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Ramos MC, Sardinha JC, Alencar HDRD, Aragón MG, Lannoy LHD. Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause genital ulcers. Rev Soc Bras Med Trop 2021; 54:e2020663. [PMID: 34008730 PMCID: PMC8210487 DOI: 10.1590/0037-8682-663-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
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 (lymphogranuloma venereum), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections and guidelines for their diagnosis and treatment are presented, including strategies for surveillance, prevention, and control actions to support health managers and professionals in the qualification of care. Approximately 70% of the genital ulcers attended in specialized clinics are due to sexually transmitted infections, particularly in adolescents and young adults.
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Affiliation(s)
| | - José Carlos Sardinha
- Fundação de Dermatologia Tropical e Venerologia Alfredo da Matta, Manaus, AM, Brasil
| | | | - Mayra Gonçalves Aragón
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil.,Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brasil
| | - Leonor Henriette de Lannoy
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil.,Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brasil
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Ramos MC, Sardinha JC, Alencar HDRD, Aragón MG, Lannoy LHD. [Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause genital ulcers]. ACTA ACUST UNITED AC 2021; 30:e2020663. [PMID: 33729413 DOI: 10.1590/s1679-4974202100010.esp1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
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.
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Affiliation(s)
- Mauro Cunha Ramos
- Secretaria de Estado de Saúde do Rio Grande do Sul, Ambulatório de Dermatologia Sanitária, Porto Alegre, RS, Brasil
| | - José Carlos Sardinha
- Fundação de Dermatologia Tropical e Venerologia Alfredo da Matta, Manaus, AM, Brasil
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Noda AA, Rodríguez I, Grillová L, Bosshard PP, Lienhard R. Accuracy of PCR and serological testing for the diagnosis of primary syphilis: Both tests are necessary. Int J STD AIDS 2019; 30:1087-1094. [PMID: 31551003 DOI: 10.1177/0956462419859764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Syphilis, caused by the spirochete Treponema pallidum subspecies pallidum, is a rising global public health concern and laboratory diagnostics remain challenging. Especially during early disease, rapid and accurate diagnosis is crucial to ensure patients and their contacts receive timely treatment to eradicate infection and prevent further transmission. In this prospective observational study, we evaluated the performance of polymerase chain reaction (PCR) and serological testing for the diagnosis of primary syphilis by evaluating anogenital swabs and sera from 178 Cuban patients presenting with ulcers. Three different PCR assays were evaluated targeting polA, tpp47 and 16S rDNA loci. Sera were evaluated with venereal disease research laboratory (VDRL) and T. pallidum hemagglutination (TPHA) assays. Assuming both methods were confirmatory, our data showed that PCR and serology did not correlate well (agreement = 52.3%, kappa 0.0512, 95% CI −0.0928–0.1951, p = 0.496). The sensitivities, specificities, positive and negative predictive values of the PCR assays were 76.1%, 100%, 100% and 57.9%, respectively, while the values for serology were 62.5%, 100%, 100% and 45.2%, respectively. The combination of PCR and serology can offer valuable information for the diagnosis of syphilis in patients presenting with anogenital ulceration avoiding further clinical complications and disease transmission.
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Affiliation(s)
- Angel A Noda
- Department of Mycology-Bacteriology, Institute of Tropical Medicine "Pedro Kourí", Havana, Cuba
| | - Islay Rodríguez
- Department of Mycology-Bacteriology, Institute of Tropical Medicine "Pedro Kourí", Havana, Cuba
| | - Linda Grillová
- Department of Biology, Masaryk University, Brno, Czech Republic.,Department of Microbiology, Institut Pasteur, Paris, France
| | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Reto Lienhard
- Department of Serology, ADMED Microbiologie, La Chaux-de-Fonds, Switzerland
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Sukik L, Alyafei M, Harfouche M, Abu-Raddad LJ. Herpes simplex virus type 1 epidemiology in Latin America and the Caribbean: Systematic review and meta-analytics. PLoS One 2019; 14:e0215487. [PMID: 31009486 PMCID: PMC6476500 DOI: 10.1371/journal.pone.0215487] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/02/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To investigate the epidemiology of herpes simplex virus type 1 (HSV-1) in Latin America and the Caribbean. METHODS Systematic review and meta-analytics guided by the Cochrane Collaboration Handbook and reported following the PRISMA guidelines. RESULTS Thirty-three relevant reports were identified including 35 overall (and 95 stratified) seroprevalence measures, and five and nine proportions of virus isolation in genital ulcer disease (GUD) and in genital herpes, respectively. Pooled mean seroprevalence was 57.2% (95% CI: 49.7-64.6%) among children and 88.4% (95% CI: 85.2-91.2%) among adults. Pooled mean seroprevalence was lowest at 49.7% (95% CI: 42.8-56.6%) in those aged ≤10, followed by 77.8% (95% CI: 67.9-84.8%) in those aged 10-20, 82.8% (95% CI: 73.1-90.8%) in those aged 20-30, 92.5% (95% CI: 89.4-95.1%) in those aged 30-40, and 94.2% (95% CI: 92.7-95.5%) in those aged ≥40. Age was the strongest source of heterogeneity in seroprevalence, explaining 54% of variation. Evidence was found for seroprevalence decline over time. Pooled mean proportion of HSV-1 isolation was 0.9% (95% CI: 0.0-3.6%) in GUD and 10.9% (95% CI: 4.4-19.4%) in genital herpes. CONCLUSIONS HSV-1 is a widely prevalent infection in this region, but its epidemiology may be slowly transitioning, with still limited contribution for HSV-1 in genital herpes.
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Affiliation(s)
- Layan Sukik
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation—Education City, Doha, Qatar
- Department of Health Sciences, Qatar University, Doha, Qatar
| | - Maryam Alyafei
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation—Education City, Doha, Qatar
- Department of Health Sciences, Qatar University, Doha, Qatar
| | - Manale Harfouche
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation—Education City, Doha, Qatar
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation—Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, United States of America
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
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Wang Z, Yang L, Jiang H, Huang S, Palmer AE, Ma L, Lau JTF. High Prevalence of Inconsistent Condom Use With Regular Female Sex Partners Among Heterosexual Male Sexually Transmitted Disease Patients in Southern China. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:31-43. [PMID: 29741446 DOI: 10.1080/0092623x.2018.1474408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study was to investigate the prevalence of and factors associated with inconsistent condom use with regular female sex partners (RPs) among heterosexual male STD patients (MSTDPs) in China. We interviewed 413 MSTDPs who had had sex with at least one RP and had received a diagnosis within the past week to six months. The prevalence of inconsistent condom use with RPs was 42.9% since STD diagnosis. Associated factors included perceptions related to condom use, regret about the decision of having unprotected sex with RP, and perceived personal partners' responsibility of using condoms.
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Affiliation(s)
- Zixin Wang
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong
- b Shenzhen Research Institute, The Chinese University of Hong Kong , Shenzhen , China
| | - Ligang Yang
- c Dermatology Hospital, Southern Medical University , Guangzhou , China
- d Guangdong Provincial Dermatology Hospital , Guangzhou , China
| | - Hui Jiang
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong
| | - Shujie Huang
- c Dermatology Hospital, Southern Medical University , Guangzhou , China
- d Guangdong Provincial Dermatology Hospital , Guangzhou , China
| | - Allison E Palmer
- e Tulane University , School of Public Health and Tropical Medicine , New Orleans , Louisiana , USA
| | - Lu Ma
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong
| | - Joseph T F Lau
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong
- b Shenzhen Research Institute, The Chinese University of Hong Kong , Shenzhen , China
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Detección de Treponema pallidum subespecie pallidum para el diagnóstico de sífilis congénita mediante reacción en cadena de la polimerasa anidada. BIOMEDICA 2018; 38:128-35. [PMID: 29676865 DOI: 10.7705/biomedica.v38i0.3740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/24/2017] [Indexed: 11/21/2022]
Abstract
Introducción. La sífilis es una enfermedad producida por Treponema pallidum subespecie pallidum cuya incidencia mundial es de 12 millones de casos por año, aproximadamente; de estos, más de dos millones se presentan en mujeres gestantes, siendo la sífilis congénita la complicación más grave de esta infección en el embarazo.Objetivo. Detectar la presencia de T. pallidum subespecie pallidum en muestras clínicas para el diagnóstico de sífilis congénita mediante reacción en cadena de la polimerasa (PCR) anidada y determinar su concordancia con las pruebas serológicas.Materiales y métodos. Mediante PCR convencional y anidada, se amplificaron tres genes diana (polA, 16S ADNr y TpN47) y se confirmaron los productos de amplificación de los genes TpN47 y polA por secuenciación. Las pruebas serológicas empleadas fueron la VDRL (Venereal Disease Research Laboratory), la de reagina plasmática rápida (Rapid Plasma Reagin, RPR) y la de aglutinación de partículas para Treponema pallidum (Treponema pallidum Particle Agglutination Assay, TPPA).Resultados. La sensibilidad para la PCR convencional fue de 52 pg y, para la PCR anidada, de 0,52 pg. La especificidad con los iniciadores TpN47 y polA fue de 100 %; los resultados de la secuenciación mostraron una identidad de 97 % con T. pallidum. En 70 % de las muestras, los resultados de las pruebas serológicas y la PCR anidada concordaron.Conclusión. El gen TpN47 resultó ser el mejor blanco molecular para la identificación de T. pallidum. La PCR anidada se presenta como una alternativa de diagnóstico molecular promisoria para el diagnóstico de sífilis congénita.
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