Cribado de infecciones cervicales de transmisión sexual en mujeres embarazadas y su relación con la microbiota vaginal / Screening of cervical sexually transmitted infections in pregnant women and the relation with the vaginal microbiota

Resumen Introducción: La mujer embarazada está expuesta anumerosas infecciones de transmisión sexual (ITS), las que pueden producir aborto, enfermedad en el feto y/o en el recién nacido, además de alteraciones en el curso normal del embarazo. Objetivo: Realizar tamizaje de infección cervical asintomática en mujeres embarazadas y su relación con la microbiota. Pacientes y Métodos: Se enrolaron 85 mujeres embarazadas sin cervicitis clínica que consultaron en control de rutina de embarazo (47 pacientes) o que fueron derivadas a una unidad de ITS (38 pacientes). Se tomaron muestras de fondo de saco vaginal, que fueron analizadas por técnicas clásicas de microscopía y cultivo corriente y reacción de polimerasa en cadena para Neisseria gonorrhoeae, Trichomonas vaginalis y Chlamydia trachomatis. Resultados: Se encontró 12,9% de infección por C. trachomatis, 2,4% de T. vaginalis. En este estudio no se encontró N. gonorrhoeae. El 23,3% de pacientes con microbiota alterada (vaginosis bacteriana y microbiota intermedia) fue positiva para C. trachomatis. Conclusión: En este trabajo, encontramos una alta frecuencia de infección por C. trachomatis, que se relaciona en forma significativa con la presencia de microbiota alterada. Esta alta frecuencia debería promover estrategias preventivas en los controles de salud de la mujer embarazada.

Background: Pregnant woman is exposed to many sexual transmitted infections (STI). Many of these infections may produce diseases in the fetus and newborn, and also alteration in the normal course of the pregnancy. Aim: Screening of asymptomatic cervical infection in pregnant woman and its relationship with the vaginal microbiota. Patients and Methods: 85 pregnant women without clinical cervicitis who consult in the routine pregnant control (47 patients) and women derived from STI service (38 patients). The samples were obtained from the vaginal fund sac and were analyzed with optic microscopy, cultures and PCR of Neisseria gonorrhoeae, Trichomonas vaginalis and Chlamydia trachomatis. Results: 12,9% of the enrolled women were positive for C. trachomatis, 2,4% for T. vaginalis. In this study, we did not found N. gonorrhoeae. We observed 23,3% of patients with altered microbiota (bacterial vaginosis and intermediate microbiota) was positive for C. trachomatis. Conclusions: In this study, we found a high frequency of C. trachomatis infection, that correlates with the presence of altered microbiota. This high frequency would promote preventive strategies in the pregnant women routine controls.

Iron from haemoglobin and haemin modulates nucleotide hydrolysis in Trichomonas vaginalis

Extracellular ATP may act as a danger signalling molecule, inducing inflammation and immune responses in infection sites. The ectonucleotidases NTPDase and ecto-5’-nucleotidase are enzymes that modulate extracellular nucleotide levels; these enzymes have been previously characterised in Trichomonas vaginalis. Iron plays an important role in the complex trichomonal pathogenesis. Herein, the effects of iron on growth, nucleotide hydrolysis and NTPDase gene expression in T. vaginalis isolates from female and male patients were evaluated. Iron from different sources sustained T. vaginalis growth. Importantly, iron from haemoglobin (HB) and haemin (HM) enhanced NTPDase activity in isolates from female patients and conversely reduced the enzyme activity in isolates from male patients. Iron treatments could not alter the NTPDase transcript levels in T. vaginalis. Furthermore, our results reveal a distinct ATP, ADP and AMP hydrolysis profile between isolates from female and male patients influenced by iron from HB and HM. Our data indicate the participation of NTPDase and ecto-5’-nucleotidase in the establishment of trichomonas infection through ATP degradation and adenosine production influenced by iron.

Trichomonas vaginalis and associated factors among women living with HIV/AIDS in Amazonas, Brazil

OBJECTIVES: Our goal was to determine the prevalence of Trichomonas vaginalis and its associated factors among women living with HIV attending an AIDS clinic in Manaus, Amazonas, Brazil. METHODS: Cross-sectional study among women attending an AIDS clinic in Manaus between March and December 2010 for gynecological examination were invited to participate. Enrolled patients answered a face-to-face interview including demographic, behavioral and clinical data. They also underwent a gynecological evaluation and cervical scrape samples were collected for wet mount, Gram stain, culture and cytological analysis. A blood sample was obtained to determine TCD4+ lymphocytes and viral load. RESULTS: A total of 341 (91.2%) women participated in the study. The prevalence of T. vaginalis was 4.1% (95% CI: 2.0-6.2%). Median age was 32 (interquartile range 27-38) years and median years of schooling was 9.0 (interquartile range 4-11). A total of 165 (53.2%) HIV women were classified as patients with AIDS. In multivariate analyses, squamous intraepithelial lesions in cytology [OR = 2.46 (95% CI: 1.31-4.63, p = 0.005)] and anal sex practice [OR = 3.62 (95% CI: 1.08-12.19, p = 0.037)] were associated with T. vaginalis. CONCLUSIONS: These results highlight that HIV-infected women should be screened for T. vaginalis. The control of this infection may have an impact on preventing reproductive complications among these women.

Prevalencia de Trichomonas vaginalis en trabajadores sexuales / Trichomonas vaginalis prevalence in sex workers

La tricomoniasis es una infección de transmisión sexual (ITS) que se asocia a vaginitis, uretritis, cervicitis y enfermedad inflamatoria pélvica pudiendo producir infertilidad tubárica. El objetivo de este trabajo, de tipo retrospectivo longitudinal, fue determinar la prevalencia de Trichomonas vaginalis en una población de trabajadores sexuales en Mendoza, Argentina. Se estudió en forma retrospectiva una población de 720 personas asistidas por el Programa Provincial de ITS de Mendoza. Entre febrero de 2007 y junio de 2009 se procesaron 1692 muestras con un muestreo por reposición. La distribución por sexo fue de 687 mujeres y 33 varones con edades comprendidas entre 15 y 65 años. La prevalencia de tricomoniasis determinada en esta población en riesgo fue de 7.6% para las mujeres, sin encontrarse infecciones en el grupo de los hombres. La prevalencia hallada en este grupo en riesgo muestra una población con alta vulnerabilidad para contraer otras ITS de mayor gravedad. En otro sentido, sugiere una importante falta de adhesión al uso de barreras mecánicas para prevenir infecciones de transmisión sexual. Este trabajo justifica la elaboración de una guía de procedimientos para el manejo de la infección por tricomonas en el marco del Programa de Salud Reproductiva (PROSAR).

Trichomoniasis is a sexually transmitted infection (STI) usually associated to vaginitis, urethritis, cervicitis and pelvic inflammatory disease, which can cause infertility. The aim of this retrospective longitudinal study was to determine Trichomonas vaginalis prevalence in a population of male and female sex workers in Mendoza, Argentina. A cohort of 720 people who attended the STI Program in this province was retrospectively analyzed. From February 2007 up to June 2009, 1692 samples were processed using a reposition sampling method. The age and sex distribution of the population was: 687 women/33 men, from 15 to 65 years old. Trichomoniasis prevalence determined for this population at risk was 7.6% in women only, men did not present infection. The high prevalence shown for this risk group suggests a great vulnerability of this population to contract other more serious STIs. In another sense, it also shows a remarkable lack in the use of mechanical barriers to prevent sexually transmitted diseases (STDs). The present research justifies the elaboration of standardized procedures guide to diagnose T. vaginalis within the framework of the Reproductive Health Program (PROSAR).

Inquérito preliminar de Trichomonas vaginalis em população feminina e fatores de risco associados em Unidade de Atendimento Público no município de Uberlândia-MG / Survey of Trichomonas vaginalis in women attended in public health care facilities and risk factors for infection, in Uberlândia, Minas Gerais state, Brazil

Trichomonas vaginalis é o agente etiológico da tricomonose, sendo transmitido sexualmente ou por meio de fômites contaminados. O objetivo deste estudo foi determinar a prevalência do parasito, identificando os possíveis fatores de risco associados à infecção. Amostras de secreções vaginais de 157 mulheres procedentes da Unidade de Atendimento Integrado, em Uberlândia-MG, foram coletadas e questionários epidemiológicos foram aplicados com o intuito de se conhecer variáveis socioeconômicas e hábitos comportamentais. Foram coletadas duas amostras individuais de cada paciente, as quais foram analisadas por meio de exame direto a fresco, cultura e Papanicolaou. Do total, nove (5,7por cento) mulheres apresentaram o parasito, sendo encontrada maior prevalência da infecção entre as casadas, negras, morenas ou pardas e com idade média de 37 anos, apesar de não ser estatisticamente significante (p maior que 0,05). A baixa escolaridade, a fase do ciclo menstrual e a presença de sinais clínicos foram variáveis associadas à infecção (p menor que 0,05). Na comparação entre os métodos diagnósticos, o exame direto a fresco e a cultura mostraram concordância de 100por cento e apresentaram sensibilidade maior do que o Papanicolaou. Esses fatores constituem informações importantes no estudo socioepidemiológico envolvendo o parasito e são fundamentais para o controle da doença.

Incidência da tricomoníase em mulheres atendidas pelo sistema único de saúde em cascavel e no oeste do Paraná / Occurrence of tricomoniasis in women attended by the main health system in cascavel and in the west of Paraná

O Trichomonas vaginalis é o agente etiológico da tricomoníase, parasita do sistema urogenital humano e está associada a sérias complicações de saúde. Infecta principalmente o epitélio do trato genital na região da ectocérvice, podendo ser assintomática ou sintomática. O objetivo do trabalho foi verificar a incidência do protozoário Trichomonas vaginalis e estabelecer a faixa etária mais atingida por este parasita em pacientes do SUS de Cascavel e na região Oeste do Paraná. Foram analisadas 211.940 amostras de exames preventivos de pacientes com idade entre 12 e 64 anos ou mais. Os dados foram obtidos pelo DATASUS, disponíveis na internet, no período de janeiro a maio de 2006. Do total de amostras analisadas, 3.752 pacientes apresentaram infecção por T. vaginalis no Paraná, sendo 13,19% (n=495) na região Oeste e 2,24% (n=86) em Cascavel. A faixa etária mais acometida foram mulheres de 20 a 49 anos, sendo que acima de 50 anos a frequência foi diminuindo gradativamente, tanto na região Oeste como em Cascavel. No nível estadual a maior frequência foi entre mulheres de 40 a 44 anos (15,06%). Já na região Oeste e em Cascavel, a faixa etária entre 45 a 49 anos apresentou maior número de casos positivos (17,37%). A queda da incidência da tricomoníase entre mulheres acima de 50 anos pode resultar da ausência do hormônio estrogênio como fator inibidor da proliferação do parasita. Já nas mulheres de 20 a 49 anos, as alterações hormonais características do ciclo reprodutivo feminino podem contribuir para aumentar os índices da doença.

The Trichomonas vaginalis is the etiological agent of Trichomoniasis, a parasite of the human urogenital system associated to a number of health problems. It infects specially the genital epithelium in the ectocervical region, being asymptomatic or symptomatic. The purpose of this study was to verify the occurrence of the Trichomonas vaginalis protozoan and to establish the age group most affected by this parasite in SUS patients in Cascavel and in the West region of Paraná. There were 211,940 analyses of samples in preventive exams in patients aging 12 to 64 years old, or sometimes even older. The data was obtained by DATASUS, available on the internet, from January to May of 2006. From the total of samples analyzed, 3,752 patients presented the infection by T. vaginalis in Paraná: 13.19% (n=495) in the West region and 2.24% (n=86) in Cascavel. The age group that was more harmed was the one composed by women from 20 to 49 years old, and the ones above 50 years old the frequency started to lower gradually, in the West region and also in Cascavel. In a state level the biggest frequency was between women from 40 to 44 years old (15.06%). In the west region and in Cascavel, the age group from 45 to 49 years old presented a bigger number of positive cases (17.37%). The drop of the occurrence of the Trichomoniasis between women above 50 years old can be a result of the lack of the estrogen hormone as a preventing factor. In women from 20 to 49 years old the hormonal alterations of the reproductive cycle can contribute to increase the levels of the disease.