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1.
Obstet Gynecol ; 135(5): 1136-1144, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32282605

RESUMEN

OBJECTIVE: To identify factors associated with testing for and diagnosis of trichomoniasis in pregnancy and to describe patterns of treatment and tests of reinfection or persistence. METHODS: We conducted a retrospective cohort study of women who delivered from July 2016 to June 2018 at one institution. Testing for Trichomonas vaginalis infection was done by wet mount microscopy or by nucleic acid amplification testing for routine prenatal testing or symptomatic visits. Poisson regression was used to identify factors associated with testing for trichomoniasis and testing positive in pregnancy. Treatment and re-testing patterns also were assessed. RESULTS: Among 3,265 pregnant women, 2,489 (76%) were tested for T vaginalis infection. Of the total sample, 1,808 (55%) were tested by wet mount microscopy, 1,661 (51%) by nucleic acid amplification testing, and 980 (30%) by both modalities. The sensitivity for microscopy compared with nucleic acid amplification testing was 26%, with a specificity of 99%. Factors associated with increased likelihood of being tested included younger age (adjusted risk ratio [aRR] 0.99, 95% CI 0.99-1.00) and bacterial vaginosis (aRR 1.17, 95% CI 1.01-1.37). Prevalence of trichomoniasis was 15% among those tested by any modality (wet mount or nucleic acid amplification testing). Risk factors for trichomoniasis included younger age (aRR 0.97, P<.01), being of black race (aRR 2.62, P<.01), abnormal vaginal discharge (aRR 1.45, P<.01), and chlamydia during the current pregnancy (aRR 1.70, P<.01). Women diagnosed by microscopy had a shorter time to treatment compared with those diagnosed by nucleic acid amplification testing. Most (75%) women with positive infections had a test of reinfection; 29% of these were positive. Bacterial vaginosis was associated with decreased risk of a positive test of reinfection. CONCLUSION: Although testing for and treatment of trichomoniasis during pregnancy is not routinely recommended, the high burden of infection among some pregnant women demonstrates a need to further understand patterns of T vaginalis testing and infection. Opportunities exist for improving timely treatment of trichomoniasis and test of reinfection.


Asunto(s)
Complicaciones Infecciosas del Embarazo/diagnóstico , Diagnóstico Prenatal/métodos , Vaginitis por Trichomonas/diagnóstico , Trichomonas vaginalis , Excreción Vaginal/diagnóstico , Adulto , Femenino , Humanos , Microscopía , Técnicas de Amplificación de Ácido Nucleico , Distribución de Poisson , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/terapia , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/terapia , Excreción Vaginal/epidemiología , Excreción Vaginal/microbiología , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/epidemiología , Adulto Joven
2.
Pediatrics ; 145(4)2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32179661

RESUMEN

BACKGROUND AND OBJECTIVES: Rates of sexually transmitted infections (STIs) have increased over the decade. Guidelines recommend HIV testing with incident STIs. Prevalence and factors associated with HIV testing in acute STIs are unknown in adolescents. Our objective was to determine the prevalence of completed HIV testing among adolescents with incident STIs and identify patient and health care factors associated with HIV testing. METHODS: Retrospective study of STI episodes (gonorrhea, Chlamydia, trichomoniasis, or syphilis) of adolescents between 13 and 24 years old from July 2014 to December 2017 in 2 urban primary care clinics. We performed mixed effects logistic regression modeling to identify patient and health care factors associated with HIV testing within 90 days of STI diagnosis. RESULTS: The 1313 participants contributed 1816 acute STI episodes. Mean age at STI diagnosis was 17.2 years (SD = 1.7), 75% of episodes occurred in females, and 97% occurred in African Americans. Only half (55%) of acute STI episodes had a completed HIV test. In the adjusted model, female sex, previous STIs, uninsured status, and confidential sexual health encounters were associated with decreased odds of HIV testing. Patients enrolled in primary care at the clinics, compared with those receiving sexual health care alone, and those with multipathogen STI diagnoses were more likely to have HIV testing. CONCLUSIONS: HIV testing rates among adolescents with acute STIs are suboptimal. Patient and health care factors were found to be associated with receipt of testing and should be considered in clinical practice.


Asunto(s)
Infecciones por VIH/diagnóstico , Enfermedades de Transmisión Sexual , Enfermedad Aguda , Adolescente , Femenino , Gonorrea/epidemiología , Infecciones por VIH/epidemiología , Humanos , Modelos Logísticos , Masculino , Estudios Retrospectivos , Enfermedades de Transmisión Sexual/epidemiología , Sífilis/epidemiología , Vaginitis por Trichomonas/epidemiología , Adulto Joven
4.
Int J STD AIDS ; 31(3): 221-229, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31996095
5.
Sex Transm Infect ; 96(6): 436-438, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-31719170

RESUMEN

OBJECTIVE: To ascertain the prevalence of Trichomonas vaginalis and investigate associations between trichomoniasis, endometritis and sequelae among women with pelvic inflammatory disease (PID). METHODS: We assessed the prevalence of trichomoniasis identified via wet mount and its association with histologically confirmed endometritis, infertility and recurrent PID among 647 women in the PID Evaluation and Clinical Health (PEACH) study. Participants were treated for clinically suspected PID and followed for a mean of 84 months for incident sequelae. Analyses were adjusted for age, race, Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and bacterial vaginosis. Additional adjustments were incorporated for history of infertility (models of pregnancy and infertility), history of PID (recurrent PID), and self-reported partner treatment and intercourse between baseline and 30-day follow-up (persistent endometritis). RESULTS: T. vaginalis was present in the vagina of 12.8% of women. The odds of having endometritis at baseline were twice as high among women with trichomoniasis as compared with those without (adjusted OR (AOR): 1.9, 95% CI 1.0 to 3.3). Persistent endometritis was highly prevalent at 30 days (52.1%) and more common among women with baseline trichomoniasis (AOR: 2.6, 95% CI 0.7 to 10.1), although non-significantly. Infertility and recurrent PID were more common among women with trichomoniasis, while rates of pregnancy and live birth were lower. CONCLUSIONS: T. vaginalis was frequently isolated from the vagina of women with PID in the PEACH cohort. Wet mount microscopy for the identification of motile trichomonads was standard practice at the time of the PEACH study, but likely resulted in an underestimation of true T. vaginalis prevalence. Our findings of modest, although non-significant, prospective associations between trichomoniasis and sequelae are novel and underscore the need for additional investigation into whether T. vaginalis may play an aetiological role in adverse reproductive and gynaecological outcomes.


Asunto(s)
Endometritis/epidemiología , Infertilidad Femenina/epidemiología , Enfermedad Inflamatoria Pélvica/epidemiología , Índice de Embarazo , Vaginitis por Trichomonas/epidemiología , Adulto , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Femenino , Gonorrea/epidemiología , Humanos , Nacimiento Vivo/epidemiología , Infecciones por Mycoplasma/epidemiología , Mycoplasma genitalium , Enfermedad Inflamatoria Pélvica/tratamiento farmacológico , Embarazo , Recurrencia , Factores de Riesgo , Trichomonas vaginalis , Estados Unidos/epidemiología , Vaginosis Bacteriana/epidemiología
6.
Sex Transm Infect ; 96(1): 76-78, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-30992326

RESUMEN

OBJECTIVES: Using mathematical modelling, we have previously shown that the prevalence of infection with Trichomonas vaginalis (TV) is likely to increase in the general population in Australia with the transition from Pap smear-based cervical screening to human papillomavirus (HPV) DNA testing. Here we use the existing model to estimate the level of supplemental testing required to maintain TV control. METHODS: A compartmental mathematical model describing the transmission of TV in the general heterosexual population in Australia was used to evaluate the impact of a range of screening scenarios on TV prevalence over time following the transition to HPV DNA testing for cervical screening. Scenarios considered were the inclusion of a TV test with the HPV test and the addition of TV testing to routine chlamydia testing conducted in primary care. RESULTS: Our modelling suggests that with sufficient coverage, inclusion of TV testing with routine chlamydia screening in general practice, TV prevalence can be reduced over time, but at the current reported coverage will gradually increase following the transition to HPV testing. Inclusion of TV testing with HPV testing in the cervical screening programme is preferable to no supplemental testing but is considerably less effective in controlling TV. CONCLUSIONS: These findings support the inclusion of TV testing with routine chlamydia testing of young people.


Asunto(s)
Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/diagnóstico , Vaginitis por Trichomonas/diagnóstico , Trichomonas vaginalis/aislamiento & purificación , Adulto , Australia/epidemiología , Femenino , Pruebas de ADN del Papillomavirus Humano , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , Prueba de Papanicolaou , Papillomaviridae/clasificación , Papillomaviridae/genética , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/virología , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/parasitología , Trichomonas vaginalis/genética , Adulto Joven
7.
Rev Colomb Obstet Ginecol ; 70(1): 49-56, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-31613070

RESUMEN

OBJECTIVE: To determine the prevalence of potentially pathogenic microbiological agents in vaginal exudates in a sample of asymptomatic pregnant women in the Department of Atlantico, Colombia. METHODS: Descriptive cross-sectional study of a sample of asymptomatic pregnant women who attended a private primary healthcare institution in Barranquilla, Colombia, between 2014 and 2015. Pregnant women having received antimicrobial treatment within the last 30 days, with vaginal bleeding, mental disability or immunosuppression, were excluded. Consecutive sampling was performed. The prevalence of colonization time by some of the microbiological agents as well as specific prevalence were estimated: number of women with infection by agent type/number of women at risk assessed. RESULTS: Overall prevalence was 24.8% (56/226); 55.4% (31/56) was due to vaginitis causal agents, and 44.6% (25/56) to vaginosis. The specific prevalence by type of pathogen, 13.3% (30/226) was vaginitis due to colonization by Candida spp. and 0.4% (1/226) was vaginitis due to T. vaginalis. Bacterial vaginosis (BV) was found in 8.0% (18/226). CONCLUSIONS: Substantial colonization of the lower genital tract by potentially pathogenic germs is found in pregnant women between 35 and 37 weeks of gestation. Further studies are required in order to determine the benefit of population screening in terms of avoiding poor maternal and perinatal out- comes, and the impact on the resulting overcosts.


Asunto(s)
Candidiasis Vulvovaginal/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Vaginitis por Trichomonas/epidemiología , Vaginosis Bacteriana/epidemiología , Adolescente , Adulto , Colombia/epidemiología , Estudios Transversales , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Prevalencia , Atención Primaria de Salud , Vagina/microbiología , Adulto Joven
8.
Sex Health ; 16(6): 566-573, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31623703

RESUMEN

Australian Aboriginal communities experience a high burden of sexually transmissible infections (STIs). Since 2009, a comprehensive sexual health program has been implemented at nine Aboriginal Community Controlled Health Services in South Australia. This study assessed trends in STI testing and positivity using deidentified diagnostic data from this period (2008-16). METHODS: Testing data for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) from one urban, three regional and five remote Aboriginal health services were analysed using logistic regression. RESULTS: From 2008 to 2016, testing increased for CT (twofold), NG (threefold) and TV (sixfold). On average, 30% of testing occurred during an annual 6-week screen. Fewer males were tested (range 27-38% annually). Mean annual STI testing coverage was 28% for 16- to 30-year-old clients attending regional or remote services (2013-16). Positivity at first testing episode for all three infections declined during the study period. From 2013 to 2016, when testing was stable and changes in positivity were more likely to indicate changes in prevalence, there were significant reductions in CT positivity (adjusted odds ratio (aOR) 0.4; 95% confidence interval (CI) 0.2-0.5) and TV positivity (aOR 0.6, 95% CI 0.4-0.9), although declines were statistically significant for females only. There was no significant decrease in NG positivity (aOR 0.9; 95% CI 0.5-1.5). CONCLUSIONS: Since the sexual health program began, STI testing increased and STI positivity declined, but significant reductions observed in CT and TV positivity were confined to females. These findings suggest evidence of benefit from sustained, comprehensive sexual health programs in Aboriginal communities with a high STI prevalence, but highlight the need to increase STI testing among men in these communities.


Asunto(s)
Servicios de Salud del Indígena/estadística & datos numéricos , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Enfermedades de Transmisión Sexual/diagnóstico , Adolescente , Adulto , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Femenino , Gonorrea/diagnóstico , Gonorrea/epidemiología , Humanos , Masculino , Neisseria gonorrhoeae , Factores de Riesgo , Enfermedades de Transmisión Sexual/epidemiología , Australia del Sur/epidemiología , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/epidemiología , Trichomonas vaginalis , Adulto Joven
9.
BMC Infect Dis ; 19(1): 879, 2019 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-31640583

RESUMEN

BACKGROUND: In Yemen, the underlying causes of infectious vaginitis have been neglected. Therefore, this study aimed to determine the prevalence and risk factors associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonal vaginitis (TV) among non-pregnant reproductive-aged women. METHODS: A cross-sectional study was conducted among 347 non-pregnant reproductive-aged women seeking primary healthcare in Sana'a city, Yemen. Data about sociodemographic characteristics, lifestyle-related behaviors, routine hygienic practices, menstrual care and history and type of contraceptive intake were collected using a structured questionnaire. Vaginal discharge samples were collected and examined for discharge characteristics and pH by a gynecologist. Then, samples were examined for BV, VVC and TV. Data were analyzed using suitable statistical tests. RESULTS: Vaginal infections were prevalent among 37.6% of reproductive-aged women, where BV was the most prevalent (27.2%). VVC was significantly higher among symptomatic women and significantly associated with itching (P = 0.005). Using bivariate analysis, the age of < 25 years (odds ratio [OR] = 1.9, 95% confidence interval [CI]: 1.16-3.10; P = 0.010) and using intrauterine contraceptive devices (IUCDs) (OR = 1.8, 95% CI: 1.09-2.89; P = 0.020) were significantly associated with BV, while history of miscarriage was significantly associated with a lower risk of BV (OR = 0.5, 95% CI: 0.31-0.85, P = 0.009). However, polygyny was significantly associated with VVC (OR = 3.4, 95% CI: 1.33-8.66; P = 0.007). Multivariable analysis confirmed that age of < 25 years and using IUCD were the independent predictors of BV, while history of miscarriage was an independent protective factor against BV. On the other hand, marriage to a polygamous husband was the independent predictor of VVC. CONCLUSIONS: More than a third of non-pregnant reproductive-aged women seeking PHC in Sana'a have single or mixed infections with BV, VVC or TV. BV is the most frequent cause of vaginitis and is significantly associated with the age of < 25 years and using IUCDs, while VVC is significantly higher among women with polygamous husbands. Health education of polygamous husbands and their wives, regular monitoring of BV among IUCD users and screening women for vaginitis before treatment are recommended.


Asunto(s)
Candidiasis Vulvovaginal/epidemiología , Vaginitis por Trichomonas/epidemiología , Vaginosis Bacteriana/epidemiología , Adolescente , Adulto , Candidiasis Vulvovaginal/etiología , Coinfección , Estudios Transversales , Femenino , Humanos , Dispositivos Intrauterinos/estadística & datos numéricos , Matrimonio , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Atención Primaria de Salud/estadística & datos numéricos , Factores de Riesgo , Vaginitis por Trichomonas/etiología , Vaginosis Bacteriana/etiología , Yemen/epidemiología , Adulto Joven
10.
BMC Pregnancy Childbirth ; 19(1): 341, 2019 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-31547803

RESUMEN

BACKGROUND: Vaginal infections usually caused by Candida sp, organisms responsible for bacterial vaginosis and Trichomonas vaginalis are associated with considerable discomfort and adverse outcomes during pregnancy and child birth. The study determined the prevalence of vulvovaginal candidiasis (VVC), bacterial vaginosis (BV) and trichomoniasis (TV) in pregnant women attending antenatal clinic at the Kintampo Municipal Hospital. METHODS: A study adopted a cross sectional design and recruited 589 pregnant women after seeking their informed consent from September, 2014 to March, 2015. Semi-structured questionnaire were administered to participants and vaginal swabs were collected. The samples were analysed using wet mount method and Gram stain (Nugent criteria) for vaginal infection. Univariate and multivariate analysis were used to investigate association of risk factors to vaginal infections. RESULTS: The overall prevalence of at least one vaginal infection was 56.4%. The prevalence of vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis were 36.5, 30.9 and 1.4% respectively. Women with more than four previous pregnancies (OR: 0.27, 95% CI: 0.13-0.58) and those in the third trimester of pregnancy (OR: 0.54, CI: 0.30-0.96) were associated with a lower risk of bacterial vaginosis. Douching and antibiotic use were neither associated with VVC or BV. CONCLUSION: The prevalence of vaginal infections was high among pregnant women in the Kintampo area. There is the need for interventions such as adequate investigations and early treatment of vaginal infections to reduce the disease burden to avoid associated complications.


Asunto(s)
Candidiasis Vulvovaginal/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Vaginitis por Trichomonas/epidemiología , Vaginosis Bacteriana/epidemiología , Adolescente , Adulto , Antibacterianos/uso terapéutico , Estudios Transversales , Femenino , Ghana/epidemiología , Número de Embarazos , Humanos , Embarazo , Tercer Trimestre del Embarazo , Atención Prenatal , Prevalencia , Factores de Riesgo , Ducha Vaginal/estadística & datos numéricos , Adulto Joven
11.
Sex Transm Dis ; 46(10): e93-e96, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31517807

RESUMEN

Among the US civilian noninstitutionalized population aged 14 to 59 years in 2013 to 2016, prevalence of Trichomonas vaginalis infection in urine was 1.3% overall. Prevalence was 2.1% among females, 0.5% among males, and highest at 9.6% among non-Hispanic black females. Estimate instability limited analysis of factors beyond sex, age, and race/Hispanic ethnicity.


Asunto(s)
Tricomoniasis/epidemiología , Vaginitis por Trichomonas/epidemiología , Adolescente , Adulto , Grupos Étnicos , Femenino , Hispanoamericanos , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Conducta Sexual , Encuestas y Cuestionarios , Tricomoniasis/etnología , Tricomoniasis/orina , Vaginitis por Trichomonas/orina , Trichomonas vaginalis , Estados Unidos/epidemiología , Adulto Joven
12.
Obstet Gynecol ; 134(3): 573-580, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31403592

RESUMEN

OBJECTIVE: To examine the relationship between hormonal contraception and vaginal infections with bacterial vaginosis, vaginal candidiasis, or trichomoniasis. METHODS: Couples who were human immunodeficiency virus (HIV) serodiscordant in Zambia were enrolled in a longitudinal cohort study. From 1994 to 2002, both partners were seen quarterly and received physical exams including genital examinations. Separate rates for three outcome infections of interest (bacterial vaginosis, vaginal candidiasis, and trichomoniasis) were calculated. Bivariate associations between baseline and time-varying covariates and outcome infections of interest were evaluated using unadjusted Anderson-Gill survival models. Adjusted hazard ratios (aHRs) were generated using multivariable Anderson-Gill survival models that included demographic and clinical factors associated with both hormonal contraceptive use and each infection of interest. RESULTS: There were 1,558 cases of bacterial vaginosis, 1,529 cases of vaginal candidiasis, and 574 cases of trichomoniasis over 2,143 person-years of observation. Depot medroxyprogesterone acetate (DMPA) users had significantly lower rates of trichomoniasis and bacterial vaginosis. In adjusted models, DMPA was protective for bacterial vaginosis (aHR=0.72; 95% CI 0.54-0.95), candidiasis (aHR 0.75, 95% CI 0.57-1.00) and trichomoniasis (aHR=0.43, 95% CI 0.25-0.74). Oral contraceptive pills were protective for candidiasis (aHR=0.79, 95% CI 0.65-0.97). CONCLUSION: We confirm that DMPA use was associated with reduced rates of the three most common causes of vaginitis, and oral contraceptive pill use was associated with reduced rates of candidiasis among women in couples who were HIV discordant.


Asunto(s)
Anticonceptivos Hormonales Orales/efectos adversos , Seropositividad para VIH/microbiología , Anticoncepción Hormonal/efectos adversos , Vaginitis/inducido químicamente , Adulto , Candidiasis Vulvovaginal/inducido químicamente , Candidiasis Vulvovaginal/epidemiología , Candidiasis Vulvovaginal/virología , Femenino , Seronegatividad para VIH , Humanos , Masculino , Acetato de Medroxiprogesterona/efectos adversos , Parejas Sexuales , Vaginitis por Trichomonas/inducido químicamente , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/virología , Vaginitis/epidemiología , Vaginitis/virología , Vaginosis Bacteriana/inducido químicamente , Vaginosis Bacteriana/epidemiología , Vaginosis Bacteriana/virología , Zambia/epidemiología
13.
BMJ Open ; 9(8): e025013, 2019 08 27.
Artículo en Inglés | MEDLINE | ID: mdl-31462459

RESUMEN

OBJECTIVES: Self-collected vaginal swabs can facilitate diagnosis of vaginal discharge (VD) in resource-limited settings, provided reliability of the method is established. The aim of this study was to evaluate the concordance between self-collected and physician-collected vaginal swabs for aetiological diagnosis of VD and to determine the prevalence of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonas vaginitis (TV). METHODS: A total of 550 females (median age: 32 years; range: 18-45 years) attending two sexually transmitted infection/reproductive tract infection (STI/RTI) clinics with VD from January 2015 to May 2016 were included in the study after obtaining written informed consent. Swabs were self-collected by patients after instructions and subsequently by a physician under speculum examination. Samples were processed for standard bedside tests, Gram staining, wet mount and culture (gold standard) according to the national guidelines. Concordance between the two methods was determined by the Cohen's kappa value. RESULTS: BV, VVC and TV were diagnosed in 79 (14.4%), 144 (26.2%) and 3 (0.5%) patients, respectively. VVC coexisted with BV in 58 (10.5%) patients. There was no coinfection of TV with BV or VVC. Candida albicans was isolated in 84 (58.3%) VVC cases. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of self-collected swabs for diagnosing BV was 91.1%, 100%, 100% and 98.5%, respectively, while for the C. albicans VVC and TV, sensitivity, specificity, PPV and NPV all were 100% as compared with physician-collected swabs. Highly concordant results were obtained between two methods by the Kappa values of 0.95 (BV), 0.99 (VVC) and 1.0 (TV). CONCLUSION: The comparative performance of self-collected and physician-collected vaginal swabs establishes self-collection of samples for BV, VVC and TV as a viable alternative tool in the management of STIs/RTIs, especially in peripheral and resource-constrained settings. This would be effective in implementing the diagnostic approaches for STIs/RTIs in community-based surveillance studies at national or regional level and therefore strengthening the National STI/RTI Control Programme.


Asunto(s)
Candidiasis Vulvovaginal/diagnóstico , Autocuidado , Vaginitis por Trichomonas/diagnóstico , Frotis Vaginal/métodos , Vaginosis Bacteriana/diagnóstico , Adolescente , Adulto , Factores de Edad , Candidiasis Vulvovaginal/epidemiología , Estudios Transversales , Países en Desarrollo , Femenino , Humanos , India/epidemiología , Persona de Mediana Edad , Prevalencia , Reproducibilidad de los Resultados , Vaginitis por Trichomonas/epidemiología , Vaginosis Bacteriana/epidemiología , Adulto Joven
14.
J Infect Dis ; 220(9): 1503-1510, 2019 09 26.
Artículo en Inglés | MEDLINE | ID: mdl-31287879

RESUMEN

BACKGROUND: While bacterial vaginosis has been associated with an increased risk of Trichomonas vaginalis (TV) acquisition, it is unknown whether other characteristics of the vaginal microbiota, including the presence of key bacterial species, influence a woman's risk of TV acquisition. METHODS: The vaginal microbiota before 25 unique episodes of TV infection involving 18 women was compared to that of 50 controls who remained uninfected. TV was detected by transcription-mediated amplification. Vaginal microbiota were quantified using broad-range polymerase chain reaction analysis and taxon-specific quantitative PCR of the 16S ribosomal RNA gene. RESULTS: TV acquisition was significantly associated with the presence of Prevotella amnii (risk ratio [RR], 2.21; 95% confidence interval [CI], 1.12-4.38; P = .02) and Sneathia sanguinegens (RR, 2.58; 95% CI, 1.00-6.62; P = .049). When adjusted for menstrual phase, the association between P. amnii and TV acquisition remained similar (adjusted RR, 2.11; 95% CI, 1.03-4.33; P = .04), but the association between S. sanguinegens and TV acquisition was attenuated (adjusted RR, 2.31; 95% CI, .86-6.23; P = .10). CONCLUSIONS: Key vaginal bacterial species may contribute to the susceptibility to TV acquisition. Understanding how these bacterial species increase a woman's risk of TV acquisition could help to guide the development of novel strategies to reduce women's risk of TV infection.


Asunto(s)
Bacterias/aislamiento & purificación , Biota , Susceptibilidad a Enfermedades , Vaginitis por Trichomonas/epidemiología , Trichomonas vaginalis/aislamiento & purificación , Vagina/microbiología , Vagina/parasitología , Adulto , Bacterias/clasificación , ADN Bacteriano/genética , ADN Protozoario/genética , Femenino , Humanos , Persona de Mediana Edad , Técnicas de Amplificación de Ácido Nucleico , Estudios Prospectivos , Medición de Riesgo
16.
J Glob Health ; 9(2): 020408, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31360448

RESUMEN

Background: The epidemiology of sexually transmitted infections (STIs) and the role of commercial heterosexual sex networks in driving STI transmission in the Middle East and North Africa (MENA) region remain largely unknown. Objective: To characterize the epidemiology of Treponema pallidum (syphilis), Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus type 2 (HSV-2) among female sex workers (FSWs) in MENA using an in-depth quantitative assessment. Methods: A systematic review on ten international, regional, and country-level databases was conducted, and reported following PRISMA guidelines. Pooled prevalences of current and/or ever infection for each STI were estimated using random-effects meta-analyses. Sources of between-study heterogeneity were investigated through random-effects meta-regressions. Results: One T. pallidum incidence study and 144 STI prevalence studies were identified for 45 812 FSWs in 13 MENA countries. The pooled prevalence of current infection was 12.7% (95% confidence interval (CI) = 8.5%-17.7%) for T. pallidum, 14.4% (95% CI = 8.2%-22.0%) for C. trachomatis, 5.7% (95% CI = 3.5%-8.4%) for N. gonorrhoeae, and 7.1% (95% CI = 4.3%-10.5%) for T. vaginalis. The pooled prevalence of ever infection (seropositivity using antibody testing) was 12.8% (95% CI = 9.4%-16.6%) for T. pallidum, 80.3% (95% CI = 53.2%-97.6%) for C. trachomatis, and 23.7% (95% CI = 10.2%-40.4%) for HSV-2. The multivariable meta-regression for T. pallidum infection demonstrated strong subregional differences, with the Horn of Africa and North Africa showing, respectively 6-fold (adjusted odds ratio (AOR): 6.4; 95% CI = 2.5-16.7) and 5-fold (AOR = 5.0; 95% CI = 2.5-10.6) higher odds of infection than Eastern MENA. There was also strong evidence for declining T. pallidum odds of infection at 7% per year (AOR = 0.93; 95% CI = 0.88-0.98). Study-specific factors including diagnostic method, sample size, sampling methodology, and response rate, were not associated with syphilis infection. The multivariable model explained 48.5% of the variation in T. pallidum prevalence. Conclusions: STI infection levels among FSWs in MENA are considerable, supporting a key role for commercial heterosexual sex networks in transmission dynamics, and highlighting the health needs of this neglected and vulnerable population. Syphilis prevalence in FSWs appears to have been declining for at least three decades. Gaps in evidence persist for multiple countries.


Asunto(s)
Trabajadores Sexuales/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , África del Norte/epidemiología , Infecciones por Chlamydia/epidemiología , Femenino , Gonorrea/epidemiología , Herpes Genital/epidemiología , Humanos , Medio Oriente/epidemiología , Sífilis/epidemiología , Vaginitis por Trichomonas/epidemiología
17.
PLoS One ; 14(6): e0217041, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31220094

RESUMEN

Trichomonas vaginalis is the most common curable sexually transmitted infection (STI) worldwide. Although predominately asymptomatic, the disease spectrum of trichomoniasis in women is characterized primarily by signs and symptoms of vaginitis, including purulent discharge and localized vulvar pruritus and erythema. Several FDA-cleared nucleic acid amplification tests (NAATs) are available for the diagnosis of T. vaginalis infections, but laboratory developed tests (LDTs) are widely utilized and cost-effective solutions in both the research and clinical diagnostic settings. LDT diagnosis of T. vaginalis is particularly appealing since it can be performed using remnant specimens collected for other STI testing. Using a LDT implemented as part of this study, T. vaginalis was detected in 7% of participating Louisiana women (14/199). The mean T. vaginalis organism burden was 1.0x106 ± 4.5x105 organisms per mL of ThinPrep PreservCyt. Using DNA eluates obtained after HPV testing on the cobas 4800 system, the T. vaginalis LDT was characterized by excellent intra- and interassay reproducibility (coefficient of variation values all <3.5%). Compared with two commercially available NAATs from TIB MOLBIOL, the sensitivity and specificity of the LDT was 92.9 and 99.5%, respectively. Collectively, this study details the diagnostic and quantitative utility of a LDT for T. vaginalis. When applied in the clinical research setting, we confirmed the high prevalence of T. vaginalis, but also observed extraordinarily high organism burdens in the cervix. These findings highlight the unique host-pathogen relationship of T. vaginalis with lower reproductive tract tissues, and substantiate the need for continued investigation of this highly prevalent STI.


Asunto(s)
Cuello del Útero/microbiología , Vaginitis por Trichomonas/epidemiología , Trichomonas vaginalis/fisiología , Adulto , Femenino , Humanos , Louisiana/epidemiología , Tamizaje Masivo , Persona de Mediana Edad , Prevalencia , Vaginitis por Trichomonas/diagnóstico , Flujo de Trabajo
18.
Sex Transm Dis ; 46(7): 458-464, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31194717

RESUMEN

BACKGROUND: Trichomonas vaginalis (TV) is the most common curable sexually transmitted infection (STI) worldwide. Trichomonas vaginalis infection is associated with an increased risk of pelvic inflammatory disease, human immunodeficiency virus transmission, and preterm birth in women. Data on the prevalence and risk factors for TV infection in sub-Saharan African countries remain scarce. METHODS: A total of 350 Kenyan female sex workers, aged 18 to 50 years, participated in a 2-year longitudinal study of the acquisition of STIs, including TV infection. Every 3 months, cervical and vaginal brush samples were collected for STI testing. At baseline, a sociodemographic and behavior questionnaire was administered. Testing for TV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae, Mycoplasma genitalium, and high-risk human papillomavirus was performed using APTIMA assays. RESULTS: The TV baseline prevalence was 9.2% (95% confidence interval [95% CI], 6.3-12.7%) and 2-year cumulative TV incidence was 8.1 per 1000 person months (6.9-9.3). Risk factors for higher TV prevalence at baseline were CT infection (adjusted prevalence ratio [PR], 8.53; 95% CI, 3.35-21.71), human immunodeficiency virus seropositivity (PR, 3.01; 95% CI, 1.45, 6.24) and greater than 4 years of sex work (PR, 2.66; 95% CI, 1.07-6.60). Risk factors for elevated 2-year TV incidence were CT (hazard ratio [HR], 4.28; 95% CI, 1.36-13.50), high-risk human papillomavirus infection (HR, 1.91; 95% CI, 1.06-3.45) and history of smoking (HR, 2.66; 95% CI, 1.24-5.73). DISCUSSION: CT infection was positively associated with both prevalent and 2-year incident TV infections.


Asunto(s)
Trabajadores Sexuales/estadística & datos numéricos , Vaginitis por Trichomonas/epidemiología , Trichomonas vaginalis/aislamiento & purificación , Adolescente , Adulto , Cuello del Útero/parasitología , Demografía , Femenino , Humanos , Incidencia , Kenia/epidemiología , Estudios Longitudinales , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Trabajo Sexual , Conducta Sexual , Encuestas y Cuestionarios , Vaginitis por Trichomonas/parasitología , Vagina/parasitología , Adulto Joven
19.
APMIS ; 127(9): 627-634, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31225920

RESUMEN

Sexually transmitted infections (STIs) remain major public health problems globally. Appropriate laboratory diagnosis of STIs is rare in Ukraine. We investigated the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) using the US FDA-approved Aptima Combo 2 and Aptima TV assays and compared the results with the conventional routine diagnostic tests (CDTs) in Ukraine. Urogenital swabs from consecutive mostly symptomatic females (n = 296) and males (n = 159) were examined. The prevalences were as follows: 10% (n = 47) of TV, 5.3% (n = 24) of CT and 1.5% (n = 7) of NG. The specificity of some CDTs was high, for example, 100% for NG culture, TV IgG ELISA, CT IgM ELISA and CT microscopy, but lower for other CDTs, that is, from 44% to 99.8%. The sensitivity of all CDTs was suboptimal, that is, 71% (n = 5) for NG microscopy, 57% (n = 4) for NG culture, 53% (n = 8) for CT IgG ELISA, 33% (n = 1) for TV IgG ELISA, 28% (n = 13) for TV microscopy, 25% (n = 1) for CT IgA ELISA, 20% (n = 3) for CT IgM ELISA and 0% (n = 0) for CT microscopy. The prevalences of particularly TV and CT were high, but substantial also for NG, in Ternopil, Ukraine. The sensitivities of all CDTs were low, and widespread implementation of validated, quality-assured and cost-effective molecular diagnostic STI tests in Ukraine is imperative.


Asunto(s)
Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Gonorrea/diagnóstico , Gonorrea/epidemiología , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/epidemiología , Adolescente , Adulto , Chlamydia trachomatis/aislamiento & purificación , Estudios Transversales , Pruebas Diagnósticas de Rutina/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Técnicas de Diagnóstico Molecular/métodos , Neisseria gonorrhoeae/aislamiento & purificación , Prevalencia , Sensibilidad y Especificidad , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Trichomonas vaginalis/aislamiento & purificación , Ucrania/epidemiología , Estados Unidos , United States Food and Drug Administration , Adulto Joven
20.
PLoS One ; 14(4): e0215001, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31013277

RESUMEN

The anogenital prevalence of sexually transmitted infections (STIs) and the use of cervico-vaginal self-collected vs. clinician-collected samples were evaluated for the diagnosis of human immunodeficiency virus (HIV)-infected and HIV-uninfected women in the Tapajós region, Amazon, Brazil. We recruited 153 women for a cross-sectional study (112 HIV-uninfected and 41 HIV-infected) who sought health services. Anal and cervical scrapings and cervico-vaginal self-collection samples were collected. Real-time polymerase chain reaction methods were used for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium. A syphilis test was also performed. Risk factors for STIs were identified by multivariate analysis. The overall prevalence of STIs was 30.4% (34/112) in HIV-uninfected women and 24.4% (10/41) in HIV-infected women. Anogenital Chlamydia trachomatis infection was the most prevalent in both groups of women (20.5% vs 19.5%). There was significant agreement for each STI between self-collected and clinician-collected samples: 91.7%, kappa 0.67, 95% confidence interval (CI) 0.49-0.85 for Chlamydia trachomatis; 99.2%, kappa 0.85, 95% CI 0.57-1.00 for Neisseria gonorrhoeae; 97.7%, kappa 0.39, 95% CI -0.16-0.94 for Trichomonas vaginalis; and 94.7%, kappa 0.51, 95% CI 0.20-0.82 for Mycoplasma genitalium. Women with human papillomavirus had coinfection or multiple infections with other STIs. Risk factors for STIs were being ≤ 25 years old, being employed or a student, reporting a history of STI and having a positive HPV test. A high prevalence of STIs in women in the Tapajós region was found. Cervico-vaginal self-collection is a useful tool for STI screening and can be used in prevention control programs in low-resource settings, such as in northern Brazil.


Asunto(s)
Infecciones por Chlamydia , Coinfección , Gonorrea , Infecciones por VIH , Infecciones por Mycoplasma , Infecciones por Papillomavirus , Manejo de Especímenes , Vaginitis por Trichomonas , Adolescente , Adulto , Brasil/epidemiología , Cuello del Útero/microbiología , Cuello del Útero/virología , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/microbiología , Infecciones por Chlamydia/virología , Chlamydia trachomatis , Coinfección/epidemiología , Coinfección/microbiología , Coinfección/virología , Estudios Transversales , Femenino , Gonorrea/epidemiología , Gonorrea/microbiología , Gonorrea/virología , Infecciones por VIH/epidemiología , Infecciones por VIH/microbiología , Infecciones por VIH/virología , VIH-1 , Humanos , Tamizaje Masivo , Persona de Mediana Edad , Infecciones por Mycoplasma/epidemiología , Infecciones por Mycoplasma/microbiología , Infecciones por Mycoplasma/virología , Mycoplasma genitalium , Neisseria gonorrhoeae , Papillomaviridae , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/microbiología , Infecciones por Papillomavirus/virología , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/microbiología , Vaginitis por Trichomonas/virología , Trichomonas vaginalis
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