International International Archives of Medicine 2016

Medical Society Section: Microbiology Vol. 9 No. 360

http://imedicalsociety.org ISSN: 1755-7682 doi: 10.3823/2231

Pap Smears: Frequency of Gardnerella Vaginalis,

Candida spp., Trichomonas Vaginalis and
Pill Use or Copper Intrauterine Device Use
ORIGINAL

José Antonio Barreto Alves1, Mariangela da Silva Nunes1, Ricardo Fakhouri1,

Paulo Ricardo Saquete Martins-Filho1,
Maria do Carmo de Oliveira Ribeiro1, Thiago dos Santos Valença1, Alberto Correa de Vasconcellos1,
Alanna Gleice Carvalho Fontes Lima1, Patricia Oliveira Santos1,
Murilo Marchioro1, Gladslene Goes Santos Frazão1, Andreia Centenaro Vaez1, Karine Vaccaro Tako1

1  Federal University of Sergipe, Aracaju,

Sergipe, Brazil.
Abstract
Objective: To verify the frequency of Gardnerella vaginalis, Candida Contact information:
sp. Trichomonas vaginalis in pap smears and the presence of these Jose Antonio Barreto Alves.
when using the copper intrauterine device or the oral contraceptive.
Address: Department of Nursing, Federal
University of Sergipe, Sergipe, Brazil.
Method: The analysis of 119,312 examinations of women seen by the
public health system in the Northeast region of Brazil from the period
from January 2006 to December 2010. The variables analyzed were [email protected]
age, frequency of microorganisms, contraceptive use, type of con-
traception adopted correlated with the presence of microorganisms.

Results: The average age among the women was 33.4 ± 11.15 years.
The most frequent microorganism, Gardnerella vaginalis, was found
in 16,137 examinations, followed by Candida spp. in Trichomonas va- Keywords
ginalis and the 12,661 in 2023. The use of oral contraceptives was Gardnerella Vaginalis;
found in 21,792 women, and these, showed the presence of Gardne- Intrauterine Device; Vaginitis;
rella vaginalis in 1054, Candida spp. and Trichomonas vaginalis in 687 Abnormal Vaginal Flora;
in 133 tests. Regarding the use of use of copper intrauterine device, Vaginal Smears.
used by 18,894 women, the presence of Gardnerella vaginalis was
detected in 964, Candida spp. and Trichomonas vaginalis in 595 in
122 of the cases.

Conclusion: The presence of microorganisms associated with contra-

ceptive use is evident, in particular, Garnerella vaginalis which is more
common in both kinds of contraception methods adopted by women.

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 International Archives of Medicine 2016
Section: Microbiology Vol. 9 No. 360
ISSN: 1755-7682 doi: 10.3823/2231

Introduction may suggest the presence of certain microbiological

The normal vaginal microbiota, its interaction with agents such as Garderella vaginalis, Candida spp.
the products of microbial metabolism, hormonal and Trichomonas vaginalis [7, 10]. This technique is
status and host immune response, are factors that a valuable diagnostic tool, especially in places where
promote the balance in the vaginal ecosystem [1]. technological resources are limited [11].
The presence of women with genital tract infec- Thus, the possibility of severe complications
tion caused by Gardnerella vaginalis, Candida spp. among women colonized increases the importance
or Trichomonas vaginalis is frequent in gynecologi- of studies to identify the age group most likely to
cal medical offices and public health services [2, develop bacterial vaginosis, candidiasis and tricho-
3]. moniasis, as well as to determine the most appro-
In this context, it is observed that bacterial vagi- priate contraceptive method.
nosis affects 30% of women in childbearing age, Prevalence studies can be an alternative to
with asymptomatic prevalence and is associated check for possible risk factors. This information
mainly to the presence of Gardnerella vaginalis [4]. may be used in the planning of assistance poli-
Vaginal candidiasis is developed when there is ex- cies to women’s health and hence, measures of
cessive proliferation of Candida spp. and it may be prevention and treatment become more effective
present even in acidic vaginal ph [5]. Trichomoniasis by reducing the proliferation of resistant microor-
is considered a sexually transmitted disease, asymp- ganisms. The purpose of this study was to deter-
tomatic for most men, in contrast to what occurs mine the frequency of Candida spp., Trichomonas
with women, whose etiologic agent is the proto- vaginalis and Gardnerella vaginalis in Pap tests and
zoan Trichomonas vaginalis [2]. the presence of the copper intrauterine device or
The presence of these microorganisms in the oral contraceptive.
vagina may be predominantly asymptomatic. Nev-
ertheless, when symptoms are present, they can
range from mild discomfort to severe complications Method
such as infertility, spontaneous abortion, premature This is a descriptive, cross-sectional study, using se-
labor, pelvic inflammatory disease and pelvic endo- condary data. We analyzed the information con-
metritis [6, 7]. The use of the copper intrauterine tained in preventive screening of the cervix smear
device, spermicides, intercourse frequency and the collection, which took place in establishments that
habit of using vaginal douches are considered risk provide service to the public health system, the
factors for these infections. However, the use of women’s health attention program in the city of
barrier methods or oral contraceptives is protective Aracaju, Northeast Brazil. With the performance of
against such illnesses [8]. 133 family health teams, the city of Aracaju, is a
There is no agreement for the most appropriate reference in health services for other counties of the
contraceptive method for women who have recur- region and it has 43 institutions of primary health
ring infections in the genital tract [9]. Despite the care, which have performed the Pap smear.
problem, there are very few studies on the rela- A number of 119,312 pap smears tests collect-
tionship between the use of contraceptives and the ed from January 2006 to December 2010 whose
presence of infectious agents. data were collected from the Database Information
Although the Pap smear has been designed for System for cervical cancer (SISCOLO), under the re-
recognition epithelial changes in the neoplastic or sponsibility of the Municipal Health Department of
pre-neoplastic nature of the cervix, through it, one that city, were analyzed. This system is designed

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 International Archives of Medicine 2016
Section: Microbiology Vol. 9 No. 360
ISSN: 1755-7682 doi: 10.3823/2231

to store the identification of women, demographic Results

and epidemiological information, in addition to the Gardnerella vaginalis was the most common organ-
results of cytopathology and histopathology tests ism in all years investigated with 16,137 (13.52%)
performed by the Public Health System in Brazil. women affected, followed by Candida spp. with
All the information has been transferred, catego- 12,661 (10.61%) and finally 2,023 with Trichomonas
rized and analyzed in computer database software vaginalis (1.7%). The mixed infection caused by Can-
program SPSS (Statistical Package for the Social dida spp. with Gardnerella vaginalis was identified
Sciences) version 18.0, and presented in the form in 504 cases with Trichomonas vaginalis Gardnerella
of tables, using the chi-square test to check for vaginalis in 172 cases, Candida spp. associated with
the level of significance between groups. The sig- Trichomonas vaginalis was identified in 52 cases and
nificance level of 5% was considered to the whole Candida spp. Gardnerella vaginalis associated with
study. the presence of Trichomonas vaginalis in 07 cases,
The variables analyzed in this study were: fre- Table 1.
quency of Candida spp. Gardnerella vaginalis and It was observed that 21,792 women reported
Trichomonas vaginalis, the use of pills or the intra- using oral contraceptive, and among these ones,
uterine device, average age of patients and type of there was the presence of Gardnerella vaginalis in
contraception method associated with the presence 1054 women, Candida spp. in 687 cases and 133
of microorganisms. Trichomonas vaginalis. Regarding the use of cop-
This study was approved by the Ethics Commit- per intrauterine device, 18,894 women have it as
tee in Research of the Federal University of Sergipe a contraception method and there was no record
under no-CAAE 1292.0.000.107-11. of the presence of Gardnerella vaginalis in 964,
Candida spp. and Trichomonas vaginalis in 595 in

Table 1. O
 ccurrence of microorganisms in pap smears. Information System Cervical Cancer: SISCOLO,
Sergipe, 2006-2010.
Variables 2006 % 2007 % 2008 % 2009 % 2010 % Total % p-valor*
Total number of exams 16550 - 27292 - 23983 - 27138 - 24349 - 119312 -
Gardnerella Vaginalis 2010 12.15 4162 15.25 2803 11.69 3402 12.54 3708 15.23 16137 13.52 0.001
Candida Spp. 1705 10.3 3237 11.86 2061 8.59 2622 9.66 2996 12.3 12661 10.61
Trichomonas Vaginalis 385 2.33 517 1.89 405 1.69 392 1.44 317 1.3 2023 1.7
Gardnerella Vaginalis/
74 0.45 129 0.47 75 0.31 110 0.41 114 0.47 504 0.42 0.156
Candida Spp.
Gardnerella Vaginalis/
35 0.21 54 0.2 33 0.14 28 0.1 21 0.09 172 0.14 0.351
Trichomonas Vaginalis
Candida Spp./Trichomonas
8 0.05 11 0.04 13 0.05 10 0.04 10 0.04 52 0.04 0.655
Vaginalis
Gardnerella Vaginalis/
Candida Spp./ 2 0.01 2 0.01 3 0.01 0 0 0 0 7 0.01 0.418
Trichomonas Vaginalis
*: Chi-square p ≤ 0.05

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 International Archives of Medicine 2016
Section: Microbiology Vol. 9 No. 360
ISSN: 1755-7682 doi: 10.3823/2231

Table 2. U
 se of pill or IUD associated with the presence of microorganisms. Information System Cervical
Cancer (SISCOLO), Sergipe, 2006-2010.
Variable Microrganisms 2006 p-value* 2007 p-value* 2008 p-value* 2009 p-value* 2010 p-value*
Gardnerella 131 0.01 288 0.01 247 0.01 259 0.01 39 0.02
IUD Candida Spp. 62 0.01 187 0.01 139 0.19 187 0.01 20 0.01
Trichomonas 11 0.83 37 0.06 35 0.46 35 0.6 4 0.52
Gardnerella 136 0.45 310 0.27 257 1.3 274 0.01 77 0.05
PILL Candida Spp. 74 0.01 210 0.33 150 0.56 204 0.08 49 0.04
Trichomonas 17 0.67 37 0.01* 35 0.62 39 0.31 5 0.59
*: Chi-square p ≤ 0.05

122, Table 2. The average age among women who disease has been associated with lack of proper
had some kind of micorganisms considered poten- sexual orientation, education, hygiene habits, early
tial infectious agent was 33.4 ± 11.15 years. onset of sexual activity and multiple partners [2,
8-10]. On the other hand, the disequilibrium in the
vaginal ecosystem, due to the rise in pH above 4.5
Discussion and a decrease or absence of colonization by lac-
Although the Pap test is not designed to diagnose tobacilli, decrease of vitamin A, folate and calcium
the presence of microorganisms, its use for this pur- may be predisposing factors to the proliferation of
pose until the present day is a routine and remains microrganismo [6, 8, 19].
controvsial [12, 13]. When comparing its performan- Like Gardnerella vaginalis, the presence of Tricho-
ce to that end, encouraging results are found in the monas vaginallis can also be verified in Pap smear
diagnosis of Gardnerella vaginalis [10, 14]. tests [20]. Its infection is considered a sexually trans-
The present study found the presence of Gard- mitted disease, which risk factors are the number of
nerella vaginalis in pap smears in the years 2006, sexual partners, socioeconomic status, personal hy-
2007, 2008, 2009 and 2010 with 12.15%, 15.25%, giene, not using condoms and their association with
11.69%, 12.54% and 15.23%, followed by the other sexually transmitted diseases [21]. In pregnant
yeast Candida spp. with 10.30%, 11.86%, 8.59%, women it can cause premature rupture of membra-
9.66% and 12.30%, finally showing Trichomonas nes and premature labor [7].
vaginalis 2.33% 1.89% 1.69% 1.44 % and 1.30% The colonization by Candida spp. is not generally
respectively for each year. These findings support well detected in Pap tests, due to its lower sensiti-
those found in several regions of Brazil where Gard- vity when compared to the liquid médium [20, 22,
nerella vaginalis is the most pathogenic microorga- 23]. In addition, the detection of Candida spp. in
nism present in the female genital tract, compared smear Pap tests is more difficult when the abnormal
with Candida spp. which was the second, followed bacterial flora is also present or not when it comes
by Trichomonas vaginalis through this technique [7, to Candida albicans, which often do not make the
15-17]. pseudo-hyphae easily detected [9].
The infection caused by Gardnerella vaginalis is The so-called mixed infection in which there is
considered by some authors to be of sexual trans- presence of two or more potentially pathogenic
mission [18], although this hypothesis is refuted by microorganisms was detected in 735 tests. with a
its presence in virgins school girls [8]. This type of prevalence of the association bertween Gardnerella

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 International Archives of Medicine 2016
Section: Microbiology Vol. 9 No. 360
ISSN: 1755-7682 doi: 10.3823/2231

vaginallis and Candida spp., followed by Gardnere- the occurrence of mixed infections with evidence
lla vaginalis associated with Trichomonas vaginalis. of three potentially pathogenic microorganisms. Re-
One hypothesis for this finding may be related to garding the use of contraceptives, the oral type is
a vaginal pH which is friendly to this type of colo- more used when compared with the copper intra-
nizing [7]. uterine device. In the presence of microorganisms
The contraceptive use was identified in only 34.1% associated with the use of contraception, there is
of all analyzed tests (n = 119,312). The pill was the a greater frequency of Garnerella vaginalis in both
most reported with 18.2%, followed by copper in- types of contraception methods used by women.
trauterine device with 15.8%. In other tests the type Note also that after ten years of implementation of
of contraceptive method was not identified. This SISCOLO, there are still many missing data, which
lack of information is an obstacle to epidemiological hinders epidemiological studies, related to women’s
studies aimed at using data from the Information health to facilitate the most appropriate contracep-
System Cancer of the cervix (SISCOLO). Even with tive gynecologists can state in order to prevent op-
this difficulty, the data stored in this system rep- portunistic infections.
resent an important resource for epidemiological
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ce and clinical practice. IAM is considered a megajournal with
51:882-5. independent sections on all areas of medicine. IAM is a really
international journal with authors and board members from all
around the world. The journal is widely indexed and classified
Q2 in category Medicine.

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