ABSTRACT
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.
Subject(s)
Vulvodynia , Female , Humans , Vulvodynia/therapy , Amitriptyline/therapeutic use , Pain Measurement , Pain , Electric StimulationABSTRACT
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.
Subject(s)
Vulvodynia , Adult , Female , Humans , Brazil , Cross-Sectional Studies , Pain , Pain Management , Vulvodynia/diagnosis , Vulvodynia/therapyABSTRACT
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.
Subject(s)
Acquired Immunodeficiency Syndrome , Anti-HIV Agents , HIV Infections , Male , Humans , Adolescent , Young Adult , Adult , Female , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , HIV , Anti-HIV Agents/therapeutic use , Cross-Sectional Studies , Retrospective Studies , HIV Infections/drug therapy , Medication Adherence , Anti-Retroviral Agents/therapeutic use , Antiretroviral Therapy, Highly ActiveABSTRACT
Objetivo: Identificar los factores sociodemográficos, clínicos y farmacológicos asociados a la no adherencia al tratamiento antirretroviral enpacientes con infección por virus de la inmunodeficiencia humana/sidaatendidos entre 2017 y 2020 en diferentes ciudades de Colombia.Método: Se realizó un estudio observacional, de corte transversal yretrospectivo, con una población de pacientes con infección por virusde la inmunodeficiencia humana/sida atendidos entre 2017 a 2020.Se aplicaron las escalas Morisky-Green, el cuestionario simplificado deadherencia a la medicación y la escala simplificada para detectar problemas de adherencia al tratamiento antirretroviral, para determinar laadherencia de los pacientes. Se realizó una regresión logística múltiplepara evaluar los factores que mejor explican la no adherencia.Resultados: Se evaluaron 9.835 pacientes, de los cuales el 74,4% eranhombres, el 71,1% tenían una edad entre 18 a 44 años, el 76,0% cursócomo máximo hasta secundaria, el 78,1% eran solteros y el 97,6% residían en zona urbana. Se encontró una proporción de no adherencia altratamiento del 10% después de aplicar tres escalas diferentes a cadapaciente. Las personas que presentaron algún problema relacionado conlos medicamentos tuvieron un riesgo significativamente mayor de no seradherentes, al igual que aquellos que tuvieron alguna reacción adversa alos medicamentos antirretrovirales. (AU)
Objective: To identify sociodemographic, clinical, and pharmacological factors associated with nonadherence to antiretroviral treatment inpatients with human immunodeficiency virus/acquired immunodeficiencysyndrome 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 binomialmultiple logistic regression was performed to evaluate the factors that bestexplain 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% hadattended at most secondary school, 78.1% were single, and 97.6% resided in an urban area. After applying three different scales to eachpatient, 10% of the study population were identified as nonadherent totreatment. The risk of nonadherence was significantly higher in patientswho presented any drug-related problem or had an adverse reaction toantiretroviral drugs. (AU)
Subject(s)
Humans , Medication Adherence , Anti-HIV Agents , Pharmacies , HIV , ColombiaABSTRACT
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.
Subject(s)
Anti-HIV Agents , HIV Infections , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , Cholesterol/therapeutic use , Cross-Sectional Studies , HIV Infections/drug therapy , Humans , Lipoproteins/therapeutic use , Medication Adherence , Retrospective Studies , Treatment Failure , Viral LoadABSTRACT
Objetivo: Determinar los factores asociados al fracaso virológico enpacientes con el virus de la inmunodeficiencia humana con tratamientoantirretroviral atendidos en una institución de salud colombiana.Método: Estudio transversal, observacional, retrospectivo y analítico enpacientes con el virus de la inmunodeficiencia humana con tratamientoantirretroviral entre 2007-2020. Se recogieron variables sociodemográficas,farmacológicas y clínicas, incluyendo la carga viral, el grado de adherenciay la tasa de reclamación de medicamentos. Para el análisis estadístico seobtuvieron las odds ratio crudas y ajustadas y los intervalos de confianza.Resultados: De una población de 5.406 pacientes, la proporción defracaso virológico fue de 16,7% y en el modelo ajustado se encontró asociación entre el fracaso virológico con el tiempo en el tratamiento mayora un año, la tasa de posesión de la reclamación inferior al 80%, la noreclamación oportuna por omisión o suspensión, la adherencia inferior al85%, 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 ypresencia de micosis.Conclusiones: En nuestra cohorte de pacientes con el virus de la inmunodeficiencia humana, un menor tiempo en tratamiento, un recuento deCD4 menor de 200, una baja tasa de reclamación de los medicamentos,así como la no reclamación oportuna por omisión y suspensión y un menorgrado de adherencia son factores que se relacionan con el fracaso virológico. (AU)
Objective: To determine the factors associated with virologic failurein HIV patients on antiretroviral treatment treated in a Colombian healthinstitution.Method: This was a cross-sectional observational retrospective analytical study of HIV patients receiving antiretroviral treatment between2007-2020. Sociodemographic, pharmacological and clinical variableswere collected, including viral load, adherence, and the medication possession ratio. For statistical analysis, crude and adjusted odds ratios andconfidence intervals were obtained.Results: In a population of 5,406 patients, the proportion of virologicfailure was 16.7%. Moreover, in the adjusted model, an association wasfound between virologic failure and time on treatment greater than oneyear, 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 above201 mg/dL, high density lipoproteins under 39 mg/dL and presence ofmycosis.Conclusions: In our cohort of HIV patients, short treatment periods, CD4counts under 200, a low medication possession ratio, failure to timelyclaim medications from the pharmacy due to omission or discontinuation,and a lower degree of adherence were factors related to virologic failure. (AU)
Subject(s)
Humans , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , Cholesterol/therapeutic use , HIV Infections/drug therapy , Treatment Failure , Cross-Sectional Studies , Lipoproteins/therapeutic useABSTRACT
Abstract Introduction: psoriasis is a systemic, inflammatory, and chronic disease with a global prevalence between 0.6-6.5 %. It is related to multiple comorbidities and generates a significant decrease in quality of life. Objective: to characterize sociodemographic, clinical, pharmacological, and quality of life variables in a population of patients with moderate-severe psoriasis. Methods: descriptive observational study the patients with a diagnosis of severe-moderate psoriasis treated in the Clínica Integral de Psoriasis-CLIPSO between May 2018 - June 2020. A collection format was designed for defined variables and a univariate analysis was performed. Results: 948 patients were identified with a median age of 50 years (IQR: 38-60) of which 51.0 % were women. 23.6 % were incidents with a median treatment time of 114 days (IQR: 98-127) and 73.9 % were prevalent with a median treatment time of 228 days (IQR: 160-371). The type of therapy used was mainly non-biological systemic and 90.9 % of the patients were adherent to the treatment. The clinical variables were similar for both groups and the most common phenotype was psoriasis vulgaris (57.1 %). The health-related quality of life in both groups was greater than 60 points and the affected dimensions were physical and psychological health. 27.3 % of the patients had comorbidities associated with cardiovascular risk and 44.7 % were overweight. Conclusion: knowing the sociodemographic, clinical, pharmacological, and quality of life characteristics of patients with moderate-severe psoriasis allows the identification of risk factors and comprehensive management of the disease.
Resumen Introducción: la psoriasis es una enfermedad sistémica, inflamatoria y crónica con una prevalencia global entre 0,6-6,5 %. Está relacionada con múltiples comorbilidades y genera una disminución significativa en la calidad de vida. Objetivo: caracterización sociodemográfica, clínica, farmacológica y calidad de vida de un grupo de pacientes con psoriasis moderada-severa. Métodos: estudio observacional descriptivo en pacientes con diagnóstico de psoriasis moderada-severa atendidos en la Clínica Integral de Psoriasis (CLIPSO) entre mayo 2018 y junio 2020. Se diseñó un formato para la recolección de las variables definidas y se realizó un análisis univariado. Resultados: se identificaron 948 pacientes con una mediana de edad de 50 años (RIC:38-60) de los cuales el 51 % eran mujeres. El 23,6 % eran incidentes, con una mediana en tiempo de tratamiento de 114 días (RIC:98-127) y 73,9 % eran prevalentes, con una mediana de tiempo de tratamiento de 228 días (RIC:160-371). El tipo de terapia utilizada fue principalmente sistémica no biológica y el 90,9 % de los pacientes eran adherentes al tratamiento. Las variables clínicas fueron similares en los incidentes y los prevalentes y el fenotipo más común fue psoriasis vulgar (57,1 %). La calidad de vida en ambos grupos fue mayor a 60 puntos y las dimensiones más afectadas en la calidad de vida fueron la salud física y la psicológica. El 27,3 % presentaban comorbilidades asociadas a riesgo cardiovascular y 44,7 % presentaban sobrepeso. Conclusión: conocer las características sociodemográficas, clínicas, farmacológicas y calidad de vida de los pacientes con psoriasis moderada-severa permite la identificación de factores de riesgo y un manejo integral de la enfermedad.
ABSTRACT
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.
Subject(s)
Vulvodynia , Blood Flow Velocity/physiology , Clitoris/diagnostic imaging , Cross-Sectional Studies , Female , Humans , Regional Blood Flow , Ultrasonography, Doppler , Ultrasonography, Doppler, ColorABSTRACT
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.
Subject(s)
Candidiasis, Vulvovaginal , Vaginosis, Bacterial , Adult , Candidiasis, Vulvovaginal/diagnosis , Cross-Sectional Studies , Female , Habits , Humans , Hygiene , Sexual Behavior , Vagina/microbiology , Vaginosis, Bacterial/diagnosisABSTRACT
INTRODUCTION: The influence of vaccination on composition of the human microbiome at distinct sites has been recognized as an essential component in the development of new vaccine strategies. The HPV vaccine is widely used to prevent cervical cancer; however, the influence of HPV vaccine on the vaginal microbiota has not been previously investigated. In his study, we performed an initial characterization of the microbiome and cytokine composition in the vagina following administration of the bivalent vaccine against HPV 16/18. MATERIAL AND METHODS: In this exploratory study, fifteen women between 18 and 40 years received three doses of the HPV-16/18 AS04-adjuvanted vaccine (Cervarix®). Cervicovaginal samples were collected before the first dose and 30 days after the third dose. HPV genotyping was performed by the XGEN Flow Chip technique. The cytokines IFN-γ, IL-2, IL-12p70, TNF-α, GM-CSF, IL-4, IL-5, IL-10, and IL-13 were quantitated by multiplex immunoassay. The vaginal microbiome was identified by analysis of the V3/V4 region of the bacterial 16S rRNA gene. RESULTS: The most abundant bacterial species in the vaginal microbiome was Lactobacillus crispatus, followed by L. iners. Bacterial diversity and dominant organisms were unchanged following vaccination. Small decreases in levels of pro and anti-inflammatory cytokines were observed following HPV vaccination, but there was no association between vaginal cytokine levels and microbiome composition. CONCLUSION: Vaginal microbiome is not altered following administration of the standard three-dose HPV-16/18 AS04-adjuvanted (Cervarix®) vaccine.
Subject(s)
Bacteria , Cytokines , Microbiota , Papillomavirus Infections , Papillomavirus Vaccines , Vagina , Adult , Bacteria/drug effects , Bacteria/genetics , Cytokines/immunology , Female , Human papillomavirus 16 , Human papillomavirus 18 , Humans , Microbiota/drug effects , Microbiota/genetics , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/pharmacology , RNA, Ribosomal, 16S/genetics , Vagina/microbiology , Young AdultABSTRACT
Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an upper female genital tract acute infection due to canalicular spread of endogenous cervicovaginal microorganisms and especially the sexually transmitted microorganisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The main sequelae are chronic pelvic pain, infertility, and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment must start immediately after the clinical suspicion. Guidelines for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling sexual partners and special populations are described. Given the increased availability of the molecular biology techniques in Brazil, C. trachomatis and N. gonorrhoeae screening are recommended as a disease prevention strategy. Pelvic inflammatory disease is one of the most significant sexually transmitted infections, and in most cases, it is a main consequence of cervicitis.
Subject(s)
Chlamydia Infections , Gonorrhea , Pelvic Inflammatory Disease , Sexually Transmitted Diseases , Brazil , Chlamydia Infections/diagnosis , Chlamydia Infections/drug therapy , Chlamydia trachomatis , Female , Humans , Mass Screening , Pelvic Inflammatory Disease/diagnosis , Pregnancy , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/prevention & controlABSTRACT
Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an acute infection of the upper female genital tract due to canalicular spread of endogenous cervicovaginal microorganisms, in particular sexually transmitted organisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The most important sequels are chronic pelvic pain, infertility and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment should start immediately upon clinical suspicion. The article contains guidance for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling of sexual partnerships and special populations. In view of increased availability of the molecular biology technique in Brazil, C. trachomatis and N. gonorrhoeae screening is recommended as a disease prevention strategy.
O tema doença inflamatória pélvica está contemplado no Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. A doença inflamatória pélvica é a infecção aguda do trato genital superior feminino decorrente da ascensão canalicular de microrganismos cervicovaginais endógenos e, principalmente, os de transmissão sexual. Entre os agentes etiológicos envolvidos, destacam-se Chlamydia trachomatis e Neisseria gonorrhoeae. As sequelas mais importantes são dor pélvica crônica, infertilidade e gravidez ectópica. O diagnóstico clínico apresenta-se como a abordagem prática mais importante. O tratamento com antibióticos deve ser iniciado imediatamente diante da suspeição clínica. Descrevem-se orientações para gestores e profissionais de saúde sobre testes diagnósticos, tratamento preconizado, seguimento, aconselhamento, notificação, manejo de parcerias sexuais e de populações especiais. Com a maior disponibilidade da técnica de biologia molecular no Brasil, recomenda-se o rastreio de C. trachomatis e N. gonorrhoeae como estratégia preventiva da doença.
El tema de la enfermedad inflamatoria pélvica está incluido en el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral para Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. La enfermedad inflamatoria pélvica es una infección aguda del tracto genital superior femenino resultante del ascenso canalicular de microorganismos cervicovaginales endógenos y, principalmente, los de transmisión sexual. Entre los agentes etiológicos involucrados, se destacan Chlamydia trachomatis y Neisseria gonorrhoeae. Las secuelas más importantes son: dolor pélvico crónico, infertilidad y embarazo ectópico. El diagnóstico clínico es el enfoque práctico más importante. El tratamiento con antibiótico debe iniciarse inmediatamente ante la sospecha clínica. Se describen pautas para gestores y profesionales de la salud sobre pruebas de diagnóstico, tratamiento, seguimiento, asesoramiento, notificación, manejo de parejas sexuales y poblaciones especiales. Con la mayor disponibilidad de la técnica de biología molecular, se recomienda el cribado de C. trachomatis y N. gonorrhoeae como estrategia preventiva para la enfermedad.
Subject(s)
Pelvic Inflammatory Disease , Sexually Transmitted Diseases , Brazil , Chlamydia trachomatis , Female , Humans , Pelvic Inflammatory Disease/diagnosis , Pelvic Inflammatory Disease/epidemiology , Pelvic Inflammatory Disease/therapy , Pregnancy , Sexual Behavior , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/prevention & controlABSTRACT
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.
Subject(s)
Pelvic Organ Prolapse , Vaginal Discharge , Estrogens , Female , Humans , Pessaries , Treatment OutcomeABSTRACT
Genitourinary syndrome of menopause (GSM) is a term used to define a compilation of signs and symptoms arising from decreased estrogenic stimulation of the vulvovaginal and lower urinary tract. Among 27-84% of women in postmenopausal are affected for symptoms of GSM, and these can unquestionably impair health, sexual function, consequently the quality of life of these women. The main signs and symptoms of GSM include, among others, burning, irritation, vulvovaginal dryness, dyspareunia, urinary symptoms of urgency, dysuria, or recurrent urinary tract infection. The diagnosis can be made through anamnesis, questionnaires, physical exams, and, sometimes, complementary exams. Objective vaginal assessment is essential and can be complemented by using the Vaginal Health Index (VHI), Vaginal Maturation Index (VMI), or vaginal pH measurement. The acknowledgment of this condition by health professionals is crucial for its identification and proper management and exclusion of other conditions that make a differential diagnosis with it.
ABSTRACT
OBJECTIVE: The aim of the study was to evaluate the associated factors associated with pessary dislodgment in women with advanced pelvic organ prolapse (POP). METHODS: A cohort study with women (N = 98) with advanced POP who chose conservative treatment with ring pessary between December 2016 and 2018 identified by screening. Demographic data, history of POP, urinary, and/or bowel symptoms were collected. A medical visit was scheduled 3 and 6 months after pessary insertion to evaluate symptoms (vaginal discharge, bleeding, pain, discomfort, new-onset urinary, or fecal problems) and any pessary dislodgment. Two groups were created (women who were able to retain the pessary versus who were not able), and univariate and multivariate analysis were performed to look for risk factors for pessary dislodgment. Women who requested to have their pessaries removed during the 6-month follow-up were excluded. RESULTS: Ninety-three women included in the study, 78 successfully continued to use the pessary at 6 months, and 15 had pessary dislodgment (16.1%). Demographic characteristics were similar between the treatment group and the control group. After multivariate analysis, women who had their pessaries dislodged presented higher rates of previous surgery (odds ratio = 8.11; 95% confidence interval = 2.09-31.58; P = 0.003) with advanced Pelvic Organ Prolapse Quantification system staging (odds ratio, 13.41; confidence interval, 1.97-91.36; P = 0.008). CONCLUSIONS: The presence of advanced apical POP and previous POP surgery are risk factors for ring pessary dislodgment. This information should guide physicians for counseling patients before pessary insertion.
Subject(s)
Pelvic Organ Prolapse/surgery , Pessaries/adverse effects , Aged , Cohort Studies , Equipment Failure/statistics & numerical data , Female , Humans , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Risk FactorsABSTRACT
O tema doença inflamatória pélvica está contemplado no Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. A doença inflamatória pélvica é a infecção aguda do trato genital superior feminino decorrente da ascensão canalicular de microrganismos cervicovaginais endógenos e, principalmente, os de transmissão sexual. Entre os agentes etiológicos envolvidos, destacam-se Chlamydia trachomatis e Neisseria gonorrhoeae. As sequelas mais importantes são dor pélvica crônica, infertilidade e gravidez ectópica. O diagnóstico clínico apresenta-se como a abordagem prática mais importante. O tratamento com antibióticos deve ser iniciado imediatamente diante da suspeição clínica. Descrevem-se orientações para gestores e profissionais de saúde sobre testes diagnósticos, tratamento preconizado, seguimento, aconselhamento, notificação, manejo de parcerias sexuais e de populações especiais. Com a maior disponibilidade da técnica de biologia molecular no Brasil, recomenda-se o rastreio de C. trachomatis e N. gonorrhoeae como estratégia preventiva da doença.
Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an acute infection of the upper female genital tract due to canalicular spread of endogenous cervicovaginal microorganisms, in particular sexually transmitted organisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The most important sequels are chronic pelvic pain, infertility and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment should start immediately upon clinical suspicion. The article contains guidance for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling of sexual partnerships and special populations. In view of increased availability of the molecular biology technique in Brazil, C. trachomatis and N. gonorrhoeae screening is recommended as a disease prevention strategy.
El tema de la enfermedad inflamatoria pélvica está incluido en el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral para Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. La enfermedad inflamatoria pélvica es una infección aguda del tracto genital superior femenino resultante del ascenso canalicular de microorganismos cervicovaginales endógenos y, principalmente, los de transmisión sexual. Entre los agentes etiológicos involucrados, se destacan Chlamydia trachomatis y Neisseria gonorrhoeae. Las secuelas más importantes son: dolor pélvico crónico, infertilidad y embarazo ectópico. El diagnóstico clínico es el enfoque práctico más importante. El tratamiento con antibiótico debe iniciarse inmediatamente ante la sospecha clínica. Se describen pautas para gestores y profesionales de la salud sobre pruebas de diagnóstico, tratamiento, seguimiento, asesoramiento, notificación, manejo de parejas sexuales y poblaciones especiales. Con la mayor disponibilidad de la técnica de biología molecular, se recomienda el cribado de C. trachomatis y N. gonorrhoeae como estrategia preventiva para la enfermedad.
Subject(s)
Humans , Female , Pregnancy , Sexually Transmitted Diseases/epidemiology , Pelvic Inflammatory Disease/diagnosis , Pelvic Inflammatory Disease/therapy , Pelvic Inflammatory Disease/epidemiology , Sexual Behavior , Brazil/epidemiology , Chlamydia trachomatis/pathogenicity , Clinical Protocols , Neisseria gonorrhoeae/pathogenicityABSTRACT
Resumo O tema doença inflamatória pélvica está contemplado no Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. A doença inflamatória pélvica é a infecção aguda do trato genital superior feminino decorrente da ascensão canalicular de microrganismos cervicovaginais endógenos e, principalmente, os de transmissão sexual. Entre os agentes etiológicos envolvidos, destacam-se Chlamydia trachomatis e Neisseria gonorrhoeae. As sequelas mais importantes são dor pélvica crônica, infertilidade e gravidez ectópica. O diagnóstico clínico apresenta-se como a abordagem prática mais importante. O tratamento com antibióticos deve ser iniciado imediatamente diante da suspeição clínica. Descrevem-se orientações para gestores e profissionais de saúde sobre testes diagnósticos, tratamento preconizado, seguimento, aconselhamento, notificação, manejo de parcerias sexuais e de populações especiais. Com a maior disponibilidade da técnica de biologia molecular no Brasil, recomenda-se o rastreio de C. trachomatis e N. gonorrhoeae como estratégia preventiva da doença.
Abstract Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an acute infection of the upper female genital tract due to canalicular spread of endogenous cervicovaginal microorganisms, in particular sexually transmitted organisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The most important sequels are chronic pelvic pain, infertility and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment should start immediately upon clinical suspicion. The article contains guidance for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling of sexual partnerships and special populations. In view of increased availability of the molecular biology technique in Brazil, C. trachomatis and N. gonorrhoeae screening is recommended as a disease prevention strategy.
Resumen El tema de la enfermedad inflamatoria pélvica está incluido en el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral para Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. La enfermedad inflamatoria pélvica es una infección aguda del tracto genital superior femenino resultante del ascenso canalicular de microorganismos cervicovaginales endógenos y, principalmente, los de transmisión sexual. Entre los agentes etiológicos involucrados, se destacan Chlamydia trachomatis y Neisseria gonorrhoeae. Las secuelas más importantes son: dolor pélvico crónico, infertilidad y embarazo ectópico. El diagnóstico clínico es el enfoque práctico más importante. El tratamiento con antibiótico debe iniciarse inmediatamente ante la sospecha clínica. Se describen pautas para gestores y profesionales de la salud sobre pruebas de diagnóstico, tratamiento, seguimiento, asesoramiento, notificación, manejo de parejas sexuales y poblaciones especiales. Con la mayor disponibilidad de la técnica de biología molecular, se recomienda el cribado de C. trachomatis y N. gonorrhoeae como estrategia preventiva para la enfermedad.