Trichomonas vaginalis and HIV infection: relation and prevalence among women in southern Brazil

Trichomoniasis is a curable sexually transmitted infection (STI) that has been reported to be linked to exposure to human immunodeficiency virus (HIV), although few studies have described this association. The purpose of this study was to focus on the incidence of trichomoniasis in low-income women, its relation to HIV status, viral load levels and TCD4+cell counts, among other risk factors, using an in vitro culture as a diagnostic test. A cross-sectional study among 267 women (103 HIV-positive and 164 HIV-negative) was conducted in 2015. The overall prevalence of Trichomonas vaginalis (TV) infection was 6.4%. Among HIV-positive and HIV-negative women, the prevalence was 3.9% and 7.9%, respectively, yet these results were not statistically different (p=0.1878). The factors associated with TV infection were cigarette smoking (OR= 3.52), vaginal itching (OR=4.43) and bacterial vaginosis (BV) (OR= 5.29). HIV status, TCD4+ cell count and viral load were not associated with TV infection in this group. The prevalence rates found, lower than those observed in other studies, may be due to the fact that the women evaluated in the present study are part of a low-risk population as well as the limited sample size of HIV positive women

Aptima Trichomonas vaginalis assay elucidates significant underdiagnosis of trichomoniasis among women in Brazil according to an observational study.

OBJECTIVES: Trichomonas vaginalis (TV) infection is the most common non-viral STI globally and can result in adverse pregnancy outcomes and exacerbated HIV acquisition/transmission. Nucleic acid amplification tests (NAATs) are the most sensitive diagnostic tests, with high specificity, but TV NAATs are rarely used in Brazil. We investigated the TV prevalence and compared the performance of the US Food and Drug Association-cleared Aptima TV assay with microscopy (wet mount and Gram-stained) and culture for TV detection in women in Pelotas, Brazil in an observational study. METHODS: From August 2015 to December 2016, 499 consecutive asymptomatic and symptomatic sexually active women attending a Gynaecology and Obstetrics Outpatient Clinic were enrolled. Vaginal fluid and swab specimens were collected and wet mount microscopy, Gram-stained microscopy, culture and the Aptima TV assay performed. RESULTS: The median age of enrolled women was 36.5 years (range: 15-77). The majority were white, had a steady sexual partner and low levels of education. The TV detection rate was 4.2%, 2.4%, 1.2% and 0% using the Aptima TV assay, culture, wet mount microscopy and Gram-stained microscopy, respectively. The sensitivity of culture and wet mount microscopy was only 57.1% (95% CI 36.5 to 75.5) and 28.6% (95% CI 13.8 to 50.0), respectively. CONCLUSIONS: A 4.2% positivity rate of T. vaginalis was found among women in Pelotas, Brazil and the routine diagnostic test (wet mount microscopy) and culture had low sensitivities. More sensitive diagnostic tests (NAATs) and enhanced testing of symptomatic and asymptomatic at-risk women are crucial to mitigate the transmission of TV infection, TV-associated sequelae and enhanced HIV acquisition and transmission.

Prevalence of Trypanosoma cruzi/HIV coinfection in southern Brazil

Abstract Chagas disease reactivation has been a defining condition for acquired immune deficiency syndrome in Brazil for individuals coinfected with Trypanosoma cruzi and HIV since 2004. Although the first coinfection case was reported in the 1980s, its prevalence has not been firmly established. In order to know coinfection prevalence, a cross-sectional study of 200 HIV patients was performed between January and July 2013 in the city of Pelotas, in southern Rio Grande do Sul, an endemic area for Chagas disease. Ten subjects were found positive for T. cruzi infection by chemiluminescence microparticle immunoassay and indirect immunofluorescence. The survey showed 5% coinfection prevalence among HIV patients (95% CI: 2.0-8.0), which was 3.8 times as high as that estimated by the Ministry of Health of Brazil. Six individuals had a viral load higher than 100,000 copies per µL, a statistically significant difference for T. cruzi presence. These findings highlight the importance of screening HIV patients from Chagas disease endemic areas.

Chlamydia trachomatis infection in young pregnant women in Southern Brazil: a cross-sectional study.

This study estimated the prevalence of Chlamydia trachomatis infection during pregnancy in a sample of women up to 29 years of age in the city of Pelotas, Rio Grande do Sul State, Brazil, and investigated socio-demographic risk factors such as maternal age, marital status, maternal schooling, and family income. C. trachomatis infection was diagnosed with PCR using BD ProbeTecTM CT/GC Amplified DNA Assay. Socio-demographic, behavioral, and reproductive data were collected using structured questionnaires. All collections were performed by previously trained medical students. The study included a stratified probabilistic sample from four maternity hospitals in the city. The sample included 562 pregnant women, and prevalence of C. trachomatis infection was 12.3% (95%CI: 9.6-15.0). No significant association was identified between C. trachomatis infection and any of the target variables, including obstetric outcomes such as history of preterm delivery. Our findings in terms of low treatment adherence, only 43% of the women and 9.7% of partners, associated with high C. trachomatis prevalence, reinforce the need to implement routine screening for C. trachomatis during prenatal care. The attempt to diagnose and treat this infection after delivery, as in this study, limits the possibility of success.

Prevalence of Trypanosoma cruzi/HIV coinfection in southern Brazil.

Chagas disease reactivation has been a defining condition for acquired immune deficiency syndrome in Brazil for individuals coinfected with Trypanosoma cruzi and HIV since 2004. Although the first coinfection case was reported in the 1980s, its prevalence has not been firmly established. In order to know coinfection prevalence, a cross-sectional study of 200 HIV patients was performed between January and July 2013 in the city of Pelotas, in southern Rio Grande do Sul, an endemic area for Chagas disease. Ten subjects were found positive for T. cruzi infection by chemiluminescence microparticle immunoassay and indirect immunofluorescence. The survey showed 5% coinfection prevalence among HIV patients (95% CI: 2.0-8.0), which was 3.8 times as high as that estimated by the Ministry of Health of Brazil. Six individuals had a viral load higher than 100,000copies per µL, a statistically significant difference for T. cruzi presence. These findings highlight the importance of screening HIV patients from Chagas disease endemic areas.

Chlamydia trachomatis infection in young pregnant women in Southern Brazil: a cross-sectional study / Infecção por Chlamydia trachomatis em gestantes jovens no Sul do Brasil: um estudo transversal / Infección por Chlamydia trachomatis en gestantes jóvenes en el sur de Brasil: un estudio transversal

Abstract: This study estimated the prevalence of Chlamydia trachomatis infection during pregnancy in a sample of women up to 29 years of age in the city of Pelotas, Rio Grande do Sul State, Brazil, and investigated socio-demographic risk factors such as maternal age, marital status, maternal schooling, and family income. C. trachomatis infection was diagnosed with PCR using BD ProbeTecTM CT/GC Amplified DNA Assay. Socio-demographic, behavioral, and reproductive data were collected using structured questionnaires. All collections were performed by previously trained medical students. The study included a stratified probabilistic sample from four maternity hospitals in the city. The sample included 562 pregnant women, and prevalence of C. trachomatis infection was 12.3% (95%CI: 9.6-15.0). No significant association was identified between C. trachomatis infection and any of the target variables, including obstetric outcomes such as history of preterm delivery. Our findings in terms of low treatment adherence, only 43% of the women and 9.7% of partners, associated with high C. trachomatis prevalence, reinforce the need to implement routine screening for C. trachomatis during prenatal care. The attempt to diagnose and treat this infection after delivery, as in this study, limits the possibility of success.

Resumo: Este estudo estimou a prevalência de Chlamydia trachomatis durante a gestação entre mulheres de até 29 anos e investigou fatores de risco sociodemográficos, como idade materna, estado civil, escolaridade materna e renda familiar, para a infecção na cidade de Pelotas, Rio Grande do Sul, Brasil. Infecção por C. trachomatis foi diagnosticada por PCR utilizando BD ProbeTecTM CT/GC Amplified DNA Assay system. Dados sociodemográficos, comportamentais e reprodutivos foram coletados através de questionários estruturados. Todas as coletas foram realizadas por estudantes de medicina treinados. Amostra probabilística estratificada de quatro maternidades da cidade foi estudada. A amostra constou de 562 gestantes e a prevalência de infecção por C. trachomatis foi de 12,3% (IC95%: 9,6-15,0). Não foi identificada associação significativa entre infecção por C. trachomatis e as variáveis investigadas, incluindo desfechos obstétricos como parto pretermo. Nossos achados de baixa adesão ao tratamento, de apenas 43% entre as mulheres e de 9,7% entre os parceiros, associados a alta prevalência, reforçam a necessidade de implementar rastreamento de rotina para C. trachomatis durante a assistência pré-natal. A tentativa de diagnosticar e tratar esta infecção depois do parto, como feito neste estudo, limita a possibilidade de sucesso.

Resumen: Este estudio estimó la prevalencia de Chlamydia trachomatis durante la gestación, entre mujeres de hasta 29 años, e investigó factores de riesgo sociodemográficos como: edad materna, estado civil, escolaridad materna y renta familiar, para esta infección en la ciudad de Pelotas, Rio Grande do Sul, Brasil. La infección por C. trachomatis fue diagnosticada mediante PCR, utilizando BD ProbeTecTM CT/GC Amplified DNA Assay system. Los datos sociodemográficos, comportamentales y reproductivos se recogieron a través de cuestionarios estructurados. Todas las recogidas de datos se realizaron por parte de estudiantes de medicina entrenados. Se estudió la muestra probabilística estratificada de cuatro maternidades de la ciudad. La muestra constó de 562 gestantes y la prevalencia de infección por C. trachomatis fue de un 12,3% (IC95%: 9,6-15,0). No se identificó una asociación significativa entre infección por C. trachomatis y las variables investigadas, incluyendo desenlaces obstétricos como el parto pretérmino. Nuestros hallazgos de baja adhesión al tratamiento, solamente un 43% entre las mujeres y un 9,7% entre los compañeros, asociados a la alta prevalencia, refuerzan la necesidad de implementar una exploración de rutina para C. trachomatis durante la asistencia prenatal. La tentativa de diagnosticar y tratar esta infección después del parto, como se realizó en este estudio, limita la posibilidad de éxito.

Maternal Chlamydia trachomatis Infections and Preterm Births in a University Hospital in Vitoria, Brazil.

BACKGROUND: Preterm birth (PTB) is a major determinant of neonatal morbimortality with adverse consequences for health. The causes are multifactorial, with intrauterine infection probably explaining most of these outcomes. It is believed that infection with Chlamydia trachomatis (CT) is also involved in PTB and premature rupture of membranes. OBJECTIVES: To evaluate the prevalence of and associated factors for CT among cases of PTB attended at a University Hospital in Vitoria, Brazil. METHODS: A cross-sectional study performed among parturient who had preterm birth from June 2012 to August 2013 in Vitoria, Brazil. Participants answered a questionnaire including demographic, behavioral, and clinical data. A sample of urine was collected and screened for CT using polymerase chain reaction. Chi-square tests were used for proportion differences and Student's-t tests and variance analysis were used for testing differences between mean values. Odds ratio was used as a measure of association with a 95% confidence interval. RESULTS: The prevalence of PTB during the period of the study was 26% and the prevalence of CT among them was 13.9%. A total of 31.6% pregnant women were younger than 25 years old and women infected by CT were even younger than women not infected by CT (p = 0.022). Most of them (76.2%) were married or had a living partner, and CT infection was more frequent among the single ones (p = 0.018); 16.7% of women reported their first sexual intercourse under 14 years old. The causes of prematurity were maternal-fetal in 40.9%; rupture of the membranes in 29.7% and premature labor in 29.4%. In multivariate analysis, being married was a protective factor for infection [OR = 0.48 (95%CI:0.24-0.97)]. None of the other characteristics were associated with CT infection. CONCLUSIONS: This study shows a high prevalence of CT infection among parturient who have preterm birth. This high prevalence highlight the need for defining screening strategies focused on young pregnant women in Brazil.

Serological diagnosis of Chagas disease in HIV-infected patients.

INTRODUCTION: This study assessed the rate of request for the serological diagnosis of Chagas disease among human immunodeficiency virus (HIV)-infected patients treated at the Specialized Care Service of Pelotas, Rio Grande do Sul, Brazil. METHODS: This cross-sectional study used secondary data obtained from the medical records of 252 patients aged between 18 and 75 years. RESULTS: The serological diagnosis of Chagas disease was requested only in 3.2% of cases. CONCLUSIONS: The results demonstrate poor adherence to protocols on the part of healthcare professionals, indicating the need to reevaluate the procedures applied to HIV-infected patients from endemic regions for both diseases.

Trichomonas Vaginalis Infection Among Women Attending in the Public Service in Rio Grande do Sul,Brazil: Frequency, Risk Factors and Clinical Signs / Infecção por Trichomonas Vaginalis em Mulheres a Tendidas pelo Serviço Público no Rio Grande do Sul, Brasil: Frequência, Fatores de Risco e Sinais Clínicos

Trichomoniasis is a cosmopolitan disease that can affect the female fertility, and is commonly underdiagnosed, both in private practices and in public health services, because of the low sensitivity of the wet mount exam used routinely. Objective: To understand the occurrence of T. vaginalis infection by means of in vitro culture in women receiving care in a public health unit, in the city of Pelotas, Rio Grande do Sul, Brazil, as well as to identify the possible risk factors associated with this infection. Methods: Cross­sectional study was carried out, which included 201 women undergoing interview and gynecological exam, with the collection of vaginal discharge in the Gynecology Ambulatory at the School of Medicine of Universidade Federal de Pelotas. The material collected was examined in the form of fresh smears and cultivated in Diamond's medium. Epidemiological data were obtained by means of patient interviews and clinical trials, from the medical records. The results were statistically analyzed through χ 2 and Fisher's exact tests, using version 9.0 of the Statistix program. Results: The occurrence of T. vaginalis infection was 7% (14/201). In the wet mount exam, used routinely for the diagnosis of this agent, only 42.85% of the infected women (6/14) were positive. It was noted that 21.4% of the infected women were asymptomatic, and 89.05% were not aware of the existence of the Trichomonas vaginalis infection. Factors independently associated with the infection were the smoking habit (odds ratio [OR] = 11.8), not having a stable sexual partner (OR = 6.36), presence of vaginal discharge with odor (OR = 5.65), and altered vaginal microbiota (OR = 5.31). Conclusion : T. vaginalis infection was present among the women studied, being underestimated because of the diagnostic technique, and because many of them were asymptomatic. The smoking habit, not having a stable sexual partner, having fetid discharge, and altered vaginal microbiota are the risk factors for infection.

A tricomoníase é cosmopolita, pode afetar a fertilidade feminina, e geralmente é subdiagnosticada, tanto em consultórios particulares, quanto em serviços públicos, devido à baixa sensibilidade do exame a fresco, usado rotineiramente. Objetivo: Conhecer a ocorrência de infecção por Trichomonas vaginalis , através de cultivo in vitro , em mulheres atendidas em unidade pública, na cidade de Pelotas, Rio Grande do Sul, além de identificar os possíveis fatores de risco associados a essa infecção. Métodos: Estudo de corte transversal que incluiu 201 mulheres, submetidas a entrevista e exame ginecológico, com coleta de conteúdo vaginal, no Ambulatório de Ginecologia da Faculdade de Medicina da Universidade Federal de Pelotas. O material coletado foi examinado a fresco e cultivado em meio de Diamond. Foram obtidos dados epidemiológicos através de entrevista, e clínicos, nos prontuários. Os resultados foram analisados estatisticamente através dos testes do χ 2 e exato de Fisher, utilizando o programa Statistix versão 9.0. Resultados: A ocorrência da infecção por T. vaginalis foi de 7% (14/201). No exame a fresco, usado como rotina para o diagnóstico desse agente, apenas 42,85% das infectadas (6/14) foram positivas. Constat ou­se que 21,4% das mulheres infectadas são assintomáticas, e que 89,05% desconhecia a existência da tricomoníase. Os fatores independent emente associados com a infecção foram o hábito de fumar (OR=11,8), não ter companheiro fixo (OR=6,36), apresentar corrimento vaginal fétido (OR=5,65) e microbiota vaginal alterada (OR=5,31). Conclusão: A infecção por T. vaginalis está presente entre as mulheres estudadas, e sendo subestimada, devido à técnica de diagnóstico e por muitas serem assintomáticas. O hábito de fumar, não ter companheiro fixo, ter corrimento fétido e microbiota vaginal alterada são fatores de risco para a infecção.

High incidence of oncogenic HPV genotypes found in women from Southern Brazil.

Oncogenic HPV genotypes are strongly associated with premalignant and malignant cervical lesion. The purpose was to determine human papillomavirus (HPV) prevalence and genotypes, and to estimate cervical cancer risk factor associations. Cervical samples were obtained from 251 women seeking gynecological care at the Pelotas School of Medicine Clinic. This is a cross-sectional study. HPV-DNA was amplified by nested-PCR using MY09/11 and GP5/6 primers, and the sequencing was used for genotyping. Sociodemographic and behavioral risk factors were obtained by closed questionnaire, and its relationship to HPV infection prevalence were analyzed. Statistical analyses were performed using SPSS 16.0 software, and differences were considered significant at p < 0.05. As results, the prevalence of HPV infection was 29.9%. The most frequent genotype was HPV-16 (41.3%), followed by HPV-18 (17.3%), and HPV-33 (9.3%). Others nine HPV genotypes were also found. On this population, prevalence of oncogenic HPV genotypes was high, but does not seem to confer relationship with the risk factors investigated. Future investigations in larger populations are necessary, for the proposition of more appropriated monitoring strategies and treatment according to the Brazilian health service reality, as well as patients.

High incidence of oncogenic HPV genotypes found in women from Southern Brazil

Oncogenic HPV genotypes are strongly associated with premalignant and malignant cervical lesion. The purpose was to determine human papillomavirus (HPV) prevalence and genotypes, and to estimate cervical cancer risk factor associations. Cervical samples were obtained from 251 women seeking gynecological care at the Pelotas School of Medicine Clinic. This is a cross-sectional study. HPV-DNA was amplified by nested-PCR using MY09/11 and GP5/6 primers, and the sequencing was used for genotyping. Sociodemographic and behavioral risk factors were obtained by closed questionnaire, and its relationship to HPV infection prevalence were analyzed. Statistical analyses were performed using SPSS 16.0 software, and differences were considered significant at p < 0.05. As results, the prevalence of HPV infection was 29.9%. The most frequent genotype was HPV-16 (41.3%), followed by HPV-18 (17.3%), and HPV-33 (9.3%). Others nine HPV genotypes were also found. On this population, prevalence of oncogenic HPV genotypes was high, but does not seem to confer relationship with the risk factors investigated. Future investigations in larger populations are necessary, for the proposition of more appropriated monitoring strategies and treatment according to the Brazilian health service reality, as well as patients.

Conhecimento sobre sorologia para sífilis e HIV entre profissionais do sexo de Pelotas, Brasil / Knowledge about HIV and syphilis serologic status among sex workers from Pelotas, Brazil

Introdução: os profissionais do sexo apresentam maior vulnerabilidade à sífilis e ao HIV. O conhecimento do estado sorológico possibilita tratamento e práticas de prevenção. Objetivo: avaliar o conhecimento dos profissionais do sexo de Pelotas/RS sobre seu estado sorológico para sífilis e HIV. Métodos: estudo transversal de base populacional, descritivo, realizado em 2006, com 322 profissionais do sexo maiores de 18 anos. Aplicou-se questionário sobre conhecimento da sorologia para sífilis e HIV e foi feito teste rápido para sífilis. Resultados: a maioria dos entrevistados era mulher (76,1%), entre 22-39 anos (64,9%), branca (63,7%), com 5-8 anos de escolaridade (45,7%), e 57,5% nunca haviam realizado sorologia para sífilis. Entre os que realizaram, 19,6% foram reagentes, 65% utilizaram a rede pública, e o motivo mais referido foi pré-natal. O teste rápido foi reagente para 24 entrevistados. Oitenta e oito por cento já haviam realizado sorologia para HIV. Os motivos mais frequentes foram "achar que tinha risco", "precaução" ou "controle" (27%) e pré-natal (24%). Dos entrevistados, 17 sabiam ter HIV e 13 destes estavam em tratamento. Conclusão: é baixo o percentual de testagem para sífilis entre os entrevistados. A testagem mais frequente para HIV pode estar relacionada ao maior conhecimento sobre a doença. A rede pública é o principal local de testagem e o pré-natal é motivo comum para os exames. Muitos dos profissionais fizeram os testes por reconhecer que têm risco para essas doenças.

Introduction: sex workers are more vulnerable to syphilis and HIV. Knowledge about serologic status allowed treatment and prevention behaviors. Objective: to evaluate the knowledge of sex workers from Pelotas/RS about their serologic status for syphilis and HIV. Methods: cross-sectional study population based, descriptive, done in 2006, with 322 sex workers aged 18 years old or more. A questionnaire about knowledge of syphilis and HIV serologic status was applied and we did rapid test for syphilis. Results: most of the interviewed were female (76.1%), between 22-39 years (64.9%), white skin (63.7%), schooling between 5-8 years (45.7%), 57.5% had never been tested for syphilis. Among those tested, 19.6% had a positive test, 65% went to public laboratories, and the most common reason was antenatal care. syphilis rapid test was positive for 24 people. 88% had already been tested for HIV. Most frequent reasons for this test were "I think I have risk", "precaution", "control" (27%) and antenatal care (24%). Seventeen sex workers already knew being HIV+ and 13 were under clinical care. Conclusion: percentage of syphilis testing among the interviewed was low. More frequent HIV testing may be related to the greater knowledge about this disease. Public laboratories are the main place for testing and antenatal care is a common reason for the exams. Many of the interviewed realized the test because recognized being at risk.