Infecções genitais em mulheres atendidas em Unidade Básica de Saúde: prevalência e fatores de risco

OBJETIVO: descrever a prevalência e o perfil comportamental para infecções genitais em mulheres atendidas em uma Unidade Básica de Saúde em Vitória, Espírito Santo. MÉTODOS: estudo em corte transversal, realizado em mulheres de 15 a 49 anos, atendidas numa área atendida pelo Programa Saúde da Família (PSF). Os critérios de exclusão foram: ter sido submetida a um exame ginecológico há menos de um ano e ter histórico de tratamento recente (nos últimos três meses) para infecções genitais. Foi aplicada entrevista contendo dados sócio-demográficos, clínicos e comportamentais. Espécimes genitais foram coletados para citologia, bacterioscopia pelo Gram e cultura; e amostra de urina para teste de biologia molecular para Chlamydia trachomatis. RESULTADOS: participaram do estudo 299 mulheres. A mediana de idade foi de 30,0 (intervalo interquartil: 24;38) anos; a média de idade do primeiro coito foi de 17,3 (dp=3,6) anos. A média de idade da primeira gravidez foi de 19,2 (dp=3,9) anos. Aproximadamente 70% relataram até oito anos de escolaridade; 5% relataram infecção sexualmente transmissível prévia e 8% uso de drogas ilícitas. Somente 23,7% relataram uso consistente de preservativo. As queixas clínicas relatadas foram: úlcera genital (3%); disúria (7,7%); fluxo vaginal (46,6%); prurido (20%) e dor pélvica (18%). As taxas de prevalência foram: Chlamydia trachomatis com 7,4%; gonorréia 2%; tricomoníase 2%; vaginose bacteriana 21,3%; candidíase 9,3%; e alterações citológicas sugestivas de vírus 3,3%. No modelo final de regressão logística, os fatores independentemente associados a infecções genitais foram: muco cervical anormal, OR=9,7 (IC95%=5,6-13,7); realização de teste de HIV prévio, OR=6,5 (IC95%=4,0-8,9); ter mais de um parceiro no último ano, OR=3,9 (IC95%=2,7-5,0) e ter mais de um parceiro na vida, OR=4,7 (IC95%=2,4-6,8). CONCLUSÕES: os resultados mostram alta freqüência de infecções genitais e a necessidade de medidas de prevenção, como o rastreamento de infecções sexualmente transmissíveis e programas de redução de risco em mulheres que procuram o serviço ginecológico de rotina.

Síndromes Sexualmente Transmissíveis

O Vídeos abordam Infecções pelo HPV; Síndrome de Úlcera Genital; Síndrome de Corrimento Uretral Masculino e Infecção pelo HPV e Síndrome de Corrimento Vaginal/Cervical Feminino e DIPA.

Medidas de assistência e diagnóstico da Aids e DST na Atenção Básica

Este vídeo integra o curso Doenças infectocontagiosas na Atenção Básica à Saúde (2016) e apresenta medidas de assistência e diagnóstico da Aids e DST na Atenção Básica

Proposta educacional on-line sobre úlcera por pressão para alunos e profissionais de enfermagem

OBJETIVOS: Desenvolver uma proposta educacional on-line sobre o tema úlcera por pressão para alunos e profissionais de enfermagem. MÉTODOS: Pesquisa aplicada, de produção tecnológica, composta pelas etapas de concepção/ planejamento e desenvolvimento, caracterizadas por um conjunto de procedimentos, documentação, digitalização de informações e de imagens. Foram utilizados recursos computacionais didáticos interativos como: o Cybertutor e o Homem Virtual. RESULTADOS: Desenvolvimento de uma proposta educacional virtual sobre úlcera por pressão (UP) dividida em módulos de aprendizagem, contendo lista de discussão, estudos de casos e recursos didáticos, tais como fotos e o Homem Virtual. CONCLUSÕES: Utilizou-se de novas tecnologias educacionais, com a finalidade de promover o aprendizado sobre UP a estudantes de graduação de enfermagem e possibilitar a educação continuada de enfermeiros, uma vez que as UP representam um desafio aos profissionais da saúde e aos serviços de saúde.

Morphology of the male agouti accessory genital glands (Dasyprocta prymnolopha Wagler, 1831)

The morphology of the accessory genital glands of the male agouti was studied in twenty-three animals that were raised in captivity. Twenty animals had their genital glands dissected in situ for macroscopic description. The samples of each gland were recovered, embedded in paraffin, sliced and stained by Hematoxylin-Eosin technique. It was founded four pairs of glands: the vesicular glands, the coagulating glands, the prostate and the bulbourethral glands. Histological characteristics of the vesicular, coagulating and prostate glands showed similar morphology, within the pseudostratified columnar epithelium. The tubulo-alveolar type of the bulbourethral glands showed a lack of connective tissue among the tubules, a small amount of red stained presented it the cytoplasm, and the presence of vacuoles in the tissue. This study concluded that the agouti showed to have similar morphological aspect described in the others species of rodents.

Effect of coinfection with STDs and of STD treatment on HIV shedding in genital-tract secretions - Systematic review and data synthesis

Objective: To determine whether coinfection with sexually transmitted diseases (STD) increases HIV shedding in genital-tract secretions, and whether STD treatment reduces this shedding. Design: Systematic review and data synthesis of cross-sectional and cohort studies meeting. predefined quality criteria. Main Outcome Measures: Proportion of patients with and without a STD who had detectable HIV in genital secretions, HIV toad in genital secretions, or change following STD treatment. Results: Of 48 identified studies, three cross-sectional and three cohort studies were included. HIV was detected significantly more frequently in participants infected with Neisseria gonorrhoeae (125 of 309 participants, 41%) than in those without N gonorrhoeae infection (311 of 988 participants, 32%; P = 0.004). HIV was not significantly more frequently detected in persons infected with Chlamydia trachomatis (28 of 67 participants, 42%) than in those without C trachomatis infection (375 of 1149 participants, 33%; P = 0.13). Median HIV load reported in only one study was greater in men with urethritis (12.4 x 10(4) versus 1.51 x 10(4) copies/ml; P = 0.04). In the only cohort study in which this could be fully assessed, treatment of women with any STD reduced the proportion of those with detectable HIV from 39% to 29% (P = 0.05), whereas this proportion remained stable among controls (15-17%), A second cohort study reported fully on HIV load; among men with urethritis, viral load fell from 12.4 to 4.12 x 10(4) copies/ml 2 weeks posttreatment, whereas viral load remained stable in those without urethritis. Conclusion: Few high-quality studies were found. HIV is detected moderately more frequently in genital secretions of men and women with a STD, and HIV load is substantially increased among men with urethritis, Successful STD treatment reduces both of these parameters, but not to control levels. More high-quality studies are needed to explore this important relationship further.

Predictors of genital warts among women attending two family planning clinics

Objectives: To establish the prevalence and predictors of genital warts among healthy women presenting for contraceptive advice at two family planning clinics, one in a major Australian city and one in a country town in the same state. Methods: Consecutive consenting attendees (n = 1218)at two family planning clinics in Queensland completed a questionnaire and were examined for genital warts. Results: The point prevalence of visible genital warts was 3.3 per cent in the city clinic and 14.4 per cent in the country town. For half of these clients a finding of warts was unexpected, in that the client was unaware of their presence and presentation to the family planning clinic was not specifically for advice about sexually transmitted infections. The major predictor of a finding of warts was client age, with the highest prevalence in 20- to 25-year-olds. Warts were also commoner amongst smokers in the country town but not in Brisbane. However, no analysed sociodemographic variable predicted a finding of warts of which the client was not aware. Conclusions: Genital warts are common among young women presenting for contraceptive advice. Such women are often unaware that they have warts. Examination for genital warts should be a part of any routine examination of sexually active women, and medical practitioners should be aware of appropriate advice for patients who are found to have genital warts on routine examination.

Association between HIV-1 infection, the etiology of genital ulcer disease, and response to syndromic management

Background: Reports on the effect of HIV-1 infection on healing rates of ulcers are conflicting. Goal: The goal was to determine the etiology and response to treatment of genital ulcer disease (GUD) in relation to HIV-1 infection. Study Design: This was a cohort study of patients with GUD treated with local syndromic management protocols. Results: Among the 587 recruited, the prevalences of infections due to HSV, Treponema pallidum, Chlamydia trachomatis (lymphogranuloma venereum [LGV]), Haemophilus ducreyi, Calymmatobacterium granulomatis, and HIV-1 were 48%, 14%, 11%, 10%, 1%, and 75%, respectively. The prevalence of T pallidum was higher among men (P = 0.03), and an association was seen among HIV-1-seronegatives on univariate and multivariate analyses (P < 0.001; P = 0.01). The prevalence of C trachomatis (LGV) was higher among females (P = 0.004), and an association was seen among HIV-1-seropositives on univariate analysis (P = 0.04). At follow-up, 40/407 (10%) showed a decreased healing tendency, not associated with ulcer etiology or HIV-1 seropositivity. Conclusion: Response to syndromic management of GUD was acceptable and not associated with HIV-1 coinfection.

COL1A1 Sp1-binding site polymorphism as a risk factor for genital prolapse

The objective of this study was to verify the possible association between the Sp1-binding site polymorphism and genital prolapse. A case-control study was conducted in 107 patients with stages III and IV genital prolapse. The control group included 209 women with stages 0 and I. The polymorphism of type I collagen Sp1-binding site was identified by amplification of the first intron of the COL1A1 gene. We did not find differences in the prevalence of the GT and TT genotypes between the groups (p=0.34), even when we grouped patients with at least one polymorphic allele (GT and TT) and compared them with patients without the polymorphic allele (GG; p=0.17) The presence of at least one vaginal delivery, family history for prolapse, and macrosomatic fetus were independent risk factors for prolapse. In conclusion, the COL1A1 Sp1-binding site was not significantly associated with genital prolapse among our study subjects.

Genital Manifestation of Graft-vs.-Host Disease: A Series of Case Reports

Introduction. After hematopoietic stem cell transplantation (HSCT), many patients present genital graft-vs.-host disease (GVHD) that can culminate with sexual problems, which are poorly dimensioned. Aim. We hope to draw attention to the need to perform genital biopsy to diagnose genital GVHD, and thus to call attention to the need to incorporate careful attention to sexual health in the treatment of these patients. Methods. Five allogeneic stem cell transplant recipients complaining of coital pain after HSCT were clinically diagnosed for genital GVHD. Genital biopsies were given for histological analysis, and microphotographs of the corresponding marked field in the slide were taken. Specimens were evaluated by the site pathologist and then sent to a reference pathologist, each blinded to the histological findings. A literature search was performed in PubMed/MEDLINE (1966-2009) for cross-sectional and cohort studies or trials related to genital GVHD. Expert opinions peer reviews and case reports were also considered. Main Outcome Measures. HSCT, genital GVHD, genital biopsy. Results. The biopsy showed evidence of dilated apoptotic cells in the basal layer and detachment of the epithelial lining of the mucosa, hyalinization and thickening of collagen fibers, capillary ectasia, and mononuclear inflammatory infiltrate of the submucosa. Three patients presented vulval lesion such as leucoplasia and ulcer on the large lip. Histological analyses showed evidence of epithelial hyperplasia and influx of inflammatory cells to the epithelial surface, intercellular edema and spongiosis, apoptotic bodies on the basal layer of the epithelium, spongiosis, and nuclear vacuolization. A common treatment based on corticotherapy resulted in complete remission of coetaneous or mucous genital lesions in all five patients. Conclusion. Genital biopsy is important to differentially diagnose GVHD and secondary symptoms due to hypoestrogenism. Prevention is the most important step in controlling the evolution GVHD in the vagina to prevent vaginal obstruction and sexual dysfunction. da Silva Lara LA, de Andrade JM, Mauad LMQ, Ferrarese SR, Marana HRC, Tiezzi DG, and de Sa Rosa e Silva ACJ. Genital manifestation of graft-vs.-host disease: A series of case reports. J Sex Med 2010;7:3216-3225.

Spatially dynamic expression of Sry in mouse genital ridges

We have studied the spatial dynamics of Sry transcription in the genital ridges of mouse embryos. We find that Sry is expressed in a dynamic wave that emanates from the central and/or anterior regions, extends subsequently to both poles, and ends in the caudal pole. This dynamism may explain the relative positioning of ovarian and testicular tissue seen in ovotestes in mice. Since direct regulatory targets of SRY ought to be expressed in a corresponding or complimentary wave, our observations pave the way for identification of target genes. Sry is expressed in internal cells but not in coelomic surface epithelial cells, indicating that its effect on proliferation of surface cells is achieved non-cell-autonomously. The cellular dynamism of Sry expression revealed in this study thus provides important insights into both the cellular and molecular mode of action of SRY, and how perturbations in Sry expression can lead to anomalies of sexual development. (C) 2001 Wiley-Liss, Inc.

Detecção de HPV na mucosa oral e genital pela técnica PCR em mulheres com diagnóstico histopatológico positivo para HPV genital

A infecção do papilomavírus humano (HPV) é uma das mais freqüentes doenças sexualmente transmissíveis em todo o mundo. A relação entre o HPV genital e oral permanece incerta, assim como o seu papel na carcinogênese oral. O objetivo deste estudo foi verificar a presença do DNA do HPV na mucosa oral e genital de mulheres com infecção genital por HPV, pela técnica de reação em cadeia de polimerase (PCR). FORMA DE ESTUDO: Coorte transversal. MATERIAL E MÉTODO: Trata-se de um estudo piloto, prospectivo, com 30 mulheres, idade de 14 a 51 anos, portadoras de infecção genital por HPV confirmada pelo exame de histopatológico. Todas as pacientes foram submetidas a exame e coleta por raspagem da cavidade oral e genital para pesquisa do DNA do HPV pela técnica PCR. RESULTADOS: Nenhuma das amostras da cavidade oral foi positiva para HPV, enquanto no genital, o HPV foi detectado em 17 (57%) das 30 pacientes, principalmente o HPV 6b e 16. CONCLUSÃO: Os resultados mostraram maior porcentagem do HPV genital em relação à cavidade oral, e sugerem que o HPV genital não parece ser fator predisponente para a infecção oral no mesmo paciente.

Prevalencia de microorganismos asociados a secreción genital femenina, Argentina

OBJETIVO: Hay un aumento significativo de pacientes con Secreción Genital Femenina, en el Sector Público del gran Buenos Aires. Fue necesario actualizar la prevalencia de los microorganismos asociados a los efectos de revisar el apoyo necesario de laboratorio y ajustar las medidas de prevención y control. MÉTODOS: Se incorporan a este estudio, la totalidad de los casos atendidos (1997-1998): 84 adolescentes (15 a 19 años) y 784 adultas (20 a 60 años) sintomáticas. El protocolo incluye (secreción vaginal y endocervical) detección de Neisseria gonorrhoeae, Streptococcus agalactiae, Trichomonas vaginalis, Candida spp y vaginosis bacteriana. Aplicando métodos específicos directos y cultivo, Chlamydia trachomatis (detección de antígeno), Ureaplasma urealitycum y Mycoplasma hominis (cultivos) fueron estudiados en parte de la población total. RESULTADOS: El aumento de la demanda de consulta fue continuo desde 1997 y aumentó 2.10 veces del primero al último semestre de 1998. En las mujeres adultas se encontró: vaginosis bacteriana, 23,8%; Candida spp 17,8%; S. agalactiae 5,6%; T. vaginalis 2,4%. En 50,3% no se detecto ninguno. En adolescentes se detectó: vaginosis bacteriana, 17,8%; Candida spp 29,7%; S. agalactiae 3,6%, T. vaginalis 2,4%: En 46,4% de los casos el resultado fue negativo. En el grupo de mujeres adultas sintomáticas, no en la totalidad, se detectó: C. trachomatis (7/400) 1,76%, U. urealyticum (209/340) 61,4% y M. hominis (45/272) 16,5%. CONCLUSIONES: El aumento significativo de consultas se debe a problemas sociales en la población, no al aumento de ninguna patología en especial. Impacta como problema clínico concreto la prevalencia de vaginosis bacteriana y Candida spp. Llama la atención, la nula incidencia de N. gonorrhoeae y la baja circulación de T. Vaginalis y C. trachomatis, en este tipo de población. La prevalencia de U. urealyticum y M. hominis es alta, pero su real participación en la patología genital de adultas debe ser reconsiderada. Las prevalencias establecidas motivan la necesidad de adecuar los manuales de procedimientos apuntando a la aplicación de metodologías simples de alto valor predictivo.

O papel da angiogênese e da hemólise na úlcera de perna de pessoas com anemia falciforme

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Paracoccidioidomicose genital feminina. Descrição de um caso clínico

A paracoccidioidomicose é doença sistêmica que atinge mais o sexo masculino do que o feminino. Modelos experimentais mostram maior sensibilidade dos machos do que as fêmeas à dsseminação da doença. A literatura médica é rica em relatos de casos de Pbmicose do trato genital masculino. A raridade da Pbmicose sistêmica na mulher devido à ação hormonal tornou inusitada a descrição de um caso com envolvimneto genital. Paciente de 57 anos, branca, procedente de Conchas (SP), queixando-se de dor abdominal há 10 anos, difusa, seguida de eólica periumbelical periódica, com diarréia e obstipação alternadas. Piorou desse quadro e evoluiu para abdome agudo cirúrgico. O anátomo patológico revelou Pbmicose no epiplon e ovário direito. A biópsia do endométrio mostrou endometrite crônica granulomatosa. A radiologia e a planigrafia revelaram nódulo parahilar direito. Os achados clínicos e laboratoriais permitiram explicar a provável origem do envolvimento genital.