Brazilian Protocol for Sexually Transmitted Infections 2020: epidemiological surveillance

Acquired syphilis in older people in Brazil from 2010-2020

BACKGROUND

The infection caused by Treponema pallidum remains a severe public health problem, with a high prevalence in individuals over 60 years. However, research into infections such as syphilis continues to be neglected in geriatrics. This study aims to evaluate data on the detection rate of syphilis in Brazil, in individuals between 60 and 120 years, by characterizing the epidemiological profile and respective factors associated with it, in addition to performing a temporal trend analysis, from 2010 to 2020.

METHODOLOGY

Ecological, time-series study, which started with the collection of notifications from the database of the Information System on Compulsory Notification of Diseases. The epidemiological profile was characterized based on sociodemographic variables. The Statistical Package for the Social Sciences program, version 19.0, was used for incidence and prevalence analysis. The 2010 census by the Brazilian Institute of Geography and Statistics and projections for older people were considered. In the trend analysis, the Joinpoint regression model was used.

MAIN FINDINGS

There was an upward variation in the detection of syphilis in older people from 2010 to 2018, with a peak in 2018. In 2019, there was a slight reduction in the notification of cases, which was accentuated in 2020. The prevalence of the infection was equivalent to 12.84 cases for each 100,000 Brazilians, with a mean age of 68.04 years (±7.15) for those between 60 and 120 years, being higher in white and black males. The highest proportion of older people with syphilis occurred in the South and Southeast regions. However, the trend analysis showed a significant and homogeneous increase in all regions of Brazil, for both sexes and all age groups.

CONCLUSIONS

There is a tendency for an increase in cases of syphilis in older people, which reinforces the need to plan health actions to combat the disease in this population.

Congenital Syphilis: a Review of Global Epidemiology

In 2007, the World Health Organization (WHO) launched a global health initiative for the elimination of mother-to-child transmission (MTCT) of syphilis. This condition is highly preventable through antenatal identification of syphilis infection and treatment with penicillin during pregnancy. This review summarizes the global status of MTCT of syphilis and concludes that this condition remains a significant issue worldwide. There are large variations in case rates by region, with the highest numbers of cases in the African and Eastern Mediterranean regions, where there are also the least data available. There are also pockets of high-incidence areas within the other regions. Although the general trend is of decreasing rates over time, there are concerning indications of consistently increasing congenital syphilis cases in some areas, particularly in areas which have previously had very low case numbers. A concerted effort will be required to achieve the 2007 WHO goal of worldwide elimination of MTCT of syphilis in the near future.

Challenges in Diagnostic of the Ulcerative Rectitis by Lymphogranuloma venereum in Chlamydia trachomatis Infection and AIDS

Lymphogranuloma venereum is a rare manifestation of Chlamydia trachomatis infection and may manifest with anorectal symptoms, rectitis, proctitis, and inguinal masses. The new outbreaks of Chlamydia infection have allowed the description of new cases with rectal symptoms (rectitis/proctitis), mainly in people living with HIV and men who have sex with men. The authors present the clinical findings in people living with HIV men who have sex with men with lymphogranuloma venereum with ulcerative rectitis identified by colonoscopy. Differentiation of proctitis was made from other causes of sexually transmitted infections, such as gonorrhea and herpes virus, inflammatory diseases (Crohn's disease), and neoplastic and opportunistic infections such as cytomegalovirus, tuberculosis, and histoplasmosis. The symptoms of the patient and the endoscopic lesions were suspected of lymphogranuloma venereum with ulcerative proctitis, which was confirmed by biopsy and performing the polymerase chain reaction. After appropriate treatment with doxycycline, the patient evolved favorably.

Management Solutions for the Restructuring of Laboratories Associated to the Sentinel Services for Syphilis and Other STIs

This article aims to develop management solutions to accompany the processes of acquiring and distributing equipment and/or materials needed for the restructuring of associated laboratories to the sentinel services (Sentinel Laboratories) for syphilis and other sexually transmitted infection in the scope of the "Syphilis No!" Project. To this end, we have taken steps to create an overview of the restructuring project for the sentinel laboratories, define the stages of project execution, monitor the implementation of the project, and elaborate a standard operating procedure for the delivery of equipment and/or materials to the sentinel laboratories. Among the results, we highlight: the detailed workflow for the process of public procurement through direct purchases or bidding; the workflow for storage of the equipment and materials; the standard operating procedures (SOP) for contact with the laboratories; and the SOP for delivery of items acquired for the sentinel laboratories.