Microbiota vaginal, hepatites B e C, sífilis e HIV em mulheres atendidas em serviço de infertilidade em uma maternidade de Fortaleza

Abstract

Infertility is a major public health problem, affecting more than 186 million people worldwide. There are gaps in the research and development of prevention policies, as well as infertility handling,and a wide approach is needed to understand the preventable risk factors in various population contexts. A complex relationbetween Sexually Transmitted Infections (STIs), vaginal microbiota, and infertility has been described. This observational, descriptive, and cross-sectional study aims at identifying the prevalence of syphilis, viral hepatitis B and C, and HIV, in addition to the types of vaginal microbiota and its association with symptoms and clinical findings in women with infertility assistedat the specialized outpatient clinic of Maternidade-Escola Assis Chateaubriand (MEAC) in the city of Fortaleza, Ceará State, in the period from February to December, 2018. The patients filled in a form in which socio-demographic information and gynecologic and obstetric history were informed in order to evaluate the epidemiological data. Quick testing was performed for syphilis, viral hepatitis B and C, and HIV, with pre and post test counseling, and vaginal contentpH measurement. Vaginal fluid samples were collected to evaluate microbiota type and bacterial vaginosisdiagnosis via Gram stain to determine the Nugent score. The investigation of Candida and Trichomonas vaginalis was performed through direct examination of vaginal content. The study included 107 women with infertility. The prevalence of bacterial vaginosis evaluated by Nugent score was of 42.1%. The vaginal microbiota was regular in 26.2%, and intermediate in 31.8% of cases. The prevalence of Candida and Trichomonas vaginalis by direct examination was of 24.3%, and 1.9%, respectively. The vaginal pH was greater than 4.5 in 47.7% of cases. The prevalence of syphilis was of 4.7%. There were no hepatitis B and C and HIV positive cases in the evaluated sample. Conclusion: the prevalence of abnormal vaginal microbiota between infertile patients in our sample was larger than data described in the literature. Further studies are needed to establish cause-and-effect relationship between changes of vaginal microbiota and infertility to support a routine screening and treatment of bacterial vaginosis in infertile women.