Syphilis prevalence and risk factors among young men presenting to the Brazilian Army in 2016: Results from a national survey

The outer membrane protein Tp92 of Treponema pallidum delays human neutrophil apoptosis via the ERK, PI3K/Akt, and NF-κB pathways

Syphilis is a persistent sexually transmitted disease caused by infiltration of the elusive pathogen Treponema pallidum. Despite the prevalence of human polymorphonuclear neutrophils (hPMNs) within cutaneous lesions, which are characteristic of incipient syphilis, their role in T. pallidum infection remains unclear. Tp92 is the only T. pallidum helical outer membrane protein that exhibits structural features similar to those of outer membrane proteins in other gram-negative bacteria. However, the functional mechanism of this protein in immune cells remains unclear. Neutrophils are short-lived cells that undergo innate apoptosis in response to external stimuli that typically influence this process. In this study, we determined that Tp92 impedes the activation of procaspase-3 via the ERK MAPK, PI3K/Akt, and NF-κB signaling pathways, consequently suppressing caspase-3 activity within hPMNs, and thereby preventing hPMNs apoptosis. Furthermore, Tp92 could also modulate hPMNs apoptosis by enhancing the expression of the anti-apoptotic protein Mcl-1, stimulating IL-8 secretion, and preserving the mitochondrial membrane potential. These findings provide valuable insights into the molecular mechanisms underlying T. pallidum infection and suggest potential therapeutic targets for syphilis treatment.

The Brazilian army and the low prevalence of sexually transmitted infections in women of the military garrison of Campinas between 2017 to 2020: a prospective, cross-sectional epidemiological study

BACKGROUND

Given the characteristics of military missions, intense interpersonal contact, and wide variation in casual relationships, the military has long been recognized as a high-risk population for sexually transmitted infections (STIs).

OBJECTIVE

To assess the prevalence of STIs and socioepidemiological profile of women in the military garrison of Campinas.

DESIGN AND SETTING

This prospective, cross-sectional epidemiological study, assisted by the Health Fund in the military garrison of Campinas, assessed the prevalence of human immunodeficiency virus (HIV), hepatitis B and C, syphilis, human papillomavirus (HPV), chlamydia, and gonococcus in military women or companions of soldiers with active or previously active sexual life.

METHODS

This study included 647 women based on the non-inclusion criteria. They underwent clinical and laboratory tests for diagnosis of STIs. For statistical analysis, patients were divided into groups according to the presence or absence of STIs and into age groups.

RESULTS

Most women were military dependents, and the majority were asymptomatic. The prevalence of STIs, in ascending order, was 0.3% for hepatitis B and C, 0.62% for syphilis, 0.62% for gonorrhea, 1.08% for chlamydia, and 2.63% for HPV. There were no cases of HIV infection.

CONCLUSIONS

The Brazilian Army has the most women-like dependents in the military, belonging to the hierarchical circle of the squares. Early onset of sexual activity favored STIs approximately twice, and younger women had approximately seven times more chlamydia infections. In the general population studied, the prevalence of STIs was lower than expected than in the armed forces of other nations.

Sero-prevalence and associated factors of sexually transmitted infections among youth-friendly services Attendees

BACKGROUND

Worldwide, more than one million peoples acquire sexually transmitted infections (STIs). The burden of STIs and the youth awareness level on the transmission of STIs is under investigated in Sidama Regional State.

OBJECTIVE

To determine the seroprevalence of STIs such as hepatitis B surface antigen (HBsAg), Anti-hepatitis C virus (HCV) antibodies, Human Immunodeficiency virus (HIV) seroprevalence, and syphilis and to determine associated factors among youth-friendly services Attendees at selected health facilities in Hawassa city, Ethiopia.

METHODS

A multicenter cross-sectional study was conducted among 416 randomly selected youth attending youth-friendly services at selected health facilities from May to August 2021. To collect the background characteristics of participants an interviewer-administered questionnaire was used. Blood samples were collected, processed, and tested using Advanced Quality One Step rapid colloidal gold immunochromatographic assay for detection of antibodies for syphilis and hepatitis C virus infection, and hepatitis B virus surface antigen. For the diagnosis of syphilis Rapid Plasma Reagin was also used. HIV1/2 STAT PAK, HIV1/2/O ABON and HIV1/2 SD Bioline were used for testing antibodies for HIV infection. Data entry and analysis were performed using Statistical Package for the Social Sciences (SPSS) version 20.0 software. A crude and adjusted odds ratio with a 95% confidence interval (CI) was computed to identify associated factors.

RESULTS

The overall seroprevalence of STIs was 11.5% (48/422), with a 95% CI: (8.7-14.9). Out of the 48 positive results, the proportions of HBsAg, Anti-HCV, HIV, and syphilis were 56.3% (27/48), 27.1% (13/48), 10.4% (5/48), and 6.3% (3/48) respectively. Out of 416 participants, 17.1% responded that it is safe to have sex without using a condom. The Odds of developing STI among female participants, participants who did not identify alcohol intake as a risk factor for STIs, and those who engaged in transactional sex were (AOR = 2.989: 95% CI: 1.27, 7.02), and (AOR = 2.393, 95% CI: 1.18, 4.81) and practice of transactional sex (AOR = 5.527, 95% CI: 1.62, 18.75).

CONCLUSIONS

STIs are common among youth-friendly services Attendee in Hawassa city The overall STI was significantly associated with sex (females), not able to identify alcohol intake as a risk factor, and practice of transactional sex. High number of (n = 289, 69.5%) participants think that the use of condoms is not effective in preventing STIs and they engage in sexual activity without using condoms.

[Syphilis in young Brazilian military recruits in 2016: sociodemographic, behavioral, and clinical aspects]

The objective was to characterize sociodemographic, behavioral, and clinical aspects in young Brazilian military recruits according to prevalence of syphilis. This was a descriptive study based on a nationwide population-based survey in 2016 with a probabilistic sample of military recruits 17 to 22 years of age. A confidential self-applied questionnaire was used. Blood samples were drawn from participants for treponemal and non-treponemal syphilis tests. Descriptive statistical techniques were used to estimate syphilis prevalence rates and distribution of frequencies between the target variables, considering 95% confidence intervals (95%CI), after weighting the data. Of the total of 37,282 participants, 73.7% were sexually initiated. Prevalence rates for lifetime and confirmed syphilis were 1.6% and 1.1%, respectively. The following population variables showed higher prevalence of syphilis: lack of Internet access at home; initiation of sexual activity before 14 years of age; men who have sex with men; more than five sexual partners; having received presents, drugs, or other incentives in exchange for sex; and prior history of symptoms of sexually transmissible infections. An increase was observed in syphilis in Brazilian military recruits when compared to previous surveys. This increase emphasizes the importance of this sentinel population for performing active surveillance in order to support healthcare strategies for youth, including in the school system.

Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis

The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care of People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020, includes updates concerning acquired syphilis. The document comprises rapid test use, safety and efficacy of benzathine benzylpenicillin, case follow-up, neurosyphilis clinical and laboratory management, approaching sex partners, assistance and monitoring of diagnosed pregnant women, and syphilis and HIV co-infection specificities, as well as a case notification summary. Health managers and professionals must be continuously trained so as to integrate care and surveillance, to strengthen actions for efficient control of syphilis, to broaden the search for sex partners, and to expand access of most vulnerable populations to health services. Most people with syphilis are asymptomatic; this contributes to the maintenance of the transmission chain. Without adequate treatment of pregnant women with syphilis, severe consequences can occur, such as miscarriage, prematurity, low birth weight, natimortality, and congenital syphilis.

A co-infection model for HPV and syphilis with optimal control and cost-effectiveness analysis

A co-infection model for human papillomavirus (HPV) and syphilis with cost-effectiveness optimal control analysis is developed and presented. The full co-infection model is shown to undergo the phenomenon of backward bifurcation when a certain condition is satisfied. The global asymptotic stability of the disease-free equilibrium of the full model is shown not to exist when the associated reproduction number is less than unity. The existence of endemic equilibrium of the syphilis-only sub-model is shown to exist and the global asymptotic stability of the disease-free and endemic equilibria of the syphilis-only sub-model was established, for a special case. Sensitivity analysis is also carried out on the parameters of the model. Using the syphilis associated reproduction number, [Formula: see text], as the response function, it is observed that the five-ranked parameters that drive the dynamics of the co-infection model are the demographic parameter [Formula: see text], the effective contact rate for syphilis transmission, [Formula: see text], the progression rate to late stage of syphilis [Formula: see text], and syphilis treatment rates: [Formula: see text] and [Formula: see text] for co-infected individuals in compartments [Formula: see text] and [Formula: see text], respectively. Moreover, when the HPV associated reproduction number, [Formula: see text], is used as the response function, the five most dominant parameters that drive the dynamics of the model are the demographic parameter [Formula: see text], the effective contact rate for HPV transmission, [Formula: see text], the fraction of HPV infected who develop persistent HPV [Formula: see text], the fraction of individuals vaccinated against incident HPV infection [Formula: see text] and the HPV vaccine efficacy [Formula: see text]. Numerical simulations of the optimal control model showed that the optimal control strategy which implements syphilis treatment controls for singly infected individuals is the most cost-effective of all the control strategies in reducing the burden of HPV and syphilis co-infections.

[Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis]

The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020, includes the update on acquired syphilis. The document comprises rapid tests use, safety and efficacy of the administration of benzathine benzylpenicillin, follow-up of cases, clinical and laboratory management of neurosyphilis, approach to sexual partnerships, assistance and monitoring of diagnosed pregnant women, and specificities of syphilis and HIV co-infection, as well as a summary of the notification of cases. It is necessary to train health managers and professionals on a continuous basis, with a view to integrating care and surveillance, strengthening effective syphilis control actions, increasing the search for sexual partnerships, and expanding the access of the most vulnerable populations to health services.

Knowledge, attitudes and practices of university adolescents about syphilis: a cross-sectional study in the Northeast

OBJECTIVE

To analyze knowledge, attitudes and practices of university adolescents about syphilis.

METHODS

Cross-sectional, analytical, census-type study, developed with the universe of adolescents aged 18 and 19 years (n = 598), enrolled in three institutions of higher education in a municipality of Piauí (n = 598), which total 20 courses in the areas of Health Sciences, Applied Social Sciences, Exact and Earth, Engineering and Linguistics, Letters and Art. Data collection occurred from March to May 2019, based on a questionnaire adapted from the Pesquisa de Conhecimentos, Atitudes e Práticas da População Brasileira of 2013 (PCAP - Survey of Knowledge, Attitudes and Practices in the Brazilian Population), consisting of questions related to sociodemographic variables (gender, family arrangement, father's schooling, mother's schooling, skin color or race, employment, household income), knowledge, attitude and practice regarding the disease, the last three being classified by scores. The variables that presented p ≤ 0.20 in the bivariate analysis, by Pearson's chi-square test, were included in three multivariate logistic models, and the outcomes in each model were knowledge, attitude and practice, respectively; remaining at the end those at the level of p < 0.05.

RESULTS

Boys have a 39.6% lower chance of having adequate/regular knowledge (ORa = 0.604; 95%CI 0.415-0.878), whereas the highest chances are associated with "living alone, with relatives and friends" (ORa = 4.567; 95%CI 1.417-14.719) and having a very positive/positive attitude (ORa = 6.937; 95%CI 4.562-10.550). Lower chances of an adequate practice are associated with boys (ORa = 0.480; 95%CI 0.301-0.766) and lower father's schooling (ORa = 0.440; 95%CI 0.241-0.806).

CONCLUSION

Most participants' knowledge and attitude regarding syphilis were not sufficient to the adoption of an adequate sexual practice for the prevention of the disease, showing the need to investigate other variables that may be implicated in this cognitive incoherence.

Syphilis in the state of São Paulo, Brazil, 2011‒2017

OBJECTIVE

To analyze how syphilis detection rates evolved from 2011 to 2017 according to sex, age and place of residence in the state of São Paulo.

METHODS

A historical series was organized with data from the Notification Disease Information System. The acquired syphilis detection rates (ASDR) per 100,000 inhabitants and the acquired syphilis detection rates including pregnant women with syphilis (PASDR) per 100,000 inhabitants were described. For a trend analysis of the rates in the studied period, the Poisson Jointpoint (inflection point) model was performed, and the annual percentage change (APC) per segment and the average annual percentage change (AAPC) were estimated, with respective 95% confidence intervals (95%CI).

RESULTS

A total of 205,424 cases of acquired syphilis and syphilis in pregnant women in the period were reported. The ASDR per 100,000 inhabitants ranged from 26.0 to 84.6 between 2011 and 2017 and the PASDR per 100,000 inhabitants ranged from 33.7 to 108.9; the trend was increasing in both, and an inflection point was identified dividing the ASDR and PASDR curve into two periods: 2011 to 2013 and 2013 to 2017: the AAPC found for ASDR was 21.0% (95%CI 15.5 ‒ 26.4) and the PASDR was 21.2% (95%CI 16.4 ‒ 26.1), in the age groups up to 24 years old, there was a significant growth in both sexes. A heterogeneity in the evolution of rates by region of the state was observed between 2011 and 2017.

CONCLUSIONS

The increasing trend in acquired syphilis detection rates can be attributed to better adherence to notification and disproportionate involvement of young people.

Sexually Transmitted Infections in Soldiers - A Cross-Sectional Assessment in German Paratroopers and Navy Soldiers and a Literature Review

Introduction

The study was performed to estimate the prevalence and determinants of occurrence of sexually transmitted infections (STIs) in paratroopers and navy soldiers by anonymously analyzing medical records from the medical departments of two large German barracks in order to assess the need for medical STI prevention.

Methods

Medical records from 80 paratroopers and 80 navy soldiers were screened for records of STI. Results were anonymously collected next to information on risk factors, as well as diagnostic and therapeutic management, and comparatively assessed.

Results

Proportions of suspected STIs were 17.5% and 20%, and proportions of diagnosed STIs were 13.9% and 11.3% for paratroopers and navy soldiers, respectively. Chlamydia trachomatis, human papillomavirus, and genital scabies were observed in paratroopers and navy soldiers, while Gardnerella vaginalis, herpes simplex virus, Molluscum contagiosum virus, Neisseria gonorrhoeae, and Trichomonas vaginalis were additionally identified in navy soldiers.

Conclusions

Although clinical hints for STIs were frequently observed, clinical management was usually restricted to syndrome-based antibiotic treatment without detailed diagnostic workup, leaving room for procedural improvement. Ongoing need for medical STI prevention in the military could be confirmed.

A portrait of risk behavior towards HIV infection among Brazilian Army conscripts by geographic regions, 2016

INTRODUCTION

Knowledge about risky sexual behavior among young people has been widely acknowledged as a key tool to controlling the spread of HIV. This article aimed at presenting the risk behavior of Brazilian Army conscripts toward HIV infection according to the country's geographic regions. .

METHOD

We collected data from 37,282 conscripts, aged 17 to 22, during enlistment in the Brazilian Army in 2016. The prevalence of HIV infection, both self-reported and measured through laboratory results, and risk behavior factors were estimated by region.

RESULTS

75% of the sample of conscripts reported to have already started sexual activity, and the average age of their sexual initiation was 15. Condom use varied according to the type of sexual relationship, being lower among steady partners and greater among less stable relationships. HIV prevalence assessed by laboratory tests was 0.12% across the country and the highest prevalence was observed in the North region (0.24%). Alcohol and illicit drug usage was higher in the South region.

DISCUSSION

The study allowed the observation of risk behavior monitoring for HIV infection among young Brazilians. Lower condom usage among steady partners may be contributing to an increase in the number of HIV-infected individuals.

CONCLUSION

Results suggest the need to intensify prevention campaigns to disseminate safe sex practices among young people, in addition to the expansion of testing offer to this population.