Trichomonas vaginalis and Chlamydia trachomatis Prevalence, Incidence and Associated Factors in Pregnant Adolescents from Belém City, in the Brazilian Amazon
Author(s)
Camila Marconi1,
Marli Teresinha Cassamassimo Duarte2,
Márcia Guimarães da Silva3*,
Larissa Doddi Marcolino3,
Jossimara Polettini4,
Ana Paula Gonçalves5,
Adriano Dias6,
Marilza Vieira Cunha Rudge7
Affiliation(s)
1 Basic Pathology Department, UFPR—Universidade Federal do Paraná, Parana, Brazil. 2 UNOESTE, The University of Western Sao Paulo, Sao Paulo, Brazil. 3 Department of Pathology, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Sao Paulo, Brazil. 4 Department of Nursing, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Sao Paulo, Brazil. 5 Department of Nursing, Institute of Health Sciences, UFPA—Universidade Federal do Pará, Belém, Brazil. 6 Department of Public Health, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Sao Paulo, Brazil. 7 Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Sao Paulo, Brazil.
1 Basic Pathology Department, UFPR—Universidade Federal do Paraná, Parana, Brazil. 2 UNOESTE, The University of Western Sao Paulo, Sao Paulo, Brazil. 3 Department of Pathology, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Sao Paulo, Brazil. 4 Department of Nursing, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Sao Paulo, Brazil. 5 Department of Nursing, Institute of Health Sciences, UFPA—Universidade Federal do Pará, Belém, Brazil. 6 Department of Public Health, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Sao Paulo, Brazil. 7 Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Sao Paulo, Brazil.
ABSTRACT
Background: Adolescents are disproportionally affected by sexually transmitted infections (STI). Chlamydia trachomatis (CT) and Trichomonas vaginalis (TV) are the most frequent curable STI in adolescents, causing serious consequences for their reproductive health. Therefore, we aimed to determine the prevalence and incidence of CT and TV, as well as their risk factors in pregnant adolescents from Belém, northern Brazilian Amazon. Methods: This prospective study enrolled 199 adolescents up to 20 weeks of pregnancy. They were scheduled for follow-up visit between 28 and 29 weeks of pregnancy. Sociodemographic and behavioral data were obtained by interview. Cervicovaginal samples were taken to test for TV, CT, Neisseria gonorrhoeae and bacterial vaginosis. Univariate and multivariate analyses were performed to test the association of prevalent/incident CT and TV with the variables. Results: Prevalence of cervical CT infection was 33.7% (n = 67/ 199), and for trichomoniasis it was 4.0% (n = 8/199). Cervical ectopy increased the risk for prevalent CT (OR, 1.93; 95% CI, 1.01 - 3.70), while having treated vaginal discharge in the past (OR, 0.51; 95% CI, 0.26 - 0.98) and being married (OR, 0.10; 95% CI, 0.01 - 0.83) were protective against current CT and TV, respectively. Among the 95 (47.7%) adolescents who completed follow-up, 15 cases of incident CT were identified. Incident CT was associated with having a formal or informal job (OR, 28.4; 95% CI, 2.1 - 391.6) and bacterial vaginosis treatment at the baseline (OR, 0.08; 95% CI, 0.01 - 0.69). Conclusion: Prevalence and incidence rates of TV and CT are high in this population devoid of STI routine screening. Treatment of bacterial vaginosis may benefit this population by reducing risk for CT acquisition.
Background: Adolescents are disproportionally affected by sexually transmitted infections (STI). Chlamydia trachomatis (CT) and Trichomonas vaginalis (TV) are the most frequent curable STI in adolescents, causing serious consequences for their reproductive health. Therefore, we aimed to determine the prevalence and incidence of CT and TV, as well as their risk factors in pregnant adolescents from Belém, northern Brazilian Amazon. Methods: This prospective study enrolled 199 adolescents up to 20 weeks of pregnancy. They were scheduled for follow-up visit between 28 and 29 weeks of pregnancy. Sociodemographic and behavioral data were obtained by interview. Cervicovaginal samples were taken to test for TV, CT, Neisseria gonorrhoeae and bacterial vaginosis. Univariate and multivariate analyses were performed to test the association of prevalent/incident CT and TV with the variables. Results: Prevalence of cervical CT infection was 33.7% (n = 67/ 199), and for trichomoniasis it was 4.0% (n = 8/199). Cervical ectopy increased the risk for prevalent CT (OR, 1.93; 95% CI, 1.01 - 3.70), while having treated vaginal discharge in the past (OR, 0.51; 95% CI, 0.26 - 0.98) and being married (OR, 0.10; 95% CI, 0.01 - 0.83) were protective against current CT and TV, respectively. Among the 95 (47.7%) adolescents who completed follow-up, 15 cases of incident CT were identified. Incident CT was associated with having a formal or informal job (OR, 28.4; 95% CI, 2.1 - 391.6) and bacterial vaginosis treatment at the baseline (OR, 0.08; 95% CI, 0.01 - 0.69). Conclusion: Prevalence and incidence rates of TV and CT are high in this population devoid of STI routine screening. Treatment of bacterial vaginosis may benefit this population by reducing risk for CT acquisition.
KEYWORDS
Adolescence, Pregnancy, Sexually Transmitted Infection, Chlamydia trachomatis, Trichomonas vaginalis
Adolescence, Pregnancy, Sexually Transmitted Infection, Chlamydia trachomatis, Trichomonas vaginalis
Cite this paper
Marconi, C. , Duarte, M. , Silva, M. , Marcolino, L. , Polettini, J. , Gonçalves, A. , Dias, A. and Rudge, M. (2015) Trichomonas vaginalis and Chlamydia trachomatis Prevalence, Incidence and Associated Factors in Pregnant Adolescents from Belém City, in the Brazilian Amazon. Open Journal of Obstetrics and Gynecology, 5, 677-687. doi: 10.4236/ojog.2015.512096.
Marconi, C. , Duarte, M. , Silva, M. , Marcolino, L. , Polettini, J. , Gonçalves, A. , Dias, A. and Rudge, M. (2015) Trichomonas vaginalis and Chlamydia trachomatis Prevalence, Incidence and Associated Factors in Pregnant Adolescents from Belém City, in the Brazilian Amazon. Open Journal of Obstetrics and Gynecology, 5, 677-687. doi: 10.4236/ojog.2015.512096.
References
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http://dx.doi.org/10.1016/S1413-8670(12)70304-5 [22] Sturm-Ramirez, K., Brumblay, H., Diop, K., Guèye-Ndiaye, A., Sankalé, J.L., Thior, I., et al. (2000) Molecular Epidemiology of Genital Chlamydia trachomatis Infection in High-Risk Women in Senegal, West Africa. Journal of Clinical Microbiology, 38, 138-145. [23] Leon, S.R., Konda, K.A., Bernstein, K.T., Pajuelo, J.B., Rosasco, A.M., Caceres, C.F., et al. (2009) Trichomonas vaginalis Infection and Associated Risk Factors in a Socially-Marginalized Female Population in Coastal Peru. Infectious Diseases in Obstetrics and Gynecology, 2009, Article ID: 752437.
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http://dx.doi.org/10.1155/2011/842652
[1] Groseclose, S.L., Zaid, A.A., DeLisle, S.J., Levine, W.C. and St Louis, M.E. (1999) Estimated Incidence and Prevalence of Genital Chlamydia trachomatis Infections in the United States, 1996. Sexually Transmitted Diseases, 26, 339-344.
http://dx.doi.org/10.1097/00007435-199907000-00006 [2] Sonnenberg, P., Clifton, S., Beddows, S., Soldan, K., Tanton, C., Mercer, C.H., et al. (2013) Prevalence, Risk Factors, and Uptake of Interventions for Sexually Transmitted Infections in Britain: Findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). The Lancet, 382, 1795-1806.
http://dx.doi.org/10.1016/S0140-6736(13)61947-9 [3] Van Der Pol, B., Williams, J.A., Orr, D.P., Batteiger, B.E. and Fortenberry, J.D. (2005) Prevalence, Incidence, Natural History, and Response to Treatment of Trichomonas vaginalis Infection among Adolescent Women. The Journal of Infectious Diseases, 192, 2039-2044.
http://dx.doi.org/10.1086/498217 [4] Hosenfeld, C.B., Workowski, K.A., Berman, S., Zaidi, A., Dyson, J. and Mosure, D. (2009) Repeat Infection with Chlamydia and Gonorrhea among Females: A Systematic Review of the Literature. Sexually Transmitted Diseases, 36, 478-489.
http://dx.doi.org/10.1097/OLQ.0b013e3181a2a933 [5] Cotch, M., Pastorek 2nd, J., Nugent, R., Hillier, S.L., Gibbs, R.S., Martin, D.H., et al. (1997) Trichomonas vaginalis Associated with Low Birth Weight and Preterm Delivery. Sexually Transmitted Diseases, 24, 353-360.
http://dx.doi.org/10.1097/00007435-199707000-00008 [6] Kissinger, P., Amedee, A., Clark, R., Dumestre, J., Theall, K.P., Myers, L., et al. (2013) Trichomonas vaginalis Treatment Reduces Vaginal HIV-1 Shedding. Sexually Transmitted Diseases, 36, 11-16.
http://dx.doi.org/10.1097/OLQ.0b013e318186decf [7] Torrone, E., Geisler, W.M., Gift, T.L. and Weinstock, H.S. (2013) Chlamydia trachomatis Infection among Women 26 to 39 Years of Age in the United States, 1999 to 2010. Sexually Transmitted Diseases, 40, 335-337.
http://dx.doi.org/10.1097/OLQ.0b013e31827cd60d [8] Burstein, G.R., Gaydos, C.A., Diener-West, M., Howell, M.R., Zenilman, J.M. and Quinn, T.C. (1998) Incident Chlamydia trachomatis Infections among Inner-City Adolescent Females. JAMA, 280, 521-526.
doi:10.1001/jama.280.6.52 [9] Swartzendruber, A., Sales, J.M., Brown, J.L., Davis, T.L., DiClemente, R.J. and Rose, E. (2013) Predictors of Repeat Chlamydia trachomatis and/or Neisseria gonorrhoeae Infections among African-American Adolescent Women. Sexually Transmitted Diseases, 89, 76-82.
http://dx.doi.org/10.1136/sextrans-2012-050530 [10] Krashin, J.W., Koumans, E.H., Bradshaw-Sydnor, A.C., Braxton, J.R., Evan Secor, W. and Sawyer, M.K. (2010) Trichomonas vaginalis Prevalence, Incidence, Risk Factors and Antibiotic-Resistance in an Adolescent Population. Sexually Transmitted Diseases, 37, 440-444. [11] Silva, L.C.F., Miranda, A.E., Batalha, R.S., Monte, R.L. and Talhari, S. (2013) Trichomonas vaginalis and Associated Factors among Women Living with HIV/AIDS in Amazonas, Brazil. The Brazilian Journal of Infectious Diseases, 17, 701-703.
http://dx.doi.org/10.1016/j.bjid.2013.03.006 [12] Benzaken, A.S., Bazzo, M.L., Galban, E., Pinto, I.C., Nogueira, C.L. and Golfetto, L. (2014) External Quality Assurance with Dried Tube Specimens (DTS) for Point-of-Care Syphilis and HIV Tests: Experience in an Indigenous Populations Screening Programme in the Brazilian Amazon. Sexually Transmitted Infections, 90, 14-18.
http://dx.doi.org/10.1136/sextrans-2013-051181 [13] Nugent, R.P., Krohn, M.A. and Hillier, S.L. (1991) Reliability of Diagnosing Bacterial Vaginosis Is Improved by a Standardized Method of Gram Stain Interpretation. Journal of Clinical Microbiology, 29, 297-301. [14] Morré, S.A., Sillekens, P., Jacobs, M.V., van Aarle, P., de Blok, S., van Gemen, B., et al. (1996) RNA Amplification by Nucleic Acid Sequence-Based Amplification with an Internal Standard Enables Reliable Detection of Chlamydia trachomatis in Cervical Scrapings and Urine Samples. Journal of Clinical Microbiology, 34, 3108-3114. [15] Biello, K.B., Pettigrew, M.M. and Niccolai, L.M. (2011) Multiple Chlamydia Infection among Young Women: Comparing the Role of Individual- and Neighbourhood-Level Measures of Socioeconomic Status. Sexually Transmitted Infections, 87, 560-562.
http://dx.doi.org/10.1136/sextrans-2011-050185 [16] Marconi, C., Donders, G.G., Parada, C.M.G.L., Giraldo, P.C. and da Silva, M.G. (2013) Do Atopobium vaginae, Megasphaera sp. and Leptotrichia sp. Change the Local Innate Immune Response and Sialidase Activity in Bacterial Vaginosis? Sexually Transmitted Infections, 89, 167-173.
http://dx.doi.org/10.1136/sextrans-2012-050616 [17] Ginocchio, C.C., Chapin, K., Smith, J.S., Aslanzadeh, J., Snook, J., Hill, C.S., et al. (2012) Prevalence of Trichomonas vaginalis and Coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae in the United States as Determined by the Aptima Trichomonas vaginalis Nucleic Acid Amplification Assay. Journal of Clinical Microbiology, 50, 2601-2608.
http://dx.doi.org/10.1128/JCM.00748-12 [18] Berggren, E.K. and Patchen, L. (2013) Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae and Repeat Infection among Pregnant Urban Adolescents. Sexually Transmitted Diseases, 38, 172-174.
http://dx.doi.org/10.1097/OLQ.0b013e3181f41b96 [19] Haar, K., Bremer, V., Houareau, C., Meyer, T., Desai, S., Thamm, M., et al. (2013) Risk Factors for Chlamydia trachomatis Infection in Adolescents: Results from a Representative Population-Based Survey in Germany, 2003-2006. Eurosurveillance, 18, 2003-2006. [20] Chacko, M.R. and Lovchik, J.C. (1984) Chlamydia trachomatis Infection in Sexually Active Adolescents: Prevalence and Risk Factors. Pediatrics, 76, 836-840. [21] Sacramento, M.C.M., Costa e Silva, B.F.B., Gomes, I.L.C., Santana, I.U. and Grassi, M.F.R. (2012) Prevalence of Cervical Chlamydia trachomatis Infection in Sexually Active Adolescents from Salvador, Brazil. The Brazilian Journal of Infectious Diseases, 16, 188-191.
http://dx.doi.org/10.1016/S1413-8670(12)70304-5 [22] Sturm-Ramirez, K., Brumblay, H., Diop, K., Guèye-Ndiaye, A., Sankalé, J.L., Thior, I., et al. (2000) Molecular Epidemiology of Genital Chlamydia trachomatis Infection in High-Risk Women in Senegal, West Africa. Journal of Clinical Microbiology, 38, 138-145. [23] Leon, S.R., Konda, K.A., Bernstein, K.T., Pajuelo, J.B., Rosasco, A.M., Caceres, C.F., et al. (2009) Trichomonas vaginalis Infection and Associated Risk Factors in a Socially-Marginalized Female Population in Coastal Peru. Infectious Diseases in Obstetrics and Gynecology, 2009, Article ID: 752437.
http://dx.doi.org/10.1155/2009/752437 [24] Mitchell, H.D., Lewis, D.A., Marsh, K. and Hughes, G. (2013) Distribution and Risk Factors of Trichomonas vaginalis Infection in England: An Epidemiological Study Using Electronic Health Records from Sexually Transmitted Infection Clinics, 2009-2011. Epidemiology & Infection, 2013, 1-10. [25] Mascarenhas, R.E.M., Machado, M.S.C., Costa e Silva, B.F.B., Pimentel, R.F., Ferreira, T.T., Leoni, F.M., et al. (2012) Prevalence and Risk Factors for Bacterial Vaginosis and Other Vulvovaginitis in a Population of Sexually Active Adolescents from Salvador, Bahia, Brazil. Infectious Diseases in Obstetrics and Gynecology, 2012, Article ID: 378640.
http://dx.doi.org/10.1155/2012/378640 [26] Crucitti, T., Van Dyck, E., Tehe, A., Abdellati, S., Vuylsteke, B., Buve, A., et al. (2003) Comparison of Culture and Different PCR Assays for Detection of Trichomonas vaginalis in Self Collected Vaginal Swab Specimens. Sexually Transmitted Infections, 79, 393-398.
http://dx.doi.org/10.1136/sti.79.5.393 [27] Simoes, J.A., Giraldo, P.C. and Faúndes, A. (1998) Prevalence of Cervicovaginal Infections during Gestation and Accuracy of Clinical Diagnosis. Infectious Diseases in Obstetrics and Gynecology, 6, 129-133.
http://dx.doi.org/10.1155/S1064744998000246 [28] Grama, D.F., Casarotti, L. da S., Morato, M.G., Silva, L.S., Mendonca, D.F., Limongi, J.E., et al. (2013) Prevalence of Trichomonas vaginalis and Risk Factors in Women Treated at Public Health Units in Brazil: A Transversal Study. Transactions of the Royal Society of Tropical Medicine and Hygiene, 107, 584-591.
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http://dx.doi.org/10.1007/s00404-009-0971-x [30] Miller, M., Liao, Y., Gomez, A.M., Gaydos, C.A. and D’Mellow, D. (2008) Factors Associated with the Prevalence and Incidence of Trichomonas vaginalis Infection among African American Women in New York City Who Use Drugs. The Journal of Infectious Diseases, 197, 503-509.
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