Vaginal microbiome of women with premature ovarian insufficiency: a descriptive cross-sectional study.

OBJECTIVE: This study aimed to describe the vaginal microbiome of women with premature ovarian insufficiency (POI) receiving systemic hormone therapy (HT). METHODS: Forty women with POI receiving systemic HT for at least 6 months, who were sexually active, were included in the descriptive cross-sectional study. Vaginal secretion was collected for DNA extraction followed by pyrosequencing of the 16S rRNA. The samples were pooled into phylogenetic groups (Ravel groups I-V). RESULTS: Women had mean age of 37.13 (± 7.27) years and POI diagnosis at age 27.90 (± 8.68) years, and a mean HT duration of 8.20 (± 8.73) years. It was observed that 33.4% of the women presented group I flora, with a predominance of Lactobacillus crispatus; 9% group II flora, with a predominance of Lactobacillus gasseri; 33.4% group III flora, with a predominance of Lactobacillus iners; 15.2% group IV flora, with a predominance of anaerobic bacteria; and 9% group V flora, with a predominance of Lactobacillus jensenii. CONCLUSION: Women with POI receiving HT presented a vaginal microbiome with a predominance of lactobacilli in the composition of the vaginal flora, specifically L. crispatus and L. iners when evaluated by molecular biology through pyrosequencing of 16S rRNA.

Does the addition of electrical stimulation or kinesiotherapy improve outcomes of amitriptyline treatment for women with vulvodynia? A randomized clinical trial.

INTRODUCTION AND HYPOTHESIS: Women diagnosed with provoked vulvodynia frequently report a great deal of frustration in achieving symptomatic relief. Physical therapy and drug treatment are among the interventions most indicated by guidelines; however, whether those modalities are effective when combined remains unclear. The objective was to evaluate the effectiveness of adding a physical therapy modality compared with amitriptyline alone for the treatment of vulvodynia. METHODS: Eighty-six women with vulvodynia were randomized to (G1) 25 mg amitriptyline, once a day (n=27), (G2) amitriptyline + electrical stimulation therapy (n=29) or (G3) amitriptyline + kinesiotherapy (n=30). All treatment modalities were administered for 8 weeks. The primary endpoint was the reduction in vestibular pain. Secondary measurements focused on sexual pain, frequency of vaginal intercourse, Friedrich score, and overall sexual function. Data were analyzed using intention-to-treat. RESULTS: All treatment modalities resulted in a significant decrease in vestibular pain (p<0.001), sexual pain (p<0.05), Friedrich score (p<0.001), and an increase in the frequency of sexual intercourse (p<0.05). G3 was more effective than G1 at reducing sexual pain (G1: 5.3±3.3 vs G3: 3.2±2.7; p=0.01) and at improving sexual function (G1: 18.8±9.8 vs G3: 23.9±7.8; p=0.04). CONCLUSION: Kinesiotherapy and electrotherapy additions to amitriptyline administration as well as amitriptyline alone, were effective at improving vestibular pain in women with vulvodynia. Women receiving physical therapy had the greatest improvement in sexual function and frequency of intercourse at post-treatment and follow-up.

Current Practices in Brazil on Diagnosis and Management of Women With Vulvodynia.

OBJECTIVE: Vulvodynia (VVD) is a frequent and harrowing condition for which diagnosis and management remain insufficient. Our study aimed to describe and compare vulvovaginal signs and symptoms of Brazilian women with VVD and controls and describe previous medical assessment, past treatments, and vulvar pain relief among women with VVD. METHODS: This cross-sectional descriptive study included Brazilian women with (n = 151) and without VVD (n = 106). All women were assessed for vaginal infection, vulvar pain intensity by means of a cotton swab test based on a numerical rate scale, and answered the Female Sexual Function Index questionnaire and a structured instrument about current vulvar symptoms. Previous treatments were assessed in the VVD group, and vulvar pain relief achieved with previous treatments was qualified through a 4-point Likert scale. RESULTS: Volunteers were mainly White, with mean age of 30 years. Vulvovaginal signs and symptoms were significantly more frequent in women with VVD (p < .05), and vulvar pain duration was 5.8 (±4) years. More than 50% consulted with three or more physicians, and 49% remained without a conclusive diagnosis. Previous diagnosis and treatment of vulvovaginal infection were often reported by women with VVD. Most of the tried prescriptions were self-reported as providing only low vulvar pain relief. CONCLUSIONS: Prolonged duration of vulvar pain, multiple visits to health care professionals, and poor relief of pain are common aspects in the clinical history of women with VVD. In addition to pain, vulvar fissure, edema, erythema, vaginal discharge, and foul odor are common and should be considered to avoid misdiagnosis. Appropriate treatments to VVD are still poorly reported.

Clitoral blood flow using color Doppler ultrasonography in women with and without provoked vestibulodynia.

INTRODUCTION AND HYPOTHESIS: To compare blood flow of the dorsal clitoral artery in women diagnosed with provoked vestibulodynia (PVD) and in healthy controls using color Doppler ultrasonography. We hypothesized that women with PVD would have a restricted blood flow compared to controls. METHODS: This cross-sectional study evaluated the function of the dorsal clitoral artery through the spectral wave analysis of color Doppler ultrasonography (US) in 20 women diagnosed with PVD according to Friedrich's criteria and 21 healthy controls. Participants were evaluated during their follicular phase and were asked to abstain from sexual activities 24 ho prior the examination. Assessment was performed by an assessor blinded to participant diagnosis, in the morning after a 10-min rest period in a supine lying position in a room with temperature set at 22 °C. Measurements of the peak systolic velocity (PSV), time-averaged maximum velocity (TAMX), end-diastolic velocity (EDV), pulsatility (PI) and resistance index (RI) were performed at rest considering the mean value of three consecutive waveforms. RESULTS: Women with PVD and healthy controls did not present any statistically different baseline characteristics. Participants with PVD presented higher values of Doppler-US PSV, TAMX, EDV and RI compared to controls (p ≤ 0.05), which are suggestive of a decrease in blood flow. However, non-significant difference was found regarding PI values between the two groups (p > 0.05). CONCLUSION: Our findings revealed decreased peripheral tissue perfusion in women with PVD compared to healthy controls using color Doppler US, based on the alteration of four of the five assessed data of US parameters.

ESTROgen use for complications in women treating pelvic organ prolapse with vaginal PESSaries (ESTRO-PESS)-a randomized clinical trial.

INTRODUCTION AND HYPOTHESIS: To evaluate the complications of new users' vaginal pessaries (VP), with and without the use of vaginal estrogen after a 6-month follow-up. METHODS: A parallel, single-blinded, randomized, controlled trial. Symptomatic postmenopausal women (n = 98) with pelvic organ prolapse (POP) (stage 3/4) were recruited from August 2018 to October 2019. Patients were randomized into the local estrogen group (promestriene 3 × for a week) and the control group (no estrogen). They were evaluated for their vaginal symptoms at the baseline, after 3 months, and after 6 months, and a physical examination and vaginal sampling for microbiological analysis were done. Data were analyzed according to an intention-to-treat analysis (ITT). A 5% significance level was established for statistical analysis. RESULTS: Twenty women discontinued treatment (20.4%), mainly due to pessary extrusion (n = 15) and 5 for other reasons (lost to follow-up, pain, and surgery). Baseline characteristics were not statistically different between the estrogen and control groups. Regarding the presence of complications, the presence of erosion was 10% in the control group, but there was no significant difference between the groups (p = 0.175) after 6 months. Bacterial vaginosis (BV) was more prevalent in the control group, according to the Nugent (p = 0.007) and Amsel (p = 0.014) criteria. Urinary urgency and increased urinary frequency were significantly improved in the estrogen group after 6 months. CONCLUSION: There was no evident benefit related to complications such as ulcerations, itching, and vaginal discharge/odor from the use of vaginal estrogen in POP women using pessaries.

Characterization of the Vaginal Microbiome in Women of Reproductive Age From 5 Regions in Brazil.

BACKGROUND: Composition of the vaginal microbiome is strongly related to a woman's reproductive health and risk of sexually transmitted infections. Ethnoracial, behavioral, and environmental factors can influence microbiome. The Brazilian population is unique in terms of miscegenation of ethnic groups and behavioral characteristics across different regions. We aimed to characterize the vaginal microbiome of women from 5 geographical regions of Brazil. METHODS: We sequenced V3-V4 regions of 16S rRNA gene in vaginal samples of 609 reproductive-aged women. We performed logistic regression analyses to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between sociodemographic and behavioral factors with Lactobacillus-depleted microbiome (community state type [CST] IV). RESULTS: Vaginal samples were grouped into 5 CST: CST I (L. crispatus predominant, 30.5%), CST II (L. gasseri predominant, 4.4%), CST III (Lactobacillus iners predominant, 36.5%), CST IV (Lactobacillus-depleted, 27.4%), and CST V (L. jensenii predominant, 1.2%). Several factors were independently associated with CST IV, such as smoking (OR, 1.80; 95% CI, 1.02-3.18), number of partners (OR, 2.11; 95% CI, 1.20-3.70), and vaginal douching (OR, 2.24; 95% CI, 1.34-3.74). A protective effect was observed for milk/dairy intake (OR, 0.47; 95% CI, 0.27-0.82) and sitz bathing (OR, 0.43; 95% CI, 0.19-0.98). CONCLUSIONS: Nearly two thirds of Brazilian women may be at an increased risk for adverse outcomes associated with a vaginal microbiota characterized by the depletion of Lactobacillus or dominance by L. iners, whose protective role has been widely questioned. Several factors related to sexual behavior and intimate hygiene were associated with CST IV.

Pelvic Floor Biometric Changes Assessed by 4D Translabial Ultrassound in Women With Vulvodynia Submitted to Physical Therapy: A Pilot Study of a Randomized Controlled Trial.

BACKGROUND: Vulvodynia is a disabling condition in which pelvic floor muscles' (PFM) hypertonicity plays an important role. AIM: To evaluate biometric changes in PFM in women with vulvodynia undergoing kinesiotherapy treatment protocol (KTP). METHODS: A single-blinded randomized controlled trial of 57 women with vulvodynia randomly assigned to either KTP + amitriptyline or amitriptyline alone (controls) for treatment. Four-dimensional translabial ultrasound assessed PFM regarding symphysis-levator distance at rest, anorectal angle at rest, excursion of the levator plate angle, and levator hiatal narrowing. Volunteers underwent a vaginal examination for a cotton swab test (CST), fulfillment of Friedrich criteria score and PFM power of contraction, and completed a diary of sexual pain and frequency of vaginal intercourse. Outcomes were assessed at baseline and after 8 weeks of treatment. OUTCOMES: Primary outcomes were differences in biometric parameters assessed by four-dimensional translabial ultrasound after treatment, between groups. Secondary outcomes were changes in clinical variables (CST, Friedrich criteria, PFM power of contraction, frequency of intercourse, and intensity of sexual pain) between groups and correlation analysis between biometric parameters and clinical variables. RESULTS: Only the KTP group had statistically significant changes in biometric parameters after treatment (symphysis-levator distance: 0.22 ± 0.2, 95% CI = 0.1-0.4, P = .008; levator hiatal narrowing: -0.33 ± 0.2, 95% CI = -1 to -0.2, P = .04). Comparisons between groups showed that symphysis-levator distance (0.3, 95% CI = 0.2-0.6, P = .005) and excursion of levator plate angle (4.9, 95% CI = -0.4 to 10.1, P = .02) improved significantly after KTP treatment. Clinical variables showed greater improvement in the group treated with KTP for CST (difference of -3.7, 95% CI = -7 to -0.4, P = .01), Friedrich criteria (difference of -1.9, 95% CI = -3.2 to -0.6, P = .003), PFM power of contraction (0.3, 95% CI = 0.1-0.6, P = .05) and intensity of sexual pain (reduction of 1.7, 95% CI = -3.1 to -0.2, P = .01). Some clinical and biometric variables correlated positively, for example, frequency of vaginal intercourse and anorectal angle (P = .04; r = 0.25), or inversely, for example, pain intensity at CST and anorectal angle (P = .004, r = -0.31). CLINICAL IMPLICATIONS: This study provides evidence on efficiency of a physical therapy protocol for improvement of symptoms of vulvodynia and hypertonicity changes. CONCLUSION: This pilot study suggests that KTP for women with vulvodynia promoted significant changes in PFM biometric measures, consistent with alterations in hypertonicity and clinical improvement. Bardin MG, Giraldo PC, Martinho N. Pelvic Floor Biometric Changes Assessed by 4D Translabial Ultrassound in Women With Vulvodynia Submitted to Physical Therapy: A Pilot Study of a Randomized Controlled Trial. J Sex Med 2020;17:2236-2246.

Standard hormone therapy is inadequate for bone density in premature ovarian insufficiency.

To assess standard dose hormone therapy (HT) and bone mass in premature ovarian insufficiency (POI), 239 women with POI, 132 using standard estrogen dose HT and 107 women without HT, were evaluated. All underwent bone mineral density (BMD) evaluation in the lumbar spine (LS) and total femur (TF). Mean age, age at last period and body mass index (BMI) for the untreated and for the HT groups were 38.1 ± 6.1 and 36.8 ± 7.3 years; 31.4 ± 7.3 and 30.7 ± 7.2 years; 26.6 ± 7.1 and 25.8 ± 4.6 kg/m2, respectively, (p=NS). The women taking standard dose HT started treatment at the age of 33.8 ± 6.3 years and had been on hormone treatment for 3 years at the time of the bone densitometry examination. The BMD in LS was 1.06 ± 0.15 and 1.00 ± 0.17 g/cm2 (p = 0.003); the BMD in TF was 0.92 ± 0.19 and 0.91 ± 0.13 g/cm2 (p = 0.039), respectively, for the untreated and HT groups. A 45% altered BMD (osteopenia/osteoporosis) in LS was verified in women without treatment and 60.1% in those using the standard dose TH (p = 0.01). The BMD in TF was altered in 32.3% in those without HT and 36.4% in the HT users (p = 0.34). In conclusion, standard dose HT was not adequate to reduce impaired bone mass in the spine and femur of women with POI.

Characterization of Immunoglobulin A/G Responses During 3 Doses of the Human Papillomavirus-16/18 ASO4-Adjuvanted Vaccine.

BACKGROUND: Individuals receiving the human papillomavirus (HPV) vaccine develop high levels of circulating neutralizing antibodies. However, data about antibody responses in the cervix are limited. METHODS: This study was designed to describe the course of IgA/IgG responses in cervical secretions and in serum after intramuscular administration of the HPV16/18 AS04-adjuvant vaccine. An enzyme-linked immunosorbent assay for detection of IgA and IgG anti-HPV-VLP was developed for this purpose. RESULTS: Immunoglobulin G seroconversion after the second dose was observed in 100% of the participants and remained 1 month after the third dose. Regarding IgG reactivity in cervical secretions, conversion was observed in 85% of women after the final dose. Immunoglobulin A seroconversion was observed in 76.7% of women after the third dose. Lower levels of IgA were detected in the cervical mucus (28.3%) and decreased to 23.3% after the last dose. Comparing local and systemic IgG responses, positivity in both serum and cervical samples was observed in 85%, whereas in 15% only, the serum was IgG antibody positive. A weak agreement between local and systemic IgA responses was observed. Only 18.3% of participants were local and systemic IgA positive, 58.4% were positive only in serum, 5% were positive only in the cervix, and 18.3% were both local and systemic IgA antibody negative. CONCLUSIONS: After the third vaccination, there is a strong agreement between cervical and systemic IgG antibody responses and a weak agreement between cervical and systemic IgA antibody responses. The induction of IgA antibodies seems to be secondary to that of IgG antibodies in response to HPV intramuscular vaccination.

Vaginal epithelium and microflora characteristics in women with premature ovarian failure under hormone therapy compared to healthy women.

PURPOSE: To evaluate some microbiological aspects of the vaginal flora and the vaginal trophism of women with premature ovarian failure (POF) in use of oral hormone therapy. METHODS: A cross-sectional study with 36 women with POF under the age of 40 years using oral hormonal therapy. They were age matched with 36 women with normal gonadal function (control group). The characteristics of the vaginal epithelium were assessed through the hormonal vaginal cytology, vaginal pH measurement and vaginal health index to identify vaginal disturbances. Vaginal microflora was evaluated by the amine test, bacterioscopy (Nugent score) and culture for fungi to identify vaginal abnormal microflora and fungi infections. RESULTS: Despite the fact that there were no statistical significant differences related to the cytological aspects and pH measurements, it was found that the vaginal health index was highly superior in the control group than in the POF group (23.4 ± 1.8 vs 20.8 ± 3.5), p < 0.0001 despite both groups had trophic scores. There were no statistical significance differences regarding to vaginal microflora types and fungi infection. CONCLUSION: Oral hormone therapy for young women with POF seems to be good enough to reestablish the epithelium cells, vaginal pH and microflora.

Short-term physical therapy treatment for female urinary incontinence: a quality of life evaluation.

INTRODUCTION: Urinary incontinence (UI) is a widespread health condition and in some situations conservative treatment has been recommended. The aim of this study was to compare women's quality of life (QoL) before and after short-term physical therapy treatment. METHODS: We carried out a clinical trial involving 72 women who received an eight-session intervention based on pelvic floor electrical stimulation (PFES), pelvic floor muscle training (PFMT) and behavioral training. QoL was evaluated by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The Wilcoxon signed-rank test compared the ICIQ-SF scores; the relative changes were calculated by dividing the differences by the initial score, and McNemar's χ(2) compared the questions related to the type of, possible causes of or situations related to UI (p < 0.05). RESULTS: There was a significant reduction in the frequency (p < 0.03), amount (p < 0.04) and impact (p < 0.001) of UI on QoL. The total score decreased from 14.6 ± 4.2 to 7.2 ± 4.5 (p < 0.001). All questions regarding the type of, possible causes of or situations related to UI had significantly decreased. Also, 15 women reported the 'never leaked urine' condition (p < 0.001) after treatment. CONCLUSION: A short-term physical therapy treatment based on PFES, PFMT and behavioral modifications reduced the frequency, amount and impact of UI and therefore resulted in QoL improvement.

The risk of high-grade squamous intraepithelial lesions in women with low serum levels of vitamin A.

BACKGROUND: The progression of the cervical squamous intraepithelial lesion (SIL) is associated with many cofactors, and nutritional aspects are gradually assuming an important role in understanding the physiopathogenesis. OBJECTIVE: To assess the serum levels of retinol in women from a poor region of Brazil with a histological diagnosis of cervical high-grade SIL (HSIL). METHODS: A cross-sectional study was conducted in 62 women aged 14-48 years who had a cervical biopsy and were treated at the Federal University of Ceara in Fortaleza, Brazil. Serum retinol levels were measured in peripheral blood by a spectrophotometry technique. Values were categorized as subnormal (<20 µg/dl) or normal (≥20 µg/dl). Multivariate logistic regression was used to determine the association between serum levels of retinol and HSIL for a confidence interval of 95%. RESULTS: Twenty-six out of 62 women (42%) had a negative histopathological result for SIL and 36 (58%) were diagnosed with SIL (20 low SIL and 16 high SIL). The level of retinol was more frequently low in women with HSIL, but there was no statistical significance [p = 0.409, OR: 2.26 (0.33-15.59)]. CONCLUSION: There was no association between high SIL and low levels of retinol in peripheral blood.

Cervicovaginal levels of proinflammatory cytokines are increased during chlamydial infection in bacterial vaginosis but not in lactobacilli-dominated flora.

OBJECTIVE: The purpose of this study was to assess the cervicovaginal levels of proinflammatory cytokines in women with Chlamydia trachomatis (CT) infection in the presence of bacterial vaginosis (BV) and normal flora and to compare with those negative for CT. MATERIALS AND METHODS: In this cross-sectional study, nonpregnant women were enrolled at 2 outpatient clinics and at 1 primary medical care unit in São Paulo State, Brazil. Cervicovaginal samples from 256 women with BV, of which 68 (26.6%) had concomitant CT infection and 188 (73.4%) were CT-negative, were measured for interleukin-1ß (IL-1ß), IL-6, and IL-8 by enzyme-linked immunosorbent assay. A matching number of samples from women with normal flora, CT-positive (n = 68) and negative (n = 188), were evaluated as control. Cytokine levels were compared by Mann-Whitney test and differences were considered significant at p < .05. RESULTS: In CT-negative women, IL-1ß was increased in BV (p < .001) when compared to normal flora, while the levels of IL-6 and IL8 were unchanged. The presence of CT infection was not associated with differences on cytokine levels in women with normal flora. However, women with BV had higher levels of IL-1ß (p = .02), IL-6 (p = .02), and IL-8 (p = .03) in the presence of CT when compared to those who tested negative for CT. CONCLUSIONS: Detection of endocervical CT is associated with increased cervicovaginal IL-1ß, IL-6, and IL-8 levels in women with concomitant BV but not in those with normal flora.

Do Atopobium vaginae, Megasphaera sp. and Leptotrichia sp. change the local innate immune response and sialidase activity in bacterial vaginosis?

OBJECTIVES: To investigate if the participation of Atopobium vaginae, Megasphaera sp. and Leptotrichia sp. in the bacterial community of bacterial vaginosis (BV) is associated with distinct patterns of this condition. METHODS: In this cross-sectional controlled study, 205 women with BV and 205 women with normal flora were included. Vaginal rinsing samples were obtained for measuring the levels of pro-inflammatory cytokines and bacterial sialidases. Real-time PCR was used to quantify the BV-associated bacteria and to estimate the total bacterial load using the 16S rRNA. Principal component analysis (PCA) using the measured parameters was performed to compare the BV samples with lower and higher loads of the species of interest. RESULTS: Higher bacterial load (p<0.001), levels of interleukin 1-ß (p<0.001) and sialidase activity (p<0.001) were associated with BV. Women with BV and higher relative loads of A vaginae, Megasphaera sp. and Leptotrichia sp. presented increased sialidase activity, but unchanged cytokine levels. PCA analysis did not indicate a different pattern of BV according to the loads of A vaginae, Megasphaera sp. and Leptotrichia sp. CONCLUSIONS: Greater participation of A vaginae, Megasphaera sp. and Leptotrichia sp. in vaginal bacterial community did not indicate a less severe form of BV; moreover, it was associated with increased sialidase activity.

Evaluation of sexual function in Brazilian women with recurrent vulvovaginal candidiasis and localized provoked vulvodynia.

INTRODUCTION: Recurrent vulvovaginitis is an important trigger for inflammatory processes that in many cases may result in vulvovaginal pain. Vulvodynia, a vulvar disorder, can also cause a lot of pain in the female genitals. The sexual function in women with vulvodynia or recurrent vulvovaginitis will possibly be negatively affected and therefore should be evaluated. AIM: To assess sexual function in women with recurrent vulvovaginal candidiasis (RVVC) and localized provoked vulvodynia (LPV) in comparison with women without lower genital tract dysfunction. METHODS: A 1-year cross-sectional study evaluated sexual function in 58 women (11 with RVVC, 18 with LPV, and 29 controls) seen at a university outpatient clinic. Sexual function was assessed by taking into account the results obtained from the application of the Female Sexual Function Index (FSFI) questionnaire. Kruskal-Wallis, Mann-Whitney, chi-square, and Fisher's tests were used for statistical analysis. MAIN OUTCOME MEASURE: FSFI, a validated questionnaire in Portuguese. RESULTS: There were no significant differences in the three groups with respect to age, marital status, schooling, race, body mass index, contraceptive method, and parity. The FSFI questionnaire total score found was 25.51 (±5.12), 21.17 (±5.15), and 29.56 (±3.87) for the RVVC, LPV, and control groups, respectively. The scores were significantly statistically lower in the study groups compared with the control group (P<0.05). Women with RVVC and LPV also had lower total scores compared with 26.55 values, considered a cutoff score for sexual dysfunction in literature. The LPV group showed a significant difference and scored worse in the domains of arousal, lubrication, orgasm, satisfaction, and pain but not in the domain of sexual desire. The same occurred with the RVVC group but only for the domains of orgasm and satisfaction. CONCLUSION: Women with RVVC and LPV had significantly more symptoms of sexual dysfunction than women without lower genital tract diseases.

The prevalence of urogenital infections in pregnant women experiencing preterm and full-term labor.

Urogenital infections are extremely prevalent during pregnancy and are an important cause of premature labor. However, the prevalence of urogenital infections during childbirth is not well known. Objective. Identify urogenital infections present at the beginning of labor in both full-term and preterm pregnancies. Study Design. Ninety-four women were admitted to the inpatient maternity clinic of the Federal University of Rio Grande do Norte (UFRN). In total, 49 women in preterm labor and 45 women in full-term labor were included in the study, and samples of urinary, vaginal, and perianal material were collected for microbiological analysis. Results. The prevalences of general infections in the preterm labor group and the full-term labor group were 49.0% and 53.3% (P = 0.8300), respectively. Urogenital infections in the preterm and full-term labor groups included urinary tract infection in 36.7% and 22.2% of women, vaginal candidiasis in 20.4% and 28.9% of women, bacterial vaginosis in 34.7% and 28.9% of women, and group B streptococcus in 6.1% and 15.6% of women, respectively. Conclusions. Urogenital infections were prevalent in women in preterm labor and full-term labor; however, significant differences between the groups were not observed.

Electromyography and vaginal pressure of the pelvic floor muscles in women with recurrent vulvovaginal candidiasis and vulvodynia.

OBJECTIVE: To evaluate the electrical potentials and pressure exerted by the pelvic floor muscles in women with recurrent vulvovaginal candidiasis (RVVC) or vulvodynia as compared to control women. STUDY DESIGN: A cross-sectional study performed in the Female Outpatient Clinic of Genital Infections in the Department of Obstetrics and Gynecology of the Universidade Estadual de Campinas analyzed and compared electromyography (EMG) and vaginal pressure of the pelvic floor muscles in 61 women. Of these 61 women, 19 had vulvodynia, 12 had RVVC and 30 women had no disorder (control group). For data collection, the instrument used was the Miotool Uro device and its software Biotrainer (Miotec Ltd., Porto Alegre, Rio Grande do Sul, Brazil). RESULTS: The EMG evaluation of the pelvic floor muscles showed significantly lower values in the vulvodynia group (tonic contractions) and RVVC group (phasic and tonic contractions) when compared to the control group. No significant differences in basal tone EMG and vaginal pressure values at rest or during pelvic floor muscle contractions were found among groups. The maximum time of sustained contraction in patients with RVVC or vulvodynia was significantly lower (p < 0.0001) than in controls. CONCLUSION: Women with vulvodynia and RVVC have more frequent pelvic floor muscle dysfunction than controls when observed by EMG evaluation.

Related factors to non-adherence to antiretroviral therapy in HIV/AIDS patients.

OBJECTIVE: To identify sociodemographic, clinical, and pharmacological factors  associated with nonadherence to antiretroviral treatment in patients with  human immunodeficiency virus/acquired immunodeficiency syndrome treated  between 2017 and 2020 in four cities in Colombia. METHOD: An observational, cross-sectional, retrospective study was conducted of a population of patients with human immunodeficiency virus/acquired immunodeficiency syndrome treated between 2017 and 2020. The Morisky-Green scale, the simplified medication adherence  questionnaire, and the simplified scale to detect adherence problems to  antiretroviral treatment were applied to determine patient adherence. A  binomial multiple logistic regression was performed to evaluate the factors that  best explain nonadherence. RESULTS: A total of 9,835 patients were evaluated, of whom 74.4% were men,  71.1% were aged between 18 and 44 years, 76.0% had attended at most  secondary school, 78.1% were single, and 97.6% resided in an urban area.  After applying three different scales to each patient, 10% of the study  population were identified as nonadherent to treatment. The risk of  nonadherence was significantly higher in patients who presented any drug- related problem or had an adverse reaction to antiretroviral drugs. CONCLUSIONS: The variables most strongly associated with nonadherence to  antiretroviral treatment were drug-related problems, adverse drug reactions, a  history of nonadherence to treatment, and psychoactive substance use.

OBJETIVO: Identificar los factores sociodemográficos, clínicos y farmacológicos asociados a la no adherencia al tratamiento antirretroviral en pacientes con infección por virus de la inmunodeficiencia humana/sida atendidos entre 2017 y 2020 en diferentes ciudades de Colombia.Método: Se realizó un estudio observacional, de corte transversal y retrospectivo, con una población de pacientes con infección por virus de la  inmunodeficiencia humana/sida atendidos entre 2017 a 2020. Se aplicaron las  escalas Morisky-Green, el cuestionario simplificado de adherencia a la  medicación y la escala simplificada para detectar problemas de adherencia al  tratamiento antirretroviral, para determinar la adherencia de los pacientes. Se  realizó una regresión logística múltiple para evaluar los factores que mejor  explican la no adherencia. RESULTADOS: Se evaluaron 9.835 pacientes, de los cuales el 74,4% eran hombres, el 71,1% tenían una edad entre 18 a 44 años, el 76,0% cursó como máximo hasta secundaria, el 78,1% eran solteros y el 97,6%  residían en zona urbana. Se encontró una proporción de no adherencia al  tratamiento del 10% después de aplicar tres escalas diferentes a cada paciente. Las personas que presentaron algún problema relacionado con los medicamentos tuvieron un riesgo significativamente mayor de no ser adherentes, al igual que aquellos que tuvieron alguna reacción adversa a los medicamentos antirretrovirales. CONCLUSIONES: Los problemas relacionados con el uso de medicamentos, las  reacciones adversas a medicamentos, los antecedentes de no adherencia al  tratamiento y el consumo de sustancias psicoactivas fueron las variables que  más se asociaron con la no adherencia al tratamiento antirretroviral.

Habits of Genital Hygiene and Sexual Activity among Women with Bacterial Vaginosis and/or Vulvovaginal Candidiasis.

OBJECTIVE: To evaluate genital hygiene among women with and without bacterial vaginosis (BV) and/or vulvovaginal candidiasis (VVC). METHODS: A cross-sectional study of reproductive-aged women who underwent gynecological and laboratory tests and fulfilled a genital hygiene questionnaire. RESULTS: This study evaluated 166 healthy controls and 141 women diagnosed with either BV (n = 72), VVC (n = 61), or both (n = 8). The use of intimate soap and moist wipes after urination was more frequent among healthy women (p = 0.042 and 0.032, respectively). Compared to controls, bactericidal soap was more used by women with BV (p = 0.05). CONCLUSION: Some hygiene habits were associated to BV and/or VVC. Clinical trials should address this important issue in women's health.

OBJETIVO: Avaliar a higiene genital de mulheres com e sem vaginose bacteriana (VB) e/ou candidíase vulvovaginal (CVV). MéTODOS: Estudo transversal com mulheres em idade reprodutiva submetidas a exames ginecológicos e laboratoriais e preenchimento de questionário de higiene genital. RESULTADOS: Este estudo avaliou 166 controles saudáveis e 141 mulheres com diagnóstico de VB (n = 72), VVC (n = 61) ou ambas (n = 8). O uso de sabonete íntimo e lenços umedecidos após a micção foram hábitos mais frequentes entre mulheres saudáveis (p = 0,042 e 0,032, respectivamente). Em comparação com os controles, o sabonete bactericida foi mais usado por mulheres com VB (p = 0,05). CONCLUSãO: Alguns hábitos de higiene foram associados à VB e/ou VVC. Os ensaios clínicos devem abordar esta questão importante na saúde da mulher.

Factors associated with virologic failure in HIV patients on antiretroviral therapy.

OBJECTIVE: To determine the factors associated with virologic failure n HIV  patients on antiretroviral treatment treated in a Colombian health institution. METHOD: This was a cross-sectional observational retrospective analytical study of HIV patients receiving antiretroviral treatment between 2007­2020. Sociodemographic, pharmacological and clinical variables were collected, including viral load, adherence, and the medication  possession ratio. For statistical analysis, crude and adjusted odds ratios and confidence intervals were obtained. RESULTS: In a population of 5,406 patients, the proportion of virologic failure  was 16.7%. Moreover, in the adjusted model, an association was found  between virologic failure and time on treatment greater than one year,  medication possession ratio under 80%, failure to claim medications from the  pharmacy due to dose omission or discontinuation, adherence under 85%, CD4  count under 500, total cholesterol levels above 201 mg/dL, high density  lipoproteins under 39 mg/dL and presence of mycosis. CONCLUSIONS: In our cohort of HIV patients, short treatment periods, CD4 counts under 200, a low medication possession ratio, failure to timely claim medications from the pharmacy due to omission or  discontinuation, and a lower degree of adherence were factors related to  virologic failure.

OBJETIVO: Determinar los factores asociados al fracaso virológico en pacientes  con el virus de la inmunodeficiencia humana con tratamiento antirretroviral  atendidos en una institución de salud colombiana.Método: Estudio transversal, observacional, retrospectivo y analítico en pacientes con el virus de la inmunodeficiencia humana con tratamiento antirretroviral entre 2007-2020. Se recogieron variables  Sociodemográficas, farmacológicas y clínicas, incluyendo la carga viral, el  grado de adherencia y la tasa de reclamación de medicamentos. Para el  análisis estadístico se obtuvieron las odds ratio crudas y ajustadas y los  intervalos de confianza. RESULTADOS: De una población de 5.406 pacientes, la proporción de fracaso  virológico fue de 16,7% y en el modelo ajustado se encontró asociación entre  el fracaso virológico con el tiempo en el tratamiento mayor a un año, la tasa de posesión de la reclamación inferior al 80%, la no reclamación oportuna por  omisión o suspensión, la adherencia inferior al 85%, el recuento de CD4  inferior a 500, niveles de colesterol total mayores de 201 mg/dl, lipoproteína  de alta densidad menor de 39 mg/dl y presencia de micosis. CONCLUSIONES: En nuestra cohorte de pacientes con el virus de la  Inmunodeficiencia humana, un menor tiempo en tratamiento, un recuento de CD4 menor de 200, una baja tasa de reclamación de los medicamentos, así  como la no reclamación oportuna por omisión y suspensión y un menor grado  de adherencia son factores que se relacionan con el fracaso virológico.