Vaginose bacteriana e tricomoníase: prevalência, fatores associados e desempenho de testes diagnósticos em mulheres atendidas em ambulatório de ginecologia preventiva
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2022-02-21
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Universidade Federal de Goiás
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INTRODUCTION. Bacterial vaginosis BV and genital infections have a great impact
on women's health and are the main causes of demand for health services. GOALS.
To investigate the prevalence, associated factors and performance of diagnostic
methods for BV and Trichomonas vaginalis TV. METHODS. The thesis is presented in
articles, in an original cross-sectional article and a systematic review. The Crosssectional
study, conducted with women seen at a preventive gynecology clinic, in the
public network of Goiânia, referred to a gynecological consultation. Gynecological
examination with evaluation of the characteristics of the vaginal secretion, and the
collection of cervicovaginal material for cytological study, fresh examination, vaginal
pH, Whiff test, Gram-stained bacterioscopy and the polymerase chain reaction (PCR)
for the detection of TV . The samples were analyzed at the Genetic Diversity
Laboratory of the Pontifical Catholic University of Goiás (PUC GO) and at the Rômulo
Rocha Clinical Analysis Center of the Faculty of Pharmacy of the Federal University of
Goiás (FF/UFG). Sociodemographic and behavioral characteristics were analyzed
using descriptive statistics. Logistic regression analysis was performed to identify
factors associated with BV. The degree of agreement between the clinical
characteristics of the vaginal secretion and the different diagnostic methods was
evaluated by the Kappa index. The systematic review study was registered in the
International Prospective Register of Systematic Reviews (PROSPERO) and
performed according to the methodological guidelines of the “Preferred Reporting
Items for Systematic Reviews and Meta-Analyses” (PRISMA). The search was
performed on PubMed and Scopus databases in September 2021, with no language
restriction. Articles were considered eligible if they investigated the prevalence of BV
in Brazil; used Amsel's clinical diagnostic criteria or Gram-stained bacterioscopy in
women of reproductive age and without comorbidities. Studies were evaluated by two
investigators to establish reliability. The risk of bias and the quality of the selected
studies were assessed using the Joana Briggs Institute (JBI) tool. RESULTS. The
cross-sectional study showed a prevalence of BV, according to the Nugent criteria, of
33.7% and of trichomoniasis by PCR, of 0.5%. The complaint of abnormal vaginal
secretion was significantly associated with the diagnosis of BV (OR = 2.2; 95%CI: 1.0-
4.5); The diagnostic accuracy for BV, by the methods of Amsel, Ison & Hay and
cytological examination, compared to the Nugent criteria was 35.6%, 97.0% and
84.2%, respectively. The sensitivity and degree of agreement for the diagnosis of TV,
by the fresh test was 0.0% and 0.0% and by the cytological test, 100% and 1,
respectively. Systematic review included ten articles. The mean prevalence of BV in
the included studies was 25.4% (95%CI: 24.0-26.8), ranging from 15.3% (95%CI: 11.8-
19.4) to 51. 0% (95%CI: 43.1-58.7). In three population-based studies, the prevalence
ranged from 15.3% (95%CI:11.8-19.4) to 20% (95%CI:16.9-23.6), with a mean of
18,1% (CI:16.0-20.5). In seven clinical-based studies, the prevalence ranged from
18.6% (95%CI: 13.6-25.0) to 51% (95%CI: 43.1-58.7), with an average of 27.2%
(95%CI: 24.6-29.9). Factors associated with BV were use of sexual accessories (OR:
2.4; 95%CI: 1.1-4.9), single marital status (OR: 1.4; 95%CI: 1.1-1.8), partner infidelity
(OR: 1.5; 95%CI: 1.2-1.9), abnormal vaginal discharge (OR: 1.5; 95%CI:1.2-2.0),
presence of trichomoniasis (OR: : 4.1 (95% CI: 1.5-11.5).CONCLUSION. The crosssectional
study showed a high prevalence of BV and a low prevalence of TV; The report
of abnormal vaginal secretion as the only factor associated with BV; the methods with
the best diagnostic performance for BV, compared to the Nugent method, were those
Abstract xix
of Ison and Hay and cytological examination and cytological examination considered
to be easily accessible in the daily clinic. The systematic carried out in this study
showed a high prevalence of BV and associated factors linked to sexual behavior,
although it is not considered a sexually transmitted infection.
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CAMARGO, K. C. Vaginose bacteriana e tricomoníase: prevalência, fatores associados e desempenho de testes diagnósticos em mulheres atendidas em ambulatório de ginecologia preventiva. 2022. 140 f. Tese (Doutorado em Ciências da Saúde) - Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, 2022.