RESUMEN

BACKGROUND: Some sexually transmitted infectious agents, such as Chlamydia trachomatis and Herpes simplex, cause local inflammation, and could contribute to Human Papillomavirus (HPV) and cervical lesion progression. Thus, the aim of this study was to determine any association between the presence of microorganisms of gynecological importance, sexual behavior, clinical and demographical variables to the development and progress of cervical lesions. METHODS: One hundred and thirty-two women between 14 and 78 years and living at Vitória da Conquista, Bahia, Brazil, were included (62 individuals with cervical lesions and 70 without lesions). They answered a questionnaire to provide data for a socioeconomic and sexual activity profile. Samples of cervical swabs were collected and analyzed by PCR to detect genital microorganisms and HPV. Quantitative PCR was used to detect and quantify Ureaplasma urealyticum and Ureaplasma parvum. Univariate and multiple logistic regression were performed to measure the association with the cervical lesions, and an odds ratio (OR) with 95% confidence intervals (95%CI) were calculated. The Mann-Whitney U test was also used to compare the microorganism load in the case and control groups. The significance level was 5% in all hypotheses tested. RESULTS: Cervical lesions were associated with: women in a stable sexual relationship (OR = 14.21, 95%CI = 3.67-55.018), positive PCR for HPV (OR = 16.81, 95%CI = 4.19-67.42), Trichomonas vaginalis (OR = 8.566, 95%CI = 2.04-35.94) and Gardnerella vaginalis (OR = 6.13, 95%CI = 1.53-24.61), adjusted by age and qPCR for U. parvum. U. parvum load showed a statistical difference between the case and control groups (p-value = 0.002). CONCLUSION: Variables such as stable relationship, HPV, T. vaginalis, G. vaginalis were associated with cervical lesions in epidemiological studies. U. parvum load was higher in woman with cervical lesions compared with women without lesions. Additional studies are needed to better understand the role of these factors in cervical lesion development.

Asunto(s)

Infecciones por Papillomavirus/diagnóstico , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades del Cuello del Útero/diagnóstico , Adolescente , Adulto , Anciano , Brasil , Cuello del Útero/microbiología , Cuello del Útero/virología , Coinfección/diagnóstico , Coinfección/microbiología , Coinfección/virología , ADN Bacteriano/aislamiento & purificación , ADN Bacteriano/metabolismo , ADN Viral/aislamiento & purificación , ADN Viral/metabolismo , Femenino , Gardnerella vaginalis/genética , Gardnerella vaginalis/aislamiento & purificación , Humanos , Modelos Logísticos , Persona de Mediana Edad , Oportunidad Relativa , Papillomaviridae/genética , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/transmisión , Infecciones por Papillomavirus/virología , Reacción en Cadena en Tiempo Real de la Polimerasa , Enfermedades de Transmisión Sexual/microbiología , Enfermedades de Transmisión Sexual/transmisión , Enfermedades de Transmisión Sexual/virología , Encuestas y Cuestionarios , Trichomonas vaginalis/genética , Trichomonas vaginalis/aislamiento & purificación , Ureaplasma/genética , Ureaplasma/aislamiento & purificación , Ureaplasma urealyticum/genética , Ureaplasma urealyticum/aislamiento & purificación , Enfermedades del Cuello del Útero/microbiología , Enfermedades del Cuello del Útero/virología , Adulto Joven

RESUMEN

Background: The prevalence of cervicovaginal infections during pregnancy has been associated with adverse perinatal outcomes however, the actual approach used for diagnosis is not effective. The aim of this study was to compare the diagnosis of vaginal infections in pregnant women using clinical, molecular diagnostic and traditional microbiological culture in a pilot study, to determine the prevalence and association with the development of preterm labor. Materials and methods: We performed a nested cross-sectional study composed by 54 women in a cohort of pregnant women in Mexico City. Cervicovaginal infections were evaluated by clinical methods, microbiology culture and a commercially available molecular biology test. Results: Prevalence of cervicovaginal infections during pregnancy was estimated between 28% and 50% according to methodologies. Considering the clinical diagnosis of preterm labor as the gold standard, all diagnostic tests were poor as predictors of preterm labor. Conclusion: Traditional approaches to establish the significance of cervicovaginal infection in pregnancy are exhausted, so be sought new ways to understand this complex relationship. Meanwhile it is recommended to continue to use traditional methods to identify infections during pregnancy in both knowledge of new methods aimed at understanding these relationships are sophisticated.

Asunto(s)

Técnicas de Diagnóstico Molecular/métodos , Complicaciones Infecciosas del Embarazo/diagnóstico , Enfermedades del Cuello del Útero/diagnóstico , Enfermedades Vaginales/diagnóstico , Adolescente , Adulto , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , México , Trabajo de Parto Prematuro/epidemiología , Proyectos Piloto , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Resultado del Embarazo , Enfermedades del Cuello del Útero/microbiología , Enfermedades Vaginales/microbiología , Adulto Joven

RESUMEN

BACKGROUND: In the United States 19 million people acquire a sexually transmitted disease every year. Sexually transmitted diseases impact in gynecological terms because they may cause sterility, infertility and ectopic pregnancy. OBJECTIVE: To compare the effectiveness of two combinations of three oral antimicrobial drugs in the treatment of mixed cervical-vaginal infections, included those caused by Mycoplasma and Chlamydia trachomatis. MATERIAL AND METHOD: Aclinical, random, comparative, double-blind study included 50 patients assisting to infectology consult with diagnosis of mixed cervical-vaginal infection. Patients were divided into two groups: Group A (n = 25): fluconazole 37.5 mg, tinidazole 500 mg and azithromycin 250 mg; group B (n = 25): fluconazole 37.5 mg, tinidazole 500 mg and clindamycin 312.5 mg. Patients of both groups received two tablets twice p.o. for one day. Cultures were performed to corroborate the diagnosis and then to demonstrate effectiveness of the schemes studied. For the analysis of the data we used measures of central tendency, dispersion and inferential statistics for comparison of proportions by c2 and Fisher's exact tests with a significance level of p < 0.05. RESULTS: All patient got clinical cure; however, regarding the microbiologic eradication a positive case was identified in group A, requiring rescue treatment. The compliance in both groups was of 100%. In both groups, statistical analysis did not show significant differences. Three patients in group A had mild adverse effects. Patients mean age was 33.4 +/- 5.3 years. CONCLUSIONS: Both treatments showed similar effectiveness against mixed cervical-vaginal infections. Microbiological efficacy was of 96% and 100% in group A and B, respectively, besides, scheme of group B was better tolerated.

Asunto(s)

Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Antitricomonas/uso terapéutico , Azitromicina/uso terapéutico , Clindamicina/uso terapéutico , Fluconazol/uso terapéutico , Infecciones por Mycoplasma/tratamiento farmacológico , Tinidazol/uso terapéutico , Enfermedades del Cuello del Útero/tratamiento farmacológico , Enfermedades del Cuello del Útero/microbiología , Enfermedades Vaginales/tratamiento farmacológico , Enfermedades Vaginales/microbiología , Adulto , Infecciones por Chlamydia/tratamiento farmacológico , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos

RESUMEN

A criação de ovinos tem se desenvolvido nas últimas décadas, entretanto ainda são escassas informações sobre a composição e potencial patogênico da microbiota cérvico-vaginal de ovelhas. O presente estudo teve como objetivo conhecer os microrganismos constituintes da microbiota cérvico-vaginal de ovelhas, bem como sua susceptibilidade aos antimicrobianos. Foram realizadas coletas em 60 animais sadios, pertencentes a rebanhos de Petrolina e região. Foi realizado o isolamento bacteriano em ágar sangue e ágar MacConkey, sendo os microrganismos identificados de acordo com características morfológicas, tintoriais e bioquímicas. As amostras foram submetidas ao teste de difusão em disco para determinar o perfil de sensibilidade aos antimicrobianos: sulfametazina, enrofloxacina, doxiciclina, tetraciclina, penicilina, amoxicilina, cefalotina e lincomicina. Foram obtidos 94 isolados, sendo constatada uma maior frequência de Staphylococcus spp. (32,97 por cento), Escherichia coli e Micrococcus spp., sendo observado ainda, isolados de Acinetobacter spp., Shigella spp., Enterobacter spp., Klebsiella spp. e Streptococcus spp. Os isolados apresentaram alta sensibilidade aos antimicrobianos testados sendo observado o menor percentual de sensibilidade para lincomicina. A presença de microrganismos oportunistas de potencial patogênico, na microbiota, como Staphylococcus spp e Escherichia coli, remete a uma análise criteriosa em relação ao diagnóstico de infecções genitais. Os isolados bacterianos obtidos neste estudo são sensíveis à maioria dos grupos de drogas antimicrobianas testadas, demonstrando o potencial de utilização desses princípios ativos, além da disponibilidade de escolha, visto a ausência de multirresistência.(AU)

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Sheep farming has developed in recent decades; however there is still little information on the composition and pathogenic potential of cervical-vaginal flora of sheep. The purpose of the present study was to determine the main constituents of microorganisms in the cervical-vaginal flora of sheep and their antimicrobial susceptibility. Samples were taken from 60 healthy sheep belonging to herds in the region of Petrolina, Pernambuco. Bacterial isolation was performed on blood agar and MacConkey agar, and the microorganisms were identified according to morphology, Gram staining and biochemical characteristics. The samples were subjected to disk diffusion test for determination of sensitivity to the following antimicrobial drugs: sulfamethazine, enrofloxacin, doxycycline, tetracycline, penicillin, amoxicillin, cephalothin and lincomycin. We obtained 94 isolates and found a higher frequency of Staphylococcus spp., Escherichia coli and Micrococcus spp., and also observed isolates of Acinetobacter spp., Shigella spp., Enterobacter spp., Klebsiella spp. and Streptococcus spp. The isolates were highly sensitive to the antibiotics tested, with the lowest percentage of susceptibility to lincomycin. The presence of opportunistic microorganisms of a potential pathogenic microbiota, such as Staphylococcus spp. and Escherichia coli, refers to a careful analysis in the diagnosis of genital infections. The bacterial isolates obtained in this study are sensitive to most groups of antibiotics tested, demonstrating the potential use of these active ingredients, plus the availability of choice, given the lack of multidrug resistance.(AU)

Asunto(s)

Animales , Enfermedades del Cuello del Útero/microbiología , Enfermedades del Cuello del Útero/veterinaria , Infecciones Bacterianas/prevención & control , Infecciones Bacterianas/veterinaria , Conservantes de Alimentos , Pruebas Antimicrobianas de Difusión por Disco/veterinaria

Asunto(s)

Tuberculosis de los Genitales Femeninos/patología , Enfermedades del Cuello del Útero/microbiología , Enfermedades Vaginales/microbiología , Anciano , Femenino , Humanos , Posmenopausia , Tuberculosis de los Genitales Femeninos/diagnóstico , Tuberculosis de los Genitales Femeninos/microbiología , Tuberculosis Pulmonar/complicaciones , Enfermedades del Cuello del Útero/diagnóstico , Enfermedades del Cuello del Útero/patología , Enfermedades Vaginales/diagnóstico , Enfermedades Vaginales/patología

RESUMEN

AIM AND METHOD: To identify Chlamydia trachomatis (CT) endocervical infection among gestations at risk for preterm birth by means of DNA amplification. RESULTS: One hundred fifty eight (n = 158) gestations of Guayaquil (63.3%) and Quito (36.7%) Ecuador, at risk for preterm birth: threatened preterm labor (TPL, 60.8%) and preterm premature rupture of membranes (PPROM, 39.2%) were recruited. CT infection was presented in 8.2% of cases (TPL: 10.4% and PPROM: 4.8%). No significant difference was observed in this frequency in regard to city or diagnosis. CONCLUSION: Although the causative role of CT infection for these antenatal complications cannot be completely ruled out, its presence may justify an antenatal routine screening program in order to provide appropriate therapy.

Asunto(s)

Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/aislamiento & purificación , Rotura Prematura de Membranas Fetales/microbiología , Trabajo de Parto Prematuro/microbiología , Complicaciones Infecciosas del Embarazo/microbiología , Enfermedades del Cuello del Útero/microbiología , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/genética , ADN/química , ADN/genética , Ecuador , Femenino , Humanos , Reacción en Cadena de la Polimerasa , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico

RESUMEN

This study compares the detection rates of Chlamydia trachomatis by two techniques, direct immunofluorescence (IMF) and real time polymerase chain reaction (PCR), in patients with and without intra-epithelial cervical lesions (SIL) in Recife. We conducted a transversal study involving 35 women with SIL and 35 without SIL attended at Ambulatório Especializado da Mulher, Recife, Brazil. They were tested for Chlamydia trachomatis using two techniques, direct IMF or real time PCR. The rates of Chlamydia trachomatis detection were compared and the association with intra-epithelial cervical lesions was determined using the chi-square test at a 5% level of significance. Concordance between the tests was evaluated using kappa. The global prevalence of Chlamydia infection was 47.1% by direct IMF and 58.6% by real time PCR. A significant association was observed between Chlamydia diagnosis and presence of intra-epithelial cervical lesions, with about 80% positive results by direct IMF and 77.1% by real time PCR. However, the detected rate of infection with Chlamydia trachomatis was significantly greater in patients without intra-epithelial cervical lesions tested by real time PCR (40%) when compared to direct IMF (14.3%). The concordance between the tests was weak, with a kappa coefficient of 0.4. Both real time PCR and direct IMF detected elevated rates of Chlamydia infection in patients with intra-epithelial cervical lesions (80%) but the tests were discordant when patients without cervical lesions were tested, possibly because sensitivity of real time PCR is greater.

Asunto(s)

Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/aislamiento & purificación , Técnica del Anticuerpo Fluorescente Directa , Reacción en Cadena de la Polimerasa/métodos , Enfermedades del Cuello del Útero/microbiología , Chlamydia trachomatis/genética , Estudios Transversales , Femenino , Humanos , Sensibilidad y Especificidad

RESUMEN

This study compares the detection rates of Chlamydia trachomatis by two techniques, direct immunofluorescence (IMF) and real time polymerase chain reaction (PCR), in patients with and without intra-epithelial cervical lesions (SIL) in Recife. We conducted a transversal study involving 35 women with SIL and 35 without SIL attended at Ambulatório Especializado da Mulher, Recife, Brazil. They were tested for Chlamydia trachomatis using two techniques, direct IMF or real time PCR. The rates of Chlamydia trachomatis detection were compared and the association with intra-epithelial cervical lesions was determined using the chi-square test at a 5 percent level of significance. Concordance between the tests was evaluated using kappa. The global prevalence of Chlamydia infection was 47.1 percent by direct IMF and 58.6 percent by real time PCR. A significant association was observed between Chlamydia diagnosis and presence of intra-epithelial cervical lesions, with about 80 percent positive results by direct IMF and 77.1 percent by real time PCR. However, the detected rate of infection with Chlamydia trachomatis was significantly greater in patients without intra-epithelial cervical lesions tested by real time PCR (40 percent) when compared to direct IMF (14.3 percent). The concordance between the tests was weak, with a kappa coefficient of 0.4. Both real time PCR and direct IMF detected elevated rates of Chlamydia infection in patients with intra-epithelial cervical lesions (80 percent) but the tests were discordant when patients without cervical lesions were tested, possibly because sensitivity of real time PCR is greater.

Asunto(s)

Femenino , Humanos , Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/aislamiento & purificación , Técnica del Anticuerpo Fluorescente Directa , Reacción en Cadena de la Polimerasa/métodos , Enfermedades del Cuello del Útero/microbiología , Estudios Transversales , Chlamydia trachomatis/genética , Sensibilidad y Especificidad

RESUMEN

The aims of this study were to compare a novel PCR-based Chlamydia trachomatis detection and genotyping (Ct-DT) assay with the FDA-approved, commercially available C. trachomatis detection Hybrid Capture 2 (HC2) assay and to investigate the C. trachomatis serovar distribution among young women in a rural Costa Rican study population. A total of 5,828 sexually active women participating in a community-based trial in Costa Rica were tested for C. trachomatis by HC2. A sample of 1,229 specimens consisting of 100% HC2 C. trachomatis-positive specimens (n = 827) and a random sample of 8% HC2 C. trachomatis-negative specimens (n = 402) were tested with the Ct-DT assay. Agreement between the two assays was determined by the unweighted kappa statistic. Discrepant specimens were tested with a second commercially available test (COBAS TaqMan). The Ct-DT-positive specimens were further analyzed with the Ct-DT genotyping step to investigate the distribution of 14 different C. trachomatis serovars (A, B/Ba, C, D/Da, E, F, G/Ga, H, I/Ia, J, K, L1, L2/L2a, and L3). After accounting for the sampling fraction selected for Ct-DT testing, crude agreement with the HC2 assay was 98% and the kappa was 0.92 (95% confidence interval [CI], 0.89 to 0.97). The 33 discordant samples that were further analyzed with the COBAS TaqMan test showed better agreement with the Ct-DT assay (31/33, P < 0.001). Among the 806 Ct-DT-positive samples, serovar E was the most common serovar (31%), followed by serovars F and D (both 21%) and serovar I (15%). In conclusion, the novel Ct-DT assay permits reliable detection and identification of C. trachomatis serovars.

Asunto(s)

Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/clasificación , Chlamydia trachomatis/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Enfermedades del Cuello del Útero/microbiología , Adulto , Chlamydia trachomatis/genética , Costa Rica , Femenino , Humanos , Población Rural

RESUMEN

OBJECTIVES: To examine the prevalence of Human papillomavirus and Chlamydia trachomatis DNA in cervical samples among women with normal and abnormal cervical cytology from La Plata, Argentina. METHODS: Two hundred and seventy-nine women (200 with cervical neoplasia or ICC and 79 women with normal cytology) provided cervical samples for the detection of HPV and C. trachomatis DNA by PCR-based assays. RESULTS: HPV DNA increased with the cervical lesion severity, ranging from 30% among women with normal cytology to 99-100% among women with HSIL or ICC. C. trachomatis DNA prevalence increased from low levels in women with normal cytology (11%) to 47% in those with HSIL, but was uncommon among ICC patients (20%). Among women with normal cytology, C. trachomatis prevalence was higher in HPV DNA positive (12.5%) than HPV DNA negative women (10.9%), but this difference was not significant. CONCLUSIONS: HPV prevalence in the general population is slightly higher than those reported for other developing countries. C. trachomatis DNA positivity was associated with a higher risk of both LSIL and HSIL lesions, but not with ICC.

Asunto(s)

Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/genética , Papillomaviridae/genética , Infecciones por Papillomavirus/epidemiología , Enfermedades del Cuello del Útero/epidemiología , Enfermedades del Cuello del Útero/microbiología , Adolescente , Adulto , Anciano , Argentina/epidemiología , Infecciones por Chlamydia/microbiología , ADN Viral/análisis , Femenino , Humanos , Persona de Mediana Edad , Infecciones por Papillomavirus/virología , Reacción en Cadena de la Polimerasa , Enfermedades del Cuello del Útero/virología , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/microbiología , Neoplasias del Cuello Uterino/virología , Displasia del Cuello del Útero/epidemiología , Displasia del Cuello del Útero/microbiología , Displasia del Cuello del Útero/virología

RESUMEN

Chlamydia trachomatis is now one of the most prevalent bacteria found in classic sexually transmissible diseases (STD), and as such, constitutes a serious public health problem. We examined the prevalence of Chlamydia trachomatis, by polymerase chain reaction (PCR), in 121 sexually active women who sought treatment for STD in the Alfredo da Matta Institute of Dermatology and Venerology and the Institute of Tropical Medicine of Amazonas in Manaus, Brazil. These women were examined by a specific PCR for the chlamydial plasmid, and the nature of the amplicon was determined by restriction analysis and DNA sequencing. The PCR diagnosis revealed a prevalence of 20.7% infected women.

Asunto(s)

Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/aislamiento & purificación , Enfermedades del Cuello del Útero/microbiología , Adolescente , Adulto , Brasil , Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/genética , ADN Bacteriano/análisis , Femenino , Humanos , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Sensibilidad y Especificidad , Enfermedades del Cuello del Útero/diagnóstico , Frotis Vaginal

RESUMEN

OBJECTIVE: To identify the possible association between cervicovaginal infections (CVI) and preterm delivery. DESIGN: Cohorts. REFERENCE FRAME: Instituto Nacional de Perinatología, Hospital Central Militar and Hospital General Regional No. 1, IMSS, Culiacán, Sinaloa, México. PATIENTS: Four hundred and sixty eight patients attending prenatal control and delivery care. INTERVENTIONS: Fresh smears, Gram stain, and cervicovaginal sample culture from samples obtained during the following gestational stages: First sample at 16-24 weeks, second sample at 25-32 weeks, and third sample at 33-42 weeks. The following microorganisms were studied: Candida albicans, Gardnerella vaginalis, Ureaplasma urealyticum, Streptococcus agalactiae, Mycoplasma hominis, Neisseria gonorrhoeae, Listeria monocytogenes, and Chlamydia trachomatis. In case of a positive culture, the specific treatment was indicated. MEASUREMENTS: Positive or negative culture for each of the studied pathogens, and the presence or absence of a preterm delivery for each of the patients included in the study. RESULTS: Three hundred and ninety eight were still present at the end of the study, of which 156 had a CVI and 242 had no CVI. No differences between both groups were observed concerning preterm delivery. Significant relative risks were: In the first stage, Ureaplasma urealyticum and Mycoplasma hominis with RR = 9.0 (6.81, 11.8); in the second stage, Ureaplasma urealyticum with RR = 6.2 (3.30, 11.7) and Escherichia coli with RR = 3.4 (1.33, 8.6); in the third stage, Ureaplasma urealyticum with RR = 9.19 (6.93, 12.1). The logistic regression analysis identified Ureaplasma urealyticum during the second stage with OR = 16.6 (2.9, 93.7), statistically significant with p = 0.001. The survival analysis showed differences between the two groups concerning pregnancy duration (p < 0.001). CONCLUSIONS: There is a difference in the duration in pregnancy in patients with CVI and without CVI. Ureaplasma urealyticum is consistently associated with preterm delivery.

Asunto(s)

Trabajo de Parto Prematuro/microbiología , Enfermedades del Cuello del Útero/microbiología , Enfermedades Vaginales/microbiología , Adulto , Femenino , Humanos , Embarazo , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Factores de Riesgo , Enfermedades del Cuello del Útero/complicaciones , Enfermedades Vaginales/complicaciones

RESUMEN

OBJECTIVE: To identify the possible association between cervicovaginal infections (CVI) and preterm delivery. DESIGN: Cohorts. REFERENCE FRAME: Instituto Nacional de PerinatologÝa, Hospital Central Militar and Hospital General Regional No. 1, IMSS, Culiacßn, Sinaloa, MÚxico. PATIENTS: Four hundred and sixty eight patients attending prenatal control and delivery care. INTERVENTIONS: Fresh smears, Gram stain, and cervicovaginal sample culture from samples obtained during the following gestational stages: First sample at 16-24 weeks, second sample at 25-32 weeks, and third sample at 33-42 weeks. The following microorganisms were studied: Candida albicans, Gardnerella vaginalis, Ureaplasma urealyticum, Streptococcus agalactiae, Mycoplasma hominis, Neisseria gonorrhoeae, Listeria monocytogenes, and Chlamydia trachomatis. In case of a positive culture, the specific treatment was indicated. MEASUREMENTS: Positive or negative culture for each of the studied pathogens, and the presence or absence of a preterm delivery for each of the patients included in the study. RESULTS: Three hundred and ninety eight were still present at the end of the study, of which 156 had a CVI and 242 had no CVI. No differences between both groups were observed concerning preterm delivery. Significant relative risks were: In the first stage, Ureaplasma urealyticum and Mycoplasma hominis with RR = 9.0 (6.81, 11.8); in the second stage, Ureaplasma urealyticum with RR = 6.2 (3.30, 11.7) and Escherichia coli with RR = 3.4 (1.33, 8.6); in the third stage, Ureaplasma urealyticum with RR = 9.19 (6.93, 12.1). The logistic regression analysis identified Ureaplasma urealyticum during the second stage with OR = 16.6 (2.9, 93.7), statistically significant with p = 0.001. The survival analysis showed differences between the two groups concerning pregnancy duration (p < 0.001). CONCLUSIONS: There is a difference in the duration in pregnancy in patients with CVI and without CVI. Ureaplasma urealyticum is consistently associated with preterm delivery.

Asunto(s)

Adulto , Femenino , Humanos , Embarazo , Enfermedades del Cuello del Útero/microbiología , Enfermedades Vaginales/microbiología , Trabajo de Parto Prematuro , Enfermedades del Cuello del Útero/complicaciones , Enfermedades Vaginales/complicaciones , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Factores de Riesgo

RESUMEN

Antecedentes. La embarazada desarrolla fácilmente infecciones de la vía urinaria por cambios funcionales y por ubicación del meato uretral. En la pielonefritis aguda del embarazo no es muy conocida la participación de la infección del tracto genital inferior en los resultados del tratamiento antibiótico y en la presencia de contracción uterina del aborto y parto prematuro. Objetivos. Conocer la microbiología de la vía uterina y del tracto genital en la pielonefritis aguda del embarazo y su relación con los resultados del tratamiento y con la existencia de contracción uterina. Diseño del estudio. Embarazada entre 12 y 34 semanas de gestación con el diagnóstico de pielonefritis aguda se enrolaron. Se tomaron muestras de orina y cervicovaginales para cultivo. Recibieron randomizadamente cefuroxima o cefradina. Se observó la contracción uterina. En el seguimiento se pidieron cultivos de orina como controles. Resultados. 97 mujeres cumplieron con los criterios de inclusión. Escherichia coli se aisló del urocultivo en el 94,8 por ciento de los casos. La vaginosis bacteriana se presentó en el 32,0 por ciento y la infección cervicovaginal en el 57,7 por ciento de las pacientes. En la infección cervicovaginal E. coli se aisló en el 65,2 por ciento. El fracaso en la erradicación de la bacteria de la vía urinaria, se asoció con infección cervicovaginal (76,9 por ciento vs 52,9 por ciento, p< 0.05) y con leucocitos aumentados en la muestra cervical (76,9 por ciento vs 47,1 por ciento, p< 0,01). La contracción uterina se asoció significativamente con: infección cervicovaginal (p < 0,01), vaginosis bacteriana (p < 0,001) y con hallazgo en la muestra cervical de : leucocitos aumentados (p < 0,01), flora polimicrobiana (p < 0,001), aislamiento de E. coli (p < 0.001) y disminución de Lactobacillus sp (p < 0.01). Conclusiones: La infección del tracto genital inferior existente en la pielonefritis aguda del embarazo se relaciona con el fracaso de la terapia antimicrobiana en la erradicación de la bacteria de la vía urinaria y con contracción uterina presente

Asunto(s)

Humanos , Femenino , Embarazo , Adulto , Adolescente , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/microbiología , Pielonefritis/microbiología , Enfermedades del Cuello del Útero/microbiología , Aborto Espontáneo/epidemiología , Cefuroxima/administración & dosificación , Cefradina/administración & dosificación , Contracción Uterina , Trabajo de Parto Prematuro/epidemiología , Pielonefritis/complicaciones , Enfermedades del Cuello del Útero/complicaciones , Vaginosis Bacteriana/microbiología

RESUMEN

Las enfermedades infecciosas inflamatorias del cérvix uterino, vagina y vulva se encuentran entre las patologías con mayor frecuencia en la práctica clínica cotidiana; forman parte de los 12 motivos principales de demanda de consulta en medicina familiar en el Instituto Mexicano del Seguro Social (IMSS). La cérvico-vaginitis de origen infeccioso se asocia con incremento en la frecuencia de parto pretérmino secundario a ruptura prematura de membranas amnióticas durante el embarazo y con enfermedad inflamatoria pélvica crónica, esterilidad de origen tubario y carcinoma cérvico-uterino. Todas estas patologías impactan en forma desfavorable la salud de las mujeres en edad reproductiva y dan lugar a secuelas de alto costo social y económico. En virtud de lo anterior, en el presente trabajo se efectúa la revisión y síntesis de los factores de riesgo, las medidas preventivas y los criterios más aceptados para el diagnóstico y tratamiento de los tipos más frecuentes de cérvico-vaginitis infecciosas, con el fin de contribuir a su difusión y a la utilización de protocolos actualizados y uniformes por parte del personal médico familiar y ginecoobstetra de nuestra institución

Asunto(s)

Humanos , Femenino , Vaginitis/diagnóstico , Vaginitis/microbiología , Vaginitis/tratamiento farmacológico , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/prevención & control , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Cervicitis Uterina/diagnóstico , Cervicitis Uterina/microbiología , Cervicitis Uterina/tratamiento farmacológico , Enfermedades del Cuello del Útero/microbiología

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 Sexuales

RESUMEN

As alteraçöes histopatológicas do colo uterino associadas ao Papillomavírus Humano (HPV) säo bastante prevalentes. Dentre os métodos utilizados para a identificaçäo da infecçäo pelo HPV estäo a Citologia, Histologia e os métodos de Biologia Molecular. Este é um estudo transversal onde o desfecho clínico de interesse é a infecçäo pelo HPV e os fatores em estudo säo os diferentes mótodos diagnósticos, sendo avaliada a concordância entre e Citologia, Histologia e o método de Polimerase Chain Reaction (PCR). Foram analisados exames citológicos e histológicos de 216 mulheres que consultaram no HCPA. Em 25 destas mulheres foi realizado PCR. O exame citológico indicava infecçäo em 37 por cento da amostra, enquanto a Histologia em 91 por cento. A PCR evidenciou DNA viral em todas as amostras estudadas, tendo uma concordância de 100 por cento com o histológico e 20 por cento com o citológico. A concordância entre o citológico e a biópsia foi de 40 por cento. Os resultados permitem estimar a concordância diagnóstica entre tais métodos, o que ainda näo havia sido feito em nosso meio

Asunto(s)

Humanos , Femenino , Enfermedades del Cuello del Útero/diagnóstico , Enfermedades del Cuello del Útero/microbiología , Diagnóstico Diferencial , Papillomaviridae , Reacción en Cadena de la Polimerasa

RESUMEN

Gardnerella vaginalis is a microorganism of great importance because of its participation in some gynecological diseases. Data contained in 3421 cervicovaginal cytology reports obtained from the Profamilia Clinic, Cartagena, Colombia between June 1993 and February 1994 were analyzed retrospectively and analytically. Cells suggestive of Gardnerella vaginalis were found in 723 reports, the greatest proportion being in the 25-29, 30-34, 35-39 year-old age groups (without statistical significance). There is a high frequency of Gardnerella vaginalis as related to healthy cervix and flux. Among the population with Gardnerella vaginalis a low percentage of neoplasia and non-classified atypical cell were found inflammatory reaction was reported in more than half of the cases. In 95% of the reports, Gardnerella vaginalis was the only agent found, the remaining 5% had associated HVP, fungus and trichomonas. Because of the medical staff responsible for taking the samples, cervico-vaginal cytology is an effective method for studying the state of the vagina and cervix.

Asunto(s)

Gardnerella vaginalis/aislamiento & purificación , Enfermedades del Cuello del Útero/microbiología , Vaginosis Bacteriana/microbiología , Adolescente , Adulto , Distribución por Edad , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Colombia/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Enfermedades del Cuello del Útero/epidemiología , Vaginosis Bacteriana/epidemiología

RESUMEN

A partir del conocimiento de la infección subclínica por VPH se han intentado múltiples tratamientos, con diversos resultados. El objetivo de esta comunicación es establecer la utilidad del asa diatérmica como procedimiento de consultorio en el tratamiento de la infección cervical subclínical por VPH. Durante el periodo comprendido de enero de 1992 a dicimebre de 1993, 49 pacientes portadores de infección cervical por VPH fueron tratadas en la Clínica de Colposcopia Privada mediante asa diatérmica. La edad fue entre 20 y 49 años, con una media de 36.1, siendo la mayoría multíparas. Los conos obtenidos fueron satisfactorios para estudio histopatológico y los márgenes de excisión se encontraron libres de infección por VPH. El procedimiento quirúrgico fue bien tolerado en 45 pacientes (91.8 por ciento) y sólo 4 pacientes (8.1 por ciento) se quejaron de molestias moderadas. Cinco pacientes (10.2 por ciento) presentaron sangrado genital tardío y 3 (6.1 por ciento) infección cervical. La base media del cono cervical fue de 1.43 cm, con un rango de 1.0 a 3.0 cm. La tasa de éxito fue de 98 por ciento ya que solo en un caso se confirmó falla en el tratamiento. Se concluye que los resultados a corto plazo son satisfactorios

Asunto(s)

Adulto , Persona de Mediana Edad , Humanos , Femenino , Procedimientos Quirúrgicos Ambulatorios , Procedimientos Quirúrgicos Ambulatorios/instrumentación , Colposcopía/estadística & datos numéricos , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/cirugía , Condiloma Acuminado/terapia , Papillomaviridae/patogenicidad , Procedimientos Quirúrgicos Operativos , Enfermedades del Cuello del Útero/microbiología

RESUMEN

The purpose of this study was to analyze 19 patients infected with Human Papilloma Virus (HPV), in order to determine the most frequent subtype. Subjects were patients of the National Institute of Perinatology (INPer), between 1991-1992. All the patients had positive cytology, cervical biopsy was done through colposcopy control. Sample characteristics were: Mean age 29 years, married; most of them multiparous (9/19) and 7 were monogamous. Six out of 12 cytologies were positive for HPV, 12 out of 19 had an inespecific inflammatory reaction and one patient had NICIII. The histopathologic study showed in 15 cases a positive reaction to HPV, 2 out of 19 had both dysplasia and condyloma, two cases had moderate and severe dysplasia. All the cases were studied with in situ hybridization with biotinilaty probes, two cases were positive to Subtype 18 and one to Subtype 16. Positive cases were selected for electron microscopy in order to confirm viral particles. This study suggests that subtype 18 and 16 positivity must be considered as high risk of cancer.

Asunto(s)

Papillomaviridae/clasificación , Infecciones por Papillomavirus/microbiología , Enfermedad Inflamatoria Pélvica/microbiología , Infecciones Tumorales por Virus/microbiología , Enfermedades del Cuello del Útero/microbiología , Adulto , Citodiagnóstico , Femenino , Humanos , Hibridación in Situ , Infecciones por Papillomavirus/diagnóstico , Paridad , Enfermedad Inflamatoria Pélvica/diagnóstico , Infecciones Tumorales por Virus/diagnóstico , Enfermedades del Cuello del Útero/clasificación