RESUMO
BACKGROUND: Chlamydia trachomatis (Ct) is not a disease subject to mandatory reporting in Brazil, and the prevalence rate of this genital infection varies according to the region in which studies are conducted, as well as by the detection technique employed. Ct has been associated with persistence of Human papillomavirus (HPV) infection and the facilitation of cervical carcinoma development. We evaluated the Chlamydia trachomatis infection and its association with cytology, p16/Ki-67 dual-stained cytology and cervical intraepithelial lesions status in a screening cohort in Brazil. METHODS: This was a cross-sectional study of 1481 cervical samples from asymptomatic women aged 18 to 64. Samples were collected for liquid-based cytology and Ct detection by polymerase chain reaction. p16/Ki-67 double staining was performed on samples with abnormal cytology. Statistical analysis was by chi-square and likelihood-ratio tests. Odds ratio (OR) and 95% confidence intervals (95% CI) were determined. RESULTS: The frequency of Ct was 15.6% and its presence was not associated with detection of p16/Ki-67 [OR = 1.35 (0.5-3.4)]. There was also no association between abnormal cervical cytology and Ct-positivity [OR = 1.21 (0.46-3.2)]. Associations were observed between p16/Ki-67 and high-grade lesions detected by cytology and in biopsies [OR = 3.55 (1.50-8.42) and OR = 19.00 (0.6-7.2), respectively]. CONCLUSIONS: The asymptomatic women in our study had a high frequency of Ct infection but this was not associated with p16/Ki-67 detection in samples with abnormal cytology. The expression of p16/Ki-67 was highest in women with high-grade CIN (p = 0.003).
RESUMO
A relação entre o câncer cervical e a infecção pelo Papilomavírus Humano (HPV) está bem estabelecida. Múltiplos parceiros e múltiplas práticas sexuais são os fatores de risco associados à infecção pelo HPV. Existe uma grande probabilidade em que as mulheres internas em presídios tenham uma maior suscetibilidade de adquirir a infecção genital. A avaliação de alterações celulares, pelo exame de Papanicolaou, e identificação molecular de DNA-HPV de alto risco são utilizadas para a detecção e prevenção do câncer cervical. Quatrocentas e nove amostras cervicais de mulheres internas, nopresídio feminino da cidade de São Paulo, com idade entre 18 e 60 anos, foram analisadas, em 2006. Os achados celulares foram classificados com base no Sistema Bethesda (2001). O DNA-HPV foi identificado pelo PCR convencional, empregando os primersuniversais MY09/11, e os tipos identificados por PCR/RFLP, utilizando enzimas de restrição. Vinte e sete (6,60%) dos 409 esfregaços das internas do sistema penal revelaramLesões Escamosas Intraepiteliais de Baixo Grau (LSIL), 3 (11,11%) mostram alterações compatíveis com Lesões Escamosas Intraepiteliais de Alto Grau (HSIL), 5 (18,53%) exibiram Atipias Escamosas de Significado Indeterminado (ASC-US), 1 (3,70%) mostrou Células Glandulares Atípicas (CGA) e 1 (3,70%) revelou Carcinoma de Células Escamosas. DNA-HPV de alto risco foi identificado em 12 (44,43%) amostras (HPV 16, 18, 31, 33, 34, 39 e 61). Oito (29,62%) amostras revelaram infecção por HPV de baixo risco (HPV 6b). O presente estudo detectou uma alta prevalência de LSIL e HSIL associada à presença de DNA-HPV de alto risco, nas mulheres internas no sistema prisional.
The association between cervical cancer and Human PapillomavirusInfection (HPV) has been determinated. Multiple partners andmultiple sexual practices are risk factors associated with HPVinfection. There is a high probability that women resident in prisionscould be more susceptible to acquire genital HPV infection. Thescreening of cellular changes by pap-smear and the molecularidentification of high risk DNA-HPV is usefull for the detection andprevention of cervical cancer. Four hundred nine samples of cervicalsmear from women resident in a prisional system in São Paulo,between 18 to 60 years old were analyzed in 2006. The cellularresults were reported according to the Bethesda System Terminology,2001. The DNA-HPV detection was made by Conventional PCR usingConsensus Primers MY 09/11 and the HPV types were identify byPCR-RFLP using restriction endonuclease enzymes.Twenty seven(6,60%) out of 409 pap-smears samples showed pre malignant lesion.Seventeen (62,96%) out of these 27 samples revealed Low Squamous Intraepitheal Lesion (LSIL), 3 (11,11%) showed changessuggestive of High Squamous Intraepithelial Lesion (HSIL), 5(18,53%) samples presented Atypical Squamous Cells ofUndetermined Significance (ASC-US), 1 (3,70%) sample had AtypicalGlandular Cells (AGC), and 1 (3,70%) sample showed CervicalSquamous Carcinoma. High Risk DNA-HPV was identified in 12(44,43%) (HPV 16, 18, 31, 33, 34, 39 and 61). Eight (29,62%) samplesrevealed the low risk for neoplasic lesion subtype HPV-6b. Thepresent study reveal a high prevalence of LSIL and HSIL associatedwith the presence of High-risk DNA-HPV in women resident in aprisional system.
Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Teste de Papanicolaou , Papillomaviridae , Infecções por Papillomavirus , Reação em Cadeia da Polimerase , Prisões , Lesões Intraepiteliais Escamosas CervicaisRESUMO
Nas últimas duas décadas, a incidência de casos de infecção pelo Papilomavírus humano (HPV) vem aumentando progressivamente, o que lhe confere um caráter epidêmico e o posiciona como a doença sexualmente transmissível mais comum. O aumento do câncer genital está diretamente associado ao HPV de alto risco. O presente trabalho objetivou identificar a presença de tipos dePapilomavírus (HPV) através da reação em cadeia pela polimerase (PCR), em esfregaços cérvico-vaginais classificados como inflamatórios(Bethesda,2001). Concluindo, no presente trabalho foi verificada a existência de DNA viral de alto risco em amostras citológica com padrão inflamatório sem evidências de sinais citopatológicos da ação viral...