You are on page 1of 8

African Journal of Microbiology Research Vol. 7(1), pp. 27-34, 1 January, 2013 Available online at http://www.academicjournals.

org/AJMR DOI: 10.5897/AJMR12.651 ISSN 1996-0808 ©2013 Academic Journals

Full Length Research Paper

Aetiology and frequency of cervico-vaginal infections among Mexican women
Fabiola Hernández-Martínez, Juan A Hernández-García, Marcos D Martínez-Peña, Brenda L Muñíz-Becerril, Cecilia Hernández-Cortez, Graciela Castro-Escarpulli and M. G Aguilera-Arreola*
Laboratorio de Bacteriología médica, departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional (IPN). Ciudad de México, D.F. México.
Accepted 24 September, 2012

There are major concerns worldwide regarding sexually transmitted infections (STI), bacterial vaginosis (BV), and candidiasis as a major cause of morbidity as they result in significant health and economic consequences, particularly in developing countries. This study was intended to obtain information about the prevalence of these pathologies in women considered to be at low risk using both traditional and in-house NAAT methods. Cervical and vaginal samples were collected all volunteers signed an informed consent form and completed a survey. BV, trichomoniasis, candidiasis, genital mycoplasmas colonization and Chlamydia trachomatis or Neisseria gonorrhoeae cervicitis were diagnosed. Candidiasis and abnormal vaginal flora associated with BV were very frequent. The high colonization with micoplasmas was detected. C. trachomatis cervicitis was found in 10.67% from which a third of the cases were of asymptomatic woman. No cases of gonorrhoea or trichomoniasis were diagnosed. In house NAAT’s used seems to viable tools for the cheap and reliable test for the diagnosis of gonorrhoea and chlamydial infections. Increased awareness of the importance of protected sexual intercourse is imperative to prevent the transmission of sexually transmitted. Further studies for a comprehensive understanding of the rates of these infections in Mexican women are necessary and should be an impulse for make community-based assessment of STI and RTI. Key words: Bacterial vaginosis, candidosis, STI, cervicitis, gonorrhoea.

INTRODUCTION There are major concerns worldwide regarding sexually transmitted infections (STI) as a major cause of morbidity as they result in significant health and economic consequences, particularly in developing countries. In women, STI like gonorrhoea, clamidial infection or trichomonosis are often chronic and present with few symptoms or asymptomatic, but they can eventually lead to severe repercussions such as chronic pelvic inflammatory disease, ectopic pregnancy, and infertility (Araújo et al., 2007; CDC, 2010; Kurewa et al., 2010). Thorough screening for STI in women should be performed on a routine basis world-wide to rapidly diagnose and treat infected individuals since timely treatment of STI will prevent further transmission and help control the spread of infection (Da Ros and Schmitt, 2008). Reliable epidemiological data on chlamydia bacterial STI and other reproductive tract infections (RTI) as the

*Corresponding author. E-mail: lupita_aguilera@hotmail.com. Tel: (+0052) 55-57-29-60-00. Ext. 62374, 62567. Fax: (+0052) 55-57-29-62-07.

self-taken vaginal swabs. this study was intended to obtain evidence about the prevalence of STI (Trichomonas vaginalis. The questionnaire gathered information about demographic characteristics (Table 1). a ≥7 score according to Nugent’s criteria. burning or increase of normal secretion volume or kind. under-reporting of cases is high. dysbiotic conditions bacterial vaginosis (BV) or candidiasis is scanty and insufficient among Mexican women (Ponce and Ronzón. 2009). BV or Candidiasis were referred to a physician. Although gonorrhoea. vaginalis was diagnosed by observation on wet mount in physiological saline solution. Microbiol. Leaflet was handed out in public places. sexual behaviour and clinical findings that present the enrolled participants. C. and/or G. France) was used for culture. and those who tested positive for an STI. gonorrhoeae and C. Contributing to the lack of appropriate epidemiological information. the slide was evaluated immediately that the vaginal sample was taken.. Livengood. we also excluded pregnant women and women who had received a course of antibiotics in the previous month. 2001). Marcy I’Etoile. cervical and urethral swabs.. Women were diagnosed with bacterial vaginosis if they presented three or more of Amsel’s clinical criteria. congenital syphilis and other viral infections has been built (Reyna-Figueroa et al. J. vaginalis growth on Casman plates. candidiasis. 2001. Vaginal samples The presence of BV. 2000. Data and sample collection Informed consent was obtained for each participant prior to her recruitment into the study. Vaginal samples were obtained using either a plastic or a wooden Dacron swab while a cervical brush was used to sample cervical cells for DNA detection of N. bacterial vaginosis and Mycoplasma) in women considered to be at low risk using low cost methods (traditional and in-house NAAT’s Secondarily describes demographic characteristics. trachomatis. The Mycoplasma IST 2 gallery (bioMérieux. and a self-administered questionnaire was gathered from each participant. 2005. However. including different locations surrounding the Lázaro Cárdenas-IPN Campus. trichomoniasis and mycoplasmas was studied in vaginal samples. trachomatis and N. Participants were required to not have had sexual intercourse in the three days prior to sample collection... Avila-Ríos et al. Whiley et al. no requirement for viable organisms and the use of non-invasive specimens. gonorrhoeae has some limitations such as cost. All together with the questionnaire about symptomatic occurrence was taken account for diagnosis. storage and transport of samples is simpler. participants younger than 18 years old were excluded because of legal ramifications as they were under the age of consent. trachomatis and N. Res... nucleic acid amplification tests (NAAT’s) have become widely used. In contrast. This fact creates an environment whereby proactive screening is not only vital for improving health status but also represents a cost-effective measure (Reyna-Figueroa et al. since at 5°C can be retained up to 60 days without affecting the results overcome limitations (Bañuelos-Pánuco et al. as previously described (Money.. Tlalnepantla Edo. AIDS. 2006). de México) were used to identify candidiasis. better reliable epidemiological overview of syphilis. At least two of this criterion has to be concurrent for a diagnosed BV. Inc. Van Dyck et al. gonorrhoeae) and RTI (Candida spp. 2011). as well as culture in BiGGY medium (MCD LAB. diagnosis of these infections is available only for women who are already presenting symptoms or serious consequences. trichomoniasis and candidiasis are notifiable diseases.. México City and it briefly described the study and suggested that women interested in participating should schedule an appointment for sample collection at the most convenient date and time. risk of carryover contamination. T. HIV. Thus. NAAT’s for the detection of C. either in-house or commercial assays offer several advantages over culture and other methods for the detection of these microorganisms in clinical samples such as increased sensitivity. Asymptomatic infections caused by pathogens such as Chlamydia trachomatis or Neiseria gonorrhoeae make transmission easier and frequently these untreated asymptomatic infections progress to sequel (Avila-Ríos et al. 2011).. Observation of budding yeast and/or pseudomycelium on wet mount in physiological saline solution. the presence of microbiological findings was correlated with specific symptoms such as itch. identification and evaluation of antibiotic susceptibility according to the manufacturer’s instructions.28 Afr. 2011). 2011. Cervical samples were frozen in 2-sucrose phosphate medium (2- . Mexican public health services do not offer population-level screening or monitoring for all these diseases. inhibition and inability to provide antibiotic resistance data. including infertility. trachomatis detection This study protocol received ethical approval from the Institutional Ethics Committee from Escuela Nacional de Ciencias Biológicas. Currently. In addition. Recruitment was undertaken by distribution of a leaflet inviting women to participate in the study. the possibility of detection of genetic material in urine. Since almost 10 to 30% of women have candida colonization without any symptoms. high throughput. Exclusion criteria Women younger than 18 years old and older than 65 years old were excluded from the study. Cervical samples Details of ethical approval and recruitment process C. MATERIALS AND METHODS Results were reported to all participants.

6 13. Foster City.0 2.6 81.3 62.7 2.8 16.9 22. Deoxyribonucleic acid (DNA) extraction for C.9 8.2 31.9 1. Hercules.8 35. behavioural and clinical categorical variable in the survey was obtained.2 33. (2005).Hernández-Martínez et al.0).3 12.3 13. trachomatis detection was performed by enzymatic cellular lysis with lysozyme and proteinase K. behavioural and clinical answers of the enrolled participants. and CA) according to the manufacturer’s instructions.5 33. DNA extraction was performed from the sample using the InstaGeneTM Matrix Kit (BioRad Laboratories..3 SP) until use. gonorrhoeae culture and detection N. Variables (N = 105) Age group 18-25 26-33 34-41 42-49 >50 Reason for consultation gynaecological check-up symptomatic without answer Current partner type monogamous concurrent without answer Number of sexual partners in the past less than 2 two o more without answer Use of condom Yes No without answer Main symptoms Itching Burning Discharge Painful intercourse Urination pain Two or more without answers Frequency 44 24 9 14 14 67 30 8 85 3 17 35 66 4 37 33 35 13 0 28 3 1 25 35 (%) 41. Genetic detection was performed by making small modifications to PCR conditions proposed by Boel et al. 2000).3 63. CA) following the standard methodology outlined by the manufacturer. Statistical analysis Data collection was performed with a statistical package for the social sciences (SPSS version 17. Polymerase chain reaction (PCR) amplification of the omp1 gene.3 33. The frequency of each demographic. which encodes the species-specific major outer membrane protein (MOMP). 29 Table 1. The identity of a random positive PCR reaction was confirmed by sequencing with ABI-PRISM™ 310 sequencer (Applied Biosystems. gonococcal plates with Thayer-Martin medium (TM) immediately after sampling..4 0. Demographic.0 26. In order to establish the statistical significance all categorical variables were analysed by means of 2 x 2 N. was performed under conditions previously described (Bañuelos-Pánuco et al. gonorrhoeae was detected by PCR and culture on selective .8 28.9 3. Inc.0 76.6 7.

8% (3/105) declared having a concurrent relationship. U. 20. Among the symptoms that participants reported. Whiff test positive and/or clue cells. The remainder seven participants did not report .90% (4/105) did not respond.30 Afr.71) *Since in menarche woman 15 concurrent infections were founded the total was bigger than the cases number of infected diagnosis.9% (3/105). it is important to emphasize that 76. Regarding the current partner type.9% (65/105) of the participants.8% (25/105) between 21 and 25 years and 3.50% (11/105) reported having had either five or six partners. J. The two asymptomatic participants with Candida were cases of colonized but not as active infections since no budding yeast. Any other categorical variable analysed shows statistical significance.43) 11 (10. urealyticum was concurrent with BV in 5 cases and was present with increased polymorphonuclear cell counts in 11 of 22 remaining cases. p<0.0%).61% (71/105) between 16 and 20 years. Menarche women Diagnosis Microbiologically healthy Infected C. 67. The seven participants with asymptomatic bacterial vaginosis (BV) have abnormal vaginal flora (Nugent >7) accompanied of other altered signs as pH. RESULTS After approval by the ethics committee a total of 105 samples were collected from the sexually active female population. Age of first sexual intercourse and health status of the participant were dependent variables (V = 0. Frequency of STI and RTI in healthy and infected Mexican women enrolled. albicans BV M.2% (37/105) reported the use of condoms. ** In menopausal woman 1 concurrent infection was founded so the total was bigger than the cases number of colonized diagnosis. The mean age of the participants was 32 years.47) 8 (7.57) 54 (51.6% (30/105) complained of gynaecological symptoms.3% (35/105) did not respond. vaginal discharge was the most frequent one (26.4 to 13/105%). redness or other signs of illness. 81% (85/105) had a monogamous relationship and only 2. the remaining 4. urealyticum Total** Cases n = 28 17 11 A 0 0 3 1 3 7 S 0 0 3 0 2 5 Total N (%) 105 (100) 51 (48. In 14 of these 21 cases symptoms were declared in the survey. only 35. painful intercourse in 2.61) 27 (25. BV was diagnosed in 21 cases. no cases of burning were declared and 33. On the other hand.6% (8/105) did not specify the reason. There were a total of 51 microbiologically healthy and 54 colonized women (Table 2). hominis U. trachomatis C. 31. urination pain only in one case (1. The division of asymptomatic (A) or symptomatic (S) was performed with basis of how the participant described herself as well as other symptomatology detected by the technician during the sampling such as discharge. 10. Table 2. Most women reported that their first incidence of sexual intercourse occurred before the age of 20: one participant first had sexual intercourse when she was under 10 years old.041) so in this population the early age of first sexual intercourse was a predisposing factor for developing some STI.9%) women reported having had more than six sexual partners. the number of sexual partners in the past was one or two in 61.302. contingency tables using Cramer's V (V) and chi square (p<0.8% (67/105) while 28. albicans BV M. Microbiol.50% (33/105) reported never using condom and 33.8% (4/105) between 26 and 30 years. most of them in the group of menarche women. 23.05). the rest 7. 3. urealyticum Total* Cases n = 77 34 43 A 4 2 4 2 4 16 S 7 6 11 3 18 45 Menopausal women Diagnosis Microbiologically healthy Infected C. hominis U.61) 21 (20) 8 (7.7 to 28/105%).3% (35/105) did not respond. Two groups were generated based on hormonal stadium in menarche women and menopausal ones. The average number of sexual partners was 3. Res.3% (25/105) presented two or more concurrent symptoms (Table 1). Among the women in this study.0% (21/105) declared having had three to four partners. followed by itching (12. pseudomicelium or other sign of infection was founded. The major reason of the participants for consultation was because they wanted to have a gynaecological check up 63. trachomatis C.8% (4/105) reported first having sexual intercourse between 11 and 15 years. The main characteristics of the studied population are shown in Table 1. and four (4.

The Gram stain smear was employed to perform BV diagnosis with Nugent´s score. 2011). 21 participants were diagnosed with BV. Accurate diagnosis of BV is important as it is associated with adverse pregnancy outcome. Additionally. Avila-Ríos et al. hominis was resistant to ERY4 (66. PCR was employed to test for N.. U. Finally. The BV frequency observed in our study (23. At least one STI or RTI was diagnosed in 51. urealyticum was resistant to OFL4. urealyticum and Candida spp.. this bacterium was concurrent with BV in 5 cases. M.. In Mexico. some studies have reported a BV prevalence of 12 to 25% in family clinics. Candida spp. from the 77 cases included in the normal group. Because BV increases women’s risk of medical complications as pelvic inflammatory disease or adverse pregnancy outcomes the high prevalence results displeasing. For this reason conventional and in house design NAAT were preferred at the present work. in three cases and concurrent infection with U. but were declared as cases of colonization not as active infections since no budding yeast. unprotected sex.76% each). they belonged to the same age group and were between the ages of 18 and 20 at the time of first sexual intercourse). trachomatis were detected in two cases (Table 2).43% of the study participants. and 32 to 64% in Sexually Transmitted Diseases (STD) clinics. The low frequency of complaints associated with STI or RTI in this group of women may be attributed to the false interpretation of physiological signs and symptoms as normal. M. ERY4 (14. 77 cases were declared as normal.3%). hominis was detected in eight cases and always concurrent with BV. Two asymptomatic participants with Candida were found. 2001). M. Interestingly most of the participants attended to the study because their desires a gynaecological check-up but no reports have any symptoms. In agreement with other authors the Nugent’s criteria demonstrating the usefulness for determination of BV in women (Livengood. mainly in patients with BV which was found in concurrence in nine cases with microorganisms such as G. Clinical findings were taken into consideration in each group. an intermediate Nugent´s score was found in association with G. 49 cases were symptomatic however the symptoms could be associated to other noninfectious pathologies. However. as mentioned before. vaginalis. number of sexual partners). positive Whiff test and/or clue cells in Gram stain smear. Currently the criteria as defined by Nugent et al. co-infection of U. In addition. urealyticum was detected in 27 cases mainly in menarche women.28%) and CIP2 (33. 2000.Hernández-Martínez et al. Although. but no cases of gonococcal cervicitis were detected.. C. AZI4 (66. According to this. trachomatis. trachomatis infection shared similar demographic characteristics with the uninfected patients (that is. nevertheless were declared with asymptomatic BV because they had abnormal vaginal flora (Nugent >7) accompanied of other altered signs such as pH.4%. C.8% in the general population) is similar to that reported in women presenting to healthcare services. (1991) are considered as the standard procedure to score vaginal smears by Gram stain. 2009).47%) from which four cases were of asymptomatic participants. This issue should be attended. None case of trichomoniasis was detected. DISCUSSION The diagnosis of genital infections among women in low income countries remains a major challenge. CIP2 (33. Kurewa et al. which allowed us to divide the participants (n = 105) in three groups according to the present vaginal flora. In the intermediate group (7 cases). 2011).61%) only in menarche women. meanwhile. urealyticum. and C. Marrazzo. 4 patients reported symptomatology and 3 were asymptomatic. urealyticum and C. when samples were taken the analyst observe abnormal vaginal or cervical discharge and swollen and redness areas. . probably by offering early screening and treatment in general population not only in order to prevent complications but also recurrent episodes (Ponce and Ronzón. trachomatis was present in 11 menarche women (10. 28 participants declared having no symptoms. gonorrhoeae infection in the subjects.. JOS8 and CLA4 (4.6%). 20. STI and other vaginal conditions primarily affect young women worldwide (Bañuelos-Pánuco et al. trachomatis in one case. there were 15 cases of co-infection between two or more pathogens microorganisms. 2009. hominis. albicans was founded in 8 cases (7. pseudomicelia or other sign of infection was founded. U. U. 2010. 7 cases as intermediate and 21 with BV. 2011) in most resource limited setting the high costs and technical requirements of commercial laboratory test make their routine use difficult and compromise STI control and management (Vickerman et al. 2003).g.52%). 2010. Marrazzo.. 31 any symptomatology. vaginalis and C. Participants with C. TET8 (9. earlier sexual debut. Health education should be directed to empower women to recognize symptoms and signs related to STI/RTI as early as possible (Araújo et al. BV is an endogenous infectious and remarkably prevalent condition in women occurring in up to 30% of the female population (Livengood. The survey was an attempt to review the presence of symptoms and riskier behaviour (e.6%) and CLA4 (33.3%). it should be considered that BV probably enhances women’s likelihood of sexual acquisition of HIV (Verstraelen et al. 2007).3%).

and even M. premature rupture of membranes. In the population analysed only C. Carey and Beagley. mainly associated with U. indicating the necessity of modifying recommended treatments. trachomatis. causing failures in patient recovery. Also. 2006. 2009). there are no previous studies of C. trachomatis infection should be included in all routine checkups or at least in checkups for women with high-risk behaviours (Paavonen and Eggert-Kruse. C. In addition to coinfection with multiple microorganisms. 2005.5% when population-level screening is implemented.g. Carey and Beagley. the number of cases detected can be increased from 29. Bébéar and de Barbeyrac. premature labour. J. It has been reported that genital mycoplasmas can be isolated from the cervix or vagina of 50-80% of sexually active women and. the commonest of which is Candida glabrata (Torulopsis glabrata).. 2006). According to the IST 2 gallery manufacturers.32 Afr. 2007). 2005. e.. Although non-gonococcal cervicitis is not a notifiable disease in Mexico. there is an official regulation (NOM039-SSA2-2002) that establishes a protocol for the diagnosis of an STI. urealyticum and less frequently with M. 2010. In the present two asymptomatic participants with Candida infection were found. to the less frequent asymptomatic Candida vaginal infection with positive microscopy and culture and the carrier state. 2009. 2009. which is generally only identified in patients showing symptoms of chronic infection (Paavonen and Eggert-Kruse. Shao et al. in which asymptomatic women without signs of disease and with negative routine microscopy are found to have positive vaginal yeast cultures (Sobel.. endometritis. BV and postpartum infections of mothers and newborns. an indicator of BV. Probably the most important challenge in vulvovaginitis Candida (VVC) diagnosis is to differentiate symptomatic Candida vulvovaginitis. it has been reported that genital mycoplasmas can be isolated from the cervix or vagina of 50 to 80% of sexually active women and. Nevertheless. Marrazzo. Other studies have provided significant evidence of the importance of routine screening for C. hominis has been previously reported (Livengood. these were declared as cases of colonization (carries state) not as active infections since no budding yeast. Baker et al. the vaginal environment is altered. 2010. 2007. pseudomicelia or other sign of infection was founded. 2008). in accordance with other authors. In a few cases U. allowing bacteria such as mycoplasmas to flourish. U.. we observed a 32% frequency of vaginitis. In this study. thus concurrent infection by G. 2008. 1999. Pavlin et al... mycoplasmas were frequently associated with other pathogenic microorganisms such as G. urealyticum had been the most frequently reported mycoplasma in these cases (Ponce and Ronzon 2001. Kechagia et al. another important issue in the diagnosis of genital mycoplasmas is their antibiotic susceptibility pattern. 2010). as in the present study. 2010. 2007. Bayraktar et al. urealyticum was present as a unique agent along with inflammatory cells. Castellano-González et al. trachomatis screening to 62. including gonococcal and nongonococcal cervicitis. However. hominis. but concentrations ≤104 CFU indicate that they are only as a part of the normal flora (Castellano-González et al. albicans was isolated. Castellano-González et al. vaginalis. 2010). Several studies have reported that 50% of chlamydial cervicitis cases manifest no symptoms of infection which agree with our results (Jalil et al. Pavlin et al. a result closer to data reported by the international community. urealyticum has been the most frequently reported mycoplasma in these cases (Ponce and Ronzón. U. These studies support our assertion that screening for C. Shao et al... Boel et al. In cases of BV... This concurs with literature´s description that between 85% and 95% of yeast strains isolated from the vagina belong to the species C.. Bayraktar et al. This is a quite important issue as newborns might get infected during childbirth with multidrug resistance genital micoplasmas leading to acute infections that may end up in death (CastellanoGonzález et al.. vaginalis. urealyticum. 2010) emphasising and reinforces the importance of routine screening for this bacteria. In general. Mycoplasmas infections are associated with urethritis.. U. Antibiotic susceptibility must be defined because of the previously reported high frequency of resistance. Kechagia et al. genital mycoplasmas are resistant to most of the antibiotics recommended for their treatment in the official Mexican guidelines. 2010. 2007). the genital mycoplasmas presence at a concentration of ≥104 CFU is sufficient to presume that they are involved as pathogens. the resistance profiles observed in this report are consistent with the findings of other Mexican studies. in Mexico. 2001.. 2011)..78% of the population tested.. Cultures have been the gold . In the present study. 1999. their aetiological role is widely controversial as colonization of the female genitourinary tract hinders evolution of these microorganisms as infectious agents. Microbiol. albicans while the remainder are non-albicans species. trachomatis infection was detected in 10. Res. The importance of identifying antibiotic-resistant strains is underlined by the fact that M.7% when testing patients who ask for C. Balfe et al. hominis resistance to erythromycin has been previously reported and was identified in a significant proportion of subjects in this study. as in the present study. trachomatis prevalence that screen general population. Ekiel et al. including mycoplasmas’ natural resistance to penicillin and cephalosporins because of their lack of a cell wall.. 2008. 2008.

reveal a high frequency of asymptomatic Chlamydia cervicitis and RTI as bacterial vaginosis. MG AGUILERA-ARREOLA and G CASTROESCARPULLI received COFAA. about the possible risks and consequences of not using protection against STI. but disadvantages. Avila-Ríos S. predominantly C. 2008). Sexually transmitted infections. The presence of concurrent infections has a direct impact on the course of treatment. Jalil et al. Ignatius R.. Franco SKL. Miralles I. Inst. The results obtained in this study regarding gonococcal cervicitis are consistent with the findings of several other studies (Flores-Paz et al. PLoS One. suggesting that this PCR method has wide utility. and candidiasis in women of reproductive age in rural Northeast Brazil: a populationbased study. Balfe et al. González-Hernández LA. 2010). G. 6: e27812. in the analysed population the results show false interpretation of physiological signs and symptoms as normal since low frequency of complaints associated with STI or RT. 2008). we found a frequent association of C. such as the time between collection of samples to culture.. Torres-Escobar I. have led to the widespread use of NAAT diagnostic methods. bacterial vaginosis. Pavlin et al. 2001. Ormsby CE. an in-house PCR assay for the detection of the N. as care must be taken to avoid treating only one microorganism while the other remains untreated (Pavlin et al. EDI. although the aetiological role of these bacteria is widely controversial a relevant issue is concern about their antibiotic susceptibility pattern. especially in Mexico. Hernández-Juan R. Finally. these molecular methods are not affordable for small laboratories and some hospitals. García-Morales C. trachomatis and M. a problem that has restricted their broad adoption. and efforts must be made to inform more Mexican women. ACKNOWLEDGEMENTS This investigation received financial support from SIP 20100629 and PICDS08-77 grants from Instituto Politécnico Nacional (IPN) and the Instituto de Ciencia y Tecnología del Distrito Federal (ICyT-DF). . Garrido-Rodríguez D. Feldmeier H (2007). In summary. and SNI support. the results obtained by PCR corroborated those obtained by culture. vaginalis and Candida spp. Further studies for a comprehensive understanding of the rates of these infections in Mexican women are necessary and should be an impulse for make community-based assessment of STI and RTI. hominis and/or U.. we did not observe any signs of inhibition when using DNA extracted from clinical samples. Pfleger V. Heukelbach J. Quiroz SA... World Health Organization recommends the use of the syndromic approach to the management of urethral discharge in men and vaginal discharge and lower abdominal pain in women. Oswaldo Cruz. Also high frequency also of genital mycoplasmas (U. respectively. 102:751-756. urealyticum. Lang K. trachomatis and other microorganisms such as M. Reyes-Terán G. Moreover. since newborns might get infected during childbirth with multidrug resistance genital micoplasmas leading to acute infections that may end up in death. While the syndromic approach appears to be satisfactory in men it has several important limitations in women mainly due that a large proportion of genital gonococcal and chlamydial infections are asymptomatic in women. where this infection is not a notifiable disease and the only information available is from individual reports. urealyticum and M. gonorrhoeae 16S rRNA gene was used (van Dyck et al. Mexican HIV Molecular Epidemiology Project Group (2011).. It is imperative to increase the awareness of the importance of protected sexual intercourse. as previous studies have demonstrated associations between C. In this study.Hernández-Martínez et al. hominis. Whiley et al... We believe that in-house PCR-based diagnosis not only accurately detects nutritionally fastidious microorganisms but also provides a more affordable technique for specific diagnosis. In the present study. the in house NAAT’s tested in the present work seems to viable tools for the cheap and reliable test for the diagnosis of gonorrhoea and chlamydial infections among women in developing countries. which points out the relevance of accurate diagnosis to provide an adequate treatment. 2006. National prevalence and trends of HIV transmitted drug resistance in Mexico. trachomatis with U. 2006. Stoffler-Meilicke M. 2006. Mem. urealyticum. We also examined the frequency of mixed infections. Chui et al. The development of cheap and reliable test for the diagnosis of gonorrhoea and chlamydial infections among women in developing countries could greatly improve STI control and the in house NAAT’s tested in the present work seems to viable tools for this purpose however it is necessary to continue testing and improving their diagnostic capabilities and accuracy in wide at high at risk population. U. Fraga F. Andrade-Villanueva J. 2003. 33 standard for diagnosis of gonococcal and nongonococcal cervicitis. trachomatis cervicitis infection. hominis) was founded. urealyticum. Navarro-Álvarez S. Unfortunately. Most cases of infertility related to microbial infections have been associated with multiple infections. More studies must be performed to improve the early diagnosis of bacterial STI in woman and other vulnerable populations (men who have sex with men or women who have sex with women). REFERENCES Araújo OF. There is still much to be learned about the risk factors for C.

Whiley DM. The laboratory diagnosis of bacterial vaginosis. 2:28-37. Androl. Vickerman P. Benzaken AS. Kurewa NE. Castellano-Gonzalez M. Deleón-Rodríguez I. Nugent RP. Pavlin NL. Mol. Mapingure MP. Ribeiro D. Reprod. Munjoma MW. Update 5:433-447. Sci. 24:1177-1181. Pattyn S. culture. J. Arriaga-Alba M (2003). Res. A comparison of three real-time PCR assays for the confirmation of Neisseria gonorrhoeae following detection of N. Incidence and antimicrobial susceptibilities of genital mycoplasmas in outpatient women with clinical vaginitis in Athens. Bras. Ronzón FJB (2001). Am. 63:576-586. BMC Infect. Egecioglu E. Tapsall JW. Prevalence and risk factors for Chlamydia trachomatis infection in female New Zealand university students. Fernández-Bravo M. J. Z. 10:81. Rincón-Villalobos G (2007). Richardson-Lopez CVL (2011). 823-838. Nucleic acid amplification testing for Neisseria gonorrhoeae: an ongoing challenge. Krohn MA. Hernández-Méndez JT. Van Dyck E. Gunn JM. O’Connoll E. Clin. Vaginal colonization by genital mycoplasmas in pregnant and non-pregnant women. J. 16:77-79. Hum. 29:297-301. 44:114-123. Centers for Disease Control and Prevention (2010). 14:473-479. Rev. The burden and risk factors of Sexually Transmitted Infections and Reproductive Tract Infections among pregnant women in Zimbabwe. Microbiol. 39:1751-1756. Rivera SR. J. Bañuelos-Pánuco CA. Brugha R. Martirosian G (2009). Infect. Poland. Dis. Shao R. Acta Cytol. Health 6:221. Oliveira EC. (eds) Sexually transmitted diseases. Van Damme L. Sobel DJ (2008). Dis. Moherdaui F. Dis. Bacterial Vaginosis: an Overview for 2009. Etiology of cervical vaginal infection among patients of the Juárez Hospital of Mexico. Infect. Vulvovaginal Candidiasis. Bébéar C. Hum. Clin. Stray-Pedersen B (2010). Beagley KW (2010). Chui L. J. Chemother. Ponce GG. Sex. Nitric oxyde synthases and tubal ectopic pregnancies induced by Chlamydia infection: basic and clinical insights. Infect. Invest. Infect. 118:U1607. Ortega-Benito J. MacDonald J. J. Mabey D. Korean Med. Friedek DA. Reyna-Figueroa J. 48:46-48. Celik O (2010). Verhelst R. Boel CH. Hocking J (2006). Garcia EG. Interpreting the epidemiology and natural history of bacterial vaginosis: are we still confused? Anaerobe 17:186-190. Balfe M. Ekiel AM. Verstraelen H. 12:59. Prevalence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in pregnant women. Rev. Bayraktar MR. Int. Jalil EM. Miranda-Murillo J. 30:614-619. Gucluer N. BMC Pub. The Mc Graw Hill companies. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. Antimicrob. Esparza-Aguilar M. Genital Chlamydia trachomatis infections. Sloots TP (2006). García-Jiménez E. Sexually transmitted diseases treatment guidelines 2010. Evaluation of conventional and real-time PCR assays using two targets for confirmation of results of the COBAS AMPLICOR Chlamydia trachomatis/Neisseria gonorrhoeae test for detection of Neisseria gonorrhoeae in clinical samples. Billig H (2010). Alary M. Norström A. Peeling RW (2003). Perozo-Mena A. Clin. Hillier SL (1991). Temmerman M (2010). In Holmes et al. Leven M. gonorrhoeae using Roche COBAS AMPLICOR. Marrazzo JM (2011). 8:3-15. MMWR RR. Microbiol. Microbiol.34 Afr. Reprod. Clin. Clin. Young women’s decisions to accept chlamydia screening: influences of stigma and doctor-patient interactions. Immunol. Jozviak J. Microbiol. Kechagia N. Rusakaniko S. Microbiol. Health 10:425. Diagn. BMC Infect. J. 15:4-10. Garret N. Fairley CK. Reprod. Schmitt CS (2008). CDC. pp. Med. Paavonen J. Barbosa MJ (2008). Vaneechoutte M. Leslie K. Rev. Eggert-Kruse W (1999). Mol. ReyesMaldonado E (2000). Gynecol. Microbiol. Genital studies: How to increase positivity. Chatzipanagiotou S (2008). Congenital syphilis. Occurence of Ureaplasma parvum and Ureaplasma urealyticum in women with cervical dysplasia in Katowice. Med. Asian J. Livengood CH (2009). Transm. Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by enzyme immunoassay. Sex. Chirenje MZ. Martínez-Guzmán LA. Fernández-Canton S. a hidden epidemic: Effects on female reproduction and options for treatment. Obstet. J. . Parker R. Carey AJ. United States of America. Ozerol IH. Flores-Paz R. J. 10:127. 10:110-114. 43:2231-2235. Baker M. Pathol. Dis. van Herk CM. O’Donovan D. J. Vaughan D (2010). 14:90-95. Weijdegard B. Prevalence of Chlamydia and Neisseria gonorrhoeae infections in pregnant women in six Brazilian cities. Global epidemiology of sexually transmitted diseases. a reemergent disease in Mexico: its epidemiology during the last 2 decades. Hernández-Hernández L del C. Infect. Detection of Chlamydia trachomatis in pregnant women by Papanicolaou technique. The epidemiology of bacterial vaginosis in relation to sexual behaviour. McNicholas A (2005). Romanik MK. Obstet. Mex. 79:363-367. Berretty PJ. Chlamydia trachomatis. Cniu T. Onland GH. Transm. Da Ros CT. Sensitivity requirements for the point of care diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae in women. Clin. Chlamydia trachomatis: impact on human reproduction. Zou S. and three nucleic acid amplification tests. Kakulphimp J. Akle-Fierro D. de Barbeyrac B (2009). Bersimis S. 16:907-915. Laga M (2001). Pinto VM. Van Den Brule AJC (2005). BMC Pub. Money D (2005). Watts C. Brännström M. Bromhead C. 38:798-801. Dis. Greece. Tyrrell GJ (2008). Alaña F. Gynecol. Implementing chlamydia screening: what do women think? A systematic review of the literature. Ginestre-Pérez M. 48:419-429. N. Zhang SX. J. 62:122-125. Salud Publica Mexico 45(5):694-697. enzyme immunoassay and polymerase chain reaction. Can. Clin. Microbiol.