Perfil epidemiológico, rastreamento citológico e de infecções genitais por Papilomavirus Humano, Chlamydia Trachomatis e Neisseria Gonorrhoeae nas mulheres indígenas do Xingu
Data
2021-07-07
Autores
Porto, Claudia Regina Cinti Corrêa [UNIFESP]
Orientadores
Speck, Neila Maria Gois [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
OBJETIVO: Identificar três dos principais agentes causadores de infecções sexualmente transmissíveis, Papilomavirus humano(HPV), Neisseria gonorrhoeae(NG) e Chlamydia trachomatis(CT) nas mulheres sexualmente ativas com idade superior a 18 anos, indígenas, que vivem no Parque Indígena do Xingú.
MÉTODOS: Através de coleta cérvico vaginal e Reação em Cadeia Polimerase (PCR) avaliamos o meio ambiente cérvico-vaginal quanto as principais infecções sexualmente transmissíveis Chlamydia trachomatis, Neisseria gonorrhoeae e Papilomavírus humano. Foi realizada citologia oncótica em meio líquido para análise citológica, que foi realizada por dois citopatologistas. Todos os achados foram correlacionados entre si, com faixa etária, com tipos prevalentes de HPV e com achados citológicos. A análise de acurácia citológica foi feita mediante a teste comparativo entre os resultados dos dois citopatologistas.
RESULTADOS: Avaliamos citologia e testes moleculares de 992 mulheres indígenas que vivem no Parque Indígena do Xingu. Encontramos 18,2% de positividade para HR-HPV. Destes, 6% apresentavam HPV16, 5% HPV18 e 81% tinham outros tipos de HR-HPV. A coinfecção por HPV16 e outros tipos foi observada em 5% das mulheres e 3% apresentaram a coinfecção HPV18 e outros tipos. Além disso, 1,8% apresentaram teste de CT positivo e não foi detectado nenhum caso de NG. HR-HPV foi observado em 33% das mulheres com CT, todos associados ao grupo outros tipos de HR-HPV. Mulheres mais jovens foram mais suscetíveis à infecção por HPV e por CT. Em relação a análise de acurácia citológica, houve 87,5% de concordância e 12,5% de discordância entre os dois observadores. O maior número de discordâncias esteve presente nos casos com alterações menores (ASCUS, LBG e AGC)
CONCLUSÃO: nossos dados mostraram alta frequência de HR-HPV e importante frequência de CT. Não houve associação entre CT, NG e HR-HPV para ação patogênica combinada. Os achados citológicos mostraram baixa ocorrência de lesões graves e a alta ocorrência de testes citológicos negativos com alta percentual de concordância entre os observadores.
OBJECTIVE: To identify three of the main causative agents of sexually transmitted infections, human papillomavirus (HPV), Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in sexually active women over 18 years old, indigenous, living in the Indigenous Park Xingu METHODS: Through cervical vaginal collection and Polymerase Chain Reaction (PCR) we evaluated the cervico-vaginal environment for the main sexually transmitted infections, Chlamydia trachomatis, Neisseria gonorrhoeae and Human papillomavirus. Liquid-based oncotic cytology was performed for cytological analysis, which was performed by two cytopathologists. All findings were correlated with each other, age, prevalent types of HPV and with cytological findings. The analysis of cytological accuracy was performed using a comparative test between the results of the two cytopathologists. RESULTS: We evaluated cytology and molecular tests of 992 indigenous women living in the Xingu Indigenous Park. We found 18.2% positivity for HR-HPV. Of these, 6% had HPV16, 5% HPV18 and 81% had other types of HR-HPV. Co-infection with HPV16 and other types was observed in 5% of women and 3% had co-infection with HPV18 and other types. Furthermore, 1.8% had a positive CT test and no case of NG was detected. HR-HPV was seen in 33% of women with CT, all associated with the other types of HR-HPV group. Younger women were more susceptible to HPV and CT infection. Regarding the analysis of cytological accuracy, there was 87.5% agreement and 12.5% disagreement between the two observers. The greatest number of disagreements was present in cases with minor alterations (ASCUS, LBG and AGC) CONCLUSION: our data showed a high frequency of HR-HPV and an important frequency of CT. There was no association between CT, NG and HR-HPV for combined pathogenic action. The cytological findings showed a low occurrence of serious lesions and a high occurrence of negative cytological tests with a high percentage of agreement between observers
OBJECTIVE: To identify three of the main causative agents of sexually transmitted infections, human papillomavirus (HPV), Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in sexually active women over 18 years old, indigenous, living in the Indigenous Park Xingu METHODS: Through cervical vaginal collection and Polymerase Chain Reaction (PCR) we evaluated the cervico-vaginal environment for the main sexually transmitted infections, Chlamydia trachomatis, Neisseria gonorrhoeae and Human papillomavirus. Liquid-based oncotic cytology was performed for cytological analysis, which was performed by two cytopathologists. All findings were correlated with each other, age, prevalent types of HPV and with cytological findings. The analysis of cytological accuracy was performed using a comparative test between the results of the two cytopathologists. RESULTS: We evaluated cytology and molecular tests of 992 indigenous women living in the Xingu Indigenous Park. We found 18.2% positivity for HR-HPV. Of these, 6% had HPV16, 5% HPV18 and 81% had other types of HR-HPV. Co-infection with HPV16 and other types was observed in 5% of women and 3% had co-infection with HPV18 and other types. Furthermore, 1.8% had a positive CT test and no case of NG was detected. HR-HPV was seen in 33% of women with CT, all associated with the other types of HR-HPV group. Younger women were more susceptible to HPV and CT infection. Regarding the analysis of cytological accuracy, there was 87.5% agreement and 12.5% disagreement between the two observers. The greatest number of disagreements was present in cases with minor alterations (ASCUS, LBG and AGC) CONCLUSION: our data showed a high frequency of HR-HPV and an important frequency of CT. There was no association between CT, NG and HR-HPV for combined pathogenic action. The cytological findings showed a low occurrence of serious lesions and a high occurrence of negative cytological tests with a high percentage of agreement between observers
Descrição
Citação
PORTO, C.R.C.C. Perfil epidemiológico, rastreamento citológico e de infecções genitais por Papilomavirus Humano, Chlamydia Trachomatis e Neisseria Gonorrhoeae nas mulheres indígenas do Xingu. São Paulo, 2022. 91 f. Tese (Doutorado em Ginecologia) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). São Paulo, 2022.