RESUMEN
BACKGROUND: Vaginal candidiasis (VC) commonly affects pregnant women. Traditionally, clotrimazole vaginal tablets (CLO) have been the cornerstone of management. However, sertaconazole ovules (SER) offer a novel topical antimycotic option. This double-blinded, randomized trial evaluated the efficacy of single-dose SER and CLO in treating acute VC during pregnancy. METHODS: From June 2020 to May 2021, this trial recruited pregnant women aged ≥ 18 years with VC symptoms (abnormal vaginal discharge and/or vulvar/vaginal itching) confirmed by microscopy. Participants with ≥ 4 VC episodes in the prior year, immunocompromised status, or imidazole contraindications and those who were absent at the 2-week follow-up were excluded. Participants were randomized to receive either 300 mg SER or 500 mg CLO. Evaluations 2 weeks after the initial medication administration included clinical cure (self-reported resolution of all symptoms), microscopic cure (pseudohyphal absence), patient satisfaction, side effects, and time to clinical cure. Participants with persistent VC received weekly SER doses until delivery. Assessments of recurrence and pregnancy outcomes were done. RESULTS: The analysis included 96 participants (48 per group, mean age 27.4 ± 7.4 years, gestational age at diagnosis 22.9 ± 6.4 weeks). Without statistical significance, SER achieved a higher clinical cure rate (62.5% vs 50%, p = 0.217; a mean difference of 12.5%, 95%CI: -17.5% to 42.5%; and a rate ratio of 1.25, 95%CI: 0.71 to 2.23) and a lower microscopic cure (47.9% vs. 62.5%, p = 0.151; a mean difference of -14.6%, 95%CI: -44.3% to 15.1%; and a rate ratio of 0.77, 95%CI: 0.43 to 1.37). The two groups had comparable times to clinical cure (SER: 3.1 ± 1.8 days, CLO: 3.4 ± 2.7 days; p = 0.848) and substantial satisfaction rates (SER: 66.7%, CLO: 60.4%; p = 0.753). No side effects were reported. Of 60 participants who gave birth at Siriraj Hospital, there were no significant differences in pregnancy outcomes. Repeated SER dosing eradicated symptoms and enhanced the microscopic cure rate. Recurrence was observed in four SER and two CLO participants within 1-2 months. CONCLUSION: In the treatment of acute VC during pregnancy, 300 mg SER and 500 mg CLO exhibited comparable efficacy in terms of clinical and microscopic cure rates, satisfaction, side effects, time to clinical cure, recurrence rates, and pregnancy outcomes. TRIAL REGISTRATION: TCTR20190308004 (registration date March 8, 2019).
Asunto(s)
Candidiasis Vulvovaginal , Clotrimazol , Tiofenos , Adulto , Femenino , Humanos , Embarazo , Adulto Joven , Antifúngicos/uso terapéutico , Candidiasis Vulvovaginal/tratamiento farmacológico , Clotrimazol/uso terapéutico , Imidazoles/uso terapéutico , Mujeres Embarazadas , Supositorios , Tailandia , Pueblos del Sudeste AsiáticoRESUMEN
At concentrations achieved following systemic administration, the primary effect of imidazoles and triazoles on fungi is inhibition of 14-α-sterol demethylase, a microsomal cytochrome P450 (CYP) enzyme. Imidazoles and triazoles impair the biosynthesis of ergosterol for the cytoplasmic membrane and lead to the accumulation of 14-α-methyl sterols. The synthetic imidazole miconazole is additionally able to increase intracellular reactive oxygen species, at least in part through inhibition of fungal catalase and peroxidase. This unique feature of miconazole is probably the basis for its fungicidal activity in C. albicans, in addition to the fungistatic mode of action. Studies show that miconazole is superior to nystatin treatment and demonstrate its impact as one of the best options in managing vulvovaginal candidiasis. Regarding recurrent vulvovaginal candidiasis, several new drugs are currently developed to ensure effective treatment also for this group of patients.
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Candidiasis Vulvovaginal , Miconazol , Femenino , Humanos , Miconazol/efectos adversos , Candidiasis Vulvovaginal/tratamiento farmacológico , Candidiasis Vulvovaginal/microbiología , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Imidazoles/farmacología , Imidazoles/uso terapéutico , Nistatina/farmacología , Nistatina/uso terapéutico , Candida albicans , Sistema Enzimático del Citocromo P-450/uso terapéuticoRESUMEN
The study aims to evaluate the additive effect of intra-vaginal gentian violet (GV) on a single dose oral 200 mg fluconazole for acute vaginal candidiasis (VC). Women aged ≥18 years who had VC were randomly allocated to receive either fluconazole 200 mg (group 1, FLU, N = 90); or the fluconazole with GV (group 2, FLU + GV, N = 93). Outcome measures were 2-week clinical cure rate, conversion of positive fungal culture, time-to-cure, side effects, satisfaction and symptomatic recurrence within 2 months. No significant difference of participants' characteristics was observed. They were 32.4 ± 8.7 year-old and non-obese. Participants receiving FLU + GV had higher clinical cure rates (81.7% vs. 74.4%, p=.236); lower recurrence rate (19.4% vs. 30.0%, p=.097); shorter time-to-cure (3.1 vs. 4.0 days, p=.013); but lower culture conversion rate (74.2% vs. 80.0%, p=.351). Participants in both groups reported high satisfaction and none had severe adverse events. In conclusion, the addition of GV results in a shorter time-to-cure but not cure rate. Clinical trial registration: TCTR20180917003 (http://thaiclinicaltrials.org/show/TCTR20180917003).Impact StatementWhat is already known on this subject? The efficacy of fluconazole for acute vaginal candidiasis is limited to 75-90% due to drug resistance and non-albicans Candida. Gentian violet (GV) has long been used for mucosal candidiasis; and is recommended as the second line treatment for women with recurrent vulvovaginal candidiasis (RVVC).What do the results of this study add? Adding GV to a single oral 200 mg fluconazole results in a quicker resolution of symptoms of acute VC but not cure rate. The participants' satisfaction and acceptance are high. Lifestyle modification, particularly reduction of sugar-rich diet, associates with the higher culture-based cure rate.What are the implications of these findings for clinical practice and/or further research? As GV is widely and easily accessible, and speculum examination with or without microscopy is the main diagnostic tool of VC; the single application of GV seems doable in real-life practice. This simple anti-septic solution can accelerate symptom resolution. However, the proper frequency of GV application should be further explored. As importantly, lifestyle modification should always be included in counselling session to optimise treatment outcome.
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Candidiasis Vulvovaginal , Candidiasis , Adolescente , Adulto , Antifúngicos , Candidiasis Vulvovaginal/inducido químicamente , Femenino , Fluconazol , Violeta de Genciana/uso terapéutico , Humanos , Azúcares/uso terapéutico , Adulto JovenRESUMEN
BACKGROUND: Youth with perinatally acquired HIV (YPHIV) are at higher risk for anogenital human papillomavirus (HPV) infection. METHODS: We enrolled a cohort of YPHIV and HIV-negative youth in Thailand and Vietnam, matched by age and lifetime sex partners, and followed them up for 144 weeks (to 2017). Participants had annual pelvic examinations with samples taken for HPV genotyping. Concordant infection was simultaneous HPV detection in multiple anogenital compartments (cervical, vaginal, anal); sequential infection was when the same type was found in successive compartments (cervicovaginal to/from anal). Generalized estimating equations were used to assess factors associated with concordant infection, and Cox regression was used to assess factors associated with sequential infection. RESULTS: A total of 93 YPHIV and 99 HIV-negative women were enrolled, with a median age of 19 years (interquartile range, 18-20 years). High-risk anogenital HPV infection was ever detected in 76 (82%) YPHIV and 66 (67%) HIV-negative youth during follow-up. Concordant anogenital high-risk HPV infection was found in 62 (66%) YPHIV versus 44 (34%) HIV-negative youth. Sequential cervicovaginal to anal high-risk HPV infection occurred in 20 YPHIV versus 5 HIV-negative youth, with an incidence rate of 9.76 (6.30-15.13) versus 2.24 (0.93-5.38) per 100 person-years. Anal to cervicovaginal infection occurred in 4 YPHIV versus 0 HIV-negative women, with an incidence rate of 1.78 (0.67-4.75) per 100 person-years. Perinatally acquired HIV was the one factor independently associated with both concordant and sequential high-risk HPV infection. CONCLUSIONS: Children and adolescents with perinatally acquired HIV should be prioritized for HPV vaccination, and cervical cancer screening should be part of routine HIV care for sexually active YPHIV.
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Infecciones por VIH , Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Adolescente , Adulto , Niño , Detección Precoz del Cáncer , Femenino , Infecciones por VIH/epidemiología , Humanos , Papillomaviridae/genética , Infecciones por Papillomavirus/epidemiología , Prevalencia , Factores de Riesgo , Tailandia/epidemiología , Neoplasias del Cuello Uterino/epidemiología , Adulto JovenRESUMEN
PURPOSE: To compare the clinical response, microscopic examination and fungal culture between dequalinium chloride (DQC) and clotrimazole (CT) for treating vaginal candidiasis (VC). METHODS: The double-blind, randomized study was conducted from September 2014 to September 2016 at Siriraj Hospital, Thailand. Eligible participants were Thai women diagnosed with VC by microscopic examination. The exclusion criteria included immunocompromised conditions, consumption of antifungal drugs, and having recurrent VC. Each participant was randomized with a 1:1 allocation to receive six vaginal tablets of 100 mg CT or 10 mg DQC. Two visits included 10 ± 2 days (C1) and 38 ± 4 days (C2). Outcome measures were improvement of VC symptoms, microscopic examination, culture, satisfaction and tolerability. RESULTS: Of 155 eligible participants, 150 were randomized and allocated into CT (N = 76) and DQC (N = 74). The average age was 31.1 ± 7.2 years. Comparable improvement of clinical response was demonstrated (OR at C1 0.79, 95% CI 0.56-1.10, p = 0.197; and OR at C2 0.99, 95% CI 0.69-1.43, p = 0.985). Of CT and DQC groups, the microscopic examination was positive at 11/75 (14.9%) vs 18/72 (25.3%) at C1 and 18/74 (24.3%) vs 28/66 (42.4%) at C2. And the culture was positive at 25/75 (33.8%) vs 46/72 (65.7%) at C1 and at 26/74 (36.6%) vs 46/66 (69.7%) at C2. Most participants had high satisfaction and tolerability and none reported any side effects. CONCLUSION: DQC and CT show comparable clinical response but CT results in greater improvement of microscopic examination and fungal culture. CLINICAL TRIAL REGISTRATION: The Clinical Trial Registry number was NCT02242695. (September 17, 2014).
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Antiinfecciosos Locales/uso terapéutico , Antifúngicos/uso terapéutico , Candidiasis Vulvovaginal/tratamiento farmacológico , Clotrimazol/uso terapéutico , Decualinio/uso terapéutico , Adulto , Candidiasis Vulvovaginal/diagnóstico , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Comprimidos/administración & dosificación , Tailandia , Cremas, Espumas y Geles VaginalesRESUMEN
BACKGROUND: Female youth with perinatally acquired human immunodeficiency virus (PHIV) may be at higher risk than uninfected youth for persistent anogenital human papillomavirus (HPV) infection, due to prolonged immunodeficiency. METHODS: A 3-year cohort study was conducted between 2013 and 2017 among Thai and Vietnamese PHIV and HIV-uninfected females 12-24 years, matched by age group and number of lifetime sexual partners. For HPV genotyping, cervical and anal samples were obtained at baseline and annually. Vaginal samples were collected at baseline and every 6 months. Factors associated with high-risk HPV (HR-HPV) persistence and incidence were assessed. RESULTS: We enrolled 93 PHIV and 99 HIV-uninfected females. Median age was 19 (interquartile range [IQR] 18-20) years. For the 7 HR-HPV types (16, 18, 31, 33, 45, 52, 58) in the nonavalent HPV vaccine, PHIV had significantly higher incidence (P = .03) and persistence (P = .01) than HIV-uninfected youth over a 3-year period. Having HIV (adjusted hazard ratio [aHR] 2.1, 95% confidence interval [CI] 1.1-3.9) and ever using illegal substances (aHR 4.8, 95% CI 1.8-13.0) were associated with incident 7 HR-HPV infections. HIV-positive status (adjusted prevalence ratio [aPR] 2.2, 95% CI 1.5-3.2), recent alcohol use (aPR 1.75, 95% CI 1.2-2.5), and higher number of lifetime partners (aPR 2.0, 95% CI 1.4-3.1, for 3-5 partners; aPR 1.93, 95% CI 1.2-3.2, for ≥6 partners) were significantly associated with persistent 7 HR-HPV infections. CONCLUSIONS: Female PHIV were at higher risk of having anogenital HR-HPV acquisition and persistence. Primary and secondary prevention programs for HPV infection and HPV-related diseases should be prioritized for PHIV children and youth.
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Infecciones por VIH , Infecciones por Papillomavirus , Adolescente , Adulto , Niño , Estudios de Cohortes , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Incidencia , Papillomaviridae/genética , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/epidemiología , Prevalencia , Factores de Riesgo , Tailandia , Adulto JovenRESUMEN
Objectives: The aim of this study was to compare changes in body weight in women using a combined oral contraceptive (COC) consisting of 30-µg ethinylestradiol (EE) and 2-mg chlormadinone acetate (CMA) or a COC consisting of 30-µg EE and 3-mg drospirenone (DRSP).Methods: This randomised double-blind controlled trial (ClinicalTrials.gov NCT01608698) was conducted at a university hospital-based clinic in Thailand between June 2012 and September 2015. A total of 102 women were enrolled in the study, 99 of whom were randomised to EE/CMA (n = 45) or EE/DRSP (n = 54). Each participant was treated for six cycles. Body weight and other parameters as well as side effects were recorded at baseline and at the end of the third and sixth cycles of treatment.Results: A significant difference was observed in mean body weight change between the EE/CMA and EE/DRSP groups from both baseline to third cycle (0.51 ± 1.36 kg vs -0.43 ± 1.56 kg; p = .003) and baseline to sixth cycle (1.00 ± 1.84 kg vs -0.20 ± 2.23 kg; p = .013). The mean difference in body mass index and waist circumference had a similar trend to that of the mean difference in body weight. There was no significant difference in side effects between groups.Conclusion: A COC containing 30-µg EE/3-mg DRSP tended to confer a significantly more favourable change in body weight over a 6-month period compared with a COC containing 30-µg EE/2-mg CMA, which was associated with an increase in body weight.
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Androstenos/efectos adversos , Peso Corporal/efectos de los fármacos , Acetato de Clormadinona/análogos & derivados , Anticonceptivos Orales Combinados/efectos adversos , Etinilestradiol/análogos & derivados , Aumento de Peso/efectos de los fármacos , Adolescente , Adulto , Índice de Masa Corporal , Acetato de Clormadinona/efectos adversos , Método Doble Ciego , Etinilestradiol/efectos adversos , Femenino , Humanos , Adulto JovenRESUMEN
Background: Infection with high-risk human papillomavirus (HR-HPV) may be higher in perinatally human immunodeficiency virus (HIV)-infected (PHIV) than HIV-uninfected (HU) adolescents because of long-standing immune deficiency. Methods: PHIV and HU females aged 12-24 years in Thailand and Vietnam were matched by age group and lifetime sexual partners. At enrollment, blood, cervical, vaginal, anal, and oral samples were obtained for HPV-related testing. The Wilcoxon and Fisher exact tests were used for univariate and logistic regression for multivariate analyses. Results: Ninety-three PHIV and 99 HU adolescents (median age 19 [18-20] years) were enrolled (June 2013-July 2015). Among PHIV, 94% were currently receiving antiretroviral therapy, median CD4 count was 593 (392-808) cells/mm3, and 62% had a viral load <40 copies/mL. Across anogenital compartments, PHIV had higher rates of any HPV detected (80% vs 60%; P = .003) and any HR-HPV (60% vs 43%, P = .02). Higher proportions of PHIV had abnormal Pap smears (eg, atypical squamous cells of unknown significance [ASC-US], 12% vs 14%; low-grade squamous intraepithelial neoplastic lesions, 19% vs 1%). After adjusting for ever being pregnant and asymptomatic sexually transmitted infections (STI) at enrollment, PHIV were more likely to have HR-HPV than HU (odds ratio, 2.02; 95% confidence interval, 1.09-3.77; P = .03). Conclusions: Perinatal HIV infection was associated with a higher risk of HR-HPV and abnormal cervical cytology. Our results underscore the need for HPV vaccination for PHIV adolescents and for prevention and screening programs for HPV and other STIs.
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Cuello del Útero/patología , Infecciones por VIH/complicaciones , Infecciones por Papillomavirus/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Enfermedades de Transmisión Sexual/complicaciones , Adolescente , Recuento de Linfocito CD4 , Femenino , VIH/aislamiento & purificación , Infecciones por VIH/epidemiología , Humanos , Estudios Longitudinales , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Factores de Riesgo , Enfermedades de Transmisión Sexual/epidemiología , Tailandia/epidemiología , Frotis Vaginal , Vietnam/epidemiología , Carga Viral , Adulto JovenRESUMEN
STUDY QUESTION: Will the use of levonorgestrel (LNG) 1.5 mg taken at each day of coitus by women who have relatively infrequent sex be an efficacious, safe and acceptable contraceptive method? SUMMARY ANSWER: Typical use of LNG 1.5 mg taken pericoitally, before or within 24 h of sexual intercourse, provides contraceptive efficacy of up to 11.0 pregnancies per 100 women-years (W-Y) in the primary evaluable population and 7.1 pregnancies per 100 W-Y in the evaluable population. WHAT IS KNOWN ALREADY: LNG 1.5 mg is an effective emergency contraception following unprotected intercourse. Some users take it repeatedly, as their means of regular contraception. STUDY DESIGN, SIZE, DURATION: This was a prospective, open-label, single-arm, multicentre Phase III trial study with women who have infrequent coitus (on up to 6 days a month). Each woman had a follow-up visit at 2.5, 4.5 and 6.5 months after admission or until pregnancy occurs if sooner, or she decided to interrupt participation. The study was conducted between 10 January 2012 and 15 November 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 330 healthy fertile women aged 18-45 years at risk of pregnancy who reported sexual intercourse on up to 6 days a month, were recruited from four university centres located in Bangkok, Thailand; Campinas, Brazil; Singapore and Szeged, Hungary to use LNG 1.5 mg pericoitally (24 h before or after coitus) as their primary method of contraception. The participants were instructed to take one tablet every day she had sex, without taking more than one tablet in any 24-h period, and to maintain a paper diary for recording date and time for every coital act and ingestion of the study tablet, use of other contraceptive methods and vaginal bleeding patterns. Anaemia was assessed by haemoglobin evaluation. Pregnancy tests were performed monthly and pregnancies occurring during product use were assessed by ultrasound. At the 2.5-month and final visit at 6.5 months, acceptability questions were administered. MAIN RESULTS AND THE ROLE OF CHANCE: There were 321 women included in the evaluable population (which includes all eligible women enrolled), with 141.9 woman-years (W-Y) of observation and with a rate (95% confidence interval [CI]) of 7.1 (3.8; 13.1) pregnancies per 100 W-Y of typical use (which reflects use of the study drug as main contraceptive method, but also includes possible use of other contraceptives from admission to end of study) and 7.5 (4.0; 13.9) pregnancies per 100 W-Y of sole use. In the primary evaluable population (which includes only eligible enrolled women <35 years old), the rate was 10.3 (5.4; 19.9) pregnancies per 100 W-Y of typical use, and 11.0 (5.7; 13.1) pregnancies per 100 W-Y of sole use. There were three reported severe adverse events and 102 other mild adverse events (most common were headache, nausea, abdominal and pelvic pain), with high recovery rate. The vaginal bleeding patterns showed a slight decrease in volume of bleeding and the number of bleeding-free days increased over time. There was only one case of severe anaemia, found at the final visit (0.4%). The method was considered acceptable, as over 90% of participants would choose to use it in the future or would recommend it to others. LIMITATIONS, REASONS FOR CAUTION: This was a single-arm study with small sample size, without a control group, designed as a proof of concept study to explore the feasibility of this type of contraception. WIDER IMPLICATIONS OF THE FINDINGS: A larger clinical study evaluating pericoital contraception with LNG is feasible and our data show that this method would be acceptable to many women. STUDY FUNDING/COMPETING INTERESTS: This study received partial financial support from the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR) and the World Health Organization. Gynuity and the Bill and Melinda Gates Foundation (BMGF) provided financial support for project monitoring. HRA Pharma donated the LNG product. N.K. was the initial project manager when she was with WHO/HRP and was employed by HRA Pharma, which distributes LNG for emergency contraception. The other authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER: This study was registered on ANZCTR, Trial ID ACTRN12611001037998. TRIAL REGISTRATION DATE: 4 October 2011. DATE OF FIRST PATIENT'S ENROLMENT: 10 January 2012.
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Anticoncepción Postcoital/métodos , Anticonceptivos Sintéticos Orales/uso terapéutico , Levonorgestrel/uso terapéutico , Adolescente , Adulto , Coito , Anticonceptivos Sintéticos Orales/administración & dosificación , Anticonceptivos Sintéticos Orales/efectos adversos , Femenino , Humanos , Levonorgestrel/administración & dosificación , Levonorgestrel/efectos adversos , Persona de Mediana Edad , Embarazo , Conducta SexualRESUMEN
BACKGROUND: Cultures of genitourinary tract microorganisms have been included in routine evaluation for all pregnant women who present with presumptive preterm labor However some studies found that this assessment is costly and adds little value. OBJECTIVE: To determine the proportion of pregnant women with presumptive preterm labor who had positive culture of genitourinary tract microorganisms and to determine the relationship of positive genitourinary infection and pregnancy outcomes. MATERIAL AND METHOD: This retrospective cohort study was performed at Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University. Medical records of pregnant women with presumptive preterm labor who were admitted in non-private labor room between January 2003 and December 2008 were reviewed Characteristics, results of vaginal swab culture and urine culture, and clinical outcomes were analyzed and reported. RESULTS: The prevalence of positive culture of genitourinary tract microorganisms in presumptive preterm labor-women (total n = 704) was 24.3% (95% CI = 21.3-27.6), 22.1% (95% CI = 19.1-25.4) of vaginal swab culture and 5.3% (95% CI = 3.8-7.2) of urine culture. However only 9.8% were pathologic organisms. There were no statistically significant differences in characteristics and rate of preterm labor between women with a positive and a negative culture. Moreover, there were no statistically significant differences in characteristics and preterm birth outcomes between women in both groups. CONCLUSION: There were no clinical significances of positivity of pathologic bacteria from genitourinary tract as a predictor of preterm delivery and its outcomes. Although the prevalence is quite high, the value of these screenings is still questionable.
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Trabajo de Parto Prematuro , Complicaciones Infecciosas del Embarazo/microbiología , Infecciones Urinarias/microbiología , Adulto , Femenino , Humanos , Valor Predictivo de las Pruebas , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo , Prevalencia , Estudios Retrospectivos , Tailandia/epidemiología , Urinálisis , Infecciones Urinarias/epidemiologíaRESUMEN
Pyometra is an uncommon gynecologic condition that usually develops in elderly women. Most of the cases result from cervical occlusion by malignant or benign tumors, surgery, radiotherapy, or atrophic cervicitis. A spontaneous perforation of the uterus with generalized peritonitis is an extremely rare complication of pyometra and carries significant morbidity and mortality. Establishing a correct diagnosis preoperatively is not easy due to the non-specificity of the symptoms. The authors present a case report of peritonitis caused by spontaneously perforated pyometra that was diagnosed intraoperatively. The cervical canal was not occluded and the cause of perforation remains obscure.
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Peritonitis/etiología , Piómetra/complicaciones , Abdomen Agudo/etiología , Anciano de 80 o más Años , Resultado Fatal , Femenino , Humanos , Piómetra/diagnóstico por imagen , Rotura Espontánea , UltrasonografíaRESUMEN
OBJECTIVE: To report characteristics of the patients with septic abortion between 2006 and 2010. MATERIAL AND METHOD: The present retrospective study was done by reviewing the medical records of the women who were admitted to Siriraj Hospital between 2006 and 2010 with the diagnosis of septic abortion. RESULTS: Eighty-three women were admitted to Siriraj Hospital and diagnosed with septic abortion. The mean age was 25.1 years (range 14 to 40 years) and the mean gestational age was 11.3 weeks (range 6 to 24 weeks). Fifty percent of them had a history of induced abortion and 65% came with an incomplete abortion. The principal presenting symptom was abnormal uterine bleeding. Insertion of vaginal tablets appeared to be the most commonly used method of induced abortion. Ampicillin and gentamicin plus metronidazole were the mainstay empirical antibiotics. Length of hospital stay ranged from 2 to 24 days. After the clinical improvement, oral pill was the most popular contraceptive method. CONCLUSION: Septic abortion remains a big issue in Thai society. To mitigate the problem, sex education, particularly emphases on contraception, should be encouraged.
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Aborto Séptico , Aborto Séptico/diagnóstico , Aborto Séptico/tratamiento farmacológico , Aborto Séptico/epidemiología , Adolescente , Adulto , Antibacterianos/administración & dosificación , Femenino , Humanos , Tiempo de Internación , Embarazo , Estudios Retrospectivos , Tailandia/epidemiología , Cremas, Espumas y Geles Vaginales , Adulto JovenRESUMEN
OBJECTIVE: To study the prevalence and associating factors of hepatitis B infection in the Premarital Counseling Clinic at Siriraj Hospital. MATERIAL AND METHOD: The data (medical history, physical examination, and Hepatitis B profile) was collected from medical records of 740 couples who attended the Premarital Counseling Clinic in Siriraj Hospital between September 2005 and December 2009 for this retrospective study. RESULTS: The prevalence of positive HBsAg in couples who attended the Premarital Counseling Clinic, Siriraj Hospital was 4.2%, which was 3.0% in male and 1.2% in female. The mean age of male was 32.9 +/- 5.1 years old and 30.7 +/- 3.9 years old in female. History of hepatitis B vaccination was found less in male (male 6.1% vs. female 8.8%). Four point two percent of participants were positive HBsAg but negative of HBsAb. Twenty-four couples were at risk or 3.2%. Male gender and history of no hepatitis B vaccination was significantly associated with positive HBsAg. No significant difference was found between age and occupation. CONCLUSION: The prevalence of positive HBsAg in the Premarital Counseling Clinic, Siriraj Hospital was 4.2%. Male gender and history of no hepatitis B vaccination had significant association with positive HBsAg.
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Hepatitis B/epidemiología , Consejo Sexual , Adulto , Distribución de Chi-Cuadrado , Femenino , Hepatitis B/prevención & control , Antígenos de Superficie de la Hepatitis B/análisis , Vacunas contra Hepatitis B/administración & dosificación , Humanos , Modelos Logísticos , Masculino , Prevalencia , Factores Sexuales , Tailandia/epidemiologíaRESUMEN
BACKGROUND: Cervical cancer is one of the most common AIDS-related malignancies in Thailand. To prevent cervical cancer, The US Public Health Service and The Infectious Disease Society of America have recommended that all HIV-infected women should obtain 2 Pap smears 6 months apart after the initial HIV diagnosis and, if results of both are normal, should undergo annual cytological screening. However, there has been no evidence in supporting whether this guideline is appropriate in all settings - especially in areas where HIV-infected women are living in resource-constrained condition. METHODS: To determine the appropriate interval of Pap smear screenings for HIV-infected Thai women and risk factors for subsequent abnormal cervical cytology, we assessed the prevalence, cumulative incidence and associated factors of cervical cell abnormalities (atypical squamous cell of undetermined significance or higher grades, ASCUS+) among this group of patients. RESULTS: The prevalence of ASCUS+ was 15.4% at the first visit, and the cumulative incidence of ASCUS+ gradually increased to 37% in the first 3.5 years of follow-up appointments (first 7 times), and tended to plateau in the last 2 years. For multivariate correlation analysis, women with a CD4 count <350 cells/µL had a significant correlation with ASCUS+ (P = 0.043). There were no associations of subsequent ASCUS+ with age, pregnancy, contraceptive method, highly active anti-retroviral treatment, assumed duration of infection, or the CD4 count nadir level. CONCLUSION: There are high prevalence and cumulative incidence of ASCUS+ in HIV-infected Thai women. With a high lost-to-follow-up rate, an appropriate interval of Pap smear screening cannot be concluded from the present study. Nevertheless, the HIV-infected Thai women may require more than two normal semi-annual Pap smears before shifting to routinely annual cytologic screening.
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Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/patología , Cuello del Útero/patología , Prueba de Papanicolaou , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/patología , Frotis Vaginal , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/virología , Adolescente , Adulto , Anciano , Cuello del Útero/virología , Técnicas Citológicas , Detección Precoz del Cáncer , Femenino , VIH , Humanos , Incidencia , Persona de Mediana Edad , Embarazo , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Tailandia/epidemiología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/virología , Adulto JovenRESUMEN
OBJECTIVE: Vulvovaginal health is important to women's overall health, fertility, sexuality, self-perception, self-confidence and intimacy. It is important to identify the existing perceptions and levels of knowledge about intimate care practices from women in different countries, and with different cultures, religions, and perspectives to help women overcome barriers to optimal intimate care. METHODS: An anonymous online survey about general and intimate hygiene routines/habits was distributed across 10 countries (England, France, Germany, Italy, Portugal, Russia, China, Philippines, Taiwan, Thailand). The sample consisted of around 10,000 women (aged 18 to 60 years) recruited through an online panel. RESULTS: The survey indicates that for many women, cleaning the intimate area is not just about hygiene, but also about taking care of themselves. Intimate care practices, performed daily, varies widely among the countries (from 38% to 91%). Italy, Philippines Portugal, Russia and Thailand were the countries with higher percentage. Intimate care is mainly associated with hygiene and health benefit, but interestingly women engage in intimate care more often with age. Most women worldwide are comfortable talking about female genitalia but still consider it a taboo topic, particularly among younger generations. Asian countries continue to carry negative connotations. CONCLUSIONS: This survey is the first of its kind for number of women involved in this research and for multi-cultural design. Women perceive that practicing intimate care positively impacts their health and wellbeing. However, intimate care is still not one of the most frequent daily routines for many women.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Internacionalidad , Autocuidado/psicología , Adolescente , Adulto , China , Inglaterra , Femenino , Francia , Alemania , Humanos , Italia , Persona de Mediana Edad , Filipinas , Portugal , Federación de Rusia , Autocuidado/normas , Autocuidado/estadística & datos numéricos , Autoeficacia , Encuestas y Cuestionarios , Taiwán , TailandiaRESUMEN
OBJECTIVE: To describe the treatment pattern of condyloma acuminata in female. MATERIAL AND METHOD: The 5-year medical records of 449 women treated for genital condyloma acuminata at the Gynecologic Infectious Diseases and Female Sexually Transmitted Disease (GID-FSTD) unit were reviewed. Data included the distribution of age, client by category, anatomical site and size, serologically coexisting sexually transmitted infection (STI), and treatment modalities. RESULTS: About half, 50.1%, of treatment was the application of topical trichloroacetic acid; followed by podophylline in the proportion of 35.5%. While the electric cauterization and imiquimod applications were uncommon therapy. Two-fifth ofthe subjects, 40.7%, was completely cured, and the remaining cases required additional management. CONCLUSION: The present setting, the wide range of treatment available is reflection of the fact that there is no ideal management.
Asunto(s)
Condiloma Acuminado/terapia , Enfermedades de los Genitales Femeninos/terapia , Adyuvantes Inmunológicos/administración & dosificación , Administración Tópica , Adulto , Aminoquinolinas/administración & dosificación , Cáusticos/administración & dosificación , Cauterización , Femenino , Humanos , Imiquimod , Pomadas , Podofilino/administración & dosificación , Estudios Retrospectivos , Resultado del Tratamiento , Ácido Tricloroacético/administración & dosificación , Adulto JovenRESUMEN
BACKGROUND: Infection with high-risk human papillomavirus (HR-HPV) has been shown to be more prevalent and persistent in female adolescents with HIV. However, data among male adolescents with perinatally acquired HIV (PHIV) are limited. SETTING: We investigated the incidence and persistence of HR-HPV in anogenital compartments and associated factors among PHIV in comparison to HIV-uninfected (HU) male adolescents in Thailand. METHODS: PHIV and HU males aged 12-24 years were enrolled. At baseline and 3 subsequent annual visits, specimens from the scrotum, penis, and anal area were obtained for HPV and other testing. RESULTS: From June 2013 to October 2017, 49 PHIV and 47 HU male adolescents with a median age of 18 (interquartile range 17-20) years were enrolled. PHIV had higher incidence of any HR-HPV infection than HU adolescents {33.05 [95% confidence interval (CI): 20.82 to 52.46] vs. 15.73 [95% CI: 8.18 to 30.22] per 100 person-years, P = 0.04}. The persistence of any HR-HPV genotypes (detected at ≥2 annual visits) was not different by group (PHIV 27% vs. HU 23%, P = 0.75). Having ≥3 sex partners in past 6 months (adjusted prevalence ratio 2.39, 95% CI: 1.14 to 5.05; P = 0.02) and co-infection with other sexually transmitted infections (syphilis, chlamydia, and/or gonorrhea) were associated with persistent HR-HPV infection (adjusted prevalence ratio 6.21, 95% CI: 2.87 to 13.41; P < 0.001). CONCLUSIONS: Thai PHIV male adolescents had a higher incidence of HR-HPV infection than those without HIV. Having multiple sex partners and co-infection with sexually transmitted infections was associated with persistent HR-HPV infection. These data demonstrate the need to prioritize PHIV male adolescents in routine and catch-up HPV vaccination programs.
Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por Papillomavirus/epidemiología , Adolescente , Niño , Coinfección/epidemiología , Coinfección/etiología , Infecciones por VIH/complicaciones , Humanos , Incidencia , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Masculino , Infecciones por Papillomavirus/complicaciones , Factores de Riesgo , Tailandia/epidemiología , Vietnam/epidemiología , Adulto JovenRESUMEN
BACKGROUND: The single-rod Implantable contraceptive method, called 'Implanon', has been introduced for use in Thailand since the 1990s. The outstanding attribute was that it requires only a few minutes for insertion and removal as it has only one capsule. The single-rod implant was used in women at Siriraj Hospital in 2006. The present study looked at characteristics of women, complications of insertion and removal, menstrual events that occurred to women during one year of use and reason for removal of the method. MATERIAL AND METHOD: This was a retrospective clinic based study. All women's record files were examined at Siriraj Hospital's Family Planning Clinic. There were 166 women enrolled to undergo this method, and only 89 women (54.6%) came back for the one-year follow-up visit. Women's accounts on irregularity of menses, complaints during method used and reason for discontinuation, pregnancy and body weight change were assessed. RESULTS: Most women (68%) using the implant contraceptive method were 29 years of age with 74% of vocational or lower education. Their BMI was 22.66 +/- 4.06 Insertion time was about 1 minute with no difficulty or complication. Of those women, 40.4% of them considered having regular menstrual cycle and 30.3% had regular menstrual flow for a few months alternately with no menses for a few months. Prolonged menstrual bleeding was the most complaint in this group of women. Amenorrhoea was also reported. Vertigo had occurred to some women without reported medication. One woman asked for the removal of the method due to pain at the implanted site after 8 months of use. Removal time was around 2-3 minutes. There was no pregnancy that occurred in the course of one year of use. CONCLUSION: Of 89 women using the implant contraceptive method, menstrual irregularity was the important issue that women complained about. However, the removal of the method in one woman was due to the pain at the implanted site. There was no difficulty or complications in insertion or removal of the implant. Close counseling about side effects of the method is emphasized during use to maintain long-term use or until completion of the duration of the device.
Asunto(s)
Anticonceptivos Femeninos/administración & dosificación , Desogestrel/administración & dosificación , Servicios de Planificación Familiar/estadística & datos numéricos , Ciclo Menstrual/efectos de los fármacos , Adolescente , Adulto , Amenorrea , Índice de Masa Corporal , Anticonceptivos Femeninos/efectos adversos , Desogestrel/efectos adversos , Implantes de Medicamentos , Femenino , Humanos , Estudios Retrospectivos , Tailandia , Factores de TiempoRESUMEN
BACKGROUND: Oral Contraceptive (OC) services are not frequented a lot in Siriraj Hospital. Therefore, the OC services initiated the Siriraj OC Members Club to increase the number of OC users, develop a 'one-stop-service' clinic and a 'help line' to assist women cope with the side effects during OC use, and provide proper information. MATERIAL AND METHOD: Hospital personnel who worked at Sirriaj Hospital were informed about the program of the Siriraj OC Members Club by posters, leaflets, hospital website, and word of mouth. Those who registered as members participated in the half-day meeting of the program. Questionnaire assessment was distributed to all members who attended the meeting. RESULTS: The average age ofparticipants was 31.4 years. The lowest education level was secondary school and the highest was doctorate. Most married members have used at least one kind of contraceptive method OC's and condoms were the most common contraceptive method used in the past. Their source for obtaining OC was drug stores. In general, most women had had irritability and depression. Almost all women expected to have more information about advantages and disadvantages of OC use to cope with fear and side effects of OC use. CONCLUSION: Women who attended the meeting still need accurate and full information about the OC's. This program proposed to provide them with up-to-date and correct information about the OC. Furthermore, the one-stop-service will save their time and the help-line will assist them to cope with the side effects of OC use.
Asunto(s)
Anticonceptivos Femeninos , Anticonceptivos Orales , Conocimientos, Actitudes y Práctica en Salud , Aceptación de la Atención de Salud , Satisfacción del Paciente/estadística & datos numéricos , Personal de Hospital/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Adulto , Anticoncepción , Femenino , Encuestas de Atención de la Salud , Humanos , Encuestas y Cuestionarios , TailandiaRESUMEN
Our medical ethics team has a great opportunity to consider the terminology of"Moral Rights", "Good guys", "Understanding the real world" and the issues about "live salvation". What has been mentioned about these terms in Buddhism? In Buddhism, it has been cited that moral duty is the cause that leads to the moral rights as result. When we act the right as well as decent things, we are entitled to get the fair deals in return. We used to forget to consider that, isn't our moral duty or not?, to just either pay respect to the other people's rights or simply protect the other people's rights. Regarding to the Buddhism religion, there are a certain criteria to be "Good guys" i.e. firstly, not to make any sin at all such as not to exploit the others physically, verbally and mentally. Secondly, to make merits, such as helping out; showing the mercy and kindness to the underprivileged; donating money, land and properties, or even sharing the justified idea is also included. We also forgot to ask about tempting the others with a certain of hindrance i.e. assets, land and properties. Have you already made the sin with these temptations or dominating the idea of people? How the people will understand the fine line between the sin and meritorious deed? Buddhism kindly advises us to understand and consider the real world in two steps as well as in parallel way. Looking around us as surrounding of illusion. These illusion or fantasies will not be sustainable, only temporarily indeed. For example, human being has to go through aging process, illness and eventually death. What we need to consider in parallel is the matter about "Within us". What is the secret issue about "Within us"? Brain, spirit, heart or extremities, wherever we point at, will be just only human biological tissues or various elements. Last, but not least, practicing salvation when you still alive is perplexing. Live salvation is already existed within us, nowadays. No need to wait for the next life. Salvation can exist when we still alive. Salvation is to purify our spirit which require proper training to keep it clean in sustainable way.