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.

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

Resumo As infecções que causam úlcera genital são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo aborda a síndrome clínica de úlcera genital causada por infecções sexualmente transmissíveis e seus agentes etiológicos mais comuns: Treponema pallidum (sífilis), vírus herpes simples 2 (herpes genital) e vírus herpes simples 1 (herpes perioral), Haemophilus ducreyi (cancroide), Chlamydia trachomatis sorotipos L1, L2 e L3 (linfogranuloma venéreo) e Klebsiella granulomatis (donovanose). São apresentados aspectos epidemiológicos e clínicos dessas infecções, bem como orientações para seu diagnóstico e tratamento, além de estratégias para as ações de vigilância, prevenção e controle, com a finalidade de subsidiar gestores e profissionais de saúde na qualificação da assistência.

Abstract Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections, and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (venereal lymphogranuloma), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections are presented, as well as guidelines for their diagnosis and treatment, in addition to strategies for surveillance, prevention and control actions, with the purpose of supporting health managers and professionals in the qualification of care.

Resumen El tema de las infecciones que causan úlcera genital hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento fue elaborado con base en evidencias científicas y validado en discusiones con especialistas. Este artículo trata del síndrome de úlcera genital clínica provocada por infecciones de transmisión sexual, con sus agentes etiológicos más comunes: Treponema pallidum (sífilis), virus del herpes simple-1 (herpes genital) y virus del herpes simple-2 (herpes perioral), Haemophilus ducreyi (chancro blando), Chlamydia trachomatis, serotipos L1, L2 y L3 (linfogranuloma venéreo), y Klebsiella granulomatis (donovanosis). Se presentan aspectos epidemiológicos y clínicos de esas infecciones, bien como pautas para su diagnóstico y tratamiento, además de estrategias para acciones de monitoreo epidemiológico, prevención y control, a fin de contribuir con gestores y personal de salud en la cualificación de la asistencia.

Nonsexually Acquired Genital Ulceration on the Perianal Area in an Elderly Man / 대한피부과학회지

Nonsexually acquired genital ulceration (NSAGU) is characterized by the abrupt appearance of painful genital ulcers, most often in young women. The onset may be preceded by an acute systemic illness such as fever or malaise, and many of the patients have a history of oral aphthosis. Its pathogenesis is not fully understood. In our case, a 72-year-old male visited with multiple painful erythematous ulcers on the perianal area. By history taking, laboratory tests, and skin biopsy, we excluded etiologies such as herpes simplex virus infection, syphilis, chancroid, and Behcet's disease. Thus, we diagnosed the patient with NSAGU and treated him with systemic steroids, nonsteroidal anti-inflammatory drugs, antibiotics, cyclosporine, and triamcinolone injection. Approximately 13 months after resolution, there had been no relapse. NSAGU is an uncommon condition and underrecognized by physicians. There have been no documentarily reported cases of NSAGU in Korea. Therefore, we present a case of NSAGU on the perianal area in an elderly man.

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.

Current Concepts in Bacterial Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are the most common infectious diseases worldwide, with over 350 million new cases occurring each year, and have far-reaching health, social, and economic consequences. Failure to diagnose and treat STDs at an early stage may result in serious complications and sequelae. STDs are passed from person to person primarily by sexual contact and are classified into varied groups. Some cause mild, acute symptoms and some are life-threatening. They are caused by many different infectious organisms and are treated in different ways. Syphilis and gonorrhea are ancient afflictions. Now, however, Chlamydia is prevalent and has become the most common bacterial STD. Antimicrobial resistance of several sexually transmitted pathogens is increasing, rendering some regimens ineffective, adding to therapeutic problems. A standardized treatment protocol for STDs is recommended to ensure that all patients receive adequate treatment. Appropriate treatment of STDs is an important public health measure.

A comparative study of single-dose treatment of chancroid using thiamphenicol versus Azithromycin

A study was conducted in São Paulo, Brazil, to compare azithromycin with thiamphenicol for the single-dose treatment of chancroid. In all, 54 men with chancroid were tested. The etiology was determined by clinical characterization and direct bacterioscopy with Gram staining. None of the patients had positive serology or dark-field examination indicating active infection with Treponema pallidum. Genital infections due to Neisseria gonorrhoeae and herpes simplex virus were excluded by polymerase chain reaction testing. For 54 patients with chancroid, cure rates with single-dose treatment were 73 percent with azithromycin and 89 percent with thiamphenicol. HIV seropositivity was found to be associated with treatment failure (p=0.001). The treatment failed in all HIV positive patients treated with azithromycin (p=0.002) and this drug should be avoided in these co-infected patients. In the view of the authors, thiamphenicol is the most indicated single-dose regimen for chancroid treatment.

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.

Treatment and Management of Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are the most common group of identifiable infectious diseases in many countries. Adolescents and young adults (15-24 years old) comprise only 25% of the sexually active population but represent almost 50% of all newly acquired STDs. In a law for prevention of infectious diseases in Korea, STDs include syphilis, gonorrhea, chancroid, nongonococcal urethritis, clamydial infection, genital herpes, and genital wart. Bacterial vaginosis, trichomoniasis, candidiasis, amebiasis, scabies, phthiriasis, granuloma inguinale, AIDS, and high risk human papilloma virus are also included in the STDs. Individuals infected with STDs are 5-10 times more likely than uninfected individuals to acquire or transmit HIV through sexual contacts. Their control is important considering the high incidences of acute infections, complications, and sequelae, their socioeconomic impact, and their role in increasing transmission of the HIV. The purpose of this paper is to summarize the treatment and management of STDs on the basis of Centers for Disease Control and Prevention treatment guidelines for sexually transmitted diseases published in 2006.

Diagnóstico das úlceras ano-retais sexualmente transmissíveis / Diagnosis of the sexually transmitted anogenital ulcers

Contrário ao que se possa imaginar, as DST persistem com incidência elevada, tanto em países industrializados como naqueles em desenvolvimento. As úlceras anogenitais só têm freqüência menor que as lesões provocadas pelo HPV. O objetivo desse artigo é apresentar forma etiológica de abordagem das DST ulceradas que, de maneira simples, rápida e pouco onerosa, auxilia na escolha do melhor tratamento e evita a disseminação da doença mal tratada.

A study of HIV/STD infections amongst commercial sex workers in Kolkata. (India) Part-IV laboratory investigation of STD and HIV infections.

Out of 867 sex workers examined during 1998-2000 from the five important red light areas of Kolkata, 26.18%(227) were suffering from active syphilitic infection having positive VDRL test with titre 1/8 and above. Vaginal smear for gram staining was collected from all sex workers, and found positive for active gonorrhoeal infection in 41.8% (362). Culture positivity for gonorrheal infection was 34.14% (296). Sex workers were also having other STD infection, 23.64% (205) Trichomonas infection, 13.26% (115) Candidiasis, 8.77% (76), Gardenella and 3.0% (26) Chanchroid for which vaginal samples were found positive. HIV sero-positivity was found to be 13.2% (115) out of 867 blood samples examined from all sex workers under study. There were 0.34% (3) sex workers who were also positive for HIV II infection along with HIV-I infection. A case of HIV II alone was not detected in any of the sex workers. Around 49.6% (430) knew that STD/HIV can be prevented by use of condom. However, condom was used by only 6.57% (57) sex workers.

Profile of men suffering from sexually transmitted infections in Pakistan

To evolve effective prevention and efficient treatment strategies for sexually transmitted infections [STIs] in a country, comprehensive understanding of the prevalent STI and their modes of transmission is needed. The aim of this present study was to generate such data for Pakistan. Method: The study was conducted between June 1999 and September 1999 in four provincial capitals. In each city, data were collected from one or more teaching hospitals and a number of general practitioners. During this period, 465 men suffering from STIs were interviewed. The mean age of study population was 31.9 +/- 8.6 years, 60% were married, 58.3% urbanites, 81.7% living with their families and 83.3% smokers. Only 10.5% were drug addicts. Out of 465 cases, 27.5% cases had gonorrhoea, 31.6% syphilis, 17.2% chancroid, 18.3% herpes, 5.2% chlamydial infections while only one case [0.2%] was HIV positive. Most men [55%] acquired the infection heterosexually, 11.6% through homosexuality, 18.4% through bisexual relations and 2 men [0.5%] reported bestiality. Among 78.1% of those contracting the infection heterosexually, the source of infection was a sex worker. None acquired infection through his wife. The knowledge about STIs was very poor. Wrong notions were prevalent. Conclusions. The pattern of STIs is different from developed countries. Those acquiring STIs in Pakistan were older, married and living with their families whereas in developed countries most men acquiring STIs are younger, unmarried and living alone

An Epidemiological Evaluation on the Sexual Partners of Male Patients with Sexually Transmitted Diseases / 대한피부과학회지

BACKGROUND: In the management of patients with sexually transmitted diseases(STD), contact tracing is fundamental to get the information of sexual partners to be responsible of STD transmission. OBJECTIVE: The aim of this study was to obtain statistical data of the sexual partners for more effective STD control. METHOD: In order to obtain statistical knowledge of the sexual partners, we retrospectively reviewed medical records of 11,333 male patients who visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul from January 1986 to December 1995. RESULTS: As the source of STD transmission for 11,333 male patients, the so called 'high risk groups' comprised 77.6% including prostitutes 38.3%, bar girl 18.9% and call girl 20.6%. In other groups, the so called 'low risk groups' are as follows; girl friends 10.4%, acquaintance 7.6% and wife 3.5%. In regard to prevalence of STD, nongonococcal urethritis and gonorrhea comprised 46.4% and 42.9%, respectively while chancroid, syphilis, herpes progenitalis and condyloma acuminatum were 2.2%, 0.9%, 0.9% and 1.0% respectively. CONCLUSION: We obtained the epidemiological data of the sexual partners of patients with STD. This will help us make STD prevention strategies.

Thiamphenicol in the treatment of chancroid: a study of 1.128 cases

Thiamphenicol, an aminic derivate of hydrocarbilsulfonil propandiol, was used for the treatment of 1,171 chancroid bearing patients. Each patient was medicated with 5.0 g of granulated thiamphenicol, orally, in a single dose, and was reevaluated 3, 7 and 10 days after the treatment. Ten patients (0.89 percent) did not respond to the proposed treatment. 133 patients presented healed ulcers after 3 days of treatment, 976 patients healed chancres on the seventh day after the treatment, and 39 patients took 10 days to present healed chancres. The results of this study indicate that the rate of patients that were cured, the low incidence of side effects, and the practicality of administration make of thiamphenicol an excellent choice for the treatment of chancroid.

Sexually Transmitted Diseases and Sexual Behavior of Recruits in a Korean Army Training Center / 대한피부과학회지

BACKGROUND: Almost all STD(sexually tranamitted diseases) have been increasing worldwide since the 1960s. In Korea, the occurrence of STD from recent trends of sexual openness and development in the pleasure-seeking industry is becoming a social issue. However, epidemiological studies and reports concerning the incidence of STD are lacking in Korea, especially in the sexually aetive young age group. OBJECTIVE: We evaluated the incidence of YTD and sexual behavior of recruits in a Korean arrny training center to contribute to the management of STD in Korea. METHODS: We studied 1304 recruits in a Korean army training center by questionnaire, physical examination and laboratory data. The subjects were divided into 3 groups: group 1(1072 persons), those who visited the hospital for evaluation of STD; group 2(641 persons), a control group for coitus rate; and group 3(1304 persons; group 1 plus 232 persons out of group 2), those who had coital experiences. RESULTS: 1. The incidence of STD in group 1 was 65.7%(704/1072) and that of the total number of recruits was 0.43%(704/164,134). 2. Among the 704 cases of STD, the most frequently observed STD was non-gonococcal urethritis, 292 cases(41.5%) and the second was gonorrhea, 236 cases(33.5%). The others were, 68 cases(9.7%) of pediculosis pubis, 41 cases(5.8%) of condyloma acuminatum, 29 cases(4.1%) of syphilis, 20 cases(2.8%) of combined STD, 14 cases(2%) of herpes progenitalis, 2 cases(0.28%) of molluscum cohtagiosum and 2 cases(0.28%) of chancroid. 3. The coitus rate in group 2 was 36.2%(232/641). 4. The incidence of previous STD in group 3 was 20.9%(273/1304). 5. The mn;t common form of STD which the patients experienced previously was urethritis(82.8%) and the others were pediculosis pubis(7.3%), syphilis(3.3%), condylcena acuminahun and herpes progenitalis. 6. The group with more sexual partners tended to have a lower educational level. 7. The experience rate of drug abuse was higher in the group with more sexual partners. 8. The experience rate of oral and anal sex was higher in the group with experiences of clrug abuse than in the ather one. CONCLUSION: In this study, urethritis was the most common form of STD(75% of all STD) and non-gonococcal urethritis showed a greater incidence than gonorrhea. The incidence of STD is thought to be closely related to the factors associated with social or behavioral science, such as the number of sexual partners, grade of education, drug abuse, experience of oral and anal sex. To accomplish more effective management of STD, therefore, the improvement of current social problems involving sexual openness, the pleasure-seeking industry and drug abuse should be achieved.