Infecções sexualmente transmissíveis em mulheres afrodescendentes de comunidades quilombolas no Brasil: prevalência e fatores associados / Sexually transmissible infections in African-descendant women in maroon communities in Brazil: prevalence and associated factors / Enfermedades de transmisión sexual en mujeres afrodescendientes de comunidades quilombolas en Brasil: prevalencia y factores asociados

Resumo: O objetivo do estudo foi estimar a prevalência de infecções sexualmente transmissíveis (IST) e fatores associados sobre mulheres quilombolas no Brasil. Trata-se de estudo transversal de base populacional com mulheres quilombolas no período de março de 2017 a janeiro de 2019. Utilizou-se um questionário com informações sociodemográficas, comportamentais e clínicas. Foi realizado exame ginecológico para coleta de células cervicais para citologia oncótica e para detecção de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis e papilomavírus humano (HPV), por meio de teste de reação em cadeia pela polimerase. Foi realizado teste rápido para HIV e sífilis. O desfecho principal foi definido como a infecção por um ou mais agentes infecciosos de transmissão sexual. Para a análise, utilizou-se o teste do qui-quadrado e regressão logística hierárquica. De um total de 380 mulheres, 352 (92,6%) foram incluídas no estudo. A prevalência de, pelo menos, uma IST foi de 18,5% (IC95%: 14,76-22,85). A maior prevalência foi de 11,1% por HPV, seguido de 6,3% por T. vaginalis e de 4,3% por C. trachomatis. Não houve nenhum caso de N. gonorrhoeae. Para o HIV, a prevalência foi de 0,3%, e de sífilis foi de 4,3%. A citologia cervicovaginal estava alterada em 7,7%. A detecção de uma ou mais IST foi significativamente associada a idade entre 25 e 44 anos (OR = 2,33; IC95%: 1,05-5,18), a consumo de álcool (OR = 1,96; IC95%: 1,06-3,64), a resultado alterado da citologia (OR = 3,96; IC95%: 1,65-9,48) e a vaginose bacteriana (OR = 3,61; IC95%: 2,01-6,47). Em mulheres quilombolas houve elevada prevalência de uma ou mais IST, o que torna importante a elaboração de estratégias de prevenção direcionadas a essas mulheres.

Abstract: The study aimed to estimate the prevalence of sexually transmissible infections (STIs) and associated factors in women in quilombola (maroon) communities in Brazil. This was a population-based cross-sectional study of quilombola women from March 2017 to January 2019. A questionnaire was used with sociodemographic, behavioral, and clinical information. A gynecological examination was performed for the collection of uterine cervical cells for oncotic cytology and the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and human papillomavirus (HPV) via polymerase chain reaction. Rapid tests for HIV and syphilis were performed. The main outcome was defined as infection with one or more sexually transmissible pathogens. The analysis used chi-square test and hierarchical logistic regression. From a total of 380 women, 352 (92.6%) were included in the study. Prevalence of at least one STI was 18.5% (95%CI: 14.76-22.85). The highest prevalence was for HPV, with 11.1%, followed by 6.3% for T. vaginalis and 4.3% for C. trachomatis. There were no cases of N. gonorrhoeae. Prevalence was 0.3% for HIV and 4.3% for syphilis. Cervical-vaginal cytology was altered in 7.7% of the women. Detection of one or more STIs was significantly associated with age 25 to 44 years (OR = 2.33; 95%CI: 1.05-5.18), alcohol consumption (OR = 1.96; 95%CI: 1.06-3.64), altered cervical cytology (OR = 3.96; 95%CI: 1.65-9.48), and bacterial vaginosis (OR = 3.61; 95%CI: 2.01-6.47). Quilombola women showed high prevalence of one or more STIs, emphasizing the importance of organizing prevention strategies targeted to these women.

Resumen: El objetivo del estudio fue estimar la prevalencia de enfermedades de transmisión sexual (ETS) y sus factores asociados en mujeres quilombolas en Brasil. Estudio transversal de base poblacional con mujeres quilombolas durante el período de marzo de 2017 a enero de 2019. Se utilizó un cuestionario con información sociodemográfica, comportamental y clínica. Se realizó un examen ginecológico, a fin de recoger células cervicales para la citología oncótica, así como para la detección de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, y virus del papiloma humano (VPH) mediante un test de reacción en cadena de la polimerasa. Se realizó un test rápido para VIH y sífilis. El resultado principal, se definió como infección por uno o más agentes infecciosos de transmisión sexual. Para el análisis, se utilizó el test de chi-cuadrado y regresión logística jerárquica. De un total de 380 mujeres, 352 (92,6%) se incluyeron en el estudio. La prevalencia de por lo menos una ETS fue de 18,5% (IC95%: 14,76-22,85). La mayor prevalencia fue por VPH 11,1%, seguida de 6,3% por T. vaginalis y 4,3% por C. trachomatis. No hubo casos de N. gonorrhoeae. Para el VIH, la prevalencia fue de 0,3% y de sífilis fue de 4,3%. La citología cérvico-vaginal estaba alterada en un 7,7%. La detección de una o más ETS estuvo significativamente asociada con la edad entre 25 a 44 años (OR = 2,33; IC95%: 1,05-5,18), el consumo de alcohol (OR = 1,96; IC95%: 1,06-3,64), resultado alterado de la citología (OR = 3,96; IC95%: 1,65-9,48) y vaginosis bacteriana (OR = 3,61; IC95%: 2,01-6,47). Las mujeres quilombolas presentaron una elevada prevalencia por una o más ETS, por lo que es importante la elaboración de estrategias de prevención dirigidas a estas mujeres.

Manifestaciones coloproctológicas de las infecciones de transmisión sexual ocasionadas por Chlamydia Trachomatis, Neisseria Gonorrhoeae y Treponema Pallidum. Presentación casuística / Coloproctological manifestations of sexually transmitted infections caused by Chlamydia Trachomatis, Neisseria Gonorrhoeae and Treponema Pallidum. Case presentation

Introducción: Las infecciones transmisibles sexualmente (ITS) con afectación anorrectal constituyen un desafío pues las manifestaciones producidas por Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) y Treponema pallidum (TP) son similares. Objetivo: Evaluar si las manifestaciones anorrectales debidas a CT, NG y TP asociadas al examen proctológico permiten diagnóstico certero, sin estudios complementarios. Pacientes y método: Estudio retrospectivo. Revisión de registros de pacientes atendidos en consultorio coloproctológico. Periodo: 01/08/2015-01/07/2016. Se incluyeron pacientes con diagnóstico de ITS anorrectal, excepto aquellos con HPV únicamente. A todos se les pesquisaron ITS mediante hisopado anal para CT por inmunofluorescencia y para estudio directo y cultivo de NG, VDRL para TP y además HIV. Variables: sexo, edad, HIV, sexo anal, uso de preservativo, motivo de consulta y resultado de estudios efectuados. Resultados: Treinta y cuatro pacientes (32 hombres). Edad mediana 31,5 años (rango: 19-65). Veinticinco pacientes HIV + (73,5%). Veintinueve pacientes (28 hombres) mantenían sexo anal. 91% no usaba preservativo adecuadamente. 65% tuvo una única infección (ITS pura). Se diagnosticaron 14 sífilis (8 puras), 14 clamidiasis (7 puras) y 11 gonococcias (7 puras). Co-infección entre ellas: 9% y con HPV: 26%. La úlcera fue la manifestación en 7/8 casos de sífilis puras (todas dolorosas, excepto una). El resto presentó síntomas variados (condilomas virales atípicos, secreción purulenta y proctorragia). Más del 50% de las gonococias puras (4/7) se manifestó con úlcera, sin embargo, el dolor estuvo presente siempre (8/8) y en tres se asoció secreción purulenta. En cambio, la mitad de los pacientes con clamidiasis puras, se manifestó con proctorragia causada por un tumor rectal/sigmoideo inflamatorio, clínicamente indistinguible de neoplasia maligna. Todos las sífilis y gonococias tuvieron correlato con las pruebas diagnósticas, no así las clamidiasis cuyo diagnóstico no pudo confirmarse en tres casos (37,5%), que respondieron al tratamiento empírico. Conclusión: NG y TP anorrectal provocaron mayormente síntomas similares a los de etiología no venérea y se requirió del laboratorio para el diagnóstico etiológico. La presencia de tumor con biopsia negativa para neoplasia maligna en pacientes de riesgo para ITS obliga a descartar clamidiasis. (AU)

Introduction: Sexually transmitted infections (STIs) are a challenge in medical consultation. The clinical manifestations of infection by Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Treponema pallidum ( TP) share symptoms at anorectal level. This implies the need for a high index of suspicion for diagnosis, which is based on history, physical examination and laboratory tests that not always are accurate or available . Purpose: Assess whether clinical signs of anorectal infections by CT, NG and TP associated with proctologic exams, lead to an accurate etiologic diagnosis without the help of specific laboratory studies. Patients and methods: Observational, retrospective study, based on a review of records of patients treated at the outpatient clinic of the Hospital Fernandez (City of Buenos Aires) department of coloproctology, in the period between August 2015 and July 2016. Patients who underwent STI diagnosis were all considered, but to those whose only diagnosis was infection by human papilloma virus (HPV) were excluded from the analysis. All patients were tested after the three etiologies of STI (anal swab for CT study by immunofluorescence, swabbing for direct study, and cultivation of NG and TP VDRL) and HIV. Variables analyzed: sex, age, presence of HIV infection, practice of receptive anal sex, proper use of condoms, signs and symptoms that prompted the consultation, and results of diagnostic tests. Results: 34 patients (32 men) were included. Median age 31.5 years (range: 19-65, interquartile range: 26-37). Twenty-five patients (73.5%) were HIV+. Twenty-nine patients (28 men) remained receptive anal sex. 91% did not use condoms properly. 65% of infections were pure, without other STI asociada-. 14 cases of syphilis (8 pure), 14 Chlamydia (7 pure) and 11 gonococcias (7puras), including co-infection in 9% of cases, no evidence of a more frequent another co-infection diagnosed. Co-infection with HPV was detected in 9 (26%) cases. The ulcer was the sign in 7/8 cases of pure syphilis (all painful, except one). The rest is expressed by a variety of symptoms (atypical viral warts, purulent and bloody diarrhea). Similarly, just over 50% (4/7) of pure gonococcias demonstrated ulcer, but the pain was always present (8/8 of pure gonococcias) and three associated with purulent discharge. Instead of the ten patients with pure chlamydia, 50% manifested with bloody diarrhea caused by a rectal tumor / inflammatory sigmoid, clinically indistinguishable from malignancy. All cases of syphilis and gonococcal were correlated with diagnostic tests; not those whose diagnosis of chlamydial infection (confirmed in eight and was negative in three, 37.5%) who responded to empiric treatment indicated by the clinical suspicion. Conclusion: While this is a small series, it shows that the NG and TP in the anorectal location mostly caused symptoms similar to those of non-venereal ethology most of the times, and laboratory assistance for etiologic diagnosis was required. The presence of tumor with negative biopsy for malignancy in patients at risk for STIs, leads chlamydia to be ruled out. (AU)

Lower genital tract infections in young female juvenile idiopathic arthritis patients

Abstract Background: To evaluate human papillomavirus (HPV), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in juvenile idiopathic arthritis (JIA) patients. Methods: After exclusion, 33 female adolescent and young JIA patients (ILAR criteria) and 28 healthy controls were selected for this study. Demographic data, gynecological, sexual function, cervical cytology and histological abnormalities were evaluated. JIA clinical/laboratorial parameters and treatment were also assessed. HPV-DNA, CT-DNA and NG-DNA testing in cervical specimens were performed by Hybrid Capture 2 assays. Results: The mean current age was similar in JIA patients and controls (23.3 ± 6.24 vs. 26.1 ± 6.03 years, p = 0.09). The frequencies of sexual intercourse (76% vs. 89%, p = 0.201) and abnormal cervical cytology (24% vs. 11%, p = 0.201) were similar in JIA compared to controls. The higher frequency of HPV infection in JIA patients than controls (30% vs. 11%, p = 0.155) did not reach statistical significance. CT (0% vs. 7%, p = 0.207) and NG infections (0% vs. 4%, p = 0.459) were also alike in both groups. Further evaluation of JIA patients with abnormal and normal cervical cytology showed that the former group had a higher frequency of HPV infection (87% vs. 12%, p = 0.0002) with a low frequency of HPV vaccination (0% vs. 8%, p = 1.0). No differences were evidenced between these two JIA groups regarding demographic data, sexual function and clinical/laboratorial parameters. The frequencies of methotrexate (p =0.206) and biological agent use (p =0.238) were similar in both JIA groups. Conclusions: To our knowledge, this was the first study to assess lower genital infections in JIA patients allowing the identification of HPV as main cause of cervical dysplasia. Methotrexate and biological agents do not seem to increase risk of lower genital tract infections in JIA patients.

Urétrite gonococcique: preuve bactériologique de la circulation de N. gonorrhoeae dans la ville de Bukavu et revue de la littérature

Nous décrivons un cas d'urétrite gonococcique chez un patient de 31 ans qui a consulté après qu'il a eu une mictalgie et un écoulement urétral purulent, une semaine après de relations sexuelles non-protégées. Sont abordés par après le diagnostic de confirmation bactériologique, la toute première à Bukavu, la sensibilité de la souche aux antibiotiques (Ceftriaxone et Ciprofloxacine) et une brève revue de la littérature sur le Neisseria gonorrhoeae

Prevalence of Chlamydia trachomatis and Neisseria gonorrhea and associated factors among women living with Human Immunodeficiency Virus in Brazil: a multicenter study

Abstract Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) cause infections in the female genital tract, increasing susceptibility to and infectiousness of HIV. The objectives of the present study were to determine the prevalence and associated factors of CT and GC infection among HIV-infected women in Brazil. Methods: Cross-sectional study conducted from March to December 2015, including HIV-infected women attending referral centers in nine states of Brazil, aged 18-49 years, nonpregnant. An interview was conducted including socio-demographic, epidemiological and clinical characteristics. After the interview, gynecological examination was conducted to collect cervical cytology and vaginal secretion to C. trachomatis and N. gonorrhoeae tests through molecular biology. Results: A total of 802 (89.1%) women participated. The prevalence of CT was 2.1% (17/802) and CG was 0.9% (7/802). The prevalence of a positive test for both CT and/or GC was 2.7%. The factors associated with positive CT/GC test in the multivariate logistic regression analysis were abnormal Papanicolau smear (OR 4.1; 95% CI: 1.54-11.09) and the presence of abnormal cervical discharge (OR 2.6; 95% CI: 1.02-6.71). Among 377 women who reported previous STI 245 (65.0%) reported using condom more frequently after being diagnosed. 62 (16.4%) discovered the STI after the partner told he was infected; 157 (41.6%) had STI symptoms and looked for care, and 158 (41.9%) discovered it in a routine consultation for another reason. Conclusions: The control of STI represents a unique opportunity to improve reproductive health of women living with HIV. STI diagnosis can change their behavior and reduce the sexual transmission of HIV and bacterial STI.

Anogenital infection by Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected men and women in Salvador, Brazil

ABSTRACT Background: Infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae are the most common bacterial sexually transmitted infections throughout the world. These sexually transmitted infections are a growing problem in people living with HIV/AIDS. However, the presence of these agents in extra genital sites, remains poorly studied in our country. The objective of this study was to estimate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae anal and genital infection in people living with HIV/AIDS followed in a reference center in Salvador, Brazil. Methods: Cross-sectional study, from June 2013 to June 2015. Proven HIV-infected people attending this reference center were invited. Clinical and epidemiological data were obtained through interview with standardized form. Chlamydia trachomatis and Neisseria gonorrhoeae screening was performed using qPCR (COBAS 4800® Roche). Results: The frequency of positive cases of Chlamydia trachomatis and Neisseria gonorrhoeae was 12.3% in total, 9.2% cases amongst women and 17.1% amongst men. We found 14.0% of positive cases in anus and 3.1% in genital region in men, while 5.6% and 3.6%, in women, respectively. Among men, anal infection was associated with age <29 years (p = 0.033), report of anal intercourse (p = 0.029), pain during anal intercourse (p = 0.028). On the other hand, no association between genital infection and other variables were detected in bivariate analysis. Among women, we detected an association between Chlamydia trachomatis genital infection and age <29 years (p < 0.001), younger age at first sexual intercourse (p = 0.048), pregnancy (p < 0.001), viral load >50 copies/mL (p = 0.020), and no antiretroviral use (p = 0.008). Anal infection in women was associated with age <29 years old (p < 0.001) and pregnancy (p = 0.023), and was not associated with report of anal intercourse (p = 0.485). Conclusion: Missed opportunities for diagnosis in extra genital sites could impact on HIV transmission. The extra genital sites need to be considered to break the HIV and bacterial sexually transmitted infections chain-of-transmission.

Nucleic acid amplification tests (NAATs) for gonorrhoea diagnosis in women: Experience of a tertiary care hospital in north India.

Background & objectives: Gonorrhoea is among the most frequent of the estimated bacterial sexually transmitted infections (STIs) and has significant health implications in women. The use of nucleic acid amplification tests (NAATs) has been shown to provide enhanced diagnosis of gonorrhoea in female patients. However, it is recommended that an on-going assessment of the test assays should be performed to check for any probable sequence variation occurring in the targeted region. In this study, an in-house PCR targeting opa-gene of Neisseria gonorrhoeae was used in conjunction with 16S ribosomal PCR to determine the presence of gonorrhoea in female patients attending the tertiary care hospitals. Methods: Endocervical samples collected from 250 female patients with complaints of vaginal or cervical discharge or pain in lower abdomen were tested using opa and 16S ribosomal assay. The samples were also processed by conventional methods. Results: Of the 250 female patients included in the study, only one was positive by conventional methods (microscopy and culture) whereas 17 patients were found to be positive based on PCR results. Interpretation & conclusions: The clinical sensitivity of conventional methods for the detection of N. gonorrhoeae in female patients was low. The gonococcal detection rates increased when molecular method was used giving 16 additional positives. Studies should be done to find out other gene targets that may be used in the screening assays to detect the presence of gonorrhoea.

Experiencia con un método de autotoma de muestra vaginal para la detección de infección por Chlamydia trachomatis y Neisseria gonorrhoeae en mujeres jóvenes / Screening of Neisseria gonorrhoeae and Chlamydia trachomatis using techniques of self collected vaginal sample in young women

Chlamydia trachomatis and Neisseria gonorrhoeae are responsible for 3-10% of sexually transmitted diseases in adolescents. 75% are asymptomatic. International standards recommend annual screening for C. trachomatis in sexually active women under 26 years. Self-collected vaginal swab is one of the less invasive screening methods, it is well accepted by patients and rarely used in our country. Aim: To determine the frequency of C. trachomatis and N. gonorrhoeae by a self-sampling method of vaginal swab and its acceptability in a group of adolescents and young adults. Patients and Methods: Women 18 to 25 years old. Vaginal samples were processed by nucleic acid amplification tests, Gen Probe APTIMA Combo2. Data were collected on sexual behavior and perception of self-sampling by survey. Results: We studied 344 patients with an average age of 21.7 years. Detection of C. trachomatis was positive in 7.9% women and it was not found in any of the patients studied for N. gonorrhoeae. 98% considered self-sampling instructions easy to understand, 87.5% felt comfortable taking the sample. Conclusions: Prevalence of C. trachomatis in the study population was similar to that described in other national and international studies. N. gonorrhoeae was not found in this series, which is consistent with literature reports. The self-sampling technique of vaginal sample was well accepted by the patients. However, they were anxious about the quality of the sample. According to our results, it is important to emphasize the importance of annual detection of these pathogens and that self-sampling technique is a valid alternative.

Chlamydia trachomatis y Neisseria gonorrhoeae son causantes de 3 a 10% de las infecciones de transmisión sexual en adolescentes. Las normas internacionales recomiendan su detección anual en mujeres sexualmente activas menores de 26 años. La adherencia a este tamizaje en mujeres jóvenes está limitada por el temor al examen ginecológico y alto costo del examen. Objetivo: Determinar la frecuencia de detección de C. trachomatis y N. gonorrhoeae por un método de auto-toma de muestra vaginal y su aceptabilidad en un grupo de adolescentes y jóvenes adultas. Pacientes y Método: Se incluyeron mujeres de 18 a 25 años atendidas en Clínica Las Condes y el Servicio de Salud Estudiantil de la Universidad de Chile, que fueron instruidas para autotoma de muestra vaginal. Luego de dar su consentimiento, las muestras fueron estudiadas mediante reacción de polimerasa en cadena para la detección de C. trachomatis y N. gonorrhoeae. Se recopilaron datos sobre conductas sexuales y percepción de la autotoma mediante encuesta. Se determinó la relación entre estos factores y la aceptabilidad del método. Resultados: Se reclutaron 344 mujeres, con una edad promedio de 21,7 años. La detección de C. trachomatis fue de 7,9% y no se encontró muestra positiva para N. gonorrhoeae. El reporte de flujo vaginal por la paciente se asoció a 1,5 veces mayor riesgo de C. trachomatis. El 98% consideró las instrucciones de la autotoma fáciles de entender, 87,5% se sintió cómoda al tomar la muestra. Conclusiones: La prevalencia de C. trachomatis en la población estudiada fue similar a lo descrito en otras series nacionales e internacionales; no se encontró N. gonorrhoeae en esta serie, lo que coincide con lo reportado en el extranjero. La técnica de autotoma de muestra vaginal fue bien aceptada por las pacientes; sin embargo, manifestaron ansiedad acerca de la seguridad de una toma adecuada. De acuerdo a nuestros resultados, es importante insistir en la detección anual de estos patógenos siendo la técnica de autotoma una alternativa válida.

Prevalencia de infecciones de transmisión sexual en mujeres embarazadas atendidas en un hospital público de Chile / Prevalence of sexually transmitted infections in pregnant women attending a public hospital in Chile

Introduction: The epidemiologic rates of gonorrhea have declined steadily in Chile, while the incidence of infections with Trichomonas vaginalis and Chlamydia trachomatis is not well known. Aim: Since these sexually transmitted infections (STIs) are associated with adverse pregnancy outcomes and perinatal infections, this study aimed to update their prevalence in a public hospital in the Metropolitan Region of Chile. Patients and Methods: Between April and October 2010 and April and October 2011, pregnant women attending the antenatal Service, Hospital San Borja Arriarán, were randomly selected for detection of T. vaginalis, N. gonorrhoeae and C. tra-chomatis by culture in modified Diamond's broth, Thayer-Martin agar, and by omp1 gene amplification by nested PCR, respectively. We excluded pregnant women who received antibiotics within the past 30 days. Results: Two hundred and fifty five cervicovaginal samples were analyzed. C. trachomatis was detected in 15 (5.9%) and T. vaginalis in 6 (2.4%). N. gonorrhoeae was not found. Conclusion: The results show low prevalence of C. tracho-matis and T. vaginalis and absence of N. gonorrhoeae. These rates have remained stable at this medical center since the 1990s, with a slight increase in C. trachomatis.

Introducción: Las tasas epidemiológicas de gonorrea han disminuido constantemente en Chile, mientras que la incidencia de infecciones por Trichomonas vaginalis y Chlamydia trachomatis no es bien conocida. Estas infecciones de transmisión sexual (ITSs) están asociadas con resultados adversos del embarazo e infecciones peri-natales. Objetivo: Actualizar su prevalencia en un hospital público de la Región Metropolitana de Chile. Pacientes y Métodos: Entre abril y octubre de 2010 y desde abril a octubre de 2011, fueron seleccionadas al azar mujeres embarazadas atendidas en el Servicio de atención prenatal del Hospital San Borja Arriarán para detección de T. vaginalis, N. gonorrhoeae y C. trachomatis, por cultivo en caldo Diamond modificado, cultivo en Thayer-Martin y mediante amplificación del gen omp1, por RPC anidada, respectivamente. Se excluyeron mujeres embarazadas que recibieron antimicrobianos los 30 días previos. Resultados: Se analizaron 255 muestras cérvico-vaginales. C. trachomatis fue detectada en 15 (5,9%) de las mujeres embarazadas. T. vaginalis se aisló en 6 (2,4%) de ellas, mientras que N. gonorrhoeae no se encontró en las gestantes. Conclusión: Los resultados muestran prevalencia baja de C. trachomatis y de T. vaginalis y ausencia de N. gonorrhoeae, proporción que se mantiene estable en este establecimiento desde la década de 1990s, con leve aumento de C. trachomatis.

Systemic lupus Erythematosus and Neisseria gonorrhoea a case of the arthritis-dermatitis syndrome

Systemic lupus erythematosus (SLE) is a systemic disease characterized by arthritis among other protean manifestations. Occasionally lupus flares occur and is associated with increasing joint pains. In this state, complement is activated and leads to precipitation of immune complexes. Neisserial infections are cleared by complement and so in the presence of deficient complement, these infections will flourish. Disseminated gonococcal infection (DGI) occurs infrequently. A case of Neisseria gonorrhoea presenting as the arthritis-dermatitis syndrome which mimicked a lupus flare is presented and the appropriate literature reviewed.

Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infection in men attending STD clinics in Brazil / Prevalência de Neisseria gonorrhoeae e infecção pela Chlamydia trachomatis em homens atendidos em clínicas de DST no Brasil

INTRODUCTION: The study aimed to assess the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections and identify demographic, behavioral and clinical factors correlated withsuch infections in men attending six sexually transmitted disease clinics in Brazil. METHODS: Multicentric, cross-sectional study performed among men attending STD clinics in Brazil. The study included STD clinics in six cities distributed throughout the five geographic regions of Brazil in 2005. Patients provided 20 ml of first catch urine for testing for NG and CT by DNA-PCR. RESULTS: A total of 767 (92.9 percent) men were included in the study. The mean age was 26.5 (SD 8.3) years-old. Prevalence of Chlamydia infection was 13.1 percent (95 percentCI 10.7 percent-15.5 percent) and gonorrhea was 18.4 percent (95 percentCI 15.7 percent-21.1 percent). Coinfection prevalence was 4.4 percent (95 percentCI 2.95 percent-5.85 percent) in men who sought attendance in STI clinics. Factors identified as associated with C. trachomatis were younger age (15-24) [OR=1.4 (95 percentCI 1.01-1.91)], present urethral discharge [OR=4.8 (95 percentCI 1.52-15.05)], genital warts [OR=3.0 (95 percentCI 1.49-5.92)] and previous history of urethral discharge [OR=2.4 (95 percentCI 1.11-5.18)]. Variables associated with gonorrhea were younger age (15 to 24) [OR=1.5 (95 percentCI 1.09-2.05)], presence of urethral discharge [OR=9.9 (95 percentCI 5.53-17.79)], genital warts [OR=18.3 (95 percentCI 8.03-41.60)] and ulcer present upon clinical examination [OR=4.9 (95 percentCI 1.06-22.73)]. CONCLUSIONS: These findings have important implications for education and prevention actions directed toward men at risk of HIV/STD. A venue-based approach to offer routine screening for young men in STD clinics should be stimulated.

INTRODUÇÃO: Nosso objetivo foi acessar a prevalência de Neisseria gonorrhoeae e Chlamydia trachomatis e identificar fatores demográficos, comportamentais e clínicos correlacionados a essas infecções em homens atendidos em clínicas de doenças sexualmente transmissíveis no Brasil. MÉTODOS: Estudo multicêntrico, transversal conduzido em homens que procuraram atendimento em clínicas de DST. O estudo incluiu clínicas de DST em seis cidades distribuídas nas cinco regiões geográficas do Brasil em 2005. Pacientes coletaram 20ml do primeiro jato de urina para testar NG e CT por DNA-PCR. RESULTADOS: Um total de 767 (92,9 por cento) homens foi incluído no estudo. A média de idade foi 26,5 (DP 8,3) anos. A prevalência de infecção por CT foi 13,1 por cento (IC95 por cento 10,7 por cento-15,5 por cento) e NG de 18,4 por cento (IC95 por cento 15,7 por cento-21,1 por cento). A prevalência de co-infecção foi 4,4 por cento (IC95 por cento 2,95 por cento-5,85 por cento). Os fatores identificados como sendo associados com a infecção pela CT foram ser jovem (15-24) [OR=1,4 (IC95 por cento 1,01-1,91)], apresentar corrimento uretral ao exame [OR=4.8 (IC95 por cento 1,52-15,05)], verrugas genitais [OR=3,0 (IC95 por cento 1,49-5,92)] e história prévia de corrimento uretral [OR=2,4 (IC95 por cento 1,11-5,18)]. As variáveis associadas com a gonorréia foram ser jovem (15 to 24) [OR=1,5 (IC95 por cento 1,09-2,05)], apresentar corrimento uretral [OR=9,9 (IC95 por cento 5,53-17,79)], verrugas genitais [OR=18,3 (IC95 por cento 8,03-41,60)] e úlcera ao exame clínico [OR=4,9 (IC95 por cento 1,06-22,73)]. CONCLUSÕES: Estes resultados têm implicações importantes para medidas de educação e prevenção direcionadas aos homens com risco acrescido de HIV/DST. A abordagem no serviço para oferecer testes de rotina para homens jovens atendidos em clínica de DST deve ser estimulada.

Há aumento de dst no carnaval? Série temporal de diagnósticos em uma clínica de DST / Is there increase of std during carnival? Time series of diagnoses in a STD clinic

OBJETIVO: As doenças sexualmente transmissíveis (DST) são causas frequentes de procura por serviços de saúde. As campanhas de mídia sobre DST/Aids apoiam-se na hipótese de que há maior exposição às práticas de risco para DST na época do Carnaval. Nosso objetivo é estudar a distribuição temporal dos atendimentos de primeira vez em uma clínica de DST no período de janeiro de 1993 a dezembro de 2005, visando verificar se há um aumento sazonal após o Carnaval. MÉTODOS: Selecionamos 2.646 prontuários com diagnóstico de gonorreia, sífilis e tricomoníase de pacientes que procuraram o Setor de DST da Universidade Federal Fluminense em Niterói, Rio de Janeiro, Brasil. Na análise estatística, utilizamos observação da média padronizada do número de atendimentos para os 13 anos, mês a mês, ano a ano, observação da série suavizada pelo método Lowess e pelo método determinístico da média móvel. RESULTADOS: Os meses de julho e agosto concentraram o maior número de diagnósticos de gonorreia e sífilis e os de junho e julho, os de tricomoníase. A gonorreia apresentou um valor máximo em maio, tendendo a se reduzir até agosto. Com relação à sífilis, observou-se um número de diagnósticos constantes entre maio e agosto, havendo menor número em janeiro e fevereiro com pico em novembro. O comportamento sazonal para a tricomoníase exibiu um máximo de diagnóstico em julho com tendência consistente de redução até o mês de dezembro, e elevação a partir de janeiro. CONCLUSÃO: O Carnaval não influencia no aumento da ocorrência de gonorréia, sífilis e tricomoníase em pacientes atendidos em uma clínica de DST em Niterói, Rio de Janeiro.

OBJECTIVE: Sexually Transmitted Diseases (STD) are often the cause for search for medical assistance. Media campaigns on STD/Aids presume that exposure to sexual risk practices during Carnival is greater than in other periods of the year. The objective here is to study the temporal distribution of first consultations in a STD clinic, from January, 1993, to December, 2005, to verify whether there is a seasonal increase of STD after Carnival. METHODS: Two thousand, six hundred and fifty six (2,656) records of patients who had received a diagnosis of gonorrhea, syphilisor trichomoniasis were selected. These patients at the time had looked for assistance at the STD Division of the Universidade Federal Fluminense, in Niterói, State of Rio de Janeiro, Brazil. The standardized mean of the number of consultations during those 13 years, month by month, and year by year was observed in the statistical analysis and also smoothed series by the Lowess method and by the deterministic method of the variable mean was considered. RESULTS: July and August showed an increased number of diagnoses for gonorrhea and syphilis, while in June and July there was a concentration of trichomoniasis diagnoses. Gonorrhea presented its highest value in May, tending to a reduction until August. A constant number of syphilis diagnoses was noted between May and August, with a decreased number in January and February, reaching a peak in November. The seasonal behavior of trichomoniasis showed the greatest number of diagnoses in July, with a consistent reduction tendency until December, and an increase from January on. CONCLUSION: The Carnival period has no influence on the increase of gonorrhea, syphilis and trichomoniasis diagnoses in patients observed in a STD clinic in Niterói, Rio de Janeiro.

Diagnóstico microbiológico de las infecciones de transmisión sexual (ITS): Parte 1. ITS no virales / Microbiological diagnosis of sexually transmitted infections (STI): Part 1. Non-viral STI

Non-viral sexually transmitted infections (STI) are an important cause of physical, psychological and social distress, have severe consequences for women's reproductive health and may be transmitted to the newborn child. These infections are also risk factors for the acquisition and transmission of HIV and other STI, and for premature labor. In the last years we have observed a gradual decrease in the national incidence of gonorrhea. The implementation of a screening program in our country for Chlomydia trachomatis is necessary, since up to 80 percent of infections in women are asymptomatic. Due to medical, psychosocial and legal reasons, laboratory diagnosis of STI has to be certain. This offers a great challenge to laboratories. Since etiological agents are susceptible to environmental conditions, present a high adaptation to their human host and have particular physiological characteristics, their laboratory diagnosis is more difficult than diagnosis of conventional microorganisms. Otherwise, the diagnostic techniques currently available for non-viral STI are characterized by their excellent sensitivity and specificity, which result of great interest given the curable nature of these infections. Clinical specimens obtained for diagnosis of STI and other genital infections, such as bacterial vaginosis or Candidiasis represent a large proportion of specimens processed by clinical laboratories. Thus, the creation of norms and quality control guidelines for laboratories which diagnose these infections, and also the epidemiologic and genetic surveillance of circulating sex transmitted microorganisms should be considered a priority in our country. The objective of this study is to review current literature on accurate diagnostic procedures especially for three non-viral STI agents: C. trachomatis, N. gonorrhoeae, and Trichomonas vaginalis.

Prevalencia de Chlamydia trachomatis y Neisseria gonorrhoeae en adolescentes chilenas / Rates of Chlamydia trachomatis and Neisseria gonorrhoeae in Chilean adolescents

Background: Chlamydia trachomatis and Neisseria gonorrhoeae are common sexually transmitted diseases among young women and little has been doing to study them in Chilean adolescents. Aim: Determine the rates of C trachomatis and N gonorrhoeae in Chilean young women. Material and methods: Urine samples were obtained from 203 sexually active females under 25 year-old, who attended hospitals from either high or low-income areas in Chile's capital, Santiago. C trachomatis and Ngonorrhoeae were detected by nucleic acid amplification testing. Results: Seven percent of samples were positive for C trachomatis. AU samples were negative for N gonorrhoeae. Among pregnant women, 19 percent of samples were positive for C trachomatis, while non-pregnant women were positive on 5.5 percent (p =0.04). Systematic use of barrier contraception was referring by 12 percent of women. AU of the latter was free of C trachomatis. No association was observing between age, number of sexual partners, age of first sexual intercourse, and presence of uro-gynecological symptoms, socioeconomic status and the rate of C trachomatis. Conclusions: Seven percent of this group of Chilean young women was infected with C trachomatis. The figure rises to 19 percent if pregnant. Surveillance and screening programs should been implemented to prevent sequels on this vulnerable population.

Simultaneous detection of Neisseria gonorrhoeae and Chlamydia trachomatis by PCR in genitourinary specimens from men and women attending an STD clinic.

Neisseria gonorrhoeae and Chlamydia trachomatis are the two most common bacterial sexually transmitted infections that manifest primarily as urethritis in males and endocervicitis in females, though the infection may be asymptomatic especially in women. Since complications may occur in untreated symptomatic and asymptomatic infected individuals, early diagnosis and treatment of infected individuals is required to prevent severe sequelae and spread of these diseases. Recently molecular amplification assays like Polymerase Chain Reaction (PCR) and Ligase Chain Reaction (LCR) have been found to be highly sensitive and specific methods for detection of N. gonorrhoeae and C. trachonmatis not only in urethral and cervical specimens but also in urine. The objective of this study was to screen male and female Sexually Transmitted Disease (STD) clinic attenders, with and without symptoms suggestive of urethritis and cervicitis for presence of N. gonorrhoeae and C. trachomatis using a multiplex PCR based assay, to compare its performance with culture for N. gonorrhoeae and Direct Fluorescent Antibody (DFA) staining for C. trachomatis and also to compare the efficacy of PCR test performed on urine and genital swab specimens collected from this high risk group. Genital specimens and urine was collected from STD clinic attenders. N. gonorrhoeae and C. trachomatis was detected in genital specimens by culture and DFA respectively. Multiplex PCR was used to detect N. gonorrhoeae and C. trachomatis infection in both genital and urine specimens. Among men with urethritis, N. gonorrhoeae was detected in 70% by culture and 77% by PCR, while C. trachomatis as detected in 7.5% by DFA and 17.5% by PCR. Among females with endocervicitis, N. gonorrhoeae was detected in 7.7% by culture and 30.7% by PCR, while C. trachomatis was detected in 7.7% by DFA and in 15.4% by PCR. None of the asymptomatic males were positive for N. gonorrhoeae and C. trachomatis by conventional methods, while 43.9% were positive for N. gonorrhoeae and 7.5% for C. trachomatis by PCR. Fifty per cent of asymptomatic women were positive for C. trachomatis by PCR alone. We encountered PCR positive but culture/DFA negative results and also PCR negative but culture/DFA positive results. In view of this a single PCR test cannot be used for diagnosis and treatment of N. gonorrhoeae and C. trachomatis infection unless confirmed by a second test.

Two Cases of FitziHugh-Curtis Syndrome in Acute Phase / 대한소화기학회지

Fitz-Hugh-Curtis syndrome has been defined as perihepatitis accompanying pelvic inflammatory disease caused by Neisseria gonorrhoeae and Chlamydia trachomatis. In the acute phase, patients usually complain of severe right upper quadrant pain of sudden onset. The pain is sharp, pleuritic and most intense at the level of the right lower rib margin and thus it is frequently confused with acute cholecystitis or pleurisy. Definitive diagnosis of Fitz-Hugh-Curtis syndrome needs invasive procedures such as laparoscopy or laparotomy, but considering that Fitz-Hugh-Curtis syndrome is a benign condition that can be cured by oral administration of appropriate antibiotics, noninvasive diagnosis is desirable. Recently, we have experienced two cases of Fitz-Hugh-Curtis syndrome in acute phase accompanied with sharp and pleuritic right upper quadrant pain. In one case, pelvic inflammatory disease was not definite, so at first we mistook it for acute cholecystitis and reactivation of chronic hepatitis B. In the other case, Fitz-Hugh-Curtis syndrome followed the preceding, typical pelvic inflammatory disease. Both cases were diagnosed noninvasively and treated successfully by oral administration of antibiotics.

Screening for Chlamydia and Gonorrhea by Strand Displacement Amplification in Homeless Adolescents Attending Youth Shelters in Korea

We conducted the screening of sexually transmitted infections to define the prevalence of genital Chlamydia trachomatis and Neisseria gonorrhoeae infections and status of sexual risk behavior among homeless adolescents (10-19 yr old) in Korea. Adolescents who ran away from home and are under the care of youth shelters in ten cities in Korea served as the study population. Participants filled out a self-administered questionnaire related to sexuality. First-void urine was analyzed for chlamydial and gonococcal infection by strand displacement amplification (BDProbTec(TM)ET, BD Diagnostic Systems, MD, U.S.A.). A total of 175 adolescents from 15 youth shelters took part in the study. Their median age was 16 yr, and 54.9% of them reported having sexual intercourse at least once. The prevalence of C. trachomatis and N. gonorrhoeae among homeless adolescents was 12.6% and 15.4%, respectively. Factors significantly associated with the infections were number of sexual partners during the past year and lifetime. This is the first community-based sexually transmitted infection (STI) screening among adolescent in Korea. Screening programs targeting sexually active adolescents are important for detection of STIs. They should be considered an alternative population-based surveillance system in order to control STIs nationally.