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OBJECTIVES: Sexual networks are known to structure sexually transmitted infection (STI) transmission among men who have sex with men (MSM). We sought to estimate the risks of STI diagnosis for various partnership types within these networks. METHODS: Our cross-sectional survey analysed data from 1376 MSM screened for a partner management intervention in Lima, Peru. Participants were tested for HIV, syphilis, gonorrhoea (NG) and chlamydia (CT) and completed surveys on their demographics, sexual identity/role, HIV status, partnership types and sexual network from the prior 90 days. χ2 and Wilcoxon rank-sum tests compared participants without an STI to those diagnosed with (1) syphilis, (2) NG and/or CT (NG/CT) and (3) syphilis and NG/CT coinfection (coinfection). RESULTS: 40.8% (n=561/1376) of participants were diagnosed with an STI (syphilis: 14.9%, NG/CT: 16.4%, coinfection: 9.5%). 47.9% of all participants were living with HIV and 8.9% were newly diagnosed. A greater proportion of participants with syphilis and coinfection were living with HIV (73.5%, p<0.001; 71.0%, p<0.001) compared with those with NG/CT (47.8%) or no STI (37.8%). Participants with syphilis more often reported sex-on-premises venues (SOPVs) as the location of their last sexual encounter (51.7%, p=0.038) while those with NG/CT tended to meet their last sexual partner online (72.8%, p=0.031). Respondents with coinfection were the only STI group more likely to report transactional sex than participants without an STI (31.3%, p=0.039). CONCLUSIONS: Sexual networks and partnership types of Peruvian MSM are associated with differential risks for STIs. Participants diagnosed with syphilis tended to meet single-encounter casual partners at SOPV, while MSM with NG/CT were younger and often contacted casual partners online. Coinfection had higher frequency of transactional sex. These findings suggest the potential importance of public health interventions through combined syphilis/HIV screening at SOPV, syphilis screening at routine clinic appointments for MSM living with HIV and directed advertisements and/or access to NG/CT testing through online platforms.

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As infecções que causam cervicite são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo apresenta aspectos epidemiológicos e clínicos das infecções que causam cervicite, bem como recomendações sobre a triagem, diagnóstico e tratamento das pessoas acometidas e suas parcerias sexuais. Além disso, discutem-se estratégias para as ações de vigilância, prevenção e controle desses agravos para os profissionais de saúde e gestores envolvidos no manejo programático e operacional das infecções sexualmente transmissíveis. A ampliação do acesso aos testes para diagnóstico e o tratamento precoce são cruciais para o controle da disseminação dos patógenos causadores de cervicite.

Infections that cause cervicitis are a topic presented in the "Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections", published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with experts. This article presents epidemiological and clinical aspects of infections that cause cervicitis, as well as recommendations on screening, diagnosis and treatment of affected people and their sexual partnerships. In addition, it discusses strategies for surveillance, prevention and control of these infections for health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections. Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cevicitis.

Las infecciones que causan cervicitis son uno de los temas que integran el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. El documento fue desarrollado en base a evidencia científica y validado en discusiones con expertos. Este artículo presenta aspectos epidemiológicos y clínicos de las infecciones que causan cervicitis, así como recomendaciones sobre el cribado, diagnóstico y tratamiento de las personas afectadas y sus parejas sexuales. Además, se discuten estrategias de vigilancia, prevención y control de estas enfermedades para los profesionales y gestores de salud involucrados en el manejo programático y operativo de las infecciones de transmisión sexual. Ampliar el acceso a las pruebas de diagnóstico y a un tratamiento precoz es crucial para controlar la propagación de los agentes patógenos que causan cervicitis.

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Resumo As infecções que causam cervicite são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo apresenta aspectos epidemiológicos e clínicos das infecções que causam cervicite, bem como recomendações sobre a triagem, diagnóstico e tratamento das pessoas acometidas e suas parcerias sexuais. Além disso, discutem-se estratégias para as ações de vigilância, prevenção e controle desses agravos para os profissionais de saúde e gestores envolvidos no manejo programático e operacional das infecções sexualmente transmissíveis. A ampliação do acesso aos testes para diagnóstico e o tratamento precoce são cruciais para o controle da disseminação dos patógenos causadores de cervicite.

Abstract Infections that cause cervicitis are a topic presented in the "Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections", published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with experts. This article presents epidemiological and clinical aspects of infections that cause cervicitis, as well as recommendations on screening, diagnosis and treatment of affected people and their sexual partnerships. In addition, it discusses strategies for surveillance, prevention and control of these infections for health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections. Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cevicitis.

Resumen Las infecciones que causan cervicitis son uno de los temas que integran el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. El documento fue desarrollado en base a evidencia científica y validado en discusiones con expertos. Este artículo presenta aspectos epidemiológicos y clínicos de las infecciones que causan cervicitis, así como recomendaciones sobre el cribado, diagnóstico y tratamiento de las personas afectadas y sus parejas sexuales. Además, se discuten estrategias de vigilancia, prevención y control de estas enfermedades para los profesionales y gestores de salud involucrados en el manejo programático y operativo de las infecciones de transmisión sexual. Ampliar el acceso a las pruebas de diagnóstico y a un tratamiento precoz es crucial para controlar la propagación de los agentes patógenos que causan cervicitis.

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Abstract Infections that cause cervicitis are a topic presented in the "Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections", published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with experts. This article presents epidemiological and clinical aspects of infections that cause cervicitis and recommendations on screening, diagnosis, and treatment of affected people and their sexual partnerships. Also, it discusses strategies for surveillance, prevention, and control of these infections for health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections. Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cervicitis.

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RESUMEN La imposibilidad para concebir, después de un año de relaciones sexuales sin protección, es un término aceptado como infertilidad. Entre un 15 y un 20 % de parejas en Cuba requieren algún tipo de ayuda para lograr un hijo. La laparoscopia contrastada es uno de los estudios protocolizados que se debe realizar en la búsqueda de la etiología de esa incapacidad, sobre todo cuando se sospecha una posible causa tubo-peritoneal. El síndrome de Fitz-Hugh-Curtis o perihepatitis, consiste en una inflamación de la cápsula hepática, provocada por una infección (la más frecuente: clamidias), como manifestación extrapélvica de una enfermedad inflamatoria. Se informó el hallazgo insospechado de este síndrome durante la realización de una laparoscopia contrastada, asociada a una obstrucción bilateral de las trompas, sin síntomas clínicos, que hizo sospechar de un proceso pélvico infeccioso previo, como posible factor etiológico de la dificultad para concebir.

ABSTRACT The inability to conceive after one year of unprotected intercourse is a term accepted as infertility. In Cuba 15-20% of couples require some type of help to conceive a child. Hysterosalpingography is one of the established studies that should be performed when the etiology of this inability is sought, especially when a possible tubal-peritoneal cause is suspected. Fitz-Hugh-Curtis syndrome or perihepatitis, consists of an inflammation of the liver capsule, caused by an infection (chlamydial infection is the most common), as an extrapelvic manifestation of an inflammatory disease. The unsuspected finding of this syndrome was reported during the performance of hysterosalpingography, associated with a bilateral tubal obstruction, without clinical symptoms, which led us to suspect a previous pelvic infectious process, as a possible etiological factor of the difficulty to conceive.

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Introduction: Chlamydia trachomatis (CT) is the most prevalent sexually transmitted bacterial infection, affecting mainly young, sexually active women. Untreated infection may lead to reproductive complications due to tubal damage. Infections during pregnancy may cause preterm labor, low birth weight, perinatal death, and neonatal conjunctivitis and pneumonia. There are few data on CT infection in Brazil. The aim of this study was to determine CT prevalence in infertile and pregnant women. Methods: A cross-sectional study included 77 infertile and 60 asymptomatic pregnant women. First-void urine was tested for CT using PCR (Polymerase Chain Reaction). Blood samples were collected for CT IgG antibodies testing using indirect immunofluorescence. A questionnaire about medical, gynecological, and sexual history was completed by all participants. Results: We found statistically similar prevalence of PCR and IgG antibodies between the groups. There was a 61% prevalence of CT IgG antibodies in infertile women and 56.7% in pregnant women. PCR was positive in only one (1.3%) infertile woman and in none pregnant women. Conclusion: There is a high prevalence of CT IgG antibody in Brazilian pregnant and infertile women, but we found a low prevalence of positive PCR in the urine samples. CT antibodies were associated with sexual behavior and smoking (AU)

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OBJETIVO: Avaliar a prevalência de infecção por Chlamydia trachomatis e Neisseria gonorrhoeae em mulheres submetidas à reprodução assistida em um serviço público de referência da região Centro-Oeste do Brasil. MÉTODOS: Estudo transversal com 340 mulheres com idade entre 20 e 47 anos, histórico de infertilidade, submetidas às técnicas de reprodução assistida. Foram analisadas as infecções por Chlamydia trachomatis e Neisseria gonorrhoeae detectadas em amostras de urina pela técnica de PCR e o perfil da infertilidade. Utilizou-se o teste do χ2 ou o teste exato de Fisher para avaliar a associação entre a infecção e as variáveis. RESULTADOS: Observou-se prevalência de 10,9% das mulheres com infecção por Chlamydia trachomatis, sendo que houve coinfecção por Neisseria gonorrhoeae em 2 casos. Mulheres infectadas por Chlamydia trachomatis apresentaram mais de 10 anos de infertilidade (54,1%; p<0,0001). O fator tubário foi a principal causa nos casos com infecção (56,8%; p=0,047). A obstrução tubária foi encontrada em 67,6% dos casos com infecção positiva (p=0,004). CONCLUSÃO: Houve associação da obstrução tubária com a infecção por Chlamydia trachomatis e Neisseria gonorrhoeae, reforçando a necessidade de estratégias efetivas para detecção precoce das doenças sexualmente transmissíveis, principalmente em mulheres assintomáticas em idade fértil. .

PURPOSE: To evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in women undergoing assisted reproduction in a public reference service in the midwestern region of Brazil. METHODS: A cross-sectional study was conducted on 340 women aged from 20 to 47 years with a history of infertility, undergoing assisted reproduction techniques. Infections with Chlamydia trachomatis and Neisseria gonorrhoeae identified in urine specimens by PCR, and the profile of infertility were analyzed. We used the χ2 test or Fisher's exact test to evaluate the association between infection and variables. RESULTS: The prevalence of Chlamydia trachomatis infection was 10.9%, and Neisseria gonorrhoeae co-infection was observed in 2 cases. Women infected with Chlamydia trachomatis had more than 10 years of infertility (54.1%; p<0.0001). The tubal factor was the main cause in infected cases (56.8%; p=0.047). Tubal occlusion was found in 67.6% of cases with positive infection (p=0.004). CONCLUSION: There was an association of tubal obstruction with infection by Chlamydia trachomatis and Neisseria gonorrhoeae, reinforcing the need for effective strategies for an early detection of sexually transmitted diseases, especially in asymptomatic women of childbearing age. .

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OBJETIVO: Foi avaliar a prevalência de Chlamydia trachomatis e os fatores de risco associados à infecção em amostras endocervicais de mulheres atendidas em ambulatório de Ginecologia e Obstetrícia. MÉTODOS: Amostras de secreção endocervical de 200 mulheres atendidas em Hospital Universitário foram avaliadas para diagnosticar C. trachomatis com uso da reação em cadeia da polimerase (PCR) utilizando primers CT05/CT06 que amplificam 281 pares de bases da principal proteína de membrana externa de C. trachomatis. Todas as participantes responderam a um questionário pré-codificado e autoaplicável. Os dados foram analisados no programa do software SPSS 17.0; para a análise multivariada foi utilizada a regressão de Poisson. RESULTADOS: Das 200 mulheres que foram incluídas no estudo, a prevalência de infecção por C. trachomatis foi de 11% (22 pacientes) e destas 55 (27,5%) foram positivas para o HPV. Os fatores de risco associados à infecção por C. trachomatis foram: ter 8 anos ou menos de escolaridade (p<0,001), renda familiar de até 1 salário mínimo (p=0,005), primeira relação sexual com 15 anos ou menos (p=0,04) e ser portadora do vírus HIV (p<0,001). Após a análise multivariada, apenas as variáveis escolaridade igual ou inferior a oito anos (RP 6,0; IC95% 1,26 - 29,0; p=0,02) e presença do HIV (RP 14,1; IC95% 3,4 - 57,5; p<0,001) permaneceram significantes. CONCLUSÕES: A prevalência de C. trachomatis em amostras endocervicais pelo método de PCR foi de 11%. Os fatores associados à maior infecção por C. trachomatis foram menor escolaridade e ser portar o vírus HIV.

PURPOSE: It was to determine the prevalence of Chlamydia trachomatis and the risk factors associated with infection in endocervical specimens from women seen in outpatient Obstetrics and Gynecology. METHODS: Samples of endocervical secretion of 200 women treated at the University Hospital of the Federal University of Rio Grande were analyzed for the presence of C. trachomatis by polymerase chain reaction (PCR) using primers that amplify CT05/CT06 281 base pairs of the main outer membrane protein of C. trachomatis. All participants completed a pre-coded and self-report questionnaire. Data were analyzed with the SPSS 17.0 software; for multivariate analysis it was used Poisson regression. RESULTS: Of the 200 women who were included in the study, the prevalence of infection with C. trachomatis was 11% (22 patients) and these 55 (27.5%) were positive for HPV. Risk factors associated with infection by C. trachomatis were: 8 years or less of schooling (p<0.001), family income below the poverty level (p=0.005), first intercourse at age 15 or less (p=0.04) and being a carrier of the virus HIV (p<0.001). After multivariate analysis, only the variables of schooling or less than eight years (PR 6.0; 95%CI 1.26 - 29.0; p=0.02) and presence of HIV (RP 14.1; 95%CI 3.4 - 57.5; p<0.001) remained statistically significant. CONCLUSIONS: The prevalence of C. trachomatis in endocervical specimens by PCR was 11%. The factors associated with a higher infection by C. trachomatis were lower education and being HIV positive.

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A Chlamydia trachomatis é fator etiológico mais comum de doenças sexualmente transmissíveis, constituindo problema de saúde pública universal. Em casais, a infecção é frequentemente assintomática e sexualmente transmitida. Em homens, causa uretrite não gonocócica, conjuntivite e inflamação das articulações podem ocorrer. Em mulheres, as complicações graves podem resultar em salpingite aguda e doença inflamatória pélvica, cujas consequências incluem dor pélvica crônica, gravidez ectópica e infertilidade. Entre mulheres adolescentes, a taxa de incidência pode chegar a 30%. Segundo a Organização Mundial da Saúde, o custo para tratar pacientes com doença inflamatória pélvica pode atingir US$ 10 bilhões anuais. A infecção urogenital por C. trachomatis tem alta morbidade com estimativa de 89 milhões de novos casos anuais. Sexarca precoce, multiplicidade de parceiros sexuais, mais que um parceiro sexual nos últimos 90 dias, solteira, não uso de preservativo e desconhecimento de doenças sexualmente transmissíveis são fatores importantes. Poucos serviços públicos oferecem diagnóstico desse patógeno. Nos privados, pesquisa-se C. trachomatis se há sintomas ou quando um parceiro relata a bactéria. A pesquisa da C. trachomatis não faz parte da rotina da maioria dos médicos que atendem doenças sexualmente transmissíveis, exceto nos serviços de reprodução humana. Recomenda-se o uso de antibiótico profilático prévio à histerossalpingografia para pacientes com tubas dilatadas, história de doença inflamatória pélvica ou dano tubário.

The Chlamydia trachomatis is the most common sexually transmitted disease factor and is an universal public health problem. For couples, the infection is frequently assimptomatic, and sexually transmitted. In men it causes non gonococcus urethritis, conjunctivitis and joint inflammation. In women, serious complications can occur, like acute salpingitis, pelvic inflammatory disease that has consequences like chronic pelvic pain, ectopic pregnancy and infertility. The incidence in teenagers is as high as 30%. According to World Health Organization, the treatment cost for pelvic inflammatory disease can reach US$ 10 billion annually. The C. trachomatis urogenital infection has high morbidity as is estimated to have annually 89 millions of new cases events. Precocious first sexual relation, multiple sexual partners, more than one sexual partner in last 90 days, single, non condom use and ignorance about sexually transmitted diseases are relevant factors. There are little public services that offer diagnosis for these bacteria. At private services, generally search is done in symptomatic cases or one partner has C. trachomatis. The C. trachomatis screening is not routine at most doctor’s offices, except Human Reproduction Services. There are prophylac ticrecommendation antibiotics previous to hysterosalpingography to patients with hydrosalpinx, pelvic inflammatory disease or tubal infection disease.

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Objetivo: Conhecer a prevalência de infecção ocular em amostras de raspado conjuntival causada por C. trachomatis, no período de janeiro de 2004 a junho de 2007 em laboratório de Genética e Biologia Molecular da região metropolitana de Florianópolis, SC. Métodos: Realizou-se um estudo transversal e descritivo, envolvendo todos os casos de conjuntivite registrados no banco de dados do Laboratório de Genética e Biologia Molecular (DNAnálise) de janeiro de 2004 a junho de 2007. Foi observada a positividade de C. tracomatis nas amostras coletadas de raspado ocular. Resultados: Dos 660 exames realizados foram detectados 359 casos positivos (54,4%), sendo a maior parte do sexo feminino (66,3%). A prevalência foi maior na faixa etária de zero a 15 anos em pacientes de ambos os sexos, sendo 55,8% para o sexo masculino e 62,5% para o sexo feminino. Verificou-se um grande aumento de casos positivos no primeiro semestre do ano de 2006, representando 79,2% de todos os pacientes analisados. Conclusão: Houve um aumento no número de casos de conjuntivite na região metropolitana de Florianópolis no ano de 2006, causada pela C. trachomatis no laboratório de Genética e Biologia Molecular. O grande aumento de casos verificados sugere a necessidade da intensificação das ações de vigilância epidemiológica do tracoma nessa região para confirmar clinicamente o aumento da prevalência do tracoma.

Objective: To estimate the prevalence of ocular infection by Chlamydia trachomatis in conjuctival material, from january 2004 to june 2007 at Genetic and Molecular Biology Laboratory from Florianópolis Metropolitan area, SC. Methods: A cross-sectional and descriptive study involving all cases of conjunctivitis using the database of Genetic and Molecular biology Laboratory (DNAanálises) recorded in the period from january 2004 to june 2007 was carried out. The positivity to C. trachomatis in conjunctival material was observed. Results: A total of 660 exams to the detection of C. trachomatis in ocular samples were observed 359 (54,4%) positive cases which the most part of them were from female patients (66,3%). The majority of the cases were observed at the female group (66.3%). The highest prevalence was between one to 15 years old in both sex groups, being 55.8% in the male and 62.5% in the female group. We observed an increased number of cases between january and june of 2006 representing 79.2% of the total positive cases. Conclusion: There was an increased number of conjunctivitis at Florianópolis Metropolitan area at the year of 2006, caused by Chlamydia trachomatis detected at Genetic and Molecular Biology Laboratory. The great number of cases detected in the studied area suggests the need for strengthening epidemiological surveillance activities at the region to confirm clinically the increased prevalence of trachoma.

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OBJETIVO: este trabalho buscou estimar a prevalência das infecções pela Chlamydia trachomatis e pela Neisseria gonorrhoeae em gestantes de seis cidades brasileiras e identificar sua associação com variáveis socioeconômicas e demográficas. MÉTODOS: este estudo faz parte de uma pesquisa multicêntrica, de âmbito nacional, transversal, com amostra de gestantes atendidas entre 2004 e 2005 nos serviços de pré-natal da atenção básica de seis cidades brasileiras (Manaus, Fortaleza, Goiânia, Rio de Janeiro, São Paulo e Porto Alegre). Amostras cérvico-vaginais foram coletadas de todas as gestantes e submetidas posteriormente à técnica de captura híbrida para identificação da clamídia e do gonococo. As informações sociodemográficas, médicas, sexuais e obstétricas foram coletadas por meio de questionários específicos. Para avaliar os fatores de risco associados à infecção por gonorréia e clamídia, foi utilizado o Odds Ratio (OR). A análise estatística foi feita com a utilização do teste t de Student, o χ2 e o teste exato de Fischer. RESULTADOS: foram recrutadas 3.303 gestantes, cuja idade média foi 23,8 anos (±6,9). As prevalências da infecção por clamídia e pelo gonococo foram, respectivamente, 9,4 e 1,5 por cento. Dez por cento das gestantes com infecção por clamídia apresentaram presença simultânea do gonococo. O risco de apresentar uma dessas infecções foi duas vezes maior para as gestantes com menos de 20 anos. Os principais preditores da infecção foram: idade menor de 20 anos, raça/cor negra, ser solteira ou separada e relato de mais de um parceiro no último ano. CONCLUSÕES: este estudo observou prevalências elevadas da infecção pela Chlamydia trachomatis e pela Neisseria gonorrhoeae em gestantes brasileiras. O principal fator de risco para a infecção foi ter menos de 20 anos de idade.

PURPOSE: This paper has aimed at estimating the prevalence of infections by Chlamydia trachomatis and by Neisseria gonorrhoeae in pregnant women from six Brazilian cities, identifying its association with socio-economical and demographic variables. METHODS: This study has been part of a multicentric nationwide transversal research, with samples of pregnant women attended from 2004 to 2005 in basic attention pre-natal services from six Brazilian cities (Manaus, Fortaleza, Goiânia, Rio de Janeiro, São Paulo and Porto Alegre). Cervico-vaginal samples have been collected from all the pregnant women, and have afterwards been submitted to the hybrid capture technique in order to identify chlamydia and gonococcus. Socio-demographic, medical, sexual and obstetric information have been collected through specific questionnaires. The Odds Ratio (OR) has been used to evaluate risk factors associated to infection by gonorrhea and chlamydia. Statistical analysis has been done with the t-Student, χ2 and Fisher's exact tests. RESULTS: Three thousand and three pregnant women with an average age of 23.8 years old (±6.9) took part in the study. Infection prevalence by chlamydia and gonococcus were 9.4 and 1.5, respectively. Ten per cent of the pregnant women with chlamydia have presented gonococcus simultaneously. The risk of presenting one of those infections was two times higher for the women under 20. The infection main predictors have been: age under 20, race/black, single/separated and report of over one partner in the previous year. CONCLUSIONS: This study has observed high prevalence of infection by Chlamydia trachomatis and by Neisseria gonorrhoeae in Brazilian pregnant women. The main risk factor for the infection has been to be under 20 years old.

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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.

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