR, 3.7; 95% CI, 0.5-29.6). Thus, duration of prostitution, lack of consistent condom use, and past infection with C. trachomatis were significantly associated with HTLV-I seropositivity.