Linfogranuloma venéreo / Venereal lymphogranuloma

El Linfogranuloma venéreo (LGV) es una infección de transmisión sexual (ITS) ulcerativa poco frecuente causada por la bacteria Chlamydia trachomatis (CT), serotipos L1, L2 y L3, originada por el contacto no protegido genital, anal y/u oral. Se asocia con co-infecciones de otras ITS, entre ellas las ocasionadas por el virus de la inmunodeficiencia humana (VIH) y la sífilis. Endémico en áreas tropicales y subtropicales de África, Sudeste Asiático, Latinoamérica y el Caribe, a partir del 2003 se han registrado nuevos brotes en Europa, América del Norte y Australia, en especial entre la población de hombres que tienen sexo con hombres (HsH) y en pacientes VIH positivos. Si bien lo más frecuente de observar en HsH es la proctitis con escasa repercusión ganglionar regional, se debe sospechar LGV ante toda úlcera ano-genital transitoria y linfadenopatías inguinales en esta población. Se presenta un caso de LGV en un paciente HsH no VIH cuya forma de inicio genital permitió el diagnóstico y el tratamiento adecuado.

Lymphogranuloma venereum (LGV) is a rare ulcerative sexually transmitted infection (STI) caused by the bacterium Chlamydia trachomatis (CT), serotypes L1, L2 and L3, caused by unprotected genital, anal and/or oral contact. It is associated with co-infections with other STIs, including those caused by the human immunodeficiency virus (HIV) and syphilis. Endemic in tropical and subtropical areas of Africa, Southeast Asia, Latin America and the Caribbean, since 2003 there have been new outbreaks in Europe, North America and Australia, especially among the population of men who have sex with men (MSM) and in HIV positive patients. Although the most common sign to observe in MSM is proctitis with little regional lymph node repercussion, LGV should be suspected in the presence of any transient anogenital ulcer and inguinal lymphadenopathy in this population. We present a case of LGV in a non-HIV MSM patient whose form of genital onset led to diagnosis and treatment.

Linfogranuloma venéreo genital en un hombre que tiene sexo con hombre: reporte de caso no importado en Chile / Lymphogranuloma venerous genital in men who have sex with men: a non-imported case report in Chile

Resumen El linfogranuloma venéreo (LGV) es una infección de transmisión sexual (ITS) causada por Chlamydia trachomatis. En los últimos años, ha emergido principalmente en hombres que tienen sexo con hombres (HSH). Es frecuente su asociación con otras ITS como el virus de inmunodeficiencia humana (VIH) y la sífilis. Si bien el compromiso genital es la forma de presentación clásica, el síndrome anorrectal constituye el principal cuadro clínico en la actualidad. Presentamos el caso de un HSH con infección por VIH en terapia anti-retroviral, herpes genital recurrente y sífilis latente tratada, sin viajes recientes al extranjero, con adenopatías inguinales fistulizadas a piel, asociada a una úlcera genital dolorosa, sin síntomas anorrectales ni sistémicos, refractario a múltiples tratamientos antibacterianos y antivirales. El estudio con RPC de secreción de la fístula fue positiva a C. trachomatis. Se trató con doxiciclina por seis semanas, con buena respuesta clínica, sin complicaciones.

Abstract Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by Chlamydia trachomatis bacteria. In the past years, it has emerged as a relevant infectious agent, mainly affecting men who have sex with men (MSM), frequently associated with other sexually transmitted infections as human immunodeficiency virus (HIV) and syphilis. Even though genital lesions correspond to the classical presentation of LGV, nowadays anorectal syndrome is more frequently reported. We present a MSM patient, HIV infected, being treated with antiretroviral drugs, with a history of recurrent genital herpes, also recently treated for a syphilis in a latent stage. He had no recent trips. He referred inguinal fistulized enlarged lymph nodes, associated with a painful genital ulcer, he denied anorectal or systemic symptoms. He had been treated with multiple antibiotic and antiviral drugs, with no clinical response. Molecular studies from the content of the fistulized lymph node identified C. trachomatis. The patient received doxycycline for 6 weeks, showing good clinical response.

El Linfogranuloma venéreo rectal: presentación clínica emergente / Rectal lymphogranuloma venereum: an emergent clinical presentation

El linfogranuloma venéreo (LGV) es una enfermedad de transmisión sexual (ETS) poco frecuente causada por los serotipos L1, L2 y L3 de Chlamydia trachomatis.Desde hace más de una década se produjo un aumento de la incidencia de proctitis por LGV casi exclusivamente en hombres que tienen sexo con hombres con prácticas sexuales de riesgo para ETS.Se presentan cuatro casos con LGV rectal

Lymphogranuloma venereum is a rare sexually transmitted infection (STI) caused by serotypes L1, L2 and L3 of Chlamydia trachomatis.For over a decade, there has been a considerable increase in the incidence of LGV proctitis in almost exclusively men who have sex with men with STI risk behaviors.Four cases of rectal LGV are reported

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: abordagem às pessoas com vida sexual ativa / Brazilian Protocol for Sexually Transmitted Infections 2020: approaching sexually active individuals / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: enfoque en las personas con vida sexual activa

Este artigo tem como objetivo apresentar conceitos e práticas clínicas recomendados para a abordagem da pessoa com vida sexual ativa. Esses conceitos são parte integrante das recomendações do Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis (IST) publicado pelo Ministério da Saúde do Brasil em 2020. O artigo propõe uma abordagem abrangente da sexualidade para promoção da saúde e apresenta aspectos importantes do processo de comunicação, que deve ocorrer de forma clara, sem preconceitos ou juízos de valor, com foco na saúde sexual e reprodutiva. Destacam-se pontos relevantes acerca do exercício da sexualidade em fases específicas da vida, recomendando avaliação dos riscos e vulnerabilidades, bem como o rastreamento de IST e o uso de preservativos. Dessa maneira, é possível contribuir para que as pessoas possam exercer sua sexualidade de forma plena, responsável e segura.

This article aims to present concepts and clinical practices recommended to approach people with an active sex life. These concepts are an integral part of the recommendations of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections (STI), published by the Ministry of Health of Brazil in 2020.The article proposes a comprehensive approach to sexuality for health promotion and presents important aspects of the communication process that must develop clearly, without prejudice and judgment, with a focus on sexual and reproductive health. It also highlights relevant points about the exercise of sexuality at specific stages of life, recommending assessment of risks and vulnerabilities, as well as screening for STI and condom use. In this way, it is possible to contribute so that people can exercise their sexuality fully, responsibly and safely.

Este artículo tiene como objetivo presentar los conceptos y las prácticas clínicas recomendados para un abordaje de la persona con una vida sexual activa. Estos conceptos son parte de las recomendaciones contenidas en el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a Personas con Infecciones de Transmisión Sexual (ITS), publicado por el Ministerio de Salud de Brasil en 2020. El artículo propone un abordaje amplio de la sexualidad para la promoción de la salud. Presenta aspectos importantes del proceso de comunicación, que debe ocurrir con claridad, sin prejuicios y juicios de valor, con un enfoque en la salud sexual y reproductiva. Destaca puntos relevantes sobre el ejercicio de la sexualidad en etapas específicas de la vida, recomendando evaluación de riesgos y vulnerabilidades, así como el rastreo de ITS y el uso de preservativos. De esta forma, es posible contribuir para que las personas puedan ejercer su sexualidad de manera plena, responsable y segura.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecções que causam úlcera genital / Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause genital ulcers / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infecciones que causan úlcera genital

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.

Proctitis infecciosa por Chlamydia Trachomatis / Infectious proctitis by Chlamydia Trachomatis

Introducción: Las infecciones transmisibles sexualmente (ITS) son motivo de consulta frecuente, encontrándose Chlamydia trachomatis (CT) entre las prevalentes. Este germen provoca proctitis de diversa gravedad según el biovar involucrado. Los casos más floridos suelen ser ocasionados por el biovar LGV, responsable de la entidad linfogranuloma venéreo. Se desconocen la prevalencia de CT como causa de proctitis en Argentina y los biovares implicados. Con el objetivo de estudiar estas variables, se diseñó un protocolo para detectar y genotipificar CT en pacientes con proctitis infecciosa. Pacientes y métodos: Se incluyeron pacientes mayores de 18 años con cuadro de proctitis infecciosa atendidos en un centro público y otro privado. Se excluyeron pacientes con enfermedad inflamatoria intestinal y radioterapia pelviana. El estudio fue aprobado por un Comité de Ética y los pacientes firmaron un consentimiento informado. En las muestras de hisopado anal se realizó detección y tipificación molecular de CT. Resultados: Entre 31de agosto de 2017 y 31 de mayo de 2018, se incluyeron 56 pacientes (1 mujer, 53 hombres, 2 mujeres trans), 79% HIV+. En 29 casos (52%) se detectó CT. Todos eran hombres que tienen sexo con hombres (HSH) y refirieron practicar sexo anal u oral receptivo no protegido. La mediana de edad de este subgrupo fue de 31 años; 83% HIV+ en tratamiento antirretroviral y mediana de CD4 637 cel/mm3. La coinfección con otras ITS fue del 41% (siendo las más frecuentes HPV, gonococia y sífilis). Los motivos de consulta más frecuentes fueron proctorragia, pujo y tenesmo, proctalgia y secreción. Las manifestaciones clínicas fueron variadas: proctitis, úlcera perianal, tumor endoanal/rectal y absceso/fístula. El 86% de las proctitis correspondió al biovar LGV, siendo 62% moderadas a graves. La mediana de tiempo de evolución hasta el diagnóstico fue 21 días. Los casos más prolongados correspondieron a cuadros clínicos y endoscópicos más graves. La duración del tratamiento se adecuó al biovar involucrado. Todos los pacientes respondieron favorablemente; sin embargo, las dos fístulas perianales requirieron resolución quirúrgica. Conclusiones: Proctitis, úlceras y fístulas son manifestaciones inespecíficas; el hallazgo clínico y endoscópico per se no son suficientes para definir la etiología; sólo una anamnesis minuciosa permite presumir una ITS como agente causal. La tipificación logra definir el biovar, dato fundamental para adecuar el tratamiento, cortar la cadena de transmisión y contar con datos epidemiológicos a nivel local. Como resultado de esta investigación, el Ministerio de Salud de Nación proyectó la emisión de una alerta sobre la presencia de LGV en nuestro medio. Tipo de estudio: Observacional, transversal, analítico, multicéntrico.

Introduction: Sexually transmitted infections (STI) are a frequent reason for consultation, being Chlamydia trachomatis (CT) among the most prevalent ones. It causes proctitis of varying severity depending on the biovar involved. The most severe cases are usually caused by the LGV biovar, responsible for the entity called lymphogranuloma venereum. The prevalence of CT as a cause of proctitis in Argentina and the biovars involved are unknown. In order to study these variables, a protocol was designed to detect and genotype CT in patients with infectious proctitis. Patients and methods: Patients over 18 years old with infectious proctitis were attended in a public and private center. Patients with inflammatory bowel disease and pelvic radiation therapy were excluded. The study was approved by an Ethics Committee and the patients signed an informed consent. The detection and molecular typing of CT was performed in anal swab samples. Results: Between 31-08-2017 and 31-05-2018, 56 patients were included (1 woman, 53 men, 2 trans women), 79% HIV +. In 29 cases (52%) CT was detected. All were MSM and reported to practice unprotected receptive oral or anal sex. The median age of this subgroup was 31 years; 83% HIV + on antiretroviral treatment and median CD4 637 cel / mm3. The coinfection with other STIs was present 41% (the most frequent were HPV, gonococcal and syphilis). The most frequent symptoms were bleeding, tenesmus, proctalgia and secretion. The clinical manifestations were varied: proctitis, perianal ulcer, endoanal / rectal tumor and abscess / anal fistula. 86% of the proctitis corresponded to the LGV biovar, being 62% moderate to severe. The median time of evolution until the diagnosis was 21 days. The most prolonged cases corresponded to more severe clinical and endoscopic symptoms. The duration of the treatment was adapted to the biovar involved. All patients responded favorably; however, the two perianal fistulas required surgical resolution. Conclusions: Proctitis, ulcers and fistulas are nonspecific manifestations; the clinical and endoscopic findings per se are not sufficient to define the etiology; only a meticulous anamnesis allows us to presume an STI as a causative agent. The typification allows to define the biovar, a fundamental data to adapt the treatment, stop chain of transmission and provides local epidemiological data. As a result of this investigation, the Ministry of Health of the Argentina issued an alert about the presence of LGV in our country. Type of study: Observational, cross-sectional, analytical, multicenter study.

Polimorfismo clínico de linfogranuloma venéreo anorrectal en la Ciudad de Buenos Aires / Clinical polymorphism of anorectal lymphogranuloma venereum in Buenos Aires City

Desde 2003, en los países desarrollados han aumentado las comunicaciones sobre casos de linfogranuloma venéreo con cuadros clínicos diferentes de la forma inguinal clásica. Las presentaciones anorrectales, hasta hace poco atípicas, predominan en hombres infectados por HIV que tienen sexo con hombres. El objetivo de este trabajo es informar sobre la presencia de esta infección en la Ciudad Autónoma de Buenos Aires y describir sus variadas manifestaciones clínicas. En el contexto de una pesquisa sistemática de la infección rectal por clamidias, en apenas un trimestre fueron identificados ocho casos de linfogranuloma venéreo por Chlamydia trachomatis biovar LGV en hombres HIV positivos que tienen sexo con hombres. Las manifestaciones anorrectales más frecuentes fueron pujo, tenesmo, urgencia evacuatoria y secreción mucosa o hemopurulenta. En su mayoría presentaban proctitis leve o moderada, acompañada en algunos casos de lesiones perianales. Dados el polimorfismo y la inespecificidad de las manifestaciones clínicas del linfogranuloma venéreo rectal, se advierte sobre la circulación de esta infección en nuestro medio. En caso de detectar Chlamydia trachomatis, es importante genotipificarla para el correcto diagnóstico y tratamiento de la enfermedad y también para su vigilancia epidemiológica. Si la genotipificación no es posible, se debe considerar el caso como producido por el biovar LGV y aplicar el tratamiento correspondiente.

From 2003 to date there has been a rising number of reports from developed countries on cases of lymphogranuloma venereum with anorectal localization in HIV-infected men who have sex with men. This localization differs from the classical inguinal abscesses which are typical of the disease in the tropics. The objective of this work is to document the presence of anorectal lymphogranuloma venereum in Buenos Aires and to describe its varied clinical manifestations. In the context of a systematic survey of rectal chlamydial infection, in just one trimester, eight cases of lymphogranuloma venereum caused by Chlamydia trachomatis biovar LGV were identified in HIV-infected men who have sex with men. The most frequent anorectal manifestations were pus, tenesmus, rectal urgency, and mucous or haemopurulent discharge. The proctitis was mostly mild or moderate and, in some cases, it was accompanied by perianal lesions. Given the great polymorphism and unspecificity of the clinical manifestations of the disease, we warn on the presence of this form of rectal lymphogranuloma venereum in our setting. If Chlamydia trachomatis is detected, it should be genotyped, not only for the correct diagnosis and treatment but also for epidemiological surveillance. Where genotyping is not available, the disease must be considered as caused by the LGV biovar and treated accordingly.

Protocolo del Sistema Nacional de Vigilancia Epidemiológica de transmisión sexual y VIH/VIH avanzado. No. 07 / Protocol of the National Epidemiological Surveillance System for sexual transmission and advanced HIV / HIV. No. 07

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país. En el presente protocolo se incluirán tres elementos: La vigilancia en poblaciones clave será centinela Se instituirá la vigilancia para la población general a través de Epiweb La vigilancia de la mujer embarazada para la prevención y eliminación de la transmisión materno infantil de la sífilis congénita, a través de Epiweb

Chlamydial Proctitis in a Young Man Who Has Sex with Men: Misdiagnosed as Inflammatory Bowel Disease / 전남의대학술지

We report the case of a 20-year-old man with a 2-month history of anal pain and bloody rectal discharge. He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD). The colonoscopy showed mucosal nodularities on the rectum and an anal tag. Because the colonoscopic findings were not consistent with the typical manifestations of IBD, we took an additional sexual history and performed studies for infectious proctitis, including serologic tests for Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. He had homosexual experience, and the serologic tests and PCR of a rectal swab were positive for C. trachomatis infection. Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.

Chlamydial Proctitis in a Young Man Who Has Sex with Men: Misdiagnosed as Inflammatory Bowel Disease / 전남의대학술지

We report the case of a 20-year-old man with a 2-month history of anal pain and bloody rectal discharge. He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD). The colonoscopy showed mucosal nodularities on the rectum and an anal tag. Because the colonoscopic findings were not consistent with the typical manifestations of IBD, we took an additional sexual history and performed studies for infectious proctitis, including serologic tests for Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. He had homosexual experience, and the serologic tests and PCR of a rectal swab were positive for C. trachomatis infection. Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.

Úlceras genitais / Genital ulcers

Este trabalho visa agrupar as informações mais importantes a cerca das úlceras genitais sexualmente transmitidas, para o correto diagnóstico e tratamento destas afecções, visto que podem provocar grandes morbidades para os pacientes, além de ser um problema de saúde pública.

This work aims to group the most important particularity about sexually transmitted genital ulcers, to a correct diagnosis and treatment of this disorders that can cause severe morbidity for the patients, as well as being a health public problem.

Lymphogranuloma venereum and non-Hodgkin lymphoma: a case report / Linfogranuloma venéreo e linfoma não Hodgkin: um relato de caso

Lymphogranuloma venereum (LGV) is an uncommon, contagious, sexually transmitted disease (STD). We report a case of a 17-year-old teenager who presented with a 2-month-old ulcerous vegetant lesion in the right inguinal region. The patient was diagnosed with LGV and received erythromycin treatment. Three months after treatment, he presented with a new ulcerous lesion, very similar to the previous one, in the right supraclavicular region. He was diagnosed with a diffuse large B-cell non-Hodgkin lymphoma. Both diseases are rare in Rio de Janeiro City, Brazil, and physicians should not neglect the possibility of STDs in such cases.

Linfogranuloma venéreo (LGV) é uma doença sexualmente transmissível e de ocorrência pouco frequente. Relatamos um caso de um adolescente com 17 anos de idade que apresentou uma lesão ulcerativa vegetante a cerca de dois meses na região inguinal direita. Foi diagnosticado como LGV e o paciente foi tratado com eritromicina. Três meses após o tratamento o paciente apresentou uma nova lesão ulcerativa, muito semelhante à anterior, na região supraclavicular direita. O diagnóstico desta lesão foi de linfoma difuso de células B do tipo não-Hodgkin. Ambas as patologias não são comuns na Cidade do Rio de Janeiro, Brasil e um médico não deve negligenciar a possibilidade da ocorrência de uma doença sexualmente transmissível (DST).

The role of a commercial enzyme immuno assay antigen detection system for diagnosis of C. trachomatis in genital swab samples.

In the present pilot study, endocervical and urethral swabs collected from 100 patients attending sexually transmitted disease (STD) clinics and regional centre for STD in two referral hospitals in New Delhi were analyzed by enzyme immune assay (EIA), polymerase chain reaction (PCR) and direct fluorescent antibody (DFA) for detection of C. trachomatis. It was found that EIA could detect a very low number of cases (3/100) as against DFA (11/100) and PCR (9/100). Thus, in spite of the widespread availability, lower cost and ease of performance of the enzyme-linked-immunosorbent serologic assay, the present study highlights the need to employ sophisticated diagnostic tools like DFA and PCR for detection of Chlamydia trachomatis in STD patients.

Doenças sexualmente transmissíveis na mulher: como abordar? / Sexually transmitted diseases in women: how to broach them?

O presente estudo visou realizar uma revisão sistemática da literatura em relação à abordagem das mulheres com doenças sexualmente transmissíveis (DST). As síndromes clínicas abordadas abrangeram uretrites, cervicites, corrimento vaginal e úlceras genitais. A propedêutica indicada incluiu exames diretos e bioquímicos, métodos sorológicos, microbiológicos e de biologia molecular. O tratamento foi recomendado de acordo com o diagnóstico sindrômico ou etiológico, de acordo com a disponibilidade de exames complementares. Além disso, incluiu-se também a abordagem de parceiros, gestantes e mulheres coinfectadas pelo HIV.

This paper presents a systematic literature review on the management of women with sexually transmitted diseases (STD). The clinical syndromes discussed were urethritis and cervicitis, vaginal discharge and genital ulcers. Complementary studies included direct examination and biochemical reactions, serology, microbiological and molecular biology methods. The treatment was recommended in accordance with syndromic or etiologic diagnosis and with the availability of complementary examinations. Moreover, the approach towards partners, pregnant women and HIV co-infected women was also included.

Lymphogranuloma venereum: "a clinical and histopathological chameleon?" / Linfogranuloma venéreo: "um camaleão clínico e histopatológico?"

Lymphogranuloma venereum is an infection caused by a variety of the bacterium Chlamydia trachomatis. Both genital and extragenital manifestations of the disease can cause serious differential diagnostic difficulties, indirectly leading to progression and dissemination of the infection. This work describes cases of patients with lymphogranuloma venereum showing atypical clinical and/or histopathological findings. It also focuses on alternative therapeutic approaches, such as surgical excision at stage 1, that may lead to a positive outcome. It is not completely clear whether histopathological findings of lymphogranuloma venereum can reveal progression or changes in the course of the disease over time, as is the case in other diseases. We conclude that both clinical and histopathological observations in a larger number of patients are needed in order to further evaluate the findings presented in this article.

Linfogranuloma venéreo é uma infecção causada por um tipo específico da bactéria Chlamydia trachomatis. Manifestações genitais e extragenitais da doença podem causar uma série de dificuldades no diagnóstico diferencial, indiretamente levando a progressão ou disseminação da infecção. Este trabalho apresenta casos de pacientes com linfogranuloma venéreo cujos achados clínicos e/ou histopatológicos são atípicos, além de abordar métodos de terapia alternativos, tais como excisão cirúrgica na fase 1, os quais podem trazer um resultado positivo. Ainda não se sabe se achados histopatológicos do linfogranuloma venéreo podem revelar progressão ou mudanças no curso da doença ao longo do tempo, como ocorre com outras enfermidades. Concluímos que observações clínicas e histopatológicas devem envolver um número maior de pacientes a fim de avaliar os resultados clínicos deste trabalho.

Rectal Lymphogranuloma Venereum in a Man Who Had Sex with Men

We present the case of a 41-yr-old homosexual man who was managed for suspected rectal cancer before lymphogranuloma venereum was clinically diagnosed. At first, he presented with constipation and tenesmus for several days. Upon rectal examination, the mass was palpated at 3 cm from the anal verge. Colonoscopy revealed a tumor of lower rectum, but multiple endoscopic biopsies were unable to reveal the nature of the tumor, so the pathologist just gave the diagnosis of a rectal pseudo-tumor. Positive chlamydial serology was found, and the final diagnosis was made. He was treated for Chlamydia trachomatis with Doxycycline, 100 mg twice daily for 21 days.

Actitudes terapéuticas manejo sindrómico de las infecciones de transmisión sexual / Therapeutic attitudes: syndromic handling of sexually transmitted infections

En el presente artículo tratamos acerca de los gérmenes causantes de las infecciones de transmisión sexual (ITS), sus manifestaciones clínicas y revisamos los nuevos tratamientos; en especial, el llamado Manejo Sindrómico que es tratar con antibióticos combinados los síntomas de las ITS con el fin de combatir a los agentes causales más frecuentes.

The current article is about causing germs of Sexually Transmitted Infections (STI), its clinical manifestations and to review the new treatment concepts; moreover, the so called syndromic management that is to treat with combined antibiotics the STI symptoms so as to fight the biggest causations.(au)

Diagnosis and Clinical Symptoms of Sexually Transmitted Diseases

Screening and detecting sexually transmitted diseases (STDs) is a form of secondary prevention, which interrupts further transmission as well as progression of the infection and its sequelae. Unfortunately, primary prevention, by means of education and taking safe sex partners, has not been enough to significantly curb the prevalence and high cost of STDs. Bacterial STDs are decreasing in their prevalence whereas the prevalence of viral STDs has increased significantly in recent years. The differential diagnosis for genital ulcers, urethritis, and genital warts is very important. For example, syphilis, chancroid, lymphogranuloma venereum, and herpes simplex for genital ulcer are mistaken for other causes such as Behcet's syndrome, drug eruption, erythema multiforme, amebiasis, trauma, and carcinoma. Confirmatory testings made by cultures, PCR, or serologic studies are important for appropriate treatment and eradication of the disease in both patients and their partners. The physicians treating STDs should make special efforts to be sure that his or her methods of diagnosis and treatment reflect the latest knowledge, since the epidemiologic characteristics and treatment trends are rapidly changing based on newly appearing resistant strains.

Cutaneous Diseases of the External Genitalia

Cutaneous Diseases of the External Genitalia. The patients with cutaneous diseases of the external genitalia are usually concerned about a presence of sexually transmitted diseases, but other cutaneous diseases of inflammatory or autoimmune origin also present as cutaneous diseases of the external genitalia. The commonly found cutaneous diseases of the external genitalia are inflammatory diseases, such as contact dermatitis, psoriasis, Reiter's syndrome, Lichen planus, seborrheic dermatitis, balanitis, and balanoposthitis. Also sexually transmitted diseases are mainly composed of syphilis, genital herpes, lymphogranuloma venereum, condyloma, and molluscum contagiosum. The sexual partners of these sexually transmitted diseases need treatment at the same time. Fungal diseases, such as tinea and candidiasis also occur in genital areas and need careful diagnosis. Autoimmune diseases, such as Behcet's disease, also manifest as ulcerative lesions in the genital areas.