RESUMEN
BACKGROUND: Syphilis incidence has exponentially increased in recent decades, particularly among men who have sex with men (MSM). Primary syphilis is characterised by a chancre appearing at the site of Treponema pallidum (TP) inoculation. Atypical morphological variants of syphilitic chancre are frequent. Clinical suspicion must be confirmed either by the demonstration of TP within the lesion through direct tests, such as dark field microscopy (DFM) or T. pallidum nucleic acid amplification technique (TP-NAAT), or by serological tests. OBJECTIVES: To analyse the clinical features, the sexual behaviour and the role of diagnostic tests in a cohort of men with primary syphilis in Milan. METHODS: Epidemiological, clinical and laboratory data of male patients with primary syphilis seen at the STI Center of the University of Milan between 2015 and 2019 were retrospectively evaluated. Diagnosis was confirmed by at least one positive diagnostic test of either DFM, TP-NAAT or serology. RESULTS: Among a total of 244 patients, 160 (65.6%) were MSM and 32 (13.1%) were living with HIV. One hundred twenty-four (50.8%) patients had a clinically atypical chancre. Chancres were exclusively extragenital in 30 (12.3%) patients, with MSM being more commonly affected (MSM vs heterosexuals: 16.3% vs 4.8%, respectively; p=0.012), and anal region the most frequently involved site. Chancres were multiple in 68/242 (28.1%) patients and morphologically atypical in 76/244 (31.1%). Diagnosis was obtained by (1) both serology and direct methods in 158/244 patients (64.7%), (2) serology solely in 47/244 (19.3%) and (3) direct methods solely in 39/244 (16%). DFM yielded positive results in 83/139 (59.7%) patients, while TP-NAAT gave positive results in 114/121 (94.2%) patients. CONCLUSIONS: Patients with primary syphilis frequently present with morphologically atypical chancres. Furthermore, MSM commonly exhibit extragenital involvement. A combined diagnostic approach including both direct and indirect tests is needed.
Asunto(s)
Técnicas de Laboratorio Clínico , Sífilis/diagnóstico , Sífilis/epidemiología , Treponema pallidum/inmunología , Adulto , Infecciones por VIH/epidemiología , Infecciones por VIH/microbiología , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Pruebas Serológicas , Conducta Sexual , Sífilis/microbiología , Sífilis/patología , Treponema pallidum/genéticaRESUMEN
The authors describe an atypical case of primary syphilis of the neck. The unusual clinical presentation and localization led to an initial diagnostic mistake. This case confirms the polymorphic character of syphilis. Considering the increased incidence of sexually transmitted infections worldwide, a high index of suspicion should be maintained by physicians.
Asunto(s)
Enfermedades de Transmisión Sexual , Humanos , Incidencia , SífilisRESUMEN
Hepatitis E virus (HEV) is a feco-orally transmitted pathogen and one of the most common cause of acute hepatitis worldwide. Recent studies in developed countries suggested that a direct human-to-human contact such as for sexually transmitted diseases may play a significant role in the HEV spread. The aim of this study was to investigate the seroprevalence of HEV and HAV in a group of MSM, including subjects HIV, and Treponema infected, in Milan, Italy. The overall anti HEV IgG seroprevalence in MSM was 10.2% (65/636), instead in the control group the detection rate was 5.2% (15/288) (P < 0.05); the anti HAV seroprevalence was 42.8% in MSM, when in the control group the positivity rate was 29.2% (P < 0.05). The rate of coinfection HEV/HAV was 14.6% in MSM and 1% in control group (P < 0.05). In the future, sexual history, HIV status, and STI risk might address specific investigations to prevent spread of pathogens such HEV in MSM, before becoming a substantial public health problem like for HAV outbreaks.
Asunto(s)
Hepatitis A/epidemiología , Anticuerpos Antihepatitis/sangre , Hepatitis E/epidemiología , Homosexualidad Masculina , Adulto , Anciano , Anciano de 80 o más Años , Coinfección/epidemiología , Infecciones por VIH/complicaciones , Humanos , Inmunoglobulina G/sangre , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Seroepidemiológicos , Sífilis/complicaciones , Adulto JovenRESUMEN
BACKGROUND: Although syphilis rates have been relatively high in Italy for more than 15 years, no data on the molecular types of Treponema pallidum subspecies pallidum circulating in this country are yet available. Likewise, no data on how widespread is resistance to macrolide or tetracycline antibiotics in these strains exist. Such data would, however, promote comprehensive studies on the molecular epidemiology of syphilis infections in Italy and inform future interventions aiming at syphilis control in this and other European countries. GOALS AND STUDY DESIGN: Swabs from oral, genital, cutaneous, or anal lesions were obtained from 60 syphilis patients attending dermatology clinics in Milan, Turin, Genoa, and Bologna. Molecular typing of T. pallidum DNA was performed to provide a snapshot of the genetic diversity of strains circulating in Northern Italy. Samples were also screened for mutations conferring resistance to macrolides and tetracyclines. RESULTS: T. pallidum DNA was detected in 88.3% (53/60) of the specimens analyzed. Complete and partial T. pallidum typing data were obtained for 77.3% (41/53) and 15.0% (8/53) of samples, respectively, whereas 4 samples could not be typed despite T. pallidum DNA being detected. The highest strain type heterogeneity was seen in samples from Bologna and Milan, followed by Genoa. Minimal diversity was detected in samples from Turin, despite the highest number of typeable samples collected there. Resistance to macrolides was detected in 94.3% (50/53) of the strains, but no known mutations associated with tetracycline resistance were found. CONCLUSIONS: Genetic diversity among T. pallidum strains circulating in Northern Italy varies significantly among geographical areas regardless of physical distance. Resistance to macrolides is widespread.
Asunto(s)
Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , Farmacorresistencia Bacteriana Múltiple/genética , Macrólidos/uso terapéutico , Sífilis/epidemiología , Treponema pallidum/clasificación , Adolescente , Adulto , Anciano , Canal Anal/microbiología , Canal Anal/patología , ADN Bacteriano/genética , Femenino , Genotipo , Hospitales/estadística & datos numéricos , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Tipificación Molecular , Mutación Puntual , Piel/microbiología , Piel/patología , Sífilis/tratamiento farmacológico , Sífilis/microbiología , Treponema pallidum/aislamiento & purificación , Adulto JovenRESUMEN
PURPOSE: To evaluate the oncological and functional outcomes of patients diagnosed with penile cancer undergoing conservative treatment through thulium-yttrium-aluminium-garnet (Tm:YAG) laser ablation. METHODS: Twenty-six patients with a penile lesion underwent ablation with a RevoLix 200 W continuous-wave laser. The procedure was carried out with a pen-like laser hand piece, using a 360 µm laser fiber and 15-20 W of power. Median (IQR) follow-up time was 24 (15-30) months. Recurrence rate and post-operative sexual function were assessed. RESULTS: Median age at surgery was 61 years. Median (inter quartile range) size of the lesions was 15 [10-20] mm. Overall, 11 (47.8%) and 12 (52.2%) at the final pathology presented in situ and invasive squamous cell carcinoma (SCC), respectively. The final pathological stage was pTis, pT1a, pT2, and pT3 in 11 (47.8%), 7 (30.4%), 3 (13.0%), and 2 (8.7%) patients, respectively. Moreover, four (17.4%) patients had a recurrence of which three (13.0%) and one (4.3%) patients developed an invasive or in situ recurrence, respectively. After treatment 6 (26.1%) patients reported a conserved penile sensitivity, while 13 (56.5%) and 4 (17.4%) patients experienced a better or worse sensitivity after ablation, respectively. Post-treatment sexual activity was achieved within the first month after laser ablation in 82.6% of the patients. CONCLUSION: Early stage penile carcinomas can be effectively treated with an organ preservation strategy. Tm:YAG conservative laser treatment is easy, safe and offers good functional outcome, with a minor impact on patient's quality of life.
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Carcinoma in Situ/cirugía , Carcinoma de Células Escamosas/cirugía , Terapia por Láser/métodos , Neoplasias del Pene/cirugía , Anciano , Aluminio , Carcinoma in Situ/patología , Carcinoma de Células Escamosas/patología , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Erección Peniana , Neoplasias del Pene/patología , Calidad de Vida , Salud Sexual , Tulio , Resultado del Tratamiento , ItrioAsunto(s)
Melanoma , Enfermedades de la Piel , Neoplasias Cutáneas , Proliferación Celular , Dermoscopía , HumanosAsunto(s)
Gammopatía Monoclonal de Relevancia Indeterminada/diagnóstico , Mieloma Múltiple/complicaciones , Enfermedades de la Piel/patología , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Células de la Médula Ósea/patología , Femenino , Humanos , Inmunoglobulina G/análisis , Mieloma Múltiple/diagnóstico por imagen , Mieloma Múltiple/tratamiento farmacológico , Xantogranuloma Necrobiótico/diagnóstico , Xantogranuloma Necrobiótico/etiología , Paraproteinemias , Células Plasmáticas/patología , Tomografía Computarizada por Rayos X/métodosAsunto(s)
COVID-19 , Enfermedades de Transmisión Sexual/epidemiología , Infecciones por Chlamydia/epidemiología , Condiloma Acuminado/epidemiología , Gonorrea/epidemiología , Infecciones por VIH/epidemiología , Herpes Genital/epidemiología , Humanos , Italia/epidemiología , Infecciones por Mycoplasma/epidemiología , Mycoplasma genitalium , SARS-CoV-2 , Sífilis/epidemiologíaRESUMEN
BACKGROUND: The sexually transmitted infection gonorrhea remains a public health concern for becoming resistant to drug treatments available. The purpose of this study was to evaluate the usefulness of the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) to identify and cluster Neisseria gonorrhoeae. From a current monitoring in Italy, as part of the European Gonococcal Antimicrobial Surveillance Programme (EURO-GASP), 93 gonococci collected from 2007 to 2012 susceptible (44 isolates) and resistant (49 isolates) to cefixime were selected. Minimum Inhibitory Concentration (MIC) values for cefixime was assessed by Etest carried out in agreement with the manufacturer's instructions and interpreted referring to European Committee on Antimicrobial Susceptibility testing (EUCAST) clinical breakpoints criteria. Data obtained by N. gonorrhoeae multiantigen sequence typing (NG-MAST) and the dendrogram based on the concatenation of porB and tbpB genes were evaluated. MALDI-TOF MS, to reconfirm gonorrhea identification, analyzed single colonies from freshly grown isolates and applied directly on a ground-steel MALDI target plate. For the MALDI-TOF dendrogram cluster analysis, MSPs (Main Spectrum Profile) from each isolate were created acquiring 5000 shots from 10 technical replicates obtained from bacteria extraction. RESULTS: Molecular typing by NG-MAST showed 28 sequence types (STs); G1407 was the predominant accounting for 75 gonococci. All the 93 gonococci, except one, were correctly identified at species level by MALDI-TOF MS and G1407 isolates were divided into two clusters. CONCLUSION: MALDI-TOF MS for a real-time detection and cluster analysis of gonorrhea is a promising tool for surveillance purposes. Moreover, additional studies are required to collect more data on the performance of MALDI-TOF MS for gonococci.
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Técnicas Bacteriológicas/métodos , Neisseria gonorrhoeae/clasificación , Neisseria gonorrhoeae/aislamiento & purificación , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/métodos , Antibacterianos/farmacología , Cefixima/farmacología , Análisis por Conglomerados , Genotipo , Humanos , Italia , Pruebas de Sensibilidad Microbiana , Tipificación de Secuencias Multilocus , Neisseria gonorrhoeae/química , Neisseria gonorrhoeae/efectos de los fármacos , FenotipoRESUMEN
Buschke-Löwenstein tumor, or giant condyloma acuminatum, represents a rare, sexually transmitted disorder, with a slow evolution and the tendency to infiltrate in the adjacent tissues associated with human papillomavirus (HPV). This article reports the first case of male Buschke-Löwenstein tumor associated with HPV6 and HPV52.
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Tumor de Buschke-Lowenstein/patología , Condiloma Acuminado/patología , Papillomaviridae/genética , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Adulto , Tumor de Buschke-Lowenstein/cirugía , Condiloma Acuminado/cirugía , Papillomavirus Humano 6/genética , Humanos , Masculino , Papillomaviridae/patogenicidad , Neoplasias del Pene/patología , Neoplasias del Pene/cirugía , Resultado del TratamientoAsunto(s)
Varicela , Dengue , Exantema , Betacoronavirus , COVID-19 , Infecciones por Coronavirus , Humanos , Pandemias , Neumonía Viral , SARS-CoV-2Asunto(s)
Infecciones por Coronavirus/patología , Eritema/patología , Neumonía Viral/patología , Piel/patología , Anciano de 80 o más Años , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/complicaciones , Eritema/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , SARS-CoV-2RESUMEN
The emergence of Neisseria gonorrhoeae isolates displaying resistance to antimicrobial agents is a major public health concern and a serious issue related to the occurrence of further untreatable gonorrhea infections. A retrospective analysis on 1,430 N. gonorrhoeae isolates, collected from 2003 through 2012, for antimicrobial susceptibility by Etest and molecular characterization by Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) was carried out in Italy. Azithromycin-resistant gonococci decreased from 14% in 2007 to 2.2% in 2012. Similarly, isolates with high MICs to cefixime (>0.125 mg/liter) decreased from 11% in 2008 to 3.3% in 2012. The ciprofloxacin resistance rate remains quite stable, following an increasing trend up to 64% in 2012. The percentage of penicillinase-producing N. gonorrhoeae (PPNG) significantly declined from 77% in 2003 to 7% in 2012. A total of 81 multidrug-resistant (MDR) gonococci were identified, showing 11 different antimicrobial resistance patterns. These were isolated from men who have sex with men (MSM) and from heterosexual patients. Two sequence types (STs), ST661 and ST1407, were the most common. Genogroup 1407, which included cefixime-, ciprofloxacin-, and azithromycin-resistant isolates, was found. In conclusion, a change in the antimicrobial resistance profiles among gonococci was identified in Italy together with a percentage of MDR isolates.
Asunto(s)
Antibacterianos/farmacología , Neisseria gonorrhoeae/efectos de los fármacos , Azitromicina/farmacología , Cefixima/farmacología , Ciprofloxacina/farmacología , Humanos , Italia , Masculino , Neisseria gonorrhoeae/enzimología , Penicilinasa/metabolismo , Penicilinas/farmacología , Estudios Retrospectivos , Tetraciclina/farmacologíaRESUMEN
This position statement is aimed at front-line clinical practitioners and public health authorities in WHO European Region providing services for people wishing to reduce their risk of acquiring sexually transmitted infections (STIs), including HIV.