Uso dos antifúngicos no tratamento da candidíase vulvovaginal: uma revisão integrativa / Use of antifungals in the treatment of vulvovaginal candidiasis: an integrative review

Objective: To identify scientific evidence available in the literature and analyze the action of antifungal drugs used for the treatment of vulvovaginal candidiasis. Methods:Integrative literature review conducted in the databases Medline/PubMed, Embase, Web of Science, Cochrane Library, CINAHL, SCOPUS and VHL; with the descriptors "woman", "antifungal agents"; "vulvovaginal candidiasis". Results:Ten scientific articles published between 1983 and 2020 were obtained. Of these, four were developed in Iran; followed by Mexico, England, Taiwan, Thailand, Denmark, and the United States. In terms of methodological design, most studies are clinical trials (n=8), and two are cross-sectional studies. Regarding the level of evidence, eight are level II, and only two investigations are level IV. Concerning the antifungal drugs used in the treatment, there was a predominance of clotrimazole (n=4; efficacy ranging from 42.4% to 98.3%), followed by econazole (n=2; efficacy between 39% and 89%), combined or not with another antifungal drug. Conclusion: The use of clotrimazole stands out, as it is highly effective in the treatment of vulvovaginal candidiasis. This study contributes to the advancement of knowledge and improvement of the clinical practice of nursing and other health professionals. It is expected that these results will encourage further studies and update clinical practices.Descriptors:Women;Antifungal Agents;Candidiasis, Vulvovaginal

Objective: To identify scientific evidence available in the literature and analyze the action of antifungal drugs used for the treatment of vulvovaginal candidiasis. Methods: Integrative literature review conducted in the databases Medline/PubMed, Embase, Web of Science, Cochrane Library, CINAHL, SCOPUS and VHL; with the descriptors "woman", "antifungal agents"; "vulvovaginal candidiasis". Results:Ten scientific articles published between 1983 and 2020 were obtained. Of these, four were developed in Iran; followed by Mexico, England, Taiwan, Thailand, Denmark, and the United States. In terms of methodological design, most studies are clinical trials (n=8), and two are cross-sectional studies. Regarding the level of evidence, eight are level II, and only two investigations are level IV. Concerning the antifungal drugs used in the treatment, there was a predominance of clotrimazole (n=4; efficacy ranging from 42.4% to 98.3%), followed by econazole (n=2; efficacy between 39% and 89%), combined or not with another antifungal drug. Conclusion:The use of clotrimazole stands out, as it is highly effective in the treatment of vulvovaginal candidiasis. This study contributes to the advancement of knowledge and improvement of the clinical practice of nursing and other health professionals. It is expected that these results will encourage further studies and update clinical practices.Descriptors:Women;Antifungal Agents;Candidiasis, Vulvovaginal

Vaginosis citolítica: actualización diagnóstica y terapéutica / Cytolytic vaginosis: diagnostic and therapeutic update

El objetivo es conocer el abordaje diagnóstico y terapéutico de la vaginosis citolítica. Para ello se hizo una búsqueda sistemática de la literatura médica mediante las bases de datos: PubMed, Central, etc. Se limitó a ensayos clínicos aleatorizados, metaanálisis y revisiones bibliográficas, con disponibilidad del texto completo para evaluarlos en su totalidad e incluirlos en la revisión; publicados entre 1980 y 2021. Se incluyeron 27 publicaciones. La vaginosis citolítica es un trastorno infradiagnosticado. En mujeres con síntomas y signos de candidiasis vulvovaginal, que no responden a la terapia, se debe considerar la probabilidad de estar en presencia de una vaginosis citolítica. El tratamiento obliga a elevar el pH vaginal a valores básicos y a disminuir el número excesivo de Lactobacillus, resultando de utilidad las duchas vaginales con bicarbonato de sodio y/o un tratamiento con antibióticos derivados de la penicilina junto a un inhibidor de ß-lactamasas o doxiciclina en las pacientes alérgicas a la penicilina. Finalmente, se concluye que la vaginosis citolítica es una afección común, frecuentemente se diagnostica de forma errónea porque se confunde con la candidiasis vulvovaginal; se caracteriza por producir un cuadro clínico similar. El tratamiento se enfoca en disminuir el número de Lactobacillus y la elevación del pH vaginal.

The objective is to know the diagnostic and therapeutic approach of cytolytic vaginosis. A systematic search of the medical literature was carried out using the following databases: Medline via PubMed, Central, and Cochrane Database of Systematic Reviews, among others. The search was limited to randomized clinical trials, meta-analyses, and literature reviews that had the full text available for full evaluation and inclusion in the review; published between 1980 and 2021. Twenty-seven publications were included. Cytolytic vaginosis is a frequently underdiagnosed disorder, which mimics Candida vaginitis. In women with symptoms and signs of vulvovaginal candidiasis who do not respond to antifungal therapy, the possibility of cytolytic vaginosis should be considered. The treatment of this condition requires raising the vaginal pH to basic values and reducing the excessive number of Lactobacillus, resulting in useful vaginal douches with sodium bicarbonate and/or treatment with antibiotics derived from penicillin together with a ß-lactamases inhibitor or doxycycline in patients allergic to penicillin. Finally, we conclude that cytolytic vaginosis is a common condition, frequently misdiagnosed because it is confused with vulvovaginal candidiasis, since it is characterized by producing a similar clinical picture. Treatment focuses on reducing the number of Lactobacillus and raising vaginal pH.

Actividad de fosfolipasas y proteasas en aislamientos de especies de Candida colonizadoras y causantes de vulvovaginitis en mujeres gestantes / Phospholipase and proteinase activities of isolatesof colonizing Candida spp. causing vulvovaginitis in pregnant women

Introducción. Las proteasas y las fosfolipasas son factores de virulencia de Candida spp. que cumplen un papel importante en la invasión de los tejidos. Entre los factores relacionados con el huésped, se encuentran algunos asociados con las características ambientales y otros con la colonización. Objetivo. Determinar la actividad de fosfolipasas y proteasas en aislamientos de especies colonizadoras y patógenas de Candida spp., aisladas de mujeres gestantes de Cartagena de Indias. Materiales y métodos. Se determinó la actividad de fosfolipasas y proteasas en 56 aislamientos mediante degradación del sustrato y cálculo del coeficiente de actividad enzimática. Se compararon las actividades de fosfolipasas y proteasas, entre los aislamientos colonizadores y los patógenos. Resultados. La actividad de la fosfolipasa fue "muy alta" (< 0,69) en 34 aislamientos e, igualmente, la de la proteasa en 14. No hubo diferencias significativas al comparar las actividades de las fosfolipasas y de las de las proteasas, entre los aislamientos colonizadores y los patógenos. Conclusiones. La actividad de las fosfolipasas predominó como factor de virulencia en los aislamientos estudiados. No obstante, no se encontró una diferencia significativa entre los grupos de aislamientos colonizadores y los patógenos, en cuanto a las actividades de fosfolipasas y proteasas.

Introduction. Proteases and phospholipases are virulence factors of Candida spp. that play an important role in tissue invasion. Among the factors related to the host some are associated with environmental characteristics and others with Candida colonization. Objectives. To determine phospholipase and protease activities in colonizing and pathogenic strains, isolated from pregnant women in Cartagena de Indias. Materials and methods. Phospholipase and protease activity was determined in 56 isolates, evaluating substrate degradation and calculating the enzyme activity coefficient. Phospholipase and protease activities were compared between colonizing and pathogenic strains. Results. "Very high" (<0.69) phospholipase and protease activity was found in 34 and 14 isolates, respectively. There was no significant difference when comparing phospholipase and protease activities between colonizing and pathogenic isolates. Conclusions. Phospholipase activity predominated as a virulence factor in the studied strains, but no significant difference was found between colonizing and pathogenic strains for phospholipase and protease activities.

Aspectos da abordagem terapêutica sobre candidíase vulvovaginal / Aspects of the therapeutic approach to vulvovaginal candidiasis / Aspectos del abordaje terapéutico de la candidiasis vulvovaginal

A candidíase vulvovaginal, é uma infecção da vulva e vagina causada por vários tipos de Candida spp. Essa patologia afeta 75% de todas as mulheres pelo menos uma vez durante a vida, ocorrendo com mais frequência durante a idade fértil. A transmissão dessa infeção fúngica ocorre por meio de contato com mucosas e secreções em pele de portadores ou doentes, contato sexual, água contaminada e transmissão vertical. Alguns outros sintomas característicos mais vistos em casos de CVV, são lesões brancas, cremosas e planas, sendo mais intensos no período pré-menstrual, quando a acidez vaginal aumenta. numerosos antifúngicos estão disponíveis no mercado, os quais são encontrados para administração oral na forma de comprimidos ou, para uso tópico, na forma de cremes, loções, comprimidos vaginais, supositórios e tampões revestidos. O objetivo geral do trabalho foi analisar através da revisão de literatura, tratamentos convencionais e alternativos para abordagem terapêutica da Candidíase Vulvovaginal contextuando a mesma, utilizando definições, dados epidemiológicos e sua sintomatologia frente à sociedade. O presente trabalho é uma revisão integrativa, que teve a coleta de dados realizada de março de 2021 a outubro de 2021 nas bases de dados Lilacs, Scielo, Google acadêmico, A busca resultou em 902 artigos, dos quais 14 atenderam ao critério de inclusão. A busca por tratamentos frente a candidíase vulvovaginal tem se mostrado ampla de acordo com os artigos selecionadas. Concluímos que a patologia candidíase vulvovaginal, vem apresentando resistência em algumas abordagens terapêuticas, assim como algumas mulheres não aderem há algum tipo de tratamento, devido à falta de conhecimento sobre a patologia.

Vulvovaginal candidiasis is an infection of the vulva and vagina caused by various types of Candida spp. This condition affects 75% of all women at least once in their lifetime, occurring more frequently during their childbearing years. The transmission of this fungal infection occurs through contact with mucous membranes and secretions on the skin of patients or patients, sexual contact, contaminated water and vertical transmission. Some other characteristic symptoms more seen in cases of VVC are white, creamy and flat lesions, being more intense in the premenstrual period, when the vaginal acidity increases. numerous antifungals are available on the market which are available for oral administration in tablet form or, for topical use, in the form of creams, lotions, vaginal tablets, suppositories and coated tampons. The general objective of the work was to analyze, through a literature review, conventional and alternative treatments for the therapeutic approach of Vulvovaginal Candidiasis in its context, using definitions, epidemiological data and its symptoms in society. The present work is an integrative review, which had data collection carried out from March 2021 to October 2021 in the Lilacs, Scielo, Google academic databases. The search resulted in 902 articles, of which 14 met the inclusion criteria. The search for treatments against vulvovaginal candidiasis has been shown to be wide according to the selected articles. We conclude that the vulvovaginal candidiasis pathology has been showing resistance in some therapeutic approaches, as well as some women do not adhere to any type of treatment, due to lack of knowledge about the pathology.

La candidiasis vulvovaginal es una infección de la vulva y la vagina cau- sada por diversos tipos de Candida spp. Esta afección afecta al 75% de las mujeres al menos una vez en la vida, siendo más frecuente durante la edad fértil. La transmisión de esta infección fúngica se produce por contacto con mucosas y secreciones de la piel de pacientes o enfermos, contacto sexual, agua contaminada y transmisión vertical. Otros síntomas característicos más observados en los casos de CVV son las lesiones blancas, cremosas y planas, siendo más intensas en el período premenstrual, cuando aumenta la acidez vaginal. Existen en el mercado numerosos antifúngicos disponibles para adminis- tración oral en forma de comprimidos o, para uso tópico, en forma de cremas, lociones, comprimidos vaginales, supositorios y tampones recubiertos. El objetivo general del tra- bajo fue analizar, a través de una revisión bibliográfica, los tratamientos convencionales y alternativos para el abordaje terapéutico de la Candidiasis Vulvovaginal en su contexto, utilizando definiciones, datos epidemiológicos y su sintomatología en la sociedad. El pre- sente trabajo es una revisión integradora, que tuvo recolección de datos realizada de marzo de 2021 a octubre de 2021 en las bases de datos académicas Lilacs, Scielo, Google. La búsqueda resultó en 902 artículos, de los cuales 14 cumplieron los criterios de inclu- sión. La búsqueda de tratamientos contra la candidiasis vulvovaginal se ha mostrado am- plia según los artículos seleccionados. Concluimos que la patología de la candidiasis vul- vovaginal viene mostrando resistencia en algunos abordajes terapéuticos, así como algu- nas mujeres no se adhieren a ningún tipo de tratamiento, debido al desconocimiento de la patología.

Factores de riesgo asociados al trabajo de parto pretérmino en gestantes del Hospital Universitario Maternidad Nuestra Señora de la Altagracia septiembre-diciembre 2018 / Risk factors associated to preterm labor in pregnant patients in teaching Hospital Maternidad Nuestra Señora de la Altagracia September-December 2018

Objetivo: Determinar los factores de riesgo asociados al trabajo de parto pre-término en gestantes del Hospital Universitario Maternidad Nuestra Señora de la Altagracia, periodo septiembre­diciembre 2018. Método: se realizó un estudio retrospectivo, descriptivo y de corte transversal, con una muestra de 52 mujeres. Los datos obtenidos fueron procesados con el sistema Epi-info 7.0. Resultados: el estudio muestra que entre los factores de riesgo más relevantes se encuentra la multiparidad, mostrando que el 65.4 % tuvieron un número mayor a dos embarazos, de las cuales se encontró que el 52.9 % tienen historia de abortos. Otros factores de riesgo asociados a partos prematuros es la enfermedad obstétrica relacionada, con mayor relevancia la anemia, con un 31.6 %, seguida por las infecciones urinarias con un 17.5 %. Conclusión: el estudio demuestra que dentro de los factores de riesgo asociados a partos pretérminos se encuentran la anemia con un 31.6 % y las infecciones urinarias con un 17.5 %, además el 48.1 % de las pacientes tenían una edad gestacional que rondaba entre 33 y 36 semanas de gestación.

Objective: Determine the risk factors associated to preterm labor in pregnant patients in ''Hospital Maternidad Nuestra Señora de la Altagracia'' in Santo Domingo, September­December 2018. Methods: It is a descriptive, retrospective, and a cross-sectional study, with a sample of 52 women. The data collected was processed with the system Epi-info 7.0. Results: The study shows that multiparity is one of the most relevant risk factors for preterm delivery, showing that 65.4% had a number equal or greater than 2 pregnancies, of which 52.9% had a history of abortion. Others risk factors related to preterm delivery is a concomitant diseases within the pregnancy, being the anemia the most relevant with 31.6% and follow up by urinary tract infections with 17.5%. Conclusion: The study shows that within the risk factors associated with preterm delivery, anemia is within 31.6% and the urinary tract infections are 17.5%, Also related to preterm delivery we have the gestational age which was around 33 ­ 36 weeks in 48.1% of the preterm deliveries.

Candidiasis y Candida albicans / Candidiasis and Candida albicans

La candidiasis es una enfermedad micótica debida a levaduras pertenecientes al género Candida. Dentro del gran conjunto de microorganismos que colonizan al ser humano, Candida albicans es el agente etiológico más comúnmente detectado ya que habita como comensal en las superficies mucosas y la piel. C. albicans participa en procesos de fermentación de azúcares y asimilación de nutrientes, pero, en algunas ocasiones se relaciona con procesos patológicos. En los últimos años los avances tecnológicos y médicos; así como el aumento en la incidencia de infecciones por el virus de la inmunodeficiencia humana, el auge creciente de la terapia inmunomoduladora y el uso de antibióticos de amplio espectro durante largos períodos de tiempo se han convertido en los factores de riesgo más importantes para la creciente incidencia de infecciones por microorganismos del género Candida. Debido a esto, resulta imperativo el conocimiento de esta enfermedad y sus formas clínicas más importantes, así como el abordaje diagnóstico y el tratamiento actual; información que recolectamos en este documento para brindar una visión general sobre esta patología(AU)

Candidiasis is a fungal disease caused by yeasts belonging to the genus Candida. Within the large group of microorganisms that colonize humans, candida albicans is the most commonly detected etiological agent since it inhabits mucosal surfaces and skin as a commensal. C. albicans participates in sugar fermentation processes and assimilation of nutrients but, on some occasions, it is related to pathological processes. In recent years, technological and medical advances; As well as the increase in the incidence of human immunodeficiency virus infections, the growing boom in immunomodulatory therapy and the use of broad-spectrum antibiotics for long periods of time have become the most important risk factors for the increasing incidence of infections by microorganisms of the genus Candida. Due to this, knowledge of this disease and its most important clinical forms, as well as the current diagnostic approach and treatment, is imperative; information that we collect in this document to provide an overview of this condition(AU)

Concordance Between Clinical and Laboratory Diagnosis of Abnormal Vaginal Discharge in Chilean Women / Concordância entre o diagnóstico clínico e laboratorial de corrimento vaginal anormal em mulheres chilenas

Abstract Objective To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota. Methods Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women>18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of Trichomonas vaginalis and Candida albicans. The Cohen kappa coefficient was used in the concordance analysis. Results Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant (p=0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa=0.21; p=0.003) and candidiasis (Kappa=0.22; p=0.001), and slight for trichomoniasis (Kappa=0.14; p=0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests. Conclusion The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms.

Resumo Objetivo Determinar a concordância entre o diagnóstico clínico de mulheres com corrimento vaginal anormal (AVD) e os resultados laboratoriais por meio da detecção molecular e observação da microbiota vaginal. Métodos Estudo transversal realizado em 2018 em Temuco, Chile. Participaram 25 parteiras de 12 centros de saúde. Um total de 125 mulheres>18 anos, voluntárias, foramrecrutadas. A amostra do fórnice vaginal posterior foi obtida por especuloscopia. Foram observadas características da secreção e da genitália externa e interna. A coloração de Gram foi usada para observar a microbiota vaginal, blastoconídios e pseudo-hifas, e a reação em cadeia da polimerase foi usada para a detecção de Trichomonas vaginalis e Candida albicans. O coeficiente kappa de Cohen foi usado na análise de concordância. Resultados De um total de 125 mulheres com AVD, 85,6% consultaram espontaneamente e 14,4% foram diagnosticados clinicamente durante um check-up de rotina. A concordância absoluta foi significativa (p=0,0012), com concordância de 13,6%. A concordância relativa foi significativa, mas razoável para vaginose bacteriana (Kappa =0,21; p=0,003) e candidíase (Kappa=0,22; p=0,001), e leve para tricomoníase (Kappa=0,14; p=0,009). O percentual de coincidência dos diagnósticos (solteiros ou mistos) por laboratório e parteiras foi: vaginose bacteriana 63,2% (12/19), candidíase 36,5% (27/74) e tricomoníase 12,5% (4/32). Houve 20% de coinfecção. Umtotal de 36% dos diagnósticos clínicos de AVD tiveram exames laboratoriais negativos. Conclusão As condições de vulvovaginite candidíase e tricomoníase parecem ser sobrediagnosticadas, e a vaginose bacteriana parece ser subdiagnosticada pelo diagnóstico clínico quando comparado com o diagnóstico laboratorial. A baixa concordância obtida mostra a importância de complementar o diagnóstico clínico comestudo laboratorial de AVD, principalmente emmulheres com falha de tratamento e / ou coinfecções com sinais e sintomas inespecíficos e variáveis.

Laboratorial aspects of cytolytic vaginosis and vulvovaginal candidiasis as a key for accurate diagnosis: a pilot study / Aspectos laboratoriais da vaginose citolítica e candidíase vulvovaginal como uma chave para o diagnóstico preciso: Um estudo piloto

Abstract Objective To identify clinical, microscopic, and biochemical characteristics that differentiate cytolytic vaginosis (CV) from vulvovaginal candidiasis (VVC). Methods The present cross-sectional study analyzed the vaginal contents of 24 non-pregnant women aged 18 to 42 years who were attended at the Genital Infections Clinic at Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas (CAISM-UNICAMP). They were diagnosed either with (CV = 8, VVC = 8) or without vulvovaginitis or vaginal dysbiosis (controls). The socio-demographic, clinical, and gynecological data were obtained from a detailed patient interview. Samples of the vaginal contents were collected for analysis of vaginal pH, gram stain, and specific fungal culture. The Kruskal-Wallis and Fisher exact tests were used to compare the differences between the groups. Odds ratios were used to compare the categorical variables. The significance level was considered at p < 0.05. Results Both women with CV and VVC had a lumpy vaginal discharge (p = 0,002) and vaginal hyperemia (p = 0.001), compared with controls. The inflammatory process was more intense in the VVC group (p = 0.001). In the CV group, there was statistical significance for the lactobacillus amount (p = 0.006), vaginal epithelium lysis (p = 0.001), and vaginal pH (p = 0.0002). Conclusion Cytolytic vaginosis and VVC diagnoses rarely differ on clinical characteristics but have different laboratorial findings. The present study highlights the importance of conducting an accurate investigation through laboratory tests rather than clinical criteria to avoid misdiagnosis.

Resumo Objetivo Identificar características clínicas, microscópicas e bioquímicas que diferenciam a vaginose citolítica (VC) da candidíase vulvovaginal (CVV). Métodos O presente estudo de corte transversal analisou o conteúdo vaginal de 24 mulheres não grávidas, com idades entre 18 e 42 anos, atendidas no ambulatório de Infecções Genitais do Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas (CAISM-UNICAMP). Elas foram diagnosticadas com (CV = 8, CVV = 8) ou sem vulvovaginite ou disbiose vaginal (controles = 8). Os dados sociodemográficos, clínicos e ginecológicos foram obtidos em uma entrevista detalhada do paciente. Amostras do conteúdo vaginal foram coletadas para análise do pH vaginal, coloração de Gram e cultura específica de fungos. Os testes exatos de Kruskal-Wallis e Fisher foram utilizados para comparar as diferenças entre os grupos. A razão de chances foi utilizada para comparar as variáveis categóricas. O nível de significância considerado foi de p < 0,05. Resultados As mulheres com VC e CVV apresentaram corrimento vaginal irregular (p = 0,002) e hiperemia vaginal (p = 0,001), em comparação aos controles. O processo inflamatório foi mais intenso no grupo CVV (p = 0,001). No grupo VC, houve significância estatística para a quantidade de lactobacilos (p = 0,006), lise do epitélio vaginal (p = 0,001) e pH vaginal (p = 0,0002). Conclusão Os diagnósticos de VC e CVV raramente diferem nas características clínicas, mas apresentam achados laboratoriais diferentes. O presente estudo destaca a importância de conduzir uma investigação precisa por meio de testes laboratoriais, em vez de critérios apenas clínicos, a fim de evitar erros de diagnóstico.

Infecciones cervicovaginales en exudados vaginales / Cervicovaginal infections in vaginal exudates

Introducción: Se desconocen las características de las infecciones cervicovaginales, diagnosticadas mediante el exudado vaginal, sobre todo en mujeres cubanas de mediana edad. En otras etapas del ciclo vital femenino, sí se han realizado estos estudios. Esta información es importante, fundamentalmente para realizar acciones de promoción de salud. Objetivo: Determinar las características de las infecciones cervicovaginales más frecuentes diagnosticadas mediante el exudado vaginal. Método: Se realizó un estudio transversal en 1118 mujeres. Se recogió la edad (agrupada en 20 - 44 años y 45 y más años), los resultados del exudado vaginal, la percepción de secreción vaginal o la ausencia de esta (asintomáticas) y los microorganismos identificados en el exudado. Resultados: El 49,9 por ciento de exudados vaginales fueron positivos a vaginosis bacteriana, Cándidas albicans, Trichomonas vaginalis y desequilibro en la ecología vaginal. El 45 por ciento de las pacientes no tenían secreción vaginal, es decir, estaban asintomáticas. Conclusión: Las infecciones cervicovaginales se caracterizaron por ser de elevada frecuencia, usualmente asintomáticas, con predominio de vaginosis bacteriana, candidiasis y trichomoniasis(AU)

ABSTRACT Introduction: The characteristics of cervicovaginal infections diagnosed by vaginal exudate are unknown, especially in middle-aged Cuban women. At other stages of the female life cycle, these studies have been done. Due to the importance of this information, to carry out health promotion actions, this research was carried out. Objective: To determine the characteristics of the most frequent cervicovaginal infections diagnosed by vaginal exudate. Method: A cross-sectional study was conducted in 1118 women. Age (grouped into 20-44 years and 45 and over), the results of positive vaginal discharge, the perception of presence or not of vaginal discharge (asymptomatic) and the microorganisms identified in the discharge were collected. Results: 49.9 percent of vaginal exudates were positive for bacterial vaginosis, Candidas albicans, Trichomonas vaginalis and imbalance in vaginal ecology. 45 percent of the patients had no vaginal discharge, that is, they were asymptomatic. Conclusion: Cervicovaginal infections were characterized by being of high frequency, usually asymptomatic, with prevalence of bacterial vaginosis, candidiasis and trichomoniasis(AU)

Fatores associados à presença de Candida spp. em amostras de fluido vaginal de mulheres residentes em comunidades quilombolas / Factors associated with the presence of Candida spp. in vaginal fluid samples from women living in quilombola settlements

RESUMO: Objetivo: Investigar a frequência e fatores associados à detecção de Candida spp. em fluido vaginal de mulheres residentes em uma comunidade quilombola. Materiais e Método: Um estudo transversal foi conduzido com 177 mulheres residentes em uma comunidade quilombola no Nordeste do Brasil. Foram coletados dados sociodemográficos, hábitos de vida, saúde geral e saúde reprodutiva. O material coletado na região do colo do útero foi submetido a exame citopatológico. Amostras de fluido vaginal foram coletadas para a análise microbiológica. Os testes Qui-quadrado, exato de Fisher e modelos de Re-gressão Logística foram utilizados na análise estatística. Resultados: Foi detectado Candida spp. em 28,9% das amostras. A espécie mais frequente nos casos positivos foi a Candida albicans (49%), seguida da Candida krusei (39,2%). Após o ajustamento, observou-se que mulheres com idade igual ou maior que 50 anos apresentaram maior chance da detecção de Candida spp. no fluido vaginal (OR ajustada = 3,46; IC95% = 1,68-7,12), enquanto as mulheres com queixa de corrimento vaginal apresentaram uma chance menor de detecção de Candida spp. (OR ajustada = 0,29; IC95% = 0,11-0,78). Conclusão: Os achados sugerem uma elevada detecção de Candida spp. no fluido vaginal entre mulheres residentes em comunidades quilombolas, o que sinaliza a necessidade do planejamento de medidas para prevenção e rastreamento de caso de candidíase vulvovaginal neste grupo populacional. Além disso, a presença de Candida spp. foi mais elevada em mulheres a partir da quinta década de vida, menor nas mulheres com queixas de corrimento vaginal. (AU)

ABSTRACT: Objective: Investigate the frequency and factors associated with the detection of Candida spp. in vaginal fluid from women living in a quilombola settlement. Materials and Method: A cross-sectional study was conducted with 177 women living in a quilombola settlement in Northeast, Brazil. Socio-demographic data, living habits, general health, and reproductive health were collected. The material collected in the region of the cervix was submitted to cytopathological examination. Vaginal fluid samples were collected for microbiological analysis. Chi-square test, exact Fisher's test, and logistic regression models were used for the statistical analysis. Results: Candida spp. was detected in 28.9% of the samples. The most frequent species in positive cases were Candida albicans (49%), followed by Candida krusei (39.2%). After adjustment, it was observed that women aged over 50 years had a higher chance of detecting Candida spp. in vaginal fluid (OR adjusted = 3.46; 95% CI = 1.68-7.12), while women complaining of vaginal discharge had a lower chance of detecting Candida spp. (OR adjust-ed = 0.29; 95% 95% CI= 0.11-0.78). Conclusion: The findings suggest a high detection of Candida spp. in vaginal fluid among women living in quilombola settlements, which indicates the need for planning measures for prevention and track the cases of vulvovaginal candidiasis in this population group. Besides, the presence of Candida spp. was higher in women from the fifth decade of life, lower in women with complaints of vaginal discharge. (AU)

Mitos y creencias del cuidado e higiene íntima en mujeres peruanas jóvenes / Myths and beliefs of intimate care and hygiene in young peruvian women

Introducción: Muchas veces se propagan mitos y creencias sobre la higiene íntima femenina, que podrían traer consecuencias en muchos aspectos. Objetivo: Determinar la asociación entre los mitos y creencias del cuidado e higiene íntima y los cuidados reales de higiene íntima en mujeres peruanas jóvenes. Método: Se realizó un estudio transversal analítico, que presentó una revisión del tema para realizar una encuesta de 21 interrogantes, en temas comunes en la higiene íntima, post piloto, se preguntó de su realización y la frecuencia semanal; esta última se asoció a variables socio-educativas. Resultados: De las 600 mujeres jóvenes encuestadas, hubo diferencia en cuanto la edad según la percepción del uso de ropa interior de algodón (p=0,013), la limpieza de la zona íntima de adelante hacia atrás (p<0,001), el uso de ropa interior no muy ajustada (p<0,001), el uso de ropa sintética (p=0,045), el uso de jabón exclusivo para la zona íntima (p<0,001), la edad de inicio de relaciones sexuales (p=0,031) y el uso de métodos anticonceptivos como causantes de flujo (p=0,008). En cuanto al ser o no estudiantes, hubo diferencia en la percepción de que el rasurado del pubis para la limpieza (p=0,018) y que los ejercicios de relajación disminuyen el flujo vaginal (p=0,030). Conclusiones: Se describió algunos mitos y creencias en cuanto a la limpieza íntima; a su vez, se encontró que algunas prácticas de higiene tienen asociación con la edad y el ser estudiante. Esto debe ser estudiado a profundidad, ya que, esto podría llevar a problemas mayores.

Introduction: Myths and beliefs about female intimate hygiene are often spread, which could have consequences in many aspects. Objective: To determine the association between the myths and beliefs of intimate care and hygiene and the actual care of intimate hygiene in young Peruvian women. Method: An analytical cross-sectional study was conducted, which exposed a review of the topic to conduct a survey of 21 questions on common issues in intimate hygiene, post pilot, asked about its performance and weekly frequency; The latter was associated with socio-educational variables. Results: Of the 600 young women surveyed, there was a difference regarding age according to the perception of the use of cotton underwear (p = 0.013), the cleaning of the intimate area from front to back (p <0.001), the use of underwear not very tight (p <0.001), the use of synthetic clothing (p = 0.045), the use of exclusive soap for the intimate area (p <0.001), the age of onset of sexual intercourse (p = 0.031) and the use of contraceptive methods as causing flow (p = 0.008). Regarding whether or not they were students, there was a difference in the perception that shaving the pubis for cleaning (p = 0.018) and that relaxation exercises decrease vaginal discharge (p = 0.030). Conclusions: Some myths and beliefs regarding intimate cleansing were described; In turn, some hygiene practices were found to be associated with age and being a student. This should be studied in depth, as this could lead to bigger problems.

Accuracy in clinical examinations for the diagnosis of vulvovaginitis by CANDIDA SPP. and IN VITRO susceptibility to the main antifungals

Vulvovaginal candidiasis (VVC) is a common infection. This work aims to determine the positive predictive value (PPV) of the clinical diagnosis of VVC and to characterize Candida species isolated from the vaginal mucosa. This cross-sectional study was conducted from February 2016 to February 2017 at the Gynecology and Obstetrics Outpatient Clinic of the Hospital das Clínicas, in Goiânia, Goiás State, Brazil. The study included samples of vaginal secretion from 55 women who complained of vaginal discharge and itching as their main symptoms. The PPV of the clinical diagnosis of VVC was estimated in comparison to the laboratory culture method. The phenotypic methods and molecular tests were performed to identify Candida spp. In vitro susceptibility of Candida spp. isolates to fluconazole, itraconazole, clotrimazole, nystatin, and amphotericin B was determined using the broth microdilution assay. Yeast growth using the enzymes protease, phospholipase, and hemolysin was carried out in media containing respectively bovine albumin, egg yolk, and sheep erythrocytes. A PPV of 61.8% (34/55) was determined. Among the 55 vulvovaginal samples collected, we identified 36 isolates in which C. albicans was the most common species. High resistance to fluconazole and low minimal inhibitory concentration (MIC) values for clotrimazole, nystatin and amphotericin B were observed. All isolates were proteinase and hemolysin producers, while seven strains were phospholipase negative. The clinical diagnosis of VVC presented a moderate PPV, which meant that cultures had to be conducted in the laboratory to confirm infection. The high resistance to fluconazole and itraconazole indicated the importance of the in vitro susceptibility test.

Antifungal effects of Ziziphora tenuior, Lavandula angustifolia, Cuminum cyminum essential oils against clinical isolates of Candida albicans from women suffering from vulvovaginal candidiasis / Efecto antifungico de los aceites esenciales de Ziziphora tenuior, Lavandula angustifolia y Cuminum cyminum contra aislados clínicos de Candida albicans de mujeres que sufren de candidiasis vulvovaginal

Candida sp. especially C. albicans is the main cause of candidiasis in women in reproductive ages. The prevalence of drug resistant C. albicans along with adverse effects of current treatments have encouraged the scientists to research on medicinal plant's essential oils. The aim of this study was to evaluate the potential effects of Ziziphora tenuior, Lavandula angustifolia, Cuminum cyminum essential oils against clinical isolates of C. albicans, which were isolated from women with vulvovaginal candidiasis. The anti-candidal effects of these commercial essential oils were screened against these clinical isolates (n=80) by disc diffusion and micro-broth dilution assays. The means of inhibition zone diameters, MIC and MFCs were reported for each essential oil. Also, the capability of fungal strain for biofilm formation in comparison with C. albicans ATCC 10231 were determined. The anti-biofilm effects of essential oils against 11 biofilm producing strains of C. albicans were determined. The results showed C. cyminum and Z. tenuior essential oils had the best anti-candidal effects, while the best biofilm killing effects was for L. angustifolia essential oil. C. cyminum and Z. tenuior essential oils can be formulated for more evaluations in preclinical and clinical studies.

Candida sp., especialmente C. albicans, es la principal causa de candidiasis en mujeres en edad reproductiva. La aparición de resistencia a los antifungicos de C. albicans, junto con el riesgo de efectos adversos de los tratamientos actuales, ha llevado a los científicos a buscar alternativas en los aceites esenciales derivados de plantas. Los objetivos del estudio fueron evaluar los efectos potenciales de los aceites esenciales de Ziziphora tenuior, Lavandula angustifolia, Cuminum cyminum, contra aislados clínicos de C. albicans, obtenidos de mujeres con candidiasis vulvovaginal. Los efectos anti-Candida de estos aceites esenciales comerciales fueron probados contra estos aislados clínicos (n=80) por difusión en disco y ensayos de microdilución. Se obtuvo el promedio de diámetro de inhibición, MIC y MFCs para cada aceite esencial. También se comparó la capacidad de formación de biopelículas de 11 cepas de C. albicans de cada aislado frente a la cepa de referencia C. albicans ATCC 10231 y la capacidad de cada aceite esencial para evitar la formación de biopelículas. Los resultados muestran que los aceites esenciales de C. cyminum y Z. tenuior tuvieron la mejor actividad anti-Candida, mientras que los mejores efectos para destruir biopelículas se obtuvieron con los aceites esenciales de L. angustifolia. Los aceites esenciales de C. cyminum y Z. tenuior ameritan tener mayores evaluaciones preclínicas y clínicas.

Prevalencia de disfunción vaginal en mujeres de la ciudad de Bahía Blanca (Argentina) / Vaginal dysfunction prevalence in women of the city of Bahía Blanca (Argentina) / A prevalência de disfunção vaginal em mulheres da cidade de Bahía Blanca (Argentina)

La disfunción vaginal (vaginosis/vaginitis) es la patología genital hoy reconocida más prevalente. El objetivo del trabajo fue generar información sobre la prevalencia de Disfunción vaginal y los factores de riesgo asociados en mujeres sintomáticas y asintomáticas. Se incorporó además la detección de C. trachomatis y N. gonorrhoeae. Se consolida la validez del Balance del Contenido Vaginal (BACOVA) en el diagnóstico integral de disfunción vaginal y de la amplificación génica en la detección de C. trachomatis. Se estudiaron 295 mujeres que asistieron al Hospital Municipal de Bahía Blanca. La mayor prevalencia correspondió a vaginosis bacteriana (21,36%), luego levaduras (13,90%), T. vaginalis (3,73%) y C. trachomatis (3,05%). No se detectó ningún caso de gonococia. Los factores de riesgo encuadran en el marco de valores de la región centro sur del país, pero se debe destacar la frecuencia significativa de alteraciones de la función vaginal (68,87%) y la infección por clamidias (4,35%) detectadas en mujeres asintomáticas. Esto impone la necesidad de revisar y optimizar la política de cumplimiento de las Normas Ministeriales de prevención y control con la aplicación de una metodología de laboratorio normatizada en el protocolo de control de mujeres en edad fértil, embarazadas o no.

Vaginal dysfunction (vaginosis/vaginitis) is the most prevalent genital pathology recognized today. The objective of the work was to generate information on the prevalence of vaginal dysfunction and the associated risk factors in symptomatic and asymptomatic women. The detection of C. trachomatis and N. gonorrhoeae was also incorporated. The validity of the Vaginal Content Balance (BACOVA) in the comprehensive diagnosis of vaginal dysfunction and of gene amplification in the detection of C. trachomatis is consolidated. A total of 295 women who attended the Municipal Hospital of Bahía Blanca were studied. The highest prevalence corresponded to bacterial vaginosis (21.36%), then yeasts (13.90%), T. vaginalis (3.73%) and C. trachomatis (3.05%). No cases of gonorrhea were detected. The risk factors fit within the framework of values of the south central region of the country, but the significant frequency of alterations of vaginal function (68.87%) and chlamydial infection (4.35%) detected in asymptomatic women should be noted. This imposes the need to review and optimize the compliance policy of the Ministerial Standards of prevention and control, with the application of a standardized laboratory methodology, in the control protocol for women of childbearing age, pregnant or not.

A disfunção vaginal (vaginose/vaginite) é a patologia genital mais prevalente hoje reconhecida. O objetivo do trabalho foi gerar informações sobre a prevalência de disfunção vaginal e os fatores de risco associados em mulheres sintomáticas e assintomáticas. A detecção de C. trachomatis e N. gonorrhoeae também foi incorporada. A validade do Equilíbrio do Conteúdo Vaginal (BACOVA) no diagnóstico integral da Disfunção Vaginal e da amplificação gênica na detecção de C. trachomatis está consolidada. Estudamos 295 mulheres que freqüentaram o Hospital Municipal de Bahía Blanca. A maior prevalência correspondeu à vaginose bacteriana (21,36%), depois leveduras (13,90%), T. vaginalis (3,73%) e C. trachomatis (3,05%). Nenhum caso de gonorreia foi detectado. Os fatores de risco enquadram-se no quadro de valores da região centro-sul do país, mas deve-se notar a frequência significativa de alterações da função vaginal (68,87%) e infecção por clamídia (4,35%), detectadas em mulheres assintomáticas. Isso impõe a necessidade de rever e otimizar a política de compliance das Normas Ministeriais de prevenção e controle, com a aplicação de metodologia laboratorial padronizada, no protocolo de controle para mulheres em idade fértil, gestantes ou não.

Identificación y características de Candida spp en secreción vaginal de pacientes embarazadas y no embarazadas / Identification and characteristics of Candida spp in vaginal secretion of pregnant and non-pregnant patients

El objetivo de este estudio fue identificar las especies de Candida spp. aisladas de secreción vaginal de pacientes embarazadas y no embarazadas y relacionarlas con la microscopía, síntomas y signos característicos de la vaginitis causada por esta levadura. Se estudiaron 743 muestras de secreción vaginal de pacientes que acudieron al Departamento de Bacteriología y Micología del Laboratorio Central en el 2015. Las muestras fueron sembradas en CHROM agar Candida y agar Sabouraud. La identificación se hizo por macro y micromorfología, pruebas bioquímicas, auxonograma y método comercial. En las 522 pacientes embarazadas se aislaron 536 Candida spp.: C. albicans 463 (86,4%), C. glabrata 46 (8,6%), C. krusei 9 (1,7%), C. parapsilosis 9 (1,7%), C. tropicalis 8 (1,5%), C. lusitaniae 1 (0,1%).En las 221 pacientes no embarazadasse aislaron 222 Candida spp.: C. albicans 163 (73,4%), C. glabrata 31 (14%), C. krusei 10 (4,6%), C. parapsilosis 9 (4,1%), C. tropicalis 6 (2,7%), C. guilliermondii 1 (0,4%), C. kefyr 1 (0,4%) y C. novergensis 1 (0,4%). Se observó un mayor porcentaje de aislamiento de Candida no albicansen las no embarazadas (26,6% vs 13,6%). En 15 pacientes (2%) se aislaron dos especies de Candida.Tanto en embarazadas como no embarazadas el prurito, la reacción inflamatoria y la presencia de pseudohifas fueron más frecuentes cuando el aislamiento era C. albicans. Enfatizamos la importancia de la siembra de las muestras en agar cromogénico para identificar y diferenciar especies de Candida para la epidemiología y un tratamiento eficazde la vaginitis causada por esta levadura.

The objective of this study was to identify Candida spp. isolated from vaginal secretion of pregnant and non-pregnant women and relate them with microscopy, symptoms and signs characteristic of vaginitis caused by this yeast. A total of 743 vaginal secretion samples wasstudied from patients consulting at the Department of Bacteriology and Mycology of the Central Laboratory in 2015. All samples were cultured on CHROM agar Candida and Sabouraud agar. The identification was made by macro and micromorphology, biochemical tests, auxonogram and commercial method. In pregnant patients (n = 522), 536 Candida spp. were isolated: C. albicans 463 (86.4%), C. glabrata 46 (8.6%), C. krusei 9 (1,7%), C. parapsilosis 9 (1.7%), C. tropicalis 8 (1.5%), C. lusitaniae 1 (0.1%). In no-pregnant patients (n = 221),222 Candida spp.were isolated: C. albicans 163 (73.4%), C. glabrata 31 (14%), C. krusei 10 (4.6%), C. parapsilosis 9 (4.1%), C. tropicalis 6 (2.7%), C. guilliermondii 1 (0.4%), C. kefyr 1 (0.4%) and C. novergensis 1 (0.4%).In the non-pregnant women, a higher percentage of non-albicans Candida species isolation was observed (26.6% vs 13.6%). Fifteen patients (2%) with two Candida species were detected. In pregnant as well non pregnant women, presence of pruritus, inflammatory reactions and and presence of pseudohifas were more frequent when Candida albicans was isolated.We emphasize the importance of culturing samples in chromogenic agar to identify and differentiate Candida species for epidemiology and an effective treatment of the vaginitis caused by this yeast.

In vitro synergistic activity of lidocaine and miconazole against Candida albicans / Atividade sinérgica in vitro de lidocaína e miconazole contra Candida albicans

Candida albicans is the main yeast isolated from vulvovaginal candidiasis(VVC) and a major antifungal used to treat VVC is miconazole (MZ), it shows local toxic effects, such as irritation and burns. The lidocaine (LD) is a local anesthetic. The aim of this study was to evaluate the synergistic activity of LD/MZ against 19 strains of C. albicans isolated from vaginal secretion. 78.9% of the strains were susceptible to the combination LD/MZ, demonstrating synergism of drugs. These drugs can be used to produce vaginal creams to treat VVC, especially drug resistant.

Candida albicans é a principal levedura isolada de candidíase vulvovaginal (CVV) e o principal antifúngico usado para tratar a VVC é miconazol (MZ), que apresenta efeitos tóxicos locais, tais como irritação e queimaduras. A lidocaína (LD) é um anestésico local. O objetivo deste estudo foi avaliar a atividade sinérgica de LD/MZ contra 19 cepas de C. albicans isoladas de secreção vaginal. Foram suscetíveis à combinação LD/MZ, 78.9% das cepas testadas, demonstrando sinergismo de drogas. Estes fármacos podem ser utilizados para a produção de cremes vaginais para tratar VVC, especialmente aquelas resistentes aos fármacos disponíveis.

Study of the antifungal potential of (r)-(+)-citronellal and its association with therapeutic agents used in the treatment of vulvovaginal candidiasis / Estudo do potencial antifúngico do (r)-(+)-citronelal e sua associação com agentes terapêuticos utilizados no tratamento da candidíase vulvovaginal

Vulvovaginal candidiasis (VVC) is a common fungal infection that affects healthy women of all ages. At least 75% of women will develop one or more infections once during their lifetime, with 6 to 9% of those individuals developing recurrent infections. In view of this context, this study sought to evaluate the antifungal potential of the isolated (R)-(+)-citronellal [(R)-(+)-CT] and associated to therapeutic agents of clinical importance. The enantiomer was solubilized in tween 80 and dimethylsulfoxide (DMSO). Posteriorly diluted in sterile distilled water up to the concentration of 2048µg/mL. The minimum inhibitory concentration (MIC) of the product was determined by microdilution in RPMI-1640 obtaining dilutions of 1024-4µg/mL. The minimum fungicidal concentration (MFC) was determined by the Sabouraud dextrose agar (SDA) depletion technique from aliquots of 1µL of the MIC, MIC × 2 and MIC × 4. The MIC and the MFC values of (R)-(+)-CT for 90% of the C. albicans strains were 16 and 32µg/mL respectively. In the susceptibility test, C. albicans presented a high resistance to fluconazole and to itraconazole, 12 (92.30%) of the strains. However, for ketoconazole and miconazole the resistance was of 4 (30.76%) and 3 (23.07%) of the strains respectively. In the combination testing of the (R)-(+)-CT with ketoconazole and miconazole, the resistance was completely reverted. For fluconazole and itraconazole, the resistance was reverted in 9 (75%) and 7 (58.33%) of the strains respectively. The (R)-(+)-CT presented fungicide activity with MFC of MIC × 2. When in combination with ketoconazole, fluconazole, itraconazole and miconazole increased the inhibition zones of these antifungal drugs, reducing the resistance against C. albicans.

Candidíase vulvovaginal (CVV) é uma infecção fúngica comum que afeta mulheres saudáveis de todas as idades. Pelo menos 75% das mulheres irão desenvolver uma ou mais infecções uma vez durante a vida, com 6 a 9% dos indivíduos desenvolvendo infecções recorrentes. Diante deste contexto, buscou-se avaliar neste estudo o potencial antifúngico do (R)-(+)-citronelal [(R)-(+)-CT] isolado e associado a agentes terapêuticos de importância clínica. O enantiômero foi solubilizado em tween 80 e dimetilsulfóxido (DMSO). Posteriormente diluiu-se em água destilada estéril até a concentração de 2048µg/mL. A concentração inibitória mínima (CIM) do produto foi determinada por microdiluição em meio RPMI-1640 obtendo diluições de 4-1024µg/mL. A concentração fungicida mínima (CFM) foi determinada pela técnica de esgotamento em agar Sabouraud dextrose (ASD) a partir de alíquotas de 1mL da CIM, CIM × 2 e CIM × 4. A CIM e a CFM do (R)-(+)-CT para 90% das cepas de C. albicans foram 16 e 32µg/mL respectivamente. No ensaio de suscetibilidade, C. albicans apresentou alta resistência ao fluconazol e ao itraconazol, 12 (92.30%) das cepas. No em tanto, para o cetoconazol e o miconazol a resistência foi de 4 (30.76%) e 3 (23.07%) das cepas respectivamente. No ensaio de combinação do (R)-(+)-CT com cetoconazol e miconazol, a resistência foi completamente revertida. Para o fluconazol e o itraconazol, a resistências foi revertida em 9 (75%) e 7 (58.33%) das cepas respectivamente. O (R)-(+)-CT apresentou atividade fungicida com CFM igual à CIM × 2. Quando em combinação com cetoconazol, fluconazol, itraconazol e miconazol ampliou as zonas de inibição desses antifúngicos, diminuindo a resistência contra C. albicans.