Sexually transmitted infections, bacterial vaginosis, and candidiasis in women of reproductive age in rural Northeast Brazil: a population-based study

Abstract

Population-based data on sexually transmitted infections (STI), bacterial vaginosis (BV), Laboratory testing included polymerase chain reaction (PCR) for human papillomavirus (HPV), ligase chain reaction (LCR) for Chlamydia trachomatis and Neisseria gonorrhoeae, ELISA for human immunodeficiency virus (HIV), venereal disease research laboratory (VDRL) and fluorescent treponema antibody absorption test (FTA-ABS) for syphilis, and analysis of wet mounts, gram stains and Pap smears for trichomoniasis, candidiasis, and BV. Only women who had initiated sexual life were included in the analysis (n = 592). The prevalences of STI were , chlamydia 4. 5% (3.0-6.6), trichomoniasis 4.1% (2.7-6.1), gonorrhoea 1. 2% (0.5-2.6), syphilis 0. 2% (0.0-1.1), and HIV 0%. The prevalence of ) and 12. 5% (10.0-15.5 ), respectively. The most common gynaecological complaint was lower abdominal pain. STI are common in women in rural Brazil and represent an important health threat in view of the HIV pandemic.Key words: sexually transmitted infections -reproductive tract infections -prevalence -epidemiology -Brazil Sexually transmitted infections (STI) are a major cause of morbidity throughout the world, particularly in developing countries (Gerbase et al. 1998). In women, STI are often chronic and present with little or no symptoms, but eventually may lead to severe sequels, such as chronic pelvic inflammatory disease, ectopic pregnancy, and infertility (WHO 2000). The impact of STI on the health of women tends to be more severe in resourcepoor settings where diagnostic and treatment facilities are inappropriate. Here, women often are not aware of STI as health problems, and health care seeking behaviour is poor (Giffin & Lowndes 1999). Relatively high prevalences of STI have been documented in such settings e.g. from Brazil, Papua New Guinea, and The Gambia (Walraven et al. 2001, Mgone et al. 2002, Soares et al. 2003. STI, as well as bacterial vaginosis (BV), are considered to increase the risk of acquiring human immunodefiency virus (HIV) (Sewankambo et al. 1997, Rottingen et al. 2001.In Brazil, the HIV epidemic is characterized by changing dynamics, currently reaching new population groups, namely women, underprivileged individuals, and communities outside the great urban centres (Fonseca et al. 2000, Brazilian Ministry of Health 2006. Reliable epidemiological data from Brazilian women on STI and other reproductive tract infections (RTI), such as BV and candidiasis, are scanty. Syphilis and HIV in pregnant women, AIDS, and congenital syphilis are notifiable infections, but the epidemiologic situation of other RTI is rather enigmatic. Studies have addressed the issue of STI in certain specific groups, such as patients attending STI clinics, gynaecology and obstetric outpatient departments, female prisoners or commercial sex workers (Miranda et al. 2000, Benzaken et al. 2002, Codes et al. 2002, Cook et al. 2004. However, these studies do not allow to conclude on the burden of disease on the community level.To increase further the knowledge...

Candidosis vaginal. Segunda parte:diagnóstico, tratamiento y situación de algunos países latinoamericanos

“…Las infecciones vaginales son comunes en las mujeres de todas las edades y por su frecuencia destacan aquellas debidas a Trichomonas (protozoo), Candida (hongo) y bacterias [5][6][7][8][9][10][11][12][13][14][15][16]. En ocasiones la vulvovaginitis es de origen multifactorial, lo que dificulta el diagnóstico y favorece la cronicidad del proceso.…”

“…En ocasiones la vulvovaginitis es de origen multifactorial, lo que dificulta el diagnóstico y favorece la cronicidad del proceso. Candida spp, se presenta aproximadamente en un tercio de las pacientes diagnosticadas con vulvovaginitis [5,9,[13][14][17][18][19][20][21][22][23][24][25][26]. Ocasionalmente se reportan casos de candidosis en el aparato genital masculino [3]; un estudio efectuado en 478 hombres demostró a Candida en el 26% como colonizante y en 18% como causante de balanitis [27].…”

“…En la exploración física se advierten eritema y edema vulvar, fisuras, lesiones papulopustulosas, placas amarillentas-blancas en las paredes de la vagina y cuello uterino y descarga vaginal que varía de acuosa a grumosa espesa (consistencia de requesón), espectro clínico que suele exacerbarse durante la semana previa a la menstruación; se estima que hasta un 75% de las mujeres llega a experimentar dicho cuadro agudo al menos una vez en su vida [15][16][17][18][19][20][52][53][54][55]. Los episodios agudos de infección de VVC son auto medicados con antimicóticos o manejados empíricamente por los médicos sin la obtención de cultivos [8][9][10][11][15][16][17][18][19][20]. La candidosis vulvovaginal recurrente se define como la presencia de al menos cuatro episodios al año, sintomáticos y documentados, con resolución de síntomas entre los episodios.…”

Conjuntivite neonatal com ênfase na sua prevenção

“…Dessa forma, não se tem uma noção razoável sobre sua verdadeira ocorrência em nosso meio. No entanto, relatos recentes sobre a elevada prevalência de DST em mulheres em idade fértil e em gestantes (16)(17)(18)(19)(20)(21)(22)(23) , além das precárias condições de controle pré-natal e do elevado índice de transmissão da infecção da mãe para o RN (1) permitem inferir que a prevalência da CN seja elevada, o que justifica a utilização de método preventivo.…”

Prevalência da infecção endocervical de Chlamydia trachomatis em universitárias do estado do Pará, Região Amazônica, Brasil

“…No Brasil, a prevalência de infecções por C. trachomatis varia entre 4,3% e 31,0%, conforme estudos de base populacional/comunitária de grandes centros urbanos e estudos de base clínica, realizados com participantes frequentadoras de ambulatórios e clínicas ginecológicas 10,11,12,13,14,15,16,17,18,19 . Nas comunidades amazônicas, há escassez de conhecimento sobre a epidemiologia da infecção endocervical por C. trachomatis, o que impossibilita a criação de diretrizes que estabeleçam o rastreio e controle dessa infecção.…”