Analysis of liquid-based cervical cytology and screening for sexually transmitted infections using molecular biology in women in situations of social vulnerability in the city of Rio de Janeiro

Abstract

Introduction: Health interventions should be implemented at different levels of care for each population. Women with vulnerabilities are more susceptible to STIs, and most are asymptomatic. When symptomatic, they face difficulties in accessing care. Objective: To investigate pathogens of sexually transmitted infections using RT-PCR panel and liquid-based oncological colpocytology analysis in women in situations of social vulnerability in the city of Rio de Janeiro. Methods: Observational cross-sectional study for clinical and laboratory gynecological evaluation with collection of cervicovaginal samples among women in situations of social vulnerability, conducted from 2022–2023 in the Menina, Moça, Mulher project in the city of Rio de Janeiro. The analysis consisted of collecting samples for colposcopy (Bethesda 2018) in liquid medium (SurePath®) and RT-PCR Allplex™ STI, using Seegene MuDT™ technology (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), Mycoplasma hominis (MH), Ureaplasma urealyticum (UU), Ureaplasma parvum (UP), and Trichomonas vaginalis (TV)). Serological tests for syphilis and HIV were performed. All tests were performed at the same registered laboratory. Exclusion criteria: systemic or vaginal treatment with antimicrobials within the last 30 days of the consultation. Results: 115 women were included. Twelve women were excluded for not meeting the requirements. The average age was 36 years. The youngest was 17 years old, the oldest 71 years old. Colposcopy results: Normal, 17 (14.78%), Mild inflammatory, 56 (48.59%), Moderate inflammatory, 26 (22.60%), Severe inflammatory, 1 (0.86%), Low-grade intraepithelial lesion, 6 (5.21%), Intraepithelial lesion of undetermined significance, 4 (3.47%), Atypical glandular cells, 1 (0.86%), Squamous cell carcinoma of the cervix, 2 (1.73%), confirmed by colposcopy and biopsy. The diagnosis of endometrial carcinoma, 1 (0.86%), was by endometrial biopsy with normal colpocitology, but presented clinical symptomatology, Unsatisfactory material, 1 (0.86%), Bacterial vaginosis, 6 (5.21%), Candidiasis, 7 (6.08%), Trichomoniasis, 3 (2.60%). RT-PCR results: TV, 15 (13.04%), CT, 5 (4.34%), NG, 2 (1.73%), MG, 1 (0.86%), MH, 31 (26.95%), UU, 20 (17.39%), UP, 37 (32.17%), Negative, 45 (39.13%). Several samples presented more than one pathogen. Diagnosis by TV colpocitology was 3 (2.60%) and by PCR was 15 (13.04%). Four women (4/115=3.47%) were positive for syphilis by treponemal and non-treponemal serology. Three other women (3/115=2.60%) were positive for HIV. Conclusion: The rates of STIs, alterations in oncotic colpocitology, including malignant lesions, and co-infections between STIs, HIV, and syphilis in vulnerable women in Rio de Janeiro are concerning. Diagnosis by PCR Testing for Trichomonas vaginalis was much more efficient than using colposcopy. People in situations of social vulnerability should have an open channel for medical care, STI screening, and gynecological examinations with laboratory resources.