Alta seroprevalencia de sífilis y herpes genital en migrantes en tránsito en Chiapas, México / High seroprevalence of syphilis and genital herpes in migrants in transit in Chiapas, Mexico / Alta soroprevalência de sífilis e herpes genital em migrantes em trânsito por Chiapas, México

RESUMEN Objetivos. Determinar la prevalencia de anticuerpos contra Treponema pallidum y virus herpes simple tipo 2 (VHS-2), así como identificar los factores asociados a dichas infecciones entre migrantes en tránsito en Chiapas, México. Métodos. Estudio transversal realizado durante 2021-2022, en tres albergues para migrantes en Chiapas, México. Las personas contestaron un cuestionario y proporcionaron una muestra de sangre para la detección de anticuerpos contra Treponema pallidum y VHS-2. Se calculó la seroprevalencia y se evaluaron los factores asociados mediante pruebas de χ2 y razones de momios. Resultados. Participaron 462 migrantes, con edad promedio de 31,2 años, 56,9 % eran mujeres, 41,1 % provenían de Honduras. La seroprevalencia de VHS-2 fue 29,9 % mientras que la de sífilis fue 4,5 %, siendo mayor en hombres (8,0 %) que en mujeres (1,9 %). El 15,4 % de las embarazadas presentaban anticuerpos contra sífilis. Entre las variables asociadas a sífilis destacan el ser hombre, antecedente de lesiones genitales, así como tener parejas del mismo sexo y la seropositividad a VHS-2. Con relación al VHS-2, factores como ser mujer, edad, escolaridad, dormir en la calle, antecedente de prueba de VIH, debut sexual temprano, número de parejas sexuales y sífilis estuvieron asociados a la infección. Conclusiones. Se encontró una prevalencia elevada de sífilis y VHS-2 entre la población migrante evaluada. La sífilis se confirma como una infección reemergente, incluso en las mujeres. Los migrantes presenta vulnerabilidades asociadas al comportamiento sexual, por lo que se deben enfocar medidas de prevención, diagnóstico y tratamiento para este grupo poblacional.

ABSTRACT Objectives. To determine the prevalence of antibodies against Treponema pallidum and herpes simplex virus type 2 (HSV-2), and to identify the factors associated with these infections among migrants in transit in Chiapas, Mexico. Methods. Cross-sectional study conducted during 2021-2022, in three migrant shelters in Chiapas, Mexico. Participants answered a questionnaire and provided a blood sample to detect antibodies against Treponema pallidum and HSV-2. The study calculated seroprevalence and assessed associated factors using Chi-square (χ2) tests and odds ratios. Results. A total of 462 migrants participated, with an average age of 31.2 years; 56.9% were women, and 41.1% came from Honduras. The seroprevalence of HSV-2 was 29.9%; for syphilis it was 4.5%, and it was higher in men (8.0%) than in women (1.9%). Among pregnant women, 15.4% had antibodies against syphilis. Notable variables associated with syphilis include being male, having a history of genital lesions, having same-sex partners, and seropositivity to HSV-2. Regarding HSV-2, factors associated with infection included being female, age, schooling, sleeping in the street, a history of HIV testing, early sexual debut, number of sexual partners, and syphilis. Conclusions. A high prevalence of syphilis and HSV-2 was found among the migrant population evaluated. Syphilis is confirmed as a re-emerging infection, even in women. Migrants have vulnerabilities associated with sexual behavior, so prevention, diagnosis, and treatment measures should be focused on this population group.

RESUMO Objetivos. Determinar a prevalência de anticorpos contra Treponema pallidum e vírus herpes simples tipo 2 (HSV-2) e identificar os fatores associados a essas infecções entre migrantes em trânsito por Chiapas, México. Métodos. Estudo transversal realizado nos anos de 2021 e 2022 em três abrigos de migrantes em Chiapas, México. Os participantes preencheram um questionário e forneceram uma amostra de sangue para a detecção de anticorpos contra Treponema pallidum e HSV-2. Calculou-se a soroprevalência e avaliaram-se os fatores associados usando testes de χ2 e razões de chances. Resultados. O estudou incluiu 462 migrantes com idade média de 31,2 anos, dos quais 56,9% eram mulheres e 41,1% vinham de Honduras. A soroprevalência do HSV-2 foi de 29,9%. A soroprevalência de sífilis, por sua vez, foi de 4,5%, sendo mais alta nos homens (8,0%) do que nas mulheres (1,9%). Os anticorpos contra a sífilis estavam presentes em 15,4% das mulheres grávidas. As principais variáveis associadas à sífilis foram sexo masculino e história de lesões genitais, além de parceiros do mesmo sexo e soropositividade para HSV-2. Com relação ao HSV-2, fatores como sexo feminino, idade, escolaridade, dormir na rua, história de teste de HIV, iniciação sexual precoce, número de parceiros sexuais e sífilis estavam associados a infecção. Conclusões. A população migrante avaliada apresenta alta prevalência de sífilis e HSV-2. Confirmou-se que a sífilis é uma infecção reemergente, inclusive em mulheres. Os migrantes apresentam vulnerabilidades associadas ao comportamento sexual; portanto, é preciso concentrar medidas de prevenção, diagnóstico e tratamento nesse grupo populacional.

Antígeno nativo y no nativo para determinar la seroprevalencia de Trypanosoma cruzi en mujeres embarazadas en el estado de Morelos, México / Native and non-native antigen to determine the seroprevalence of Trypanosoma cruzi in pregnant women from the state of Morelos, Mexico

INTRODUCCIÓN: La enfermedad de Chagas es una infección parasitaria crónica sistémica, de importancia global, causada por Trypanosoma cruzi. OBJETIVO: Determinar la prevalencia de anticuerpos contra T cruzi en mujeres embarazadas en el estado de Morelos, México. MATERIALES Y MÉTODOS: Se analizaron 1.620 sueros de mujeres embarazadas mediante dos pruebas serológicas: ELISAc (antígeno crudo nativo) y ELISAr (antígeno recombinante, no nativo). Las muestras reactivas se analizaron posteriormente mediante hemaglutinación indirecta (HAI). Se utilizaron dos enfoques de detección, en paralelo (son positivas las muestras reactivas por cualquier método) y en serie (son positivas las muestras confirmadas por HAI). Se evaluaron factores sociodemográficos y de salud asociados a la presencia de anticuerpos contra T. cruzi mediante razones de momios al 95%. RESULTADOS: Se obtuvo una seroprevalencia de 4,87% con el diagnóstico en paralelo y de 0,43% en serie. A partir de los resultados en paralelo las mujeres que fueron atendidas en los hospitales generales de Tetecala y Jojutla tuvieron, respectivamente, 2,2 y 2,0 veces mayor posibilidad de presentar anticuerpos contra T cruzi con respecto a las mujeres que fueron atendidas en el Hospital General de Cuautla. CONCLUSIÓN: La prevalencia de anticuerpos contra T cruzi en mujeres embarazadas en el estado de Morelos fluctuó entre 0,43 y 4,87%, según el antígeno y el abordaje utilizado. Es necesario continuar con la vigilancia de la seroprevalencia de anticuerpos contra T cruzi en mujeres embarazadas en el estado de Morelos, México, con las técnicas de mayor sensibilidad y especificidad disponibles.

BACKGROUND: Chagas disease is a globally important chronic systemic parasitic infection caused by Trypanosoma cruzi. AIM: To determine the prevalence of antibodies against T cruzi in pregnant women from the state of Morelos, México. METHODS: 1,620 sera from pregnant women were analyzed using two serological tests: ELISAc (native crude antigen) and ELISAr (recombinant, non-native antigen). Reactive samples were subsequently analyzed by indirect hemagglutination (IHA). Two detection approaches were used, in parallel (reactive samples by any method are positive) and serial (samples confirmed by IHA are positive). Sociodemographic and health factors associated with the presence of antibodies against T cruzi were evaluated using 95% odds ratios. RESULTS: A seroprevalence of 4.87% was obtained with parallel diagnosis and 0.43% in series. From the parallel results, the women who were attended at the general hospitals of Tetecala and Jojutla had respectively 2.2 and 2.0 times greater chance of presenting antibodies against T cruzi compared to the women who were attended at the General Hospital of Cuautla. CONCLUSION: The prevalence of antibodies against T cruzi in pregnant women from the state of Morelos fluctuated between 0.43 and 4.87%, depending on the antigen and the approach used. It is necessary to continue with the surveillance of the seroprevalence of antibodies against T cruzi in pregnant women from the state of Morelos, Mexico, using the techniques with the highest sensitivity and specificity available.

Congenital syphilis in Mexico. Analysis of national and international standards from the perspective of laboratory diagnosis

Introduction: Congenital syphilis continues to be a public health problem in Mexico. Objective: To assess the similarities and differences between national standards, guidelines and international documents related to the detection of syphilis in pregnant women and congenital syphilis. Method Two algorithms were developed based on the standard of female care during pregnancy and on the standard for prevention and control of sexually transmitted infections. Based on the Centers for Disease Control (CDC) guidelines, algorithms were developed for syphilis during pregnancy, syphilis in the newborn and sexual contacts. Results: The standard for pregnancy mentions that syphilis testing should be carried out in every pregnant woman on her first contact or at delivery, without diagnostic tests being specified. The Official Mexican Standard (NOM) on sexually transmitted infections mentions the traditional algorithm for syphilis detection, treatment follow-up, coinfection with human immunodeficiency virus and congenital syphilis criteria. The CDC recommend reverse algorithm, antibody titer, treatment and follow-up as part of diagnosis. Conclusions: The elimination of mother-to-child transmission of syphilis requires NOMs updating and homogenizing, as well as the study of stillbirths and neonates born to mothers with syphilis.

Prevalencia de anticuerpos antitreponémicos y características sociodemográficas de la población mexicana adulta en el año 2000 / Anti-Treponema pallidum seroprevalence and sociodemographic characteristics in Mexican adult population, 2000

OBJETIVO: Determinar la frecuencia de anticuerpos antitreponémicos en mexicanos adultos de ambos sexos y las características de la población relacionadas con la infección sifilítica. MATERIAL Y MÉTODOS: Se analizaron para anti-Treponema pallidum 12 010 sueros seleccionados de forma aleatoria de la Encuesta Nacional de Salud 2000, con aplicación de un algoritmo conformado por técnicas serológicas treponémicas y no treponémicas, de tamizaje y confirmatorias, y se realizó un análisis estadístico para identificar los factores vinculados con la seropositividad. RESULTADOS: La seroprevalencia de anticuerpos antitreponémicos fue de 3.1 por ciento (IC95 por ciento 2.5-3.7). Las características relacionadas de modo significativo con la exposición a la infección fueron la mayor edad (RM 3.3), sexo masculino (RM 1.3), residencia en la región geográfica sur del país (RM 1.7), vivir en unión libre (RM 2.7) o ser viudo (RM 1.8), inicio de relaciones sexuales a edad temprana (RM 6.3) y, en las mujeres en particular, se identificó el antecedente de mortinatos (RM 1.8) y el informe de falta de uso del condón como método anticonceptivo (RM 14.1). CONCLUSIONES: Los hallazgos del estudio demuestran que la magnitud del antecedente de la infección por el treponema en la población mexicana adulta es considerablemente mayor respecto del que permite calcular la notificación oficial de casos de la enfermedad. Como sucede con otras infecciones de transmisión sexual, aspectos sociodemográficos, de género y las prácticas sexuales no seguras incrementan la transmisión del agente etiológico. En México existe la necesidad de reforzar la vigilancia de la infección sifilítica a través de un diagnóstico oportuno y eficaz de los casos, más su adecuado tratamiento, para coadyuvar al control del padecimiento.

OBJECTIVE: To measure for the first time in a population based study the prevalence of antibodies against Treponema pallidum among the Mexican adult population and correlates of infection. MATERIALS AND METHODS: This study was derived from the Mexican National Health Survey carried out in 2000. Anti-T. pallidum seroprevalence was determined according to an algorithm based on a set of treponemic and non-treponemic serological tests for 12 010 sera randomly selected from participating women and men 20 years and older. A statistical analysis was applied to identify seropositivity associated variables. RESULTS: Anti-T. pallidum seroprevalence was 3.1 percent (CI95 percent 2.5-3.7). Population characteristics significantly related to infection exposure were: older age (OR 3.3), being male (OR 1.3), inhabiting the southern region of the country (OR 1.7), having a regular partner not being married (OR 2.7) or being a widow (OR 1.8), early age at sexual debut (OR 6.3), and for women, having had still births (OR 1.8) and not using the condom as a contraceptive measure (OR 14.1). CONCLUSIONS: Results obtained show that exposure to T. pallidum infection among Mexican adults is at present a true public health problem, unknown until now. Factors associated with seropositivity were those expected considering the epidemiology of sexually transmitted infections. Health authorities must reinforce the surveillance and diagnosis of syphilis in Mexico to help prevent and control the transmission of the etiologic agent.