Microbiota unbalance in relation to high-risk human papillomavirus cervical infection.

OBJECTIVES: To assess vaginal dysfunction using basic vaginal states and the presence of lactobacillary microbiota in patients with human papillomavirus (HPV) infection with no squamous intra-epithelial lesions (SIL), with low-grade squamous intra-epithelial lesions (L-SIL), and with high-grade squamous intra-epithelial lesions (H-SIL) or squamous cell carcinoma compared with a control group (HPV-negative); to establish the prevalence of bacterial vaginosis, candidiasis, and trichomoniasis in the different age groups; and to characterize the species of lactobacilli according to the type of lesion. METHODS: A cross-sectional study was carried out of patients who underwent clinical examination and collection of vaginal fornixes to study basic vaginal states and culture. Species identification of lactobacilli was performed by mass spectrometry. The results were analyzed using the χ2 and Fisher's tests; p<0.05 was considered significant. High-risk viral types were determined using a multiplex real-time polymerase chain reaction test. RESULTS: A total of 741 patients were analyzed and divided into three age groups: Group 1 aged 18-24 years (n=138), Group 2 aged 25-50 years (n=456), and Group 3 aged >50 years (n=147). All groups were further divided into an HPV-negative (control) group and an HPV-positive group without lesions, with L-SIL, or with H-SIL/squamous cell carcinoma. The prevalence of unbalanced basic vaginal states in patients with H-SIL/squamous cell carcinoma was 72.7% (p=0.03) in Group 1, 53.1% (p=0.05) in Group 2, and no cases of unbalance were detected in Group 3. The prevalence of bacterial vaginosis in women with H-SIL/squamous cell carcinoma in Group 1 was 54.5% and in Group 2 was 43.7%. Patients with H-SIL/squamous cell carcinoma had a prevalence of 21.4% of Lactobacillus crispatus, 42.9% of L. jensenii, and 14.3% of L. iners. CONCLUSIONS: A greater unbalance of vaginal microbiota was observed in patients with SIL, especially in those with H-SIL/squamous cell carcinoma. In this group, an increase in L. jensenii and L. iners compared with control was found. L. crispatus had a similar prevalence to the control group. It is important to characterize the lactobacilli species since the unbalance alters the vaginal microenvironment and acts as a co-factor in the persistence of HPV infection.

Estado actual de la gonorrea / Current state of gonorrhea

La gonorrea es una infección de transmisión sexual conocida desde la antigüedad que se ha perpetuado en el tiempo. Su agente etiológico, Neisseria gonorrhoeae, fue adquiriendo resistencia a la mayoría de los antimicrobianos utilizados para su tratamiento empírico. Las resistencias emergentes en los últimos años son a fluorquinolonas, macrólidos y cefalosporinas orales y parenterales. Hay aislamientos multirresistentes que plantean un desafío para su tratamiento. En países donde estos hallazgos ocurrieron precedentemente, la experiencia de tratamientos con antibióticos no convencionales, por ejemplo aminoglucósidos, es limitada y también emergieron cepas resistentes. Una de las estrategias utilizadas frente a la sensibilidad disminuida a ceftriaxona es aumentar la dosis o utilizar tratamientos combinados. En el marco actual de la multirresistencia de este microorganismo es importante promover la prevención de la infección, realizar vigilancia epidemiológica y buscar nuevas estrategias para su tratamiento.

Gonorrhea is a sexually transmitted infection known since antiquity that has been perpetuated over time. Its etiologic agent, Neisseria gonorrhoeae, was becoming resistant to most antimicrobials agents used for empiric therapy. Emerging resistance in recent years are fluoroquinolones, macrolides, oral and parenteral cephalosporins. There are multiresistant isolates that represent a challenge for its treatment. In countries where these findings occurred previously, the experience with unconventional treatments such as aminoglycosides is limited and resistant strains have emerged. One of the strategies used against the reduced susceptibility to ceftriaxone is to increase the dose or use combined treatments. In the current context of multidrug resistance of this organism it is important to promote the prevention of infection, epidemiological surveillance and look for new strategies for treatment.