Guidelines for HPV-DNA Testing for Cervical Cancer Screening in Brazil.

Evidence-based clinical guidelines ensure best practice protocols are available in health care. There is a widespread use of human papillomavirus deoxyribonucleic acid (HPV-DNA) tests in Brazil, regardless of the lack of official guidelines. On behalf of the Brazilian Association for the Lower Genital Tract Pathology and Colposcopy (ABPTGIC, in the Portuguese acronym), a team of reviewers searched for published evidence and developed a set of recommendations for the use of HPV-DNA tests in cervical cancer screening in Brazil. The product of this process was debated and consensus was sought by the participants. One concern of the authors was the inclusion of these tests in the assessment of women with cytologic atypia and women treated for cervical intraepithelial neoplasia (CIN). Testing for HPV is recommended in an organized screening scenario to identify women with precursor lesions or asymptomatic cervical cancer older than 30 years of age, and it can be performed every 5 years. It also has value after the cytology showing atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSILs) as a triage test for colposcopy, in the investigation of other cytological alterations when no abnormal findings are observed at colposcopy, seeking to exclude disease, or, further, after treatment of high-grade cervical intraepithelial neoplasia, to rule out residual disease.

O uso de diretrizes clínicas baseadas em evidências visa assegurar as melhores práticas na área de cuidado à saúde. O uso de testes de ácido desoxirribonucleico de papilomavírus humano (DNA-HPV) vem crescendo e se disseminando sem que existam recomendações de uso no cenário brasileiro. Em nome da Associação Brasileira de Patologia do Trato Genital Inferior e Colposcopia (ABPTGIC), grupos de revisores pesquisaram evidências e formularam recomendações para o uso dos testes de DNA-HPV no rastreamento do câncer do colo do útero, no seguimento de mulheres com atipias citológicas, e após tratamento de neoplasia intraepitelial cervical (NIC). O produto desse processo foi debatido e foi buscado consenso entre participantes. Os testes de DNA-HPV são recomendados num cenário de rastreamento organizado para identificação de mulheres portadoras de lesões precursoras ou câncer assintomático com mais de 30 anos e podem ser realizados a cada 5 anos. Também têm valor após a citologia mostrando células escamosas atípicas de significado indeterminado (ASC-US) ou lesão intraepitelial escamosa de baixo grau (LSIL) como teste de triagem para colposcopia, na investigação de outras alterações citológicas quando não são observados achados anormais à colposcopia, buscando excluir doença, ou, ainda, no seguimento após tratamento das neoplasias intraepiteliais de alto grau, para exclusão de doença residual.

Guidelines for HPV-DNA testing for cervical cancer screening in Brazil / Recomendações para o uso de testes de DNA-HPV no rastreamento do câncer do colo útero no Brasil

Abstract Evidence-based clinical guidelines ensure best practice protocols are available in health care. There is a widespread use of human papillomavirus deoxyribonucleic acid (HPVDNA) tests in Brazil, regardless of the lack of official guidelines. On behalf of the Brazilian Association for the Lower Genital Tract Pathology and Colposcopy (ABPTGIC, in the Portuguese acronym), a team of reviewers searched for published evidence and developed a set of recommendations for the use of HPV-DNA tests in cervical cancer screening in Brazil. The product of this process was debated and consensus was sought by the participants. One concern of the authors was the inclusion of these tests in the assessment of women with cytologic atypia and women treated for cervical intraepithelial neoplasia (CIN). Testing for HPV is recommended in an organized screening scenario to identify women with precursor lesions or asymptomatic cervical cancer older than 30 years of age, and it can be performed every 5 years. It also has value after the cytology showing atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSILs) as a triage test for colposcopy, in the investigation of other cytological alterations when no abnormal findings are observed at colposcopy, seeking to exclude disease, or, further, after treatment of high-grade cervical intraepithelial neoplasia, to rule out residual disease.

Resumo O uso de diretrizes clínicas baseadas em evidências visa assegurar as melhores práticas na área de cuidado à saúde. O uso de testes de ácido desoxirribonucleico de papilomavírus humano (DNA-HPV) vem crescendo e se disseminando sem que existam recomendações de uso no cenário brasileiro.Emnomeda Associação Brasileira de Patologia doTrato Genital Inferior e Colposcopia (ABPTGIC), grupos de revisores pesquisaram evidências e formularamrecomendações para o uso dos testes de DNA-HPV no rastreamento do câncer do colo do útero, no seguimento de mulheres com atipias citológicas, e após tratamento de neoplasia intraepitelial cervical (NIC). O produto desse processo foi debatido e foi buscado consenso entre participantes. Os testes de DNA-HPV são recomendados num cenário de rastreamento organizado para identificação de mulheres portadoras de lesões precursoras ou câncer assintomático com mais de 30 anos e podem ser realizados a cada 5 anos. Também têm valor após a citologia mostrando células escamosas atípicas de significado indeterminado (ASC-US) ou lesão intraepitelial escamosa de baixo grau (LSIL) como teste de triagempara colposcopia, na investigação de outras alterações citológicas quando não são observados achados anormais à colposcopia, buscando excluir doença, ou, ainda, no seguimento após tratamento das neoplasias intraepiteliais de alto grau, para exclusão de doença residual.

Prevalence of Chlamydia trachomatis and Neisseria gonorrhea and associated factors among women living with Human Immunodeficiency Virus in Brazil: a multicenter study

Abstract Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) cause infections in the female genital tract, increasing susceptibility to and infectiousness of HIV. The objectives of the present study were to determine the prevalence and associated factors of CT and GC infection among HIV-infected women in Brazil. Methods: Cross-sectional study conducted from March to December 2015, including HIV-infected women attending referral centers in nine states of Brazil, aged 18-49 years, nonpregnant. An interview was conducted including socio-demographic, epidemiological and clinical characteristics. After the interview, gynecological examination was conducted to collect cervical cytology and vaginal secretion to C. trachomatis and N. gonorrhoeae tests through molecular biology. Results: A total of 802 (89.1%) women participated. The prevalence of CT was 2.1% (17/802) and CG was 0.9% (7/802). The prevalence of a positive test for both CT and/or GC was 2.7%. The factors associated with positive CT/GC test in the multivariate logistic regression analysis were abnormal Papanicolau smear (OR 4.1; 95% CI: 1.54-11.09) and the presence of abnormal cervical discharge (OR 2.6; 95% CI: 1.02-6.71). Among 377 women who reported previous STI 245 (65.0%) reported using condom more frequently after being diagnosed. 62 (16.4%) discovered the STI after the partner told he was infected; 157 (41.6%) had STI symptoms and looked for care, and 158 (41.9%) discovered it in a routine consultation for another reason. Conclusions: The control of STI represents a unique opportunity to improve reproductive health of women living with HIV. STI diagnosis can change their behavior and reduce the sexual transmission of HIV and bacterial STI.

Prevalence of Chlamydia trachomatis and Neisseria gonorrhea and associated factors among women living with Human Immunodeficiency Virus in Brazil: a multicenter study.

BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) cause infections in the female genital tract, increasing susceptibility to and infectiousness of HIV. The objectives of the present study were to determine the prevalence and associated factors of CT and GC infection among HIV-infected women in Brazil. METHODS: Cross-sectional study conducted from March to December 2015, including HIV-infected women attending referral centers in nine states of Brazil, aged 18-49 years, nonpregnant. An interview was conducted including socio-demographic, epidemiological and clinical characteristics. After the interview, gynecological examination was conducted to collect cervical cytology and vaginal secretion to C. trachomatis and N. gonorrhoeae tests through molecular biology. RESULTS: A total of 802 (89.1%) women participated. The prevalence of CT was 2.1% (17/802) and CG was 0.9% (7/802). The prevalence of a positive test for both CT and/or GC was 2.7%. The factors associated with positive CT/GC test in the multivariate logistic regression analysis were abnormal Papanicolau smear (OR 4.1; 95% CI: 1.54-11.09) and the presence of abnormal cervical discharge (OR 2.6; 95% CI: 1.02-6.71). Among 377 women who reported previous STI 245 (65.0%) reported using condom more frequently after being diagnosed. 62 (16.4%) discovered the STI after the partner told he was infected; 157 (41.6%) had STI symptoms and looked for care, and 158 (41.9%) discovered it in a routine consultation for another reason. CONCLUSIONS: The control of STI represents a unique opportunity to improve reproductive health of women living with HIV. STI diagnosis can change their behavior and reduce the sexual transmission of HIV and bacterial STI.

Os três líquens: escleroso, plano e plano erosivo / The three lichens: sclerosus, planus and erosive

Líquen escleroso (LE) e líquen plano (LP) são doenças de natureza inflamatória que atacam a pele e a região anogenital e que, por vezes, podem ser de difícil diferenciação clínica em seus respectivos estágios iniciais. O LE teve sua incidência demonstrada em 1,7% dos atendimentos ginecológicos, em todas as faixas etárias. Já o LP ataca cerca de 1% das mulheres, mas sua incidência real é difícil de avaliar. LE e LP são doenças cuja patogênese é multifatorial. Fatores genéticos e hormonais e infecções e trauma foram associados ao desenvolvimento de LE, enquanto que LP tem seu desenvolvimento menos compreendido; no entanto, também é associado a fatores genéticos, a infecções e ao uso de certos medicamentos. As duas doenças causam bastante desconforto às pacientes, pois podem se apresentar com dor, ardência, prurido e também há a possibilidade de estenose do introito vaginal e consequente dispareunia. Na suspeita de LE e LP, deve ser feito diagnóstico diferencial com outras doenças de pele e com neoplasia intraepitelial vulvar (NIV). O risco de transformação maligna justifica o acompanhamento que as pacientes devem ter pelo resto da vida. O tratamento de primeira linha para LE e LP consiste em corticosteroides tópicos superpotentes. O diagnóstico requer frequente biópsia para sua confirmação. O objetivo deste trabalho foi revisar a fisiopatologia, complicações e tratamento dessas duas doenças, as quais são muito importantes, pois não possuem cura e podem comprometer seriamente a qualidade de vida das pacientes.(AU)

Lichen sclerosus (LS) and lichen planus (LP) are diseases of an inflammatory nature that attack the skin and anogenital region, and sometimes they might have a difficult clinical differentiation in their early stages. LE has its incidence demonstrated in 1.7% of gynecological consultations in all age groups. LP attacks about 1% of women, but its true incidence is difficult to assess. LE and LP are diseases whose pathogenesis is multifactorial. Genetic and hormonal factors, infections and trauma were associated with the development of LE, while LP has its development less understood; however, it is also associated with genetic factors, infections and the use of certain medications. Both diseases cause much discomfort to the patient, because they may present with pain, burning, itching and there is also the possibility of stenosis of the vaginal opening and consequent dyspareunia. On suspicion of LE and LP should be done differential diagnosis with other skin diseases and vaginal intraepithelial neoplasia (VIN). The risk of malignant transformation justifies the monitoring that patients should have in the rest of their life. The first-line treatment for LE and LP consists of topical corticosteroids super powerful. The diagnosis often requires biopsy for confirmation. The aim of this study was to review the pathophysiology, complications and treatment of these diseases, which are very important because they have no cure and can seriously compromise the quality of life of patients.(AU)

Gravidez prolongada? O que fazer? / Delayed pregnancy? What to do?

Cinqüenta pacientes com 42 semanas ou mais de gestaçäo, calculadas a partir da data da última menstruaçäo, foram estudadas quanto à autenticidade do pós-datismo, sua incidência e as repercussöes sobre a unidade feto-placentária. Cardiotocografia anteparto foi feita diariamente. A vitalidade no 5§ minuto de pós-parto e o Capurro também foram analisados

Avaliaçäo da idade média da menarca nas portadoras de mioma uterino / Evaluation of the average age of menarche in patients with uterine myoma

Os autores analisaram 78 pacientes portadoras de irregularidade de sangramento uterino através do estudo clínico, da aspiraçäo do endométrio e das peças cirúrgicas. Foram estudados: número de gestaçöes, número de abortos, número de partos, incidência de laqueadura tubária, história patológica pregressa, uso prévio e atual de hormônios, estudo da peça cirúrgica (que confirmou o mioma em 69,23% dos casos) e a idade média da menarca, que foi calculada em 12 anos e 10 meses

Avaliaçäo da idade média da menarca nas portadoras de hemorragia uterina disfuncional / Evaluation of the mean age of menarche in patients with dysfunctional uterine bleeding

Säo analisadas 78 pacientes portadoras de irregularidade de sangramento uterino, através do estudo clínico e da aspiraçäo do endométrio. Trinta e nove pacientes apresentavam hemorragia uterino disfuncional. Foi estudado o número de gestaçöes, de filhos, de abortos, a incidência de laqueadura tubária e analisada a existência de patologia prévia, uso anterior e atual de hormônios, e a idade média da menarca. Conclui-se que a idade média da menarca näo é um parâmetro válido para prediçäo de hemorragia uterino disfuncional