RESUMO
GOAL OF THIS STUDY: To determine the prevalence of Chlamydia trachomatis urogenital infection and to identify behavioral, demographic, and clinical factors associated with the infection in pregnant women in Martinique. STUDY DESIGN: One-thousand-four-hundred-eleven patients 15-39 years old, at 10-16 weeks of gestation and attending the prenatal clinic at Lamentin Hospital, were tested for Chlamydia trachomatis infection of the cervix and urethra using tissue culture. RESULTS: Chlamydia trachomatis was isolated from 375 (26.7%) women; 34% of them were positive in the cervix and urethra, 58% in the cervix only, and 8% in the urethra only. Factors found by multivariate analysis to be significantly associated with chlamydial infection were age less than 25 years, first intercourse at less than 18 years old, previous induced abortions, mucopurulent cervicitis, and repeated candidiasis. CONCLUSIONS: None of the factors associated with chlamydial infection was sensitive enough to permit efficient selective screening. It is cost effective to recommend a routine screening for chlamydial infection together with an educational program.
PIP: To determine the prevalence of Chlamydia trachomatis urogenital infection among pregnant women in Martinique, 1411 consecutive women presenting to Lamentin Hospital for their initial prenatal visit between 1988-90 underwent specimen collection and extensive interviews. The mean age of study subjects was 27.1 years and the mean number of life-time sex partners was 3.2. C. trachomatis was isolated from 375 women (26.7%), two-thirds of whom were asymptomatic. There was an inverse correlation between age and infection rate; 164 (43.7%) infected women were under 25 years of age. 34% had evidence of infection in both the cervix and urethra, 58% in the cervix only, and 8% in the urethra only. Other sexually transmitted pathogens with a high prevalence in this group included Ureaplasma urealyticum (39.9%), Candida albicans (32%), and Trichomonas vaginalis (13.7%). Factors that correlated significantly with chlamydia infection by multivariate analysis were age less than 25 years, first intercourse less than 18 years, previous induced abortion, cervicitis, and repeated candidiasis. However, no single risk factor or constellation of risk factors was sufficiently sensitive to form the basis of a selective screening program. Considering the serious maternal and infant complications of C. trachomatis infection, routine screening in pregnant women is urged. Given a prevalence rate of 27%, 1630 infected pregnant women should be identified each year in Martinique. The cost of screening and treating these women and their partners would be US$250,000 compared to $1.2 million required to treat chlamydia-related conjunctivitis and pneumonia in infants and postpartum salpingitis in mothers.
Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Complicações Infecciosas na Gravidez/epidemiologia , Doenças Uretrais/epidemiologia , Doenças do Colo do Útero/epidemiologia , Aborto Induzido , Adolescente , Adulto , Candidíase Vulvovaginal/complicações , Distribuição de Qui-Quadrado , Infecções por Chlamydia/complicações , Infecções por Chlamydia/prevenção & controle , Suscetibilidade a Doenças , Feminino , Humanos , Modelos Logísticos , Martinica/epidemiologia , Razão de Chances , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Prevalência , Fatores de Risco , Comportamento Sexual , Doenças Uretrais/complicações , Doenças Uretrais/prevenção & controle , Doenças do Colo do Útero/complicações , Doenças do Colo do Útero/prevenção & controleRESUMO
Case-control studies of cervical intra-epithelial neoplasia grade III (CIN III) and of invasive cervical cancer were carried out in Spain and Colombia to assess the relationship between cervical cancer and 6 common sexually transmitted agents (STAs). The CIN-III studies included 525 cases and 512 controls matched for age and for the place of recruitment; the invasive-cancer studies included 373 histologically confirmed cases of squamous-cell carcinoma and 387 age-stratified controls selected randomly from the populations that generated the cases. Antibodies to Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, herpes simplex virus type II (HSV-2) and cytomegalovirus (CMV) were tested in 88% of the women. Cervical scrapes were examined for HPV DNA in 63% of the women using a polymerase-chain-reaction assay (PCR). Among controls, the highest antibody prevalence was to CMV (96.5%), followed by HSV-2 (31.4%) and C. trachomatis (23.3%). For all STAs, the sero-prevalence was markedly higher in Colombia than in Spain both for cases and for controls. After adjustment for the presence of HPV DNA, C. trachomatis was the only STA associated with CIN III in both countries; Spain and Colombia. In both countries, the risk of CIN III increased with increasing of C. trachomatis antibody titers. Among Spanish women, an increase in risk of invasive carcinoma was found for those with antibodies to N. gonorrhoeae; those with antibodies to HSV-2 and those with antibodies to C. trachomatis. These associations were present only in HPV-DNA-negative women. Among HPV-DNA-positive women, none of the STAs considered were associated with cervical neoplasia. Our findings could be interpreted as indicating that past infections with HSV-2, N. gonorrhoeae and C. trachomatis are surrogate markers of HPV, but because HPV DNA may have escaped detection, we cannot exclude that these STAs are also of separate etiological significance.
Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Gonorreia/epidemiologia , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Sífilis/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Estudos de Casos e Controles , Infecções por Chlamydia/complicações , Infecções por Chlamydia/diagnóstico , Colômbia/epidemiologia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Feminino , Gonorreia/complicações , Gonorreia/diagnóstico , Herpes Simples/complicações , Herpes Simples/diagnóstico , Herpes Simples/epidemiologia , Humanos , Invasividade Neoplásica , Reação em Cadeia da Polimerase , Prevalência , Trabalho Sexual , Infecções Sexualmente Transmissíveis/complicações , Infecções Sexualmente Transmissíveis/diagnóstico , Espanha/epidemiologia , Sífilis/complicações , Sífilis/diagnóstico , Neoplasias do Colo do Útero/complicaçõesRESUMO
Seven hundred and sixteen pregnant women attending the prenatal clinic at Lamentin Hopital, Martinique, were tested for chlamydia trachomatis (Ct) infection and risk factors associated with the infection. Samples for Ct isolation were taken from the endocervical canal and the urethra and cultured on cycloheximide-treated MacCoy cells. Ct inclusions are identified by monoclonal antibodies. Specific serum antibodies (Ab) were evaluated by an immunofluorescence method. Two hundred sixty-seven women (37.3 percent) had positive Ct culture, 34.5 percent from the cervix and 2.8 percent from the urethra alone. Comparing the group that did have Ct infection with the group that was not infected, the prevalence of the following factors was found to be significantly different (p<0.01): married (39.3 percent vs 27.2 percent), previous induced abortions (47.9 percent vs 30.8 percent), first intercourse at less than 18 years of age (43.3 percent vs 28.3 percent), more than two lifetime sex partners (40.9 percent vs 25 percent), friability of the cervix (45.3 percent vs 34.1 percent), polymorphonuclear neutrophils in cervical mucus (45.9 percent vs 26 percent), yellow endocervical discharge (44 percent vs 28 percent) concomitant trichomonas vaginalis (22.4 percent vs 15.8 percent), gardnerella vaginalis (19.8 percent vs 9.8 percent) and ureaplasma urealyticum (53.1 percent vs 34.5 percent) infection. Four-hundred and twenty women (58.8 percent) had Ct specific Ab. The mean level of Ab was lower in culture positive women (1/117) than in culture negative (1/272). The positive predictive value of Ab changed according to the age group (AU)