This document only includes an excerpt of the corresponding thesis or dissertation. To request a digital scan of the full text, please contact the Ruth Lilly Medical Library's Interlibrary Loan Department (rlmlill@iu.edu).

Ungdomar genomgår en mognadsprocess innehållande ett flertal viktiga faktorer i dagens samhälle. Utvecklingen består av att bli självständig, forma personligheten, hantera känslor samt hantera sexualitet. I detta ingår att skydda sig mot den sexuellt överförbara infektionen Chlamydia trachomatis (CT). Syftet med studien var att beskriva gymnasieungdomars uppfattning om infektionen. Hur är kunskapen i ämnet? På vilket sätt tror de att ungdomar skyddar sig? Hur ser de på kärlek och sexualitet? Författarna har valt en kvalitativ ansats med fokusgrupps intervjuer och analyserat resultatet enligt innehållsanalys. Fyra intervjuer har utförts där två flickgrupper respektive två pojkgrupper medverkat. Fyra teman förekommer i resultatet; Uppfattning och kunskap kring att drabbas av CT, uppfattning om sex och kärlek, attityder till skydd samt sexualundervisning. Resultatet visar likheter och skillnader hos flickor och pojkar i författarnas intervjuer. Kunskap om CT varierar, men att konsekvensen av en obehandlad CT kan leda till infertilitet hade samtliga ungdomar kunskap om. Även psykologiska aspekter framkommer. Resultatet speglar skillnader gällande sex och kärlek. Det första samlaget är en ”milstolpe” enligt pojkarna medan flickor anser att det hör ihop. Skydd förknippas med ”lathet” och skydd mot oönskad graviditet, inte skydd mot CT. / Youths are going through a growing process involving many different factors.  The development consists of becoming independent, shape personality, handle feelings and sexuality.  This includes protecting yourself against the sexually transmitted disease, Chlamydia trachomatis (CT). The purpose of this study was to describe upper secondary school youths knowledge and understanding of the infection. How is the knowledge in the subject? In what way do they think youths protect themselves? What are their views about love and sexuality? The authors have chosen a qualitative approach with interviews in focus groups. The data was analyzed with content analyse. Four interviews have been done, where two groups of girls and two groups of boys participated. Four themes exist in the results; knowledge and understanding of CT, understanding of sex and love, attitudes towards protection and sexual education. The result shows similarities and differences between boys and girls in the interviews. The knowledge about CT fluctuates, but the knowledge about that a not treated CT can give rise to infertility did the group knowledge about. Even psychological aspects appear. The result reflects differences about sex and love. The first intercourse is a "milestone" according to the boys whereas the girls have the opinion that it belongs together. Protection is put together with "laziness" and unplanned pregnancy, not protection against CT.

<p>Ungdomar genomgår en mognadsprocess innehållande ett flertal viktiga faktorer i dagens samhälle. Utvecklingen består av att bli självständig, forma personligheten, hantera känslor samt hantera sexualitet. I detta ingår att skydda sig mot den sexuellt överförbara infektionen Chlamydia trachomatis (CT). Syftet med studien var att beskriva gymnasieungdomars uppfattning om infektionen. Hur är kunskapen i ämnet? På vilket sätt tror de att ungdomar skyddar sig? Hur ser de på kärlek och sexualitet? Författarna har valt en kvalitativ ansats med fokusgrupps intervjuer och analyserat resultatet enligt innehållsanalys. Fyra intervjuer har utförts där två flickgrupper respektive två pojkgrupper medverkat. Fyra teman förekommer i resultatet; Uppfattning och kunskap kring att drabbas av CT, uppfattning om sex och kärlek, attityder till skydd samt sexualundervisning. Resultatet visar likheter och skillnader hos flickor och pojkar i författarnas intervjuer. Kunskap om CT varierar, men att konsekvensen av en obehandlad CT kan leda till infertilitet hade samtliga ungdomar kunskap om. Även psykologiska aspekter framkommer. Resultatet speglar skillnader gällande sex och kärlek. Det första samlaget är en ”milstolpe” enligt pojkarna medan flickor anser att det hör ihop. Skydd förknippas med ”lathet” och skydd mot oönskad graviditet, inte skydd mot CT.</p> / <p> </p><p>Youths are going through a growing process involving many different factors.  The development consists of becoming independent, shape personality, handle feelings and sexuality.  This includes protecting yourself against the sexually transmitted disease, Chlamydia trachomatis (CT). The purpose of this study was to describe upper secondary school youths knowledge and understanding of the infection. How is the knowledge in the subject? In what way do they think youths protect themselves? What are their views about love and sexuality? The authors have chosen a qualitative approach with interviews in focus groups. The data was analyzed with content analyse. Four interviews have been done, where two groups of girls and two groups of boys participated. Four themes exist in the results; knowledge and understanding of CT, understanding of sex and love, attitudes towards protection and sexual education. The result shows similarities and differences between boys and girls in the interviews. The knowledge about CT fluctuates, but the knowledge about that a not treated CT can give rise to infertility did the group knowledge about. Even psychological aspects appear. The result reflects differences about sex and love. The first intercourse is a "milestone" according to the boys whereas the girls have the opinion that it belongs together. Protection is put together with "laziness" and unplanned pregnancy, not protection against CT.</p>

Orientador: Paulo César Giraldo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T17:07:18Z (GMT). No. of bitstreams: 1 Andrade_ElisaTomazzini_M.pdf: 2783793 bytes, checksum: 73e44a9ff1fd74358814f080307a0b58 (MD5) Previous issue date: 2012 / Resumo: Introdução: A importância da infecção por Chlamydia trachomatis não está relacionada apenas à sua elevada frequência, mas principalmente pelas graves repercussões no aparelho genital feminino. Apenas 30% das pacientes infectadas apresentam sintomas e só 40% terão sinais que possam evidenciar sua presença. Cerca de 70% dos casos de infecção por Chlamydia trachomatis são assintomáticos e acabam não sendo diagnosticados, havendo, portanto a necessidade de programa de rastreamento para diagnóstico e tratamentos precoces, o qual não existe no Brasil. Objetivo: Avaliar custo-efetividade do rastreamento por biologia molecular (captura híbrida) para Chlamydia trachomatis em mulheres brasileiras sexualmente ativas. Desenho do estudo: Estudo de custo-efetividade. A decisão de rastrear Chlamydia trachomatis foi estruturada a partir de uma coorte hipotética de 10.000 mulheres sexualmente ativas com idade entre 15 e 25 anos. O horizonte de tempo trabalhado no modelo de Markov foi de 10 anos e foi realizada a análise de prevalência e probabilidades de transição interestados de saúde a partir de revisão de dados já publicados obtidos nas bases de dados Medline, Embase, LILACS, Cochrane Controlled Trial Register. Resultados: A simulação do rastreamento da infecção por Chlamydia trachomatis por biologia molecular (Captura Híbrida) em população geral entre 15 e 25 anos, acarreta a redução de 2.072 casos de sequelas (Dor Pélvica Crônica, Gravidez Ectópica e Infertilidade de causa tubária) em 10.000 mulheres, ao custo de R$917,00 por caso de sequela evitado. Conclusão: A análise demonstrou uma boa relação de custo-efetividade considerando a estratégia de evitar sequelas de infecção por Chlamydia trachomatis não diagnosticada clinicamente e tratada através de rastreamento por biologia molecular / Abstract: Introduction: The importance of Chlamydia trachomatis is not only related to its high frequency, but mainly to the severe repercussion on the female reproductive system. Only 30% of infected patients presented symptoms and only 40% will have a sign that could show its presence. About 70% of these cases are asymptomatic and will be not diagnosed, so there is a need for a specific program that will track patients at the time of diagnosis and their early treatment period. It is clear that this program does not exist in Brazil. Objective: To evaluate the cost effectiveness of tracking Chlamydia trachomatis on sexually active women through a simulation of a tracking program that could be applied to the Brazilian population. Study design: Cost effectiveness study. The decision of tracking Chlamydia trachomatis was structured by a hypothetical cohort of 10.000 sexually active women aged up to 25 years. The working time horizon was 10 years on the Markov model and the prevalence analysis was made with the data revision of already published data (secondary data analysis) obtained on databases, using web sites such as Medline, Embase, LILACS, Cochrane Controlled Trial Register. Results: The simulation of Chlamydia trachomatis screening by molecular biology (Hybrid Capture) in the general population aged between 15 and 25 causes a reduction of 2,072 cases of sequelae (chronic pelvic pain, ectopic pregnancy and tubal infertility cause) in 10,000 women, at a cost of R$917.00 per case of sequelae. Conclusion: The analysis shows the strategy of avoiding sequelae of Chlamydia trachomatis using molecular biology to screen the population at risk to be cost-effective / Mestrado / Fisiopatologia Ginecológica / Mestre em Ciências da Saúde

Bacterial infection of mucosal epithelial cells triggers cell exfoliation to limit the dissemination of infection within the tissue. Therefore, mucosal pathogens must possess strategies to counteract cell extrusion in response to infection. Chlamydia trachomatis L2 spends most of its intracellular development in the non-infectious form, and premature extrusion of the host cell is detrimental to the pathogen. Here I show that Chlamydia trachomatis L2-infected cells exhibited increase adhesion as demonstrated by increased resistance to detachment by mild trypsinization. In addition, I observed an increase in the number and size of the focal adhesions of the Chlamydia trachomatis L2-infected cells. I demonstrated that this phenotype was not exclusive of C. trachomatis serovar L2 and that it was not restricted to a single type of cell line. Quantitative confocal and live-cell TIRF microscopy revealed that this bacterium actively modulated host cell focal adhesions by enhancing their stability. Infection conferred resistance to disassembly upon inhibition of myosin II or ROCK1 activity. Furthermore, I was able to demonstrate that the Chlamydia trachomatis effector TarP is able to colocalize to the sites of focal adhesions when ectopically expressed in mammalian cells. This resulted in increased number of the host cell focal adhesions. TarP was also able to confer resistance to myosin II inhibition, in a VBD-dependent manner. Also, I have found that C. trachomatis transmembrane protein CT228 cooperates with TarP to confer resistance to ROCK1 inhibition. Super resolution microscopy revealed a reorganisation of focal adhesions in Chlamydia trachomatis L2-infected cells. In summary, this work shows for the first time that Chlamydia trachomatis L2 uses TarP and CT228 to modulate the host cell focal adhesions. Finally, I have also described that both Chlamydia trachomatis L2 and TarP are able to alter the nanoscale architecture, this has never been reported in any other system.

Chlamydia trachomatis infection targets the mucosal epithelium, where squamous and columnar epithelia can be found. Research on Chlamydia trachomatis-epithelia interaction has predominantly focused on columnar epithelia, with very little known on how Chlamydia trachomatis interacts with the squamous epithelium. The stratification and differentiation processes found in the squamous epithelium might influence chlamydial growth and infection dissemination. For this reason, 3D stratified squamous epithelial cultures were adapted to mimic the stratified squamous epithelium, and chlamydial infection was characterized. Chlamydia trachomatis infection in monolayers and 3D cultures were monitored by immunofluorescence and transmission electron microscopy to characterize inclusion growth and chlamydial interconversion between elementary and reticulate body. We observed that the stratified epithelium varied in susceptibility to Chlamydia trachomatis infection. The undifferentiated basal cells were susceptible to infection, while the terminally differentiated upper layers were resistant. If given access to the basal layer Chlamydia trachomatis is able to disseminate and disrupt the epithelial. This disruption have clinical relevance, such as facilitating secondary infection by other STIs. The use of a punch biopsy in 3D cultures revealed that infected samples were unable to close the wound as efficiently as the mock-infected sample. A simplified 2D wound healing assay confirmed these observations. Additionally, this correlated with a reorganization of hemidesmosomes in Chlamydia trachomatis-infected cells but, most importantly, in bystander uninfected cells within the infected sample. The lack of motility and the hemidesmosomes reorganization was shown to be dependent on myosin II contractility and the chlamydial protein CTL0480. This chlamydial protein recruits MYPT1 to the inclusion membrane, which could potentially prevent the cell from controlling the actomyosin tension. In summary, this is the first study to use a 3D stratified epithelial to determine how Chlamydia interacts with this physiologically relevant tissue. Most importantly, this work demonstrates that Chlamydia trachomatis is able to alter the organization of hemidesmosomes which has never been reported for any other bacterial pathogen.

Chlamydia trachomatis is an obligate intracellular pathogen that replicates inside a vacuole, the so-called inclusion. During replication by a biphasic life-cycle Chlamydia secrete via their type 3 secretion system various effector proteins into the inclusion lumen, the inclusion membrane or the host cell cytosol to form their favored replication niche. Chlamydia-infected cells are highly resistant against apoptosis since the replicative form of Chlamydia is non-infectious and premature cell death would cause complete loss of one Chlamydia generation. The bacteria block apoptosis by preventing mitochondrial outer membrane permeabilization. Various proteins with anti-apoptotic function are enriched in Chlamydia-infected cells such as Mcl-1, cIAP2, Survivin or HIF1α. The accumulation of these proteins is a result of increased gene expression and direct protein stabilization. However, the molecular mechanisms and involved bacterial effector proteins are mostly unknown. With this work the molecular mechanisms of Mcl-1 stabilization and the participation of chlamydial factors were investigated. Mcl-1 is a member of the Bcl-2 protein family and has an extremely short half-life causing its permanent ubiquitination and subsequent degradation by the 26S proteasome under normal homeostasis whilst Mcl-1 accumulation results in apoptosis inhibition. It was shown that during C. trachomatis infection Mcl-1 ubiquitination is reduced causing its stabilization albeit no cellular ubiquitin-proteasome-system components are involved in this process. However, C. trachomatis express the two deubiquitinases ChlaDUB1 and ChlaDUB2 which are mostly uncharacterized. With this work the expression profile, subcellular localization, substrates and function of the deubiquitinases were investigated. It was shown that ChlaDUB1 is secreted to the surface of the inclusion where it interacts with Mcl-1 which is accumulated in the proximity of this compartment. By utilization of infection experiments, heterologous expression systems and in vitro experiments a direct interaction of ChlaDUB1 and Mcl-1 was demonstrated. Furthermore, it was shown that Mcl-1 is deubiquitinated by ChlaDUB1 causing its stabilization. During replicative phase of infection, ChlaDUB2 seems to be accumulated in the chlamydial particles. However, ChlaDUB2 substrates could not be identified which would give an indication for the physiological role of ChlaDUB2. Since 2011, a protocol to transform C. trachomatis with artificial plasmid DNA is available. As part of this work the transformation of C. trachomatis with plasmid DNA suitable for the permanent or inducible protein overexpression on a routinely basis was established. In addition, the first targeted homologous recombination into the chlamydial genome to replace the ChlaDUB1 gene by a modified one was performed and validated. The targeted homologous recombination was also used to create a ChlaDUB1 knock-out mutant; however deletion of ChlaDUB1 seems to be lethal for C. trachomatis. Due to the fact that ChlaDUB1-lacking Chlamydia could not be obtained an inhibitor screen was performed and identified CYN312 as a potential ChlaDUB1 inhibitor. Application of CYN312 during infection interfered with chlamydial growth and reduced Mcl-1 quantity in infected cells. Furthermore, CYN312 treated Ctr-infected cells were significantly sensitized for apoptosis. Taken together, C. trachomatis secretes the deubiquitinase ChlaDUB1 to the surface of the inclusion where it deubiquitinates Mcl-1 causing its accumulation in infected cells resulting in apoptosis resistance. Application of the ChlaDUB1 inhibitor CYN312 interferes with Mcl-1 stabilization sensitizing infected cells for apoptosis. / Chlamydia trachomatis ist ein obligat intrazelluläres Bakterium, welches sich in einer Vakuole, der sogenannten Inclusion vermehrt. Chlamydien durchlaufen einen zweiphasigen Entwicklungszyklus während welchem sie zu bestimmten Zeitpunkten der Infektion Effektorproteine mittels ihres Typ 3 Sekretionssystems in das Inclusionslumen, die Inclusionsmembran oder das Wirtszellzytoplasma sekretieren. Durch die Aktivität der Effektorproteine schaffen die Chlamydien die für sie favorisierten Bedingungen. Zusätzlich zeigen infizierte Zellen eine hohe Resistenz gegenüber Apoptose. Ein vorzeitiger Zelltod der Wirtszelle würde zum Verlust einer vollständigen Generation an Chlamydien führen, da die replizierende Form der Chlamydien nicht infektiös ist. Chlamydien hemmen die Wirtszellapoptose indem sie die Permeabilisierung der äußeren Mitochondrienmembran verhindern. Es ist bekannt, dass mehrere anti-apoptotische Proteine wie Mcl-1, cIAP2, Survivin oder HIF1α während der Infektion mit Chlamydien zu bestimmten Zeitpunkten angereichert werden und für die Apoptoseinhibition wichtig sind. Allerdings sind die molekularen Mechanismen sowie die beteiligten bakteriellen Proteine weitestgehend unbekannt. Mit dieser Arbeit wurden die molekularen Mechanismen der Mcl-1 Stabilisierung sowie die darin involvierten chlamydialen Proteine untersucht. Mcl-1, ein Mitglied der Bcl-2 Proteinfamilie, ist ein extrem instabiles Protein welches unter normalen Bedingungen permanent ubiquitiniert und vom 26S Proteasom abgebaut wird; eine Anreicherung von Mcl-1 hingegen führt zur Apoptoseinhibierung. In dieser Arbeit konnte gezeigt werden, dass während der Chlamydieninfektion Mcl-1 weniger ubiquitiniert wird was dessen Stabilisierung zur Folge hat. Es konnte jedoch keine Beteiligung von Komponenten des zellulären Ubiquitin-Proteasom-Systems festgestellt werden. C. trachomatis exprimiert zwei Deubiquitinasen welche weitestgehend uncharakterisiert sind. Ein weiteres Ziel dieser Arbeit war es das Expressionsprofil, die Lokalisierung, Substrate und die Funktion der Deubiquitinasen zu untersuchen. Es konnte gezeigt werden, dass ChlaDUB1 zur Oberfläche der Inclusion sekretiert wird und dort mit Mcl-1 interagiert, welches in diesem Kompartiment angereichert vorliegt. Unter Verwendung von Infektionsmodellen, heterologen Expressionssystemen sowie in vitro Experimenten konnte eine direkte Bindung beider Proteine sowie die spezifische Deubiquitinierung von Mcl-1 durch ChlaDUB1 gezeigt werden. Durch die permanente Deubiquitinierung mittels ChlaDUB1 wird Mcl-1 stabilisiert und im Bereich der Inclusionsoberfläche angereichert. Im Gegensatz zu ChlaDUB1 konnte ChlaDUB2 während der replikativen Phase der Infektion nicht im Zytoplasma sondern lediglich innerhalb der Bakterien detektiert werden. Außerdem konnten bislang keine Substrate für ChlaDUB2 identifiziert werden, welche auf die physiologische Funktion dieses Effektors schließen lassen könnten. Seit 2011 ist ein Protokoll für die Transformation von Chlamydien mit artifizieller Plasmid-DNA verfügbar. Als Teil dieser Arbeit wurde die routinemäßige Transformation von Chlamydien mit Plasmid-DNA zur permanenten und induzierbaren Proteinüberexpression etabliert. Außerdem konnte die erste gezielte homologe Rekombination ins chlamydiale Genom durchgeführt werden. Hierbei wurde das ChlaDUB1-Gen durch eine modifizierte Form ersetzt. Die Herstellung einer ChlaDUB1-Deletionsmutante mittels homologer Rekombination war jedoch nicht erfolgreich, da ChlaDUB1 vermutlich essentiell für C. trachomatis ist. Da ChlaDUB1-defiziente Chlamydien nicht generiert werden konnten, wurde ein Inhibitorscreen durchgeführt und CYN312 als ChlaDUB1-Inhibitor identifiziert. Die Anwendung von CYN312 während Infektionsversuchen zeigte eine deutliche Reduktion des Chlamydienwachstums sowie eine verminderte Mcl-1 Stabilisierung. Als Folge dessen waren Chlamydien-infizierte und mit CYN312 behandelte Zellen signifikant für die Apoptoseinduktion sensibilisiert. Mit der vorliegenden Arbeit konnte gezeigt werden, dass C. trachomatis die Deubiquitinase ChlaDUB1 während der Infektion an die Oberfläche der Inclusion sekretiert. Dort katalysiert ChlaDUB1 die Deubiquitinierung von Mcl-1 was dessen Anreicherung in infizierten Zellen und somit eine erhöhte Apoptoseresistenz zur Folge hat. Die Verwendung des ChlaDUB1-Inhibitors CYN312 verhindert die Mcl-1 Stabilisierung und sensibilisiert somit infizierte Zellen für Apoptose.

Thèse d'exercice : Médecine. Médecine générale : Université de Nantes : 2005. / Bibliogr. f. 75-81 [60 réf.].

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Farmácia, Florianópolis, 2016. / Made available in DSpace on 2017-04-18T04:17:11Z (GMT). No. of bitstreams: 1 345303.pdf: 3466861 bytes, checksum: e9c2e5bdc3733d3791f1d037929b06b9 (MD5) Previous issue date: 2016 / A infecção genital por Chlamydia trachomatis (CT) é reconhecida atualmente como uma das infecções sexualmente transmissíveis (ISTs) mais prevalentes no mundo, acometendo principalmente mulheres jovens. O caráter primariamente assintomático da infecção por CT constitui a base para formação de reservatórios que perpetuam a transmissão e a aquisição de demais IST, favorecendo a ascensão da infecção para o trato genital superior, resultando em agravos que modulam o risco de transição da infecção cervical para a malignidade. Admite-se que a coinfecção por CT em mulheres HIV soropositivas favorece a infectividade viral, prolongando e/ou aumentando o seu potencial de infecciosidade no trato genital, promovendo o aumento da excreção viral em decorrência do recrutamento de leucócitos infectados pelo HIV em resposta à infecção local e/ou por causa da crescente produção de citocinas inflamatórias que podem estimular a replicação do vírus. Diante desse cenário, o objetivo deste estudo transversal foi avaliar a prevalência de CT em mulheres HIV soropositivas atendidas pelo Sistema Único de Saúde do Município de Palhoça/SC. Durante o período de abril a julho de 2016, foram coletadas 111 amostras endocervicais durante consulta médica ginecológica no Centro Especializado em Aconselhamento e Prevenção (CEAP) de Palhoça/SC. As análises foram realizadas em parceria com o Laboratório de Biologia Molecular, Sorologia e Micobactérias (LBMM) da Universidade Federal de Santa Catarina. As amostras foram submetidas à extração de DNA utilizando um método in house baseado na extração por Acetato de Amônio, e posteriormente submetidas à técnica padronizada de PCR multiplex, utilizando os conjuntos de iniciadores PCO3/PCO4 para identificação do gene da ß-globina humana, e CTP1/CTP2 para a identificação do DNA bacteriano. A coinfecção CT/HIV foi detectada com taxa de prevalência de 1,8% (2/111) na população estudada. Observou-se associação da coinfecção CT/HIV com a variável idade (p=0,013). Não houve diferença significativa entre as demais variáveis e a positividade para CT. Das 104 (93,7%) participantes que relataram 2 ou mais parceiros ao longo da vida, 48,1% (50) relataram uso irregular de camisinha. No grupo das coinfectadas CT/HIV, 50,0% (1) também declarou uso descontínuo de preservativo. Esse fato eleva a chance de infecção por outras ISTs e/ou reinfecção, possibilitando inclusive gestações de alto risco. Foi observada a associação entre o conhecimento de ter HPV e o histórico de lesão no colo do útero (p=0,001). De maneira mais minuciosa, do total de 96 (86,5%) pacientes que responderam não ter HPV ou desconhecer ter, 10 (10,4%) declararam algum grau de lesão. O histórico de condiloma acuminado (HPV) também foi associado ao conhecimento de ter HPV (p=0,000). A metodologia de PCR multiplex exibiu bom desempenho no estudo para a identificação do material genético bacteriano. A técnica de PCR é financeiramente vantajosa e pode ser aplicada em processos de rastreamento que se baseiam na investigação de infecções assintomáticas em mulheres HIV soropositivas. Apesar da baixa prevalência na população analisada, mais estudos acerca da epidemiologia sinérgica da coinfecção CT/HIV em mulheres são necessários a fim de reduzir as conseqüências à saúde da mulher e os custos com tratamento, principalmente em mulheres com idade =30 anos. Por conseguinte, é necessário aprimorar a gestão de campanhas de prevenção e esclarecimento a respeito das ISTs, suas causas e desfechos, juntamente com a inclusão do rastreamento de CT em mulheres HIV soropositivas na prática clínica aos programas já existentes no Município.<br> / Abstract : Chlamydia trachomatis (CT) genital infection is currently recognized as one of the most prevalent sexually transmitted infections (STIs) in the world, affecting mainly young women. The primary asymptomatic character of CT infection is the basis for the formation of reservoirs that perpetuate the transmission and acquisition of other STIs, favoring the rise of infection to the upper genital tract, resulting in diseases that modulate the risk of transition from cervical infection to malignity. It is believed that CT coinfection in HIV-seropositive women favors viral infectivity by prolonging and / or increasing its infectivity potential in the genital tract, promoting the increase of viral excretion due to the recruitment of HIV-infected leukocytes in response to infection and/or due to increased production of inflammatory cytokines that may stimulate virus replication. In view of this scenario, the objective of this cross-sectional study was to evaluate the prevalence of TC in HIV-seropositive women treated by the Unified Health System of the city of Palhoça/SC. During the period from April to July 2016, 111 endocervical samples were collected during a gynecological medical visit at the Specialized Center for Counseling and Prevention (CEAP) in Palhoça/SC. The analyzes were carried out in partnership with the Laboratory of Molecular Biology, Serology and Mycobacteria (LBMM) of the Federal University of Santa Catarina. The samples were submitted to DNA extraction using an in-house method based on Ammonium Acetate extraction, and then submitted to a standard multiplex PCR technique, using the PCO3/PCO4 primer sets to identify the human ß-globin gene, and CTP1/CTP2 for identification of bacterial DNA. CT/HIV coinfection was detected with a prevalence rate of 1,8% in the studied population. There was an association between CT/HIV coinfection and age (p=0.013). There was no significant difference between the other variables and the positivity for CT. Of the 104 (93,7%) participants who reported 2 or more lifetime partners, 48,1% (50) reported using irregular condoms. In the CT/HIV coinfected group, 50,0 (1/2) also reported discontinuous condom use. This fact raises the chance of infection by other STIs and/or reinfection, making possible even high-risk pregnancies. The association between the knowledge of having HPV and the history of cervical lesion (p=0.001) was observed. In a more detailed way, of the total of 96 (86,5%) patients who responded not to have HPV or to be unaware of it, 10 (10,4%) reported some degree of injury. The history of condyloma acuminata (HPV) was also associated with knowledge of having HPV (p = 0.000). The multiplex PCR methodology showed good performance in the study for the identification of bacterial genetic material. The PCR technique is financially advantageous and can be applied in screening processes that are based on the investigation of asymptomatic infections in HIV-seropositive women. Despite the low prevalence in the analyzed population, more studies on the synergistic epidemiology of CT/HIV coinfection in women are needed in order to reduce the consequences to women's health and treatment costs, especially in women aged =30 years. Therefore, it is necessary to improve the management of prevention and enlightenment campaigns regarding STIs, their causes and outcomes, together with the inclusion of CT screening in HIV-seropositive women in clinical practice to existing programs in the county.

IBIAPINA, Flávio Lúcio Pontes. Infecção genital por Clhamydia trachomatis em gestantes : prevalência e fatores associados. 2008. 73 f. Dissertação (Mestrado em Tocoginecologia) - Universidade Federal Ceará. Faculdade de Medicina, 2008. / Submitted by denise santos (denise.santos@ufc.br) on 2012-10-22T13:18:52Z No. of bitstreams: 1 2008_dis_flpibiapina.pdf: 217559 bytes, checksum: c74eced6e1e5dd1db0e1078e37ef23d1 (MD5) / Approved for entry into archive by Erika Fernandes(erikaleitefernandes@gmail.com) on 2012-10-26T15:11:52Z (GMT) No. of bitstreams: 1 2008_dis_flpibiapina.pdf: 217559 bytes, checksum: c74eced6e1e5dd1db0e1078e37ef23d1 (MD5) / Made available in DSpace on 2012-10-26T15:11:52Z (GMT). No. of bitstreams: 1 2008_dis_flpibiapina.pdf: 217559 bytes, checksum: c74eced6e1e5dd1db0e1078e37ef23d1 (MD5) Previous issue date: 2008 / To estimate the prevalence of Chlamydia trachomatis in pregnant women, comparing the positive group to the negative one in respect to socio-demographic factors, gynecologic history and exam, evaluating the risk factors associated to Chlamydia trachomatis genital infection. Subjects and methods: Hybrid capture test for Chlamydia trachomatis was performed in 446 pregnant women at Hospital Geral Dr César Cals, from the Health Secretary of the State of Ceará, from August, 2003 to May, 2004. Medium age in the group was 25.98 years and 19 weeks was the medium age of pregnancy. A structured questionnaire was applied, no matter the age of pregnancy, whether they were or not symptomatic, excluding those who had used antibiotics or any other substance into the vagina, during the previous fifteen days or who had kept sexual relationship until two days before the consultation, with a endocervical swab being performed, in order to have a hybrid capture test for the presence of Chlamydia trachomatis, as indicated by the manufacturer. Data were analysed by STATA 13.0, performed by means of the qui-square and logistic regression tests with descriptive and analytic presentation. Results: The prevalence of Chlamydia trachomatis among the pregnant women was 2.91%. Risk factors independently associated to Chlamydia trachomatis genital infection were history of pelvic pain or pelvic inflammatory disease, vulvar discharge and not using condom with an eventual sex partner. Respective odds ratio and confidence intervals were calculated to these variable. Conclusions: The positive group was younger, had smaller salaries and presented a greater frequency of divorced women, with less preservative use and more positive history of genital discharge and pelvic pain in the past. The OR to the presence of Chlamydia trachomatis genital infection was 1, 7 for those women not using condom and 0, 10 and 0, 17, respectively for a negative history of pelvic pain / PID, and the absence of vulvar discharge. / determinar a prevalência de infecção genital por Chlamydia trachomatis em gestantes, comparando o subgrupo com diagnóstico positivo com o de diagnóstico negativo quanto aos fatores bio-sócio-demográficos, história ginecológica e exame físico ginecológico, avaliando-se os fatores associados à presença de infecção genital por Chlamydia trachomatis. Sujeitos e métodos: submeteram-se ao teste de captura híbrida para Chlamydia trachomatis 446 gestantes do ambulatório de pré-natal do Hospital Geral Dr César Cals, da Secretaria Estadual de Saúde-Ceará, no período de Agosto de 2003 a Maio de 2004. A idade média do grupo foi de 25,98 anos, idade gestacional média de 19 semanas. Aplicou-se questionário diretamente às gestantes, independente da idade gestacional e de estarem sintomáticas ou não, excluindo-se aquelas que tivessem feito uso de antibióticos ou de qualquer substância química intravaginal nos quinze dias anteriores à coleta, ou que tivessem mantido relações sexuais nos dois dias anteriores à consulta de pré-natal, com coleta de swab endocervical para realização de teste de captura híbrida II, com material colhido em tubo com solução conservadora utilizando o sistema de micro placa, conforme procedimento descrito pelo fabricante. Os dados foram analisados utilizando o software STATA 13.0, procedendo-se análise descritiva e analítica através do teste de qui-quadrado e regressão logística, subtraindo-se variáveis. Resultados: A prevalência de Chlamydia trachomatis entre as gestantes foi de 2.91%. Identificou-se como fatores de risco independentemente associados à infecção genital por Chlamydia trachomatis a história de dor pélvica ou doença inflamatória pélvica, presença de corrimento vulvar ao exame físico e não uso de preservativo com parceiro eventual. Calculou-se o Odds-ratio (OR), para cada um destes fatores, com respectivos intervalos de confiança. Conclusões: O subgrupo com rastreamento positivo para Chlamydia trachomatis caracterizou-se por apresentar uma faixa etária e renda familiar menor que o subgrupo com sorologia negativa, além de apresentar maior frequencia de pacientes separadas, que usam menos preservativos com parceiros eventuais e com mais antecedentes de corrimento genital e dor pélvica. A OR para presença de infecção genital por Chlamydia trachomatis foi de 1,7 para aquelas que não usam preservativos e foi de 0,10 e 0,17, respectivamente, para ausência de dor pélvica/DIP e corrimento vulvar.