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      Infecciones cervicovaginales en exudados vaginales Translated title: Cervicovaginal infections in vaginal exudates

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          Abstract

          Introducción: Se desconocen las características de las infecciones cervicovaginales, diagnosticadas mediante el exudado vaginal, sobre todo en mujeres cubanas de mediana edad. En otras etapas del ciclo vital femenino, sí se han realizado estos estudios. Esta información es importante, fundamentalmente para realizar acciones de promoción de salud. Objetivo: Determinar las características de las infecciones cervicovaginales más frecuentes diagnosticadas mediante el exudado vaginal. Método: Se realizó un estudio transversal en 1118 mujeres. Se recogió la edad (agrupada en 20 - 44 años y 45 y más años), los resultados del exudado vaginal, la percepción de secreción vaginal o la ausencia de esta (asintomáticas) y los microorganismos identificados en el exudado. Resultados: El 49,9 % de exudados vaginales fueron positivos a vaginosis bacteriana, Cándidas albicans, Trichomonas vaginalis y desequilibro en la ecología vaginal. El 45 % de las pacientes no tenían secreción vaginal, es decir, estaban asintomáticas. Conclusión: Las infecciones cervicovaginales se caracterizaron por ser de elevada frecuencia, usualmente asintomáticas, con predominio de vaginosis bacteriana, candidiasis y trichomoniasis.

          Translated abstract

          ABSTRACT Introduction: The characteristics of cervicovaginal infections diagnosed by vaginal exudate are unknown, especially in middle-aged Cuban women. At other stages of the female life cycle, these studies have been done. Due to the importance of this information, to carry out health promotion actions, this research was carried out. Objective: To determine the characteristics of the most frequent cervicovaginal infections diagnosed by vaginal exudate. Method: A cross-sectional study was conducted in 1118 women. Age (grouped into 20-44 years and 45 and over), the results of positive vaginal discharge, the perception of presence or not of vaginal discharge (asymptomatic) and the microorganisms identified in the discharge were collected. Results: 49.9% of vaginal exudates were positive for bacterial vaginosis, Candidas albicans, Trichomonas vaginalis and imbalance in vaginal ecology. 45% of the patients had no vaginal discharge, that is, they were asymptomatic. Conclusion: Cervicovaginal infections were characterized by being of high frequency, usually asymptomatic, with prevalence of bacterial vaginosis, candidiasis and trichomoniasis.

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          Diagnosis of bacterial vaginosis by direct gram stain of vaginal fluid.

          To determine whether bacterial vaginosis (BV), also known as nonspecific vaginitis, could be diagnosed by evaluating a Gram stain of vaginal fluid, we examined samples from 60 women of whom 25 had clinical evidence of BV and 35 had candidal vaginitis or normal examinations. An inverse relationship between the quantity of the Lactobacillus morphotype (large gram-positive rods) and of the Gardnerella morphotype (small gram-variable rods) was noted on Gram stain (P less than 0.001). When Gram stain showed a predominance (3 to 4+) of the Lactobacillus morphotype with or without the Gardnerella morphotype, it was interpreted as normal. When Gram stain showed mixed flora consisting of gram-positive, gram-negative, or gram-variable bacteria and the Lactobacillus morphotype was decreased or absent (0 to 2+), the Gram stain was interpreted as consistent with BV. Gram stain was consistent with BV in 25 of 25 women given a clinical diagnosis of BV and in none of 35 women with candidal vaginitis or normal examinations. Duplicate slides prepared from 20 additional specimens of vaginal fluid were stained by two methods and examined by three evaluators. Interevaluator interpretations and intraevaluator interpretations of duplicate slides were in agreement with one another and with the clinical diagnosis greater than or equal to 90% of the time. We concluded that a microscopically detectable change in vaginal microflora from the Lactobacillus morphotype, with or without the Gardnerella morphotype (normal), to a mixed flora with few or no Lactobacillus morphotypes (BV) can be used in the diagnosis of BV.
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            Throwing the dice for the diagnosis of vaginal complaints?

            Backround Vaginitis is among the most common conditions women are seeking medical care for. Although these infections can easily be treated, the relapse rate is high. This may be due to inadequate use of the diagnostic potential. Methods We evaluated the misjudgement rate of the aetiology of vaginal complaints. A total of 220 vaginal samples from women with a vaginal complaint were obtained and analysed for numbers of total lactobacilli, H2O2-producing lactobacilli, total aerobic cell counts and total anaerobic cell counts including bifidobacteria, Bacteroides spp., Prevotella spp. Additionally, the presence of Atopobium vaginae, Gardnerella vaginalis, Candida spp. and Trichomonas vaginalis was evaluated by DNA-hybridisation using the PCR and Affirm VPIII Microbial Identification Test, respectively. Results The participating physicians diagnosed Bacterial vaginosis (BV) as origin of discomfort in 80 cases, candidiasis in 109 cases and mixed infections in 8 cases. However, a present BV, defined as lack of H2O2-lactobacilli, presence of marker organisms, such as G. vaginalis, Bacteroides spp. or Atopobium vaginae, and an elevated pH were identified in only 45 cases of the women examined. Candida spp. were detected in 46 cases. Interestingly, an elevated pH corresponded solely to the presence of Atopobium vaginae, which was detected in 11 cases. Conclusion Errors in the diagnosis of BV and candida vulvovaginitis (CV) were high. Interestingly, the cases of misjudgement of CV (77%) were more numerous than that of BV (61%). The use of Amsel criteria or microscopy did not reduce the number of misinterpretations. The study reveals that the misdiagnosis of vaginal complaints is rather high.
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              Neoplasia cervical en la mujer climatérica

              Se plantea que en la actualidad la neoplasia cerviconterina es una de las enfermedades más frecuentes en la mujer y se indica lo importante que es establecer un diagnóstico temprano y oportuno para disminuir la morbimortalidad por dicha entidad. Se estudia su incidencia en mujeres en edad climatérica debido entre otros factores a los cambios biológicos e inmunológicos que ellas experimentan. Otros factores asociados fueron la edad, hábito de fumar, déficit nutricional, promiscuidad, etc. Se indican los diferentes tratamientos aplicados y recomendaciones desde nuestra experiencia.
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                Author and article information

                Journal
                mil
                Revista Cubana de Medicina Militar
                Rev Cub Med Mil
                ECIMED (Ciudad de la Habana, , Cuba )
                0138-6557
                1561-3046
                September 2020
                : 49
                : 3
                : e578
                Affiliations
                [1] La Habana orgnameUniversidad de Ciencias Médicas de las Fuerzas Armadas Revolucionarias orgdiv1Hospital Militar Central "Dr. Carlos J. Finlay" Cuba
                [2] La Habana orgnameEscuela Latinoamericana de Medicina orgdiv1Departamento de Investigaciones Diagnósticas Cuba
                Article
                S0138-65572020000300008 S0138-6557(20)04900300008
                b8cbf016-2e6c-4aae-9291-7bfbb83910e2

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 29 April 2020
                : 24 November 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 0
                Product

                SciELO Cuba

                Categories
                ARTÍCULOS DE INVESTIGACIÓN

                candidiasis vulvovaginal,trichomoniasis,vaginosis bacteriana,sexually transmitted diseases,exudado vaginal,candidiasis, vulvovaginal,trichomonas infection,vaginosis, bacterial,infecciones de transmisión sexual

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