Basic vaginal pH, bacterial vaginosis and aerobic vaginitis: prevalence in early pregnancy and risk of spontaneous preterm delivery, a prospective study in a low socioeconomic and multiethnic South American population.

BACKGROUND: Bacterial vaginosis (BV) increases the risk of spontaneous preterm deliveries (PD) in developed countries. Its prevalence varies with ethnicity, socioeconomic conditions and gestational age. Aerobic vaginitis (AV) has also been implicated with spontaneous PD. The present study aimed to estimate the prevalence of asymptomatic BV, the accuracy of vaginal pH level to predict BV and to estimate the risk of spontaneous PD <34 and <37 weeks' gestation of BV and AV. METHODS: Women attending prenatal public services in Rio de Janeiro were screened to select asymptomatic pregnant women, < 20 weeks' gestation, with no indication for elective PD and without risk factors of spontaneous PD. Vaginal smears of women with vaginal pH > = 4.5 were collected to determine the Nugent score; a sample of those smears was also classified according to a modified Donders' score. Primary outcomes were spontaneous PD < 34 and <37 weeks' gestation and abortion. RESULTS: Prevalence of asymptomatic BV was estimated in 28.1% (n = 1699); 42.4% of the smears were collected before 14 weeks' gestation. After an 8-week follow up, nearly 40% of the initially BV positive women became BV negative. The prevalence of BV among white and black women was 28.1% (95% CI: 24.6%-32.0%) and 32.5% (95% CI: 28.2%-37.2%), respectively. The sensitivity of vaginal pH= > 4.5 and = > 5.0 to predict BV status was 100% and 82%, correspondingly; the 5.0 cutoff value doubled the specificity, from 41% to 84%. The incidence of < 37 weeks' spontaneous PDs among BV pregnant women with a pH= > 4.5 was 3.8%. The RR of spontaneous PD < 34 and <37 weeks among BV women with pH > =4.5, as compared with those with intermediate state, were 1.24 and 1.86, respectively (Fisher's exact test, p value = 1; 0.52, respectively, both ns). No spontaneous case of PD or abortion was associated with severe or moderate AV. CONCLUSIONS: A high prevalence of asymptomatic BV was observed without statistically significant difference between black and white women. The RRs of spontaneous PD < 34 and <37 weeks among women with BV, as compared with those with intermediate state were not statistically significant but were consistent with those found in the literature.

Prepregnancy body mass index, vaginal inflammation, and the racial disparity in preterm birth.

The authors sought to quantify the overall and race/ethnic-specific relations between prepregnancy body mass index and both preterm birth and vaginal inflammation. Data from a cohort of 11,392 women who enrolled in the multicenter Vaginal Infections and Prematurity Study (1984-1989) at 23-26 weeks' gestation were used. Compared with a prepregnancy body mass index of 22, a body mass index of 16 increased the risk of preterm birth by 90% (odds ratio = 1.9, 95% confidence interval (CI): 1.5, 2.6), and a body mass index of 18 increased the risk by 40% (odds ratio = 1.4, 95% CI: 1.2, 1.7). Ethnicity substantially modified the magnitude of the body mass index effect and the shape of the preterm birth risk curve, with underweight having a greater impact on preterm birth among Blacks and Hispanics than among Whites. Low body mass index increased the risk of a high level of neutrophils (> 5 per oil immersion field) and a high vaginal pH measurement (> or = 5.0) among Black women; for a body mass index of 16 versus 22, the odds ratio = 1.7 (95% CI: 1.1, 2.6). Compared with Black women with a body mass index of 22, Blacks with a body mass index of 16 had a 1.7-fold increased risk for a high level of neutrophils and a high vaginal pH measurement, while those with a body mass index of 18 had a 1.3-fold increased risk.

The vaginitis monologues: women's experiences of vaginal complaints in a primary care setting.

Vaginal complaints are a common presenting problem in primary care settings. A disease model has dominated current research and treatment paradigms, with little attention to the illness or experiential dimensions of vaginal complaints. In this paper, we report data from a qualitative study of the experiences of women diagnosed with vaginitis. In semi-structured interviews with 44 women in New York City, United States, we investigated women's interpretations and explanations of their illness, their accounts of its impact on their lives, their experiences with treatment, and the role of vaginal symptoms in communicating distress and anger. We found that women's explanations of vaginal complaints differed strikingly from the current medical model described in the literature on vaginitis. Vaginal symptoms often occasioned extreme anxiety; their impact on social and sexual functioning could be severe. Finally, vaginal symptoms often functioned to express distress and gender conflict. These findings have important implications for the management of the disorder.

Estudo preliminar para detecçäo de cérvico-vaginites e lesöes precursoras do câncer de colo uterino, em índias da tribo Parakanä / Preliminary study on low-trait genital infection and cervical epithelial dysplasia in indian of the Parakanä tribe

OBJETIVO. Avaliaçao preliminar da freqüência de inflamaçoes genitais e lesoes precursoras do câncer cérvico-uterino em um grupo indígena isolado da Amazônia oriental brasileira. MATERIAL E MÉTODO. Estudo transversal, dirigido às mulheres maiores de dez anos das aldeias Maroxewara e Paranatinga, da tribo Parakana. Foram obtidas informaçoes demográficas, etno-culturais, tocoginecológicas; procedeu-se a um exame físico e ginecológico, com coleta de material para bacterioscopia e colpocitologia oncótica.RESULTADOS. Foram examinadas 80 mulheres (89,9 por cento), das quais 69 foram avaliadas laboratorialmente; 14(20,3 por cento) estavam grávidas. Na aldeia Paranatinga, a bacterioscopia revelou um maior número de mulheres com ausência de flora Döderlein (60,0 por cento vs.29,l por cento). Na colpocitologia, o padrao mais encontrado foi o inflamatório (91,5 por cento); das colpites de etiologia específica (63,1 por cento), em 63,4 por cento suspeitou-se de infecçao por Gardenerella vaginalis, em 7,3 por cento por Trichomonas vaginalis, e em 4,9 por cento por microrganismos semelhantes à Candida sp. Em 23,2 por cento dos esfregaços havia alteraçoes citopatológicas relacionadas à infecçao por papilomavírus humano (PVH). As alteraçoes celulares sugeriram NIC I em um caso, NIC II em outro e carcinoma epidermóide em uma índia de 48 anos; nos três casos, foi proposta a posterior realizaçao de biópsia dirigida e avaliaçao clínica em ambientes hospitalar. Conclusoes. A maioria das mulheres Parakanas apresenta alguma patologia cervical, a maior parte das quais de menor gravidade. Apresentam, ainda, início precoce da vida sexual, multiplicidade de parceiros, curto intervalo interparto e alteraçoes citopatológicas sugestivas de infecçao pelo PVH, condiçoes de risco para transmissao sexual de doenças e desenvolvimento de câncer cérvico-uterino.

[Preliminary study on low-trait genital infection and cervical epithelial dysplasia in women from the Parakanä tribe of South America]. / Estudo preliminar para detecção de cérvico-vaginites e lesões precursoras do câncer de colo uterino, em índias da tribo Parakanã.

BACKGROUND: We evaluated the occurrence of low-trait genital infection and cervical epithelial dysplasia in women from a South-american indian tribe in the Brazilian Amazonia. METHODS: Cross-sectional study of women older than 10 years from two indian settlements of the Parakanã tribe: Paranatinga and Maroxewara. Demographic data and information about sexual behavior as well as obstetric/gynaecological history were recorded. Two gynecologists examined 80 patients (89.9%), and collected vaginal and cervical specimens of 69 indians for further laboratory analysis, by Gram stain and Papanicolaou method. Fourteen (20.3%) women resulted to be pregnant. RESULTS: Parakanã women begin sexual activity early, after menarche; they have multiple sexual partners; are multiparous. Some of his partners already had intercourse with women of our society. In Paranatinga, vaginal discharges were a very frequent sign and not age-related, and women presented high frequency of disturbances on lactobacilli flora, greater than among inhabitants of Maroxewara. Pap smears in 91.5% of all patients showed inflammatory pattern. When found an possible etiologic agent (61.3%), in 63.4% it was Gardnerella vaginalis, in 7.3% Trichomonas vaginalis and in 4.9% Candida sp. In 23.2% of smears cythophatic signs related to infection by human papillomavirus were identified. One case had morphological changes compatible with cervical intraepithelial neoplasia grade I, another with CIN II and, in a 48 year old indian, cervical cancer. CONCLUSIONS: Near all women had some grade of cervical disease. Measure HPV-infection prevalence among Parakanã indians with adequate methods may improve our understanding about worldwide occurrence of HPV infections. Established risk factors for cancer of the cervix and sexually transmitted diseases were common in this tribe.

Nutrition, genital tract infection, hematologic values, and premature rupture of membranes among African American Women.

Using a prospective comparative design, African American gravidae with and without genital tract infection were assessed with respect to dietary intakes, serum nutrient values, hematologic values, and pregnancy outcomes. Intakes of ascorbic acid, vitamin A, protein, and iron were the dietary variables while levels of ascorbic acid, protein, albumin, globulin, and ferritin were the variables measured in serum. The hematologic variables included hemoglobin, hematocrit, and red and white blood cell counts. Pregnancy outcome was defined on the basis of premature rupture of the membranes (PROM), and infant birth weight, birth length, gestational age, and head circumference. The sample consisted of 335 nulliparous women who were between 16-35 years of age, 96 of whom had genital tract infection based on laboratory reports. Findings indicated no significant differences between the mean dietary intakes as well as serum values of the infected and non-infected women, and no difference in the incidence of PROM. However, non-infected women had a better mean hematologic profile than the infected gravidae during pregnancy. Also, for the non-infected group, there were significant relationships between head circumference and protein consumption (P = .015) and serum ferritin (P = .05). For the infected women, the relationship between the hemoglobin and hematocrit measurements obtained at the first prenatal visit and infant birth weight, birth length and head circumference were statistically significant.