Frequência de doenças sexualmente transmissíveis em pacientes assintomáticas e associação com neoplasia intraepitelial cervical

Abstract

Introduction: Sexually transmitted diseases (STDs) are considered one of the most common public health problems. Infections such as chlamydia, Neisseria, ureaplasma and mycoplasma are in most cases asymptomatic, and are related to the presence of human papillomavirus and cervical intraepithelial neoplasia. The high-risk HPV is critical to the development of cervical intraepithelial neoplasia and cervical cancer, however, only some among infected women will develop CIN, suggesting that other cofactors are required for HPV persistence and neoplastic changes. Objectives: In order to determine the frequency of human papillomavirus (HPV), Chlamydia trachomatis, Neisseria gonorrehae, Mycoplasma hominis, Mycoplasma genitalium and Ureaplasma infection in women examined in a general gynecology clinic and other in a colposcopy clinic. Specific objectives: 1-To study the association of these infections with CIN. 2- To evaluate risk factors for these STDs and NIC. 3- To assess the need to require STD exams as standard. Patients and Methods: A cross-sectional study was performed with a colposcopy clinic group and another from a general gynecology clinic in the 2014-2015 period. The colposcopy group consisted of 71 patients and the general gynecology group of 55 patients, all patients underwent cervical cytology and had cervical samples submitted to real-time PCR for detection of HPV and the following STDs; Chlamydia, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma and Neisseria. Colposcopy group patients were submitted to colposcopy and biopsy when indicated. For the statistical analysis, the chi-square test was used to determine whether there was a significant association between the variables, considering the 0.05 significance level. Multivariate analysis was performed by logistic regression. Results: The prevalence of STDs was: HPV: 46.8%, Chlamydia: 27.8%, Mycoplasma genitalium: 28.6%, Mycoplasma hominis: 0.8%, Ureaplasma:4,8%, Neisseria 4.8%. The risk factors for cervical intraepithelial neoplasia were HPV infection (p = 0.024), chlamydia (p = 0.009), Mycoplasma genitalium (p = 0.040), co-infection with HPV and chlamydia (p = 0.023) and HPV infection associated to the presence of at least one STD (p = 0.011). After multivariate analysis we found positive association between HPV and CIN (p = 0.040 OR , 2.48 ; CI: 1.04 to 5.92 ) and between Chlamydia and NIC (p = 0.028 OR: 2.69 CI: 1,11 6.53 ) . Conclusions: Frequency of STDs (HPV, Chlamydia, Neisseria, Mycoplasma genitalium and Ureaplasma) was high in asymptomatic patients. Risk factors for CIN were HPV infection, chlamydia, mycoplasma genitalium, co-infection with HPV and chlamydia and HPV infection associated with the presence of at least one DST. HPV and Chlamydia infections are independently associated with the presence of cervical neoplasia. High frequency of STD in asymptomatic women confirms the need for routine screening of these infections.