Master's study by biologist José Marcos Sanches, developed within the Postgraduate Program in Tocogynecology at the Faculty of Medical Sciences (FCM), identified biochemical differences in two of the main female genital infections – vulvovaginal candidiasis and cytolytic vaginosis. “These infections were previously differentiated only by vaginal bacterioscopy (bacterial morphotypes). Now, using the mass spectrometry technique, this study made it possible to point out that the answer to this difference may be related to the vaginal lipid and organic acid pathways", the author found.
According to Paulo Giraldo, full professor at FCM, gynecologist at Hospital da Mulher – Caism and supervisor of this study, recognizing the similarity between these infections was of fundamental importance for the medical and scientific community, since the patients' symptoms and complaints are quite similar, which made both the diagnosis and treatment of both difficult.
These results obtained in the study have just generated a scientific article published in Plos One, a high-impact magazine available exclusively in the Online. The work addresses vaginal lipidomics (qualitative identification of lipids in the vagina) in 24 women (with these two diseases and healthy women) treated at the Genital Infections Outpatient Clinic of the Hospital da Mulher – Caism at Unicamp.
Women with these diseases have in common a history of misdiagnosed vaginal discharge and therefore end up receiving the wrong treatment. The same clinical conditions may be present in both infections, especially in women with recurrent vulvovaginal candidiasis. “Despite the clinical similarity, many women do not have vulvovaginal candidiasis but rather cytolytic vaginosis, showing significant acidity in relation to the acidity considered normal in the vagina”, stated the gynecologist.
José Marcos revealed in the investigation the presence of potential lipids and organic acids present in the vaginal contents through mass spectrometry, as this is an instrumental analysis technique in analytical chemistry, in which the molecular universe of biological systems can be visualized with great precision. This type of study had never been done on vaginal contents for this purpose.
The article indicated the main organic acids related to the pathophysiology of these two conditions. “We observed that, in candidiasis, there are acids more related to oxidative stress (which is the mismatch between the production and elimination of reactive oxygen species) and apoptosis (programmed cell death)”, highlighted the researcher.
In cytolytic vaginosis, due to the increase in the number of lactobacilli, José Marcos verified the presence of organic acids linked to the proliferation of bacteria that acidify the vaginal environment, causing flaking, membrane destruction cellphone and release of substances that promote vaginal irritation, a trait that stood out in both pathologies.
Until recently, the literature had almost no work on the vaginal ecosystem that differentiated candidiasis from cytolytic vaginosis. But, for Paulo Giraldo, the mistake in diagnosis involves two fundamental aspects. One is that, as the woman treats the problem in a simplistic way, she ends up not making the complaints that should be made to guide the medical diagnosis. The consequence is that “the patient is referred from one doctor to another without having a correct diagnosis and ends up suffering emotional (due to not discovering the problem), organic and financial disorders”.
Another aspect, he mentioned, is that, in the meantime, women are creating greater resistance to fungi, especially as they inadvertently use antifungals. “These medications start to not act as expected, as is the case with antibiotics. And the increase in resistant fungal strains increases therapeutic failure rates.”
The professor recalled that, when antifungals from the “azole” group appeared on the market, they were very effective in controlling fungal growth and that, now, there is already a lot of clinical resistance, as they have different mechanisms to circumvent the action of the drugs. .
Award
José Marcos' work, in addition to being published in Plos One, won an award at the Portuguese Congress of Gynecology, held in Vilamoura, Portugal, considered the best of the event, among more than 100 scientific works that competed for this distinction.
Paulo Giraldo stated that this investigation – carried out at the Female Genital Infections Outpatient Clinic (AIGF) of Caism, in conjunction with the Thomson laboratory Spectrometry de Institute Masses de Chemistry (IQ) from Unicamp – was important because most studies on genital infections do not focus on cytolytic vaginosis and because it innovated with the idea of using mass spectrometry with liquid chromatography to identify the main vaginal lipids and organic acids.
When studying the vaginal ecosystem, techniques for identifying resident microorganisms are generally used (identification of fungi and bacteria through their different morphotypes or the study of the microbiome), but there are few groups of researchers dedicated to studying this part. vaginal biochemistry or the physical characteristics of the vaginal cavity (pH, humidity, temperature).
In Paulo Giraldo's view, this work added cutting-edge technology to a subject whose clinical relevance is invaluable and it was also clear that, despite this research being important and audacious, there are gaps to be filled. “Even so, we open new perspectives in the study of the vaginal ecosystem, in particular cytolytic vaginosis, which could be a milestone in the study of female genital infections and in gynecology.”
José Marcos' dissertation is part of a broader line of research on genital infections, in the search not only for understanding diseases that afflict thousands of women around the world, but also for new treatment options, moving away from conventional approaches based solely and exclusively on in the indiscriminate use of antifungals and antibiotics.
“The publication of the article in Plos One and the international award certainly resulted from my time at Unicamp and the work that has been done in the area of infections at this institution. It is very gratifying to receive professional recognition for those who are starting their scientific activities and who wish to pursue a career as a researcher”, highlighted the biologist.
The research group coordinated by professor Paulo Giraldo also has two other lines of research in the Caism Gynecology Division: one on female genital hygiene, to prevent infections, and another on re-education of the pelvic floor muscles, to increase tissue oxygenation of the pelvic floor. framework of the vaginal canal. These alternatives, he believes, are essential to avoid medicalization when it comes to genital infections.
José Marcos' research provided a new view of female genital infections, taking as a starting point the verification of the main lipids that can differentiate vulvovaginal candidiasis from cytolytic vaginosis. It also had the collaboration of doctor Rose Amaral, currently responsible for the Outpatient Clinic. of Female Genital Infections at Caism, where care is provided to patients with genital infections on Tuesdays and Friday afternoons, and also pharmacist Michelle Discacciati, both PhDs from the Postgraduate Program in Tocogynecology at FCM.
