Human papillomavirus infection among sexual partners attending a Sexually Transmitted Disease Clinic in Rio de Janeiro, Brazil

Cervical cancer is a major source of illness and death among women worldwide and genital infection with oncogenic human papillomavirus (HPV) its principal cause. There is evidence of the influence of the male factor in the development of cervical neoplasia. Nevertheless, the pathogenic processes of HPV in men are still poorly understood. It has been observed that different HPV types can be found among couples. The objective of the present study was to investigate HPV infections in female patients (n = 60 females/group) as well as in their sexual partners and to identify the concordance of HPV genotypes among them. By using the polymerase chain reaction, we detected a 95% prevalence of HPV DNA in women with cervical intraepithelial neoplasia (CIN) compared to 18.3% in women with normal cervical epithelium, with a statistically significant difference (P < 0.001). The HPV DNA prevalence was 50% in male partners of women with CIN and 16.6% in partners of healthy women. In the control group (healthy women), only 9 couples were simultaneously infected with HPV, and only 22.2% of them had the same virus type, showing a weak agreement rate (kappa index = 0.2). Finally, we observed that HPV DNA was present in both partners in 30 couples if the women had CIN, and among them, 53.3% shared the same HPV type, showing moderate agreement, with a kappa index of 0.5. This finding supports the idea of circulation and recirculation of HPV among couples, perpetuating HPV in the sexually active population, rather than true recurrences of latent infections.

Human papillomavirus infection among sexual partners attending a Sexually Transmitted Disease Clinic in Rio de Janeiro, Brazil.

Cervical cancer is a major source of illness and death among women worldwide and genital infection with oncogenic human papillomavirus (HPV) its principal cause. There is evidence of the influence of the male factor in the development of cervical neoplasia. Nevertheless, the pathogenic processes of HPV in men are still poorly understood. It has been observed that different HPV types can be found among couples. The objective of the present study was to investigate HPV infections in female patients (n = 60 females/group) as well as in their sexual partners and to identify the concordance of HPV genotypes among them. By using the polymerase chain reaction, we detected a 95% prevalence of HPV DNA in women with cervical intraepithelial neoplasia (CIN) compared to 18.3% in women with normal cervical epithelium, with a statistically significant difference (P < 0.001). The HPV DNA prevalence was 50% in male partners of women with CIN and 16.6% in partners of healthy women. In the control group (healthy women), only 9 couples were simultaneously infected with HPV, and only 22.2% of them had the same virus type, showing a weak agreement rate (kappa index = 0.2). Finally, we observed that HPV DNA was present in both partners in 30 couples if the women had CIN, and among them, 53.3% shared the same HPV type, showing moderate agreement, with a kappa index of 0.5. This finding supports the idea of circulation and recirculation of HPV among couples, perpetuating HPV in the sexually active population, rather than true recurrences of latent infections.

Penile myiasis: a case report.

We report a case of penile myiasis in a Brazilian man caused by the larva of Dermatobia hominis. Myiasis is a parasitic disease of humans and other vertebrates caused by larvae of several fly species. Although urinary myiasis is well recognised, infestation of the genital tissue is a rare occurrence. Once the diagnosis has been made, the treatment is usually straightforward and uncomplicated.

Epidemiological aspects of human papillomavirus infection and cervical cancer in Brazil.

OBJECTIVES: A study was conducted to determine the prevalence of HPV infection in cervical lesions of Brazilian women and to search for specific risk factors associated to progression to malignancy. METHODS: Five hundred and fourteen paraffin-embedded biopsies obtained from female cervical lesions were classified according to the Bethesda System in low grade squamous intraepithelial lesion (LSIL), high grade SIL (HSIL) and squamous cell carcinoma (SCC). Specimens were tested for the presence of human papillomavirus (HPV) types 6/11,16/18 and 31/33/35 DNA using non-isotopic in situ hybridization. RESULTS: HPV prevalence ranged from 85.6% in LSIL to 55.2% in SCC. Patients were analysed through an 8 year period: 27. 1% of the lesions spontaneously regressed while 43.6% persisted and 29.3% progressed to carcinoma. High risk types were present in 80.5% (Crude OR 13.8, P=0.0003) of the progressive lesions. Possible co-factors have also been evaluated: history of other sexually transmitted diseases, mainly syphilis, showed to be positively related to progression (Adjusted OR 13.0, P=0.0003) while oral contraceptive use and tobacco smoking were not significantly related to it (P>O.1). Association of two or more co-factors also proved to be related to progression. CONCLUSIONS: Oncogenic HPV types 16 and 18 and history of other concurrent sexually transmitted diseases were found to be significantly associated with progression to cancer. Smoking and the use of oral contraceptives did not show a relation to cancer establishment, but when they were associated a significant co-operative role in progression was demonstrated. Our study indicated that HPV and other risk factors for cancer can act together, corroborating the observation of a poor prognosis for Brazilian women presenting SILs.

Vulvar myiasis.

Myiasis is a parasitic infestation caused by larvae of several fly species. Diagnosis and treatment are simple. This infestation is, however, rarely seen in the vulvar area. We present a short review of the disease and the case of a 19-year-old pregnant girl with vulvar myiasis and concomitant syphilis, vaginal trichomoniasis and genital candidiasis. The patient was also positive for human immunodeficiency virus.

Miíase vulvar / Vulvar myiasis

A miíase é uma infecção parasitária causada por larvas de diversos tipos de moscas. Embora o reconhecimento e tratamento sejam fáceis, constituem uma infecção pouco freqúente na região vulvar. Este estudo apresenta uma revisão a respeito da patologia por miíase e a descrição do caso de uma adolescente de 19 anos, gestante, portadora de miíase vulvar associada à tricomoníase, candidíase e sífilis, além se ser soropositiva para HIV.

Estudo prospectivo controlado comparando lomefloxacina e ampicilina mais probenecide em dose única oral no tratamento de uretrite gonocócica aguda no homem / Controlled prospective study comparing lomefloxacin and ampicilin more probenecid in a single dose in the treatment of acute gonococcal urethritis in the man

As infecçöes gonocócicas há muito constituem um fator de importância para a saúde pública, devido à sua alta prevalência na populaçäo. Torna-se, portanto, imperioso a obtençäo de tratamentos eficazes e práticos, visando a observância completa do paciente ao tratamento, a cura clínica e a interrupçäo do ciclo de transmissäo. Neste estudo comparou-se lomefloxacina e ampicilina, quanto a sua eficácia clínica, laboratorial e seus efeitos colaterais, administradas em dose única. A lomefloxacina mostrou-se superior quanto à eficácia e apresentou menos efeitos adversos em relaçäo à ampicilina.

Prevalence of human papillomavirus DNA in female cervical lesions from Rio de Janeiro, Brazil

A hundred-sixty paraffin-embedded specimens from female cervical lesions were examined for human papillomavirus (HPV) types 6, 11, 16 and 18 infections by non-isotopic in situ hybridization. The data were compared with histologic diagnosis. Eighty-eight (55) biopsies contained HPV DNA sequences. In low grade cervical intraepithelial neoplasias (CIN I), HPV infection was detected in 78.7 of the cases, the benign HPV 6 was the most prevalent type. HPV DNA was detected in 58 of CIN II and CIN III cases and in 41.8 of squamous cell carcinomas (SCC). Histologically normal women presented 20 of HPV infection. Oncogenic HPV was found in 10 of these cases, what may indicate a higher risk of developing CINs and cancer. Twenty-five percent of the infected tissues contained mixed infections. HPV 16 was the most common type infecting the cervix and its prevalence raised significantly with the severity of the lesions, pointing its role in cancer pathogenesis. White women presented twice the cervical lesions of mulatto and African origin women, although HPV infection rates were nearly the same for the three groups (approximately 50). Our results showed that HPV typing by in situ hybridization is a useful tool for distinguishing between low and high risk cervical lesions. Further studies are required to elucidate risk factors associated with HPV infection and progression to malignancy in Brazilian population.

Prevalence of human papillomavirus DNA in female cervical lesions from Rio de Janeiro, Brazil.

A hundred-sixty paraffin-embedded specimens from female cervical lesions were examined for human papillomavirus (HPV) types 6, 11, 16 and 18 infections by non-isotopic in situ hybridization. The data were compared with histologic diagnosis. Eighty-eight (55%) biopsies contained HPV DNA sequences. In low grade cervical intraepithelial neoplasias (CIN I), HPV infection was detected in 78.7% of the cases, the benign HPV 6 was the most prevalent type. HPV DNA was detected in 58% of CIN II and CIN III cases and in 41.8% of squamous cell carcinomas (SCC). Histologically normal women presented 20% of HPV infection. Oncogenic HPV was found in 10% of these cases, what may indicate a higher risk of developing CINs and cancer. Twenty-five percent of the infected tissues contained mixed infections. HPV 16 was the most common type infecting the cervix and its prevalence raised significantly with the severity of the lesions, pointing its role in cancer pathogenesis. White women presented twice the cervical lesions of mulatto and African origin women, although HPV infection rates were nearly the same for the three groups (approximately 50%). Our results showed that HPV typing by in situ hybridization is a useful tool for distinguishing between low and high risk cervical lesions. Further studies are required to elucidate risk factors associated with HPV infection and progression to malignancy in Brazilian population.

Human papillomavirus detection in genital lesions by in situ hybridization and ultrastructural observations

Detection of papillomavirus DNA in sity hybridization technique was perfomed in 29 symptomatic patients (6 males and 23 females) during the period of 1989-1991 at the Clinic for Sexually Transmitted Diseases, Universidade Federal Fluminense, State of rio de Janeiro. All the male patients had condyloma acuminata. Only HPV 6/11 were found in these lesions. Clinical features inthe female patients included vulvar condyloma acuminata, bowenoid populosis, flat cervical condyloma, cervical condyloma acuminatum and cervical intraepithelialneoplasia grade II (CIN II). We also found cases of condyloma acuminata associated to vulvar intraepithelial neoplasia grade III (VIN III), as well as to vaginal invasive carcinoma. HPV 6/11 and 16/18 were found in vulvar condyloma acuminata. Mixed infection by 6/11-16/18 HPV were also seen in these lesions as well as in the patient who had cervical condyloma acuminatum. HPV 16/18 were found in the condyloma acuminatum plus VIN III and in the CIN II lesions. We have found HPV31/33/51 in the specimen of condyloma acuminatum plus invasive carcinoma. In order to investigate the ultrastructural aspects of HPV infection in genital tissue, the biopsies of three female patients were observed under electron microscope.Mature virus particles were found in the cells of a condyloma acuminatum as wellas in the condyloma acuminatum plus invasive carcinoma case. In another sample, chromosome breakages were found in the nuclei of the infected cells although no viral particles were observed

Human papillomavirus detection in genital lesions by in situ hybridization and ultrastructural observations.

Detection of papillomavirus DNA in situ hybridization technique was performed in 29 symptomatic patients (6 males and 23 females) during the period of 1989-1991 at the Clinic for Sexually Transmitted Diseases, Universidade Federal Fluminense, State of Rio de Janeiro. All the male patients had condyloma acuminata. Only HPV 6/11 were found in these lesions. Clinical features in the female patients included vulvar condyloma acuminata, bowenoid papulosis, flat cervical condyloma, cervical condyloma acuminatum and cervical intraepithelial neoplasia grade II (CIN II). We also found cases of condyloma acuminata associated to vulvar intraepithelial neoplasia grade III (VIN III), as well as to vaginal invasive carcinoma. HPV 6/11 and 16/18 were found in vulvar condyloma acuminata. Mixed infection by 6/11-16/18 HPV were also seen in these lesions as well as in the patient who had cervical condyloma acuminatum. HPV 16/18 were found in the condyloma acuminatum plus VIN III and in the CIN II lesions. We have found HPV 31/33/51 in the specimen of condyloma acuminatum plus invasive carcinoma. In order to investigate the ultrastructural aspects of HPV infection in genital tissue, the biopsies of three female patients were observed under electron microscope. Mature virus particles were found in the cells of a condyloma acuminatum as well as in the condyloma acuminatum plus invasive carcinoma case. In another sample, chromosome breakages were found in the nuclei of the infected cells although no viral particles were observed.

Creatine-kinase and pyruvate-kinase activities in normal children: implications in Duchenne muscular dystrophy carrier detection.

Serum creatine-kinase (CK) and pyruvate-kinase (PK) levels were determined in 201 boys and girls less than 15 years old to establish values and to investigate a possible correlation between enzyme activity, sex, and age. It was observed that the mean CK activity in boys was significantly higher than in females (of all ages), whereas it did not differ statistically between girls and women. A slight but significant correlation between CK activity and age was found only in females. The mean PK activity in children was significantly greater than in adult women and it decreased significantly with age in children of both sexes. Furthermore, a slight correlation between CK and PK was observed only in girls. Based on these results, we suggest that the results of CK and PK determinations of females at risk for Duchenne muscular dystrophy should be compared with controls of comparable age and sex.

Creatine-kinase (CK) and pyruvate-kinase (PK) activities in cord blood of normal newborn infants: application to Duchenne muscular dystrophy screening programs.

Creatine-kinase (CK) and pyruvate-kinase (PK) were determined in cord blood samples from 125 normal newborn infants in order 1) to investigate the correlation between CK and PK, 2) to evaluate a possible influence of the mode of delivery (cesarean section versus vaginal delivery) and birth weight on enzyme activity, 3) to establish normal values for both sexes. In the present investigation, the enzyme activities of cord blood were significantly higher than in the normal adult, and no correlation was observed between enzyme activity and mode of delivery or birthweight. Although there was an apparent and significant correlation (r = 0.5) between CK and PK levels in cord blood samples, in no case did we find both high CK and PK values, something that would suggest preclinical DMD or a false-positive result. These results have led us to suggest determination of serum PK activity in male newborn screening programs. This would allow an early discrimination between false-positives and clinical cases already in the neonatal period. Furthermore, the concomitant use of PK and CK in boys not walking by 18 months could be a useful test for diagnosing preclinical DMD boys.