Dijagnostika infekcija spolnoga sustava

Vanja KaliternaOdjel za bakteriološku i molekularnu dijagnostiku infekcija spolnoga sustavaSlužba za mikrobiologijuZavod za javno zdravstvo Splitsko-dalmatinske županij

Dijagnostika infekcija spolnoga sustava

Vanja KaliternaOdjel za bakteriološku i molekularnu dijagnostiku infekcija spolnoga sustavaSlužba za mikrobiologijuZavod za javno zdravstvo Splitsko-dalmatinske županij

Has the time come for Croatia to introduce chlamydia screening among the adolescent population?

Uvod: Infekcije uzrokovane klamidijom ubrajaju se u najčešće spolno prenosive bolesti, posebno kod populacije mlađe od 25 godina. Često su asimptomatske, pa infekcija ostane neprepoznata i neliječena i može dovesti do razvoja komplikacija. Odgovornost za nadzor nad klamidijskom infekcijom je na javnom zdravstvu jer provedba preventivnih programa s ciljem pravovremenog otkrivanja i liječenja infekcije sprječava razvoj komplikacija. Cilj je ovoga rada bio utvrditi učestalost infekcije bakterijom Chlamydia trachomatis u Splitsko-dalmatinskoj županiji, analizirati učestalost s obzirom na dob i spol, te na osnovu rezultata zaključiti je li vrijeme da Republika Hrvatska uvede probir na klamidiju među adolescentskom populacijom. Metode: Za potrebe ovoga rada analizirani su šestogodišnji podaci rutinskog testiranja na bakteriju C.trachomatis u Nastavnom zavodu za javno zdravstvo Splitsko-dalmatinske županije (NZJZ-SDŽ). Testiranja su napravljena PCR metodom na sustavu Cobas 4800 (Roche). Rezultati: U šestogodišnjem razdoblju (2015. - 2020.) ukupno je testirano 45 431 pacijenata na DNK C.trachomatis, te je otkriveno 1 010 (2,2 %) pozitivnih uzoraka. U skupini osoba mlađih od 25 godina testirano je samo 5 886 uzoraka (13,0 % od ukupnog broja testiranih), a među njima je bilo 6,1 % pozitivnih na klamidiju (5,7 % od testiranih žena i 9,0% od testiranih muškaraca, mlađih od 25 godina). Kod osoba starijih od 25 godina bilo je tek 1,6 % pozitivnih na klamidiju (1,4 % žena i 3,2 % muškaraca). Zaključak: Prema rezultatima naše studije, prevalencija klamidijske infekcije u adolescenata znatno je viša od 3,0 %, što ukazuje na neophodnost i ekonomsku opravdanost uvođenja probira na klamidiju među adolescentskom populacijom u Hrvatskoj.Background: Infections caused by chlamydia are among the most common sexually transmitted diseases, especially in population younger than 25 years. They are often asymptomatic, so infection remains unrecognized and untreated. Control of chlamydial infection is a public health responsibility, and implementation of chlamydial screening allows timely detection, early treatment of infection and prevention of complications. The aim of this study was to determine the incidence of Chlamydia trachomatis infection in Split-Dalmatia County, to analyse the incidence regarding to age and gender, and based on the results to conclude has the time come for Croatia to introduce chlamydia screening among the adolescent population. Methods: For the purposes of this paper, six-year data from routine testing for C. trachomatis at the Teaching Institute for Public Health of Split-Dalmatia County (TIPH-SDC) were analysed. The tests were performed by PCR method on the Cobas 4800 system (Roche). Results: In the six-year period (2015–2020), a total of 45,431 patients were tested for C.trachomatis, and 1,010 (2.2%) were positive. In the group of persons younger than 25 years, only 5,886 samples were taken (13.0% of the total number tested). Among them, 6.1% were positive for chlamydia (5.7% of tested women and 9.0% of tested men, younger than 25 years). In the age group older than 25 years, only 1.6% patients were positive for chlamydia (1.4% of women and 3.2% of men). Conclusion: According to the results of our study, the prevalence of chlamydial infection in adolescent population is significantly higher than 3.0%, which indicates the necessity and cost-effectiveness for introduction of chlamydia screening among adolescent population in Croatia

Human Papillomavirus DNA Typing in the Cervical Specimens among Women of Split and Dalmatian County

Human papillomavirus (HPV) infection is the main cause of cervical cancer, the second most common cancer in women worldwide. More than 200 types of HPV have been described, and within this range more than 40 types attack epithelium of genital tract. The types that were most commonly related to the development of cervical cancer are called high-risk types (HR HPV). There are very few studies about HPV prevalence in Croatia and there is an absolute lack of data for Split and Dalmatian County. Therefore, during a 6 month period, we routinely screened 570 women for HPV DNA at the Educational Public Health Institute of Split and Dalmatian County. HR HPV was detected in cervical exfoliated cells, by using Hybrid Capture 2 HPV DNA test. Out of the total number of tested women, 200 (35%) of them were positive to HR HPV. Polymerase chain reaction (PCR) based assays were employed for HR HPV genotyping in positive specimens. The following frequency was observed: HPV 16 in 10%, HPV 18 in 6.1%, HPV 31 in 2.6%, HPV 33 in 1.9%, HPV 52 in 1.4%, HPV 59 in 0.7%, HPV 45 in 0.4% specimens, while 11.9% of tested specimens currently remained untyped. It is necessary to expand this study to a larger number of women, in order to better evaluate genital HPV types distribution among women in this region

HPV Testing for Cervical Cancer Screening in Croatia

Opportunistic screening based on the Pap smear has been undertaken in Croatia since 1953. However, cervical cancer remains an important health problem in Croatia when compared to European countries with organised screening programmes. In Croatia, in addition to screening based on well established cytology, Human papillomavirus (HPV) testing is widely used as secondary test as a triage to borderline cytology and as a follow-up after treatment of severe cervical lesions. Many different approaches for HPV testing arose in Croatia over the last decade depending on the needs of each medical institution involved. Presently, there is an urgent need for better networking between the laboratories, the implementation of quality assessment and the adaptation of a uniform system of referring to and reporting of HPV testing. In conclusion, the best possible organisation for HPV testing would be essential for implementation of HPV testing as primary screening test in Croatia, an thus ultimately and hopefully, the more successful cervical cancer control

Prevalence of Human Papillomavirus (HPV) among Females in the General Population of the Split and Dalmatia County and Its Association with Genital Microbiota and Infections: A Prospective Study

We conducted a prospective study with the aim of determining HPV prevalence and type distribution in the general female population of Southern Croatia (SDC), and to detect the presence of other microorganisms in the lower part of the female reproductive system and their possible influence on the frequency of HPV infection. Data were collected during routine check-up exams. All participants were examined by a gynecologist, and cervico-vaginal scrapings/swabs were collected, for cytological (Pap smear) and microbiological (for bacterial growth, genital mycoplasmas, chlamydia, and HPV) analysis. Informed consent was obtained from all participants with accompanying questionnaire. A total of 1050 asymptomatic women living in SDC participated in the study during a one-year period, and 107 of them (10.2%) had HR-HPV infection. We found that the presence of some bacteria (Ureaplasma, Chlamydia, and Gardnerella) in the lower part of the female genital system has a positive correlation with the frequency of HPV infection and, consequently, a possible influence on faster progression to cervical dysplasia caused by HPV. We consider that inclusion of screening for sexually transmitted infections as monitoring in women with HPV infection could help to find women at risk of cervical cancer progression

CAN INTRODUCTION OF GUIDELINES FOR USE OF AN INTRAUTERINE DEVICE REDUCE CHANGES IN MICROBIAL FLORA OF FEMALE GENITAL SYSTEM IN IUD-USERS?

Intrauterini uložak – IUD (engl. Intrauterine Device) jedna je od najdjelotvornijih metoda kontracepcije. Rabe ga milijuni žena diljem svijeta. Iako različite studije upućuju na prednosti intrauterinog uloška pri izboru metode kontracepcije, negativna posljedica primjene intrauterinih uložaka je mogući razvoj infekcije. Prisutnost stranoga tijela (IUD-a) omogućuje adheriranje bakterija na površinu uloška i stvaranje biofilma. Infekcije koje nastaju kao posljedica formiranja biofilma kronične su i teško izlječive. Stoga, prije postavljanja uloška treba isključiti prisutnost infekcije. Ako je dokazana infekcija, potrebno je odgoditi stavljanje IUD-a do izlječenja. Iz pregleda literaturnih navoda i sveobuhvatnih rezultata navedenog istraživanja u Hrvatskoj možemo zaključiti da je primjena IUD-a mogući rizični čimbenik za razvoj infekcije. Pri liječenju infekcija u našoj populaciji žena valja imati na umu da su dominantni uzročnici Escherichia coli i neočekivano Ureaplasma urealyticum. Mislimo da bi se postojanjem i provođenjem jasnih smjernica pri postavljanu uloška mogle spriječiti komplikacije primjene IUD-a, razvoj infekcije i njezinih posljedica. To je razlog što smatramo da bi se u Hrvatskoj trebao napraviti Postupnik za postavljanje intrauterinog uloška.The intrauterine device (IUD), one of the most effective and most common methods of reversible contraception, is used by millions of women worldwide. Although various studies indicate the benefits of its use as a contraceptive method, the greatest concern regarding IUDs is the potential risk for infection. The presence of the IUD gives a solid surface for bacterial attachment and biofilm formation. Infections due to biofilm formation are chronic and difficult to resolve. However, women should be screened and treated for asymptomatic vaginal or cervical infections before IUD insertion. Based on the data in the literature and the data in study conducted in Croatia, it can be concluded that IUD users are at increased risk for development of infection. Treatment strategies in Croatia should take into consideration that Escherichia coli and Ureaplasma urealyticum are dominant causative agents. We conclude that guidelines for the use of IUD in Croatia are a necessity

SARS-CoV-2 Seroprevalence and Neutralizing Antibody Response after the First and Second COVID-19 Pandemic Wave in Croatia

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus with a pandemic spread. So far, a total of 349,910 SARS-CoV-2 cases and 7687 deaths were reported in Croatia. We analyzed the seroprevalence and neutralizing (NT) antibody response in the Croatian general population after the first (May–July 2020) and second (December 2020–February 2021) pandemic wave. Initial serological testing was performed using a commercial ELISA, with confirmation of reactive samples by a virus neutralization test (VNT). A significant difference in the overall seroprevalence rate was found after the first (ELISA 2.2%, VNT 0.2%) and second waves (ELISA 25.1%, VNT 18.7%). Seropositive individuals were detected in all age groups, with significant differences according to age. The lowest prevalence of NT antibodies was documented in the youngest (<10 years; 16.1%) and the oldest (60–69/70+ years; 16.0% and 12.8%, respectively) age groups. However, these age groups showed the highest median NT titers (32–64). In other groups, seropositivity varied from 19.3% to 21.5%. A significant weak positive correlation between binding antibody level as detected by ELISA and VNT titer (rho = 0.439, p < 0.001) was observed. SARS-CoV-2 NT antibody titers seem to be age-related, with the highest NT activity in children under 10 years and individuals above 50 years