RESUMO
To explore sexually transmitted diseases and sexual behavior as risk factors for cervical cancer, we analyzed data from a population-based case-control study of breast and cervical cancer in Costa Rica. Data from 415 cases of cervical carcinoma in situ, 149 cases of invasive cervical cancer, and 764 controls were included in the analysis. Multivariate analysis showed that lifetime number of sex partners, first intercourse before age 15 years, number of livebirths, herpes simplex virus type 2 seropositivity, and serologic evidence of previous chlamydial infection were predictors of carcinoma in situ. Serologic evidence of previous syphilis was not associated with carcinoma in situ. Predictors for invasive cervical cancer included lifetime number of sex partners, first intercourse before age 15 years, number of livebirths, serologic evidence of previous syphilis, herpes simplex type 2 infection, and chlamydial infection. Cigarette smoking, socioeconomic status, self-reported history of sexually transmitted diseases, and douching were not associated with either carcinoma in situ or invasive cervical cancer.
Assuntos
Comportamento Sexual , Infecções Sexualmente Transmissíveis/complicações , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/etiologia , Adulto , Distribuição por Idade , Análise de Variância , Carcinoma in Situ/epidemiologia , Carcinoma in Situ/etiologia , Estudos de Casos e Controles , Costa Rica/epidemiologia , Feminino , Humanos , Incidência , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Infecções Sexualmente Transmissíveis/epidemiologia , Fumar , Fatores SocioeconômicosRESUMO
Children with sickle cell disease and acute chest syndrome were investigated for infection with Chlamydia pneumoniae and Mycoplasma pneumoniae. Of 30 patients who had 32 episodes of acute chest syndrome, four (13%) had C. pneumoniae isolated from the nasopharynx; two of these also had serologic evidence of acute infection, and one had positive nasopharyngeal isolates on two subsequent occasions during the course of 1 year with stable, elevated titers of anti-C. pneumoniae IgG, suggesting chronic infection. Two patients with negative cultures had serologic evidence of infection with C. pneumoniae. None of 32 cultures for M. pneumoniae were positive, and although anti-M. pneumoniae IgM developed in two patients, one of these patients had evidence of C. pneumoniae infection (positive culture and seroconversion). We conclude that C. pneumoniae infection is prevalent in our sickle cell population with acute chest syndrome. Until further studies clarify the pathophysiologic significance of C. pneumoniae infection, we believe that early inclusion of erythromycin as antimicrobial therapy for acute chest syndrome seems reasonable.
Assuntos
Anemia Falciforme/microbiologia , Chlamydia/isolamento & purificação , Pneumopatias/microbiologia , Adolescente , Anemia Falciforme/complicações , Criança , Pré-Escolar , Infecções por Chlamydia/complicações , Infecções por Chlamydia/tratamento farmacológico , Eritromicina/uso terapêutico , Humanos , Lactente , Pneumopatias/complicações , Pneumopatias/tratamento farmacológico , Mycoplasma pneumoniae/isolamento & purificação , Talassemia/complicações , Talassemia/microbiologiaRESUMO
A population-based study of the sero-epidemiology of chlamydia was performed among a nationally representative sample of 760 Costa Rican women aged 25 to 59 years. Interviews and sera collection were completed between September 1984 and February 1985. The overall seroprevalence of chlamydial antibodies among these women was 56.1%. Women 25 to 39 years of age had a seroprevalence of 51.1%, while women 40 to 59 years of age had a seroprevalence of 64.2%. Women who reported no prior sexual activity had a seroprevalence rate of 48.6%, compared with a seroprevalence rate of 80.7% among women who reported three or more lifetime sexual partners. The geometric mean titre (GMT) of seropositive women ranged from 34.4 among the women who reported no prior sexual activity to 155.0 among the women with three or more lifetime sexual partners. Sero-positivity was more consistently associated with sexual activity than with age. Women with serological evidence of past Herpes simplex virus type 2 (HSV-2) or syphilis infection were more likely to be seropositive than were women without evidence of exposure to these sexually transmitted diseases, even when controlled for age and the number of lifetime sexual partners. The seropositivity among never sexually active women indicates the probable presence of Chlamydia pneumoniae infections, while the high seroprevalence of chlamydial antibodies among the sexually active women suggests that sexually transmitted Chlamydia trachomatis infections represent a public health problem not previously quantified in Costa Rica. Further seroepidemiological and/or culture studies are warranted to determine the incidence and prevalence of sexually transmitted chlamydial infection among men and younger women.
Assuntos
Infecções por Chlamydia/epidemiologia , Adulto , Fatores Etários , Anticorpos Antibacterianos/sangue , Chlamydia/imunologia , Infecções por Chlamydia/imunologia , Costa Rica/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Parceiros SexuaisRESUMO
Because several cofactors may influence the development of cervical intraepithelial neoplasia (CIN) in young women, we compared differences in behaviors (sexual activity, contraception, and cigarette use), sexually transmitted disease (STD) infection rates (Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus), and cervical maturation (age of menarche and percentage of cervical ectopy) in groups of sexually active female adolescents with and without CIN. Those with CIN were compared with three non-CIN groups: (1) teenagers who were referred to a teen colposcopy clinic but had no evidence of CIN (high-risk group), (2) teenagers seen at a gynecology clinic without STD symptoms (asymptomatic group), and (3) teenagers seen at the gynecology clinic with STD symptoms (symptomatic group). The percentage of cervical ectopy was measured by colpophotography. Subjects with CIN had more lifetime sexual partners than the asymptomatic group (p less than 0.001) and were more likely to smoke cigarettes than either gynecology clinic group (p less than 0.01). No differences in behaviors existed between the CIN and high-risk groups. The mean age of menarche in those with CIN was 1 year older than all three non-CIN groups (p less than 0.05), and those with CIN had a greater area of ectopy than those without CIN (p less than 0.02). Those with CIN were more likely to have a past or present history of C. trachomatis infection than the two gynecology clinic groups; no difference was found between the CIN and high-risk groups. We conclude that cofactors such as smoking, sexual promiscuity, and C. trachomatis infection may influence cervical vulnerability. However, cervical biologic immaturity is an important risk factor for development of CIN in adolescent girls.
PIP: From April-September 1986, researchers asked all 14-19 year old females attending the University of California at San Francisco's Teen Colposcopy Clinic to take part in an epidemiologic study of risk factors for cervical intraepithelial neoplasia (CIN). The 4 comparison groups consisted of a CIN group, a high risk group (external warts or abnormal Pap smear, no CIN, similar behavioral risk factors as CIN group), as asymptomatic group, and a symptomatic group (negative Pap smears and lower genital tract infection complaints). The CIN group was more likely to smoke or have smoked than the asymptomatic and symptomatic groups (p.01) and to use oral contraceptives than the asymptomatic group (p.02). In addition, patients with CIN had more lifetime sexual partners than did the asymptomatic group (p.001). The teens in the CIN group reached menarche on average 1 year later than did those in any of the comparison groups (p.05). This also had a greater area of ectopy than the other 3 groups (p.02). External genital warts occurred more often in the CIN group than in either the asymptomatic or symptomatic groups (p.001). Further, the CIN and high risk groups were more likely to have had any sexually transmitted disease than the asymptomatic (p.001) or symptomatic (p.01) groups. In addition, chlamydiosis occurred more often in the CIN group than in the asymptomatic (p.001) or symptomatic groups (p.03). The results indicate that cervical biologic immaturity may play an important role in development of CIN in adolescents. They also showed that CIN patients had more ectopy than the others thereby demonstrating that cervical biologic immaturity may rend the epithelium vulnerable to human papilloma virus invasion and neoplastic change.
Assuntos
Comportamento do Adolescente , Comportamento Sexual , Maturidade Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Neoplasias do Colo do Útero/etiologia , Adolescente , Anticoncepcionais Orais/administração & dosagem , Feminino , Humanos , Teste de Papanicolaou , Fatores de Risco , Fumar/efeitos adversos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/fisiopatologia , Esfregaço VaginalRESUMO
Urethral cultures were obtained from 90 adolescent youth, 16 of whom denied previous sexual activity. Among the sexually active boys was a group of 32 with clinically significant pyuria, consistent with the diagnosis of urethritis, on a first-part urinalysis (FPU) specimen. To relate differences in urethral microflora to sexual activity, 42 sexually active patients with a negative FPU were compared with the never sexually active group. The profile of anaerobic, but not aerobic, bacteria isolated from the urethra was related to the presence or absence of previous sexual activity. Mycoplasma species and Ureaplasma urealyticum were isolated from sexually active patients only, and may be markers of sexual activity in adolescent boys. Of the 32 patients with FPU evidence of urethritis, 22 (69%) had cultures positive for Chlamydia trachomatis, and an additional three (9%) had cultures positive for Neisseria gonorrhoeae. The findings in sexually active patients with a positive FPU were otherwise similar to those of sexually active patients without evidence of urethritis. C. trachomatis appears to be the most important agent of urethritis among adolescent boys with a positive FPU.
Assuntos
Uretra/microbiologia , Uretrite/microbiologia , Adolescente , Adulto , Chlamydia trachomatis/isolamento & purificação , Humanos , Masculino , Mycoplasma/isolamento & purificação , Neisseria gonorrhoeae/isolamento & purificação , Comportamento Sexual , Ureaplasma/isolamento & purificaçãoRESUMO
We evaluated the fluorescein-conjugated monoclonal antibody (FA) test for screening for Chlamydia trachomatis endocervical infection in a general adolescent clinic. Three hundred sixty-three consecutive adolescent girls, ages 13 to 20 years (mean 17.3 years) were examined. Forty-five (12%) FA smears had insufficient cells. Reason for visit included non-lower genital tract-related disorders in 241 (76%) girls, and lower genital tract-related disorders in 77 (24%). C. trachomatis was isolated by tissue culture in 46 (14%) patients, and Neisseria gonorrhoeae by culture in 22 (7%), and Trichomonas vaginalis was identified by wet mount in 13 (5%). Compared with our tissue culture technique, the performance of the FA test was as follows: sensitivity 61% (28 of 46), specificity 97% (264 of 272), positive predictive value 78% (28 of 36), and negative predictive value 94% (264 of 282). There was no significant difference in test performance by race, although the sensitivity rate (64%) of the test in blacks was twice that (30%) in nonblacks. This apparent difference in test performance by race may actually represent variations in group characteristics, including exposure rate, susceptibility, and number of inclusion forming units available for tissue culture of Chlamydia in blacks compared with nonblacks. In our adolescent clinic, the tissue culture is superior to FA in detecting Chlamydia. We recommend that the FA test be used where tissue culture isolation for Chlamydia is not readily available, where known or predicted chlamydial infection rates are high, and where known or predicted numbers of inclusion forming units of Chlamydia in tissue culture are high.
Assuntos
Anticorpos Monoclonais , Infecções por Chlamydia/imunologia , Chlamydia trachomatis/imunologia , Adolescente , Adulto , Anticorpos Monoclonais/imunologia , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/crescimento & desenvolvimento , Estudos de Avaliação como Assunto , Feminino , Imunofluorescência , Humanos , Grupos Raciais , Cervicite Uterina/diagnóstico , Cervicite Uterina/etiologiaRESUMO
The prevalence of selected microorganisms in the lower genital tract in postmenarchal adolescent girls was assessed, including vaginal Gardnerella vaginalis, group B streptococcus, lactobacillus, Mycoplasma species, Ureaplasma urealyticum, Staphylococcus aureus, and yeast, and endocervical Mycoplasma species, U. urealyticum, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Specific attention was focused on important sexually transmitted disease organisms, and differences in isolations by age, sexual activity, ethnicity, contraception, and the diagnosis of nonspecific vaginitis were measured. Sexually active subjects had a mean of 6.05 organisms (SD = 3.16), compared with 3.12 organisms (SD = 3.92) in non-sexually active subjects (P = 0.001). Sexually active subjects had significantly more vaginal G. vaginalis, lactobacilli, Mycoplasma species, and U. urealyticum, as well as endocervical Mycoplasma species and U. urealyticum, compared with non-sexually active subjects; C. trachomatis, N. gonorrhoea, and T. vaginalis were isolated exclusively from the sexually active group. Significant differences in isolation rates by ethnicity were found in vaginal Mycoplasma species and U. urealyticum, and endocervical Mycoplasma species, U. urealyticum, C. trachomatis, N. gonorrhoeae, and T. vaginalis. In general, organisms were isolated from blacks most frequently; N. gonorrhoea was isolated from blacks exclusively. Differences were found in microbiologic isolations by the presence or absence of nonspecific vaginitis. Vaginal G. vaginalis and Mycoplasma species and endocervical Mycoplasma species and U. urealyticum were found significantly more often in isolates from the group with nonspecific vaginitis. It is important to define the microbial flora of the lower genital tract in adolescent girls in order to understand its role in the pathogenesis of acute salpingitis.
Assuntos
Comportamento Contraceptivo , Menarca , Comportamento Sexual , Vagina/microbiologia , Vaginite/microbiologia , Adolescente , Adulto , Negro ou Afro-Americano , Asiático , Infecções por Chlamydia/diagnóstico , Feminino , Gardnerella vaginalis/isolamento & purificação , Gonorreia/diagnóstico , Infecções por Haemophilus/diagnóstico , Hispânico ou Latino , Humanos , Infecções por Mycoplasma/diagnóstico , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Estafilocócicas/diagnóstico , Infecções Estreptocócicas/diagnóstico , Vaginite por Trichomonas/diagnóstico , Vaginite/diagnóstico , População BrancaRESUMO
To examine the role of Chlamydia trachomatis infections of the cervix and abnormal postcoital tests (PCT) in a general infertility clinic, 63 consecutive patients undergoing a midcycle PCT during a routine infertility workup underwent endocervical curettage, and a 10-ml blood sample was obtained. The endocervical tissue was cultured for C. trachomatis; the serum sample was analyzed for chlamydial IgG and IgM antibodies using an indirect microimmunofluorescence assay. A negative titer was considered to be less than or equal to 1:8 dilution for IgG antibodies and less than or equal to 1:32 dilution for IgM antibodies. A good PCT was defined as greater than or equal to 5 motile sperm per high power field (HPF). A poor PCT was defined as less than 2 motile sperm/HPF, and a fair PCT was defined as 2 to 4 motile sperm/HPF. Of the 63 PCTs done, 27 (42.9%) were good, 14 (22.2%) were fair, and 22 (34.9%) were poor. All endocervical tissue cultures for C. trachomatis obtained during PCTs were negative. All IgM chlamydial antibody titers were negative (less than or equal to 1:32 dilution), 55 (87.3%) of the patients having a zero titer. Eleven (17.5%) of the patients had negative IgG chlamydial antibody titers (less than or equal to 1:8 dilution), none of the patients had a 1:16 dilution, and 52 (82.5%) had positive IgG chlamydial antibody titers (greater than or equal to 1:32 dilution). Thus, chlamydial infections of the endocervix are rare and not commonly associated with poor PCTs in this patient population.
Assuntos
Infecções por Chlamydia/complicações , Coito , Infertilidade/etiologia , Ovulação , Adulto , Anticorpos Antibacterianos/análise , Muco do Colo Uterino , Chlamydia trachomatis/imunologia , Feminino , Hispânico ou Latino , Humanos , Imunoglobulina G/análise , Imunoglobulina M/análise , Masculino , México/etnologia , Contagem de Espermatozoides , Reversão da Esterilização , Esterilização TubáriaRESUMO
Chlamydia trachomatis is a common cause of sexually transmitted disease in adolescent girls. Of 366 adolescent patients screened, 15.3% were found to have chlamydial endocervical infections, with an infection rate of 23.3% in blacks, 14.3% in Hispanics, and 10.3% in whites (P = 0.01, excess for blacks). Of Chlamydia-positive patients, 63.6% had a diagnosis of lower genital tract infection, compared with 35.4% of Chlamydia-negative patients (P = 0.004). Oral contraceptive users had a higher prevalence of infection (23.8%) compared with those using a barrier method (16.2%) or with nonusers (9.3%) (P = 0.004). Inflammatory changes on Papanicolaou smears were associated with chlamydial infection (P = 0.0001). Other variables identified as risk factors for chlamydial infection included both a younger age at first intercourse (P = 0.02) and more years of sexual activity (P = 0.02). Chronologic, menarchal, and gynecologic age, biologic age of the cervix, the number of sexual partners in the last month and during a lifetime, and parity were not found to be associated with recovery of Chlamydia.
PIP: Chlamydia trachomatis is a common cause of sexually transmitted disease in adolescent girls. Of 366 adolescent patients screened, 15.3% were found to have chlamydial endocervical infections, with an infection rate of 23.3% in blacks, 14.3% in Hispanics, and 10.3% in whites (P=0.01, excess for blacks). Of Chlamydia-positive patients, 63.6% had a diagnosis of lower genital tract infection, compared with 35.4% of Chlamydia-negative patients (P=0.004). Oral contraceptive users had a higher prevalence of infection (23.8%) compared with those using a barrier method (16.2%) or with nonusers (9.3%) (P=0.004). Inflammatory changes on Papanicolaou smears were associated with chlamydial infection (P=0.0001). Other variables identified as risk factors for chlamydial infection included both a younger age at 1st intercourse (P=0.02) and more years of sexual activity (P=0.02). Chronologic, menarchal, and gynecologic age, biologic age of the cervix, number of sexual prtners in the last month, and during a lifetime, and parity were not found to be associated with recovery of Chlamydia.