Chlamydial infection in a high risk population: association with vaginal flora patterns.

PURPOSE: This study aimed to determine the frequency of Chlamydia trachomatis (CT) infection among high risk Brazilian women and evaluate its association with vaginal flora patterns. METHODS: This was a cross-sectional study, performed in an outpatient clinic of Bauru State Hospital, São Paulo, Brazil. A total of 142 women were included from 2006 to 2008. Inclusion criteria was dyspareunia, pain during bimanual exam, presence of excessive cervical mucus, cervical ectopy or with three or more episodes of abnormal vaginal flora (AVF) in the previous year before enrollment. Endocervical CT testing was performed by PCR. Vaginal swabs were collected for microscopic assessment of the microbial flora pattern. Gram-stained smears were classified in normal, intermediate or bacterial vaginosis (BV), and recognition of Candida sp. morphotypes. Wet mount smears were used for detection of Trichomonas vaginalis and aerobic vaginitis (AV). RESULTS: Thirty-four of 142 women (23.9%) tested positive for CT. AVF was found in 50 (35.2%) cases. The most frequent type of AVF was BV (17.6%). CT was strongly associated with the presence of AV (n = 7, 4.9%, P = 0.018), but not BV (n = 25, 17.6%, P = 0.80) or intermediate flora (n = 18, 12.7%, P = 0.28). CONCLUSIONS: A high rate of chlamydial infection was found in this population. Chlamydia infection is associated with aerobic vaginitis.

Prevalence and risk factors of Chlamydia trachomatis cervicitis in pregnant women at the genital tract infection in obstetrics unit care at Botucatu Medical School, São Paulo State University-UNESP, Brazil.

OBJECTIVE: To evaluate the prevalence of and risk factors for Chlamydia trachomatis cervicitis in pregnant women seen at the Genital Tract Infection in Obstetrics Unit Care in Botucatu Medical School, São Paulo State University - UNESP. MATERIALS AND METHODS: Between June 2006 and February 2008, 101 pregnant women were included in this study. During the gynecologic examination, cervical secretions were collected using cytobrush Plus GT (CooperSurgical Inc) to assess C. trachomatis using polymerase chain reaction. Vaginal flora were examined by Gram stain, and sociodemographic data were extracted from medical records. RESULTS: Of the 101 patients, 26 (25.7%) were positive for C. trachomatis. The median age of the infected group was 24 years (range = 13-40 y), and 48.5% of them had abnormal vaginal flora. The presence of chlamydial infection was associated with smoking (odds ratio [OR] = 2.67, 95% confidence interval [CI] = 1.01-7.19), residing in a city with fewer than 100,000 inhabitants (OR = 2.86, 95% CI = 1.03-7.94), presence of condyloma acuminatum (p = .03), and presence of discreet inflammation on Pap smear (p = .02). CONCLUSIONS: The prevalence of C. trachomatis is high in pregnant women seen at the Genital Infection Unit Care, UNESP, and is related to many risk factors. Therefore, its screening is extremely important in reducing obstetrical and neonatal complications.

Coinfecção de Chlamydia trachomatis e HPV em mulheres com condiloma acuminado / Chlamydia trachomatis and HPV coninfections in women with condiloma acuminata

Introdução:a cervicite por Chlamydia trachomatis é reconhecida como uma das doenças sexualmente transmissíveis (DST) de origem bacterianamais prevalentes no mundo e a infecção genital por Papilomavírus Humano (HPV) é uma das DST de origem viral mais frequentes. Objetivo: avaliara taxa de coinfecção de C. Trachomatis e HPV em mulheres com condiloma acuminado. Métodos: foram incluídas no estudo 30 mulheres com diagnóstico clínico e histopatológico de condiloma acuminado em região vulvar, vaginal ou perianal. As lesões genitais foram excisadas e seccionadas em duas metades, uma para exame histopatológico e outra para extração de DNA. A detecção do DNA de HPV nas amostras foi realizada empregando-se a técnica da reação em cadeia da polimerase (PCR), com posterior genotipagem pela reação de PCR multiplex com primers específicos para diferentes tipos virais. A pesquisa de C. trachomatis também foi realizada por PCR, empregando-se os primers PCT1 e PCT2. Resultados: a positividade de DNA-HPV nas amostras de condiloma acuminado foi de 100%, sendo detectados genótipos 6/11 em 33,3% das amostras, genótipo 18 em 6,7% e infecção por múltiplos genótipos em 56,7% das lesões, e em apenas uma amostra (3,3%) o genótipo não foi identificado. A positividade de C. trachomatis no canal cervical das mulheres com condiloma acuminado foi de 33,3%. Conclusão: a taxa de coinfecção de C. trachomatis e HPV, em mulheres com condiloma acuminado, é alta e a estratégia de rastreamento e tratamento da infecção clamidiana poderia ser incorporada na rotina ginecológica desse grupo de pacientes.

Introduction: Chlamydia trachomatis is worldwide recognized as one of the most prevalent sexually transmitted diseases (STD) of bacterial origin,whereas genital Human Papillomavirus (HPV) infection is one of the most important STD caused by virus. Objective: evaluate the coinfection rateof C. trachomatis and HPV in women with condyloma acuminata. Methods: thirty women were included in the study based on clinical and histopathological diagnosis of condyloma acuminata in vulvar, vaginal or perianal region. The excised lesions were divided into two halves, one was submitted to a histopathological exam and the other to DNA extraction. C. trachomatis was detected by PCR using CTP1 and CTP2 primers and the HPV DNA was detected by PCR and subsequent typed by PCR with HPV specific primers. Results: the HPV DNA positivity was 100% in all samples. HPV type 6/11 was found in 33.3% of the samples, type 18 in 6.7%, and we also found infection with multiple HPV types in 56.7% of HPV induced lesions, and only one sample (3,3%) was not genotyped. The C. trachomatis positivity in cervical secretions of women with condyloma acuminata was 33.3%. Conclusion: the coinfection rate of C. trachomatis and HPV in women with condyloma acuminata is high and the screen and treat strategy for chlamydial infection should be incorporated to gynecology routine care in these patients.