ABSTRACT
Abstract Genital ulcers (GUs) represent a diagnostic challenge and can be secondary to neoplastic and inflammatory processes of different causes. Among those of infectious etiology, there are sexually transmitted infections (STIs), a very frequent reason for seeking the health service. The most common agents are herpes simplex virus and Treponema pallidum and, more rarely, Haemophilus ducreyi, Klebsiella granulomatis and Chlamydia trachomatis. A careful dermatological examination offers important diagnostic elements; however, atypical manifestations are very common. Distinctive characteristics of ulcers to look out for include their margin, edge, bottom, and base. Regional lymph node chain alterations should be evaluated regarding their number, size, mobility, consistency, inflammation, and pain on palpation. Diagnostic tests have variable sensitivity and specificity, and molecular tests are currently considered the reference exams. The rapid immunochromatographic tests represented a significant advance, as they can be performed with blood obtained from the digital pulp, offer results in up to 30 minutes, and do not require a laboratory structure. The treatment of persons affected by GU/STIs must be immediate, as it aims to prevent complications, as well as reduce transmission. It is not always considered that people with GUs/STIs have varying degrees of depression, anxiety, and self-reproach, with an impact on relationships. Establishing a bond and trusting the professional is essential for adherence to treatment and preventive measures that must be discussed individually.
ABSTRACT
As infecções que causam úlcera genital são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo aborda a síndrome clínica de úlcera genital causada por infecções sexualmente transmissíveis e seus agentes etiológicos mais comuns: Treponema pallidum (sífilis), vírus herpes simples 2 (herpes genital) e vírus herpes simples 1 (herpes perioral), Haemophilus ducreyi (cancroide), Chlamydia trachomatis sorotipos L1, L2 e L3 (linfogranuloma venéreo) e Klebsiella granulomatis (donovanose). São apresentados aspectos epidemiológicos e clínicos dessas infecções, bem como orientações para seu diagnóstico e tratamento, além de estratégias para as ações de vigilância, prevenção e controle, com a finalidade de subsidiar gestores e profissionais de saúde na qualificação da assistência.
Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections, and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (venereal lymphogranuloma), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections are presented, as well as guidelines for their diagnosis and treatment, in addition to strategies for surveillance, prevention and control actions, with the purpose of supporting health managers and professionals in the qualification of care.
El tema de las infecciones que causan úlcera genital hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento fue elaborado con base en evidencias científicas y validado en discusiones con especialistas. Este artículo trata del síndrome de úlcera genital clínica provocada por infecciones de transmisión sexual, con sus agentes etiológicos más comunes: Treponema pallidum (sífilis), virus del herpes simple-1 (herpes genital) y virus del herpes simple-2 (herpes perioral), Haemophilus ducreyi (chancro blando), Chlamydia trachomatis, serotipos L1, L2 y L3 (linfogranuloma venéreo), y Klebsiella granulomatis (donovanosis). Se presentan aspectos epidemiológicos y clínicos de esas infecciones, bien como pautas para su diagnóstico y tratamiento, además de estrategias para acciones de monitoreo epidemiológico, prevención y control, a fin de contribuir con gestores y personal de salud en la cualificación de la asistencia.
Subject(s)
Humans , Male , Female , Ulcer/therapy , Sexually Transmitted Diseases, Viral/epidemiology , Chancroid/therapy , Sexually Transmitted Diseases/therapy , Genitalia/pathology , Brazil/epidemiology , Herpes Genitalis/therapy , Lymphogranuloma Venereum/therapy , Syphilis/therapy , Clinical Protocols , Granuloma Inguinale/therapyABSTRACT
Resumo As infecções que causam úlcera genital são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo aborda a síndrome clínica de úlcera genital causada por infecções sexualmente transmissíveis e seus agentes etiológicos mais comuns: Treponema pallidum (sífilis), vírus herpes simples 2 (herpes genital) e vírus herpes simples 1 (herpes perioral), Haemophilus ducreyi (cancroide), Chlamydia trachomatis sorotipos L1, L2 e L3 (linfogranuloma venéreo) e Klebsiella granulomatis (donovanose). São apresentados aspectos epidemiológicos e clínicos dessas infecções, bem como orientações para seu diagnóstico e tratamento, além de estratégias para as ações de vigilância, prevenção e controle, com a finalidade de subsidiar gestores e profissionais de saúde na qualificação da assistência.
Abstract Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections, and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (venereal lymphogranuloma), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections are presented, as well as guidelines for their diagnosis and treatment, in addition to strategies for surveillance, prevention and control actions, with the purpose of supporting health managers and professionals in the qualification of care.
Resumen El tema de las infecciones que causan úlcera genital hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento fue elaborado con base en evidencias científicas y validado en discusiones con especialistas. Este artículo trata del síndrome de úlcera genital clínica provocada por infecciones de transmisión sexual, con sus agentes etiológicos más comunes: Treponema pallidum (sífilis), virus del herpes simple-1 (herpes genital) y virus del herpes simple-2 (herpes perioral), Haemophilus ducreyi (chancro blando), Chlamydia trachomatis, serotipos L1, L2 y L3 (linfogranuloma venéreo), y Klebsiella granulomatis (donovanosis). Se presentan aspectos epidemiológicos y clínicos de esas infecciones, bien como pautas para su diagnóstico y tratamiento, además de estrategias para acciones de monitoreo epidemiológico, prevención y control, a fin de contribuir con gestores y personal de salud en la cualificación de la asistencia.
Subject(s)
Humans , Chancroid , Sexually Transmitted Diseases , Ulcer , Brazil/epidemiology , Sexually Transmitted Diseases/therapy , Sexually Transmitted Diseases/epidemiology , GenitaliaABSTRACT
Abstract Donovanosis is a chronic, progressive, and indolent bacterial disease that affects the skin and mucous membranes of the genital and perigenital regions, often associated with sexual transmission, and with low infectivity. The malignant transformation of donovanosis lesions occurs exceptionally, as is usually seen in long-term ulcerations.
Subject(s)
Granuloma Inguinale/diagnosis , Granuloma Inguinale/drug therapy , Skin , UlcerABSTRACT
Abstract: Donovanosis is a chronic infectious disease caused by the Gram-negative bacteria Klebsiella granulomatis, which mainly affects the skin and mucous membranes of the genital, perigenital, and inguinal regions. Also known as venereal granuloma or granuloma inguinale, it is endemic in tropical and subtropical regions of the globe and often associated with sexual transmission. We report the case of an 11-year-old female victim of chronic sexual abuse, who was diagnosed with donovanosis and presented a good therapeutic response to doxycycline.
Subject(s)
Female , Child , Sex Offenses , Child Abuse , Granuloma Inguinale/diagnosis , Doxycycline/therapeutic use , Granuloma Inguinale/etiology , Granuloma Inguinale/drug therapy , Anti-Bacterial Agents/therapeutic useABSTRACT
ANTECEDENTES: La Donovanosis o granuloma inguinal, es una enfermedad infecciosa, inflamatoria crónica, usualmente ulcerativa, preferentemente de localización ano-genital, trasmitida sexualmente y causada por la bacteria Klebsiella granulomatis. Se caracteriza por la presencia de los cuerpos de Donovan, en la microscopía de la secreción de las úlceras. El objetivo es presentar un caso de donovanosis en una pareja heterosexual, que consultaron por la presencia simultánea de lesiones en la vulva y en el pene. CASO CLÍNICO: pareja conformada por una mujer de 21 años de edad y su pareja masculina de 24 años, de elevado nivel socioeconómico, que observaron simultáneamente la aparición de una lesión indolora, ulcerada, de bordes elevados y fondo limpio, tanto en el labio mayor de la vulva como en el cuerpo del pene. Negaron la práctica de coito anal o promiscuidad. Se sospechó Donovanosis, por lo cual se realizó extendido citológico de la secreción de la lesión y se encontraron con la tinción de Giemsa, los cuerpos de Donovan en la lesión de la mujer. La muestra tomada al varón fue insuficiente para el estudio. Se realizó manejo de la pareja con doxiciclina. El varón tuvo completa mejoría, pero la mujer por presentar recidiva se le agregó azitromicina. A los cuatro meses del diagnóstico, ambos estaban asintomáticos y con una pequeña área de cicatriz. CONCLUSIÓN: La donovanosis es un cuadro infeccioso que amerita diagnóstico y adecuado tratamiento, ya que tiene potenciales complicaciones genitales e incluso extragenitales, que son consideradas secundarias y pueden llevar a graves afectaciones para la salud.
BACKGROUND: The Donovanosis or granuloma inguinale is an infectious, chronic inflammatory and usually ulcerative disease, preferentially of anogenital location, that is sexually transmitted and caused by the bacteria Klebsiella granulomatis. It is characterized by the presence of the Donovan bodies in the microscopy of the secretion of the ulcers. The objective is to present a case of Donovanosis in a heterosexual couple, who consulted by the simultaneous presence of an injury in the vulva and penis. CASE RECORD: Couple of a 21 year-old woman and a 24 year-old man of high socioeconomic level that observed simultaneously the apparition of a painless and ulcerated injury of elevated edge and clear base, as much in the labia majora of the vulva as in the body of the penis. They denied the practice of anal coitus or promiscuity. The Donovanosis was suspected and the cytological study of the secretion of the injury was carried out. The Donovan bodies were found in the injury of the woman with the Giemsa stain. The sample of the man was insufficient for the study. The treatment of the couple was done with Doxycycline. The man had complete improvement but the woman presented recurrence for what Azithromycin was added to the treatment. To the four months of the diagnosis, both of them were asymptomatic and they had a small area of scar. CONCLUSION: The Donovanosis is an infectious disease that merits diagnosis and appropriate treatment due to it has potential genital and extragenital complications that are considered side effect and could carry to severe alterations for the health.
Subject(s)
Humans , Male , Female , Young Adult , Klebsiella Infections/diagnosis , Granuloma Inguinale/diagnosis , Penis , Vulva , Klebsiella Infections/drug therapy , Doxycycline/therapeutic use , Azithromycin/therapeutic use , Cytodiagnosis , Granuloma Inguinale/drug therapy , Anti-Bacterial Agents/therapeutic useABSTRACT
As doenças sexualmente transmissíveis estão entre os problemas de saúde pública mais comuns em todo o mundo. Entre suas consequências estão a infertilidade feminina e masculina, a transmissão de mãe para filho, determinando perdas gestacionais ou doença congênita, e o aumento do risco para a infecção pelo HIV. Dessa forma, este guideline tem o objetivo de contribuir para melhorar a qualidade de atenção às pessoas com infecções sexualmente transmissíveis mais frequentes no Brasil, trazendo de forma didática e concreta o estado atual dos conhecimentos para os dermatologistas e médicos em geral que atuam no atendimento dessas pessoas e as principais recomendações para o diagnóstico e tratamento das doenças sexualmente transmissíveis mais recorrentes.
Nowadays, sexually transmitted diseases are one of the most common public health issues. Among its consequences are the possibility of transmission from mother to baby - which may cause miscarriages and congenital disease, male and female infertility, and the increase of HIV infection risk. Therefore, the main goal of these guidelines is to contribute to the improvement of the treatment for sexually transmitted diseases patients by presenting to the medical community how today's science stands on the matter and also what the recommendation for diagnosing and treating a patient are.
Subject(s)
Female , Humans , Male , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/therapy , Brazil , Diagnosis, Differential , HIV Infections/transmission , Infectious Disease Transmission, Vertical , Infertility, Female/etiology , Infertility, Male/etiology , Sexually Transmitted Diseases/complicationsABSTRACT
Donovanosis is a chronic bacterial illness frequently associated with sexually transmitted infections (STI) and is under diagnosed both in endemic areas as well as in countries in which doctors have little experience with tropical diseases. The utilization of syndromic diagnosis and treatment of STIs in various parts of the world and the previous use of antibiotics make it difficult to find Donovan bodies in the cytodiagnostic and hystopathological exams, requiring the utilization of technology that is neither routine nor often accessible to confirm the hypothesized diagnosis. Therefore, it is necessary to bring medical professionals up to date about this infectious disease.
Subject(s)
Female , Humans , Male , Granuloma Inguinale , Diagnosis, Differential , Granuloma Inguinale/complications , Granuloma Inguinale/diagnosis , Granuloma Inguinale/drug therapy , Granuloma Inguinale/epidemiologyABSTRACT
Ten patients with donovanosis were treated with thiamphenicol for two weeks. In eight of them, included two HIV infected patients, lesions healed. The safety profile of thiamphenicol makes it a useful and cost-effective agent in the management of donovanosis. Randomized controlled trials should be conducted with these treatment options.