Background: Persistent infection with high risk HPV is a necessary but insufficient cause of cervical cancer. Behavioural, viral and host factors modulate the risk of HPV persistence. In this thesis, I explore the role of the vaginal microbiota, a host factor and the presence of multiple HPV infections, a viral factor in HPV persistence. Considering the limited data on the epidemiology of HPV related diseases in low and middle-countries (LMIC), and the limited success of cervical cancer screening strategies in many LMIC, I provide data on the distribution of HPV related diseases in Nigeria and evaluate the acceptability of innovative strategies to increase cervical cancer screening uptake. Methods/Results: To achieve my aims, I implemented a longitudinal cohort study of 1,020 women in Nigeria. I begin my results chapters with two methodological papers. Attrition is an important consideration for every longitudinal cohort, particularly in LMIC, therefore, I present my findings on attrition, determinants of attrition and practical strategies to ensure low attrition in studies conducted in LMIC. Considering that sexual behaviour is an important potential confounder in all HPV studies, and the reliability of self-reported history is often questioned, I present findings on the test-retest reliability of self-reported sexual behaviour history collected in my study. Having found that attrition levels were low and that self-reported sexual behaviour history was generally reliable within my cohort, I present my findings on the association between the vaginal microbiota and persistent hrHPV; and the role of multiple HPV infections in viral persistence. I found that the vaginal microbiota was associated with persistent hrHPV in HIV negative women, but not in HIV positive women; and that multiple HPV infections did not increase the risk of viral persistence when compared to single HPV infections. Next, I present my findings on the prevalence and incidence of anogenital warts in Nigeria, with additional reports on the prevalence of cervical cancer and other HPV associated cancers using data from two population based cancer registries. Finally, I present my findings on the acceptability of innovative strategies to improve cervical cancer screening uptake in Nigeria. I found that Nigerian women had a favorable attitude to the use of HPV DNA based screening as part of routine antenatal care, however attitudes towards the use of self-sampling techniques for HPV based cervical cancer screening varied by religious affiliations. Conclusion: In my thesis, I was able to systematically investigate the epidemiology of HPV infections in a LMIC. I considered the distribution of HPV related diseases, host and viral determinants of HPV persistence and investigated control strategies to reduce the burden of cervical cancer in a LMIC. My results provide useful data for surveillance, monitoring and evaluation of control programs on HPV and cervical cancer in Nigeria and may be useful to cervical cancer control programs in other LMIC.

The human papilloma virus (HPV) is the most frequent cause of sexually transmitted diseases (STDs) and cancers for U.S. adults. The Affordable Care Act (ACA), enacted in 2010, eliminated copay expenses for childhood immunizations and expanded access to health care. The purpose of this secondary data analysis study was to determine if there was an association between ACA and the usage of HPV vaccine among adolescent females in Georgia. Data concerning HPV vaccinations from 2011 to 2015 were obtained from the National Immunization Survey-Teen dataset. Andersen's BM of health care use was applied to ascertain the factors that enhanced the usage of HPV vaccine. Multiple logistic regression analysis was used to determine if there was any association between ACA and HPV vaccination. The study results showed a significant association between ACA and provider visit (p<.05). Also, provider visit was significantly associated with HPV vaccination rate (p<.05). Adolescent females with health insurance had a higher rate of provider visit after the passage of ACA. From 2011 to 2015, 87.2% of insured adolescent females visited their provider. The rate of HPV vaccination increased among the insured adolescent females who visited the provider from 35.3% in 2011 to 53.9% in 2015. Provider visit was identified as the most influencing factor that enhanced usage of HPV vaccine. The knowledge gained from the results contributed to social change by providing insight on how, through increased provider visits, ACA has improved the HPV vaccination rate among teenage females in Georgia. The conclusion will assist in developing effective strategies and policies that will achieve the Healthy People 2020 goal of 80% of herd immunity against HPV.

Orientador: Márcia Guimarães da Silva / Resumo: Objetivo: O objetivo do presente estudo foi identificar determinantes do clearance da infecção pelo Papilomavírus Humano (HPV) em mulheres brasileiras em idade reprodutiva. Métodos: Trata-se de estudo de coorte denominado HPV-UNESP, no qual 1638 mulheres em idade reprodutiva foram recrutadas no período de setembro de 2012 e janeiro de 2013. Desse total, 544 mulheres positivas para a infecção pelo HPV participaram do seguimento longitudinal durante 30 meses, em mais 4 visitas. A infecção por HPV foi definida como detecção de qualquer um dos 36 genótipos testados pelo Linear Array Genotyping Test (Roche Molecular Systems, Inc.) e o desfecho de interesse foi o clearance da infecção, definido como a eliminação da infecção pelo HPV por, pelo menos, duas visitas consecutivas. Um questionário estruturado com 58 questões relativas à dados sociodemográficos, características comportamentais e ginecológicas foi aplicado em cada visita. Imediatamente após a entrevista, todas as mulheres realizaram exame ginecológico, no qual, após inserção de espéculo de Collins, não lubrificado, foi aferido o pH vaginal com fita (pH 4.0-7.0, Merck, Germany) no terço médio da parede vaginal. Para avaliação da microbiota vaginal, amostras foram coletadas com swab da parede vaginal e o padrão de microbiota foi classificado de acordo com os critérios de Nugent et al. (1991). O whiff test realizado por adição de solução de 10% de KOH ao conteúdo vaginal foi interpretado como positivo, negativo ou duvidoso. A... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: The objective of the present study was to identify determinants of Human Papillomavirus (HPV) infection clearance in Brazilian women of reproductive age. Methods: This is a cohort study called HPV-UNESP, in which 1638 women of reproductive age were recruited from September 2012 to January 2013. Of this total, 544 women positive for HPV infection participated in longitudinal follow-up for 30 months, in 4 more visits. HPV infection was defined as detection of any of the 36 genotypes tested by the Linear Array Genotyping Test (Roche Molecular Systems, Inc.) and the outcome of interest was infection clearance, defined as the elimination of HPV infection by least two consecutive visits. A structured questionnaire with 58 questions regarding sociodemographic data, behavioral and gynecological characteristics was applied at each visit. Immediately after the interview, all women underwent a gynecological exam, in which, after insertion of the non-lubricated Collins speculum, the vaginal pH with tape (pH 4.0-7.0, Merck, Germany) was measured in the middle third of the vaginal wall. For vaginal microbiota evaluation, samples were collected with vaginal wall swab and the microbiota pattern was classified according to the criteria of Nugent et al. (1991). The whiff test performed by adding 10% KOH solution to the vaginal content was interpreted as positive, negative or doubtful. Endocervical samples were collected with cytobrush for molecular analysis of HPV, Chlamydia trachom... (Complete abstract click electronic access below) / Doutor

Bakgrund    HPV, humant papillomvirus, är den vanligast sexuellt överförbara sjukdomen i världen. HPV kan orsaka kondylom, vilket innebär könsvårtor, men det kan även ge gynekologiska cellförändringar som kan leda till livmoderhalscancer. Syfte            Syftet var att undersöka vilken kunskap och inställning gymnasieelever, som inte ingår i vaccinationsåldern, hade till HPV och HPV-vaccination samt om det fanns några könsskillnader. Metod   En kvantitativ enkätstudie genomfördes på en gymnasieskola i Uppsala, Sverige. Enkätdistribueringen skedde vid två tillfällen och 58 (98,3 %) ifyllda enkäter kunde inhämtas, varav 38 var flickor och 20 var pojkar. Resultat    Flickorna på skolan hade en generellt högre andel rätt svar på enkäten, och totalt var det 21 (55,2 %) av flickorna som var vaccinerade medan endast 1 (5 %) av pojkarna. Av samtliga elever var det 22 (37,9 %) som kunde besvara frågan rätt angående hur många typer av HPV-virus det finns, dock kunde 51 (87,9 %) besvara frågan rätt om hur man skyddar sig mot HPV-viruset. Signifikant könsskillnad hittades i kunskapsfrågan gällande om HPV kan orsaka livmoderhalscancer (p&lt;0,045) där flickorna hade flest rätt svar på frågan. Det var fler vaccinerade flickor jämfört med pojkar (p&lt;0,001) och signifikant fler pojkar som kunde tänka sig att vaccineras (p&lt;0,019). Majoriteten, 68 %, av eleverna var positiva till den befintliga HPV-vaccinationen. Slutsats     Eleverna hade generellt sett en låg kunskapsnivå gällande HPV men trots det var det ändå mer än hälften av flickorna som var vaccinerade. Behov av ytterligare kunskap om HPV och HPV-vaccination till befolkningen behövs. / Background HPV, human papilloma virus, is the most common sexually transmitted disease in the world. HPV can cause genital warts and gynaecological dysplasia, which can lead to cervical cancer. Objective The objective was to describe the amount of knowledge the students had regarding HPV and the HPV-vaccination. Another objective was to describe how many of the students who were vaccinated and to study the existing attitudes towards HPV and the HPV-vaccination. The last objective was to compare whether there was any gender differences. Methods  A quantitative survey study was conduced at an upper secondary school in Uppsala, Sweden. The distribution of the surveys occurred on two occasions and 58 (98,3 %) completed surveys were collected. Results The girls had a generally higher percentage of correct answers on the survey. About 55 % (n=21) of the girls were vaccinated but only 5 %(n=1) of the boys. Regarding how many types of HPV there are 22(37,9 %) of the students answered correctly, although 51 (87,9 %) knew how to protect themselves against a possible infection. Significant differences in gender were found in the question whether HPV can cause cervical cancer or not (p=0,045) and whether the students would be willing to take the vaccine or not (p=0,019). The majority of the students, 68 %, were in favour of the existing HPV vaccination. Conclusion Although the students generally had poor knowledge regarding HPV the majority of the girls had taken the vaccine. The need of further knowledge is vast.

Beställningsfrekvensen för detektion av Trichomonas vaginalis samt Mycoplasma genitalium i Jönköpings län är låg jämfört med den för Chlamydia trachomatis och Neisseria gonorrhoeae.  Både T. vaginalis och M. genitalium har associerats med infektion av humant papillomvirus (HPV) samt kan bland annat orsaka salpingit med infertilitet som potentiell komplikation. Patogenerna har även beskrivits öka risken för transmission av HIV. Syftet med studien var att detektera T. vaginalis samt M. genitalium med realtids-Polymerase Chain Reaction (PCR) för uppskattning av prevalens hos individer provtagna för C. trachomatis, N. gonorrhoeae samt HPV i Jönköpings län. Hos individer över 25 år, provtagna för C. trachomatis och N. gonorrhoeae, uppskattades prevalensen till 5,5 % för M. genitalium samt 0,13 % för T. vaginalis. Hos samma individer var prevalensen av C. trachomatis och N. gonorrhoeae 4,5 % respektive 0,13 %. Prevalensen hos individer provtagna för HPV uppskattades till 2,3 % för M. genitalium samt 0,26 % för T. vaginalis. De slutsatser som dras är att relevans finns för en mer frekvent beställning av M. genitalium samt att analys för detektion av endast en patogen ej är optimal. Multiplex analys för detektion av sexuellt överförbara patogener föreslås. / The request for detection of Trichomonas vaginalis and Mycoplasma genitalium in Jönköping County is low compared to Chlamydia trachomatis and Neisseria gonorrhoeae. Both T. vaginalis and M. genitalium have been associated with Human Papilloma Virus (HPV) infection and can cause infections such as salpingitis, potentially resulting in infertility. The pathogens have also been described to increase the risk of HIV transmission. The aim of this study was to detect T. vaginalis and M. genitalium by real-time Polymerase Chain Reaction (PCR) to estimate the prevalence among individuals tested for C. trachomatis, N. gonorrhoeae and HPV in Jönköping County. In individuals above the age of 25 years, tested for C. trachomatis and N. gonorrhoeae, the prevalence was estimated to 5,5 % for M. genitalium and 0,13 % for T. vaginalis. In the same group the prevalence of C. trachomatis and N. gonorrhoeae was 4,5 % and 0,13 % respectively. The prevalence in individuals tested for HPV was estimated to 2,3 % for M. genitalium and 0,26 % for T. vaginalis. Relevance of a more frequent request for detection of M. genitalium was concluded and single pathogen detection was not deemed to be optimal. Multiplex analysis for detection of sexually transmitted pathogens is encouraged.

No description available.

O câncer cervical é considerado um grande problema de saúde pública e um dos maiores causadores de mortes relacionadas a tumores em mulheres. O principal objetivo desta tese foi aumentar a eficácia antitumoral terapêutica da proteína gDE7 por meio da associação de adjuvantes vacinais em formulações testadas em condições experimentais com a linhagem celular tumoral TC-1. A proteína gDE7 foi produzida a partir de uma linhagem de E. coli e associada a diferentes adjuvantes. A proteína gDE7 coadministrada ao poly(I:C) conferiu proteção antitumoral completa aos camundongos previamente desafiados e induziu ativação de linfócitos T CD8+ E7-específicos polifuncionais, citotóxicos e de fenótipo de memória efetora/efetor. Foi demonstrado que a proteína gDE7 ativa de forma específica a subpopulação de células dendríticas especializada na apresentação cruzada de antígenos para linfócitos T CD8+, tanto em camundongos como em seres humanos. Esses resultados abrem perspectivas para o emprego da proteína gD como plataforma vacinal para o controle de tumores induzidos pelo HPV-16. / Cervical cancer is considered a major public health problem and one of the leading causes of cancer death in women. The main goal of this thesis was the improvement of a therapeutic antitumor vaccine based on gDE7 protein in formulations admixed with adjuvants under experimental conditions with the tumor cell line TC-1. The gDE7 protein was expressed and purified from E. coli, and then tested in combination with different vaccine adjuvants. The gDE7 protein admixed with poly(I:C) conferred complete therapeutic antitumor protection to mice previously challenged with TC-1 cells and induced polyfunctional, cytotoxic E7-specific CD8+ T cells with effector/effector memory phenotype. It was also demonstrated that the gDE7 protein activated a specialized dendritic cell subset involved in specific antigen cross-presentation to CD8+ T cells, both in mice and humans. These results open perspectives for the use of the gD protein use as a vaccine platform for the control of HPV-16-induced tumors.

O câncer cervical é uma neoplasia muito prevalente na população feminina e está associado à infecção pelo papilomavírus humano (HPV). As oncoproteínas E6 e E7 de HPV de alto risco são as principais responsáveis pelas alterações celulares que levam ao desenvolvimento deste tipo tumoral. A dipeptidil peptidase IV (DPPIV/CD26) é uma enzima que exerce importantes funções relacionadas à progressão tumoral. Diversos estudos demonstram alterações na expressão e atividade desta proteína em diferentes tipos de câncer. Tendo em vista a relação entre a DPPIV/CD26 e o câncer, e que ainda não existem estudos relacionando esta proteína ao câncer cervical, neste estudo inicialmente investigamos a expressão e atividade da DPPIV/CD26 em linhagens celulares de carcinoma cervical humano (SiHa, HeLa e C33A) e em queratinócitos imortalizados (HaCaT). Nossos resultados demonstram uma baixa expressão da DPPIV/CD26 nas linhagens celulares estudadas, sendo praticamente indetectável na linhagem HeLa. Foi verificada a atividade enzimática dipeptidilpeptidásica tanto ligada à membrana quanto solúvel em todas as linhagens. Na presença do inibidor de DPPIV/CD26 (fosfato de sitagliptina) observamos que a linhagem SiHa apresentou um aumento na migração celular, e assim sugerimos que ao menos em parte a migração nesta linhagem é regulada pela atividade enzimática da DPPIV/CD26. A fim de investigar a relação da expressão da DPPIV/CD26 com as oncoproteínas E6 e E7 do HPV, avaliamos sua expressão em queratinócitos normais e transduzidos com estas oncoproteínas. Verificamos que queratinócitos expressando E6 de HPV de alto risco apresentam uma redução na expressão da DPPIV/CD26, e esta regulação parece ser dependente da degradação da p53. Considerando que as linhagens celulares estudadas apresentam baixa expressão e atividade da DPPIV/CD26, para melhor compreender a importância da expressão desta proteína, nós induzimos a superexpressão da DPPIV/CD26 em linhagem de câncer cervical (HeLa) para posterior avaliação dos efeitos em diferentes mecanismos tumorais. Os resultados demonstram uma redução no crescimento de células expressando DPPIV/CD26, sendo este efeito independente da atividade enzimática. Além disso, foi demonstrado que a indução da expressão de DPPIV/CD26 não afeta os mecanismos de migração e adesão celular na linhagem HeLa. Sendo assim, acreditamos que o esclarecimento do papel da DPPIV/CD26 no contexto do câncer cervical possibilita que novas abordagens diagnósticas e terapêuticas sejam implementadas no futuro. / Cervical cancer is a very prevalent neoplasm in female population and is associated with human papillomavirus (HPV) infection. The high risk HPV E6 and E7 oncoproteins are responsible for cellular alterations that lead to the development of this tumor type. The dipeptidyl peptidase IV (DPPIV/CD26) is an enzyme that exerts important functions related to tumor progression. Several studies have shown changes in the expression and activity of this protein in different types of cancer. Considering the relationship between DPPIV/CD26 and cancer, and that there are still no studies relating this protein to cervical cancer, in the present study we first investigated the DPPIV/CD26 expression and activity in human cervical carcinoma cell lines (SiHa, HeLa and C33A) and in immortalized keratinocytes (HaCaT). Our results demonstrate a low DPPIV/CD26 expression in the studied cell lines, being almost undetectable in HeLa cell line. The dipeptidylpeptidasic enzymatic activity was verified both membrane bound and in the soluble form in all cell lines. In the presence of the DPPIV/CD26 inhibitor (sitagliptin phosphate) we observed that SiHa cell line showed an increase in cell migration, thus we suggest that at least in part cell migration in this cell line is regulated by DPPIV/CD26 enzymatic activity. In order to investigate the relationship between DPPIV/CD26 expression and HPV E6 and E7 oncoproteins, we evaluated the expression of this protein in normal keratinocytes or transduced with these oncoproteins. We have found that keratinocytes expressing high-risk HPV E6 present a reduction in DPPIV/CD26 expression, and this regulation appears to be dependent on p53 degradation. Considering that the cell lines studied have low DPPIV/CD26 expression and activity, in order to better understand the importance of the expression of this protein, we induced the DPPIV/CD26 overexpression in a cervical cancer cell line (HeLa) for further evaluation of the effects on different tumor mechanisms. The results demonstrate a reduction in cell growth of DPPIV/CD26 expressing cells, being this effect independent of the enzymatic activity. In addition, it has been demonstrated that the induction of DPPIV/CD26 expression does not affect the cell migration and adhesion mechanisms in the HeLa cell line. Thus, we believe that the elucidation of the DPPIV/CD26 role in the context of cervical cancer enables new diagnostic and therapeutic approaches to be implemented in the future.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2015-11-16T14:07:55Z No. of bitstreams: 1 Sandra Ely Barbosa de Souza. Conhecimento e atitude...pdf: 1144576 bytes, checksum: 1cae38c0f9d2b1407f11598592cf5b02 (MD5) / Approved for entry into archive by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2015-11-16T14:10:18Z (GMT) No. of bitstreams: 1 Sandra Ely Barbosa de Souza. Conhecimento e atitude...pdf: 1144576 bytes, checksum: 1cae38c0f9d2b1407f11598592cf5b02 (MD5) / Made available in DSpace on 2015-11-16T14:10:18Z (GMT). No. of bitstreams: 1 Sandra Ely Barbosa de Souza. Conhecimento e atitude...pdf: 1144576 bytes, checksum: 1cae38c0f9d2b1407f11598592cf5b02 (MD5) Previous issue date: 2015 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / INTRODUÇÃO: A infecção viral pelo Papilomavírus Humano (HPV) é a mais frequente entre as mulheres no inicio da vida sexual, cuja persistência pode determinar câncer do colo do útero. O câncer do colo do útero pode ser prevenido secundariamente com triagem cervical e primariamente com vacinas para HPV, No Brasil, a vacina quadrivalente contra HPV passou a fazer parte do Programa Nacional de Imunização a partir de 2014, tendo como publico alvo meninas de 11 a 13 anos. O conhecimento dos enfermeiros sobre HPV, câncer cervical e vacinas contra HPV é importante para o sucesso do programa de vacinação. OBJETIVO: Avaliar o conhecimento e as atitudes de enfermeiros sobre câncer do colo do útero, infecção pelo HPV e vacinas contra HPV. Objetivos específicos: estimar a aceitabilidade da vacina contra HPV entre enfermeiros e identificar barreiras/obstáculos e facilitadores para a aceitação da vacina contra HPV por enfermeiros. MATERIAIS E MÉTODOS: Estudo de corte transversal, realizado com enfermeiros cadastrados no Conselho Regional de Enfermagem da Bahia. Foi enviado um questionário postado no SurveyMonkey®, via mala direta, sob a forma de link, para os enfermeiros com cadastro no conselho. O projeto foi aprovado previamente pelo comitê de ética em pesquisa da FIOCRUZ. RESULTADOS: Participaram do inquérito 1.283 enfermeiros, na sua maioria mulheres, pardas, casadas, Especialistas, atuando na área assistencial e na rede pública. Foram categorizados por tempo de graduação, sexo e local de atuação. Apesar de a maioria conhecer o HPV (99%) e saber da associação com o câncer cervical (98%), muitos desconhecem que o HPV também causa verrugas (10%) e acreditam que a camisinha protege completamente contra o HPV (59%). Os enfermeiros não conhecem as recomendações do Ministério da Saúde sobre a triagem do câncer cervical, acreditam que esse exame é muito sensível para detecção de lesões pelo HPV (95%). Desconhecem que o HPV pode causar câncer em outros sítios (47%) e em homens (40%). Estes achados não diferem significativamente por sexo. Os enfermeiros atuando na rede pública parecem conhecer menos sobre HPV, câncer e vacinas contra HPV. A quase totalidade (99,5%) aceita a vacina contra HPV. Itens facilitadores da aceitabilidade incluem: acreditar em vacinas como forma de prevenção, segurança da vacina e a prevenção do câncer de colo uterino. As barreiras identificadas foram: receio de eventos adversos, pouca idade da filha e falta de recomendação médica. CONCLUSÕES: Os enfermeiros conhecem moderadamente sobre HPV, câncer do colo do útero e vacinas contra HPV porém existem importantes lacunas nesse conhecimento. Os graduados há menos de cinco anos parecem conhecer menos, embora devessem estar mais atualizados. Os enfermeiros da rede pública conhecem menos que os da rede privada. / INTRODUCTION: The viral infection with Human Papillomavirus (HPV) is the most common among women after sexual debut, the persistence of which can determine cervical cancer. Cervical cancer can be secondly prevented by cervical screening and primarily by HPV vaccines. In Brazil, the HPV quadrivalent vaccine has become part of the National Immunization Program since 2014, targeting girls aged 11 to13 years old. The knowledge of nurses about HPV, cervical cancer and HPV vaccines is important for success of vaccination programs. OBJECTIVE: To evaluate knowledge and attitudes of nurses about cervical cancer, HPV infection and HPV vaccines. Specific objectives: to estimate the acceptability of HPV vaccine among nurses and identify barriers/obstacles and facilitators to accept the HPV vaccine by nurses. MATERIAL AND METHODS: A cross-sectional study carried out with nurses registered in the Regional Council of Nursing in Bahia. A questionnaire posted at the SurveyMonkey®, was sent via direct mail, in the form of link, to all nurses with registered in the board. The project was approved by the Ethics Research Committee of FIOCRUZ. RESULTS: Overall, 1,283 nurses took part in this survey, most of them women: mixed race, married, specialists, and working in patients’ assistance and on the public sector. They were stratified by time of graduation, gender and workplace. Even though most of them were aware of HPV (99%) and knew its relation to cervical cancer (98%), many were unaware that HPV causes warts (10%) and also believe that the use of condom protects against HPV (59%) successfully. The nurses did not know about the Ministry of Health recommendations regarding screening for cervical cancer, and believed that such test has high sensitivity for the detection of HPV lesions (95%). They were unaware of HPV as a cause of cancer in other sites (47%) and in men (40%). These findings did not differ significantly by gender. The nurses working in the public sector seemed to know less about HPV, cancer and HPV vaccines than those working in the private sector. Almost all accepted the HPV vaccine (99,5%). Facilitators items of acceptability included: to believe in vaccines as prevention, the vaccine safety and the prevention of cervical cancer. The barriers identified were: fear of adverse events, believing the daughter was too young and a lack of medical recommendation. CONCLUSION: Nurses moderately know about HPV, cervical cancer and HPV vaccines but there are important gaps in this knowledge. Those graduating less than five years ago seemed to know less about HPV. Also, nurses in the public sector less about HPV than those in the private sector.

Made available in DSpace on 2014-12-17T14:10:27Z (GMT). No. of bitstreams: 1 DiegoBSL_DISSERT.pdf: 829804 bytes, checksum: e8513b1969770df1630ff406301f2cb9 (MD5) Previous issue date: 2012-04-09 / This study assessed the level of knowledge, attitude and practice of Pap smear and human papillomavirus (HPV), in addition to analyzing the prevalence of genital HPV infection, Herpes Simplex Type 2 (HSV-2) and Chlamydia trachomatis in teenagers. The study consisted of two approaches, one based only on interviews conducted with adolescents enrolled in public schools or in public health facilities in the city of Natal. The other approach involved only a group of 132 adolescents enrolled among those admitted to two health units in Natal-RN. This second group of participants two specimens were collected for laboratory analysis: one was directed to prepare the blade for the Pap test, and other processed for DNA extraction for molecular analysis, focusing on the detection of HPV, HSV-2 and C . trachomatis. The presence of DNA of the three pathogens was investigated by the technique of polymerase chain reaction (PCR). The presence of each of the three pathogens was analyzed in terms of socio-demographic characteristics, as well as sexual and reproductive activity to identify risk factors for infection and development of lesions of the uterine cervix. The results show that the adolescents in this study had levels of knowledge and attitude very low, both in relation to cytology to HPV as though they have made a reasonable percentage of adequate practice exam and prevention of HPV infection. The overall prevalence of HPV infection was 54.5% and 48.2% in adolescents with normal cytology and 86.4% in those with abnormal cytology. We observed a higher proportion of cases of infection in the age group of 18 to 21. The prevalence of HPV infection was slightly higher among pregnant teenagers. The overall prevalence of HSV-2 infection was 13.6% and 11.8% in women with normal cytology and 22.7% in those with abnormal cytology. A higher proportion of cases of infection was found in the age group from 14 to 17, with a slightly higher prevalence among pregnant women. The C. trachomatis was found with an overall prevalence of 19.7% and 21.8% in adolescents with normal cytology and 9.1% in those with abnormal cytology. The prevailing rate was highest in the age group 18 to 21 years and in nonpregnant / O presente estudo avaliou o grau de conhecimento, atitude e pr?tica do exame de Papanicolaou e do v?rus do papiloma humano (HPV), al?m de analisar a preval?ncia da infec??o genital por HPV, Herpes Simples tipo 2 (HSV-2) e Chlamydia trachomatis em adolescentes. O estudo constou de duas abordagens, uma baseada apenas em entrevistadas realizadas com adolescentes recrutadas em escolas p?blicas ou em unidades de sa?de p?blica da cidade do Natal. A outra abordagem envolveu apenas um grupo de 132 adolescentes arroladas entre aquelas atendidas em duas unidades de sa?de de Natal-RN. Das participantes deste segundo grupo foram coletados dois esp?cimes para an?lise laboratorial: um foi destinado ? prepara??o de l?mina para o exame citol?gico de Papanicolaou, e outro processado para extra??o de DNA para an?lise molecular, visando ? detec??o de HPV, HSV-2 e da C. trachomatis. A presen?a do DNA dos tr?s pat?genos foi pesquisada por meio da t?cnica da rea??o em cadeia da polimerase (PCR). A presen?a de cada um dos tr?s pat?genos foi analisada em fun??o das caracter?sticas s?cio-demogr?ficas, bem com da atividade sexual e reprodutiva visando identificar fatores de risco para a infec??o e o desenvolvimento de les?es da c?rvice uterina. Os resultados mostram que as adolescentes deste estudo apresentaram graus de conhecimento e de atitude muito baixos, tanto em rela??o ao exame citol?gico quanto ao HPV, embora tenham apresentado um percentual razo?vel de pr?tica adequada do exame e da preven??o da infec??o pelo HPV. A preval?ncia global da infec??o pelo HPV foi de 54,5%, sendo 48,2% nas adolescentes com citologia normal e 86,4% naquelas com citologia alterada. Foi observada uma maior propor??o de casos da infec??o na faixa et?ria dos 18 aos 21. A preval?ncia da infec??o pelo HPV foi ligeiramente maior entre as adolescentes gr?vidas. A preval?ncia global da infec??o pelo HSV-2 foi de 13,6%, sendo 11,8% nas mulheres com citologia normal e 22,7% naquelas com citologia alterada. Uma maior propor??o de casos da infec??o foi encontrada na faixa et?ria dos 14 aos 17, sendo a preval?ncia ligeiramente maior entre as gr?vidas. A C. trachomatis foi encontrada com uma preval?ncia global de 19,7%, sendo 21,8% nas adolescentes com citologia normal e 9,1% naquelas com citologia alterada. A taxa de prevalecia foi maior na faixa et?ria dos 18 aos 21 anos e nas n?o gr?vidas