Infecções sexualmente transmissíveis (ist's) e sexualidade: como abordar em consultório - relato de experiência / Sexually transmitted infections (sti) and sexuality: how to approach it in the office - experience report / Infecciones de transmisión sexual (its) y sexualidad: cómo abordar en el consultorio - relato de experiencia

A Ética e a Bioética são princípios básicos que fundamentam o trabalho dos profissionais da saúde, considerados de extrema importância frente à dilemas encarados por essa equipe durante a abordagem da sexualidade e Infecções Sexualmente Transmissíveis (IST's). O evento teve como intuito abordar o direcionamento de uma relação de confiança com o paciente e o profissional de saúde, deixando-o confortável e seguro ao compartilhar informações pessoais e confidenciais. Dado o exposto, este relato tem por objetivo descrever as experiências do presente evento e destacar a importância da ética, bioética e sigilo médico para o exercício da profissão. RELATO: A atividade "IST's e Sexualidade: Como abordar em consultório" foi idealizada durante uma reunião do Eixo de Direitos Sexuais e Reprodutivos, e realizada com a colaboração de 8 (oito) coordenadores. As inscrições foram realizadas através de um formulário Google, amplamente divulgado nas mídias sociais: Instagram e WhatsApp. O evento foi realizado no dia 5 de maio de 2022, de forma presencial na Universidade Paranaense (UNIPAR), Umuarama - PR. Foram conduzidas duas palestras, a primeira por uma médica ginecologista e a segunda por uma psicóloga. DISCUSSÃO: O público foi extremamente receptivo com o evento, demonstrando grande satisfação com a forma de abordagem utilizada pelas palestrantes, além da fala clara e bastante didática a respeito de como se deve abordar esse tema frente ao paciente e qual o comportamento mais adequado para o profissional da saúde. CONCLUSÃO: Os pacientes, muitas vezes, já fragilizados e com receio do estigma buscam o acolhimento e apoio dos profissionais da saúde. O evento proporcionou esse direcionamento e orientação da abordagem das IST's e sexualidade em consultório. Portanto, o assunto faz-se de extrema relevância e destaca a necessidade de capacitação desses profissionais por meio da promoção de demais atividades que compreendam a saúde sexual.

Ethics and Bioethics are basic principles that underlie the work of health professionals, considered extremely important in face of the dilemmas faced by this team during the approach to sexuality and Sexually Transmitted Infections (STIs). The event aimed to address the direction of a relationship of trust with the patient and the health professional, making them comfortable and safe when sharing personal and confidential information. Given the above, this report aims to describe the experiences of this event and highlight the importance of ethics, bioethics, and medical confidentiality for the exercise of the profession. REPORT: The activity "STIs and Sexuality: How to approach it in the doctor's office" was conceived during a meeting of the Sexual and Reproductive Rights Axis, and carried out with the collaboration of 8 (eight) coordinators. The registrations were made through a Google form, widely publicized on social media: Instagram and WhatsApp. The event was held on May 5, 2022, in person at the Universidade Paranaense (UNIPAR), Umuarama - PR. Two lectures were conducted, the first by a gynecologist and the second by a psychologist. DISCUSSION: The audience was extremely receptive to the event, showing great satisfaction with the approach used by the lecturers, besides the clear and very didactic speech on how this theme should be approached in front of the patient and what is the most appropriate behavior for the health professional. CONCLUSION: Patients, many times already weakened and afraid of the stigma, seek the welcoming and support from health professionals. The event provided this direction and orientation on how to approach STIs and sexuality in the doctor's office. Therefore, the subject is extremely relevant and highlights the need for training of these professionals through the promotion of other activities that understand sexual health.

Ética y Bioética son principios básicos que fundamentan el trabajo de los profesionales de salud, considerados de extrema importancia frente a los dilemas enfrentados por este equipo durante el abordaje de la sexualidad y de las Infecciones de Transmisión Sexual (ITS). El evento tuvo como objetivo abordar la dirección de una relación de confianza con el paciente y el profesional de la salud, haciéndolo sentir cómodo y seguro al compartir información personal y confidencial. Teniendo en cuenta lo anterior, este informe tiene como objetivo describir las experiencias de este evento y resaltar la importancia de la ética, la bioética y la confidencialidad médica para el ejercicio de la profesión. INFORME: La actividad "ITS y Sexualidad: Cómo abordarla en el consultorio médico" fue idealizada durante una reunión del Eje de Derechos Sexuales y Reproductivos, y realizada con la colaboración de 8 (ocho) coordinadores. Las inscripciones se realizaron a través de un formulario de Google, ampliamente difundido en las redes sociales: Instagram y WhatsApp. El evento se realizó el 5 de mayo de 2022, de forma presencial en la Universidad Paranaense (UNIPAR), Umuarama - PR. Se realizaron dos conferencias, la primera por un ginecólogo y la segunda por un psicólogo. DISCUSIÓN: El público fue extremamente receptivo al evento, mostrando gran satisfacción con el abordaje utilizado por los conferencistas, además del discurso claro y muy didáctico sobre cómo este tema debe ser abordado delante del paciente y cuál es el comportamiento más adecuado para el profesional de salud. CONCLUSIÓN: Los pacientes, muchas veces ya debilitados y con miedo al estigma, buscan la acogida y el apoyo de los profesionales de salud. El evento proporcionó esta orientación y guía sobre el abordaje de las ITS y la sexualidad en el consultorio médico. Por lo tanto, el tema es extremadamente relevante y pone de relieve la necesidad de formación de estos profesionales a través de la promoción de otras actividades que entienden la salud sexual.

Acceptability of self-sampling for etiological diagnosis of mucosal sexually transmitted infections (STIs) among transgender women in a longitudinal cohort study in São Paulo, Brazil

ABSTRACT This study conducted among transgender women in São Paulo, Brazil assessed the acceptability and suitability of screening sexually transmitted infections (STIs), such as Chlamydia trachomatis and Neisseria gonorrhoeae, by sampling multiple anatomical sites (i.e. urethral, anorectal, oropharyngeal, and neovaginal), and utilizing self- or provider-collection methods. First, a convenience sample of 23 cohort participants were recruited during a scheduled study visit between October and November 2018. Data collection was through a short investigator-led quantitative survey in Portuguese, and included presentation of investigator-designed, gender-neutral instructional diagrams to guide self-sampling. Three supplemental focus group discussions (FGDs) with a total of 30 participants guided by semi-structured script were conducted in Portuguese between September and October 2019. All participants reported being assigned male sex at birth and self-identified with a feminine gender identity at time of study. All survey respondents (100%; n = 23) indicated willingness to provide samples for STI screening during a future study visit. Preference was for self-collection of urine samples (83%; n = 19), urethral swabs (82%; n = 18), and anorectal swabs (77%; n = 17). A lower preference for self-collection of oropharyngeal swabs (48%; n = 11) was observed. Most respondents (78%; n = 18) indicated that they would not prefer specimens to be collected by a health professional, mainly due to 'more privacy' (72%; n = 13). All respondents indicated that they would feel comfortable to provide a self-collected sample based on instructional diagrams shown. In FGDs, although the collection by a health professional was described as a technically safer option for some participants, there was a preference for self-collection to avoid discomfort and embarrassment in exposing the body. Overall, this sub-study suggested acceptability among transgender women of introducing self-sampling for etiological diagnosis of STIs from potential infection sites. Uptake and usability will be explored further in a cross-sectional STI prevalence study of transgender women in Brazil.

Sexually transmitted infections among women living with HIV in a Brazilian city

ABSTRACT Background: Clinical improvements following highly active antiretroviral therapy (HAART) may increase high-risk behaviors resulting in sexually transmitted infections (STI). Optimism related to the success of HAART in slowing disease progression, reducing viral load, and improving health status might be important factors for increasing sexual risk behaviors such as less use of condoms. Objective: To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, hepatitis B and C, high-risk HPV, and cervical cytological abnormalities among women living with HIV (WLHIV) who attended a Reference Center for STI/AIDS in Brazil. Methods: A cross-sectional study was conducted among 151 WLHIV attending an STI Clinic in Vitória city, Brazil. A structured questionnaire, including demographic, behavioral, and clinical information, was used for data collection. Serological tests for HIV, syphilis, hepatitis C and B, CD4 counts, and viral load determination were performed. Cervical samples were collected for cytology and real-time PCR for HPV, Chlamydia, and Neisseria gonorrhoeae. Results: In this study, 59% of women had at least one diagnosed STI at the time of the first clinic visit; 31% had clinical forms of anogenital HPV, 10% syphilis, 8%Neisseria gonorrhoeae, 5.0% trichomoniasis, 3% Chlamydia trachomatis, 1% hepatitis B, and 1% hepatitis C; 6.7% of the women presented with cervical cytological abnormalities. Furthermore, 46.3% of women had HR-HPV, and 17.6% had HPV 16/18. Only 5% of the women had a CD4 count <200 cells/mm3, 61.6% had undetectable HIV viral load, and 81.3% were currently on HAART. Conclusion: A high prevalence of STI and HR-HPV infections were observed among HIV-infected women in this investigation. Prevention programs need to focus on counseling WLHIV and their regular partners with focused interventions such as couples counseling and education programs.

Nivel de conocimiento de Sífilis en adolescentes de dos Instituciones Educativas del distrito de Buenaventura / Level of knowledge of Syphilis in adolescents of two Educational Institutions of the Buenaventura district

Objetivo: Establecer el nivel de conocimiento de sífilis en adolescentes de dos Instituciones Educativas del distrito de Buenaventura de grados: noveno, décimo y once. Material y métodos: Estudio descriptivo de corte transversal en jóvenes entre 12 y 18 años; muestra a conveniencia de 420 estudiantes. Se aplicó una encuesta anónima dividida en 5 secciones. Se determinaron características sociodemográficas, hábitos, vida sexual y conocimiento sobre ITS. Resultados: 91% manifestó conocer sobre las ITS; 22,4% expresó conocer los signos y síntomas. 3,1& presentó diagnóstico de ITS; no reportaron casos de sífilis; 51,9% manifestó conocer la sífilis; el 10% expresó conocer signos y síntomas. 16% manifestó conocer mecanismo de prevención. 4% de los estudiantes tiene un buen nivel de conocimiento sobre sífilis. Sobre actividad sexual, 58,7% había iniciado vida sexual, 28% tuvo su primer encuentro a los 11 años o menos, siendo mayormente de género masculino. 33,8% habían tenido 1 pareja sexual, seguido de 23,8% con 6 o más parejas sexuales. El análisis de conocimiento sobre sífilis según institución educativa evidenció que el 8,9% y el 3% de los estudiantes tenía un nivel bueno de conocimiento, en la institución rural y urbana respectivamente. Al evaluar el conocimiento sobre ETS, se encontró que el 85% y 96% de estudiantes en zona rural y urbana respectivamente afirman tener conocimiento; sobre la sintomatología, 21% y 23 % es conocedor de esta, en área rural y urbana respectivamente. Conclusiones: Un alto porcentaje de estudiantes encuestados tienen un bajo nivel de conocimiento sobre sífilis; las mayores falencias se presentan en manifestaciones clínicas, la prevención y la cura de dicha enfermedad; aunque los adolescentes tienen múltiples fuentes de conocimiento, dicha información es deficiente, especialmente la transmitida por los padres y la pareja.

Objective: To establish the level of knowledge about syphilis in adolescents of two Educational Institutions in the district of Buenaventura of the ninth, tenth and eleventh grades. Material and methods: Descriptive cross-sectional study in young people between 12 and 18 years; convenience sample of 420 students. An anonymous survey divided into five sections was applied. Sociodemographic characteristics, habits, sexual life, and knowledge about STIs were determined. Results: 91% said they know about STIs, and 22.4% said they knowing the signs and symptoms. STI diagnoses were presented in 3.1%; not report syphilis cases. 51.9% said that knew about syphilis, 10% said they know signs and symptoms. 16% said they knew about mechanism prevention. 4% of students have a good level of knowledge about syphilis. About sexual activity 58.7% had started sexual life, 28% had their first encounter at age 11 or less, they were principally male. 33.8% had one sexual partner, followed by 23.8% with six or more sexual partners. Institutional Analysis showed that 8.9% (rural) and 3% (urban) of the students, were at a good level of knowledge. When evaluating knowledge about STDs, it was found that 85% (urban) and 96% (rural) students say they know, however, when inquiring about the symptoms, in rural and urban areas, 21 % and 23% respectively are aware of it. Conclusions: The highest percentage of students surveyed has a bad level of knowledge about syphilis, where the highest % was in clinical manifestations, the prevention, and cure of said disease; although adolescents have multiple sources of knowledge, this information is deficient, especially that shared by the parents and the couple.

Clinicoepidemiological profile of sexually transmitted disease (STD) patients presenting in a tertiary care center

Background: Sexually transmitted infections (STIs) constitute a major health problem in the developing countries and prevalence of STIs varies from region to region in our country. Aim: To study the pattern and prevalence of sexually transmitted infections and HIV seropositivity among patients presenting in a tertiary care center. Materials and methods: A retrospective data was collected in the department of Dermatology at Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIHMS), Shri Mahant Indiresh Hospital (SMIH), a tertiary care center in Dehradun, Uttarakhand, India, from January 2011 to December 2018. A total of 525 patients were analyzed in this study. Results: A total of 525 patients were enrolled in our study. STIs were more common in men, with male (365): female (160) ratio of 2.2:1. Maximum numbers of patients were in the age group of 25 to 34 years. Unskilled workers (22.28%) and housewives (20.00%) constituted major proportion. Majority of the cases presented with warts (38.09%) followed by molluscum contagiosum (20.95%) and herpes genitalis (19.61%). But herpes genitalis (27.39%) was found to be the most common STD seen among males and warts (68.75%) among the females. HIV seropositivity was seen among 20 (3.80%) patients and was most commonly associated with herpes genitalis infection (60.00%). Gunjan Gupta, Jitendra Singh Bist, Rahul Sudan, Kewal Krishan, Neeti Kumari. Clinicoepidemiological profile of sexually transmitted disease (STD) patients presenting in a tertiary care center. IAIM, 2019; 6(2): 7-12. Page 8 Conclusion: Increased prevalence of viral STDs like herpes genitalis, genital warts and mollascum contagiosum was seen in our study. Widespread use of antibacterial lead to falling trend of bacterial STDs.

Detección molecular de agentes infecciosos de transmisión sexual en un grupo de hombres sintomáticos y su relación con la conducta sexual / Molecular detection of sexually transmitted agents in a symptomatic group of men and its relationship with sexual behavior

Background: Sexually transmitted infections (STIs) affect sexual and reproductive health of millions of men. Pathogens such as human papillomavirus (HPV), herpes simplex virus type 1 and 2 (HSV-1 y HSV-2), Chlamydia trachomatis,Mycoplasmagenitalium,Mycoplasma hominis and Ureaplasma urealyticum are associated with STIs. Aim: To detect pathogens associated with STIs in symptomatic men and its relationship with sexual behavior. Methodology: DNA was obtained from exfoliated cells of penis from 20 symptomatic men. Pathogens were detected using qPCR or PCR followed by reverse line blot. Sexual behavior was evaluated through a survey. Results: Two or more infectious agents were detected in 50% of samples. U. urealyticum was found in 25%, meanwhile C. trachomatis and M. hominis were detected in 15%. VHS-1, VHS-2 andM. genitalium were detected only in 5%. HPV was found in all samples. The most frequent HPV genotypes were VPH 16, 11, 70. There were no statistical link found between sexual behavior and the studied microorganisms Conclusion: Infectious agents associated with STIs were detected in symptomatic men. HPV was the most frequent pathogen and it was detected in multiple genotypes. It is necessary to increase the sample size to associate significantly the sexual behavior with the results.

Introducción: Las infecciones de transmisión sexual (ITS) afectan la salud sexual y reproductiva de millones de hombres. Patógenos como virus papiloma humano (VPH), virus herpes simplex (VHS-1 y VHS-2), Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis y Ureaplasma urealyticum están asociados a ITS. Objetivo: Detectar patógenos asociados a ITS en hombres sintomáticos y relacionarlos con su conducta sexual. Metodología: Se obtuvo ADN de exfoliado celular del pene de 20 hombres sintomáticos de ITS. Los patógenos fueron detectados por RPC cuantitativa o RPC seguida de reverse line blot. La conducta sexual se evaluó mediante una encuesta. Resultados: En 50% de las muestras se detectaron dos o más agentes infecciosos; U. urealyticum fue detectado en 25% de los casos, mientras que C. trachomatis y M. hominis en 15%. VHS-1, VHS-2 y M. genitalium sólo en 5%. VPH se encontró en todas las muestras y los genotipos más frecuentes fueron VPH 16, 11, 70. No se encontró relación estadística entre los microorganismos estudiados y la conducta sexual de los encuestados. Conclusión: Se detectaron agentes infecciosos asociados a ITS en hombres sintomáticos, siendo VPH el más frecuente y encontrándose en múltiples genotipos. Es necesario aumentar el tamaño de muestra para asociar significativamente la conducta sexual a los resultados.

Perception of sex workers of Lucknow City, Uttar Pradesh, India towards sexually transmitted infections.

The prevention, control, and management of sexually transmitted infections/reproductive tract infection (STI/RTI) are well-recognized cost-effective strategies for controlling the spread of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). A cross-sectional descriptive study was done over a period of 1 year to assess the prevalence of STI, knowledge level about STI, and the STI-HIV link among the female sex workers (FSWs) of Lucknow city, Uttar Pradesh, India along with their biosocial characteristics. Most of the FSWs were illiterate, married, Hindus, and belonged to general category. The prevalence rates of STI among street-based and home-based FSWs were 50.6% and 29.8%, respectively. Knowledge about the role of condom in prevention of STI and the STI-HIV link was significantly less among home-based FSWs than those who are street-based. There is a great lack in the awareness among FSWs regarding STI and their prevention. Behavior change communication (BCC) and advocacy strategy were developed, especially for the home-based group, to strengthen their knowledge regarding the STI-HIV link.

Asymptomatic reproductive tract infections/sexually transmitted infections among HIV positive women.

This study aims to highlight the importance of screening all HIV positive women for various reproductive tract infections/sexually transmitted infections (RTIs/STIs) irrespective of symptoms and to determine its occurrence in asymptomatic HIV positive women. Relevant specimens were collected for diagnosis of various RTIs/STIs. STIs were diagnosed in nearly one‑third of the HIV positive asymptomatic patients which is quite high. The national strategy for STIs/RTIs control misses out large number of asymptomatic RTIs/STIs in HIV positive women which is responsible for silently transmitting these infections in the community. So this strategy should be modified to include screening of all HIV positives women irrespective of symptoms of STIs/RTIs.

Evaluation of the management of sexually transmitted infections by private practitioners in Pulau Pinang, Malaysia

To determine the current practices of private practitioners for the management of STIs in Pulau Pinang, Malaysia, evaluation of pharmacotherapy for STIs in private clinics and to ascertain the management of STIs compared to standard guidelines. Methods: Data was collected by self-administered questionnaire for private practitioners, which gathered information on their socio-demographic as well as practice characteristics. Descriptive statistical analysis was performed by using SPSS for Windows version 13.0. Results: Data was collected from 78 practitioners. Most of the treatment choices mentioned for the treatment of gonorrhea were inconsistent with the guidelines. About 51.2% of practitioners did not screen their patients for HIV/AIDS. Majority of private practitioners counseled their patients about HIV/AIDS on an irregular basis. A high percentage of 59% did not inform health authorities about STI cases and 32.1% mentioned that they did not use any guidelines. Conclusions: Management of STIs by private practitioners with respect to selection of antibiotics, patient counseling and case notification leaves a lot to be desired. Current management practices can adversely impact on HIV/AIDS transmission in the country. Interventions are needed to improve the management practices of private practitioners.