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The authors report on a recently published review article on the approach to vulvovaginitis through flowcharts, taking into account the peculiarities of each service, according to the diagnostic methods that are available.

The incidence of human immunodeficiency virus (HIV)-infected women is vertiginously raising. The virus mainly affects women at the reproductive phase, and the presence of genital co-infections is very common.[...]

Introduction: Human Immunodeficiency Virus infection is a prevalent infection occurring during pregnancy. The implementation of a program to screen and prevent vertical transmission is highly important in Public Healthcare. Pregnant crack users could face difficulties to test and adhere to the Highly Active Antiretroviral Therapy. Objective: The purpose of this research paper was to investigate whether crack cocaine abuse increases Human Immunodeficiency Virus perinatal transmission rates, as well as to evaluate the risk factors associated with such an increase. Methods: Design: A retrospective study. Setting: Department of Obstetrics and Gynecology, General Hospital of Universidade Federal do Paraná. Population: pregnancies of Human Immunodeficiency Virus-positive women who were using crack cocaine (n=64) were compared with that of non-users (n=826) from 2005 to 2013. Prenatal medical records, delivery records, and newborn records were analyzed. Main Outcome Measures: The vertical transmission of Human Immunodeficiency Virus in the group of crack cocaine users was 9.37% (6) versus 2.54% (21) among non-users (p=0.009744). Results: Over the years of the study, there was a decrease in the vertical transmission rate in non-users, while this number remained constant in the group of users. When analyzing the cases of perinatal transmission, it was found that 83.34% (5) had inadequate prenatal care, and 100% (6) had inadequate Human Immunodeficiency Virus treatment, compared to the group in which there was no vertical transmission, where 65.52% (38) had inadequate prenatal care and 70.86% (41) had inadequate treatment. Conclusion: Vertical transmission is higher among crack cocaine users and did not decrease over the years of the study, as occurred among non-users. Trends that explain this increase were non-adherence to adequate prenatal care, Human Immunodeficiency Virus diagnosis during pregnancy, irregular treatment, absence of intrapartum antiretroviral prophylaxis, and vaginal delivery route.

Resumo O artigo aborda a infecção pelo papilomavírus humano (human papillomavirus, HPV), tema constitutivo do Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde. Tal documento foi elaborado com base em evidências científicas e validado em discussões e consenso entre especialistas. São apresentados aspectos epidemiológicos e clínicos, bem como orientações para os gestores e profissionais de saúde no diagnóstico, tratamento e prevenção da infecção pelo HPV. Este tema representa importante problema de saúde pública, haja vista essa infecção sexualmente transmissível ser a mais prevalente no mundo, capaz de desencadear o processo oncogênico do câncer do colo uterino, além de possibilitar a ocorrência de verrugas anogenitais. Neste artigo, são apresentadas informações importantes para o conhecimento do HPV, estratégias de ação para a prevenção e controle da infecção, uma assistência de qualidade e tratamento efetivo da doença.

Resumo O tema corrimento vaginal é um dos capítulos que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Neste artigo, são apresentados aspectos epidemiológicos e clínicos relacionados às situações de corrimento vaginal, bem como orientações aos gestores e profissionais de saúde na triagem, diagnóstico e tratamento desses agravos, que constituem uma das principais queixas entre mulheres que procuram serviços de saúde e que podem ser causados por fatores infecciosos ou não infecciosos. Além disso, são apresentadas informações sobre estratégias para as ações de vigilância, prevenção e controle, a fim de promover o conhecimento do problema e a oferta de assistência de qualidade e tratamento efetivo.

The incidence of 16,370 new cases of cervical cancer was recorded in Brazil during the year of 2018 with 5,000 deaths1. Regarding the low coverage of HPV vaccination in Brazil, we decided to write this letter to show that maybe there are some benefits of this vaccine beyond the oncogenesis process. This news could be increasing the motivation for vaccination. [...]

Mycoplasmas belong to the Mollicutes classification. The first species was discovered in 1898 by Nocaard & Roux in a case of pneumonia. In this classification four species have a higher impact on a bovine pneumonia case. The Ureaplasma genus focusing on the Urealiticum and Parvum species may be related with problems during pregnancy or even with perinatal impact(1), whereas the Mycoplasmas genus represented by the hominis and the genitalium species are more related to disturbances in the genitals, but can also have an impact on pregnancy(1). Among these, Mycoplasma genitalium (MG) stands out regarding its pathogenicity, especially the growing resistance to antibiotics as shown in recent studies(2,3). [...]

Introduction: Adolescence is marked by emotional, social and physical changes. In this stage of development, vulnerable individuals tend to engage in risk behaviors related to the use of alcohol and drugs as well as unprotected sex. Objective: To evaluate the attitude of university students with regard to sexually transmitted infections (STIs) and the influence of the university environment in this behavior. Methods: Standardized questionnaires were applied anonymously in classrooms by a trained team. The first group of respondents was made up of freshmen (first year college students) while the second group was composed of seniors (fourth year students) from 11 of the areas of the Universidade Federal do Paraná (UFPR). From a total of 1,459 respondents, 1,350 were included. The questionnaire applied was based on the Pesquisa de Conhecimentos, Atitudes e Práticas na População Brasileira de 15 a 64 anos (PCAP - Survey of Knowledge, Attitudes and Practices among the Brazilian Population aged from 15 to 64 years) of 2008, conducted by the STI, AIDS and Viral Hepatites Sector of the Health Surveillance Department of the Ministry of Health (MOH). The questionnaire was modified and adapted to the survey on vulnerability to AIDS/HIV infection, STIs, and unplanned pregnancy among UFPR students. Results: Of the 1,350 students covered, 1,070 (79.2%) had already had sexual intercourse at least once in their lives (74.9% of freshmen and 86.8% of seniors). 76.3% of female respondents and 82.7% of males had already started their sexual life. Out of the the 507 freshmen who had vaginal sex, 42.0% did not wear a condom, compared to 56.7% of 363 seniors (p

Introdução: a bactéria Chlamydia trachomatis (CT) é um dos principais agentes responsáveis por desfechos desfavoráveis em parturientes acometidas por doenças sexualmente transmissíveis no Brasil. Está envolvida com parto prematuro, rotura prematura de membranas, gestação ectópica e aborto recorrente, bem como com conjuntivite e pneumonia no recém-nascido. A prevalência da infecção é variável conforme o método utilizado e a população em estudo. Objetivo: estimar a prevalência da infecção por CT em parturientes jovens, entre 18 e 24 anos, admitidas no pronto-atendimento da Maternidade Victor Ferreira do Amaral; caracterizar comportamentos de risco através da avaliação dos dados epidemiológicos; identificar os determinantes de infecção por CT na população estudada. Métodos: na etapa do trabalho realizada em Curitiba – PR, os objetivos englobaram a estimativa da prevalência da infecção por CT em parturientes jovens entre 18 e 24 anos admitidas no pronto-atendimento da Maternidade Victor Ferreira no Amaral do Departamento de Tocoginecologia da Universidade Federal do Paraná, que atende população de gestantes de baixo risco, bem como a caracterização do comportamento de risco para a infecção na população estudada. Esse estudo faz parte de uma pesquisa multicêntrica, de âmbito nacional, transversal, cuja coleta de dados foi realizada no período compreendido entre julho de 2009 e janeiro de 2010. Amostras de urina foram coletadas durante a internação e analisadas pelo método de PCR, para identificação da bactéria. Além disso, foi aplicado um questionário abrangendo dados sociodemográficos, gineco-obstétricos e de comportamento de risco para doenças sexualmente transmissíveis. Resultados: nos resultados obtidos, das 65 amostras de urina coletadas nesta maternidade, quatro mostraram-se positivas para CT, revelando uma prevalência de 6,15%. Fatores de risco para DST, como a presença de início da atividade sexual precoce, bem como a baixa idade, tiveram relação positiva com a infecção. Conclusão: a prevalência da infecção foi inferior à obtida em outras populações de gestantes por métodos que usaram a coleta endocervical; os fatores de risco foram a ausência de parceiro sexual fixo, baixa idade e concomitância com outras DST; a pesquisa de CT em gestante é justificável e necessária.

Introdução: as doenças sexualmente transmissíveis (DST) são uma questão que preocupa os órgãos gestores da saúde. Apesar de as pesquisas mostrarem um aumento na conscientização da população para a prevenção com o uso de preservativos, a cada ano aumenta o número de pacientes infectados por doenças de transmissão sexual. Felizmente, para algumas destas doenças, já foi possível desenvolver vacinas, como o caso da hepatite B e do HPV. Entretanto, para outras doenças como a aids, as pesquisas mostram-se distantes de apresentar resultado conclusivo. Conclusão: a utilização de vacinas tem- se apresentado como uma tendência nesta área, e vem sendo apontada como uma das soluções mais viáveis para a prevenção e mesmo para o tratamento destas entidades no futuro.

Este artigo consiste em uma revisão do tema associação entre o papilomavírus humano (HPV) e o câncer peniano. Por meio de uma pesquisa funda-mentada em periódicos eletrônicos e livros de clínicas médica e cirúrgica, confirmou-se essa associação, principalmente em se tratando dos subtiposbasalóide e verrucoso de câncer peniano. Chan et al.1encontraram 15,0% de associação entre o HPV e o câncer peniano, enquanto no estudo feito porTornesello et al.2essa percentagem foi de 46,3%. Os principais tipos de HPV envolvidos no aparecimento da doença foram o 16 e o 18. Apesar des-sas conclusões, a carência de dados e o caráter recente do tema requerem novos estudos para esclarecimentos. A relação da presença do HPV com asobrevida do paciente ainda é tema que permanece em investigação.

Embora estejam freqüentemente incluídas em textos sobreDST, a candidíase e a vaginose bacteriana não são transmitidaspor esta via. Também não existe qualquer comprovação de que otratamento do parceiro traga algum benefício para a paciente nes-tas situações. Ao que parece, também não existiria benefíciodeste tratamento nem mesmo nas recidivas. Estas afirmaçõesestão fundamentadas e possuem embasamento científico.1,2,3Então, tratar o parceiro assintomático de mulher com candidíaseou vaginose recorrente não apresenta indicações consistentes.Entretanto, na presença da balanopostite por candida, o trata-mento é indicado, aliás, mesmo que sua parceira não apresente acandidíase, este deverá receber atenção adequada. [...]

Introdução: A infecção pelo vírus da imunodeficiência humana (HIV) é uma preocupação mundial nos dias atuais, atingindo as pessoas princi-palmente em idade reprodutiva e tendo como uma de suas consequências a transmissão vertical. Objetivos: o objetivo do presente trabalho foi avaliara prevalência da infecção pelo HIV entre as gestantes atendidas no pré-natal da maternidade do Hospital de Clínicas da Universidade Federal doParaná no período de junho de 1997 a março de 1998. Métodos: participaram deste estudo 436 gestantes que foram submetidas aos testes anti-HIV.Resultados:foram encontradas nove pacientes com o teste positivo para o HIV, correspondendo a 2% do total. Destas, sete gestantes tinham sidoencaminhadas ao pré-natal por terem seu estado sorológico conhecido previamente. Quando expurgamos estes encaminhamentos, obtivemos um per-centual de 0,4%. Todas as gestantes foram submetidas a um questionário-padrão, no qual se procurou observar o perfil epidemiológico e seus quepudesse estar relacionado com a positividade para o HIV. As variáveis estudadas incluíam a idade da gestante, o número de gestações, a paridade, suaocupação, local de procedência e o número de parceiros sexuais. Também foi argüido sobre antecedentes de DST anterior, transfusão sanguínea ou ouso de drogas injetáveis. Para análise estatística, os dados foram alocados em tabelas de duas entradas: uma, relativa ao estado sorológico, e outra, àsvariáveis sociodemográficas acima descritas. A análise destas possíveis dependências foram testadas pelo teste de qui-quadrado, tendo como nível designificância um p < ou = a 0,05. Conclusão: os resultados foram significativos, quando associamos a soropositividade para o HIV nestas gestantes eos antecedentes de DST e drogadição.

Resumo As infecções que causam cervicite são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo apresenta aspectos epidemiológicos e clínicos das infecções que causam cervicite, bem como recomendações sobre a triagem, diagnóstico e tratamento das pessoas acometidas e suas parcerias sexuais. Além disso, discutem-se estratégias para as ações de vigilância, prevenção e controle desses agravos para os profissionais de saúde e gestores envolvidos no manejo programático e operacional das infecções sexualmente transmissíveis. A ampliação do acesso aos testes para diagnóstico e o tratamento precoce são cruciais para o controle da disseminação dos patógenos causadores de cervicite.

Introduction: Vulvovaginal candidiasis (VVC), caused by Candida sp, may present with increased frequency and symptoms in immunocompromised patients, and there is concern about the diagnosis and adequate treatment of these patients. Objective: The aim of this study was to evaluate the prevalence of VVC compared to the immune status and species present in the microbiota of patients with HIV. Methods: This cross-sectional study was conducted from January 2017 to January 2018, including 97 women with HIV compared to a control group (n=112). For data collection, interviews were conducted, vaginal pH was measured, CD4+ T cells and viral load (VL) were evaluated, and vaginal secretions were collected for microscopy and culture. Results: The prevalence of VVC was 41.2% in seropositive patients and 3.6% in the control group (p

Objective: Characterize the risk factors associated with the development of cervical intraepithelial neoplasia (CIN) and determine the prevalence of High-risk Human Papillomavirus (HR-HPV) infection in women without cytological abnormalities and women diagnose with CIN 2 and 3, living in metropolitan region Curitiba, Paraná state, Brazil. Materials and Methods: Case-control study consisting of 382 women without cytological abnormalities, 233 women with high-grade intraepithelial lesions, which were subdivided in 131 women with CIN 2 and 102 women with CIN 3 diagnose by histological analysis of the cervical segment conical excision material. The age range of the women in the study was 15-45 years old, collected in the period of 2009 to 2012. The detection of HR-HPV DNA was performed by Hybrid Capture 2 test (CH2). An epidemiological questionnaire assessed the risk factors associated with the presence of HR-HPV and CIN 2/3 in each group. Statistical analysis was performed using the Chi-Square test and Results: The HR-HPV was detected in 12.5% of controls, 87% in CIN 2 women and 93.1% in the CIN 3 women. Risk factors associated with the development of CIN were HR-HPV infection (OR = 62.054; 95% CI: 34.57-111.37), smoking (OR = 1.837, 95% CI: 1.061-3.178), use of hormonal contraceptives (OR = 1.845, 25 years old are the most susceptible to infection (p

Introduction: Urinary tract infections (UTI) are common in women and can cause systemic repercussions. In pregnant women, for example, the occurrence of UTI or asymptomatic bacteriuria (AB) can lead to premature birth and fetal death. The generalized immune depletion caused by HIV is related to the exacerbation of infections, and may be related to UTI. Objective: The objective of this review was to evaluate the characteristics of UTI in pregnant and non-pregnant HIV-positive women as well as the factors that interfere in its occurrence. Methods: By searching the databases PubMed, Web of Science, Scielo and Lilacs, we selected eleven articles that correlated UTI and HIV infection in women. Results: Our analysis showed that HIV-positive pregnant women have a higher predisposition to UTI than HIV-negative ones. The Viral Load (VL) is directly related to UTI and AB in HIV-positive nonpregnant women. TCD4 lymphocyte levels (TCD4) lower than 200 cells/mL and VL over 10,000 copies/mL are correlated with higher UTI and AB rates in HIV-positive pregnant women. There is a tendency for greater variability of pathogens in HIV-positive women and a predisposition to higher rates of antibiotic resistance in HIV-positive pregnant women. Conclusion: HIV-positive pregnant women have higher predisposition to urinary tract infection and its incidence is correlated with a high viral load and a low TCD4 count.

ABSTRACT BACKGROUND: Brazilian opportunistic screening programs for cervical cancer have limited impact. In the regions of two cities (Campinas and Curitiba) with high human development indices, consistent information from 96-97% of all cervical cancer cases managed within the public healthcare system is available. OBJECTIVE: To estimate the incidence rate (IR) and temporal trends in these regions, covering 2001-2012. DESIGN AND SETTING: A population-based cohort study was conducted under the assumption that all cervical cancer cases were managed in cancer referral center hospitals. METHODS: 3,364 records (1,646 from Campinas; 1,718 from Curitiba) were analyzed to provide estimates of IR, age-standardized IR (ASR) and cervical cancer trends (shown per 100,000 women/year). Longitudinal patterns were analyzed using linear regression and shown as annual percentage change (APC); P < 0.05 for significance. RESULTS: Annual IR and ASR estimates for cervical cancer ranged from 3.8 to 8.0 over 2001-2012, decreasing over more recent years, and were similar for the two regions. The age-specific IR was about 50% lower among women aged 45 years or older (IR-2001/IR-2012: Campinas = 14.8/8.0; Curitiba = 18.7/8.3; P < 0.001). There was an increasing APC trend in Campinas among women aged 15-24 years, and a decreasing IR trend for squamous-cell histology in both regions (P < 0.05). CONCLUSION: Cervical cancer incidence estimates showed slowly decreasing trends in both regions, most evidently for women aged 45 years or older and for squamous-cell histology. These findings reflect the opportunistic nature of the population screening program, despite the comparatively high economic development level in the two regions.

Cervical cancer (CC) is related to HPV infection and represents the third cause of cancer in women. Annually, more than 500,000 new cases are reported worldwide, with significant death rates. It develops due to genetic and epigenetic alterations that control cell growth and differentiation, and may cause death. These alterations induce uncontrolled cell division and invasion of cervical tissue have severe consequences to women’s health(1). CC incidence and mortality drop considerably since the implementation of screening tests and vaccination strategies. Nevertheless, CC continues to have a high incidence, mainly in low-income countries, where these programs do not cover territorial frontiers and there is lack of resources to implement vaccination or screening tests. Oncogenic HPV types reached 25% of cases in Brazil over the last years(2), and there was no modification on HPV types after four years of the vaccination program, according to Tota et al.(3). Usually, screening tests in Brazil cover women from 25 to 64 years old. According to Teixeira et al.(4), rates of CC under the age of 25 tend to increase, and women over 64 achieved roughly 20% of CC on research of Brazilian women from two high-income cities. [...]

Introduction: Vaginal discharge is a frequent gynecological complaint, and may represent a disease or not. A vaginal discharge is considered recurrent when it occurs four or more episodes per year. Among the aetiologies, physiological and infectious conditions are mentioned, being the infectious ones, particularly those caused by Candida spp. fungus, the most related to the symptom. Despite the diagnostic and therapeutic resources available, empirical clinical treatments and self-treatments are very frequent and related to ineffective therapeutic results, leading this population to question what the differences regarding women with no symptoms are. Objective: To identify sociodemographic, behavioral and microbiological differences between women with recurrent vaginal discharge and asymptomatic women. Methods: Cross-sectional study involving 126 women with recurrent discharge complaints (study group) and 155 (control group), totaling 281 evaluated women. The group included women in the menacme, sexually active, and those who fit in the criteria of recurrent vaginal discharge, without definite previous diagnosis, compared with asymptomatic women, who attended an annual routine examination. Pregnant, diabetic and immunosuppressed women were excluded. The study was based on the principle of the null hypothesis, when there are no differences between the two studied groups. Results: The average age was 29.95 years, predominantly single and without children. There was no significant difference in the analysis of relationship time with the current partner, numbers of partners throughout life, gender and contraceptive method. There was predominance of normal vaginal flora (type 1) in both groups, with average prevalence of 44.9%. The alkaline vaginal pH was predominant in the study group. Conclusion: The null hypothesis was confirmed. Biological, behavioral and sociodemographic differences in the studied populations were not identified. In women with recurrent discharge group, there were no infectious etiologic factors, suggesting that clinical diagnoses are not sufficient for the most efficient management of these situations, indicating laboratory evaluation for these cases in order to improve diagnostic accuracy.

Introduction: Many evidences have demonstrated the association between human papillomavirus (HPV) infection and cervical cancer, and prophylactic vaccines have been effective to prevent this infection. In relation to the vaccination program of the population, it is important to study the sexual behavior of adolescent students, especially the onset age of sexual activity. Objective: To evaluate the sexual behavior of adolescent students from public schools in relation to some associated variables and to link the onset age of sexual activity with HPV vaccination of the population. Methods: The study was based on the application of a questionnaire to 500 students of public high schools of the city of Curitiba, aged between 13 and 19 years, to assess their sexual behavior and related questions. Of the 500 questionnaires, 488 were answered and analyzed by statistical methodology. The study was approved by local regulatory bodies. Results: Regarding sexual activity, it was observed that it was most frequent along male than female students. It is noticed that 47.8% of boys and 24.6% of girls answered positively to this question. Similarly, 38.7% of boys reported having initiated sexual activity before age 14 compared to only 8.5% of the girls. Other data about the perceived risk of contracting a sexually transmitted infection and contraception condom were assessed. The relation between drug use (tobacco, alcohol and marijuana) and sexual activity was demonstrated. About 45% of sexually active students stated regular use of drugs, compared with less than 20% of those who reported not having initiated sexual activity (p < 0.001), whereas this proportion was even more evident when analyzed only the use of marijuana. The “protector” effect of family environment shows an interesting finding: the adolescents who lived with their parents were less sexually active than those who did not report such situation with a percentage of 31.3% versus 59.4% (p = 0.003). Conclusion: We concluded that sexual activity was more evident among male participants as sexual initiation was earlier among boys. Use of drugs and independence of family environment were related to higher rate of earlier and current sexual activity. According to researches, 90% of the students who already are 17 years old had initiated sexual activity; therefore, we can conclude that the age of vaccination proposed by most governmental authorities and the Brazilian Federation of Gynecology and Obstetrics (Febrasgo) is adequately when it comes to prevent HPV infection.

As doenças sexualmente transmissíveis, incluindo a infecção pelo HIV (DST/HIV) em população indígena são pouco conhecidas e notificadas no Brasil. Através de alguns estudos específicos em algumas aldeias obtém-se uma ampla visão do panorama que pode estar ocorrendo dentro dessas comunidades. É passível de observação a vantagem dada aos povos amazônicos, por reterem o maior número de etnias, maior população e maior preservação de cultura. Também se observa que os estudos feitos na área são mais antropológicos do que ligados à saúde dos povos, demonstrando que o aspecto de preservação cultural é considerado como prioridade até em relação a doenças.