UNIVERSIDADE ESTADUAL PAULISTA 
JÚLIO DE MESQUITA FILHO 

FACULDADE DE MEDICINA DE BOTUCATU 
 
 
 

Fausto Gondo 
 
 
 
 
 
 
 
 
 
 
 
 

Prevalência das infecções do trato genital inferior  em 
gestantes de baixo risco da Estratégia de Saúde da Família 

da Atenção Primária em Saúde. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Botucatu 
2007 



 

Fausto Gondo 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Prevalência das infecções do trato genital inferior  em 
gestantes de baixo risco da Estratégia de Saúde da Família 

de Serviços de Atenção Primária em Saúde. 
 
 
 
 
 
 
 

Dissertação apresentada ao Programa de Pós-graduação em 
Ginecologia, Obstetrícia e Mastologia, Faculdade de Medicina 
de Botucatu, Universidade Estadual Paulista “Júlio de 
Mesquita Filho” UNESP, para obtenção do título de Mestre. 
 
 
 
 
 
 
 
 
Orientadora :  Profa. Titular Marilza Vieira da Cunha Rudge 
Co-Orientadora :  Profa. Dra. Márcia Guimarães da Silva 

 
 
 
 
 
 
 

Botucatu 
2007 



 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

   FICHA CATALOGRÁFICA ELABORADA PELA SEÇÃO TÉCNICA DE AQUISIÇÃO E TRATAMENTO 
 DA INFORMAÇÃO 

DIVISÃO TÉCNICA DE BIBLIOTECA E DOCUMENTAÇÃO - CAMPUS DE BOTUCATU - UNESP 
BIBLIOTECÁRIA RESPONSÁVEL: Selma Maria de Jesus 

Gondo, Fausto. 
    Prevalência das infecções do trato genital inferior em gestantes de 
baixo risco da estratégia de saúde da família de serviços de atenção 
primária em saúde / Fausto Gondo. – Botucatu : [s.n.], 2007  
   
    Dissertação (mestrado) –  Universidade Estadual Paulista,  
Faculdade de Medicina de Botucatu,   2007. 
    Orientadora: Marilza Vieira da Cunha Rudge 
    Co-Orientadora: Márcia Guimarães da Silva  
    Assunto CAPES: 40101150 
 
    1. Gravidez    2. Aparelho genital feminino - Infecções    3. Saúde da 
família    4. Atenção primária à saúde    
                                                                   CDD 618.14075 
                                                                   CDD 614.44      
Palavras-chave: Estratégia de saúde da família da atenção primária 
em saúde: Infecção genital inferior; Gestantes de baixo risco 

 



 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Aos meus Pais e Irmãs 
 

Pelo incentivo, pelos ensinamentos, apoio e preparação para enfrentar mais uma 
etapa na ampliação do conhecimento. 

 
 
 

À Danielle Cristina Alves Feitosa 
 

Pela compreensão e incentivos neste longo processo. 
 



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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À Professora Titular Marilza Vieira da Cunha Rudge, pela orientação e estímulo 

científico para elaboração desta dissertação. 

 

À Professora Doutora Márcia Guimarães da Silva, pela dedicação, disponibilidade, 

incentivo, carinho, paciência e ajuda incondicional, que tornaram possível a 

elaboração desta dissertação. 

 

À Professora Mestre Andréa da Rocha Tristão, pela disponibilidade e por desbravar 

esta área tão importante da Obstetrícia. 

 

Às Enfermeiras da Estratégia de Saúde da Família de Botucatu: Daniela Cristina da 

Silva Ramos, Fernanda Cristina Manzini Sleutjes, Maíra Rodrigues Baldin, Maria 

Cristina Heinzle da Silva Machado, Marilene Plácido da Costa Carvalho, Patrícia 

Ricci Machado dos Santos, Polyana Pimentel Proença, Regina Stella Spagnuollo, 

Renata Leite Alves de Oliveira, Telma Marques Medeiros, Valéria César Winckler por 

facilitarem o agendamento das pacientes e a coleta dos materiais necessários. 

 

À Secretaria Municipal de Saúde de Botucatu, por permitir e incentivar esta pesquisa 

nas Unidades de Saúde da Família deste município. 

 

A Hélio Rubens de Carvalho Nunes e Adriano Dias pela análise estatística. 

 

À equipe do Grupo de Apoio à Pesquisa (GAP) da FMB-UNESP pela solidariedade 

nesse processo. 

 



 

À Bibliotecária Luciana Pizzani, pelo auxílio na revisão bibliográfica. 

 

Às funcionárias do Ambulatório de Infecções Genitais do HC-UNESP e das 

Unidades de Saúde da Família de Botucatu pelo auxílio para coleta e 

processamento dos materiais necessários. 

 

Às pacientes por contribuírem para os avanços contínuos dos conhecimentos da 

Medicina. 



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Objetivos: A proposta do presente estudo foi estabelecer a prevalência de infecções 

do trato genital inferior em gestantes de baixo risco da Estratégia de Saúde da 

Família da Atenção Primária em Saúde em Botucatu, Estado de São Paulo-Brasil, e 

avaliar a relação de sinais e sintomas em infecções no trato genital inferior. 

Pacientes e Métodos: Um total de 245 gestantes foi selecionado neste estudo, e 

durante o exame, o aspecto do corrimento e pH vaginal foram observados. Swabs 

foram utilizados para coletar secreções vaginais das paredes laterais da vagina para 

um esfregaço vaginal. O diagnóstico clínico foi baseado na combinação de sintomas 

e sinais, aferição de pH vaginal, realização do teste de aminas e exames 

laboratoriais. Resultados: A taxa geral de infecção de diagnósticos clínicos foi de 

45,7%. Vaginose bacteriana foi diagnosticada em 53 mulheres grávidas (21,6%), 

candidíase vaginal em 25 (10,2%), flora intermediária em 13 (5,2%), vaginite aeróbia 

em sete (2,9%), infecção mista em sete (2,9%) e outros achados em 2,9%. Entre as 

mulheres com sintomas e/ou sinais de infecções no trato genital inferior, 22,3% das 

mulheres foram diagnosticadas com vaginose bacteriana; 14,6% como candidíase 

vaginal; 5,7% como flora intermediária; 1,9% como vaginite aeróbia, 3,8% como 

infecção mista e 3,2% com outros achados, mas em 48,4% não foram identificadas 

infecções. Conclusão: A prevalência de infecções do trato genital inferior em 

mulheres grávidas de baixo risco na Estratégia de Saúde da Família da Atenção 

Primária em Saúde é alta e nossos resultados sugerem que somente sintomas não 

deveriam ser utilizados para tratamento direto. A melhor prática para as infecções do 

trato genital inferior em gestantes deveria combinar os sinais ou sintomas e exames 

laboratoriais.  

Palavras chaves: infecção genital inferior; gestant es de baixo risco; Estratégia 

de Saúde da Família da Atenção Primária em Saúde. 



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Objective:  The purpose of the present study was to establish the prevalence of lower 

genital tract infection in low risk pregnant women of the Family Health Strategy of the 

Primary Care Services in Botucatu, São Paulo State, Brazil, and to evaluate the 

correlation of signs and symptoms to lower genital tract infections. Patients and 

Methods:  A total of 245 pregnant women were enrolled in this study and during the 

exam, the appearance and pH of the vaginal discharge were noted. Swabs were 

used to obtain vaginal secretion from the upper lateral vaginal vault for a vaginal 

smear. The clinical diagnosis were based by combining the symptoms and signs with 

office-based testing and laboratory exams. Results:  The overall infection rate by 

clinical diagnosis was 45.7%. Bacterial vaginosis was diagnosis in 53 pregnant 

women (21.6%), vaginal candidiasis in 25 (10.2%), intermediate vaginal flora in 13 

(5.2%), aerobic vaginitis in 7 (2.9%), mixed infection in 7 (2.9%) and another findings 

in 2.9%. Among women with symptoms and/or signals of the lower genital tract 

infection, 22.3% of the women were diagnosed as having bacterial vaginosis; 14.6% 

as vaginal candidiasis; 5.7% as having intermediate vaginal flora; 1.9% as aerobic 

vaginitis, 3.8% as having mixed infection, 3.2% another infection but in 48.4% no 

infection was identified. Conclusion:  The prevalence of lower genital tract infection 

in low-income pregnant women attended in the Family Health Strategy of the Primary 

Care Services is high and our results suggest that symptoms alone should not be 

used to direct treatment. The best practice guideline to lower genital tract infections in 

pregnant women should take the combining symptoms or signs and laboratory 

exams.  

Key words: lower genital infection; low risk pregna ncy women;  Family Health 

Strategy of the Primary Care Services . 



 

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Table 1. Characteristics of study population ……………..………….…... 32 

Table 2. Prevalence of the different types of genital infection …………. 33 

Table 3.  Prevalence of the different types of genital infection 
 in women with or without symptoms …………………………... 34 
 



 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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et al. = co-authors 

KOH = Potassium Hidroxide 

USPSTF = United States Preventive Services Task Force 



 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Lista de Tabelas 
 
Resumo 
 
Abstract 
 
1 – Introdução.................................................................................................. 20 
 
2 – Pacientes e Métodos ................................................................................. 22 
 
3 – Resultados ................................................................................................ 24 
 
4 – Discussão ….…………………………………………………………………... 25 
 
5 – Referências ............................................................................................... 28 
 
6 – Anexos ............................................................................................. 35 
 



 

Prevalence of lower genital tract infection in low risk pregnant 

women of the Family Health Strategy of the Primary Care Services 

Gondo, F 1, Silva, MG 2, Polettini J 2, Tristão AR 1, Peraçoli JC 1, Rudge, MVC 1.  

1Departamento de Ginecologia e Obstetrícia, Faculdad e de Medicina de Botucatu, UNESP. 

2Departamento de Patologia, Faculdade de Medicina de Botucatu, UNESP. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Padronizado de acordo com as normas para publicação  da revista 
Infectious Diseases in Obstetrics and Gynecology 



 

INTRODUCTION  

 

The genital infections during pregnancy have been very neglectful in 

practice obstetric routine, mainly in the low risk public services (Brazilian Unified 

Healthcare System - SUS). Very little is researched in these sections that assist, 

most of the Brazilian pregnant women1,2. 

Lower genital tract complaints among women account for more outpatient 

visits than any other reason that women seek health care in the United States. It has 

been estimated that vaginal infections alone account for >10% of outpatients to 

providers of women’s health care3. It would be expected that the diagnostic approach 

to such a common occurrence would have a major research focus over the years; it 

would be further expected that this area of medical practice would be influenced 

highly by evidence-based approaches that produced accurate diagnostic and very 

effective treatment regimens4. 

There is evidence that screening of the genital infection for asymptomatic 

pregnancies may reduce the rate of preterm delivery (PTD). Evidence for screening 

and selective treatment exists for bacterial vaginosis in low-risk group5. A meta-

analysis6 of 19 studies concluded that there was a 60% increased risk of PTD in the 

presence of bacterial vaginosis. However, according by Meis et al.7 neither 

Trichomanas vaginalis nor candidiasis, detected by microscopy, had significant 

association with preterm birth.  

The genital infections may be asymptomatic needing vaginal evaluation 

protocoled to firm the diagnoses and to establish prevalence, treatment, improving 

the maternal-fetal prognosis 7-11. Symptoms alone showed not be used in the 

diagnostic of the genital infection and in treatment which resources permit more 



 

complete evaluation including microscopic analyses4. Landers et al.4 showed the 

poor predictive value of symptoms in the diagnosis of lower genital tract infection. 

The purpose of the present study was to establish the prevalence of lower 

genital tract infection in low risk pregnant women of the Family Health Strategy of the 

Primary Care Services in Botucatu, São Paulo State, Brazil, and to evaluate the 

correlation of signs and symptoms to lower genital tract infections. Our hypothesis 

was that the current practice of using combinations of clinical signs and symptoms 

with office-based tests and microscopy is superior to symptom-direct approaches to 

predict correct diagnoses in pregnant women with lower genital tract infection. 

 



 

PATIENTS AND METHODS 

 

We conducted a study at eight Family Health Strategy of the Primary Care 

Services in Botucatu-(Brazilian Unified Healthcare System-SUS) and the pregnant 

population at each service was one of convenience with no attempt to select 

participants based on any specific criteria. Botucatu is a city of 130,000 people, 

located in the middle of Sao Paulo State-Brazil The population in general were of low 

income and reflect the ethnic distribution of the country. The Institution’s Research 

and Ethical Committees of the Botucatu Medical School approved the study and all 

women gave written informed consent.  

We enrolled pregnant women between 5 and 40 weeks of gestation 

receiving routine antenatal care at 8 study sites after screening for eligibility from 

September 2006 to February 2007. A total of 245 pregnant women were enrolled in 

this study. The sample was calculated considering the confidence interval of 95%, a 

precision of 5% and general prevalence of genital infections esteemed in 20%. A 

standardized medical, obstetric, sexual and social history was obtained. Women 

were excluded from the study for the following reasons: vaginal bleeding; current 

antibiotics use or vaginally medication in the preceding 3 days to sample collection or 

sexual intercourse in the preceding 72 hours to examination.  

Specimen collection: a clean, unlubricated speculum was placed into the 

vagina, and the appearance and pH of the vaginal discharge were noted. Sterile 

cotton swabs were used to obtain vaginal material from the upper lateral vaginal vault 

for a vaginal smear. Combining the symptoms and signs with office-based testing 

and laboratory exams based the clinical diagnosis: 1) Gram stain; 2) wet mount; 3) 

vaginal pH; 4) Whiff test (detection of the amine odor after exposure of vaginal 



 

secretions of KOH); 5) identification of > 20% of vaginal epithelial cells as clue cells. 

Vaginal discharges, changes in the characteristics of vaginal discharge, abnormal 

vaginal odor, vaginal itching or lower genital burning were considered as symptoms 

of lower genital tract infections. The characteristics considered as signals of lower 

genital tract infections included color, viscosity and homogeneity of vaginal secretion.  

It was used standardized methods for collection of the samples in the 8 

Family Health Strategy Units, with dedicated, trained staff and all slides stained were 

read at a central, experienced observers at the Botucatu Medical School, UNESP, 

Brazil, who were blinded to the clinical data.  

The diagnosis of the vaginal candidiasis was based on the presence of 

yeast blast spores or pseudohyphae12. Bacterial vaginosis and intermediate vaginal 

flora were diagnosed by Nugent’s criteria13 and aerobic vaginitis was diagnosed if 

smears were deficient in lactobacilli, positive for cocci or coarse bacilli, positive for 

parabasal epithelial cells, and/or positive for vaginal leucocytes14.  

The results of these exams were used to determine the definitive diagnosis 

of the following infections: vaginal candidiasis (VC), bacterial vaginosis (BV), aerobic 

vaginitis (AV), intermediate vaginal flora (IVF) and mixed infections characterized by 

the association between BV and VC. 

Data were analyzed through descriptive tables of the variables studied, 

establishing the prevalence of the infections and were entered into a database and 

analyzed with SPSS (version 12.0; SPSS Inc., Chicago, IL) and R (version 2.4.1; R 

Development Core Team) statistical software. Fisher exact test and χ2 were used to 

analyze classified data and Mann-Whitney test to numeric data. A p value less than 

0.05 was considered significant.  



 

RESULTS 

 

The complete demographics characteristics among the 245 enrolled 

pregnant women are on Table 1. The median age of the pregnant women enrolled in 

this study was 24.4 years (13-44), 81.2% were white, 4.5% were black and 14.3% 

were another ethnicity. The median number of gestation was 2 (1-10) and more than 

two third (68.6%) were multiparous. Forty five (18.4%) had history of one or more 

abortions, 57.1% were married at the moment of the study and 72.2% had a low level 

of formal education. No difference in these characteristics was detected between 

groups with and without genital infections (Table 1). 

The overall infection rate by clinical diagnosis among 245 pregnant women 

from the Family Strategy of the Primary Care Services was 45.7% (Table 2) and 7 

patients had more than one infection for a total of 119 (48.6%) positive tests. 

Bacterial vaginosis was diagnosed in 53 pregnant women (21.6%), vaginal 

candidiasis in 25 (10.2%), intermediate vaginal flora in 13 (5.2%), aerobic vaginitis in 

7 (2.9%), mixed infection in 7 (2.9%) and another findings in 2.9% (Table 2). 

The prevalence of BV, intermediate vaginal flora, aerobic vaginitis, mixed 

infection and another findings in pregnant women with and without symptoms of 

lower genital tract infection were similar. Pregnant women with symptoms of lower 

genital tract infections showed high prevalence of vaginal candidiasis and pregnant 

women without vaginal discharge showed high prevalence of normal vaginal flora 

(Table 3). 



 

DISCUSSION  

 

The prevalence of 45.7% of lower genital infection observed in this low 

income population, of the pregnant women attended at Family Health Strategy of the 

Primary Care Services in Botucatu, São Paulo State-Brazil, may be considered high. 

However this prevalence was similar to the observed by others authors 4, 15, 16.  

Bacterial vaginosis(BV), a polymicrobial clinical syndrome resulting from 

the replacement of the normal hydrogen peroxide-producing Lactobacillus species in 

the vagina with a mixture of anaerobic bacteria, Gardnerella vaginalis and 

Mycoplasma hominis, without signs of vaginal inflammation, was the most prevalent 

infection in this study, being present in 21.6% of the pregnant women .This result is 

similar to that found in Zimbabuwe17. The infection rate of BV is variable in the 

literature from 9% to 28%17 and Carey & Klebanoff18 described that BV was found in 

16.2% of 13.357 pregnant women.  

For women with a history of preterm delivery the screening for BV is an 

option and the USPSTF19 recommends against routinely screening average risk 

asymptomatic pregnant women for BV. Although there is evidence that screening and 

treating BV in unselected low-risk population groups, rather than a heterogeneous 

combination of high-risk population groups, is effective at reducing the rate of preterm 

delivery8. Our results are in agreement with this critical appraisal of the literature 

since it was demonstrated that symptoms and or signals did not predict clinical 

diagnosis.  

Vaginal candidiasis was the second more prevalent lower genital infection 

in this study, being present in almost 10% of the pregnant women. This result did not 

agree with the literature, where the most frequent genital infection during the 



 

pregnancy is candidiasis14. Vaginal candidiasis was the unique form of lower genital 

infection where the symptoms and or signals were related to clinical diagnosis. On 

the other side, in 48.4% of the pregnant women, with symptoms, the clinical 

diagnosis was normal flora. 

No cases of T. vaginalis were observed, however the methodology used 

was not the gold standard. Using the same methodology of this study, Simões et al.16 

observed infection rate of 2.1% of the vaginal trichomoniasis in Brazilian pregnant 

women, at the beginning of the third trimester.  

In our study, the prevalence of the intermediate vaginal flora (5.2%) was 

similar to described for Brazilian women and it is relatively high (6.7%) compared to 

Simões et al.16. These authors recommended that pregnant women with intermediate 

vaginal flora need to be followed during the prenatal care, due to the higher risk of 

maternal and perinatal complications.  

Although the USPSTF20 recommends against routinely providing the 

service to asymptomatic patients, the balance of benefits and harms cannot be 

determined. 

Our data are in agreement with the conclusion described by Landers et al.4 

that over the phone or in-office diagnosis and treatment that is based on symptoms is 

highly inaccurate and should be abandoned where resources permit.  

At an estimated cost of U$ 10.00 per Gram stain smear can solve the lower 

genital tract infections diagnosis that continues to be the major problem of the 

women’s heath care21. The cost of drug treatment ranging from U$ 1.39 to U$ 2.00 

for pregnant women22, depending on the genital infection type, dosage and route of 

administration of the drug23 is low and the approach to incorporate clinical diagnosis 



 

and treatment based, may be considered a good practice in lower genital tract 

infections. 

In summary, the prevalence of lower genital tract infection in low-income 

pregnant women attended at the Family Health Strategy of the Primary Care 

Services is high and low-cost and easy-to-carry out clinical diagnosis such wet mount 

and Gram stain smear should be routine in prenatal care, due to the high prevalence 

of genital infection and to the maternal and perinatal complications. Our results 

strongly suggest that symptoms alone should not be used to direct treatment. The 

best practice guideline to lower genital tract infections diagnosis in pregnant women 

should take the combination of symptoms / signs with office-based testing and 

laboratory exam (Gram stain; wet mount; vaginal pH; Whiff test (detection of the 

amine odor after exposure of vaginal secretions of KOH) and identification of > 20% 

of vaginal epithelial cells as clue cells) named here as clinical diagnosis. 



 

REFERENCES 

1. Boatto HF, Moraes MS, Machado AP, Girao MJBC, Fischman O. Correlação 

entre os resultados laboratoriais e os sinais e sintomas clínicos das pacientes 

com candidíase vulvovaginal e relevância dos parceiros sexuais na 

manutenção da infecção em São Paulo, Brasil. Rev Bras Ginecol Obstet. 

2007; 29:80-4. 

2. Neme B. Obstetrícia básica. 2a ed. São Paulo: Sarvier; 2000.  

3. Kent HL. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991; 165:1168-76. 

4. Landers DV, Wiesenfeld HC, Heine RP, Krohn MA, Hillier SL. Predictive value 

of the clinical diagnosis of lower genital tract infection in women. Am J Obstet 

Gynecol. 2204; 190:1004-10. 

5. Varma R, Gupta JK. Antibiotic treatment of bacterial vaginosis in pregnancy: 

multiple meta-analyses and dilemmas in interpretation. Eur J Obstet Gynecol 

Reprod Biol. 2006; 124:10-4. 

6. Flynn C, Helwig A, Meurer L. Bacterial vaginosis in pregnancy and the risk of 

prematurity: a meta analysis. J Fam Pract. 1999; 48:885-92. 

7. Meis PJ, Goldenberg RL, Mercer B, Moawad A, Das A, McNellis D, et al. The 

preterm prediction study: Significance of vaginal infections. Am J Obstet 

Gynecol. 1995; 173:1231-5. 

8. Varma R, Gupta JK, James DK, Kilby MD. Do screening-preventative 

interventions in asymptomatic pregnancies reduce the risk of preterm delivery: 

a critical appraisal of the literature. Eur J Obstet Gynecol Reprod Biol. 2006; 

127:145-59. 



 

9. Ugwumadu A, Manyonda I, Reid F, Hay P. Effect of early oral clindamycin on 

late miscarriage and preterm delivery in asymptomatic women with abnormal 

vaginal flora and bacterial vaginosis: a randomised controlled trial. Lancet. 

2003; 361(9362):983-8. 

10. Honest H, Bachmann LM, Knox EM, Gupta JK, Kleijnen J, Khan KS. The 

accuracy of various tests for bacterial vaginosis in predicting preterm birth: a 

systematic review. Br J Obstet Gynecol. 2004; 111:409-22. 

11. Lamont RF. Infection in the prediction and antibiotics in the prevention of 

spontaneous preterm labor and preterm birth. Int J Obstet Gynaecol. 2003; 

110(suppl 5):71-5. 

12. Sobel JD, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy PR, et al. 

Vulvovaginal candidiasis: epidemiologic, diagnostic and therapeutic 

considerations. Am J Obstet Gynecol. 1998; 178:203-11. 

13. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis 

is improved by a standardized method of gram stain interpretation. J Clin 

Microbiol. 1991; 29:297-301. 

14. Donders GGG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, 

Spitz B. Definition of a type of abnormal vaginal flora that is distinct from 

bacterial vaginosis: aerobic vaginitis. Br J Obstet Gynaecol. 2002; 109:33-43. 

15. French JI, McGregor JA, Parker R. Readily treatable reproductive tract 

infections and preterm birth among black women. Am J Obstet Gynecol. 2006; 

194:1717-27. 



 

16. Simões JA, Giraldo PC, Faúndes A. Prevalence of cervicovaginal infections 

during gestation and accuracy of clinical diagnosis. Infect Dis Obstet Gynecol. 

1998; 6:129-22. 

17. Tolosa JE, Chaithongwongwatthana S, Daly S, Maw WW, Gaitán H, 

Lumbiganon P, et al. The International Infections in Pregnancy (IIP) study: 

variations in the prevalence of bacterial vaginosis and distribution of 

morphotypes in vaginal smears among pregnant women. Am J Obstet 

Gynecol. 2006; 195:1198-204. 

18. Carey JC, Klebanoff MA. Is a change in the vaginal flora associated with an 

increased risk of preterm birth? Am J Obstet Gynecol. 2005; 192:1341-7. 

19. U.S. Preventive Services Task Force. Screening for bacterial vaginosis in 

pregnancy. Am J Prev Med. 2001; 20(3S):59-61. 

20. U.S. Preventive Services Task Force. Screening for bacterial vaginosis in 

pregnancy: recommendations and rationale. Am Fam Physician. 2002; 

65:1147-50.  

21. Ollen-Burkey MA, Hillier SL. Pregnancy complications associated with 

bacterial vaginosis and their estimated costs. Infect Dis Obstet Gynecol. 1995; 

3:149-57. 

22. Secretaria Municipal da Saúde de Botucatu. Farmácia popular do Brasil. 

[access Jun 2007]. Avaiable from: 

http://www.botucatu.sp.gov.br/farmaciapopular/.  



 

23. Centers for Disease Control and Prevention - CDC. Sexually transmitted 

diseases treatment guideline. Morb Mortal Wkly Rep. 2006; 55(RR-11):49-55. 



 

 

 

 

 

 

Table 1.  Characteristics of study population 

Characteristics N (%) 
Women 

without genital 
infection (%) 

Women with 
genital 

infection (%) 
P value 

Age (median /range) 24.4 (13-44) 25.7 (15-44) 23.8 (14-44) 0.060(1) 

Race/ethnicity        
White 199 81.2 98 80.3 101 82.1 0.846(2) 

Black 11 4.5 4 3.3 7 5.7 0.546(2) 
Other 35 14.3 20 16.4 15 12.2 0.449(2) 

Marital status        
Single 92 38.0 41 33.1 52 43.0 0.142(2) 

Married 139 57.1 78 62.9 62 51.2 0.086(2) 
Other 11 4.9 5 4.0 7 5.8 0.734(2) 

Education        
< 8 years 177 72.2 89 71.2 88 73.3 0.818(2) 
≥ 8 years 68 27.8 36 28.8 32 26.7 0.818(2) 

        
Nulliparous 77 31.4 32 28.6 45 36.6 0.242(2) 
Multiparous 168 68.6 90 71.4 78 63.4 0.242(2) 
Abortion 45 18.4 26 74.3 9 25.7  
Trimester 
Gestational 

       

First 78 32.1 38 31.4 40 32.8 0.925(2) 
Second 97 39.9 48 39.6 49 40.2 1.000(2) 

Third 68 28.0 35 28.9 33 27.0 0.859(2) 
(1) Mann-Whitney test for independente samples at significance level α = 0,05. 
(2) Test statistic Z between two proportions at significance level α = 0,05. 

 



 

 

 

 

 

 

 

 

Table 2.  Prevalence of the different types of genital infection 

Diagnosis of infection N % 

Bacterial Vaginosis 53 21.6 

Vaginal Candidiasis 25 10.2 

Intermediate Vaginal Flora 13 5.2 

Aerobic Vaginitis 7 2.9 

Mixed Infection 7 2.9 

Another findings 7 2.9 

TOTAL 112 45.7 

 



 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Table 3.   Prevalence of the clinical diagnosis of genital tract infections in pregnant 

women with or without symptoms 

Clinical Diagnosis With 
symptoms (%) 

Without 
symptoms (%) 

p value 

Bacterial Vaginosis 35 22.3 18 20.5 0.231(1) 

Vaginal Candidiasis 23 14.6 2 2.3 0.011(2) 
Intermediate Vaginal Flora 9 5.7 4 4.5 0.751(2) 

Aerobic Vaginitis 3 1.9 4 4.5 0.091(2) 
Mixed Infection(3) 6 3.8 1 1.1 0.671(2) 
Another findings 5 3.2 2 2.3 1.000(2) 
Normal Flora 76 48.4 57 64.8 0,019(1) 
TOTAL 157 100.0 88 100.0  

(1) Chi Square test at significance level α = 0,05 
(2) Fisher’s exact test at significance level α = 0,05 
(3) Mixed infection between bacterial vaginosis and vaginal candidiasis 

 

 



 

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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unesp     UNIVERSIDADE ESTADUAL PAULISTA 
CAMPUS DE BOTUCATU 

FACULDADE DE MEDICINA 

Departamento de Ginecologia e Obstetrícia  
BOTUCATU, SP-Rubião Júnior - Cep18.618-970 -� (14) 3811-6227 / 6090 - Caixa Postal 530 - FAX (14) 6822-1933 - e-mail: 

gineco@fmb.unesp.br 

 

TERMO DE CONSENTIMENTO LIVRE E ESCLARECIDO 

 Fui convidada pelo Dr. Fausto Gondo para participar da pesquisa 

“Importância da rotina diagnóstica das vulvovaginit es no acompanhamento 

pré-natal no Programa de Saúde da Família do Municí pio de Botucatu”.  

 Fui informada que será colhido material da vagina na consulta de pré-natal 

para exame. Fui esclarecida que na vagina existem muitas bactérias e conforme a 

que for encontrada posso ter algumas complicações na gravidez, como infecções, o 

bebê nascer antes do tempo e romper a bolsa das águas antes do parto. Se for 

diagnosticada qualquer alteração, será realizado tratamento específico para evitar 

essas complicações.  

 Eu, ............................................................................................................., 

após ser devidamente esclarecida, aceito participar do projeto de pesquisa, podendo 

a qualquer momento esclarecer dúvidas e desistir de participar do mesmo, sem 

prejuízo do atendimento que eu necessitar. Sei que minha participação no estudo 

não será paga e que os resultados desse estudo serão utilizados apenas 

cientificamente e minha identidade será mantida em sigilo. 

 

Botucatu, ............ de .............................................. de ............. 

Assinatura da Paciente: _______________________________________________ 

 

Assinatura do pesquisador 

Fausto Gondo 

Rua Plácido Rodrigues Venegas, 1136 

Jd. Paraíso II, Botucatu, SP 

CEP 18610-180 

Telefone: (14) 3814-1387 

Orientadora 

Profa. Titular Marilza Vieira Cunha Rudge 

Rua General Teles, 1396 Apto 81 

Centro, Botucatu, SP 

CEP 18602-120 

Tel: (14) 3811-6227



 

unesp     UNIVERSIDADE ESTADUAL PAULISTA 
CAMPUS DE BOTUCATU 

FACULDADE DE MEDICINA 

Departamento de Ginecologia e Obstetrícia  
BOTUCATU, SP-Rubião Júnior - Cep18.618-970 -� (14) 3811-6227 / 6090 - Caixa Postal 530 - FAX (14) 6822-1933 - e-mail: 

gineco@fmb.unesp.br 

Rotina Diagnóstica das Infecções do Trato Genital I nferior 
 
Nome: _______________________________________________________________ 

Matrícula: _______________   Idade: ______ USF: __________________ 

Última RS  ____/___/____    G   P   A   C    

DUM:   ____/___/____ Idade Gestacional  _____semanas ______ dias  

Solicitante: ______________________________ Data do Atendimento ____/___/____   

 
1. Queixas  
Corrimento � Sim � Não   
Tempo de evolução � Até 7 dias � De 08 a 30 dias � Mais de 30 dias � Não sabe 

Intensidade � Pouco � Moderado � Muito � Não sabe 

Aspecto � Fluido � Pastoso � Não sabe  
Cor � Branco � Amarelo � Esverdeado � Não sabe 

Odor � Sim � Não � Às vezes � Não sabe 

Prurido � Sim � Não � Às vezes � Não sabe 

 
 2. Exame Físico 

Corrimento � Sim � Não   
Intensidade � Pouco � Moderado � Muito  

Aspecto � Fluido � Pastoso � Bifásico � Outros:_______ 

Cor � Branco � Amarelo � Acinzentado � Outros:_______ 

Whiff Test � Presente � Ausente � Duvidoso  

Achados � Vulvite � Endocervicite � Ectopia � Outros:_______ 

pH vaginal:________ � Não realizado JEC:__________   

 
Exame Microscópico Direto do Conteúdo Vaginal (GRAM): 

_______________________________________________________________________________

_______________________________________________________________________________ 

_______________________________________________________________________________ 

Data _____/________/______ 



 

 

 

 



 

 
 


	Capa
	Folha de rosto
	Ficha catalográfica
	Dedicatória
	Agradecimentos
	Resumo
	Abstract
	Lista de Tabelas
	Lista de abreviaturas
	Sumário
	INTRODUCTION
	PATIENTS AND METHODS
	RESULTS
	DISCUSSION
	REFERENCES