title: Sexually transmitted infections in a female population in rural north-east Brazil: prevalence, morbidity and risk factors.
abstract: OBJECTIVE
  To determine the prevalence of major sexually transmitted infections (STIs) and gynaecological morbidity in women of reproductive age living in rural communities in north-east Brazil and to assess risk factors associated with the presence of STIs.
  
  
  METHODS
  A total of 341 women (84%) were examined gynaecologically and colposcopically. The gynaecological history was taken by means of a standardized, pre-tested questionnaire. Cervical smears were obtained and vaginal fluid was collected. Vulvovaginal candidiasis (VC), bacterial vaginosis (BV), trichomoniasis (TV) and syphilis seroreactivity were determined by standard laboratory techniques. Infections with Neisseria gonorrhoeae, Chlamydia trachomatis and human papilloma virus (HPV) were diagnosed by hybrid capture assays using vaginal lavage fluid. Odds ratios (OR) were calculated to assess risk factors associated with STIs.
  
  
  RESULTS
  The prevalence of HPV, BV and TV was 26%, 15% and 10%, respectively. VC as well as infections with N. gonorrhoeae and C. trachomatis were detected in 6%; syphilis seroreactivity, in 3%. Multiple infections were very common, and 51% of women had at least one STI. Vaginal discharge, the predominant morbidity (56%), was significantly associated with BV (OR = 6.3; P < 0.001), vulvovaginal itching with VC (OR = 3.5; P < 0.05) and lower abdominal pain with C. trachomatis infection (OR = 2.6; P < 0.04). Colpitis was diagnosed in 27% of women and significantly associated with TV (OR = 3.5%; P < 0.001) and VC (OR = 2.9; P < 0.05). Being unmarried was a significant risk factor for having an STI (OR = 2.4; P < 0.05). Among unmarried women, age (<20 years) was a significant risk factor (OR = 3.3; P = 0.01).
  
  
  CONCLUSIONS
  The STIs are highly prevalent in this female population in the rural hinterland of north-east Brazil and associated with considerable morbidity. In view of the expected spread of HIV from the urban centres at the coast to the interior there is an urgent need for providing STI-related health care and health education for adolescents and women in rural Brazil.
authors.affiliation: Department of Pathology, Faculty of Medicine, University of Health Sciences, Maceió, Alagoas, Brazil. valquiria_s@yahoo.com.br
authors.forename: Valquíria
authors.initials: V
authors.lastname: de Lima Soares
authors.forename: Ana Maria Torres S
authors.initials: AM
authors.lastname: de Mesquita
authors.forename: Fábia Gazzaneo T
authors.initials: FG
authors.lastname: Cavalcante
authors.forename: Zenaldo Porfírio
authors.initials: ZP
authors.lastname: Silva
authors.forename: Valéria
authors.initials: V
authors.lastname: Hora
authors.forename: Thomas
authors.initials: T
authors.lastname: Diedrich
authors.forename: Patrícia
authors.initials: P
authors.lastname: de Carvalho Silva
authors.forename: Poliana Gomes
authors.initials: PG
authors.lastname: de Melo
authors.forename: Alfredo Raimundo C
authors.initials: AR
authors.lastname: Dacal
authors.forename: Eduardo Maia Freese
authors.initials: EM
authors.lastname: de Carvalho
authors.forename: Hermann
authors.initials: H
authors.lastname: Feldmeier
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D017533:Marital Status; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D018456:Reproductive Medicine; D012307:Risk Factors; D012423:Rural Health; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology; D012959:Socioeconomic Factors