Relação entre agentes infecciosos de vulvovaginites e cor da pele
Palavras-chave:
Grupos de populações continentais, Vulvovaginite, Vaginose bacteriana, Candidíase, LactobacillusResumo
CONTEXTO E OBJETIVO: Muitos fatores influenciam a ocorrência de vulvovaginites. Os objetivos foram avaliar diferenças relacionadas à cor da pele e idade na flora vaginal e vulvovaginites. TIPO DE ESTUDO E LOCAL: Estudo transversal; hospital de referência terciário (Universidade Federal do Triângulo Mineiro, Uberaba). MÉTODOS: Mulheres saudáveis em atendimento de rotina para exames ginecológicos foram divididas em brancas (n = 13.881) e não brancas (n = 5.295) e avaliadas quanto a vulvovaginites e flora vaginal. Para análise estatística, foram utilizados teste X2 , regressão logística e odds ratio. RESULTADOS: Microflora vaginal foi dependente da cor da pele, com maior ocorrência de “clue cells”, Trichomonas vaginalis e bacilos cocoides em não brancas (p < 0,0001); bacilos de Döderlein e flora citolítica foram mais prevalentes em brancas (p < 0,0001 e p < 0,05, respectivamente). Flora vaginal foi dependente da idade nos grupos de cor da pele. Entre não brancas, “clue cells”, Trichomonas e bacilos cocoides foram mais prevalentes nas idades: 21 a 50 anos, até 40 anos, e 21 a 40 anos respectivamente (p < 0,05). Durante as fases proliferativa e secretória, mulheres não brancas tiveram maior probabilidade de apresentar “clue cells”, Trichomonas, Candida e cocoides (odds ratio, OR - fase proliferativa: 1,31; 1,79; 1,6 e 1,25 respectivamente; fase secretória: 1,31; 2,88; 1,74 e 1,21 respectivamente), e menor chance de apresentarem flora Döderlein (OR - fase proliferativa: 0,76; fase secretória: 0,66) comparadas com brancas, independentemente da idade. CONCLUSÕES: Há diferenças na ocorrência de vulvovaginites relacionadas com a cor da pele, podendo haver associação com variações na flora vaginal.
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Referências
Murta EF, Silva AO, Silva EA, Adad SJ. Frequency of infectious agents for vaginitis in non- and hysterectomized women. Arch Gynecol Obstet. 2005;273(3):152-6.
Murta EF, Souza MA, Araújo Júnior E, Adad SJ. Incidence of Gardnerella vaginalis, Candida sp and human papilloma virus in cytological smears. Sao Paulo Med J. 2000;118(4):105-8.
Nomelini RS, Pansani PL, Murta EF. Frequency of cervical intraepithelial neoplasia and infec- tious agents for vaginitis in menstrual cycle phase. Eur J Gynaecol Oncol. 2007;28(5):389- 93.
Murta EF, Filho AC, Barcelos AC. Relation between vaginal and endocervical pH in pre- and post-menopausal women. Arch Gynecol Obstet. 2005;272(3):211-3.
Hillier SL, Nugent RP, Eschenbach DA, et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med. 1995;333(26):1737-42.
Goldenberg RL, Iams JD, Mercer BM, et al. The preterm prediction study: the value of new vs standard risk factors in predicting early and all spontaneous preterm births. NICHD MFMU Network. Am J Public Health. 1998;88(2):233-8.
Hay PE, Lamont RF,Taylor-Robinson D, et al.Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ. 1994;308(6924):295-8.
Royce RA, Jackson TP, Thorp JM Jr, et al. Race/ethnicity, vaginal flora patterns, and pH during pregnancy. Sex Transm Dis. 1999;26(2):96-102.
French JI, McGregor JA, Parker R. Readily treatable reproductive tract infections and pre- term birth among black women. Am J Obstet Gynecol. 2006;194(6):1717-26; discussion 1726-7.
Boskey ER, Telsch KM, Whaley KJ, Moench TR, Cone RA. Acid production by vaginal flo- ra in vitro is consistent with the rate and extent of vaginal acidification. Infect Immun. 1999;67(10):5170-5.
Antonio MA, Hawes SE, Hillier SL. The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonized by these species. J Infect Dis. 1999;180(6):1950-6.
Hawes SE, Hillier SL, Benedetti J, et al. Hydrogen peroxide-producing lactobacilli and acqui- sition of vaginal infections. J Infect Dis. 1996;174(5):1058-63.
Adad SJ, de Lima RV, Sawan ZT, et al. Frequency of Trichomonas vaginalis, Candida sp and Gardnerella vaginalis in cervical-vaginal smears in four different decades. Sao Paulo Med J. 2001;119(6):200-5.
Gupta PK. Microbiology, inflammation, and viral infections. In: Bibbo M, editor. Comprehen- sive cytopathology. Philadelphia: WB Saunders; 1997. p. 125-60.
Solomon D. The Bethesda system for cervicovaginal cytopathology. In: Bibbo M, editor. Com- prehensive cytopathology. Philadelphia: WB Saunders; 1997. p. 93-100.
Wied GL, Bibbo M. Hormonal cytology. In: Bibbo M, editor. Comprehensive cytopathology. Philadelphia: WB Saunders; 1997. p. 101-24.
Tanaka VA, Fagundes LJ, Catapan A, et al. Perfil epidemiológico de mulheres com vagi- nose bacteriana, atendidas em um ambulatório de doenças sexualmente transmissíveis, em São Paulo, SP [Epidemiological profile of women with bacterial vaginosis treated at a clinic for sexually transmitted diseases in the city of Sao Paulo, SP]. An Bras Dermatol. 2007;82(1):41-6.
Peipert JF, Lapane KL, Allsworth JE, et al. Bacterial vaginosis, race, and sexually transmitted infections: does race modify the association? Sex Transm Dis. 2008;35(4):363-7.
Cherpes TL, Hillier SL, Meyn LA, Busch JL, Krohn MA. A delicate balance: risk factors for acquisition of bacterial vaginosis include sexual activity, absence of hydrogen peroxide- producing lactobacilli, black race, and positive herpes simplex virus type 2 serology. Sex Transm Dis. 2008;35(1):78-83.
Leitich H, Bodner-Adler B, Brunbauer M, et al. Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol. 2003;189(1):139-47.
Hillier SL, Kiviat NB, Hawes SE, et al. Role of bacterial vaginosis-associated microorganisms in endometritis. Am J Obstet Gynecol. 1996;175(2):435-41.
Romero R, Chaiworapongsa T, Kuivaniemi H, Tromp G. Bacterial vaginosis, the inflammatory response and the risk of preterm birth: a role for genetic epidemiology in the prevention of preterm birth. Am J Obstet Gynecol. 2004;190(6):1509-19.
Macones GA, Parry S, Elkousy M, et al. A polymorphism in the promoter region of TNF and bacterial vaginosis: preliminary evidence of gene-environment interaction in the etiology of spontaneous preterm birth. Am J Obstet Gynecol. 2004;190(6):1504-8; discussion 3A.
Ryckman KK, Simhan HN, Krohn MA, Williams SM. Predicting risk of bacterial vaginosis: the role of race, smoking and corticotropin-releasing hormone-related genes. Mol Hum Reprod. 2009;15(2):131-7.
Giraldo PC, Babula O, Gonçalves AK, et al. Mannose-binding lectin gene polymorphism, vulvovaginal candidiasis, and bacterial vaginosis. Obstet Gynecol. 2007;109(5):1123-8.
Paul K, Boutain D, Manhart L, Hitti J. Racial disparity in bacterial vaginosis: the role of socioeconomic status, psychosocial stress, and neighborhood characteristics, and possible implications for preterm birth. Soc Sci Med. 2008;67(5):824-33.
Ryckman KK, Williams SM, Krohn MA, Simhan HN. Racial differences in cervical cytokine concentrations between pregnant women with and without bacterial vaginosis. J Reprod Immunol. 2008;78(2):166-71.
auth JC, Macpherson C, Carey JC, et al. Early pregnancy threshold vaginal pH and Gram stain scores predictive of subsequent preterm birth in asymptomatic women. Am J Obstet Gynecol. 2003;188(3):831-5.
Jazayeri A, Arnold H, Jazayeri MK, Spellacy WN. A prospective study of vaginal pH as a pre- dictor of preterm delivery. J Matern Fetal Neonatal Med. 2002;11(1):30-3.
De Seta F, Maso G, Piccoli M, et al. The role of mannose-binding lectin gene polymorphisms in women with recurrent bacterial vaginosis. Am J Obstet Gynecol. 2007;197(6):613.e1-3.
Newton ER, Piper JM, Shain RN, Perdue ST, Peairs W. Predictors of the vaginal microflora. Am J Obstet Gynecol. 2001;184(5):845-53; discussion 853-5.
Lang WR. Vaginal acidity and pH; a review. Obstet Gynecol Surv. 1955;10(4):546-60.
Redondo-Lopez V, Cook RL, Sobel JD. Emerging role of lactobacilli in the control and main- tenance of the vaginal bacterial microflora. Rev Infect Dis. 1990;12(5):856-72.
Molander U, Milsom I, Ekelund P, Mellström D, Eriksson O. Effect of oral oestriol on va- ginal flora and cytology and urogenital symptoms in the post-menopause. Maturitas. 1990;12(2):113-20.
García-Closas M, Herrero R, Bratti C, et al. Epidemiologic determinants of vaginal pH. Am J Obstet Gynecol. 1999;180(5):1060-6.
Nai GA, Mello ALP, Ferreira AD, Barbosa RL. Freqüência de Gardnerella vaginalis em esfrega- ços vaginais de pacientes histerectomizadas [Frequency of Gardnerella Vaginalis in vaginal smears of hysterectomized women]. Rev Assoc Med Bras (1992). 2007;53(2):162-5.
Stevens-Simon C, Jamison J, McGregor JA, Douglas JM. Racial variation in vaginal pH among healthy sexually active adolescents. Sex Transm Dis. 1994;21(3):168-72.
Aroutcheva A, Gariti D, Simon M, et al. Defense factors of vaginal lactobacilli. Am J Obstet Gynecol. 2001;185(2):375-9.
Fiscella K, Klebanoff MA. Are racial differences in vaginal pH explained by vaginal flora? Am J Obstet Gynecol. 2004;191(3):747-50.
Cauci S, Driussi S, De Santo D, et al. Prevalence of bacterial vaginosis and vaginal flora changes in peri- and postmenopausal women. J Clin Microbiol. 2002;40(6):2147-52.
Ness RB, Hillier S, Richter HE, et al. Can known risk factors explain racial differences in the occurrence of bacterial vaginosis? J Natl Med Assoc. 2003;95(3):201-12.
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