Genital infection by human papillomavirus (HPV) tends to occur more frequently in patients with conditions associated with immune suppression. Systemic lupus erythematosus (SLE) is an immunological disorder characterized by generalized inflammation and a number of clinical manifestations and circulating autoantibodies. The aim of the present study was to determine the prevalence of genital HPV infection among female SLE patients. Women diagnosed with SLE based on American College of Rheumatology classification criteria followed at rheumatology outpatient clinic of the Escola Bahiana de Medicina e Saude Publica, Salvador, Brazil, were included in the study. As a comparison group, clinically healthy women who were attending the gynecology outpatient clinic for routine examination at the same institution were recruited. Testing for cervical HPV infection was performed using the nested polymerase chain reaction technique. Eighty-eight female SLE patients (mean age, 41.4 ± 11.6 years) and seventy healthy female subjects (control group) were studied. The prevalence of HPV infection was 80.7 % (71/88) in the SLE group and 35.7 % (25/70) in the control group (p < 0.0001). After adjustment of the variables (early sexual activity, number of partners and obstetric history), the odds ratio (OR) for genital HPV infection in women with SLE was 7.2 (95 % CI, 2.9 to 17.8; p = 0.0001). The use of immunosuppressive drugs was not associated with a higher prevalence of HPV infection. This study demonstrated that SLE patients have a higher prevalence of genital HPV infection, even when exposed to less potential risk factors for the virus.

Background: Vulvovaginal candidiasis (VVC) is the second most common vaginal infection. HIV-infection is a risk factor for this infection. Objective: To determine the frequency of VVC and to describe the main Candida species isolated and their susceptibility to antifungal drugs in HIV-infected patients, compared to HIV-uninfected women in Salvador, Brazil. Methods: Cross-sectional study including a group of 64 HIV-infected women and 76 uninfected women, followed up at the AIDS reference center and at the Gynecological Clinic of Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia, Brazil). Results: Frequency of Candida spp. was higher in HIV-infected women (29.7%) than in HIV-uninfected controls (14.5%) (p = 0.02). The odds ratio value for vulvovaginal candidiasis in HIV-infected patients was 2.6 (95% CI: 1.07 -6.32 p = 0.03). Candida albicans was the most commonly isolated species in both HIV-infected (52.3%) and uninfected women (85.7%), followed by C. parapsolis in 17.6% and 14.3%, respectively. In HIV-infected women, C. glabrata, C. parapsilosis, and a coinfection of C. albicans and C. glabrata were also identified. There was no significant difference between Candida species isolated from the vaginal mucosa of women with VVC and colonization of the vaginal mucosa of HIV-infected and HIV-uninfected women. One C. glabrata isolate from an HIV-infected patient was resistant to fluconazole and other two isolates exhibited a dose-dependent susceptibility. Conclusion: Our results confirm a higher frequency of Candida spp. isolated from the vaginal mucosa of HIV-infected women and a broader spectrum of species involved. Only Candida glabrata isolates showed decreased susceptibility to fluconazole.

CONTEXT AND OBJECTIVE: The human immunodeficiency virus (HIV) is frequently associated with high-grade intraepithelial neoplasia.Immunosuppression and high HIV viral load are the main risk factors for cervical intraepithelial neoplasia (CIN). The aim of this study was to determine the prevalence of CIN in HIV-infected women in Salvador, Bahia, Brazil, and to describe the risk factors in comparison with non-infected women. RESULTS: CIN was more prevalent among HIV-infected women than in the control group (26.6% versus 6.6%; P = 0.01). The odds ratio for CIN among HIV-infected women was 3.7 (95% confidence interval, CI: 1.23-11; P = 0.01), after adjusting for the following variables: age at first sexual intercourse, number of partners, number of deliveries and previous history of sexually transmitted disease. CONCLUSION:The prevalence of CIN among HIV-infected women was significantly higher than among women without HIV infection. HIV infection was the most important risk factor associated with the development of cervical lesions.RESUMO CONTEXTO E OBJETIVO: O vírus da imunodeficiência humana (HIV) está frequentemente associado à neoplasia intraepitelial de alto grau.Imunossupressão e carga viral do HIV elevada são os principais fatores de risco para neoplasia intra-epitelial cervical (NIC). O objetivo deste estudo foi determinar a prevalência de NIC em mulheres infectadas pelo HIV, em Salvador, Bahia, Brasil e descrever os fatores de risco, comparando-as com mulheres não infectadas.

Our results confirm a higher frequency of Candida spp. isolated from the vaginal mucosa of HIV-infected women and a broader spectrum of species involved. Only Candida glabrata isolates showed decreased susceptibility to fluconazole.

Chlamydia trachomatis (CT) is the most common bacterial cause of sexually transmitted disease. It has been associated with arthritis and it is a risk factor for human papillomavirus (HPV)-induced lesions. There are few studies on the frequency of CT infection among systemic lupus erythematosus (SLE) patients. The aim of this study was to determine the prevalence of endocervical CT infection among SLE patients and evaluate whether or not CT infection is a risk factor for HPV-induced lesions. A cross-sectional study included a group of patients who fulfilled the American College Rheumatology criteria for a definite diagnosis of SLE and a control group of non-SLE female individuals from Bahia, Brazil. Polymerase chain reaction was used on endocervical swab specimens to test for CT; a gynecological examination including a cervical cytology and biopsy was done for the identification of HPV lesions. A total of 105 SLE patients were studied, and the control group was composed of 104 age-matched apparently normal women. The prevalence of CT endocervical infection was 3.0 % [confidence interval (CI) 95 % = 0.6-8.0 %] in the SLE group and 5.0 % (95 % CI = 2.0-11.0 %) in the control group; the prevalence ratio was 0.60 (95 % CI = 0.1-2.5). The prevalence of vulvar condyloma was higher among SLE patients (11.0 vs. 1.0 %, p \ 0.001), as were the prevalences of low-grade lesion (12.0 vs. 1.0 %, p \ 0.001) and cervical intraepithelial neoplasia 1 (9.0 vs. 1.0 %, p = 0.02). There was no association between the presence of HPV lesions and CT infections. However, the small number of patients with CT prevents a definite conclusion from being drawn. The prevalence of endocervical CT infection in women with SLE is low and similar to that of the normal population. This suggests that this infection has no role in the pathogenesis of SLE or the development of HPV-induced lesions.