Aetiological molecular identification of sexually transmitted infections that cause urethral discharge syndrome and genital ulcer disease in Brazilian men: a nationwide study.

BACKGROUND: Little is known about the aetiology of urethral discharge syndrome (UDS) and genital ulcer disease (GUD) in Brazil due to limited access to laboratory tests and treatment based mainly on the syndromic approach. OBJECTIVES: To update Brazilian treatment guidelines according to the current scenario, the first nationwide aetiological study for UDS and GUD was performed. METHODS: Male participants with urethral discharge (UD) and/or genital ulcer (GU) reports were enrolled. Sample collection was performed by 12 sentinel sites located in the five Brazilian regions. Between 2018 and 2020, 1141 UD and 208 GU samples were collected in a Universal Transport Medium-RT (Copan). A multiplex quantitative PCR kit (Seegene) was used to detect UD: Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), M. hominis (MH), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Ureaplasma parvum (UP), U. urealyticum (UU) and another kit to detect GU: cytomegalovirus (CMV), Haemophilus ducreyi (HD), herpes simplex virus type 1 (HSV1), herpes simplex virus type 2 (HSV2), lymphogranuloma venereum (LGV), Treponema pallidum (TP) and varicella-zoster virus (VZV). RESULTS: In UD samples, the frequency of pathogen detection was NG: 78.38%, CT: 25.6%, MG: 8.3%, UU: 10.4%, UP: 3.5%, MH: 3.5% and TV: 0.9%. Coinfection was assessed in 30.9% of samples, with 14.3% of NG/CT coinfection. The most frequent pathogen identified in GU was HSV2, present in 40.8% of the samples, followed by TP at 24.8%, LGV and CMV at 1%, and HSV1 at 0.4%. Coinfection of TP/HSV2 was detected in 4.4% of samples. VZV and HD were not detected. In 27.7% of the GU samples, no pathogen was detected. CONCLUSION: This study provided the acquisition of unprecedented data on the aetiology of UDS and GUD in Brazil, demonstrated the presence of a variety of pathogens in both sample types and reaffirmed the aetiologies known to be most prevalent globally.

Clinical and epidemiological features of mpox in a Brazilian reference center for HIV and sexually transmitted infections: A cross-sectional study.

Background: The 2022 mpox outbreak has affected disproportionately people living with HIV (PLWH) and pre-exposure prophylaxis (PrEP) users. Methods: We conducted a cross-sectional study to evaluate factors associated with laboratory diagnosis of mpox among suspected cases, and access differences between PrEP users and PLWH with confirmed diagnostic. Results: 394 mpox suspected cases were analyzed, 309 (78.4%) confirmed. Most patients with mpox were PLWH (54.4%) and 99 (32%) PrEP users. Mpox cases were likely to be between 25 and 39 years old (aOR=2.8; p=0.042), men who have sex with men/bisexual or transgender women (aOR=17.2; p< 0.001) and to have fever (aOR=4.7; p< 0.001), adenomegaly (aOR=7.2; p< 0.001) and multiple vesicular lesions (aOR=4.2; p< 0.001). Comparing PrEP users to PLWH with confirmed mpox, PrEP users had lesions predominantly with exclusive genital involvement (p=0.016); while PLWH had higher extragenital involvement (p=0.018). Conclusions: PrEP users and PLWHA were the main epidemiological groups in our cohort. Recognizing the differences between vulnerable populations can contribute to the development public policies to control mpox in settings with reduced access to vaccines.

Anorectal gonorrhoea and chlamydia among transgender women in Brazil: prevalence and assessment of performance and cost of anorectal infection detection and management approaches.

OBJECTIVES: We aimed to determine the prevalence of anorectal Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) among transgender women in Brazil, and to assess the performance and costs of various approaches for the diagnosis and management of anorectal NG/CT. METHODS: TransOdara was a multicentric, cross-sectional STI prevalence study among 1317 transgender women conducted in five capital cities representing all Brazilian regions. Participants aged >18 years were recruited using respondent-driven sampling (RDS), completed an interviewer-led questionnaire, offered an optional physical examination and given choice between self-collected or provider-collected samples for NG/CT testing. Performance and cost indicators of predetermined management algorithms based on the WHO recommendations for anorectal symptoms were calculated. RESULTS: Screening uptake was high (94.3%) and the estimated prevalence of anorectal NG, CT and NG and/or CT was 9.1%, 8.9% and 15.2%, respectively. Most detected anorectal NG/CT infections were asymptomatic (NG: 87.6%, CT: 88.9%), with a limited number of participants reporting any anorectal symptoms (9.1%). Of those who permitted anal examination, few had clinical signs of infection (13.6%). Sensitivity of the tested algorithms ranged from 1.4% to 5.1% (highest for treatment based on the reported anorectal discharge or ulcer and receptive anal intercourse (RAI) in the past 6 months) and specificity from 98.0% to 99.3% (highest for treatment based on the reported anorectal discharge with clinical confirmation or report of RAI). The estimated cost-per-true case of anorectal NG/CT infection treated varied from lowest providing treatment for anorectal discharge syndrome based on the reported RAI ($2.70-4.28), with algorithms including clinical examinations decreasing cost-effectiveness. CONCLUSIONS: High prevalence of mostly asymptomatic anorectal NG and CT was observed among Brazilian transgender women. Multi-site NG/CT screening should be offered to transgender women. Where diagnostic testing capacity is limited, syndromic management for those presenting with anorectal symptoms is recommended.

ERRATUM: Severe monkeypox case associated with recent laboratory diagnosis of HIV: case report / ERRATA: Caso grave de monkeypox associado ao diagnóstico laboratorial recente de HIV: relato de caso

Introduction: Monkeypox is a zoonosis caused by the monkeypox virus. The first confirmed human case was in 1970, when the virus was isolated from a child in the Democratic Republic of the Congo. Since the beginning of May 2022, a large and unexpected outbreak has been documented globally, with the first cases initially described in the UK reaching around 70 countries today. The causes of this explosive increase in patients are not well understood, but exceed more than ten thousand10,000 infected by the third week of July 2022. Clinical and epidemiological presentations have been distinct from endemic cases and from small outbreaks previously described in non- endemic areas. Objective: The aim of this study was to describe the evolutionary and epidemiological, clinical characteristics of Monkeypox and human immunodeficiency virus co-infection in a patient treated at an STI/AIDS Reference Service in São Paulo, Brazil. Methods: information contained in this study was obtained through a review of the medical records, interviews with the patient, photographic record of the diagnostic methods, to which the patient was submitted and review of the literature. Results: A Brazilian man, with no epidemiological history of travel who was diagnosed with Monkeypox virus through polymerase chain reaction. At the same time of this diagnosis, he received a laboratory diagnosis of human immunodeficiency virus, Chlamydia Urethritis, and Late Latent Syphilis. Conclusion: To reduce the risk of the dissemination of Monkeypox, strategies at the public health level are necessary, with the dissemination of information and the development of prevention projects with targeted information and recommendations for vulnerable populations, especially men who have sex with men, with great prudence, seeking not to favor the development of stigmas as already experienced at the beginning of the human immunodeficiency virus epidemic.

Introdução: Monkeypox é uma zoonose causada pelo vírus monkeypox. O primeiro caso humano confirmado foi em 1970, quando o vírus foi isolado de uma criança na República Democrática do Congo. Desde o início de maio de 2022, um surto grande e inesperado tem sido documentado globalmente, com os primeiros casos inicialmente descritos no Reino Unido atingindo hoje cerca de 70 países. As causas desse aumento explosivo de pacientes não estão bem esclarecidas, mas ultrapassaram 10 mil infectados até a terceira semana de julho de 2022. As apresentações clínicas e epidemiológicas têm sido distintas dos casos endêmicos e dos pequenos surtos previamente descritos em áreas não endemicas. Objetivo: Neste relato descrevemos as características clínicas evolutivas e epidemiológicas da coinfecção do Monkeypox e do imunodeficiência humana em um paciente atendido em um serviço de referência em infecções sexualmente transmissíveis ­ IST/Aids de São Paulo, Brasil. Métodos: as informações dos métodos contidas neste estudo foram obtidas por meio de revisão dos prontuários, entrevistas com o paciente, prontuário fotográfico dos métodos diagnósticos, aos quais o paciente foi submetido e revisão da literatura. Resultados: Homem brasileiro, sem antecedente epidemiológico de viagem, foi diagnosticado com Monkeypox por meio de reação em cadeia da polimerase. Simultaneamente a esse diagnóstico, recebeu diagnóstico laboratorial de vírus da imunodeficiência humana, uretrite por clamídia e sífilis latente tardia. Conclusão: Para reduzir o risco de disseminação do Monkeypox, são necessárias estratégias no âmbito da saúde pública, com disseminação da informação e elaboração de projetos de prevenção com informações direcionadas e recomendações para populações vulneráveis, especialmente homens que fazem sexo com homens, com bastante prudência, buscando não favorecer o desenvolvimento de estigmas como os já vivenciados no início da epidemia de imunodeficiência humana.

Severe monkeypox case associated with recent laboratory diagnosis of HIV: case report / Caso grave de monkeypox associado ao diagnóstico laboratorial recente de HIV: relato de caso

Monkeypox is a zoonosis caused by the smallpox virus. The first confirmed human case was in 1970, when the virus was isolated from a child in the Democratic Republic of the Congo. Since the beginning of May 2022, a large and unexpected outbreak has been documented globally, with the first cases initially described in the UK reaching around 70 countries today. The causes of this explosive increase in patients are not well understood, but exceed more than ten thousand10,000 infected by the third week of July 2022. Clinical and epidemiological presentations have been distinct from endemic cases and from small outbreaks previously described in non- endemic areas. Objective: The aim of this study was to describe the evolutionary and epidemiological, clinical characteristics of Monkeypox and human immunodeficiency virus co-infection in a patient treated at an STI/AIDS Reference Service in São Paulo, Brazil. Methods: information contained in this study was obtained through a review of the medical records, interviews with the patient, photographic record of the diagnostic methods, to which the patient was submitted and review of the literature. Results: A Brazilian man, with no epidemiological history of travel who was diagnosed with Monkeypox virus through polymerase chain reaction. At the same time of this diagnosis, he received a laboratory diagnosis of human immunodeficiency virus, Chlamydia Urethritis, and Late Latent Syphilis. Conclusion: To reduce the risk of the dissemination of Monkeypox, strategies at the public health level are necessary, with the dissemination of information and the development of prevention projects with targeted information and recommendations for vulnerable populations, especially men who have sex with men, with great prudence, seeking not to favor the development of stigmas as already experienced at the beginning of the human immunodeficiency virus epidemic.

Monkeypox é uma zoonose causada pelo vírus varíola. O primeiro caso humano confirmado foi em 1970, quando o vírus foi isolado de uma criança na República Democrática do Congo. Desde o início de maio de 2022, um surto grande e inesperado tem sido documentado globalmente, com os primeiros casos inicialmente descritos no Reino Unido atingindo hoje cerca de 70 países. As causas desse aumento explosivo de pacientes não estão bem esclarecidas, mas ultrapassaram 10 mil infectados até a terceira semana de julho de 2022. As apresentações clínicas e epidemiológicas têm sido distintas dos casos endêmicos e dos pequenos surtos previamente descritos em áreas não endemicas. Objetivo: Neste relato descrevemos as características clínicas evolutivas e epidemiológicas da coinfecção do Monkeypox e do imunodeficiência humana em um paciente atendido em um serviço de referência em infecções sexualmente transmissíveis ­ IST/Aids de São Paulo, Brasil. Métodos: as informações dos métodos contidas neste estudo foram obtidas por meio de revisão dos prontuários, entrevistas com o paciente, prontuário fotográfico dos métodos diagnósticos, aos quais o paciente foi submetido e revisão da literatura. Resultados: Homem brasileiro, sem antecedente epidemiológico de viagem, foi diagnosticado com Monkeypox por meio de reação em cadeia da polimerase. Simultaneamente a esse diagnóstico, recebeu diagnóstico laboratorial de vírus da imunodeficiência humana, uretrite por clamídia e sífilis latente tardia. Conclusão: Para reduzir o risco de disseminação do Monkeypox, são necessárias estratégias no âmbito da saúde pública, com disseminação da informação e elaboração de projetos de prevenção com informações direcionadas e recomendações para populações vulneráveis, especialmente homens que fazem sexo com homens, com bastante prudência, buscando não favorecer o desenvolvimento de estigmas como os já vivenciados no início da epidemia de imunodeficiência humana

Syphilis in the state of São Paulo, Brazil, 2011‒2017. / Sífilis no estado de São Paulo, Brasil, 2011‒2017.

OBJECTIVE: To analyze how syphilis detection rates evolved from 2011 to 2017 according to sex, age and place of residence in the state of São Paulo. METHODS: A historical series was organized with data from the Notification Disease Information System. The acquired syphilis detection rates (ASDR) per 100,000 inhabitants and the acquired syphilis detection rates including pregnant women with syphilis (PASDR) per 100,000 inhabitants were described. For a trend analysis of the rates in the studied period, the Poisson Jointpoint (inflection point) model was performed, and the annual percentage change (APC) per segment and the average annual percentage change (AAPC) were estimated, with respective 95% confidence intervals (95%CI). RESULTS: A total of 205,424 cases of acquired syphilis and syphilis in pregnant women in the period were reported. The ASDR per 100,000 inhabitants ranged from 26.0 to 84.6 between 2011 and 2017 and the PASDR per 100,000 inhabitants ranged from 33.7 to 108.9; the trend was increasing in both, and an inflection point was identified dividing the ASDR and PASDR curve into two periods: 2011 to 2013 and 2013 to 2017: the AAPC found for ASDR was 21.0% (95%CI 15.5 ‒ 26.4) and the PASDR was 21.2% (95%CI 16.4 ‒ 26.1), in the age groups up to 24 years old, there was a significant growth in both sexes. A heterogeneity in the evolution of rates by region of the state was observed between 2011 and 2017. CONCLUSIONS: The increasing trend in acquired syphilis detection rates can be attributed to better adherence to notification and disproportionate involvement of young people.

OBJETIVO: Analisar a evolução, de 2011 a 2017, das taxas de detecção de sífilis notificada por sexo, faixa etária e região de residência no estado de São Paulo (ESP). MÉTODOS: Foi organizada série histórica com dados do Sistema de Informação de Agravos de Notificação (SINAN). Foram descritas as taxas de detecção de sífilis adquirida (TDSA) e de sífilis adquirida incluindo as gestantes com sífilis (TDSAG), por 100.000 hab. Para análise de tendência da evolução das taxas no período estudado, foi empregado o modelo Jointpoint (ponto de inflexão), bem como foram estimadas a variação percentual anual (VPA) por segmento e a média da variação percentual anual (MVPA), com os respectivos intervalos de confiança de 95% (IC95%). RESULTADOS: Foram notificados 205.424 casos de sífilis adquirida e sífilis em gestantes no período. Entre 2011 e 2017, a TDSA por 100 mil habitantes variou de 26,0 a 84,6 e a TDSAG por 100 mil habitantes, de 33,7 a 108,9; a tendência foi crescente em ambas as curvas e identificou-se um ponto de inflexão dividindo a curva de TDSA e de TDSAG em dois períodos: de 2011 a 2013 e de 2013 a 2017. A MVPA encontrada da TDSA foi de 21,0% (IC95% 15,7 ‒ 26,4) e da TDSAG, de 21,2% (IC95% 16,4 ‒ -26,1). Nas faixas etárias até 24 anos ocorreu crescimento expressivo em ambos os sexos. Observou-se heterogeneidade na evolução das taxas segundo região do Estado. CONCLUSÕES: A tendência crescente das taxas de detecção de sífilis adquirida pode ser atribuída a melhor adesão à notificação e ao acometimento desproporcional dos jovens.

Temporal evolution of antimicrobial resistance among Neisseria gonorrhoeae clinical isolates in the most populated South American Metropolitan Region.

A total of 124 Neisseria gonorrhoeae isolates recovered during a 12-year period (2003-2015) from outpatients assisted at Centro de Referência e Treinamento DST/AIDS-CRT of São Paulo city, Brazil, were analysed. The following resistance rates were observed: penicillin-59.6%, ciprofloxacin-15.3%, and azithromycin-6.7%. Although reduced susceptibility to these drugs was observed since 2003, no ceftriaxone-resistant isolates were detected. Ciprofloxacin- and azithromycin non-susceptible isolates were grouped in 11 clusters. Mutations were detected in GyrA and ParC of isolates 124 and 260, and a C2611T substitution on 23S rRNA alleles was also observed in isolate 260. Both isolates belonged to ST1901/ST6210 (MSLT/NG-MAST schemes).

Temporal evolution of antimicrobial resistance among Neisseria gonorrhoeae clinical isolates in the most populated South American Metropolitan Region

A total of 124 Neisseria gonorrhoeae isolates recovered during a 12-year period (2003-2015) from outpatients assisted at Centro de Referência e Treinamento DST/AIDS-CRT of São Paulo city, Brazil, were analysed. The following resistance rates were observed: penicillin-59.6%, ciprofloxacin-15.3%, and azithromycin-6.7%. Although reduced susceptibility to these drugs was observed since 2003, no ceftriaxone-resistant isolates were detected. Ciprofloxacin- and azithromycin non-susceptible isolates were grouped in 11 clusters. Mutations were detected in GyrA and ParC of isolates 124 and 260, and a C2611T substitution on 23S rRNA alleles was also observed in isolate 260. Both isolates belonged to ST1901/ST6210 (MSLT/NG-MAST schemes).

Factors associated with HIV co-infection in cases of acquired syphilis reported in a Reference Center for Sexually Transmitted Diseases and AIDS in the municipality of São Paulo, Brazil, 2014. / Fatores associados à coinfecção por HIV em casos de sífilis adquirida notificados em um Centro de Referência de Doenças Sexualmente Transmissíveis e Aids no município de São Paulo, 2014.

OBJECTIVE: to describe sociodemographic and behavioral characteristics and to identify factors associated with human immunodeficiency virus (HIV) co-infection in cases of acquired syphilis reported in a Reference Center for Sexually Transmitted Diseases (STD) and AIDS. METHODS: cross-sectional study with secondary data from a Reference Center for STD and AIDS in the municipality of São Paulo, Brazil, in 2014; the Poisson regression was used to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS: 648 cases of acquired syphilis were reported, and 98% were male; 88% were men who have sex with men (MSM) and 57% had HIV co-infection; male sex (PR=1.95; 95%CI 1.05;3.61) and MSM (PR=1.87; 95%CI 1.38;2.53) were factors independently associated with HIV co-infection. CONCLUSION: there was a high prevalence of HIV co-infection in the service analyzed, disproportionately affecting MSM who were notified with acquired syphilis.

Fatores associados à coinfecção por HIV em casos de sífilis adquirida notificados em um Centro de Referência de Doenças Sexualmente Transmissíveis e Aids no município de São Paulo, 2014 / Factores asociados a coinfección por VIH en casos de sífilis adquirida notificados en un Centro de Referencia de Enfermedades de Transmisión Sexual y SIDA del municipio de São Paulo, Brasil, 2014 / Factors associated with HIV co-infection in cases of acquired syphilis reported in a Reference Center for Sexually Transmitted Diseases and AIDS in the municipality of São Paulo, Brazil, 2014

Objetivo: descrever as características sociodemográficas e comportamentais e identificar os fatores associados à coinfecção pelo vírus da imunodeficiência humana (HIV) em casos de sífilis adquirida notificados em Centro de Referência de Doenças Sexualmente Transmissíveis (DST) e Aids. Métodos: estudo transversal, com dados secundários de um Centro de Referência de DST e Aids do município de São Paulo, Brasil, em 2014; empregou-se regressão de Poisson para estimar razões de prevalência (RP) e intervalos de confiança de 95% (IC95%). Resultados: foram notificados 648 casos de sífilis adquirida, 98% do sexo masculino; 88% eram homens que fazem sexo com homens (HSH) e 57% apresentavam coinfecção com o HIV; foram fatores independentemente associados à coinfecção por HIV o sexo masculino (RP=1,95; IC95% 1,05;3,61) e HSH (RP=1,87; IC95% 1,38;2,53). Conclusão: encontrou-se elevada prevalência de coinfecção por HIV no serviço, afetando desproporcionalmente os HSH notificados com sífilis adquirida.

Objetivo: describir las características sociodemográficas y comportamentales, e identificar los factores asociados a coinfección por el virus de inmunodeficiencia humana (VIH) en casos de sífilis adquirida, notificados en un Centro de Referencia de Enfermedades de Transmisión Sexual (ETS) y Sida. Métodos: estudio transversal, con datos secundarios del Centro de Referencia de ETS y SIDA del municipio de São Paulo, Brasil, en 2014; se empleó regresión de Poisson para estimar razones de prevalencia (RP) e intervalos de confianza al 95% (IC95%). Resultados: se notificaron 648 casos de sífilis adquirida, 98% del sexo masculino, 88% hombres que tienen sexo con hombres (HSH) y 57% con coinfección por VIH; fueran associados independientemente con la coinfección por VIH el sexo masculino (RP=1,95; IC95% 1,05;3,61) y HSH (RP=1,87; IC95% 1,38;2,53). Conclusión: se encontró elevada prevalencia de coinfección por VIH que afectó desproporcionadamente los HSH notificados con sífilis adquirida en ese servicio.

Objective: to describe sociodemographic and behavioral characteristics and to identify factors associated with human immunodeficiency virus (HIV) co-infection in cases of acquired syphilis reported in a Reference Center for Sexually Transmitted Diseases (STD) and AIDS. Methods: cross-sectional study with secondary data from a Reference Center for STD and AIDS in the municipality of São Paulo, Brazil, in 2014; the Poisson regression was used to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI). Results: 648 cases of acquired syphilis were reported, and 98% were male; 88% were men who have sex with men (MSM) and 57% had HIV co-infection; male sex (PR=1.95; 95%CI 1.05;3.61) and MSM (PR=1.87; 95%CI 1.38;2.53) were factors independently associated with HIV co-infection. Conclusion: there was a high prevalence of HIV co-infection in the service analyzed, disproportionately affecting MSM who were notified with acquired syphilis.

HPV-related external genital lesions among men residing in Brazil

Abstract The aims of this study were to determine the incidence of external genital lesions (EGLs), specifically histologically confirmed condyloma (genital warts) and Penile Intraepithelial Neoplasia (PeIN), and genital HPV infection progression to EGLs among healthy men aged 18-73 residing in Brazil. Subjects included 1118 men enrolled in the HPV Infection in Men (HIM) study between July 2005 and June 2009. At each visit, EGLs were biopsied and subjected to pathological evaluation. HPV status in genital swabs and biopsies was determined by Linear Array and INNO-LiPA, respectively. Age-specific EGLs incidence and the proportion and median time to EGL development were estimated. Kaplan-Meier cumulative incidence rates at 6, 12, and 24 months were determined. During follow-up, 73 men developed an incident EGL. Men could develop multiple EGLs and there were 36 men with condyloma, 27 men with lesions suggestive of condyloma, six men with PeIN, and 20 men with non-HPV lesions. HPV-positive men who developed EGLs were younger (p = 0.002) than men that did not develop lesions. Among the 815 men with HPV infection, 4% progressed to EGL with the same HPV detected in the swab. During follow up, 15.7% of genital HPV-6 and HPV-11 infections progressed to condyloma (median progression time of nine months for HPV-6 versus 6.8 months for HPV-11). Approximately 1% of HPV-16 infections progressed to PeIN with a median progression time of 25 months. HPV types covered by the 4-valent HPV vaccine were detected in 82.3% and 83.3% of condyloma and PeIN, respectively. The high burden of HPV and high frequency of progression to disease underscores the need to offer HPV prophylactic vaccination to men to reduce the overall burden of infection and diseases caused by HPV.

Prevalence and types of rectal douches used for anal intercourse among men who have sex with men in Brazil.

INTRODUCTION: Rectal douching (RD) is practised among men who have sex with men (MSM), and various products and materials are used. There have been no studies in Brazil on this practice and its risks in the transmission of sexually transmitted infections and HIV. METHOD: Between June and August 2015, 401 MSM over the age of 18 were interviewed about their sexual practices associated with RD over the last 3 months. RD was associated with the reported sexual behaviour, and descriptive statistical analyses were conducted on the same. RESULTS: Among the respondents, 85.6% identified themselves as men and 14.4% as transgender; 255 declared themselves to be white (63.6%) and 104 to be mixed (25.9%). From among those who had performed anal sex within the last 3 months (n=369), 197 reported having used RD (53.4%). The most commonly used material was a shower hose (84.5%) and the main product used was water (93%). Of those interviewed, 94.5% never received guidelines from health professionals on this practice and its potential risks. Receptive anal intercourse and RD were found to be associated (p<0.001). CONCLUSIONS: RD is a common practice among the MSM population. Health professionals must deepen their knowledge of this. We propose studies in Brazil on the practice of RD that-from that knowledge strategies for prevention and harm reduction-can be incorporated to the vulnerable populations.

HPV-related external genital lesions among men residing in Brazil.

The aims of this study were to determine the incidence of external genital lesions (EGLs), specifically histologically confirmed condyloma (genital warts) and Penile Intraepithelial Neoplasia (PeIN), and genital HPV infection progression to EGLs among healthy men aged 18-73 residing in Brazil. Subjects included 1118 men enrolled in the HPV Infection in Men (HIM) study between July 2005 and June 2009. At each visit, EGLs were biopsied and subjected to pathological evaluation. HPV status in genital swabs and biopsies was determined by Linear Array and INNO-LiPA, respectively. Age-specific EGLs incidence and the proportion and median time to EGL development were estimated. Kaplan-Meier cumulative incidence rates at 6, 12, and 24 months were determined. During follow-up, 73 men developed an incident EGL. Men could develop multiple EGLs and there were 36 men with condyloma, 27 men with lesions suggestive of condyloma, six men with PeIN, and 20 men with non-HPV lesions. HPV-positive men who developed EGLs were younger (p=0.002) than men that did not develop lesions. Among the 815 men with HPV infection, 4% progressed to EGL with the same HPV detected in the swab. During follow up, 15.7% of genital HPV-6 and HPV-11 infections progressed to condyloma (median progression time of nine months for HPV-6 versus 6.8 months for HPV-11). Approximately 1% of HPV-16 infections progressed to PeIN with a median progression time of 25 months. HPV types covered by the 4-valent HPV vaccine were detected in 82.3% and 83.3% of condyloma and PeIN, respectively. The high burden of HPV and high frequency of progression to disease underscores the need to offer HPV prophylactic vaccination to men to reduce the overall burden of infection and diseases caused by HPV.

Association of Chlamydia trachomatis infection and herpes simplex virus type 2 serostatus with genital human papillomavirus infection in men: the HPV in men study.

BACKGROUND: Studies in women indicate that some sexually transmitted infections promote human papillomavirus (HPV) persistence and carcinogenesis. Little is known about this association in men; therefore, we assessed whether Chlamydia trachomatis (CT) infection and herpes simplex virus type 2 (HSV-2) serostatus are associated with genital HPV prevalence, an early event in HPV-related pathogenesis. METHODS: Genital exfoliated cells, first-void urine, and blood from 3971 men recruited in the United States, Mexico, and Brazil were tested for HPV, CT, and HSV-2 antibodies, respectively. Multivariable logistic regression was used to assess the association of CT infection and HSV-2 serostatus with 4 HPV outcomes (any, oncogenic, nononcogenic only, and multiple infections). RESULTS: A total of 64 (1.6%) men were CT positive, and 811 (20.4%) men were HSV-2 seropositive. After adjustment for potential confounders, CT was associated with any HPV (adjusted odds ratio [aOR], 2.19; 95% confidence interval [CI], 1.13-4.24), oncogenic HPV (aOR, 3.10; 95% CI, 1.53-6.28), and multiple HPV (aOR, 3.43; 95% CI, 1.69-6.95) prevalence. Herpes simplex virus type 2 serostatus was associated with any HPV (aOR, 1.25; 95% CI, 1.02-1.52), nononcogenic HPV only (aOR, 1.38; 95% CI, 1.08-1.75), and multiple HPV (aOR, 1.33; 95% CI, 1.06-1.68) prevalence. In analyses stratified by sexual behavior, CT infection was significantly associated with HPV detection among men reporting 2 or more recent sexual partners, whereas HSV-2 serostatus was significantly associated with HPV detection in men reporting 0 to 5 lifetime sexual partners. CONCLUSION: In this population, CT infection and HSV-2 serostatus were associated with prevalent genital HPV infection. Future prospective studies should investigate whether these infections influence HPV acquisition and/or persistence.

Infecção pelo Papilomavírus Humano (HPV) em homens soropositivos e negativos ao HIV: persistência e relação histológica de lesões clínicas e subclínicas / Human Papillomavirus (HPV) infection in HIV positive and negative men: analysis of HPV persistence and histological findings in clinical and sub-clinical lesions

INTRODUÇÃO: Co-infecção HPV / HIV altera história natural das infecções por HPV, aumentando o risco de verrugas e neoplasias malignas do trato ano-genital. Há, no entanto, escassez de estudos de coorte envolvendo HPV no pênis dessa população. MÉTODOS: Estudo longitudinal, não probabilístico, com 144 homens de 18 e 70 anos de idade, sendo 72 HIV positivos e 72 HIV soronegativos, parceiros de mulheres com patologia associada a infecção pelo HPV. O estudo foi conduzido numa clínica pública de doenças de transmissão sexual em São Paulo (CRT-DST/AIDS), entre fevereiro de 2004 a março de 2005. Os participantes do estudo foram acompanhados por 180 dias para avaliar a persistência, a aquisição e a eliminação do DNA de HPV nos esfregaços penianos por meio da PCR. Este estudo também visou: Correlacionar os aspectos clínicos das lesões genitais com a histologia e a presença de DNA HPV; Comparar a aquisição, persistência, eliminação e ausência da infecção pelo HPV com a carga viral plasmática do HIV, contagem de células T CD4 e uso de terapia anti-retroviral (HAART). RESULTADOS: Não houve associação estatisticamente significativa nos dois grupos em relação a persistência, eliminação, aquisição ou mesmo ausência de HPV durante o seguimento. O grupo HIV positivo apresentou uma maior freqüência dos tipos oncogênicos de HPV em relação ao grupo HIV negativo (P = 0,041), além de uma maior freqüência de múltiplos tipos de HPV durante o seguimento de 180 dias (P = 0,049). As maiores taxas de aquisição e persistência de HPV foram observadas entre portadores de alta carga de HIV, baixo número de células T CD4, e não usuários de HAART. Aqueles em terapia anti-retroviral, com menos cópias de HIV e alto nível de T CD4 apresentaram maiores taxas de eliminação e ausência de HPV. CONCLUSÕES: Homens de ambos grupos podem ser considerados de alto risco, não tendo sido observada diferença na persistência, aquisição e a eliminação de DNA de HPV. Os homens HIV positivos...

BACKGROUND: Co-infection with HPV and HIV modifies its natural history and increases the risk of warts and neoplasia development in the anogenital tract. Cohort studies to address HPV infection in the penis are scarce, mainly in HIV infected individuals. METHODS: A longitudinal study, non-probabilistic, was conducted with 144 men of 18 to 70 years old including 72 HIV-positive and 72 HIV-negative, partners of women with HPV-associated disease. The study was conducted between February 2004 and March 2005 at a large sexually transmitted clinic in São Paulo (CRT-DST/Aids). Men were followed for 180 days to determine persistence, acquisition and clearance of HPV DNA in penile swabs using PCR. In addition, we aimed to correlate the clinical features of genital lesions with histology and the presence of HPV DNA, compare the acquisition, persistence, clearance and absence of HPV infection with plasma HIV viral load, CD4 T-cell count and use of HAART. RESULTS: Both groups showed no significant differences regarding persistence, clearance, acquisition and/or absence of HPV during follow-up. Penile smears of HIV-positive men showed a higher frequency of oncogenic types in relation to the HIV-negative (P = 0.041), as well as a higher frequency of multiple HPV types (P = 0.049). Significantly higher HPV DNA acquisition and persistence rates were observed among HIV-positive men not submitted to HAART, with higher HIV loads and lower CD4+ cells count. Among those men using anti-retroviral therapy, lower viral loads and higher T cell counts, higher rates of clearance and HPV DNA absence were observed. CONCLUSIONS: This male population altogether is considered to be at high risk of HPV DNA infection, which may be the reason why no differences in HPV acquisition, persistence and clearance were observed. HIV-positive men had a higher frequency of multiple HPV infection and the most frequent were oncogenic types. HPV types 16, 6 and 84 were the most frequently found in HIV...

Infecção pelo Papilomavírus Humano (HPV) em homens soropositivos e negativos ao HIV: persistência e relação histológica de lesões clínicas e subclínicas / Human Papillomavirus (HPV) infection in HIV positive and negative men: analysis of HPV persistence and histological findings in clinical and sub-clinical lesions

Introdução: Co-infecção HPV/HIV altera história natural das infecções por HPV, aumentando o risco de verrugas e neoplasias malignas do trato ano-genital. Há, no entanto, escassez de estudos de coorte envolvendo HPV no pênis dessa população. Métodos: estudo longitudinal, não probabilístico, com 144 homens de 18 e 70 anos de idade, sendo 72 HIV positivos e 72 HIV soronegativos, parceiros de mulheres com patologia associada a infecção pelo HPV. O estudo foi conduzido numa clínica pública de doenças de transmissão sexual em São Paulo (CRT-DST/AIDS), entre fevereiro de 2004 e março de 2005. Os participantes do estudo foram acompanhados por 180 dias para avaliar a persistência, a aquisição e a eliminação do DNA de HPV nos esfregaços penianos por meio da PCR. Este estudo também visou: Correlacionar os aspectos clínicos das lesões genitais com a histologia e a presença de DNA HPV...

Infecção pelo Papilomavírus Humano (HPV) em homens soropositivos e negativos ao HIV: persistência e relação histológica de lesões clínicas e subclínicas

Introdução: Co-infecção HPV/HIV altera história natural das infecções por HPV, aumentando o risco de verrugas e neoplasias malignas do trato ano-genital. Há, no entanto, escassez de estudos de coorte encvolvendo HPV no pênis dessa população. Métodos: estudo longitudinal, não probabilístico, com 144 homens de 18 e 70 anos de idade, sendo 72 HIV positivos e 72 HIV soronegativos, parceiros de mulheres com patologia associada a infecção pelo HPV. O estudo foi conduzido numa clínica pública de doenças de transmissão sexual em São Paulo (CRT-DST/AIDS), entre fevereiro de 2004 e março de 2005. Os participantes do estudo foram acompanhados por 180 dias para avaliar a persistência, a aquisição e a eliminação do DNA de HPV nos esfregaços penianos por meio da PCR. Este estudo também visou: Correlacionar os aspectos clínicos das lesões genitais com a histologia e a presença de DNA HPV...

Prevalência da infecção pelo Papilomavírus Humano (HPV) em homens soropositivos para HIV e homens parceiros de mulheres com infecção pelo HPV

O papilomavírus humano é provavelmente o agente mais prevalente das doenças sexualmente transmissíveis do trato genital. O HPV é responsável pelo câncer do colo uterino e está associado com a metade dos casos de câncer de pênis. A maioria dos estudos sobre HPV foi realizada nas mulheres e poucos estudos realizados na população masculina, e em indivíduos soronegativos para o HIV. Pessoas vivendo com HIV/aids tem um potencial risco para as doenças relacionadas ao HPV e uma rápida progresão para transformação maligna. Este estudo foi realizado para comparar a prevalência de DNA de HPV no pênis de homens HIV positivos e negativos e correlacionar com as variáveis de risco para a aquisição da infecção do HPV. Estudamos 144 homens adultos, metade infectada pelo HIV, para detecção do DNA do HPV em raspados da superfície peniana. Foi utilizada PCR genérica com iniciadores PGMY09/11, seguida de hidridização em pontos. A prevalência de HPV DNA nos indivíduos infectados pelo HIV foi de 59% e, no grupo HIV negativo, de 67%. No grupo HIV positivo, a presença de HPV DNA foi significativamente mais elevada na faixa etária entre 30 e 40 anos. No grupo HIV negativo, a prevalência ocorreu entre 18 e 29 anos. Os indivíduos postectomizados apresentarem menor positividade de HPV nos dois grupos, porém essa diferença não significante. A presença de lesão acetobranca, pela peniscopia, não aumentou a probabilidade de detectar DNA de HPV. Os participantes, com e sem lesão acetobranca ao exame de peniscopia, apresentaram prevalência de HPV semelhantes em ambos os grupos. Pacientes infectados pelo HIV mostraram múltiplos tipos de HPV, em maior frequência que naqueles não infectados pelo HIV. Os tipos HPV 6/11 foram os mais freqüentes nos dois grupos, e os tipos oncogênicos (16/18) foram os mais freqüentes nos pacientes infectados pelo HIV. Os tipos não-congênitos foram mais freqüentes em indivíduos soronegativos para o HIV. No grupo HIV positivo a prevalência do DNA do HPV foi significativamente mais elevada entre homens que fazem sexo com homens, naqueles com maior número de parceiros sexuais, com antecedente de DST, tabagismo e antecedente de hepatite B...