Neide Aparecida Tosato Boldrini 1, João Victor Jacomele Caldas 2, Susana Lamara Pedras Almeida 3, Dennis de Carvalho Ferreira 4, Alexandre Marques Paes da Silva 4, Bianca Nunes Balmas Tapias 2, Maria Carmen Lopes Ferreira Silva Santos 5, Helena Lucia Barroso dos Reis 6
Syphilis and HIV infections are sexually transmitted infections whose diagnosis and treatment contribute toward preventing congenital transmission.
To report a case of three sexually transmitted infections detected in a male partner during Couple Consultation and syphilis in the female partner during prenatal care.
A 34-year-old black female G2P1 pregnant woman was referred to an outpatient clinic of sexually transmitted infections in Vitória, Brazil, reporting a 30-day evolution of painless papular lesions in the external genitalia, suggestive of condylomata lata. Nontreponemal tests were positive for syphilis and negative for HIV. The husband reported unprotected receptive anal intercourse and possessed anal condylomatous lesions and perianal condylomata lata. He was positive for both HIV and syphilis. Histopathological findings showed low-grade HPV lesions and the PCR test found 16, 39, and 53 HPV subtypes. Treatment with benzathine penicillin G was successful for both partners.
This study emphasizes the need for Couple Consultation during pregnancy to identify and treat possible sexually transmitted infections.
As infecções por sífilis e HIV são infecções sexualmente transmissíveis cujo diagnóstico e tratamento contribuem para a prevenção da transmissão congênita.
Relatar um caso de três infecções sexualmente transmissíveis detectadas em um parceiro masculino durante a consulta do casal e sífilis na parceira durante o pré-natal.
Uma gestante, negra, G2P1, 34 anos, foi encaminhada a um ambulatório de infecções sexualmente transmissíveis em Vitória, Brasil, relatando uma evolução de 30 dias de lesões papulares indolores na genitália externa, sugestivas de condiloma lata. Os testes não treponêmicos foram positivos para sífilis e negativos para HIV. O marido relatou relação sexual anal receptiva desprotegida e possuía lesões condilomatosas anais e condiloma lata perianal. Ele testou positivo tanto para HIV quanto para sífilis. Os achados histopatológicos mostraram lesão de HPV de baixo grau e o teste de PCR encontrou 16, 39 e 53 subtipos de HPV. O tratamento com penicilina benzatina G foi bem-sucedido em ambos os parceiros.
Este estudo enfatiza a necessidade de consultas de casal durante a gravidez para identificar e tratar possíveis infecções sexualmente transmissíveis.
Sexually transmitted infections (STI), especially HIV/AIDS, syphilis, and viral hepatitis B infections, are a severe problem during pregnancy due to the possibility of congenital transmission to the fetus1,2. Vertical of STI transmission can lead to several problems for a newborn. Infants infected by syphilis (congenital syphilis) may experience severe sequels or death; however, this can be prevented by timely treatment of the mother with syphilis during pregnancy3. Moreover, pregnant women should always undergo HIV and other serology tests1,2. Women should, at some point in their life-time, undergo investigation by vaginal cytology and genital examination for Human papillomavirus (HPV) induced lesions and other STI, and the prenatal period is an ideal opportunity to evaluate women and their sexual partners. Thus, Couple Consultation should be performed in order to identify and treat any such diseases during prenatal care2. The case reported here regards a pregnant woman recently diagnosed with syphilis and whose sexual partner presented three STI diagnosed in such prenatal consultations.
To report a case of three STI detected in a male partner during Couple Consultation and syphilis in the female partner during prenatal care at a University hospital in the southeast region of Brazil.
A 34-year-old black female G2P1 patient, sought an STI outpatient clinic at the University Hospital in Vitória, Brazil, with complaints about multiple painless papular lesions on the external genitalia that had developed over the previous 30 days. On this occasion, she was six weeks pregnant and, upon examination, erythematous plaque lesions were observed in the external genital region, suggestive of condylomata lata (
Her husband reported in a private interview the occasional use of cocaine and unprotected anal sex with unknown men. His rapid tests results were positive for HIV and syphilis; furthermore, he had a VDRL of 1/128. He presented a perianal lesion suggestive of condylomata lata (
HPV RT- PCR was positive for the subtypes 16, 39, and 53. The male partner had condyloma acuminata and condyloma lata, as well as HIV infection. The pregnant woman was treated with 4,800,000 IU of benzathine Penicillin G for her recent secondary syphilis in pregnancy by intramuscular injection. The treatment choice was applied in two doses, with an interval of seven days, and 2.4 million for each treatment that was divided into 1.2 million IU in each gluteus, at each application. She was referred to the prenatal care and remained HIV-negative throughout the whole prenatal period.
Adequate prenatal care with vigilant screening prenatally and at delivery is critical to reduce congenital syphilis and other congenital sexually transmitted infections. Adequate investigations must be performed during prenatal care and serologic titers for syphilis can be tested monthly in women at high risk of syphilis reinfection1. Measurement of antibodies is very important for the screening and diagnosis of syphilis. Quantitative maternal nontreponemal titer, especially when higher than 1:8, might be an indicator of current infection4. Serological diagnosis for syphilis is based on the detection of both nontreponemal antibodies and treponemal-specific ones. In this case, the couple was VDRL 1/128, which suggests acquired syphilis; moreover the FTA
Histopathological findings demonstrated a low-grade squamous intraepithelial lesion (LSIL) characterized by well-differentiated atypical squamous epithelium10. HPV RT-PCR investigation was positive for the high-risk subtypes 16, 39, and 53.
The prevention of STI infections is based on various approaches, such as correct risk valuation, informing individuals of high-risk behaviors, effective diagnosis, treatment, recommendation, and follow-up of infected individuals and their partners, such as the treatment of this pregnant woman and her partner11,12,13.
As a strength of our text, we say that these combinations are not so frequent in medical practice in a prenatal care clinic. That is why it deserves publication. On the other hand, being a Case Report is a limitation.
Syphilis and HIV infections are diseases that, with early diagnosis and treatment of both partners, and when correctly performed, contribute toward the decline of congenital syphilis and HIV transmission. Couple Consultation during prenatal care also enables the diagnosis and treatment of other STI-associated infections, as observed in this case report without prejudice. It is important that health professionals be available and qualified to identify and treat these infections.
HELENA LUCIA BARROSO DOS REIS . STI/AIDS Outpatient Unit of the Gynecology and Obstetrics, Cassiano Antonio Moraes University Hospital. Avenida Marechal Campos, 1355. Vitória (ES), Brazil. CEP: 29041-295. E-mail: firstname.lastname@example.org