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Vallejo-Ortega MT, Gaitán Duarte H, Mello MB, Caffe S, Perez F. A systematic review of the prevalence of selected sexually transmitted infections in young people in Latin America. Rev Panam Salud Publica 2022; 46:e73. [PMID: 35747471 PMCID: PMC9211030 DOI: 10.26633/rpsp.2022.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To estimate the burden of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and human papillomavirus (HPV) infections among people aged 10 to 25 in Latin America and the Caribbean. Methods The MEDLINE, EMBASE, and LILACS databases were searched, as well as documents from regional organizations or national health Institutions. Population-based studies that reported prevalence or incidence of CT, NG, TP, and HPV detected through confirmatory tests in adolescents and young people were included. Two reviewers independently selected studies and extracted data. The quality of studies was assessed using the Newcastle-Ottawa Scale. Pooled estimators were calculated in cases where heterogeneity was <70%; when not feasible, prevalence ranges were reported. Results Out of a total of 3 583 references, 15 prevalence studies complied with the inclusion criteria. Due to substantial heterogeneity (>70%), it was not possible to pool frequency estimators. Among the general population, the prevalence of CT infection ranged between 2.1% and 30.1% (9 studies, 5 670 participants); for NG, prevalence ranged between 0% and 2.9% (8 studies, 5 855 participants); for TP, prevalence varied between 0% and 0.7% (3 studies, 11 208 participants), and for HPV infection, prevalence ranged between 25.1% and 55.6% (8 studies, 3 831 participants). Conclusions Reliable, population-based data on sexually transmitted infections (STIs) in adolescents and youth in Latin America and the Caribbean are limited. Additional studies are needed to better understand the burden of STIs in this population. However, given the substantial prevalence of STIs detected, countries need public health policies for prevention, early diagnosis, and treatment of STIs in young people.
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Affiliation(s)
| | - Hernando Gaitán Duarte
- Universidad Nacional de Colombia Bogotá Colombia Universidad Nacional de Colombia, Bogotá, Colombia
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2
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Huai P, Li F, Chu T, Liu D, Liu J, Zhang F. Prevalence of genital Chlamydia trachomatis infection in the general population: a meta-analysis. BMC Infect Dis 2020; 20:589. [PMID: 32770958 PMCID: PMC7414538 DOI: 10.1186/s12879-020-05307-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Background Estimating prevalence of Chlamydia trachomatis (CT) worldwide is necessary in designing control programs and allocating health resources. We performed a meta-analysis to calculate the prevalence of CT in the general population. Methods The Pubmed and Embase databases were searched for eligible population-based studies from its inception through June 5, 2019. Q test and I2 statistic were used to calculate the heterogeneity between studies. Random effects models were used to pool the prevalence of CT. Meta regression was performed to explore the possible sources of heterogeneity. Publication bias was evaluated using a funnel plot and “trim and fill” method. Results Twenty nine studies that reported prevalence of CT infection from 24 countries were identified, including a total population of 89,886 persons. The pooled prevalence of CT among the general population was 2.9% (95% CI, 2.4–3.5%), and females had a higher CT prevalence (3.1, 95% CI, 2.5–3.8%) than males (2.6, 95% CI, 2.0–3.2%) (χ2 = 10.38, P < 0.01). Prevalence of CT was highest in region of America (4.5, 95% CI, 3.1–5.9%), especially in Latin America (6.7, 95% CI, 5.0–8.4%), followed by females in region of Africa (3.8, 95% CI, 0.7–6.9%), while South-East Asia had a lowest CT prevalence 0.8% (95% CI, 0.3–1.3%). Conclusions This study provided the updated prevalence of CT among general population worldwide. General population from Latin America, especially females, and women in Africa should be given priority by WHO when design and delivery CT control programs.
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Affiliation(s)
- Pengcheng Huai
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China
| | - Furong Li
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China
| | - Tongsheng Chu
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China
| | - Dianchang Liu
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Liu
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China
| | - Furen Zhang
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China. .,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China.
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3
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Silveira MF, Bruni MP, Stauffert D, Golparian D, Unemo M. Prevalence and risk factors associated with Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium among women in Pelotas, Southern Brazil. Int J STD AIDS 2020; 31:432-439. [PMID: 32192370 DOI: 10.1177/0956462419898982] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The frequently asymptomatic sexually transmitted infections (STIs) caused by Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG) are poorly diagnosed in Brazil and can lead to severe complications/sequelae without timely detection and treatment. We investigated prevalence of CT, NG, and MG infections and associated demographic, behavioral, and clinical factors in consecutive women attending a gynecology and obstetrics outpatient clinic in Pelotas, Southern Brazil. Vaginal swab samples were prospectively obtained from asymptomatic and symptomatic women (n = 498) from August 2015 to December 2016 and tested with Aptima Combo2 and Aptima M. genitalium assays (Hologic). The prevalence of CT, NG, and MG was 6.8% (34/498), 1.0% (5/498), and 4.2% (21/498), respectively. Three (0.6%) cases of CT and NG co-infection and one (0.2%) case of CT and MG co-infection were identified. The risk factors associated with these bacterial STIs were youth (<30 years), no steady sexual partner, infection with additional STI, and lack of income. Bacterial STIs, particularly CT and MG, were prevalent among women, including pregnant women (60% of positive cases), in Pelotas, Brazil. Sensitive and specific diagnostic testing and early treatment are essential to control STIs, limit transmission chains, avoid future complications/sequelae, and reduce health and cost burdens on the population.
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Affiliation(s)
- M F Silveira
- Maternal and Child Department, School of Medicine, Federal University of Pelotas (UFPel), Pelotas, Brazil
| | - M P Bruni
- Post Graduate Program in Parasitology, Biology Institute, Federal University of Pelotas (UFPel), Pelotas, Brazil
| | - D Stauffert
- Maternal and Child Department, School of Medicine, Federal University of Pelotas (UFPel), Pelotas, Brazil
| | - D Golparian
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Páez‐Canro C, Alzate JP, González LM, Rubio‐Romero JA, Lethaby A, Gaitán HG. Antibiotics for treating urogenital Chlamydia trachomatis infection in men and non-pregnant women. Cochrane Database Syst Rev 2019; 1:CD010871. [PMID: 30682211 PMCID: PMC6353232 DOI: 10.1002/14651858.cd010871.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The genital infection caused by Chlamydia trachomatis (CT) is a common sexually transmitted infection (STI) globally. The infection is mainly asymptomatic in women, thus it can produce infertility and chronic pelvic pain. In men infection is mainly symptomatic, but can evolve to prostatitis. Clinical practice guidelines for CT urogenital infections do not give any specific recommendation about which antibiotic use as first option OBJECTIVES: To assess the efficacy and safety of antibiotic treatment for CT genital infection in men and non-pregnant women. SEARCH METHODS The Cochrane Sexually Transmitted Infections' (STI) Information Specialist developed the electronic searches in electronic databases (CENTRAL, MEDLINE, Embase and LILACS), and trials registers. We searched studies published from inception to June 2018. SELECTION CRITERIA We included parallel, randomised controlled trials (RCTs) of men, and sexually-active, non-pregnant women with CT infection (urethritis or uterine cervicitis or asymptomatic), diagnosed by cell culture for CT, nucleic acid amplification tests (NAAT) or antigen-based detection methods, who had been treated with any of the antibiotic regimens recommended by any of the updated to 2013 CT Guidelines. DATA COLLECTION AND ANALYSIS Four review authors screened evidence according to selection criteria and independently extracted data and assessed risk of bias. Two authors developed the 'Summary of findings' tables. We used a fixed-effect meta-analysis model for combining data where it was reasonable to assume that studies were estimating the same underlying treatment effect. We estimated the pooled risk ratio in order to establish the effects of the comparisons. Our primary outcomes were microbiological failure and adverse events, and our secondary outcomes were clinical failure, antimicrobial resistance and reinfection. MAIN RESULTS We selected 14 studies ( 2715 participants: 2147 (79.08%) men and 568 (20.92%) women). The studies were conducted mainly at STD clinics. Sample sizes ranged from 71 to 606 participants; follow-up was 29.7 days on average.For the comparison: azithromycin single dose versus doxycycline once or twice daily for 7 days, in men treated for CT, the risk of microbiological failure was higher in the azithromycin group (RR 2.45, 95% CI 1.36 to 4.41; participants = 821; studies = 9; moderate-quality evidence), but regarding clinical failure, the results showed that the effect is uncertain (RR 0.94, 95% CI 0.43 to 2,05; I² = 55%; participants = 525; studies = 3; low-quality evidence). Regarding adverse events (AE) in men there could be little or no difference between the antibiotics (RR 0.83, 95% CI 0.67 to 1.02; participants = 1424; studies = 6; low-quality evidence). About women treated for CT, the effect on microbiological failure was uncertain (RR = 1.71, 95% CI 0.48 to 6.16; participants = 338; studies = 5; very low-quality evidence). There were no studies assessing clinical failure or adverse events in women, however, we found that azithromycin probably has fewer adverse events in both genders (RR 0.83, 95% CI 0.71 to 0.98; I² = 0%; participants = 2261; studies = 9; moderate-quality evidence).For the second comparison: doxycycline compared to ofloxacin, for men treated for CT the effect on microbiological failure was uncertain (RR 8.53, 95% CI 0.43 to 167.38, I² not applicable; participants = 80; studies = 2; very low-quality evidence), as also it was on clinical failure (RR 0.85, 95% CI 0.28 to 2.62; participants = 36; studies = 1; very low-quality evidence). The effect of in women on clinical failure was uncertain (RR 0.94, 95% CI 0.39 to 2.25; I² = 39%; participants = 127; studies = 2; very low-quality evidence).Regarding adverse events, the effect in both men and women was uncertain (RR 1.02 95% CI 0.66 to 1.55; participants = 339 studies = 3; very low-quality evidence). The effect on microbiological failure in women and in men and women together, the effect on microbiological failure was not estimable. The most frequently AE reported were not serious and of gastrointestinal origin.No studies assessed antimicrobial resistance or reinfection in either comparison. AUTHORS' CONCLUSIONS In men, regimens with azithromycin are probably less effective than doxycycline for microbiological failure, however, there might be little or no difference for clinical failure. For women, we are uncertain whether azithromycin compared to doxycycline increases the risk of microbiological failure. Azithromycin probably slightly reduces adverse events compared to doxycycline in men and women together but may have little difference in men alone. We are uncertain whether doxycycline compared to ofloxacin reduces microbiological failure in men or women alone, or men and women together, nor if it reduces clinical failure or adverse events in men or women.Based on the fact that women suffer mainly asymptomatic infections, and in order to test the effectiveness and safety of the current recommendations (azithromycin, doxycycline and ofloxacin), for CT infection, especially in low and middle income countries, future RCTs should be designed and conducted to include a large enough sample size of women, and with low risk of bias. It is also important that future RCTs include adherence, CT resistance to antibiotic regimens, and risk of reinfection as outcomes to be measured. In addition, it is important to conduct a network meta-analysis in order to evaluate all those studies that included in one arm only the current antibiotic treatments for CT infection that are recommended by the updated clinical practice guidelines.
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Affiliation(s)
- Carol Páez‐Canro
- Faculty of Medicine, Universidad Nacional de ColombiaClinical Research InstituteBogotaColombia
| | - Juan Pablo Alzate
- Fundación Universitaria de Ciencias de la Salud, Hospital Infantil de San JoséResearch UnitBogotaColombia
| | - Lina M González
- Fundación Universitaria de Ciencias de la Salud ‐ Hospital Infantil de San José.Research UnitCra. 52 #67A‐71BogotáCundinamarcaColombia111411
| | - Jorge Andres Rubio‐Romero
- Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Obstetrics and GynecologyCiudad UniversitariaBogotaColombia
| | - Anne Lethaby
- University of AucklandDepartment of Obstetrics and GynaecologyPrivate Bag 92019AucklandNew Zealand1142
| | - Hernando G Gaitán
- Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Obstetrics and GynecologyCiudad UniversitariaBogotaColombia
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Szwarcwald CL, de Almeida WDS, Damacena GN, de Souza-Júnior PRB, Ferreira-Júnior ODC, Guimarães MDC. Changes in attitudes, risky practices, and HIV and syphilis prevalence among female sex workers in Brazil from 2009 to 2016. Medicine (Baltimore) 2018; 97:S46-S53. [PMID: 29893747 PMCID: PMC5991537 DOI: 10.1097/md.0000000000009227] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The present study aims at investigating the progress made toward controlling the human immunodeficiency virus (HIV)/AIDS epidemic among female sex workers (FSW) from 2009 to 2016. METHODS The baseline of respondent-driven sampling (RDS) study among FSW was carried out in 2009, in 10 Brazilian municipalities. In 2016, information on FSW were collected in 12 municipalities. The analyses took into account the dependence among observations, resulting from the recruitment chains, and the unequal probabilities of selection, resulting from the different network sizes. We analyzed changes in attitudes and risky behavior practices as well as variations in HIV and syphilis prevalence based on the comparison of 95% confidence intervals for each estimate. RESULTS Information on 2523 (2009) and 4245 (2016) FSW were analyzed. Commercial sex debut shifted to younger ages: while in 2009 the proportion of women who started sex work under 18 years old was 28.3%, in 2016 this percentage rose to 38.3%. The proportion of FSW affiliated to a nongovernmental organization (NGO) in defense of their rights (14.0%), in 2009, decreased to 7.8%, in 2016, as well as the proportion of FSW who received counseling on sexually transmitted infections (STI) in the past 6 months, from 47.5% to 24.4%. Relevant improvements were found for HIV testing in the last 12 months (from 20.3% to 39.3%). The proportions of those who were never tested for syphilis dropped from 57.9% to 48.5%. However, an opposite decreasing trend was found for the Pap smear examination in the last 12 months, decreasing from 43.6% to 31.5%. Regular condom use with clients significantly increased in the period. Regarding HIV prevalence, the 5% level was sustained and no significant differences were found, but syphilis prevalence was found to be more than 3 times higher in 2016 (8.5%) than in 2009 (2.4%). DISCUSSION Many are the challenges to be faced in attempting to reverse the upward trend of syphilis among FSW in Brazil. Despite the progress in condom distribution free of charge, it is necessary to increase awareness campaigns, emphasize the use, reaffirm STI counseling, and reiterate the need of regular syphilis screening in this key population group.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
| | - Wanessa da Silva de Almeida
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
| | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
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Silveira MFD, Sclowitz IKT, Entiauspe LG, Mesenburg MA, Stauffert D, Bicca GLDO, Pieniz C, Manta AB. Chlamydia trachomatis infection in young pregnant women in Southern Brazil: a cross-sectional study. CAD SAUDE PUBLICA 2017; 33:e00067415. [PMID: 28226066 DOI: 10.1590/0102-311x00067415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 03/11/2016] [Indexed: 11/22/2022] Open
Abstract
This study estimated the prevalence of Chlamydia trachomatis infection during pregnancy in a sample of women up to 29 years of age in the city of Pelotas, Rio Grande do Sul State, Brazil, and investigated socio-demographic risk factors such as maternal age, marital status, maternal schooling, and family income. C. trachomatis infection was diagnosed with PCR using BD ProbeTecTM CT/GC Amplified DNA Assay. Socio-demographic, behavioral, and reproductive data were collected using structured questionnaires. All collections were performed by previously trained medical students. The study included a stratified probabilistic sample from four maternity hospitals in the city. The sample included 562 pregnant women, and prevalence of C. trachomatis infection was 12.3% (95%CI: 9.6-15.0). No significant association was identified between C. trachomatis infection and any of the target variables, including obstetric outcomes such as history of preterm delivery. Our findings in terms of low treatment adherence, only 43% of the women and 9.7% of partners, associated with high C. trachomatis prevalence, reinforce the need to implement routine screening for C. trachomatis during prenatal care. The attempt to diagnose and treat this infection after delivery, as in this study, limits the possibility of success.
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Affiliation(s)
| | | | | | - Marilia Arndt Mesenburg
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
| | - Dulce Stauffert
- Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Brasil
| | | | - Carine Pieniz
- Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Brasil
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7
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Leon SR, Segura ER, Konda KA, Flores JA, Silva-Santisteban A, Galea JT, Coates TJ, Klausner JD, Caceres CF. High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in anal and pharyngeal sites among a community-based sample of men who have sex with men and transgender women in Lima, Peru. BMJ Open 2016; 6:e008245. [PMID: 26739719 PMCID: PMC4716251 DOI: 10.1136/bmjopen-2015-008245] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES This study aimed to characterise the epidemiology of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) and transgender women (TW) in Lima, Peru. SETTING Cross-sectional study in Lima, Peru. PARTICIPANTS We recruited a group of 510 MSM and 208 TW for a subsequent community-based randomised controlled trial. The presence of CT and NG were evaluated using Aptima Combo2 in pharyngeal and anal swabs. We also explored correlates of these infections. PRIMARY AND SECONDARY OUTCOME MEASURES Study end points included overall prevalence of C. trachomatis and N. gonorrhoeae in anal and pharyngeal sites. RESULTS Overall prevalence of CT was 19% (95% CI 16.1% to 22.1%) and 4.8% (95% CI 3.3% to 6.6%) in anal and pharyngeal sites, respectively, while prevalence of NG was 9.6% (95% CI 7.5% to 12.0%) and 6.5% (95% CI 4.8% to 8.5%) in anal and pharyngeal sites, respectively. CONCLUSIONS The prevalence of each infection declined significantly among participants older than 34 years (p<0.05). Efforts towards prevention and treatment of extraurogenital chlamydial and gonococcal infections in high-risk populations like MSM and TW in Lima, Peru, are warranted. TRIAL REGISTRATION NUMBER NCT00670163; Results.
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Affiliation(s)
- Segundo R Leon
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Cayetano Heredia University, Lima, Peru Department of Global Health, University of Washington, Seattle, Washington, USA Socios en Salud, Lima, Peru
| | - Eddy R Segura
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Kelika A Konda
- Division of Infectious Diseases, School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Juan A Flores
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Cayetano Heredia University, Lima, Peru
| | - Alfonso Silva-Santisteban
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Cayetano Heredia University, Lima, Peru
| | | | - Thomas J Coates
- Division of Infectious Diseases, School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jeffrey D Klausner
- Division of Infectious Diseases, School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Carlos F Caceres
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Cayetano Heredia University, Lima, Peru
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Nwokolo NC, Dragovic B, Patel S, Tong CYW, Barker G, Radcliffe K. 2015 UK national guideline for the management of infection with Chlamydia trachomatis. Int J STD AIDS 2015; 27:251-67. [PMID: 26538553 DOI: 10.1177/0956462415615443] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 10/09/2015] [Indexed: 01/26/2023]
Abstract
This guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of Chlamydia trachomatis genital infection. It covers the management of the initial presentation, as well the prevention of transmission and future infection. The guideline is aimed at individuals aged 16 years and older presenting to healthcare professionals working in departments offering Level 3 care in sexually transmitted infections management within the UK. However, the principles of the recommendations should be adopted across all levels, using local care pathways where appropriate.
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Affiliation(s)
| | | | - Sheel Patel
- Chelsea and Westminster Hospital, London, UK
| | | | | | - Keith Radcliffe
- British Association for Sexual Health and HIV Clinical Effectiveness Group, London, UK
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Magalhães PAF, Miranda CAN, Lima ÉG, Moizéis RNC, de Lima DBS, Cobucci RNO, de Medeiros Fernandes TAA, de Azevedo JCV, de Azevedo PRM, de Araújo JMG, Fernandes JV. Genital tract infection with Chlamydia trachomatis in women attended at a cervical cancer screening program in Northeastern from Brazil. Arch Gynecol Obstet 2014; 291:1095-102. [PMID: 25326872 DOI: 10.1007/s00404-014-3514-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/07/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE This cross-sectional study aimed to estimate the prevalence of Chlamydia trachomatis (CT) infection alone and in combination with human papillomavirus (HPV). Furthermore, the study investigates whether the CT infection increases the risk of contracting HPV and whether the presence of both pathogens is associated with a higher prevalence of cervical lesions. METHODS Cervical samples of 1,134 asymptomatic women enrolled in a screening program for cervical cancer were analyzed. Two cervical specimens were collected from each patient, one for cytologic examination and the other for detection of CT by polymerase chain reaction (PCR), using a primer pair which amplifies a specific sequence of the DNA plasmid. RESULTS The overall prevalence rate infection was 10.9%, being 10% in the women with normal cytology, 13.8% in those with atypical squamous cells of undetermined significance (ASC-US), and 25% with low-grade squamous intraepithelial lesion (LSIL). The infection by CT did not increase the risk of acquiring HPV infection. The higher prevalence of LSIL in women co-infected with HPV and CT is possibly due to HPV. CONCLUSION CT infection was more prevalent in younger women aged up to 32 years, who had an early onset of reproductive activity and a history of having had multiple sexual partners lifelong may be at a greater risk of acquiring infection of the genital tract by C. trachomatis.
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de Lima YAR, Turchi MD, Fonseca ZC, Garcia FLB, de Brito e Cardoso FA, da Guarda Reis MN, de Britto Guimarães EM, Alves RRF, Carvalho NR, de Fátima Costa Alves M. Sexually transmitted bacterial infections among young women in Central Western Brazil. Int J Infect Dis 2014; 25:16-21. [PMID: 24818991 DOI: 10.1016/j.ijid.2014.03.1389] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 03/23/2014] [Accepted: 03/27/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Studies on sexually transmitted infections in Brazil are done mainly in large metropolises and screening is available for pregnant women only. We aimed to estimate the prevalence and risk factors for Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum infection among young non-pregnant women in non-clinical settings in middle-sized cities of Central Brazil. METHODS A cross-sectional community-based sample of 1072 participants was included. Sexually active women (64.9%) provided first-catch urine samples for PCR investigation of chlamydial and gonococcal infection. Syphilis was tested in serum. Univariate analysis investigated risk factors for chlamydial infection. Multivariate logistic regression included associations with a p-value <0.20. RESULTS The mean age of participants was 18 years; 73.2% reported unprotected intercourse, 37.6% were married/cohabiting, and 5% reported a previous STI. Prevalence rates of C. trachomatis, N. gonorrhoeae, and T. pallidum were 9.6% (95% confidence interval (CI) 7.4-12.4%), 0.7% (95% CI 0.2-1.9%), and 0.15% (95% CI 0.0-0.7%), respectively. After adjustments, being <20 years old (adjusted odds ratio (aOR) 1.90, 95% CI 1.07-3.37) and having three or more lifetime sexual partners (aOR 2.57, 95% CI 1.46-4.53) were associated with the risk for chlamydial infection. CONCLUSIONS We observed a high prevalence of chlamydial infection and sexual risk behaviors in this population. These findings are important to guide screening strategies in Brazil.
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Affiliation(s)
- Yanna Andressa Ramos de Lima
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Rua 235, s/n, Setor Universitário, CEP 74605050, Goiânia, Goiás, Brazil.
| | - Marília Dalva Turchi
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Rua 235, s/n, Setor Universitário, CEP 74605050, Goiânia, Goiás, Brazil
| | - Zulmirene Cardoso Fonseca
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Rua 235, s/n, Setor Universitário, CEP 74605050, Goiânia, Goiás, Brazil
| | - Fernanda Lopes Brito Garcia
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Rua 235, s/n, Setor Universitário, CEP 74605050, Goiânia, Goiás, Brazil
| | - Fernanda Alves de Brito e Cardoso
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Rua 235, s/n, Setor Universitário, CEP 74605050, Goiânia, Goiás, Brazil
| | - Mônica Nogueira da Guarda Reis
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Rua 235, s/n, Setor Universitário, CEP 74605050, Goiânia, Goiás, Brazil
| | | | | | - Nígela Rodrigues Carvalho
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Rua 235, s/n, Setor Universitário, CEP 74605050, Goiânia, Goiás, Brazil
| | - Maria de Fátima Costa Alves
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Rua 235, s/n, Setor Universitário, CEP 74605050, Goiânia, Goiás, Brazil
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Tavares MCM, de Macêdo JL, de Lima Júnior SF, de Andrade Heráclio S, Amorim MMR, de Mascena Diniz Maia M, de Souza PRE. Chlamydia trachomatis infection and human papillomavirus in women with cervical neoplasia in Pernambuco-Brazil. Mol Biol Rep 2014; 41:865-74. [PMID: 24395291 DOI: 10.1007/s11033-013-2927-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
Chlamydia trachomatis (CT) is the most common bacterial cause of sexually transmitted disease. High-risk human papillomavirus (HR-HPV) is considered the main etiological agent for cervical neoplasia. Evidences showed that the presence of co-infection of CT and HR-HPV plays a central role in the etiology of cervical intraepithelial neoplasia (CIN) and cervical cancer. The goals of this study were: evaluate the human papillomavirus (HPV) and CT prevalence among Brazilian women with abnormal cytology and provide the effect of this association on the severity of cervical neoplasia. The population of this study was composed by 142 women with incident histological incidence of CIN grades I, II, III or cervical cancer from Recife, Northeast of Brazil. The polymerase chain reaction method on a cervical brush specimen was used to detect both agents and the automatic sequencing method was used for HPV genotyping assay. The prevalence of HPV and CT was 100 and 24.65 %, respectively. Thirteen types of HPV were detected; HPV 16, 18, 31 and 33 were the most common. The most prevalent HPV types were HPV 16 and 18. A significant association between CT positive and HPV 16 infection was found (p < 0.0106; OR = 5.31; 95 % IC 1.59-17.67). In the study population, there was diversity of HPV infections, with high-risk types being the most common. Also, the data collected suggest that CT infection may play an important role in the natural history of HPV infection.
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Chlamydia trachomatis infection in HIV-infected women: need for screening by a sensitive and specific test. Infect Dis Obstet Gynecol 2013; 2013:960769. [PMID: 24382941 PMCID: PMC3870114 DOI: 10.1155/2013/960769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/24/2013] [Accepted: 10/18/2013] [Indexed: 02/04/2023] Open
Abstract
Reproductive tract infection (RTIs)/sexually transmitted infections (STIs) are recognized as a major public health problem, particularly due to their relationship with HIV infection. Early detection and treatment of Chlamydia trachomatis infection (CTI) among HIV-infected and HIV-uninfected women may impact heterosexual HIV transmission. A total of 120 participants were enrolled: 30 HIV seropositive women with symptoms of RTIs, 30 HIV seropositive women without symptoms of RTIs, 30 HIV seronegative women with symptoms of RTIs, and 30 HIV seronegative women without symptoms of RTIs. One endocervical swab was collected from all participants and CTI was detected by real-time PCR (COBAS TaqMan CT Test, v2.0). CTI was detected in 4 (6.67%) HIV-infected women and in 1 (1.67%) HIV-uninfected woman (OR 4.214; 95% CI 0.457–38.865). Vaginal discharge was present in almost half of HIV-infected and HIV-uninfected women; lower abdominal pain was present in 11 (18.3%) of HIV-infected and in 9 (15%) of HIV-uninfected women. This study showed that CTI is more prevalent among HIV-infected females as compared to HIV-uninfected females. As the use of real-time PCR is not feasible in most hospitals, efforts should be made to develop a simple, sensitive, and specific test to identify women with CTI for prevention of sequelae and HIV transmission.
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Chlamydia trachomatis prevalence and risk behaviors in parturient women aged 15 to 24 in Brazil. Sex Transm Dis 2013; 38:957-61. [PMID: 21934572 DOI: 10.1097/olq.0b013e31822037fc] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chlamydia trachomatis (CT) is a sexually transmitted infection having repercussions on reproductive health and impact on the foetus. Our goal was to estimate the prevalence of and risk factors for CT in young parturient women in Brazil. METHODS A national cross-sectional study of parturient women, aged 15 to 24 years, attending Brazilian public hospitals was performed in 2009. Participants answered a questionnaire including demographic, behavioral, and clinical data. A sample of urine was collected and screened for CT and Neisseria gonorrhoeae (NG), using polymerase chain reaction COBAS Amplicor CT/NG (Roche Molecular Systems, Branchburg, NJ). RESULTS A total of 2400 women were selected and 2071 (86.3%) participated in the study. Mean age was 20.2 years (standard deviation = 2.7). Prevalence rates of CT and NG were 9.8% (95% confidence interval [CI]: 8.5-11.1) and 1.0% (95% CI: 0.6%-1.4%), respectively. Four percent of women infected with CT also had NG infection. CT associated factors were: being younger (15-19 years old) (odds ratio [OR] = 1.6 [95% CI: 1.15-2.17]); first sexual intercourse before 15 years of age (OR = 1.4 [95% CI: 1.04-6.24]); having more than 1 sexual partner in lifetime (OR = 1.6 [95% CI: 1.13-2.26]); Pap smear screening more than 1 year (OR = 1.5 [95% CI: 1.08-2.05]); and NG infection (OR = 7.6 [95% CI: 3.05-19.08]). CONCLUSIONS This study shows a high prevalence of CT infection among young pregnant women in Brazil. We suggest that CT screening should be included as part of antenatal care routine in this group in Brazil.
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Silva LCF, Miranda AE, Batalha RS, Sabino CCD, Dib E, Costa CMD, Ramasawmy R, Talhari S. Chlamydia trachomatis infection among HIV-infected women attending an AIDS clinic in the city of Manaus, Brazil. Braz J Infect Dis 2013; 16:335-8. [PMID: 22846120 DOI: 10.1016/j.bjid.2012.06.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 03/18/2012] [Indexed: 10/27/2022] Open
Abstract
This was a cross-sectional study aimed to determine the prevalence of and to identify risk factors for Chlamydia trachomatis (CT) among human immunodeficiency virus (HIV)-infected women attending the acquired immunodeficiency syndrome (AIDS) clinic in the city of Manaus, Brazil, in 2009-2010. Participants answered a questionnaire containing demographic, epidemiological, and clinical data. A genital specimen was collected during examination to detect CT-DNA by hybrid capture, and blood samples were taken to determine CD4(+)T and HIV viral load. There were 329 women included in the study. Median age was 32 years (IQR=27-38) and median schooling was nine years (IQR=4-11). The prevalence of CT was 4.3% (95%CI: 2.1-6.5). Logistic regression analysis showed that age between 18-29 years [OR=4.1(95%CI: 1.2-13.4)] and complaint of pelvic pain [OR=3.7 (95%CI: 1.2-12.8)] were independently associated with CT. The use of condom was inversely associated with CT [OR=0.39 (95%CI: 0.1-0.9)]. The results showed that younger women who did not use condoms are at a higher risk for CT. Screening for sexually transmitted infections must be done routinely and safe sexual practices should be promoted among this population.
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Cunha Machado MS, da Costa e Silva BFB, Caetité Gomes IL, Santana IU, Rios Grassi MF. Prevalence of cervical Chlamydia trachomatis infection in sexually active adolescents from Salvador, Brazil. Braz J Infect Dis 2012. [DOI: 10.1016/s1413-8670(12)70304-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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16
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Miranda AE, Figueiredo NC, McFarland W, Schmidt R, Page K. Predicting condom use in young women: demographics, behaviours and knowledge from a population-based sample in Brazil. Int J STD AIDS 2012; 22:590-5. [PMID: 21998181 DOI: 10.1258/ijsa.2009.009104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The goal of this study was to assess condom use and related behaviour in young women in Vitória, Brazil. From March to December 2006, a cross-sectional sample of women aged 18-29 years was recruited into a population-based study. Risk behaviours for HIV and sexually transmitted infections (STIs) were surveyed. Condom use at last intercourse was assessed as a principal outcome describing protective sexual behaviour. Of 1200 eligible women identified, 1029 (85.8%) enrolled. Among them, 904 (87.9%) reported a history of sexual activity. Only 36.6% reported condom use at last intercourse; those who did were more likely to report commercial sex work (odds ratio [OR] 9.01 [1.46-55.55]), to state that STI prevention was a primary reason for using condoms (OR = 6.84 [4.81-9.71]), to have been previously diagnosed with an STI (OR = 2.39 [1.36-4.21]), to report that 'it is easy to tell a sexual partner they will not have vaginal/anal sex without a condom' (OR = 2.30 [1.56-3.39]), to report that sexual intercourse is only risky when people have anal sex (OR = 1.98 [1.22-3.22]); and less likely to be married (OR = 0.65 [0.54-0.78]), and to find it difficult to use condom consistently in all sexual encounters (OR = 0.36 [0.25-0.52]). Women who reported condom use were more concerned with preventing STIs, and to report less difficulty insisting on condom use with partners.
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Affiliation(s)
- A E Miranda
- Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Maruípe, Vitória, Brazil.
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Chlamydial infection in a high risk population: association with vaginal flora patterns. Arch Gynecol Obstet 2011; 285:1013-8. [DOI: 10.1007/s00404-011-2085-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 09/06/2011] [Indexed: 11/25/2022]
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Luppi CG, Oliveira RLSD, Veras MA, Lippman SA, Jones H, Jesus CHD, Pinho AA, Ribeiro MC, Caiaffa-Filho H. Diagnóstico precoce e os fatores associados às infecções sexualmente transmissíveis em mulheres atendidas na atenção primária. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2011; 14:467-77. [DOI: 10.1590/s1415-790x2011000300011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 04/11/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Infecções Sexualmente Transmissíveis (IST) em mulheres permanecem um desafio para a Saúde Pública: elevada prevalência, dificuldade para implantação de estratégias de diagnóstico precoce e elevada ocorrência de sequelas. OBJETIVO: Identificar a prevalência de IST em usuárias de um serviço de atenção primária à saúde em São Paulo. MÉTODOS: Mulheres de 18 a 40 anos foram convidadas para realizar autocoleta de secreção vaginal para a detecção de Chlamydia trachomatis, Neisseria gonorrhoeae e Trichomonas vaginalis por meio de Reacão em Cadeia da Polimerase (PCR). As mulheres também responderam a um questionário com questões demográficas e relativas à história sexual face a face ou autoaplicado por meio de um computador. RESULTADOS: Das 781 mulheres incluídas no estudo, as prevalências obtidas foram: Chlamydia trachomatis (8,4%), Neisseria gonorrhoeae (1,9%) e Trichomonas vaginalis (3,2%). A positividade para pelo menos uma das três IST foi de 13%. As variáveis associadas independentemente com maior risco de IST foram: idade menor que 20 anos, mais de dois parceiros sexuais na vida e percepção de risco para IST; o uso de preservativo como método contraceptivo foi um fator protetor. CONCLUSÃO: A prevalência encontrada em usuárias indica a necessidade da implantação de estratégias de rastreamento de IST em serviços de atenção primária.
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Borges-Costa J, Matos C, Pereira F. Sexually transmitted infections in pregnant adolescents: prevalence and association with maternal and foetal morbidity. J Eur Acad Dermatol Venereol 2011; 26:972-5. [DOI: 10.1111/j.1468-3083.2011.04194.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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de Lima Freitas NS, Borborema-Santos CM, Barroso Serrão das Neves D, Costa de Oliveira CM, Dutra Ferreira JR, Astolfi-Filho S. High Prevalence Detection of Chlamydia trachomatis by Polymerase Chain Reaction in Endocervical Samples of Infertile Women Attending University Hospital in Manaus-Amazonas, Brazil. Gynecol Obstet Invest 2011; 72:220-6. [DOI: 10.1159/000324798] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Accepted: 02/02/2011] [Indexed: 11/19/2022]
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Prevalence and Risk Factors of Chlamydia trachomatis Cervicitis in Pregnant Women at the Genital Tract Infection in Obstetrics Unit Care at Botucatu Medical School, São Paulo State University - UNESP, Brazil. J Low Genit Tract Dis 2011; 15:20-4. [DOI: 10.1097/lgt.0b013e3181ed3d58] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Szwarcwald CL, Andrade CLTD, Pascom ARP, Fazito E, Pereira GFM, Penha ITD. HIV-related risky practices among Brazilian young men, 2007. CAD SAUDE PUBLICA 2011; 27 Suppl 1:S19-26. [DOI: 10.1590/s0102-311x2011001300003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 03/08/2010] [Indexed: 11/22/2022] Open
Abstract
Behavioral surveillance surveys have been carried among military conscripts, in Brazil, since 1996. This paper presents the results of the 2007 survey and compares actual findings with those obtained in previous studies carried out in the period 1999-2002. The conscripts were selected with a two stage sampling stratified by geographical region. The study included a self-reported questionnaire and blood collection for HIV and syphilis testing. Data from 35,432 conscripts aged 17-20 years old were analyzed. The findings show a reduction in regular condom use, with fixed and casual partners, mainly among those with poor educational level. The proportion of conscripts that have sex with other men was maintained (3.2%), but the index of risky sexual behavioral showed worsening results in this group. Also, the HIV prevalence rate increased from 9 to 11.3 per 10,000 in 2007, though the increase was not statistically significant. In conclusion, the evidences found in this paper indicate the need of reformulate policy among young adults.
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Machado ACS, Bandea CI, Alves MFC, Joseph K, Igietseme J, Miranda AE, Guimarães EMB, Turchi MD, Black CM. Distribution of Chlamydia trachomatis genovars among youths and adults in Brazil. J Med Microbiol 2010; 60:472-476. [PMID: 21183598 DOI: 10.1099/jmm.0.026476-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite a high prevalence of sexually transmitted Chlamydia trachomatis infections in Brazil and other countries in South America, very little is known about the distribution of C. trachomatis genovars. In this study, we genotyped C. trachomatis strains from urine or endocervical specimens collected from 163 C. trachomatis-positive female and male youths, and female adults, residing in two different regions of Brazil, the city of Goiânia located in the central part of Brazil, and the city of Vitória in the south-east region. C. trachomatis strains were genotyped by amplifying and sequencing the ompA gene encoding the chlamydial major outer-membrane protein, which is genovar specific. We found nine different C. trachomatis genovars: E (39.3%), F (16.6%), D (15.9%), I (8.6%), J (7.4%), G (4.9%), K (3.1%), H (2.4%) and B (1.8%). The distribution of the C. trachomatis genovars in the two regions of Brazil was similar, and there was no statistically significant association of serovars with age, gender, number of sexual partners or clinical symptoms. The overall distribution of C. trachomatis genovars in Brazil appears similar to that found in other regions of the world, where E, D and F are the most common. This supports the notion that, during the last few decades, the overall distribution of C. trachomatis genovars throughout the world has been relatively stable.
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Affiliation(s)
- Ana C S Machado
- Department of Microbiology, Immunology, Parasitology and Pathology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Brazil
| | - Claudiu I Bandea
- Division of Scientific Resources, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria F C Alves
- Department of Microbiology, Immunology, Parasitology and Pathology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Brazil
| | - Kahaliah Joseph
- Division of Scientific Resources, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph Igietseme
- Division of Scientific Resources, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angélica E Miranda
- Nucleus of Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil
| | - Eleuse M B Guimarães
- Division of Adolescent Medicine, Department of Pediatrics, Faculty of Medicine, Federal University of Goiás, Brazil
| | - Marília D Turchi
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Brazil
| | - Carolyn M Black
- Division of Scientific Resources, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mmari K, Blum RW. Risk and protective factors that affect adolescent reproductive health in developing countries: a structured literature review. Glob Public Health 2009; 4:350-66. [PMID: 19462269 DOI: 10.1080/17441690701664418] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The primary focus of this article is to determine which risk and protective factors are most important to adolescent reproductive health in developing countries. A comprehensive and systematic literature search was conducted on studies that examined factors in relation to the following outcomes: ever had premarital sex, condom use, pregnancy, early childbearing, sexually transmitted infections, and HIV. While the search identified over 11,000 publications, only 61 were retained for the final analysis. The results show that factors which were significantly associated to the outcomes were primarily related to the adolescents themselves. In fact, very few factors outside the individual were found to be related to sexual risk behaviours. This contrasts to similar research conducted among youth samples in the US. While this review confirms the strong need for a broader research base on the risk and protective factors related to adolescent sexual and reproductive health in developing countries, it also does identify key factors that can be addressed through innovative programmes and policies to help improve adolescent reproductive health in the developing world.
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Affiliation(s)
- K Mmari
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Guimarães EMB, Guimarães MDC, Vieira MAS, Bontempo NM, Seixas MSS, Garcia MSD, Daud LES, Côrtes RLM, Alves MDFC. Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents. BMC Med 2009; 7:8. [PMID: 19284575 PMCID: PMC2664828 DOI: 10.1186/1741-7015-7-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 03/11/2009] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Sexually transmitted infections constitute the main health risk among adolescents. In developing countries the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among female adolescents from a Health Sector of the city of Goiânia, Brazil, and validated cervicitis diagnosis using World Health Organization/Ministry of Health risk score and gynecological examination. METHODS A cross-sectional community-based sample of 914 15- to 19-year-old female teenagers was randomly selected and referred to the local Family Health Program. Of these, 472 (51.6%) were sexually active and gynecological examinations were carried out for 427. Endocervical samples were collected to perform the polymerase chain reaction for C. trachomatis and N. gonorrhoeae. Performance of risk score, the presence of mucopurulent discharge, friability, ectopia and pain during cervical maneuver were compared with the presence of C. trachomatis or N. gonorrhoeae or both. RESULTS The prevalence of C. trachomatis and N. gonorrhoeae was 14.5% and 2.1%, respectively. The risk score had a specificity of 31.9% (95% confidence interval, 21.2 to 44.2) and a positive predictive value of 20.8% (95% confidence interval, 13.5 to 29.7). Friability was the component of the gynecological examination that presented the best performance with a sensitivity of 43.5%, specificity of 81.0%, and 30.6% of positive predictive value. CONCLUSION The prevalence of infection by C. trachomatis and N. gonorrhoeae was high among these sexually active adolescents. The syndromic approach is clearly inadequate for screening and treating these infections in this population. Therefore, the implantation of other strategies to control these infections among adolescents is urgently required.
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Affiliation(s)
- Eleuse M B Guimarães
- 1Division of Adolescent Medicine, Department of Pediatrics, Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
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Lima HE, Oliveira MB, Valente BG, Afonso DAF, Darocha WD, Souza MCM, Alvim TC, Barbosa-Stancioli EF, Noronha FSM. Genotyping of Chlamydia trachomatis from endocervical specimens in Brazil. Sex Transm Dis 2007; 34:709-17. [PMID: 17414937 DOI: 10.1097/01.olq.0000258399.27873.d9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no data concerning genotyping of Chlamydia trachomatis from Brazilian samples. GOAL To characterize the genotype of C. trachomatis detected in women assisted at a STD public clinic and establish the prevalence of this infection in that population. STUDY DESIGN Endocervical samples of a group of 100 women were tested for chlamydial infection with PCR directed to C. trachomatis cryptic plasmid. Genotyping of positive samples were done after omp1 amplification and sequencing. RESULTS The overall prevalence of C. trachomatis infection was 19%, with the highest prevalence in women between 15 and 25 years old (68.4%). Four genotypes were found associated with endocervical infections: D, E, F, and K. Sequence analysis revealed a coinfection of genotypes D and E in 1 woman. CONCLUSIONS To our knowledge this is the first study to characterize Brazilian C. trachomatis endocervical samples and Brazilian C. trachomatis genotype coinfection. Our results also emphasize the importance of routine diagnosis of C. trachomatis for the control of this STD.
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Affiliation(s)
- Haleta E Lima
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Brasil
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Oliveira FA, Pfleger V, Lang K, Heukelbach J, Miralles I, Fraga F, Sousa AQ, Stoffler-Meilicke M, Ignatius R, Kerr LFS, Feldmeier H. Sexually transmitted infections, bacterial vaginosis, and candidiasis in women of reproductive age in rural Northeast Brazil: a population-based study. Mem Inst Oswaldo Cruz 2007; 102:751-6. [DOI: 10.1590/s0074-02762007000600015] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 09/05/2007] [Indexed: 11/22/2022] Open
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Lippman SA, Jones HE, Luppi CG, Pinho AA, Veras MAMS, van de Wijgert JHHM. Home-Based Self-Sampling and Self-Testing for Sexually Transmitted Infections: Acceptable and Feasible Alternatives to Provider-Based Screening in Low-Income Women in São Paulo, Brazil. Sex Transm Dis 2007; 34:421-8. [PMID: 17091118 DOI: 10.1097/01.olq.0000245958.34961.27] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether home-based screening for sexually transmitted infections (STIs) is acceptable, feasible, and increases the proportion of women screened among low-income women in São Paulo, Brazil. STUDY DESIGN Eight hundred eighteen women were randomized to receive a clinic appointment or a kit for home-based STI self-collection and testing. All participants collected 2 vaginal swabs, one for polymerase chain reaction detection of chlamydia, gonorrhea, and trichomoniasis and another for a self-conducted rapid test for trichomoniasis. RESULTS Slightly more women responded to the initiative within 2 weeks in the home group (80%) than in the clinic group (76%) with younger women showing improved response to home-based screening. Ninety-four percent of home group participants successfully completed self-collection and self-testing on their first attempt. CONCLUSIONS Home-based self-collection and self-testing was acceptable, feasible, and resulted in a slightly higher response rate. Home sampling and testing provide promising alternatives to clinic-based STI screening across diverse contexts.
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Affiliation(s)
- Sheri A Lippman
- Division of Epidemiology, University of California, Berkeley, California 94720, USA.
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Araújo RSC, Guimarães EMB, Alves MFC, Sakurai E, Domingos LT, Fioravante FCR, Machado ACS. Prevalence and risk factors for Chlamydia trachomatis infection in adolescent females and young women in central Brazil. Eur J Clin Microbiol Infect Dis 2006; 25:397-400. [PMID: 16767489 DOI: 10.1007/s10096-006-0142-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In order to determine the prevalence and risk factors for Chlamydia trachomatis infection in adolescent females and young women in central Brazil, 296 subjects attending two public health services were evaluated. The overall prevalence of C. trachomatis infection, as determined using polymerase chain reaction, was 19.6% (95% confidence interval [CI], 15.3-24.7). In multivariate analysis, young age (odds ratio [OR]adjusted 2.32, 95%CI 1.1-4.8, p<0.05) and having 2-3 (ORadjusted 3.41, 95%CI 1.6-6.3, p<0.05) or >or=4 sexual partners in life (ORadjusted 3.10, 95%CI 1.1-6.3, p<0.05) were factors significantly associated with chlamydial infection. In conclusion, the prevalence of C. trachomatis infection was high in the studied population and risk factors were related to age and sexual behavior.
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Affiliation(s)
- R S C Araújo
- Division of Adolescent Medicine, Department of Pediatrics, Faculty of Medicine, Federal University of Goiás, 74233-180 Setor Universitário, Goiânia, Brazil
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Fioravante FCR, Costa Alves MDF, Guimarães EMDB, Turchi MD, Freitas HAG, Domingos LT. Prevalence of Chlamydia trachomatis in Asymptomatic Brazilian Military Conscripts. Sex Transm Dis 2005; 32:165-9. [PMID: 15729153 DOI: 10.1097/01.olq.0000152897.44969.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few data are available on the prevalence and risk factors for Chlamydia trachomatis infection among young men in Brazil. OBJECTIVES To assess prevalence and risk factors for C. trachomatis infection in male military conscripts. METHODS In 2000, 627 young men recruited for military service in Goiania, Goias, Brazil, were enrolled in this cross-sectional study. Participants completed a demographic and sexual risk behavior questionnaire, and urine samples were screened for C. trachomatis by polymerase chain reaction. RESULTS The prevalence of chlamydial infection among asymptomatic conscripts was 5.0% (95% confidence interval [CI], 3.3-7.3). In multivariate analysis, failure to use condoms (odds ratio [OR](adjusted) 5.3; 95% confidence interval [CI], 1.2-23.4; P = 0.028) and having more than 2 sexual partners in the last 2 months (OR(adjusted) 2.6; 95% CI, 1.1-6.9; P = 0.049) were significantly associated with positivity for C. trachomatis. CONCLUSIONS A substantial number of asymptomatic young male military recruits were infected with C. trachomatis, and risk factors for this infection were related to sexual behavior. Further research is required to determine if routine screening may be considered as a strategy to reduce prevalence among this population.
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Leal MDC, Gama SGND, Frias P, Szwarcwald CL. Healthy lifestyles and access to periodic health exams among Brazilian women. CAD SAUDE PUBLICA 2005; 21 Suppl:78-88. [PMID: 16462999 DOI: 10.1590/s0102-311x2005000700009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Using data from the World Health Survey carried out in Brazil in 2003, this paper has the objective of describing the sociodemographic profile of Brazilian women (age 18-69 years of age) that have adequate health care, not only with respect to health service utilization but also to healthy lifestyles. Sociodemographic variables (age, marital status, race, education level, number of household assets, and occupation), health care variables (periodic gynecologic exam with Papanicolaou, mammography among women aged 40-69 years, body mass index, smoking, alcohol, physical activity, dental care, private health insurance), and self-rated health were analyzed by municipality size strata. Logistic regression models were used to identify the characteristics of women that have adequate health care. Coverage of periodic gynecologic exam with Papanicolaou was 65.0% and mammography coverage was 47.0%. Less than 20.0% of Brazilian women have adequate care, and the most associated factors were: being younger than 40 years old, having higher educational level, having private health insurance and being married. The results indicate the need to develop health promotion policies focused on modifying the risk habits and risk practices to health, and to stimulate preventive periodic health exams.
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Affiliation(s)
- Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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