This is a cross-sectional study involving 100 sexually active adolescents followed in the Adolescent Gynecology Clinic (Serviço de Ginecologia da Infância e Adolescência—SEGIA) of Escola Bahiana de Medicina e Saúde Pública (EBMSP—Salvador, Bahia, Brazil), included between September 2008 and August 2010. By the time of enrollment, all participants have had at least one sexual partner in their lifetime, being considered sexually active. SEGIA is an outpatient clinic that as been offering complete gynecological care to 356 patients since 2008. By August 2010, approximately 37% of patients followed in the clinic were sexually active.
Patients were included sequentially at the time of gynecological appointment. Inclusion criteria were female gender, age between 10 and 19, years and sexual activity. Pregnancy, puerperium, and intravaginal medication use were adopted as exclusion criteria. The study was approved by the Institutional Review Board of EBMSP. An informed consent form was applied and signed by all the legally responsible persons for the adolescents prior to their participation in the study. The patients with 18 years of age or older signed it themselves. All principles outlined in the Declaration of Helsinki were followed.
The clinical and demographic data were obtained by applying a semistructured questionnaire. Then, the patients were submitted to gynecological examination. To analyze the growth of Candida species, samples were collected using a vaginal swab dampened with sterile saline, plated aseptically on Sabouraud Dextrose Agar plates (Acumedia Neogene, Lansing, Michigan, USA) and incubated at 35°C for 24 to 48 hours. White, circular, medium-sized, and catalase positive colonies, observed as Gram-positive yeast in Gram staining, were tested for identification of Candida albicans. Positive germ tube test and green stain in CHROMagar Candida (Difco-Becton Dickinson Microbiolgy Systems, Maryland, USA) medium are indicative of these species. The strains that have been tested negative for the germ tube test and have not stained green in the CHROMagar medium were identified as Candida spp.
Smears prepared with vaginal and endocervical specimens collected during pelvic examination were Gram stained and observed through optical microscopes (1000X magnification) by two microbiologists. In order to make the diagnosis of bacterial vaginosis, the bacterioscopy was analyzed according to the scoring system proposed by Nugent et al. [16
]. The total score ranges from 0 to 10. BV was diagnosed when the score was equal or higher than seven points.
The diagnosis of genital Trichomonas vaginalis
infection was made with vaginal cytology using the Papanicolaou's technique. Protozoan were identified by their morphological aspects (rounded, pyriform or irregular structures, measuring 10 to 20
um, cyanophilic cytoplasm and eccentric small nuclei).
Descriptive analysis of all variables was performed, including frequency distributions for ethnic groups, family income, conjugal status, education, alcohol, tobacco and illegal drug use, age at first sexual intercourse, age at menarche, sexual abuse, use of contraceptives, condom use, and number of sexual partners. The prevalence was calculated with a confidence interval of 95%. Chi-square or Fisher's exact tests were used for the analysis of categorical variables. Students t-test was used to analyze the numeric data. A value of P ≤ 0.05 was considered statistically significant. All data were analyzed using the SPSS 17.0 software (IBM SPSS, Chicago, IL, USA) for Windows.