Bacterial vaginosis and trichomoniasis: prevalence, associated factors, and performance of diagnostic tests
DOI:
https://doi.org/10.5327/DST-2177-8264-2023351360Keywords:
Cross-sectional studies, Sensitivity and specificity, Bacterial vaginosis, Trichomonas infections, Gynecological examinationAbstract
Introduction: Bacterial vaginosis and vaginal trichomoniasis are frequent causes of health care demand. Objective: To estimate the prevalence, identify associated factors, and investigate the performance of diagnostic tests for bacterial vaginosis and trichomoniasis. Methods: Cross-sectional study with participants over 18 years old. All of them were submitted to an interview and gynecological examination with evaluation of vaginal secretion, pH verification, collection of material for Pap smear, wet mount test, Whiff test, bacterioscopy, and polymerase chain reaction for trichomoniasis detection. Logistic regression analysis was applied to identify associated factors with bacterial vaginosis. Diagnostic performance for bacterial vaginosis was evaluated following Amsel criteria, the Ison and Hay score, and the Pap smear, considering the Nugent score as the gold standard. As for trichomoniasis, diagnostic performance was evaluated through the Pap smear and the wet mount test, using the polymerase chain reaction as the gold standard. Results: The prevalence of bacterial vaginosis was 33.7%, and for trichomoniasis, 0.5%. The complaint of abnormal vaginal secretion was associated with the diagnosis of bacterial vaginosis (odds ratio 2.2). The diagnostic accuracy by Amsel criteria, the Ison and Hay score, and the Pap smear was 35.6, 97.0, and 84.2%, respectively. The sensitivity for trichomoniasis through wet mount test was 0.0%, and through the Pap smear, 100%. Conclusion: The prevalence of bacterial vaginosis was high, and trichomoniasis was low. The only associated factor with bacterial vaginosis was the report of abnormal vaginal secretion. The methods with the most accurate diagnostic performance for bacterial vaginosis were the Ison and Hay score and the Pap smear and, for trichomoniasis, the Pap smear.
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, et al Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. https://doi.org/10.15585/mmwr.rr7004a1
Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Protocolo clínico e diretrizes terapêuticas para atenção integral às pessoas com infecções sexualmente transmissíveis (IST) [Internet]. Brasília: Ministério da Saúde; 2020 [cited on 2021 Apr. 27]. Available from: https://portaldeboaspraticas.iff.fiocruz.br/wp-content/uploads/2020/08/pcdt_ist_final_revisado_020420.pdf
World Health Organization. Report on global sexually transmitted infection surveillance, 2018. Geneva: WHO; 2018.
Iwueze MO, Ezeanyanwu LN, Okafor FC, Nwaorgu OC, Ukibe SC. Prevalence of Trichomonas vaginalis infection among women attending hospitals/health centres in Onitsha Community, Onitsha North Local Government Area of Anambra State. Bioscientist. 2014;2(1):54-64.
Kenyon C, Colebunders R, Crucitti T. The global epidemiology of bacterial vaginosis: a systematic review. Am J Obstet Gynecol. 2013;209(6):505-23. https://doi.org/10.1016/j.ajog.2013.05.006
Ignacio MAO, Andrade J, Freitas APF, Pinto GVS, Silva MG, Duarte MTC. Prevalência de vaginose bacteriana e fatores associados em mulheres que fazem sexo com mulheres. Rev Latino-Am Enfermagem. 2018;26:e3077. https://doi.org/10.1590/1518-8345.2491.3077
Resende AF, Santos RWF, Gaspar LMAC, Almeida POS. Prevalência de vaginoses bacterianas em pacientes que realizaram bacterioscopia de secreção vaginal. Rev Ciênc Méd Biol. 2019;18(2):190-3. http://dx.doi.org/10.9771/cmbio.v18i2.29698
Camargo KC, Alves RRF, Baylão LA, Ribeiro AA, Araujo NLAS, Tavares SBN, et al. Secreção vaginal anormal: sensibilidade, especificidade e concordância entre o diagnóstico clínico e citológico. Rev Bras Ginecol Obstet. 2015;37(5):222-8. https://doi.org/10.1590/SO100-720320150005183
Bilardi J, Walker S, Mooney-Somers J, Temple-Smith M, McNair R, Bellhouse C, et al. Women’s views and experiences of the triggers for onset of bacterial vaginosis and exacerbating factors associated with recurrence. PLoS One. 2016;11(3):e0150272. https://doi.org/10.1371/journal.pone.0150272
Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983;74(1):14-22. https://doi.org/10.1016/0002-9343(83)91112-9
Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29(2):297-301. https://doi.org/10.1128/jcm.29.2.297-301.1991
Ison CA, Hay PE. Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics. Sex Transm Infect. 2002;78(6):413-5. https://doi.org/10.1136/sti.78.6.413
Nayar R, Wilbur DC. The Bethesda system for reporting cervical cytology definitions, criteria, and explanatory notes. 3rd ed. New York: Springer International Publishing; 2015.
Garber GE. The laboratory diagnosis of Trichomonas vaginalis. Can J Infect Dis Med Microbiol. 2005;16(1):35-8. https://doi.org/10.1155/2005/373920
Tayoun ANA, Burchard PR, Caliendo AM, Scherer A, Tsongalis GJ. A multiplex PCR assay for the simultaneous detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Exp Mol Pathol. 2015;98(2):214-8. https://doi.org/10.1016/j.yexmp.2015.01.011
Cohen CR, Lingappa JR, Baeten JM, Ngayo MO, Spiegel CA, Hong T, et al. Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: a prospective cohort analysis among African couples. PLoS Med. 2012;9(6):e1001251. https://doi.org/10.1371/journal.pmed.1001251
Sabour S, Arzanlou M, Vaez H, Rahimi G, Sahebkar A, Khademi F. Prevalence of bacterial vaginosis in pregnant and non-pregnant Iranian women: a systematic review and meta-analysis. Arch Gynecol Obstet. 2018;297(5):1101-13. https://doi.org/10.1007/s00404-018-4722-8
Andrade A, Zicker F. Métodos de investigação epidemiológica em doenças transmissíveis: manual do instrutor. Brasília: Organização Pan-Americana de Saúde/Fundação Nacional de Saúde; 1997.
Camargo KC, Alves RRF, Saddi VA. Prevalence and factors associated with bacterial vaginosis in women in Brazil: a systematc review. J bras Doenças Sex Transm. 2023;35:e23351223. https://doi.org/10.5327/DST-2177-8264-2023351223
Asmah RH, Agyeman RO, Obeng-Nkrumah N, Blankson H, Awuah-Mensah G, Cham M, et al. Trichomonas vaginalis infection and the diagnostic significance of detection tests among Ghanaian outpatients. BMC Womens Health. 2018;18(1):206. https://doi.org/10.1186/s12905-018-0699-5
Ambrozio CL, Nagel AS, Jeske S, Bragança GCM, Borsuk S, Villela MM. Trichomonas vaginalis prevalence and risk factors for women in southern Brazil. Rev Inst Med Trop Sao Paulo. 2016;58:61. https://doi.org/10.1590/S1678-9946201658061
Field N, Clifton S, Alexander S, Ison CA, Khanom R, Saunders P, et al. Trichomonas vaginalis infection is uncommon in the British general population: implications for clinical testing and public health screening. Sex Transm Infect. 2018;94(3):226-9. https://doi.org/10.1136/sextrans-2016-052660
Marconi C, Duarte MTC, Silva DC, Silva MG. Prevalence of and risk factors for bacterial vaginosis among women of reproductive age attending cervical screening in southeastern Brazil. Int J Gynaecol Obstet. 2015;131(2):137-41. https://doi.org/10.1016/j.ijgo.2015.05.016
Bautista CT, Wurapa E, Sateren WB, Morris S, Hollingsworth B, Sanchez JL. Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Mil Med Res. 2016;3:4. https://doi.org/10.1186/s40779-016-0074-5
Bradshaw CS, Walker J, Fairley CK, Chen MY, Tabrizi SN, Donovan B, et al. Prevalent and incident bacterial vaginosis are associated with sexual and contraceptive behaviours in young Australian women. PLoS One. 2013;8(3):e57688. https://doi.org/10.1371/journal.pone.0057688
Krauss-Silva L, Almada-Horta A, Alves MB, Camacho KG, Moreira MEL, Braga A. Basic vaginal pH, bacterial vaginosis and aerobic vaginitis: prevalence in early pregnancy and risk of spontaneous preterm delivery, a prospective study in a low socioeconomic and multiethnic South American population. BMC Pregnancy Childbirth. 2014;14:107. https://doi.org/10.1186/1471-2393-14-107
Antonucci FP, Mirandola W, Fontana C, Fontana C. Comparison between Nugent’s and Hay/Ison scoring criteria for the diagnosis of bacterial vaginosis inWASP prepared vaginal samples. Clin Investig. 2017;7(3):89-93.
Posser J, Girardi JP, Pedroso D, Sandri YP. Estudo das infecções cérvicovaginais diagnosticadas pela citologia. Rev Sau Int. 2015;8(15-16):1-9.
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