RESUMO

Through an age- and sex-matched case-control study, we sought to determine whether female sex workers have an increased risk of Toxoplasma gondii exposure and to determine the sociodemographic, work, clinical, and behavioral characteristics of these workers associated with T. gondii exposure. Female workers (n = 136) and controls (n = 272) were examined with enzyme-linked immunoassays (EIA) for the presence of anti-Toxoplasma IgG and IgM antibodies. IgM positive sera were additionally tested with enzyme linked-fluorescence immunoassay (ELFA). Anti-T. gondii IgG antibodies were found in 21 (15.44%) of 136 cases and in 10 (3.67%) of 272 controls (OR = 4.05; 95% CI: 1.84-8.89; P = 0.0001). Anti-T. gondii IgG levels higher than 150 IU/ml were found in 13 (9.6%) of 136 cases and in 8 (2.9%) of 272 controls (P = 0.007). Anti-T. gondii IgM antibodies were found in two cases and in six controls by EIA, but all were negative by ELFA. T. gondii seropositivity was associated with being born out of Durango State (OR = 10.47; 95% CI: 2.9-36.8; P < 0.01), injuries during sex work (OR = 6.30; 95% CI: 1.1-33.7; P = 0.03), and soil contact (OR = 4.11; 95% CI: 1.2-14.0; P = 0.02). This is the first report of an association of T. gondii infection and female sex workers.

RESUMO

OBJETIVO: Algunos estudios sugieren la posibilidad de que el proceso fisiológico del embarazo modifique algunas características del hospedero, lo que incrementa el riesgo de infección por VPH; sin embargo, esta asociación no está bien establecida. Pocos estudios se han realizado para determinar la prevalencia de infección por VPH de alto riesgo en mujeres embarazadas, y sus factores relacionados. El presente estudio busca determinar la prevalencia de infección por VPH de alto riesgo, en una muestra de mujeres embarazadas mexicanas, y sus posibles factores de riesgo. MATERIAL Y MÉTODOS: Se realizó un estudio epidemiológico de tipo transversal en una muestra de 274 mujeres embarazadas que acudieron a los servicios de primer nivel de atención del Hospital General del Instituto Mexicano del Seguro Social (IMSS) en Cuernavaca, Morelos, durante el año 2000. Se obtuvieron muestras de exudado vaginal mediante autotoma, y se aplicó un cuestionario estructurado sobre características sociodemográficas, ginecoobstétricas y de comportamiento sexual. La detección de infección por VPH de alto riesgo, se realizó empleando un método de captura de híbridos (Hybrid Capture II, HCII, Digene Corp.). RESULTADOS: La prevalencia de infección por VPH fue de 37.2 por ciento (102/274). En promedio acudieron a su primera cita prenatal al sexto mes de embarazo; la media de edad fue 25.7 años. Los principales factores de riesgo asociados a infección por VPH fueron: edad, entre 20 y 29 años (RM = 2.82; IC95 por ciento 1.02-7.76), 30 o más años (RM ajustada = 6.85; IC95 por ciento 1.22-38.2); compañeros sexuales con otras parejas (RM= 2.05; IC95 por ciento 1.2-3.7). Mostraron asociación positiva, aunque marginalmente significativas: escolaridad menor de 6 años (RM = 1.67; IC95 por ciento 0.67-4.3); más de dos parejas sexuales en su vida (RM = 1.54; IC95 por ciento 0.7-3.4); y tabaquismo actual (RM= 1.6; IC95 por ciento 0.6-5.0). CONCLUSIONES: Los hallazgos indican una mayor prevalencia de infección por VPH de alto riesgo en embarazadas que lo informado en estudios realizados en no embarazadas. Los factores de riesgo relacionados son similares a la población de no embarazadas. Se recomienda el seguimiento de estas mujeres para evaluar la persistencia o regresión de la infección.

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RESUMO

OBJECTIVE: Some studies suggest the possibility that the physiological process of pregnancy modifies certain characteristics of the mother, increasing the risk of both, infection and persistence of infection with HPV. This association, however, has not been firmly established. This study seeks to determine the prevalence of oncogenic HPV infecton in a sample of pregnant Mexican women and its possible risk factors. MATERIAL AND METHODS: A cross-sectional study was conducted using a sample of 274 pregnant women sought first level of care services during the year 2000 at the antenatal clinic of the Mexican Institute of Social Security (IMSS) in Cuernavaca, Morelos, Mexico. Samples of vaginal cells were obtained through self-collected specimens, for the high-risk HPV DNA test using the Hybrid Capture 2 test (HC2). A structured questionnaire was administered regarding sociodemographic, gynecologic, obstetric and sexual behavior characteristics. RESULTS: The mean age was 25.7 years. The average time of pregnancy when the study was conducted was 6 months. The principal risk factors associated with high-risk HPV infection were: ages between 20 and 29 (OR= 2.82; CI 95% 1.02-7.76)), age 30 and over (OR= 6.85,CI 95% 1.22-38.2); partners having sexual relations with other partners (OR= 2.05; CI 95% 1.2-3.7)); schooling less than 6 years (OR= 1.68 CI 95% 0.7-4.3); number of lifetime sexual partners > 2 (OR= 1.54 CI 95% 0.7-3.4); and current smoking (OR= 1.6 CI 95% 0.6-5.0). CONCLUSIONS: Our findings show a higher prevalence of high-risk HPV infection in pregnant women, more than double, that reported in studies of non-pregnant women. The associated risk factors are similar to those of the non-pregnant population. Follow-up in these women is recommended in order to evaluate the persistence or regression of the infection.

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