4 Infectious Diseases in Obstetrics and Gynecology Table 2: Current genitourinary signs and symptoms of the study population, stratiﬁed by the diagnosis of bacterial vaginosis (BV) or genital Candida albicans infection (n = 99). Bacterial vaginosis† n = 20 Candida albicans §& n = 22 Vaginal discharge Genital itching Dysmenorrhea Abdominal/pelvic pain Dysuria Genital lesions and/or vaginal hyperemia n (%) 9 (45) 2 (10) 2 (10) 0 0 2 (10) P 0.72 1 1 0.34 1 1 n (%) 15 (68.2) 2 (9.1) 1 (4.5) 2 (9.1) 0 3 (13.6) P 0.03∗ 1 0.45 0.61 1 0.41 ∗A P value ≤0.05 was considered statistically signiﬁcant. The group of patients with bacterial vaginosis and genital candidiasis were compared with the respective groups of uninfected patients. †The Nugent citeria was used for diagnosis. §Vaginal and/or endocervical. &4 of the these 22 patients were diagnosed with Candida spp. for diagnosing T. vaginalis when compared to parasitological and molecular diagnosis, such as direct microscopy, the culture, and polymerase chain reaction [21, 22]. Sutton et al. [23], using molecular techniques, reported a prevalence of 2.1% in a population of 1416 adolescents aged 14–19 years from non-hispanic white, nonHispanic black, and Mexican- American ethnicity. On the other hand, Krashin et al. [14] and Crosby et al. [24], also in the United States, reported higher prevalence rates, 12.9% and 14.4%, respectively. Both studies used culture methods to detect T. vaginalis and were carried out among socioeconomically disadvantaged adolescents, mostly nonwhite patients, that attended public outpatient clinics, similar to the ones included in our study. However, the individuals included in these studies reported a high frequency of sexual intercourse with nonsteady, older partners [14, 24], signiﬁcant history of delinquency and illegal drug use [24], and concurrent Neisseria gonorrhoeae infection [4], characteristics that diﬀerentiate these adoles- cents from our population. The presence of bacterial vaginosis was associated with multiple sexual partners (P = 0.01). In spite of the fact that bacterial vaginosis is not considered an STD, a greater risk for being diagnosed with this disease has been identiﬁed in patients with multiple sexual partners, which is consistent with our study [11]. In this sense, due to the number of sexual partners, in association with the commonly described irregular condom use among this population, one could infer that these adolescents were likely at increased risk for other STDs. Furthermore, male sexual partners may serve as carriers of anaerobic bacteria that cause bacterial vaginosis; the higher incidence of bacterial vaginosis among women with uncircumcised partners reinforces this hypothesis, since the presence of foreskin facilitates the conduction of microorganisms during intercourse [11]. The use of alcohol, tobacco, and illegal drugs was found be associated with bacterial vaginosis. However, it should be interpreted as an indirect risk factor for bacterial vaginosis, since the use of these substances is usually related to practices such as irregular condoms use and poor genital hygiene, that foster the development of this condition [11, 12]. Genital infection by Candida albicans was not associated with any of the risk factors evaluated, although some studies have reported that oral sex and sexual activity are important risk factors for genital infection by this microorganism [8, 18, 25]. Vulvovaginitis is an important public health problem, not only due to the gynecological and obstetric complica- tions associated with it [4, 5] but also because the inﬂamma- tion of the vaginal mucosa and the reduction of lactobacilli could facilitate the transmission of STDs, especially HIV infection [26, 27]. Moreover, the studied population showed a low frequency of condom use and a high number of sexual partners, behaviors that could lead to an important increase in the risk for STDs among these adolescents. Regarding the method for the diagnosis of bacterial vaginosis, although Amsel’s criteria are more often used in the clinical setting [28], the Nugent scoring system has a higher reproducibility [29], with comparable sensitivity and speciﬁcity to the former criteria [28, 30, 31]. This study is limited by its small sample size and the fact that a less reliable test was used for the diagnosis of T. vaginalis and might not reﬂect the real prevalence of this infection. Additionally, the small sample size can limit inference of results to other similarly aged adolescents from diﬀerent regions of Brazil and the world. 5. Conclusions In summary, the results obtained demonstrated a high prevalence of bacterial vaginosis and genital candidiasis among adolescents in a disadvantaged social environment of the third largest city in Brazil. If undiagnosed and untreated, these conditions may lead to major obstetric and gynecological complications, which considerably increase treatment costs and hospitalizations and also have a negative impact on female mortality rates. Adolescent medical care requires a multidisciplinary expertise, which guarantees motivation and enhances information quality about STDs and contraceptive methods. Programs that address these aspects could eﬃciently promote health to adolescents, signiﬁcantly reducing STDs and unplanned pregnancy rates among this population.