Vaginose bacteriana, infecção cervical pelo Papilomavírus humano (HPV) e anormalidades citológicas cervicais em mulheres adultas
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2022-02-18
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Universidade Federal de Goiás
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Resumo em língua estrangeira: Bacterial vaginosis (BV) is the most common cause of vaginal discharge and occurs when there is an imbalance in the vaginal microbiota, predominantly composed of Lactobacillus spp. Human Papillomavirus (HPV) is the most common sexually transmitted virus in the world. Persistent infection with high-risk HPV genotypes is the main cause of the development of cervical intraepithelial neoplasia and cervical cancer. The aim of this study was to investigate the association between BV, cervical HPV infection and cervical cytological abnormalities in adult women. A systematic review with meta-analysis and a cross-sectional study were performed. The systematic review and meta-analysis were based on the PRISMA methodological guidelines. PubMed and Web of Science were searched using the descriptors: “bacterial vaginosis and HPV”, in June 2019. Inclusion criteria were original studies that investigated an association between BV and cervical HPV infection; published in English, Spanish or Portuguese; performed in young and adult women, over 15 years of age, non-pregnant, declared to be HIV negative, who used the Nugent criteria for the diagnosis of BV and PCR for the detection of HPV. Odds ratios (OR) and respective 95% confidence intervals (95% CI) were calculated for the association between BV and cervical HPV infection using random effects models. A value of p<0.05 was considered statistically significant. Six studies published between 2012 and 2019 were selected for analysis and demonstrated a significant association between BV and cervical HPV infection (OR: 2.68; 95% CI: 1.64-4.40; p<0.001). The cross-sectional study was carried out in a gynecology outpatient clinic of the public health network in Goiânia, Goiás. A total of 202 women were included and underwent gynecological examination, with cervical specimen collection. Cervical cytopathological exams, bacterioscopy and Nugent's criteria were performed for the diagnosis of BV and PCR and reverse hybridization for HPV detection and genotyping. By using bivariate analysis the association between BV and cervical HPV infection and between BV and cervical cytological abnormalities were investigated. The odds ratio was calculated, with the respective 95% confidence intervals (95% CI) and 5% significance level (p <0.05). The prevalence of BV was 33.2% (67/202), of cervical HPV infection was 38.6% (78/202) and of cervical cytological abnormalities was 6.0% (12/202). Bivariate analysis did not identify a significant association between BV and cervical HPV infection (OR: 0.69; 95% CI: 0.37-1.27; p=0.23), nor between BV and cervical cytological abnormalities (OR: 0.65; 95% CI: 0.17-2.50; p=0.54). In the systematic review and meta-analysis, BV was considered a risk factor for cervical HPV infection, however, in the cross-sectional study, BV was not associated with cervical HPV infection nor with cervical cytological abnormalities in the group of adult women investigated.
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MARTINS , B. C. T. Vaginose bacteriana, infecção cervical pelo Papilomavírus humano (HPV) e anormalidades citológicas cervicais em mulheres adultas. 2022. 144 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2022.