Brazilian Journal of Sexually Transmitted Diseases

Genital Human Papillomavirus Infection in women from Florianópolis - Santa Catarina, Brazil

Edison Natal Fedrizzi — 2023-09-20

Introduction: Human Papillomavirus (HPV) infection is the most common sexually transmitted infection in women. About 80% of sexually active women will have contact with this virus at some age in their lives. Most infections will be transient, but when the infection becomes persistent, associated with high oncogenic risk HPV, there may be progression to cancer, especially cervical cancer. The best way to prevent HPV infection is through the use of vaccines. Objective: To assess which are the most prevalent types of HPV in the city of Florianópolis, Brazil and if the majority of the diagnosed types are contained in the HPV vaccines currently available on the market and in the public health sector. Methods: More than 14,727 HPV tests were evaluated for the diagnosis of genital HPV infection in women from Florianópolis. The prevalence of infection was evaluated according to age of the women. HPV detection was performed using molecular biology tests, such as hybrid capture (for diagnosis of the HPV group, high or low oncogenic risk) and PCR (viral genotyping) techniques. Results: The diagnosis of HPV infection was made for women between one and 102 years of age. The highest positivity of the exams was observed in women aged 20–25 years (51% of the exams). The most prevalent age group was 31–35 years old (23.5%), and the lowest was for women aged 70 and above (0.6%). High oncogenic risk HPV was detected in 94.1% of positive samples and was the most frequent in all age groups. Mixed infection (high- and low-risk HPV) was more prevalent in the 66–70 age group (25.6%). The most frequent genotypes were non-16/18 high oncogenic risk HPV (77% of positive cases). HPV 16 was found in 17.1% of positive cases, and HPV 18 in 6.5%. Conclusion: The most prevalent types of HPV in Florianópolis in the last 6 years are non-16/18 high oncogenic risk HPV types, viral types not covered by the current HPV vaccine available in the public health sector in Brazil.

Evaluation of YouTube Videos on HIV/AIDS: A Critical Analysis of Content Quality and Reliability

Cihan Semet — 2023-05-29

HIV and AIDS remain as significant global health issues, with misinformation and stigma surrounding the diseases still being prevalent. Accurate and reliable information is crucial for promoting prevention, early detection, and effective management of the disease. YouTube has emerged as a popular platform for sharing and consuming health-related content, but the quality and reliability of its videos on various health topics have been questioned. Objective: This study aims to systematically review and evaluate the quality and reliability of YouTube videos on HIV/AIDS. Methods: We searched for videos on YouTube using two search terms, "HIV" and "AIDS," and evaluated the top 100 videos for each search term. We recorded video features such as length, likes, comments, views, and upload date. Two independent evaluators assessed the videos' quality and reliability using the Global Quality Scale and the modified DISCERN tool. We classified the videos into two groups based on the source that uploaded the video, professional and non-professional, and analyzed the data using statistical methods. Results: Of the 159 videos evaluated, the most common content categories were HIV transmission routes, basic information and definition of HIV, and HIV/AIDS activism and awareness. Non-professional videos tended to be shorter, but there were no significant differences in views, likes, and likes per day counts. Comments were significantly higher in non-professional videos. Professional videos had higher quality and reliability scores than non-professional videos. Conclusion: Accurate and reliable information on HIV/AIDS is critical for promoting prevention, early detection, and effective management of the disease. YouTube has the potential to disseminate this information, but the quality and reliability of its videos must be improved. Our study highlights the need to prioritize professional, high-quality, and reliable video content on HIV/AIDS on YouTube to improve the public health outcome.

Acceptability of teleconsultation in a public service specialized in the prevention and care of HIV infection and other sexually transmitted infections.

Simone Queiroz Rocha — 2023-03-15

Introduction: Telemedicine was leveraged for its contribution to mitigate the impact of COVID-19 in Brazil and worldwide. Objective: We aim to evaluate the acceptability of incorporating teleconsultation through synchronized videoconference by users and professionals in a service specialized in the prevention and treatment of the human immunodeficiency virus and other sexually transmitted infections, and to identify associated factors. Methods: This is a cross-sectional study with 410 users and 57 professionals who answered a category-standardized questionnaire. Predictors of acceptability were assessed using logistic regression model. Results: A total of 364 (88.8%) users said they would accept the modality. The factors positively associated with the odds of acceptance were the self-assessment of having favorable conditions to participate in a teleconsultation (aOR 54.8; 95%CI 12.4–242.1; p<0.001), the perception of saving money (aOR 5.2; 95%CI 1.9–14.0; p=0.001), and perceived convenience of the modality (aOR 6.7; 95%CI 2.9–15.9; p<0.001). Factors associated with reduced odds of acceptance were the fear of not being evaluated well (aOR 0.2; 95%CI 0.1–0.4; p<0.001), or remaining long without seeing the professional (aOR 0.2; 95%CI 0.1–0.5; p<0.001). The acceptance of the modality among professionals was 75.4% and the perception of its convenience (aOR 16.8; 95%CI 2.6–108.4; p=0.003) and that the institution has appropriated conditions (aOR 7.7; 95%CI 1.5–40.6; p=0.016) were associated with increased odds of accepting its incorporation in their routine. Conclusion: Governance should invest in infrastructure and support, secure protocols, digital literacy, and training of its users and employees for video teleconsultation.

Clinical-epidemiological characterization of women who received post-exposure HIV prophylaxis in a public hospital in Porto Alegre, Rio Grande do Sul

Pamela Pereira Fagundes — 2023-05-18

Introduction: Prevention strategies are key to combating the epidemic of infections such as HIV and syphilis. The epidemiological scenario of Porto Alegre/RS for these infections shows the need for greater efforts in the area of prevention, seeking to characterize both the population that uses these strategies and the services involved in the care of exposed people. Objective: This study aimed to characterize the clinical and epidemiological profile of patients who received post-exposure prophylaxis (PEP) to HIV treated in a public hospital in Porto Alegre/RS. Methods: This is a retrospective, research, descriptive study based on the Clinical Protocol and Therapeutic Guidelines for PEP, updated in 2018 by the Ministry of Health. Prophylaxis request forms and medical records of patients treated were analyzed. Results: The population consisted of 87 women who received PEP from January to September 2019. There was a predominance of women aged between 20 and 29 years old (55.2%). The most frequent sexual exposure was consensual (69.0%) followed by sexual assault (31.0%). Porto Alegre was the place of residence of most patients (73.6%). The most frequently used therapeutic regimen was the combination of atazanavir, ritonavir, and tenofovir plus lamivudine. On the first visit, 8.0% of the patients showed reactive results for the treponemal syphilis test. Only 23.0% and 14.9% of patients returned for anti-HIV tests in the first and third months after exposure, respectively, and the results were non-reactive. Only 19 patients (21.8%) attended the consultations between 0 and 28 days after PEP. Conclusion: It was identified that a considerable percentage of women already had reactive serology for syphilis, most women did not return for follow-up within 28 and 90 days after the first consultation, more than half of the women were aged between 20 and 29 years old, and the most frequent sexual exposure was consensual. In this sense, efforts are needed, such as adequate counseling, adoption of interventions such as sending messages by cell phone, telephone calls, and preparation of educational materials, seeking to improve adherence to treatment and follow-up in the service, which is important given the scenario of epidemiology in Porto Alegre.

Prevalence of HPV infection and cervical intraepithelial lesions in HIV positive and negative women in the city of Florianopolis

Pâmela Raquel Coradeschi — 2023-02-15

Introduction: HPV infection is the most frequent sexually transmitted infection in women. The high oncogenic risk HPV, associated with others factors, there are a risk of progressing to a precancerous lesion of the cervix and even cancer. This evolution is related to the persistence of the infection and other factors, mainly those that interfere with the woman's immunity. The immunosuppression caused by HIV infection is an important factor for viral persistence and the appearance of these lesions. Objectives: To compare the prevalence of HPV infection and cervical intraepithelial lesions in HIV-positive and negative women and describe the possible associated risk factors. Methods: The sample consisted of 50 HIV positive women (study group) and 50 HIV negative women (control group) recruited from the public health system of Florianópolis during the months of January to April 2022. Cervical samples were collected for cytological analysis and for detection of high-risk oncogenic HPV DNA by polymerase chain reaction (PCR). Categorical variables were compared using the chi-square test, with a significance level set at 5% Results: HPV infection was more prevalent in the control group, however, HIV positive women had a higher frequency of intraepithelial lesions diagnosed on cytology. Factors such as greater number of sexual partners, depression and smoking were more frequent in the group of HIV positive women. The number of CD4 T cells less than 200 cels/mm³ was associated with a higher number of altered Pap smears and a positive HPV DNA test. The use of combination antiretroviral therapy and undetectable viral load were associated with a greater number of normal cytology and undetected HPV DNA. Conclusion: The prevalence of cervical intraepithelial lesions in HIV-infected women is higher than in women without infection. The presence of HIV infection was the most important risk factor associated with the development of cervical lesions.

Accuracy of visual inspection, cytology and colposcopy in the diagnosis of high-grade cervical intraepithelial neoplasia

Beatriz Maykot Kuerten — 2023-04-11

Introduction: Cervical cancer is still one of the leading causes of cancer and mortality in women, especially in low- and middle-income countries. Normally, the prevention of its occurrence is done through efficient screening and treatment programs for high-grade epithelial lesions, which are pre-malignant lesions. Cheaper diagnostic techniques ensure greater access to women, which can prevent a large number of cancer cases worldwide. Objective: The aim of the study was to evaluate the accuracy of visual inspection either with acetic acid or with Lugol’s iodine, cervical cytology and colposcopy in the diagnosis of cervical intraepithelial neoplasia 2 and 3. Methods: This is a study of diagnostic accuracy. We evaluated 115 women with high-grade squamous intraepithelial lesion confirmed by biopsy, 54 with cervical intraepithelial neoplasia 2 and 61 with cervical intraepithelial neoplasia 3, from January 2016 to December 2018 at the Lower Genital Tract Pathology and Colposcopy Service of the Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. A comparative analysis of the visual inspection, Pap smear and colposcopy diagnostic methods was performed. Results: The average age was 33.1 years (standard deviation=9.83) for cervical intraepithelial neoplasia 2 cases and 35.2 years (standard deviation=7.97) for cervical intraepithelial neoplasia 3. In the cervical intraepithelial neoplasia 2 group, visual inspection tests were positive for high-grade squamous intraepithelial lesion in 98.1% of the cases with acetic acid and 94.4% with Lugol’s iodine. Colposcopy identified a probable high-grade squamous intraepithelial lesion in 94.4% of the cases, while cytology only in 42.6%. In the cervical intraepithelial neoplasia 3 group, the visual inspection tests were positive for high-grade squamous intraepithelial lesion in 91.8% of the cases with acetic acid and 95.1% with Lugol’s iodine. Colposcopy identified a probable high-grade squamous intraepithelial lesion in 93.5% of the cases, while cytology in 65.6%. Conclusion: Visual inspection with acetic acid and Lugol’s iodine, and colposcopy test were more accurate for the diagnosis of cervical intraepithelial neoplasia 2 and 3 than through cytopathology.

Epidemiological profile of gestational syphilis and congenital syphilis in a reference center in Northeast Brazil: risk factors and trend from 2019 to 2021

Alice Rodrigues Barbosa de Moraes — 2023-04-18

Introduction: Syphilis is an infectious systemic disease caused by the bacterium Treponema pallidum. The Amaury de Medeiros Integrated University Health Center in Recife is a reference maternity hospital for high-risk pregnancies and the management of the most common Sexually Transmitted Infections during prenatal care, including Gestational Syphilis and Congenital Syphilis. Objective: To determine the epidemiological profile of the population exposed to these conditions, the rate of Gestational Syphilis detection, the incidence of Congenital Syphilis, and the associated unfavorable outcomes in Amaury de Medeiros Integrated University Health Center between January 2019 and December 2021. Methods: This retrospective cohort study included pregnant women and neonates diagnosed with syphilis at Amaury de Medeiros Integrated University Health Center. Data were collected from the Notification/Investigation Forms for Gestational Syphilis and Congenital Syphilis, between January 2019 and December 2021. Results: At Amaury de Medeiros Integrated University Health Center, 463 cases of Gestational Syphilis and 296 of Congenital Syphilis were reported. During the three-year study, 4444, 4360, and 4265 live births were recorded, confirming the Gestational Syphilis detection rates — 33.30, 36.92, and 36.10 per 1000 live births, with the incidence of Congenital Syphilis being 26.1, 21.33, and 20.39 per 1000 live births. Pregnant women in their third trimester who were brown, had incomplete primary education, and lived in an urban area were the main sociodemographic variables. In total, 217 (73.3%) patients were diagnosed with Gestational Syphilis during or after delivery, indicating a low prenatal coverage (70.6%). In terms of the progression of Congenital Syphilis, unfavorable outcomes was found in 40 (13.5%) patients, including 16 (40%) abortions, 10 (25%) stillbirths, nine (22.5%) deaths from Congenital Syphilis, and 5 (12.5%) deaths from other causes. Conclusion: Gestational Syphilis detection rates and Congenital Syphilis incidence remain alarming, with abortions and stillbirths being the most common unfavorable outcomes. To change the dramatic situation of Congenital Syphilis in Brazil, the associated factors point to a poor quality of prenatal care and an urgent need to change public policies for pregnant women and newborns, in conjunction with socioeconomic assistance.

Evaluation of the follow-up of children treated for congenital syphilis in a municipality in the state of Espírito Santo, when it lacked crystalline penicillin

Paula Cruz Pironi — 2023-03-31

Introduction: Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. In Brazil, its incidence has increased, along with the lack of penicillin, the antibiotic of choice for congenital syphilis, from 2014 to 2017. During this period, children were treated with alternative drugs, but to date, data from the scientific literature do not recommend another antibiotic. Objective: To compare the progression, according to the established treatment, and evaluate the follow-up in health care facilities in Vila Velha (Espírito Santo) of children with congenital syphilis aged up to two years, born in Hospital Infantil e Maternidade Alzir Bernardino Alves — a reference in neonatology and low-risk pregnancy in the state at the time — from 2015 to 2016, when the hospital experienced a greater lack of penicillin. Methods: This is a retrospective cross-sectional observational study based on data from medical records of the hospital and other healthcare facilities in the city. We performed statistical analyses, per health district, of epidemiological and sociodemographic data, as well as those related to visits, their frequency, and clinical profile, according to the follow-up parameters proposed by the Ministry of Health at the time. Results: Medical records of 121 children were evaluated, presenting as the main findings: only 35% of the children completed the follow-up; among those treated with ceftriaxone, 55.2% completed the follow-up, and 100% of the children whose venereal disease research laboratory was greater than that of their mother at birth completed the follow-up. Of the symptomatic children at birth who remained or became symptomatic at follow-up, 58.8% used ceftriaxone. Conclusion: Among symptomatic children at birth, most of those treated with ceftriaxone remained symptomatic at follow-up. The Counseling and Testing Center was the most successful facility in the follow-up of these children. District 5 had the lowest success rate in the follow-up of these patients, and districts 1 and 2 showed the lowest rates of appropriate approach to congenital syphilis during follow-up.

Situational analysis of syphilis cases taking place between 2015 and 2021 in the state of Rio Grande do Norte - Brazil

Tereza Beatriz Oliveira Assunção — 2023-01-31

Introduction: Syphilis is a sexually transmitted infection that represents a severe public health problem worldwide and in Brazil it has not been different. The national compulsory notifications regarding syphilis cases are significantly increasing, and therefore, this fact alone justifies the study of such a relevant subject. Objective: This work presents a situational analysis of syphilis cases in the state of Rio Grande do Norte, Brazil, between 2015 and 2021, aiming primarily at assisting public healthcare authorities in decision-making processes to cope with the disease. Concomitantly, this research aims to build knowledge as well as to provide awareness to the population. Methods: This study analyzed data from compulsory notifications reports from 2015 to 2021, available in the database of the Brazilian Unified Health System’s Informatics Department, in the Brazilian Information System of Notifiable Diseases and in the Brazilian Health Surveillance Secretariat. Results: In the state, 70% of patients with syphilis are aged 15 to 39 years. The rate of patients affected with acquired syphilis that have low education is 48%, and for pregnant women, this value rises to 77%. The declared mixed-race patients represent 48% of notifications for acquired syphilis, and for mixed-race pregnant women, this value increases to 60%. In congenital syphilis, 98% of compulsory notifications occurred for children aged up to 7 days of birth. Conclusion: Syphilis in Rio Grande do Norte is a public health problem that mainly affects the vulnerable population, predominantly the groups at risk with low education, mixed race, and young-adult people, being of paramount importance to combat the disease through population awareness, as well as through constant and adequate compulsory notification.

Congenital syphilis in the city of Vitória/ES in 2010-2020

Leonardo Luiz Moreira Guimarães — 2023-07-03

Introduction: Syphilis is a systemic infectious disease caused by Treponema pallidum and is a public health problem in Brazil, since it is epidemiologically growing in the Brazilian population. Objective: To describe the occurrence of congenital syphilis and the profile of reported cases in the population of the city of Vitória-ES. Methods: This was a descriptive study with a quantitative approach aimed at analyzing congenital syphilis. The study population consisted of all notifications found in the Notifiable Diseases Information System referring to congenital syphilis cases in the municipality of Vitória – ES in the period 2010–2020. Results: A total of 1,158 cases of congenital syphilis were reported in Vitória, where 36.4% were in the first trimester of pregnancy; most infants (95.7%) were diagnosed less than 7 days after birth. There was a predominance of mothers aged between 20 and 29 years (48.1%), and 61.8% of cases were recorded in brown-skinned pregnant women with low education. Prenatal care was provided to 76.2% of the pregnant women, but the treatment regimen was considered inappropriate in 54.1% of the cases. Conclusion: The large number of cases, despite failure in prenatal coverage with inadequate maternal treatment, point to poor quality of prenatal care, with congenital syphilis in the absolute majority of cases failing prenatal care. The findings indicate the need of improvements in the implementation of prenatal care that, if diagnosis and proper treatment occurs before the 36th week up to the 40th week, the case will be properly treated syphilis and will not be a congenital syphilis case.

Revaluation of the COVID-19 pandemic impact on the epidemiology of syphilis in Brazil

Nelson Pereira Marques — 2023-07-03

Introduction: Due to the coronavirus 2019 disease (COVID-19) pandemic, health systems worldwide have suffered interferences, with the interruption of sexual health clinics, limitation of ambulatory consults, prevention, diagnosis, and treatment of several diseases, especially syphilis, altering their epidemiology. Objective: To investigate the impact of the pandemic on syphilis diagnosis in Brazil, the main goal of this study was to update and reevaluate data from the Brazilian Unified Health System on the number of syphilis cases reported in all five Brazilian geographic regions and verify the response of the Brazilian health care to the COVID-19 pandemic. Methods: The data were retrieved from the National Disease Notification System and the Department of Chronic Conditions Diseases and Sexually Transmitted Infections and represent syphilis diagnosis in Brazil, from March to December 2017 to 2019, 2020, and 2021. Results: The increase in the number of syphilis cases was minor compared to 2020, keeping the Southeast region as the most impacted (+146.1%) and an increase of 22,633 cases throughout Brazil (+54.3%). Conclusion: Syphilis disease control measures were ineffective in 2021 as the drop in the number of cases was irrelevant compared to the years before the pandemic. The association between the increase in syphilis cases in Brazil and the COVID-19 pandemic should be further investigated to assist in decision-making processes and in the programming of health actions in addition to finding measures to raise the control of this disease.

Prevalence of early hospital readmissions in a reference unit for the treatment of people living with HIV located in Ribeirão Preto, Brazil

Rodrigo de Carvalho Santana — 2023-07-03

Introduction: The 30-day readmission rate after discharge has been used to indicate healthcare quality. However, precise data on this indicator are still scarce in Brazil, especially among people living with HIV. Objective: The objectives of this study were to describe the rate of early hospital readmissions in people living with HIV and the sociodemographic and clinical characteristics of readmitted patients and to identify the factors associated with readmissions. Methods: This prospective cohort study was conducted with patients admitted between August 2016 and August 2018 in a university hospital in the state of São Paulo, Brazil. Clinical and laboratory data, social indicators, use of illicit drugs, and adherence to antiretroviral treatment were evaluated. Participants were monitored for hospital readmissions within 30 days after discharge from the index hospitalization. Results: A total of 71 patients were included. There was a predominance of men aged between 30 and 60 years, with low socioeconomic and educational levels, inadequate control of HIV infection, and frequent use of psychoactive substances. The 30-day readmission rate found was 22%. Gastrointestinal diseases were the most frequent in index hospitalizations and early readmissions. Conclusion: The early readmission rate in people living with HIV was 22%. Gastrointestinal diseases were the most prevalent in the index of hospitalization and early readmissions. Most of the patients admitted and readmitted are middle-aged men with a low level of education, low insertion in the labor market, a considerable rate of psychoactive substance use, and living in conditions of social vulnerability.

Knowledge on post-exposure prophylaxis, sexual behavior, and vulnerabilities to HIV and other STIs among young adults in Brazil

Vinicius Nascimento dos Santos — 2023-07-03

Introduction: Post-exposure prophylaxis (PEP) is the use of antiretroviral drugs (ARVs) to reduce the risk of human immunodeficiency virus (HIV) infection after potential risk exposure. ARV-based interventions are recommended as part of combination HIV prevention, especially for key populations. Objective: The aim of this study was to measure knowledge about PEP among university students. Methods: A cross-sectional study was conducted on university students from the Health, Education, Exact, and Human Sciences Departments of the State University of Bahia, Brazil. Sociodemographic data, information on sexual behavior, and knowledge of PEP were collected through a standardized self-applied questionnaire. Results: We analyzed 1580 questionnaires, of which 66.7% (1024/1536) were from females, with a mean age of 23.9 (±6.5) years, and 35.4% (448/1264) reported irregular use of condoms and regular use was not associated with being students from the health area (p=0.44, OR 0.90, 95%CI 0.69–1.17). Regarding PEP, 28.5% (449/1578) had known about it and their knowledge was statistically associated with men who have sex with men (MSM) (p<0.01, OR 3.92, 95%CI 2.45–6.28). It was noted that 94.0% (1485/1579) did not know the time limit for starting PEP, 95.1% (1500/1578) did not know the duration of prophylaxis, and 91.1% (1437/1577) did not know where to get PEP. Finally, 0.4% (7/1578) referred to previous use and 96.6% (1488/1540) would not change their sexual behavior after knowing about PEP. Conclusion: PEP is a prevention strategy available for decades and is safe, effective, and cost-effective. However, it is underutilized and a lack of knowledge on PEP is one of the main obstacles to access. Among university students, there is a limited knowledge about PEP acting as a barrier in preventing new infections, which shows the need for interventions based on sexual-health education, stimulating the reduction of risk behaviors and disseminating information about combination prevention.

Bacterial vaginosis and trichomoniasis: prevalence, associated factors, and performance of diagnostic tests

Kélvia Cristina de Camargo — 2023-08-29

Introduction: Bacterial vaginosis and vaginal trichomoniasis are frequent causes of health care demand. Objective: To estimate the prevalence, identify associated factors, and investigate the performance of diagnostic tests for bacterial vaginosis and trichomoniasis. Methods: Cross-sectional study with participants over 18 years old. All of them were submitted to an interview and gynecological examination with evaluation of vaginal secretion, pH verification, collection of material for Pap smear, wet mount test, Whiff test, bacterioscopy, and polymerase chain reaction for trichomoniasis detection. Logistic regression analysis was applied to identify associated factors with bacterial vaginosis. Diagnostic performance for bacterial vaginosis was evaluated following Amsel criteria, the Ison and Hay score, and the Pap smear, considering the Nugent score as the gold standard. As for trichomoniasis, diagnostic performance was evaluated through the Pap smear and the wet mount test, using the polymerase chain reaction as the gold standard. Results: The prevalence of bacterial vaginosis was 33.7%, and for trichomoniasis, 0.5%. The complaint of abnormal vaginal secretion was associated with the diagnosis of bacterial vaginosis (odds ratio 2.2). The diagnostic accuracy by Amsel criteria, the Ison and Hay score, and the Pap smear was 35.6, 97.0, and 84.2%, respectively. The sensitivity for trichomoniasis through wet mount test was 0.0%, and through the Pap smear, 100%. Conclusion: The prevalence of bacterial vaginosis was high, and trichomoniasis was low. The only associated factor with bacterial vaginosis was the report of abnormal vaginal secretion. The methods with the most accurate diagnostic performance for bacterial vaginosis were the Ison and Hay score and the Pap smear and, for trichomoniasis, the Pap smear.

Vulnerability of the young university population to HIV/AIDS and other sexually transmitted infections

Sergio Ferreira Junior — 2023-08-29

Introduction: Brazilian universities receive annually thousands of young people who experience situations of vulnerability to the human immunodeficiency virus, sexually transmitted infections, and viral hepatitis. Objective: The aim of the present study was to analyze the secondary data obtained from the attendance record of the rapid testing campaign for these health problems at a federal university in the state of Minas Gerais, Brazil, in 2019. Methods: A cross-sectional study was conducted with secondary data of students (n=1,113) obtained from the standard attendance form by the Ministry of Health during the campaigns Fique Sabendo (Be Aware) in the period between November 25 and 29, 2019. Analyses were performed with the support of the Statistical Package for Social Sciences program, with the calculation of absolute and relative frequencies. Pearson's chi-square test (5%) was used for comparison. Results: The results revealed a young, heterosexual, white profile. More than half reported having consumed alcohol and drugs in their lives. Other findings were the non-use of condoms with steady partners (18.1%) and occasional partners (21.3%), oral sex (86.8%), and unprotected sex in the last intercourse (45.6%). Most declared never being tested for human immunodeficiency virus (74.5%), syphilis (67.4%), hepatitis B (76.1%), or hepatitis C (77.0%). Conclusion: The university population is vulnerable to human immunodeficiency virus and other sexually transmitted infections due to the number of sexual partners and discontinued use of condoms with occasional partners. Such vulnerability is increased by the use of alcohol and other drugs.

The crucial role of the partner in the incidence of cases of congenital syphilis in the state of Sergipe: an analysis in 17 years

Rute Farias — 2023-08-31

Introduction: Congenital syphilis is a highly preventable infectious disease. The relevance of the partner in the transmission of the disease is undeniable, and the underestimation of its treatment is a great risk with serious fetal consequences. Objective: The aim of this study was to analyze the partner's contribution to the inadequate treatment of pregnant women and the incidence of cases of congenital syphilis in Sergipe between 2005 and 2022. Methods: A cross-sectional, retrospective, and descriptive study was carried out through the collection of reported cases of congenital syphilis from the Notifiable Diseases Information System (SINAN). Results: There was a considerable increase in the number of reported cases of congenital syphilis in Sergipe in the past 17 years, with a predominance of untreated partners (61.5%) over treated ones (14.9%), excluding the 23.6% who had this information ignored. The variations presented from 2018 onwards stand out, resulting from the softening implemented in the notification of partner data, with an average of 23.7% of ignored information. Consequently, the diagnosis of recent congenital syphilis was found in 83.7% of newborns whose parents were not treated, in addition to 50% of cases of late infection and the vast majority of cases of stillbirths/abortion (92.6%) and deaths from the disease (78.8%). Furthermore, the non-inclusion of the partner in prenatal care (83%) contributed mainly to delays in the diagnosis of maternal syphilis, with 90.1% during delivery/curettage, 76.7% after delivery, and 77.2% of them not even identified with the disease. Conclusion: In addition to the increase in cases of congenital syphilis, there was a predominance of untreated partners, coinciding with changes in the notification criteria in 2018, which contributed to most cases of delay in maternal diagnosis, reinfection, and vertical transmission. Thus, the partner's approach is essential to guarantee the treatment and interruption of the transmission of the disease.

Analysis of combined prevention measures on HIV/AIDS incidence in Brazil (1980-2020)

Gabriela Morais Celestino Amaral — 2023-11-14

Introduction: The Human Immunodeficiency Virus (HIV) attacks the immune system, with acquired immunodeficiency syndrome (AIDS) being the most advanced clinical manifestation. Prevention strategies have evolved over time in response to scientific advancements. From an institutional perspective, the Unified Health System (SUS) provides tools for Combined Prevention to the entire Brazilian population, universally and free of charge. However, despite therapeutic advances, HIV/AIDS remains a significant public health problem. Objective: To analyze the impact of Combined Prevention measures on the incidence of HIV/AIDS in Brazil from 1980 to 2020. Methods: Quantitative, observational, longitudinal, and retrospective study. Descriptive and multivariate analyses were conducted, specifically employing linear regression techniques. The variables of interest included case incidence and the distribution of: tests for sexually transmitted infections (STIs), condoms, post-exposure prophylaxis for HIV (PEP), and pre-exposure prophylaxis for HIV (PrEP). Publicly available data were sourced from governmental repositories. Results: The country has accumulated 1,037,878 infection cases, with an average of 25,947 new cases per year. Regarding prophylaxis inputs, five out of six variables demonstrated a negative correlation with the incidence rate, with only the distribution of male condoms showing a positive correlation. The analysis of the effect of PrEP was not statistically significant. Conclusion: Brazil has reduced the incidence of the disease as Combined Prevention measures have advanced. More time is needed to assess the impact of PrEP on the incidence of new cases.

Description of a specialized outpatient clinic as a reference center for children and adolescents living with HIV/AIDS in southern Brazil

Emanuela da Rocha Carvalho — 2023-11-14

Introduction: Children living with HIV/AIDS require specialized care. Objective: To describe clinical and epidemiological characteristics of patients living with HIV/AIDS. Methods: Observational, descriptive study using medical records data of patients with HIV/AIDS under 14 years of age. Approved by the institution's Ethics Committee under number 1,432,517. Results: 60 cases were included; the median follow-up duration was 6.8 years; 50.0% were male; 88.3% were white; 75.0% were from the capital and metropolitan region. Prenatal records were available for 51 cases, but only 44.6% received antiretroviral therapy (ART) during pregnancy (mean duration of 3.3 months). HIV diagnosis was based on clinical symptoms in 28.3% of the cases, occurring in similar proportions for both childhood common infections and opportunistic infections. According to the CDC clinical classification (1994), at the start of follow-up, 56.6% of patients had moderate or severe symptoms, which would be reduced to only 18.3% upon reclassification at the last visit (p=0.016). Initially, 41.7% showed evidence of immunosuppression, compared to 19.9% at the time of the study (p=0.5). Only 6.6% remained asymptomatic. A decrease in the average number of hospitalizations was observed during follow-up. Conclusion: Among the cases diagnosed based on clinical symptoms, half were attributed to common childhood infections and lacked immunosuppression.

Prevalence of vaginal infection by candida subtypes in women with HIV compared to the control group and influence of immune status

Somaia Reda — 2023-12-01

Introduction: Vulvovaginal candidiasis (VVC), caused by Candida sp, may present with increased frequency and symptoms in immunocompromised patients, and there is concern about the diagnosis and adequate treatment of these patients. Objective: The aim of this study was to evaluate the prevalence of VVC compared to the immune status and species present in the microbiota of patients with HIV. Methods: This cross-sectional study was conducted from January 2017 to January 2018, including 97 women with HIV compared to a control group (n=112). For data collection, interviews were conducted, vaginal pH was measured, CD4+ T cells and viral load (VL) were evaluated, and vaginal secretions were collected for microscopy and culture. Results: The prevalence of VVC was 41.2% in seropositive patients and 3.6% in the control group (p<0.001). Of the patients with CD4+<200 T, 54.3% had Candida sp, while in those with CD4+ T ³200 cells/mm³, the prevalence was 33.9% (p=0.057). Regarding viral load, the prevalence of VVC was 24.1% in those with undetectable VL or <20, 50% in those with VL between 20 and 9999, and 46.9% in VL above 10000 copies/mL (p=0.08). The most prevalent species were Candida albicans, followed by C. parapsilosis, C. krusei, and C. glabrata. The mean vaginal pH was 4.6 in the control group and 5.2 in the case group. Conclusion: HIV-positive women have a higher prevalence of candida. Lower T CD4+ values and increased VL seem to be associated with a higher prevalence of infection.

A new proposal in the approach of vulvovaginitis

Adriana Bittencourt Campaner — 2023-03-23

The authors report on a recently published review article on the approach to vulvovaginitis through flowcharts, 
taking into account the peculiarities of each service, according to the diagnostic methods that are available.

The responsibility and importance of clinical registration: a case of congenital syphilis in Early Holocene as an example

Rodrigo Elias Oliveira — 2023-03-17

Letter to the editor

HIV-1 infection among trans women in the Amazon: an unknown scenario

Thaís Mayara da Silva Carvalho — 2023-09-11

Estimado editor

Las mujeres transgénero son las cinco poblaciones más vulnerables para adquirir el Virus de Inmunodeficiencia Humana (VIH). Cerca del 2% de la población adulta brasileña está compuesta por personas transgénero y no binarias, es decir, personas que se identifican con un género diferente al que les fue asignado al nacer o que no se perciben como pertenecientes exclusivamente al femenino o al masculino género1. En Brasil, existen pocos estudios sobre la epidemiología de la infección por VIH en mujeres transgénero, la mayoría de los cuales fueron realizados en las regiones Sudeste y Sur y demostraron una alta prevalencia de infección, así como un alto nivel de discriminación social, lo que interfiere directamente buscar servicios de salud pública2. La discriminación por razón de género juega un papel fundamental en la reducción de la accesibilidad de las mujeres transgénero a las consultas médicas y a los servicios de pruebas del VIH, lo que sin duda dificulta el acceso de estas personas a los servicios públicos de salud. Estos datos apuntan a la urgente necesidad de políticas públicas no discriminatorias, basadas en la defensa y promoción de los derechos humanos, que puedan favorecer la accesibilidad de las mujeres transgénero a los servicios de salud en Brasil.
En Brasil, desde 2004, se celebra anualmente, el 29 de enero, el orgullo, la existencia, la conciencia y la resistencia de la comunidad trans y travesti, dentro del movimiento LGBTQIA+. Con una Política Nacional de Salud Integral LGBTQIA+ instituida casi una década después de 2011, Brasil ha sido el país más violento durante 14 años seguidos con un récord de 133 personas trans asesinadas solo en 2022. Brasil sabe poco sobre quiénes y dónde están estas personas, porque la metodología aplicada en la recolección de datos del censo demográfico, realizado cada 10 años, no incluye preguntas sobre identidad de género, lo que provoca la exclusión de las personas transgénero en el perfil de habitantes de nuestro territorio3.
Sobre este tema, aún con el notorio avance brasileño en la incorporación de tecnologías de salud para la prevención combinada, descentralización del diagnóstico, tratamiento y seguimiento de las personas que viven con el VIH, se observó que sólo el 6% de los usuarios de Profilaxis Post-Exposición (PEP) identificado como transgénero. De las casi 50.000 personas que usan profilaxis previa a la exposición (PrEP) en el país, el 4,8 % se identifican como personas trans o no binarias, lo que demuestra que la discriminación por motivos de género juega un papel fundamental en la reducción de la accesibilidad del público transgénero a las citas médicas y el VIH servicios de pruebas.4 Estos datos apuntan a la urgente necesidad de políticas públicas no discriminatorias, basadas en la defensa y promoción de los derechos humanos, que puedan favorecer la accesibilidad de las mujeres transgénero a los servicios de salud en Brasil5.
En la Amazonía brasileña, que está compuesta por siete estados y tiene la mayor extensión territorial del país, no existe información oficial sobre la prevalencia de infección, no solo de VIH sino de otras ITS, en la población de mujeres transgénero. Como resultado, nuestro grupo de investigación llama la atención de las autoridades brasileñas sobre la necesidad de convocatorias públicas de investigación para llenar el vacío en relación con el conocimiento de la epidemiología del VIH en mujeres transgénero, con el fin de subsidiar políticas públicas para enfrentar la epidemia en la región.

Per-Anders Mardh, we thank you for your generosity and your existence

Mauro Romero Leal Passos — 2023-01-31

Letter from The Editors

A sad portrait of congenital syphilis in the State of Rio de Janeiro. Case report with Polymerase Chain Reaction (PCR) of scrapings from skin lesions and placenta fragment positive for Treponema pallidum

Felipe Dinau Leal Passos — 2023-07-31

Introduction: Congenital syphilis is a serious public health problem that causes high rates of intrauterine morbidity and mortality, revealing flaws and weaknesses in the health system. Objective: to report a case of congenital syphilis in a university hospital in the Center-South Region of the State of Rio de Janeiro, Brazil. Case report: A pregnant woman, aged between 19 and 23 years old, carrying a Pregnant Woman's Handbook with a record of seven prenatal consultations and a note of the serological reaction for positive syphilis, but without any treatment, hospitalized at the University Hospital of Vassouras (RJ), in labor, gave birth to a newborn (NB) with a clinical picture and serological test of congenital syphilis. The NB required care in an intensive care unit and was discharged 28 days after birth. Scraping of skin lesions of the NB and placenta was performed for analysis by molecular biology (PCR in house) and genetic material of Treponema pallidum was detected. Conclusion: Congenital syphilis is a serious outcome of syphilis during pregnancy, consuming high financial resources and significant emotional distress for the mother, father, the whole family, as well as for the health teams. Our case report was the first that we are aware of in Brazil with a diagnosis by PCR for positive Treponema pallidum of skin scraping and placental fragment. It also showed poor quality prenatal care, a common factor in most cases of CS in our reality.

Mpox transmitted through sexual intercourse: three case reports

Wilma Nancy Campos Arze — 2023-08-29

Introduction: In 2022, many countries, such as Brazil, experienced outbreaks of mpox (formerly called monkeypox) in sexually active people with multiple sexual partners. Objective: Report cases of patients diagnosed with Mpox. Methods: Report three cases of patients diagnosed with Mpox treated at the STD Sector at Universidade Federal Fluminense. Results: We report three cases of young adult patients who spontaneously sought our STD service with wounds in the anogenital area, mouth and other parts of the body. These cases include a 28-year-old man (HIV positive) who had lesions on his penis and body, a 34-year-old man with perianal ulcers and adenopathy, and a 40-year-old man with painful ulcers on his penis. Conclusion: The article provides information on the symptoms, transmission, and prevention of mpox, highlighting the need for early detection, diagnosis, and prompt treatment to contain and prevent the spread of the disease. The cases presented in this study show all the characteristics of a sexually transmitted disease.

Use of cerebrospinal fluid CXCL13 concentration for diagnosis and monitoring of neurosyphilis: a three-case report

Ricardo de Souza Carvalho — 2023-11-27

Introduction: Previous retrospective studies have demonstrated that the concentration of chemokine ligand CXCL13 in cerebrospinal fluid (CSF-CXCL13) is a promising biomarker in the diagnosis of neurosyphilis and, additionally, in the monitoring of therapeutic efficacy. Objective: To describe three cases of patients with neurosyphilis (NS) treated at Hospital Universitário Gaffrée e Guinle, in Rio de Janeiro, Brazil, with suspected active syphilis with neurological symptoms. Case report: Three patients from Rio de Janeiro, Brazil, were investigated for symptomatic NS. The concentration of CSF-CXCL13 was prospectively performed by enzyme-linked immunosorbent assay (ELISA) in all participants at baseline and in follow-up visits at 3 months after therapy. CSF-CXCL13 concentrations were significantly higher in all three patients with established NS. The CSF-CXCL13 concentrations decreased after 3 months of therapy compared to baseline in all cases reported. The added high concentration of CSF-CXCL13 plus CSF-TPHA reactivity above 1:40 titer agreed with the diagnosis of NS in 100% of the cases. Conclusion: In this case series, we present three cases of NS diagnosed using CXCL13 in CSF as a complementary test. These case series suggest that the clinical use of CSF-CXCL13 is useful as a supplementary biomarker for NS and for monitoring the effectiveness of NS therapy, especially in patients with nonreactive CSF-VDRL, excluding other neurologic diseases.

Clinical manifestations of syphilis in the oral cavity — a review

Ana Beatriz Villar Medeiros — 2023-03-22

Introduction: Syphilis is a sexually transmitted infection caused by Treponema pallidum bacterium, which impact on a significant increase in contagions reported worldwide, bringing up the need of urgent actions to ensure the control, treatment, and diagnosis of the disease. Objective: Given this context, this work presents a bibliographical review on syphilis, aiming to describe the most common oral manifestations that occur on the four stages of this infection. Methods: For the literature review, the searches were carried out in the PubMed, Science Direct, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature and databases of Virtual Health Library. Results: Regarding the primary syphilis, the main clinical manifestations in the oral cavity include chancres in the palate, buccal mucosa, tongue, and lips. In the secondary stage, the presence of diffuse and nonspecific oral lesions was identified. In tertiary syphilis, stomatitis and glossitis are present, being the hard palate and the tongue the main affected regions. In congenital syphilis, the patients are affected with dental and jaw malformations. Conclusion: The clinical manifestations of syphilis in the oral cavity can appear at any stage of the infection, being the oral cavity the second most affected region by this sexually transmitted infection. Therefore, the knowledge regarding this subject is extremely important for health professionals, as well as for the population, being essential to carry out the correct diagnosis and adequate treatment for the rapid cure of this infection.

Prevalence and factors associated with bacterial vaginosis in women in Brazil: a systematic review

Kélvia Cristina de Camargo — 2023-01-31

Introduction: Bacterial vaginosis is characterized by the imbalance of the vaginal flora, with decrease in Lactobacillus and increase in other bacteria. Objective: To investigate the prevalence and factors associated with bacterial vaginosis. Methods: Systematic review based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, filed in the International Prospective Register of Systematic Reviews. The research was conducted in the PubMed and Scopus databases in September 2021. After reading the titles and abstracts of 84 articles and the full text of 20 articles, 10 of them were included in the review. The articles were considered eligible if they investigated the prevalence of bacterial vaginosis and used Amsel's diagnostic criteria or Gram-stained bacterioscopy in women of reproductive age without comorbidities. The studies were evaluated by two investigators to establish reliability. The risk of bias and the quality of the selected studies were evaluated using the Joanna Briggs Institute tool. Results: The mean prevalence of bacterial vaginosis in the included studies was 25.4% (95%CI 24.0–26.8). In three population-based studies, the mean prevalence was 18.1% (95%CI 16.0–20.5); and in seven clinic-based studies, it was 27.2% (95%CI 24.6–29.9). The factors associated with bacterial vaginosis were the use of sex accessories (OR 2.4; 95%CI 1.1–4.9), marital status “single” (OR 1.4; 95%CI 1.1–1.8), partner infidelity (OR 1.5; 95%CI 1.2–1.9), abnormal vaginal secretion (OR 1.5; 95%CI 1.2–2.0), and the presence of trichomoniasis (OR 4.1; 95%CI 1.5–11.5). Conclusion: The prevalence of bacterial vaginosis was high, and the associated factors are linked to sexual behavior.

Serological ineptitude in blood banks: is there an association with sexually transmitted infections?

Julia Sampaio de Souza Morais — 2023-10-11

Introduction: Sexually transmitted infections (STIs) are a serious public health problem and some of
these infections are also transmitted through blood transfusions. Objective: To identify publications in
scientific journals in Brazil and in the world, if there is an important association between serological
inadequacy due to sexually transmitted infections traced in blood and blood products used for medical
use. Methods: Systematic review of articles published from 2018 to 2023, using the LILACS, SciELO and

PUBMED databases with a concomitant approach to the issues of serological disability and STI. Original
studies or review articles in Portuguese, English and Spanish with Brazilian and international data were
included. Editorial publications, letter to the editor, letter from the editor or comments on the subject
were excluded. Results: The search found 571 articles, of which 106 (18.40%) met the inclusion criteria,
that is, Serological disability and STI. In studies with international data, the prevalence of donors with
hepatitis C ranged from 0.12% to 4.8%; with hepatitis B from 1.3% to 8.2%; with HIV from 0.0021% to
2.5%; with syphilis from 1.73% to 2.4%; with HTLV 0.66% and with Chagas disease from 0.017% to
2.76%. Among articles with Brazilian data, the prevalence of donors with seroreactive tests for hepatitis
C ranged from 0.18% to 1.76%; with hepatitis B from 0.05% to 7.9%; with HIV from 0.03% to 0.82%; with
syphilis from 0.37% to 3.51%; with HTLV 0.02% to 0.3% and with Chagas disease from 0.8% to
0.5%. Conclusion: STIs are rarely discussed in the scientific literature in studies on serological
inadequacy. In addition, a minority of articles were with Brazilian data. However, results show that STIs,
despite being little discussed in the scientific literature in studies on the subject of serological
inadequacy, have statistically significant percentages of seropositivity for STIs. In addition, hepatitis C
and B have a relevant seroprevalence, reaching 8.2% and 4.8%, respectively, in the international
scenario. In the national, Brazilian scenario, hepatitis B continues to occupy a prominent place with a
seroprevalence of up to 7.9%. However, syphilis now occupies a very important role with a maximum
percentage of 3.51%. More studies are needed for more reflection: although STIs are little addressed in
studies about serological inadequacy in human blood banks, would they be contributors to the
maintenance and non-reduction of the general frequency of infections transmitted by blood
transfusion?

Chatbot, ChatGPT: artificial intelligence and/or business intelligence and/or robotic untruths, for now

Mauro Romero Leal Passos — 2023-03-18

The authors, like most humans on the planet at all times, go through many profound transformations throughout their lives.

Let's imagine hominids starting to master fire more than a million years ago. Inventing the wheel, writing, navigating the seas, inventing the light bulb, motor vehicles, Santos Dumont's plane, telex, teleradiography, and so many other things that for each era, it was unimaginable such an advance would be incorporated into daily of human life.

Today, in 2023, we are facing a computerized conversation through the world wide web, the internet. For now, called artificial intelligence – AI, chatbot.

How much will this technology add benefits in the health area?

When will this technology spread untruths?

How much will people blindly follow the information and experience huge gains and marked problems, side effects?

In these dialogues with the various chatbots already being made available, free or with payment of monthly fees, can these computer programs, after several human-AI arguments, write that, for the situations presented in a given conversation, suicide is plausible conduct?

The concerns of the authors are concerns that are valid in March 2023.

The editorial tests conversations. And time will show us how to learn, teach, live together, and transform this artificial intelligence.

Chlamydia trachomatis Female Genital Tract Infections: Memorium to Professor Per-Anders Mardh

Steven Sol Witkin — 2023-01-31

Editorial