Asociación de la infección del virus de papiloma humano y los microorganismos causantes de cervicovaginitis en mujeres mexicanas

Abstract

Reproductive tract infections are grouped into three categories: endogenous infections, sexually transmitted infections and iatrogenic infections; the way each one is acquired and disseminated is pointed out by their name. The first two represent a worldwide health problem since they affect men and women, as well as whole comunities. Particularly, sexually transmitted diseases affect 85% of the sexually active global population and occupy one of the top five causes of first level medical attendance; in Mexico sexually transmitted infections are between the top ten causes of morbidity. The detection of genital infections allows us to reveal the simultaneous presence of different microorganisms causing sexually transmitted infections, the accurate identification of such pathogens is the key to an effective therapy avoiding the development of more serious infections. This is why the present work offered a service for the opportune diagnosis of cervicovaginal alterations caused by the main agents of genital tract infections; on the other hand, it showed information about the possible synergic effects of the concurrent infections with HPV in Mexican women. The project was evaluated and approved by the Ethics Committee of ENCB-IPN. The spreading of the protocol was done in Casco de Santo Tomas and surroundings. Each participant was interrogated in order to determine if they gathered the inclusion criteria and each one signed an informed consent and answered a survey about clinical and epidemiological data. Diagnosis was performed as follows: Amsel´s criterion, Nugent´s score, Gardenerella vaginalis culture, wet mount, culture in chromogenic medium, quantification and antimicrobial susceptibility of Mycoplasma hominis and Ureaplasma urealyticum was done phenotipically with IST 2® galleries or AF Genital System®, Chlamydia trachomatis was detected by PCR and Neisseria gonorrhoeae by culture and PCR. Papanicolau test was done to all participants and those where HPV infection was suspected were tested with INNOLipa® system. The analysis of the data obtained was done with PASW-18 software and the chi2 test was applied to determine if there was an association between mixed infections and other microorganisms causing cervicovaginitis, as well as the probable relationship between the state of health and the age, use of condom, age of first intercourse, among others. The search of bacterial pathogens was performed in 207 samples, HPV diagnosis was done only in those participants that presented cytological alterations in the Papanicolaou test (n=34). The results show that 127 from the 207 participants (61.3%) presented at least one infection or etiological agent. The rest of them (78/207=38.7%) did not show signs of cytological alterations or any other pathology, which is why, from a microbiological approach they were considered as “healthy” participants. The most frequently detected high risk genotype was 52, followed by genotypes 16 and 58, it is important to emphasize that genotype 18, considered as one of the most frequent after genotype 16, was detected in only one participant. As well as the concurrent infection between the different viral genotypes, mixed infection was detected in the studied population, and it was defined as the presence of HPV along with a genital pathogen. This happened in 11 cases, HPV infection was accompanied by candidosis, BV and the presence of U. urealyticum in!104 UFC/mL. These kinds of infections were quite common, which has been previously widely reported. There was a significant relationship between the number of sexual partners and being healthy or sick, this relationship (p=0.047), means that having multiple sexual partners leads to acquiring at least one of the studied pathologies, meanwhile, in other variables there is no significant association. The association between U. urealyticum and BV was the most frequent. The infections with ASCUS presented at least one high-risk HPV genotype. More tan half of the participants presented one infection and/or colonization with al least one of the microorganisms studied in the present work.