RESUMEN
OBJECTIVE: To investigate the association between bacterial vaginosis and cervical human papillomavirus (HPV) infection in young and adult women. METHODS: This systematic review and meta-analysis was based on the Prisma methodological guidelines. PubMed and Web of Science were searched using the following descriptors: "bacterial vaginosis and HPV", in June 2019. Articles published from 2012 to 2019 were included. Inclusion criteria were original studies that investigated the association between bacterial vaginosis and cervical HPV infection; articles published in English, Spanish or Portuguese; studies conducted in young and adult, non-pregnant, non-HIV-infected women; studies that used the Nugent criteria for the diagnosis of bacterial vaginosis and studies in which the detection of HPV used the polymerase chain reaction technique. Assembled data, odds ratio (OR) and respective 95% confidence intervals (95%CI) were estimated for the association between bacterial vaginosis and cervical HPV infection using random-effects models. A bilateral value of p < 0.05 was considered statistically significant. RESULT: Six studies were selected for analysis and demonstrated association between bacterial vaginosis and cervical HPV infection (OR = 2.68; 95%CI: 1.64-4.40; p < 0.001). CONCLUSION: Bacterial vaginosis was considered a risk factor for cervical HPV infection, since women with bacterial vaginosis were more likely to be infected with HPV.
Asunto(s)
Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Vaginosis Bacteriana , Adulto , Femenino , Humanos , Vaginosis Bacteriana/epidemiología , Vaginosis Bacteriana/complicaciones , Vaginosis Bacteriana/microbiología , Virus del Papiloma Humano , Brasil , Cuello del Útero/microbiologíaRESUMEN
OBJECTIVE: To assess the risk of spontaneous preterm birth (sPTB) associated with genital mycoplasma infection in asymptomatic women. DESIGN: Prospective cohort. SETTING: Public and private health services in Ribeirão Preto, SP, Brazil. POPULATION: A cohort of 1349 asymptomatic women with a singleton pregnancy at 20-25 weeks of gestation. METHODS: Participants completed a sociodemographic and clinical history questionnaire during the prenatal visit and provided cervicovaginal samples for the evaluation of Mycoplasma hominis (Mh), Ureaplasma spp. and bacterial vaginosis (BV). For gestational outcome, information about the delivery was assessed and sPTB was defined as a birth that occurred before 37 weeks of gestation. The association between variables and the risk of sPTB was evaluated using logistic regression analysis to estimate the odds ratios (ORs). MAIN OUTCOME MEASURES: Genital mycoplasma infection and prematurity. RESULTS: The prevalence of sPTB and genital mycoplasma was 6.8 and 18%, respectively. The infection was not a risk factor for sPTB (aOR 0.66, 95% CI 0.32-1.35), even when Mh and Ureaplasma spp. were found together (P = 0.83). Pregnant women with genital mycoplasma infections had greater BV (P < 0.0001), but this vaginal microbiota condition was not associated with sPTB (P = 0.35). Regarding the risk factors associated with sPTB, a previous history of sPTB (aOR 12.06, 95% CI 6.21-23.43) and a cervical length of ≤2.5 cm (aOR 3.97, 95% CI 1.67-9.47) were significant. CONCLUSIONS: Genital mycoplasma infection was not a risk factor for sPTB, even in the presence of other abnormal vaginal microbiota. TWEETABLE ABSTRACT: Genital mycoplasma infection was not a risk for sPTB, even when associated with bacterial vaginosis (BV).
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Infecciones por Mycoplasma/complicaciones , Complicaciones Infecciosas del Embarazo , Nacimiento Prematuro/epidemiología , Atención Prenatal , Vaginosis Bacteriana/complicaciones , Adulto , Brasil/epidemiología , Estudios de Cohortes , Femenino , Edad Gestacional , Humanos , Mycoplasma hominis/aislamiento & purificación , Embarazo , Resultado del Embarazo , Segundo Trimestre del Embarazo , Nacimiento Prematuro/etiología , Estudios Prospectivos , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
In a vaginal 16S ribosomal RNA gene quantitative PCR study of 17 pelvic inflammatory disease (PID) cases and 17 controls who tested positive for Chlamydia trachomatis, women who additionally tested positive for Atopobium vaginae, Sneathia spp., Megasphaera spp., Eggerthella-like bacterium or Prevotella amnii were more likely to develop PID.
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Antibacterianos/uso terapéutico , Bacterias/efectos de los fármacos , Enfermedad Inflamatoria Pélvica/epidemiología , Reacción en Cadena de la Polimerasa/métodos , Vagina/microbiología , Vaginosis Bacteriana/epidemiología , Actinobacteria , Adulto , Bacterias/aislamiento & purificación , Estudios de Casos y Controles , ADN Bacteriano/genética , ADN Ribosómico/genética , Femenino , Humanos , Prevotella , ARN Ribosómico 16S/genética , Vaginosis Bacteriana/complicacionesRESUMEN
La infección vaginal constituye una de las complicaciones médicas más frecuentes asociadas al embarazo. Se realizó un estudio epidemiológico, observacional, analítico, longitudinal de casos y controles con mujeres embarazadas atendidas en el Policlínico Jimmy Hirzel, Bayamo, Granma, período junio 2016diciembre 2017, con el objetivo de identificar factores de riesgo hipotéticamente relacionados con la aparición de infección vaginal. Los datos se obtuvieron a partir de una encuesta aplicada a las pacientes y su historia clínica, previo consentimiento informado. Se aplicó modelo de riesgo proporcional de Cox para análisis univariado y multivariado, y el Chi cuadrado, con una confiabilidad del 95 por ciento y una probabilidad menor de 0.05. La historia previa de infección de transmisión sexual (OR 2,25), másde tres gestaciones (OR 3,20), los abortos previos (9,88) y el no empleo de preservativos en las relaciones sexuales (OR 5, 35) se constituyeron en los antecedentes gineco-obstétricos relacionados con la aparición de infección vaginal en mujeres embarazadas. El inicio precoz de la vida sexual (OR 2, 25) se constituyó en un factor demográfico y de conducta sexual relacionado con la aparición de infección vaginal en mujeres embarazadas. Haber recibido algún tipo de tratamiento vaginal previo al estudio (OR 1,26), constituyó un factor de riesgo relacionado con los procedimientos externos, aunque no de forma significativa. La presencia de infección de vías urinarias y de diabetes mellitus se constituyeron en factores de riesgo relacionados con la aparición de infección vaginal en mujeres embarazadas(AU)
Vaginal infection is one of the most frequent medical complications associated with pregnancy. An epidemiological, observational, analytical, longitudinal study of cases and controls was carried out with pregnant women attended at the Jimmy Hirzel Polyclinic, Bayamo, Granma, June 2016-December 2017, with the objective of identifying risk factors hypothetically related to the appearance of vaginal infection. The data was obtained from a survey applied to patients and their clinical history, with prior informed consent. Cox proportional risk model was applied for univariate and multivariate analysis, and Chi square, with a 95 percent reliability and a probability lower than 0.05. The previous history of sexually transmitted infection (OR 2.25), more than three pregnancies (OR 3.20), previous abortions (9.88) and the non-use of condoms in sexual relations (OR 5, 35) were constituted in the gynecological-obstetric history related to the appearance of vaginal infection in pregnant women. The early onset of sexual life (OR 2, 25) became a demographic and sexual behavior factor related to the appearance of vaginal infection in pregnant women. Having received some type of vaginal treatment prior to the study (OR 1.26), constituted a risk factor related to external procedures, although not in a significant way. The presence of urinary tract infection and diabetes mellitus constituted risk factors related to the appearance of vaginal infection in pregnant women(EU)
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Humanos , Femenino , Embarazo , Enfermedades Vaginales/prevención & control , Vaginosis Bacteriana/complicaciones , Complicaciones Infecciosas del Embarazo , Factores de Riesgo , Estudios Epidemiológicos , Estudios de Casos y Controles , Estudios LongitudinalesRESUMEN
La etiología que conduce al daño neonatal es multifactorial, y los procesos infecciosos pueden estar implicados en él. El objetivo de este estudio fue identificar microorganismos del tracto genital materno asociados con el daño neonatal, a fin de prevenir futuras complicaciones perinatológicas. Se estudiaron 711 embarazadas que concurrieron entre enero de 2010 y julio 2013 al consultorio externo de Obstetricia del Hospital de Clínicas de la UBA para sus controles prenatales, y cuyos partos también tuvieron lugar en dicho nosocomio. En la sangre del cordón umbilical se investigó la presencia de Ureaplasma urealyticum y Mycoplasma hominis mediante el cultivo con sustratos metabólicos (Micofast-Biomerieux), y la de Trichomonas vaginalis por PCR, con primers específicos. El estudio microbiológico del contenido vaginal se efectuó en 288 de las embarazadas en la semana 35 a 37. Se empleó la metodología convencional, a la que se agregó el cultivo en tioglicolato modificado para T. vaginalis. Se investigó la presencia de estreptococos grupo B (EGB) en hisopado anorrectaly de introito vaginal, utilizando enriquecimiento en caldo selectivo y posterior siembra en medio cromogénico. Se utilizaron los test de χ² Yates y de Fisher para muestras independientes, considerándose significativo p < 0,05. La vaginosis bacteriana (VB) se relacionó significativamente con el daño neonatal (p = 0,02), al igual que la presencia de M. hominis (p = 0,03) y de T. vaginalis (p = 0,03) en la sangre del cordón umbilical. Las complicaciones predominantes fueron el parto pretérmino, la rotura prematura de membrana (RPM), el bajo peso y un valor de Apgar <7. No se asoció al daño neonatal la presencia de U. urealyticum (p = 0,35) en el cordón umbilical, ni la de Candidaspp. (p = 0,94) o EGB (p = 0,18) en el tracto genital de las madres. Dado que ciertas alteraciones en la microbiota del tracto genital materno se relacionaron con el dano neonatal, consideramos de fundamental importancia realizar el estudio microbiológico del contenido vaginal durante el embarazo, para prevenir posibles complicaciones maternas y perinatológicas.
The etiology leading to neonatal damage is multifactorial, being genital infections one of the causes. The objective of the study was to identify microorganisms of the maternal genital tract that are associated with neonatal damage, in order to prevent future perinatal complications. Seven hundred and eleven pregnant patients attended their prenatal control during the period January 2010-July 2013. Ureaplasma urealyticum and Mycoplasma hominis presence was investigated in umbilical cord blood by metabolic substrates (Micofast-Biomerieux) and that of T. vaginalis, by PCR using specific primers. The microbiological study of the vaginal contents of 288 pregnant patients at weeks 35 to 37 was performed by conventional methods, adding the modified thioglycolate culture for T. vaginalis. Group B streptococcus (GBS) was investigated in anorectal and vaginal introitus swabs, using selective broth enrichment and subsequent isolation in chromogenic medium. The χ² Yates test and Fisher's test were used for independent samples. A p value <0.05 was considered statistically significant. The pathogens significantly related to neonatal damage were M. hominis (p = 0.03), T. vaginalis (p = 0.03), and BV (p = 0.02). Main complications were preterm birth, premature rupture of membranes (PRM), low weight and Apgar score <7. U. urealyticum (p = 0.35), Candidaspp. (p = 0.94) and GBS (p = 0.18) were not related to neonatal damage. Since different microorganisms of the maternal genital tract were related to neonatal damage, it is very important to perform the microbiological study of vaginal contents during pregnancy to prevent possible maternal and perinatal complications.
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Humanos , Femenino , Embarazo , Cordón Umbilical/microbiología , Vaginosis Bacteriana/microbiología , Sangre Fetal/microbiología , Técnicas Microbiológicas/métodos , Vaginosis Bacteriana/complicaciones , Enfermedades del Recién Nacido/prevención & controlRESUMEN
OBJECTIVE: The aim of this study was to review the available literature to explore evidence indicating an association between cervical ectopy and sexually transmitted diseases, which could help in the decision to treat or not to treat this condition. METHODS: A review of the literature was conducted using the PubMed, EMBASE and clinicaltrials.gov databases on ectopy of the cervix using the terms "ectopy OR ectropium AND cervix" filtered only by language, without limit of date. A total of 71 studies were found in the initial selection, of which 56 were deleted by title, abstract, or full text. The remaining 15 articles were analyzed in this study. RESULTS: Cervical ectopy showed a positive association with human papillomavirus, human immunodeficiency virus, bacterial vaginosis, cervical epithelial atypia, postcoital bleeding, and desquamative inflammatory vaginitis. High-quality studies reported no association between ectopy and chlamydia infection. It was also not associated with gonococcal infection and herpes simplex. CONCLUSIONS: Cervical ectopy shows a probable association with increased acquisition of some sexually transmitted diseases. Additional studies are required to confirm the possible beneficial effects of treatment and to evaluate the possible complications of these treatments.
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Infecciones por Chlamydia/complicaciones , Infecciones por VIH/complicaciones , Enfermedades de Transmisión Sexual/complicaciones , Anomalías Urogenitales/etiología , Enfermedades del Cuello del Útero/etiología , Útero/anomalías , Vaginosis Bacteriana/complicaciones , Femenino , HumanosRESUMEN
BACKGROUND AND OBJECTIVE: Cervical cancer is an important health problem in our country. It is known that there are several risk factors for this neoplasm, and it has been suggested that cervical microbiome alterations could play a role in the development and progress of cancer. Bacterial vaginosis associated bacteria such as Atopobium vaginae and Gardnerella vaginalis has been suggested as potential risk factor for cervical lesions and cervical cancer. MATERIAL AND METHODS: DNA from 177 cervical scraping samples was studied: 104 belonged to women without cytological or colposcopic alterations and 73 samples from precursor lesions with previous human papillomavirus (HPV) infection history. All samples were screened for Atopobium vaginae, Gardnerella vaginalis and HPV by PCR. RESULTS: High HPV prevalence was found in precursor samples, and 30% of samples without lesions were positive for HPV. Virtually all samples contained sequences of both bacteria, and interestingly, there was not HPV association observed; these results could suggest that these microorganisms could be part of the cervical microbiome in Mexican population. CONCLUSIONS: The results obtained indicate that the bacteria analysed could be part of normal biome in Mexican women, suggesting a potential reconsideration of the pathogen role of these microorganisms.
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Actinobacteria/aislamiento & purificación , Gardnerella vaginalis/aislamiento & purificación , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/complicaciones , Neoplasias del Cuello Uterino/microbiología , Vaginosis Bacteriana/complicaciones , Actinobacteria/genética , Coinfección/microbiología , Coinfección/virología , ADN Bacteriano/aislamiento & purificación , ADN Viral/aislamiento & purificación , Femenino , Gardnerella vaginalis/genética , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Ciclo Menstrual , México , Microbiota , Papillomaviridae/genética , Infecciones por Papillomavirus/virología , Lesiones Precancerosas/complicaciones , Lesiones Precancerosas/microbiología , Factores de Riesgo , Neoplasias del Cuello Uterino/virología , Vaginosis Bacteriana/microbiologíaRESUMEN
To access the possibility that key markers of bacterial vaginosis (KM-BV) could affect seminal parameters and thus fertility a prospective cohort study was designed (a) to develop rapid and sensitive multiplex polymerase chain reaction (M-PCR) assays to screen 13 key markers of bacterial vaginosis (KM-BV) in semen specimens, (b) to determine the prevalence of KM-BV in semen from randomized male partners of couples seeking fertility evaluation. A total of 229 semen samples were included in the study from males who visited the Sperm Analysis Section of Brazil between October 2015 and March 2016. Eligible men were 18 years or older and had a semen analysis due fertility evaluation (after failing to conceive with their partner after 1 year of unprotected intercourse). Basic seminal parameters were analyzed, and KM-BV was detected by M-PCR assays. M-PCR assays clearly distinguished 13 KM-BV in 146 semen samples (63.8%), mainly Gardnerella vaginalis (50.7%). Some important associations occurred between the presence of KM-BV in semen and changes in seminal parameters. KM-BV is commonly present in the semen of males seeking fertility evaluation and could potentially play significant roles in male subfertility and/or infertility.
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Biomarcadores/análisis , Infertilidad Masculina/etiología , Análisis de Semen , Parejas Sexuales , Vaginosis Bacteriana/complicaciones , Adolescente , Adulto , Brasil , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa/métodos , Estudios Prospectivos , Factores de RiesgoRESUMEN
Fundamento: las infecciones de trasmisión sexual constituyen un problema de salud en todo el mundo, sin embargo en la provincia se carece de información sobre bases científicas de los resultados de la aplicación de la estrategia para la atención del síndrome de flujo vaginal en la Atención Primaria de Salud. Objetivo: describir los resultados de la aplicación de la estrategia para la atención del síndrome de flujo vaginal a partir de la información aportada por especialistas de 16 consultorios médicos de familia en tres municipios espirituanos. Metodología: se realizó investigación descriptiva, transversal que incluyó los 16 especialistas de Medicina General Integral de igual número de consultorios tipo 1 de municipios priorizados para las infecciones de trasmisión sexual, a quienes se le aplicó una encuesta, los resultados se presentaron en tablas utilizando frecuencias absolutas y relativas. Resultados: más de la mitad de las gestantes atendidas padecían el síndrome de flujo vaginal y a todas le estudiaron sus parejas sexuales, los médicos conocen la existencia del flujograma; en Sancti Spíritus y Fomento los facultativos dominan mejor el contenido del stock de medicamentos para su tratamiento; carecen de información sobre la entrega gratuita del módulo de medicamentos destinado a esta problemática y la totalidad conoce la conducta a seguir ante una gestante con flujo vaginal. Conclusiones: la estrategia para el manejo del síndrome de flujo vaginal en gestantes no es aplicada adecuadamente en los municipios estudiados, por el desconocimiento de la disponibilidad de medicamentos eficaces y gratuitos en el área de salud para el tratamiento de la gestante y su pareja.
Background: sexually transmitted infections are a health problem worldwide, but in the province there is a lack of information on scientific basis of the results of the implementation of the strategy for the care of vaginal discharge syndrome in Primary Health Care. Objective: to describe the results of the implementation of the strategy for the care of vaginal discharge from the information provided by specialists from 16 family doctor offices in three municipalities of Sancti Spíritus. Methodology: descriptive, cross investigation was used that included 16 specialists in Comprehensive General Medicine with equal number of Type 1 doctor offices of prioritized municipalities for sexually transmitted infections, to whom a survey was applied, the results were presented in tables using absolute and relative frequencies. Results: more than half of the cared pregnant women suffered vaginal discharge syndrome and their sexual partners were studied as well, doctors are aware of the flowchart; physicians dominate the content of the stock of medicines for treatment better in Sancti Spiritus and Fomento; they are lack of information about the free drug delivery module devoted to this condition and all of them know the medical procedures to follow in the presence of a woman with vaginal discharge. Conclusions: the strategy for the management of vaginal discharge syndrome in pregnant women is not properly implemented in the municipalities studied, due to the lack of availability of effective and free drugs in the healthcare area for the treatment of pregnant women and their partners.
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Humanos , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Vaginosis Bacteriana/epidemiología , Vaginosis Bacteriana/transmisión , Vaginosis Bacteriana/complicacionesRESUMEN
BACKGROUND: Bacterial vaginosis (BV) increases the risk of spontaneous preterm deliveries (PD) in developed countries. Its prevalence varies with ethnicity, socioeconomic conditions and gestational age. Aerobic vaginitis (AV) has also been implicated with spontaneous PD. The present study aimed to estimate the prevalence of asymptomatic BV, the accuracy of vaginal pH level to predict BV and to estimate the risk of spontaneous PD <34 and <37 weeks' gestation of BV and AV. METHODS: Women attending prenatal public services in Rio de Janeiro were screened to select asymptomatic pregnant women, < 20 weeks' gestation, with no indication for elective PD and without risk factors of spontaneous PD. Vaginal smears of women with vaginal pH > = 4.5 were collected to determine the Nugent score; a sample of those smears was also classified according to a modified Donders' score. Primary outcomes were spontaneous PD < 34 and <37 weeks' gestation and abortion. RESULTS: Prevalence of asymptomatic BV was estimated in 28.1% (n = 1699); 42.4% of the smears were collected before 14 weeks' gestation. After an 8-week follow up, nearly 40% of the initially BV positive women became BV negative. The prevalence of BV among white and black women was 28.1% (95% CI: 24.6%-32.0%) and 32.5% (95% CI: 28.2%-37.2%), respectively. The sensitivity of vaginal pH= > 4.5 and = > 5.0 to predict BV status was 100% and 82%, correspondingly; the 5.0 cutoff value doubled the specificity, from 41% to 84%. The incidence of < 37 weeks' spontaneous PDs among BV pregnant women with a pH= > 4.5 was 3.8%. The RR of spontaneous PD < 34 and <37 weeks among BV women with pH > =4.5, as compared with those with intermediate state, were 1.24 and 1.86, respectively (Fisher's exact test, p value = 1; 0.52, respectively, both ns). No spontaneous case of PD or abortion was associated with severe or moderate AV. CONCLUSIONS: A high prevalence of asymptomatic BV was observed without statistically significant difference between black and white women. The RRs of spontaneous PD < 34 and <37 weeks among women with BV, as compared with those with intermediate state were not statistically significant but were consistent with those found in the literature.
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Etnicidad , Complicaciones Infecciosas del Embarazo/etnología , Nacimiento Prematuro/etnología , Vagina/metabolismo , Vaginitis/etnología , Vaginosis Bacteriana/etnología , Adulto , Bacterias Aerobias/aislamiento & purificación , Brasil/epidemiología , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/economía , Resultado del Embarazo , Nacimiento Prematuro/etiología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Factores Socioeconómicos , América del Sur/etnología , Factores de Tiempo , Vagina/microbiología , Frotis Vaginal , Vaginitis/complicaciones , Vaginitis/diagnóstico , Vaginosis Bacteriana/complicaciones , Vaginosis Bacteriana/diagnósticoRESUMEN
BACKGROUND: We evaluated the importance of measuring early vaginal levels of eight bacterial vaginosis (BV)-associated bacteria, at two points in pregnancy, and the risk of spontaneous preterm delivery (SPTD) among pregnant women and the subgroup of pregnant women with a history of preterm delivery (PTD). METHODS: This prospective cohort study enrolled women at five urban obstetric practices at Temple University Hospital in Philadelphia PA. Women with singleton pregnancies less than 16 weeks gestation self-collected vaginal swabs at two points in pregnancy, prior to 16 weeks gestation and between 20-24 weeks gestation, to measure the presence and level of eight BV-associated bacteria. Women were followed-up for gestational age at delivery via medical records. RESULTS: Among women reporting a prior PTD, women with higher levels of Leptotrichia/Sneathia species, BVAB1 and Mobiluncus spp., prior to 16 weeks gestation, were significantly more likely to experience a SPTD. In addition, pregnant women with a prior PTD and increasing levels of Leptotrichia/Sneathia species (aOR: 9.1, 95% CI 1.9, 42.9), BVAB1 (aOR: 16.4, 95% CI 4.3, 62.7) or Megasphaera phylotype 1 (aOR: 6.2, 95% CI 1.9, 20.6), through 24 weeks gestation, were significantly more likely to experience an SPTD. Among the overall group of pregnant women, the levels of BV-associated bacteria were not related to SPTD. CONCLUSION: Among the group of women reporting a prior PTD, increasing levels of BVAB1, Leptotrichia/Sneathia species, and Megasphaera phylotype 1, through mid-pregnancy were related to an increased risk of SPTD.
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Leptotrichia/aislamiento & purificación , Mobiluncus/aislamiento & purificación , Trabajo de Parto Prematuro/microbiología , Vagina/microbiología , Vaginosis Bacteriana/microbiología , Adulto , Técnicas de Tipificación Bacteriana , Recuento de Colonia Microbiana , ADN Bacteriano , ADN Ribosómico , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Trabajo de Parto Prematuro/etiología , Trabajo de Parto Prematuro/prevención & control , Philadelphia , Valor Predictivo de las Pruebas , Embarazo , Nacimiento Prematuro , Estudios Prospectivos , Factores de Riesgo , Vaginosis Bacteriana/complicaciones , Vaginosis Bacteriana/prevención & controlRESUMEN
Introducción: el flujo vaginal es uno de los motivos más frecuentes de consulta en un servicio de Ginecología y la vaginosis bacteriana, una de sus principales causas. Objetivo: caracterizar la vaginosis bacteriana en mujeres haitianas. Métodos: se realizó un estudio epidemiológico, observacional, descriptivo y transversal en el Hospital Fort Michelle, Haití, durante el primer semestre de 2009 en un universo de 230 mujeres mayores de 20 años con flujo vaginal, del cual se seleccionó una muestra de 65 pacientes que resultaron positivas de la enfermedad, aplicados los criterios de inclusión y exclusión. Resultados: el 41,7por ciento del universo de estudio fue positivo de infección. Los factores de riesgo más frecuentes fueron promiscuidad, inicio precoz de las relaciones sexuales, no uso del preservativo y soltería. En cuanto a la etiología de la infección vaginal, predominó la vaginosis bacteriana (67,7 por ciento), el 46,1por ciento de las pacientes tenía entre 20 y 30 años, el 69,2 por ciento no tenía estabilidad conyugal, el 81,5 por ciento inició las relaciones sexuales antes de los 21 años, el 53,8 por ciento no utilizaba ningún tipo de protección, el 61,5 por ciento refirió promiscuidad y el 84,6 por ciento algún tipo de antecedente ginecológico, con predominio de la inflamación pélvica crónica (30,8 por ciento). El 46,2 por ciento refirió varios síntomas, con predominio de la colporrea como síntoma aislado (24,6 por ciento). Conclusiones: se detectó una alta incidencia de vaginosis bacteriana entre las pacientes con infección vaginal y predominio de factores de riesgo conocidos(AU)
Introduction: vaginal discharge is one of the most frequent reasons for consultation in a Gynecology and bacterial vaginosis isone of its main causes. Objective: to characterize the bacterial vaginosis in Haitian women. Methods: an epidemiological, observational, descriptive and transversal study was conducted at Fort Michelle Hospital inHaiti, from the first half of 2009. The universe of this study was 230 women older than 20 years with vaginal discharge. We selected a sample of 65 patients that were positive for the disease after it was applied the inclusion and exclusion criteria. Results: 41.7 percent of this study universe was positive of infection. The most common risk factors were promiscuity, early onset of sexual intercourse, none condom use and singleness. Regarding the etiology of vaginal infection, bacterial vaginosis prevailed (67.7 percent), 46.1 percent of the patients aged 20-30 years, 69.2 percent had no marital stability, 81.5 percent had their first sexual intercourse earlier than age 21, 53.8 percent did not use any protection, 61.5percent reported promiscuity, and 84.6 percent had some form of gynecological history, with a predominance of chronic pelvic inflammation (30.8 percent). 46.2 percent reported various symptoms, mostly colporrhagia as an isolated symptom (24.6 percent). Conclusions: there was a high incidence of bacterial vaginosis among patients with vaginal infection and prevalence of known risk factors(AU)
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Humanos , Femenino , Vaginosis Bacteriana/complicaciones , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/etnología , Estudios Epidemiológicos , Estudio Observacional , Epidemiología Descriptiva , Estudios Transversales/métodosRESUMEN
BACKGROUND: pharmaceutical forms (presentations) influence treatment compliance and therefore the effectiveness. Here we present the results in the relief of vaginitis and vaginosis with two different dosage forms. OBJECTIVE: To compare the efficacy and safety of a combination of ketoconazole 800 mg + clindamycin in soft vaginal gel capsules 100 mg (vaginal capsules) against ketoconazole 800 mg + 100 mg clindamycin vaginal tablets (TV) in the management of vaginitis by C. albicans and/or vaginosis. MATERIAL AND METHOD: In a randomized, multicenter, comparative open label study, patients between 18 and 60 years with a diagnosis of vaginitis by C. albicans and/or vaginosis were included. Patients were evaluated clinically and direct exam of genital discharge and culture were performed. Patients were randomized to one of two treatments vaginal tablets or vaginal capsules, for 3 days. RESULTS: one hundred an sitxty nine patients were included, 85 in TV Group and 84 in vaginal capsules group. We found significant statistical difference in clinical response for tablet group at day three for burning p = 0.032 and itching p = 0.043. Microbiological cure was observed in patients with vaginitis by C. albicans, 92.5% in Group TV vs. 90.47% vaginal capsules group, all patients with G. vaginalis at baseline were negative for the organism at the end of the study, cure in patients with mixed infections were 78.94% for TV group vs. 78.26% vaginal capsules; group no adverse events were reported during treatment. CONCLUSIONS: Treatment of vaginitis/vaginosis with vaginal tablets is clinically better than vaginal soft gelatin capsules both treatments were well tolerated.
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Infecciones por Actinomycetales/tratamiento farmacológico , Candidiasis Vulvovaginal/tratamiento farmacológico , Clindamicina/uso terapéutico , Gardnerella vaginalis , Cetoconazol/uso terapéutico , Mobiluncus , Vaginosis Bacteriana/tratamiento farmacológico , Infecciones por Actinomycetales/complicaciones , Infecciones por Actinomycetales/microbiología , Administración Intravaginal , Adolescente , Adulto , Candida albicans/efectos de los fármacos , Candida albicans/aislamiento & purificación , Candidiasis Vulvovaginal/complicaciones , Candidiasis Vulvovaginal/microbiología , Cápsulas , Clindamicina/administración & dosificación , Quimioterapia Combinada , Femenino , Gardnerella vaginalis/efectos de los fármacos , Gardnerella vaginalis/aislamiento & purificación , Humanos , Cetoconazol/administración & dosificación , Persona de Mediana Edad , Mobiluncus/efectos de los fármacos , Mobiluncus/aislamiento & purificación , Aceptación de la Atención de Salud , Comprimidos , Vaginosis Bacteriana/complicaciones , Vaginosis Bacteriana/microbiología , Adulto JovenRESUMEN
A prematuridade tem um grande impacto no resultado neonatal, sendo responsável por um alto índice de morbimortalidade neonatal e agregando vários fatores em sua etiologia; dentre estes, a infecção geniturinária ocupa um papel de destaque e a vaginose bacteriana é sua principal representante. Após levantamento dos mais recentes estudos acerca da relação entre a prematuridade e a vaginose bacteriana, constou uma discrepância nos resultados, principalmente quanto à recomendação de seu rastreamento em gestantes de baixo risco para prematuridade, sendo que alguns autores recomendam e outros contraindicam sua realização. Características metodológicas podem justificar a falta de unanimidade na literatura especialmente quanto à idade gestacional ideal para o rastreamento, sendo que os melhores resultados obtidos com rastreamento precoce, entre 16 e 20 semanas de gestação. Quanto à droga de escolha para o tratamento, muitos utilizam o metronidazol, porém esta droga é ineficaz na redução da prematuridade e, por isso, alguns autores recomendam a clindamicina e os macrolídeos. Devido à importância do impacto da prematuridade na morbimortalidade neonatal, permanece a recomendação de que mais estudos sejam realizados
Prematurity has a major impact on neonatal outcome, accounting for a high rate of morbidity and mortality. Several factors are involved in the etiology of prematurity. Among these factors, genitourinary infection plays a key role. One of the main causes of genitourinary infections is bacterial vaginosis. A survey of recent studies about the relationship between bacterial vaginosis and prematurity was carried out. Results were conflicting, mainly with regard to screening low-risk pregnant women for prematurity. Some authors advise screening whereas others contraindicate it. Differences in methodological approach may account for the lack of consensus in literature, particularly concerning the ideal gestational age for tracking. The best results were achieved with early screening, between 16 and 20 weeks of gestation. Regarding drug of choice, many professionals opt for metronidazole, although this drug is ineffective in the reduction of prematurity, which explains the choice of some authors for clindamycin and macrolides. Due to the major impact of prematurity on neonatal mortality, more studies should be carried out
Asunto(s)
Femenino , Embarazo , Metronidazol/uso terapéutico , Complicaciones Infecciosas del Embarazo , Atención Prenatal , Tamizaje Masivo , Trabajo de Parto Prematuro/etiología , Trabajo de Parto Prematuro/microbiología , Vaginosis Bacteriana/complicaciones , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/tratamiento farmacológico , Mortalidad Infantil , Estudios ProspectivosRESUMEN
OBJECTIVE: To compare the levels of interleukin (IL)-1beta, IL-6, and matrix metalloproteinase (MMP)-8 in the vaginal secretions of pregnant women with a positive fetal fibronectin (fFN) test result with or without asymptomatic bacterial vaginosis (BV) before and after treatment with oral clindamycin. METHODS: A prospective cohort study was conducted among 43 pregnant women with a positive fFN test result. All patients were treated with clindamycin, and the pre- and post-treatment levels of IL-1beta, IL-6, and MMP-8 were compared. RESULTS: Before treatment, levels of IL-1beta and MMP-8 were significantly higher in women with BV compared with women without BV (P<0.05). Vaginal levels of IL-1beta and IL-6, but not MMP-8, decreased after treatment in pregnant women with BV. CONCLUSIONS: The inability of clindamycin to decrease MMP-8 vaginal levels may explain why it is ineffective in reducing preterm birth in pregnant women with positive fFN and BV.
Asunto(s)
Antibacterianos/farmacología , Clindamicina/farmacología , Metaloproteinasa 8 de la Matriz/efectos de los fármacos , Vaginosis Bacteriana/tratamiento farmacológico , Adulto , Antibacterianos/uso terapéutico , Clindamicina/uso terapéutico , Estudios de Cohortes , Femenino , Fibronectinas/análisis , Humanos , Inflamación/tratamiento farmacológico , Inflamación/etiología , Inflamación/metabolismo , Interleucina-1beta/efectos de los fármacos , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Metaloproteinasa 8 de la Matriz/metabolismo , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/fisiopatología , Nacimiento Prematuro/etiología , Nacimiento Prematuro/prevención & control , Estudios Prospectivos , Vagina/metabolismo , Vagina/microbiología , Vaginosis Bacteriana/complicaciones , Vaginosis Bacteriana/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: There is an association between periodontal diseases and preterm delivery. AIM: To assess the relationship between periodontal diseases, ascending bacterial infection and placental pathology with preterm delivery. PATIENTS AND METHODS: A periodontal examination and collection of amniotic fluid and subgingival plaque samples were performed in women with preterm labor with intact membranes, without an evident clinical cause or preterm premature rupture of membranes, without clinical chorioamnionitis or labor and a gestational age between 24 and 34 weeks. Microbial invasion of the amniotic cavity was defined as the presence of a positive amniotic fluid culture. Cervicovaginal infection was defined as a bacterial vaginosis or positive culture of cervix or vagina with a high neutrophil count. Ascending bacterial infection was diagnosed as the microbial invasion of the amniotic cavity by ascending bacteria or cervicovaginal infection. Corioamnionitis, funisitis or vellositis were diagnosed. RESULTS: Fifty-nine women were included: forty-two with preterm labor with intact membranes and seventeen with preterm premature rupture of membranes. The prevalence of periodontal diseases was 93.2%. Microbial invasion of the amniotic fluid was detected in 27.1% of patients. periodontal pathogenic bacteria were isolated in 18.6% of amniotic fluid samples and 71.2% of subgingival plaque samples. The prevalence of ascending bacterial infection was 83.1% and in 72.9% of women it was associated with periodontal disease. Preterm delivery (<37 weeks) occurred in 64.4% of patients and was significantly associated with generalized periodontal disease and with the association of ascending bacterial infection and periodontal diseases. Patients with preterm delivery and generalized periodontal disease had a higher frequency of chorioamnionitis and funisitis. CONCLUSIONS: Generalized periodontal disease and its association with ascending bacterial infection are related to preterm delivery and placental markers of bacterial ascending infection.
Asunto(s)
Corioamnionitis/etiología , Enfermedades Periodontales/complicaciones , Nacimiento Prematuro/etiología , Vaginosis Bacteriana/complicaciones , Adolescente , Adulto , Chile , Corioamnionitis/microbiología , Placa Dental/microbiología , Métodos Epidemiológicos , Femenino , Humanos , Placenta/microbiología , Embarazo , Vaginosis Bacteriana/microbiología , Adulto JovenRESUMEN
Background: There is an association between periodontal diseases and preterm delivery. Aim: To assess the relationship between periodontal diseases, ascending bacterial infection and placental pathology with preterm delivery. Patients and methods: A periodontal examination and collection of amniotic fluid and subgingival plaque samples were performed in women with preterm labor with intact membranes, without an evident clinical cause or preterm premature rupture of membranes, without clinical chorioamnionitis or labor and a gestational age between 24 and 34 weeks. Microbial invasion of the amniotic cavity was defined as the presence of a positive amniotic fluid culture. Cervicovaginal infection was defined as a bacterial vaginosis or positive culture of cervix or vagina with a high neutrophil count. Ascending bacterial infection was diagnosed as the microbial invasion of the amniotic cavity by ascending bacteria or cervicovaginal infection. Corioamnionitis, funisitis or vellositis were diagnosed. Results: Fifty-nine women were included: fortytwowith preterm labor with intact membranes and seventeen with preterm premature rupture of membranes. The prevalence of periodontal diseases was 93.2%. Microbial invasion of the amniotic fluid was detected in 27.1% of patients. Periodontal pathogenic bacteria were isolated in 18.6% of amniotic fluid samples and 71.2% of subgingival plaque samples. The prevalence of ascending bacterial infection was 83.1% and in 72.9% of women it was associated with periodontal disease. Preterm delivery (<37 weeks) occurred in 64.4% of patients and was significantly associated with generalized periodontal disease and with the association of ascending bacterial infection and periodontal diseases. Patients with preterm delivery and generalized periodontal disease had a higher frequency of chorioamnionitis and funisitis...
Asunto(s)
Adolescente , Adulto , Femenino , Humanos , Embarazo , Adulto Joven , Corioamnionitis/etiología , Enfermedades Periodontales/complicaciones , Nacimiento Prematuro/etiología , Vaginosis Bacteriana/complicaciones , Chile , Corioamnionitis/microbiología , Placa Dental/microbiología , Métodos Epidemiológicos , Placenta/microbiología , Vaginosis Bacteriana/microbiología , Adulto JovenRESUMEN
The objective of the present study was to assess infections and cytologic abnormalities in cervicovaginal smears from 153 HIV-positive women and 169 HIV-negative followed up at the UFTM School of Medicine between May 1999 and May 2002. The medical records and cervicovaginal smears were reviewed and the HIV-positive group was classified according to CD4 cell count, HIV viral load, antiretroviral therapy and HIV subgroups (with or without disease; with or without therapy) and compared to HIV-negative group. We conclude that the frequency of Candida sp, Trichomonas vaginalis and bacterial vaginosis in cervicovaginal smear, is not different between HIV-positive and HIV-negative women, even if the HIV-group is subdivided according to CD4 cell count, HIV viral load, antiretroviral therapy and HIV subgroups. The frequency of LSIL, in cervicovaginal smears, was greater in the HIV-group (17.6%) than in the HIV-negative (4.1%); there was no difference between the two groups according to frequency of HSIL (4.6% versus 1.8%), ASCUS/AGUS (7.8% versus 3.5%) and invasive carcinoma (1.3% versus 0.6%). The frequency of LSIL was greater in the HIV positive group with CD4 cell count < 350 cells/mm(3). The viral load, therapeutic regimen and HIV subgroups (HIV-positive without therapy, HIV-positive with therapy, AIDS by immunological criteria and AIDS by clinical criteria) have not shown relationship with LSIL frequency, until now.
Asunto(s)
Carcinoma de Células Escamosas/patología , Infecciones por VIH/patología , Neoplasias del Cuello Uterino/patología , Vaginosis Bacteriana/patología , Adulto , Animales , Recuento de Linfocito CD4 , Candida/aislamiento & purificación , Carcinoma de Células Escamosas/complicaciones , Chlamydia/aislamiento & purificación , Femenino , Gardnerella vaginalis/aislamiento & purificación , Infecciones por VIH/complicaciones , Infecciones por VIH/microbiología , Humanos , Trichomonas vaginalis/aislamiento & purificación , Neoplasias del Cuello Uterino/clasificación , Frotis Vaginal , Vaginosis Bacteriana/complicaciones , Vaginosis Bacteriana/microbiología , Carga ViralRESUMEN
Se realizó un estudio descriptivo retrospectivo, con el objetivo de identificar la repercusión de las infecciones del sistema reproductivo en la mujer en el trienio 2002-2004 del Consejo Popular #1, municipio Media Luna-Granma, donde se estudiaron 174 casos de mujeres sexualmente activas comprendidas en las edades de 15-54 años. Las infecciones del tracto genital y sus complicaciones se observaron con mayor frecuencia en el grupo comprendido de 25-34 años, con conducta sexual inestable y los gérmenes más frecuentes fueron las cándidas (54,9 por ciento) y los productores de vaginosis (16,3 por ciento). Los factores contribuyentes fueron la presencia de dispositivos intrauterinos y el poco uso del condón. Observándose que la complicación que prevaleció fue el dolor pélvico crónico (85,2 por ciento). Tanto las infecciones como las complicaciones, repercutieron negativamente en los aspectos social y económico(AU)
It was performed a descriptive, retrospective research with the objective to identify the repercussion of the reproductive system infections in women during the period 2002-2004 in the population council number 1, Media Luna, Granma.There were studied 174 cases of women sexually actives, since 15-54 years. The infections of genital tract and their complications were observed mainly in the group of 25-34 years with unstable sexual behaviour and the most frequents germs were Candida (54,9 percent) and the producers for vaginosis (16,3 percent). The principal factors were the presence of intrauterine device and the limited use of condoms. The prevailing complication was the chronic pelvic pain (85,2 percent). Both infections and complication affected negatively in the social and economic aspects(EU)
Asunto(s)
Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Enfermedad Inflamatoria Pélvica/diagnóstico , Enfermedad Inflamatoria Pélvica/etiología , Vaginosis Bacteriana/complicaciones , Dispositivos Intrauterinos/efectos adversos , Epidemiología Descriptiva , Estudios RetrospectivosRESUMEN
Even though vulvovaginal candidiasis and bacterial vaginosis are seldom simultaneously found, we have detected this association at an above average frequency. Thus, we set out to study the activity of proteinases and phospholipases, virulence factors of Candida albicans, to assess their role in the above mentioned association. Of a total of 70 Candida isolates were retrieved from samples of vaginal secretions analyzed at our Diagnostic Service, 65 were identified as C. albicans (a group of n=26 obtained from clinical samples of pH>4.5 and a group of n=39 from clinical samples of pH=or<4.5). The evaluation of phospholipases activity was performed on malt agar and Sabouraud dextrose agar with the addition of egg yolk as substrate. The proteolytic activity was detected on plates of agar base medium with the addition of bovine albumin serum as substrate as sole nitrogen source. Phospholipases activity was essentially the same in both groups of samples (p=0.2003). Proteolytic activity was detected in 61.5% of the isolates from the group with pH=or<4.5 and in 96.2% in the group with pH>4.5; being the former much higher than the latter (p=0.0001). Based on these results we postulate that the simultaneous occurrence of bacterial vaginosis and vulvovaginal candidiasis could be related to the proteolytic activity but unrelated to phospholipases activity.