Rev Med UAS
Vol. 14: No. 1. Enero-Marzo 2024
ISSN 2007-8013

Infecciones Vaginales: Un Problema de Salud Pública en México

Vaginal Infections: A Public Health Problem in Mexico

Omar Medina-de la Cruz1,2,3,*, Ana Sofia Romo-Báez1, Ruth Torres-Marceleño4, Lucía Guadalupe Tovar-Barrientos4, Marco Antonio Barajas-Mendiola5, Verónica Gallegos-García1, Luis Antonio Martínez-Gurrión1

  1. Facultad de Enfermería y Nutrición. Universidad Autónoma de San Luis Potosí.
  2. Hospital General de Zona No. 50. Instituto Mexicano del Seguro Social.
  3. Departamento de Atención a la Salud de la Infancia y la Adolescencia. Servicios de Salud de San Luis Potosí.
  4. Unidad de Cuidados Integrales e Investigación en Salud. Facultad de Enfermería y Nutrición. Universi-dad Autónoma de San Luis Potosí.
  5. Departamento de Biología. División de Ciencias Naturales y Exactas. Universidad de Guanajuato.

*Autor de correspondencia:Omar Medina de la Cruz.
Facultad de Enfermería y Nutrición. Universidad Autónoma de San Luis Potosí.
Niño Artillero No. 130, Zona Universitaria. C.P. 78290. San Luis Potosí, S.L.P. México.
e-mail: omar.medina@uaslp.mx

DOI http://dx.doi.org/10.28960/revmeduas.2007-8013.v14.n1.009

Texto Completo PDF

Recibido 19 de marzo 2023, aceptado 09 de noviembre 2023

RESUMEN
Las infecciones vaginales son el resultado de la alteración de un ecosistema dinámico entre bacterias, arqueas, hongos, virus y protistas que conforman la microbiota del epitelio vaginal, que al perder la homeostasis se produce la disbiosis vaginal. Las infecciones que se originan de manera más común son la candidiasis vulvovaginal, tricomoniasis y vaginosis bacteriana. Algunas de sus características clínicas que presentan, son la alteración de las secreciones y en el Potencial de Hidrógeno (pH) vaginal, inflamación, prurito, eritema y hallazgos microscópicos originados por el agente etiológico, por lo que cobra importancia el diagnostico citológico para establecer un tratamiento específico. Entre los factores de riesgo para el desarrollo de las infecciones encontramos: cambios hormonales y de pH vaginal, falta de higiene, ropa ajustada, lesiones en tejidos pélvicos, entre otros. El presente trabajo tiene como propósito describir los principales agentes causales, factores de riesgo, cuadro clínico y diagnóstico de las infecciones vaginales más comunes actualmente.
Palabras Clave: Microbiota, disbiosis vaginal, vaginosis

ABSTRACT
Vaginal infections are the outcome of disturbance of the dynamic ecosystem between bacteria, archaea, fungi, viruses, and protozoa that are part of the vaginal microbiota, when the homeostasis is lost, vaginal dysbiosis occurs. Vulvovaginal candidiasis, trichomoniasis, and bacterial vaginosis are the most common vaginal infections. Disturbance in the vaginal secretions and pH, inflammation, pruritus, erythema, and microscopic findings are relevant for the cytological diagnosis to establish specific treatments. Risk factors that induce the development of vaginal diseases are hormonal changes, vaginal pH, poor hygiene, tight clothes, and pelvic tissue injuries. The present work aims to describe the main causal agents, risk factors, clinical picture, and diagnosis of the most common of vaginal infections.
Keywords: microbiota, vaginal dysbiosis, vaginosis

Referencias

  1. Konadu DG, Owusu-Ofori A, Yidana Z, Iddrisu OF, Adu-Gyasi D, Dosoo D, et al. Prevalence of vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis in pregnant women attending antenatal clinic in the middle belt of Ghana. BMC Preg Child 2019;19:341.
  2. Bignoumba M, Moghoa KHM, Muandze-Nzambe JU, Kassa-Kassa RF, Mouanga-Ndzime Y, Gafou A, et al. Vaginal Infections; Etiologies in South-Eastern Gabon; An Overview. Int J Womens Health 2022;14:505-515.
  3. Jansåker F, Frimodt-Møller N, Li X, Sundquist K. Novel risk factors associated with common vaginal infections: a nationwide primary health care cohort study. Int J Infect Dis 2022;116:380-386.
  4. Gajer P, Brotman RM, Bai G, Sakamoto J, Schütte UM, Zhong X, et al. Temporal dynamics of the human vaginal microbiota. Sci Transl Med 2012;4(132):132ra52.
  5. Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SS, McCulle SL, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci 2011 15;108:4680-7.
  6. Ceccarani C, Foschi C, Parolin C, D'Antuono A, Gaspari V, Consolandi C, et al. Diversity of vaginal microbiome and metabolome during genital infections. Sci Rep 2019 ;9(1):14095.
  7. Gilbert GG, Donders EB, Dekeersmaecker A, Vereecken A, Van Bulck B, Spitz B. Pathogenesis of abnormal vaginal bacterial flora. Am J Obstet Gynecol 2000; (182): 4.
  8. Sánchez-Hernández JA, González-Belén L, Rojas-Valderrama K, Muñoz-Zurita G. Prevalencia de Candida albicans y su relación con cambios en el pH vaginal. Aten Fam 2017;24(1):18-22.
  9. Tarry W, Fisher M, Shen S, Mawhinney M. Candida albicans: the estrogen target for vaginal colonization. J Surg Res 2005;129(2):278-282.
  10. González-Pedraza A, Ortiz-Zaragoza C, Dávila-Mendoza R, Valencia-Gómez CM. Infecciones cervicovaginales más frecuentes: prevalencia y factores de riesgo. Rev Cuba Obstet Ginecol 2007;33(2).
  11. Fischer G, Bradford J. Vulvovaginal candidiasis in postmenopausal women: the role of hormone replacement therapy. J Low Genit Tract Dis 2011;15(4):263-267.
  12. Dirección General de Epidemiología. Anuarios de Morbilidad 1984-2022. Revisado el 8 de febrero de 2023, Disponible en: https://epidemiologia.salud.gob.mx/anuario/html/index.html
  13. Abdul-Aziz M, Mahdy MAK, Abdul-Ghani R, Alhilali NA, Al-Mujahed LKA, Alabsi SA, et al. Bacterial vaginosis, vulvovaginal candidiasis and trichomonal vaginitis among reproductive-aged women seeking primary healthcare in Sana’a city, Yemen. BMC Infect Dis 2019; 879.
  14. Martínez-Ibarra MR, Medina-de la Cruz O, Gallegos-García V. La microbiota vaginal y su relación en el desarrollo de neoplasia intraepitelial cervica. Rev Mex Enf Card 2022; 29 (3).
  15. Machado A, Foschi C, Marangoni A. Vaginal dysbiosis and biofilms. Front Cell Infect Microbiol 2022;12.
  16. Han Y, Liu Z, Chen T. Role of Vaginal Microbiota Dysbiosis in Gynecological Diseases and the Potential Interventions. Front Microbiol 2021;12:643422.
  17. Wu S, Hugerth LW, Schuppe-Koistinen I, Du J. The right bug in the right place: opportunities for bacterial vaginosis treatment. Npj Biofilms Microbiomes 2022;8(1):1-11.
  18. Khedkar R, Pajai S. Bacterial Vaginosis: A Comprehensive Narrative on the Etiology, Clinical Features, and Management Approach. Cureus 14(11):e31314.
  19. Deese J, Pradhan S, Goetz H, Morrison C. Contraceptive use and the risk of sexually transmitted infection: systematic review and current perspectives. Open Access J Contracept 2018;9:91-112.
  20. Coughlin G, Secor M. Bacterial vaginosis: update on evidence-based care. Adv Nurse Pract 2010;18(1):41-44, 53.
  21. Cerca N. Addressing the challenges with bacterial vaginosis pharmacotherapy. Expert Opin Pharmacother 2023;24(1):11-13.
  22. Bradshaw CS, Sobel JD. Current Treatment of Bacterial Vaginosis-Limitations and Need for Innovation. J Infect Dis 2016;214.
  23. Hösükoğlu FG, Ekşi F, Erinmez M, Uğur MG. An Epidemiologic Analysis of Vulvovaginal Candidiasis and Antifungal Susceptibilities. Infect Microbes Dis 2022;4(3):131.
  24. Donders G, Sziller IO, Paavonen J, Hay P, de Seta F, Bohbot JM, et al. Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion. Front Cell Infect Microbiol 2022; 12:934353.
  25. Cetin M, Ocak S, Gungoren A, Ulvi Hakverdi A. Distribution of Candida species in women with vulvovaginal symptoms and their association with different ages and contraceptive methods. Scand J Infect Dis 2007;39(6-7):584-588.
  26. Paterniti I, Casili G, Filippone A, Lanza M, Ardizzone A, Capra AP, et al. A New Approach for the Treatment of Recurrent Vulvovaginal Candidiasis with a Combination of Pea Protein, Grape Seed Extract, and Lactic Acid Assessed In Vivo. J Fungi 2022;8(12):1251.
  27. Jiménez JC, Garro ÁRG, Trabado SJT. Generalidades de la candidiasis vulvovaginal. Rev Medica Sinerg 2023;8(3):e924-e924.
  28. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infec Dis 2016; 62 (4): e50.
  29. Farr A, Effendy I, Frey TB, Hof H, Mayser P, Petricevic L, et al. Guideline: Vulvovaginal candidosis. Mycoses 2021 ;64(6):583-602.
  30. Velázquez-Hernández N, Sánchez-Anguiano LF, Lares-Bayona EF, Cisneros-Pérez V, Milla-Villeda RH, Arreola-Herrera FA, et al. Comparación de la utilidad diagnóstica entre la inspección visual con ácido acético y la citología cervical. Ginecol Obstet Mex 2010:7.
  31. Abraham E, Fairley CK, Denham I, Bradshaw CS, Farquharson RM, Vodstrcil LA, et al. Positivity and Risk Factors for Trichomonas vaginalis Among Women Attending a Sexual Health Clinic in Melbourne, 2006 to 2019. Sex Transm Dis 2022;49(11):762.
  32. Zhu X, Liu L, Yixi L, Yang Y, Zhang Y, Yang Z, et al. The prevalence and risk factors of Trichomonas vaginalis in Wuhan and the Tibetan area, China: a two-center study. Parasitol Res 2023;122(1):265-273.
  33. Divakaruni AK, Mahabir B, Orrett FA, Rao AS, Srikanth A, Chattu VK, et al. Prevalence, clinical features, and diagnosis of Trichomonas vaginalis among female STI clinic attendees in Trinidad. J Fam Med Prim Care 2018;7(5):1054.
  34. Cenkowski M, Wudel B, Poliquin V. Vaginal trichomoniasis. CMAJ Can Med Assoc J 2022;194(6):E217.
  35. Ambrozio CL, Nagel AS, Jeske S, Bragança GCM, Borsuk S, Villela MM. Trichomonas vaginalis: prevalence and risk factors for women in southern brazil. Rev Inst Med Trop São Paulo 2016;58:61.
  36. Jasek E, Chow EP, Ong JJ, Bradshaw CS, Chen MY, Hocking JS, et al. Sexually Transmitted Infections in Melbourne, Australia from 1918 to 2016: nearly a century of data. Commun Dis Intell Q Rep 2017;41(3):E212-E222.
  37. Muzny CA, Van Gerwen OT, Legendre D. Secnidazole: a treatment for trichomoniasis in adolescents and adults. Expert Rev Anti Infect Ther 2022; 20:8, 1067-1076.
  38. Sim M, Logan S, Goh LH. Vaginal discharge: evaluation and management in primary care. Singapore Med J 2020;61(6):297.
  39. Amabebe E, Anumba DOC. Psychosocial Stress, Cortisol Levels, and Maintenance of Vaginal Health. Front Endocrinol 2018;9.
  40. Tachedjian G, Aldunate M, Bradshaw CS, Cone RA. The role of lactic acid production by probiotic Lactobacillus species in vaginal health. Res Microbiol 2017; 168 (10).
  41. Lin YP, Chen WC, Cheng CM, Shen CJ. Vaginal pH Value for Clinical Diagnosis and Treatment of Common Vaginitis. Diagnostics 2021;11(11):1996.
  42. Amabebe E, Anumba DOC. The Vaginal Microenvironment: The Physiologic Role of Lactobacilli. Front Med 2018;5:181.
  43. O’Hanlon DE, Moench TR, Cone RA. Vaginal pH and Microbicidal Lactic Acid When Lactobacilli Dominate the Microbiota. PLoS ONE 2013;8(11):e80074.
  44. O’Hanlon DE, Moench TR, Cone RA. In vaginal fluid, bacteria associated with bacterial vaginosis can be suppressed with lactic acid but not hydrogen peroxide. BMC Infect Dis 2011;11:200.
  45. Miller EA, Beasley DE, Dunn RR and Archie EA (2016) Lactobacilli Dominance and Vaginal pH: Why Is the Human Vaginal Microbiome Unique? Front. Microbiol. 7:1936.
  46. Buscemi L, Arechavala A, Negroni R. Study of acute vulvovaginitis in sexually active adult women, with special reference to candidosis, in patients of the Francisco J. Muñiz Infectious Diseases Hospital. Rev Iberoam Micol 2004;21(4):177-181.
  47. Lahti E, Vuopala S, Kauppila A, Blanco G, Ruokonen A, Laatikainen T. Maturation of vaginal and endometrial epithelium in postmenopausal breast cancer patients receiving long-term tamoxifen. Gynecol Oncol 1994;55(3 Pt 1):410-414.
  48. Smeekens SP, van de Veerdonk FL, Kullberg BJ, Netea MG. Genetic susceptibility to Candida infections. EMBO Mol Med 2013;5(6):805-813.
  49. Muzny CA, Schwebke JR. Asymptomatic Bacterial Vaginosis: To Treat or Not to Treat? Curr Infect Dis Rep 2020;22(12):32.
  50. Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983;74(1):14-22.
  51. Disha T, Haque F. Prevalence and Risk Factors of Vulvovaginal Candidosis during Pregnancy: A Review. Infect Dis Obstet Gynecol 2022:e6195712.
  52. Disha T, Haque F. Prevalence and Risk Factors of Vulvovaginal Candidosis during Pregnancy: A Review. Infect Dis Obstet Gynecol. 2022 Jul 20;2022:6195712.
  53. Felix TC, de Araújo LB, Röder DVD de B, Pedroso R dos S. Evaluation of Vulvovaginitis and Hygiene Habits of Women Attended in Primary Health Care Units of the Family. Int J Womens Health 2020;12:49-57.
  54. Czerwinski BS. Variation in feminine hygiene practices as a function of age. J Obstet Gynecol Neonatal Nurs JOGNN 2000;29(6):625-633.
  55. Michelin SR, Marchi JG, Hyeda IS, Heidemann ITSB, Nitschke RG. Percepção das mulheres sobre promoção da saúde durante a consulta de enfermagem. Ciênc Cuid Saúde 2015:901-909.
  56. Elegbe IA, Botu M. A preliminary study on dressing patterns and incidence of candidiasis. Am J Public Health 1982;72(2):176-177.
  57. Moon SG, Kim SH, Lee HJ, Moon MH, Myung JS. Pelvic Fistulas Complicating Pelvic Surgery or Diseases: Spectrum of Imaging Findings. Korean J Radiol 2001;2(2):97-104.
  58. Zeng X, Zhang Y, Zhang T, Xue Y, Xu H, An R. Risk Factors of Vulvovaginal Candidiasis among Women of Reproductive Age in Xi’an: A Cross-Sectional Study. BioMed Res Int 2018;2018:9703754.
  59. Singh J, Mumford SL, Pollack AZ, et al. Tampon use, environmental chemicals and oxidative stress in the BioCycle study. Environ Health 2019;18(1):11.
  60. Hoffmann JN, You HM, Hedberg EC, Jordan JA, McClintock MK. Prevalence of bacterial vaginosis and Candida among postmenopausal women in the United States. J Gerontol B Psychol Sci Soc Sci 2014;69:S205-14.
  61. Brotman RM, Shardell MD, Gajer P, Fadrosh D, Chang K, Silver MI, Viscidi RP, Burke AE, Ravel J, Gravitt PE. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause 2014 May;21(5):450-8.
  62. Maria C, Zahra R, Sara P. Prevalence of Cervical-Vaginal Infections in the Pap-Smear Samples in Iran. Glob J Health Sci 2014;6(1):201-206.
  63. Nokiani FA, Akbari H, Rezaei M, Madani H, Ale Agha ME. Cost--effectiveness of pap smear in Kermanshah, Iran. Asian Pac J Cancer Prev APJCP. 2008;9(1):107-110.
  64. Giuliano C, Patel CR, Kale-Pradhan PB. A Guide to Bacterial Culture Identification And Results Interpretation. P T 2019;44(4):192-200.