Pre-exposure prophylaxis program in the Community of Madrid: Two years of experience.

INTRODUCTION: Pre-exposure prophylaxis (PrEP) against the human immunodeficiency virus (HIV) is an effective and safe preventive measure. However, it has not reached all target users who could benefit from it. The study aimed to understand the sociodemographic, clinical and behavioral baseline characteristics of PrEP users. As a secondary objective, the use of concomitant medication and drug consumption were described. METHODOLOGY: Observational, retrospective and descriptive study of the sociodemographic, clinical and behavioral characteristics of the users who were included in the PrEP program of the Community of Madrid during the first two years of experience. RESULTS: Two thousand two hundred fifty-six PrEP users were included, 99.0% men, with a mean age of 36.9 years (SD 8.68). 33.1% presented a sexually transmitted infection (STI) on the first visit, highlighting chlamydiasis and rectal gonococci. 70.4% reported using drugs associated with sex, and 42.4% participated in chemsex sessions in the last 3 months. A high percentage of users with concomitant medication was observed (37.6%), highlighting drugs related to mental health and alopecia. CONCLUSIONS: A multidisciplinary approach is required to cover all the needs of PrEP users, including mental health evaluation measures and addiction treatment with the clinical approach.

Concepciones de usuarios sobre nuevas vías de administración de profilaxis pre-exposición para el VIH / Users' expectations of the new pre-exposure prophylaxis for the HIV modalities

Resumen Este artículo tiene como objetivo discutir las concepciones de los Hombres Gay, Hombres Bisexuales y una Mujer Transgénero que usan o quieren usar profilaxis previa a la exposición por el virus de la inmunodeficiencia humana oral (PrEP) sobre nuevas vías de administración. Fueron entrevistados 17 usuarios del BCN Checkpoint. Las entrevistas fueron grabadas en audio, sometidas a análisis categorial temático teniendo en cuenta la perspectiva praxeográfica. Todos están adaptados al uso de la PrEP diaria y a demanda. En relación con las nuevas vías de administración (PrEP inyección intramuscular cada dos meses; pastilla mensual; inyección subcutánea cada seis meses) todos son muy receptivos a esas posibilidades, pero les falta información sobre las especificidades de cada una de ellas y una evaluación específica de sus necesidades. Tanto la satisfacción con el uso de PrEP oral, como las expectativas sobre las nuevas vías de administración son positivas. Sin embargo, lo más importante para los/a entrevistados/a es la garantía de que tendrán seguimiento para continuar cuidando de la salud afectivo-sexual, lo que no depende del tipo de vía de administración.

Abstract This article aims to discuss the expectations of Homosexual Men, Bisexual Men and a Transgender Woman, who use or want to use an oral pre-exposure prophylaxis (PrEP) for the human immunodeficiency virus (HIV) about PrEP modalities. Sixteen PrEP users, who are followed up in the BCN Checkpoint, were interviewed,. The interviews were audio-recorded, subjected to thematic categorical analysis within the theoretical framework from the praxiographic perspective. They are all adapted to the use of daily oral and event-based PrEP. In relation to the new PrEP modalities (monthly pill; intramuscular injection every two months; subcutaneous injection every six months), they are all very receptive to these possibilities, but they lack information on the specificities of each and specific assessment of their needs. Comments about the use of oral PrEP are positive, and expectations regarding the new PrEP modalities are visibly high. However, the most important thing for the interviewees is the guarantee that they will have follow-up appointments to continue taking care of their affective-sexual health, which is not dependent on the type of PrEP modalities.

Comparative performance of vulvovaginal swab sampling versus endocervical sampling for the detection of Chlamydia, Gonorrhea, Mycoplasma genitalium, and Trichomoniasis: a cross-sectional study in Spain.

INTRODUCTION: The global increase in sexual transmitted infections (STI) makes it necessary to seek public health strategies that facilitate rapid and minimally invasive diagnosis. The objective was to evaluate the concordance between vaginal and endocervical samples for STI diagnosis. MATERIALS AND METHODS: A retrospective cross-sectional study was carried out on vaginal and endocervical samples from women attended in our reference area with symptoms suggestive of vulvovaginitis or for STI screening during the study period. RESULTS: A total of 130 paired samples were analyzed; fifty-seven and 59 samples were positive for vaginal and endocervical specimens (Kappa index of 0.969 (Standard error = 0.022). The sensitivity of the vaginal samples was 96.5% (IC95%: 87.2-99.4), with a specificity of 100% (IC95%: 93.0-100). DISCUSSION: The introduction of STI screening in vaginal samples in our environment can facilitate rapid and effective diagnosis and allow early treatment of STI. Additionally, it facilitates sample collection and diagnosis in the community setting, essential for optimal screening.

AEDV Expert Recommendations on the Management of Suppurative Sexually Transmitted Infections. / Recomendaciones de expertos de la AEDV sobre el manejo de infecciones venéreas supurativas.

The incidence of sexually transmitted infections (STIs) is increasing in Spain. Suppurative STIs are one of the most frequent reasons for consultation in specialized centers. The reason for suppurative STIs is multiple and their empirical treatment varies with the currently growing problem of antimicrobial resistance. Dermatologists are trained and prepared to treat these diseases, but their correct management requires active knowledge of national and international guidelines. The present document updates, reviews and summarizes the main expert recommendations on the management and treatment of these STIs.

Expert Recommendations from the AEDV on Legal Aspects Surrounding the Management of Sexually Transmitted Diseases. / Recomendaciones de expertos de la AEDV sobre los aspectos legales en el manejo de las infecciones de transmisión sexual.

The incidence of sexually transmitted diseases has been on the rise in our setting for decades. These infections represent not only an individual problem, but also a problem of public health. Therefore, the management of STDs involves reducing community incidence, which means that common issues in the clinical practice such as failure to attend may become a more complex problem, which adds to the difficult and delicate task of locating sexual contacts that would benefit from screening and the appropriate treatment. On the other hand, STDs have direct legal implications in cases of underage patients, or suspected sexual assault. Therefore, the correct handling of these scenarios requires knowledge of the legal framework that regulates them. Dermatologists are clinically trained and prepared to deal with these conditions. Nonetheless, the legal issues involved are often difficult to solve. This document stands as a simple reference guide to help solve the main legal issues we may encounter in a consultation when dealing with STDs.

AEDV Expert Document on the Management of Ulcerative Venereal Infections. / Documento de expertos de la AEDV sobre el manejo de infecciones venéreas ulcerativas.

Currently, ulcerative sexually transmitted infections, including syphilis, herpes simplex virus (HSV), lymphogranuloma venereum (LGV), chancroid, donovanosis and, more recently, monkeypox (MPOX), represent a growing challenge for health care professionals. The incidence of syphilis and LGV has increased in recent years in Spain. Additionally, HSV, syphilis and chancroid can also increase the risk of HIV acquisition and transmission. The population groups most vulnerable to these infections are young people, men who have sex with men (MSM) and commercial sex workers. It is important to make a timely differential diagnosis since genital, anal, perianal, and oral ulcerative lesions may pose differential diagnosis with other infectious and non-infectious conditions such as candidiasis vulvovaginitis, traumatic lesions, carcinoma, aphthous ulcers, Behçet's disease, fixed drug eruption, or psoriasis. For this reason, the dermatologist plays a crucial role in the diagnosis and management of sexually transmitted infections. This chapter presents the main epidemiological, clinical and therapeutic features associated with these infections.

Incidence of sexually transmitted infections and screening models among pre-exposure prophylaxis users.

INTRODUCTION: There is discussion about the frequency of STI screening among pre-exposure prophylaxis (PrEP) users. The aim of this study was to analyse the incidence of STIs and to evaluate different screening models in order to optimise the follow-up. METHODOLOGY: A prospective study was conducted between 2017 and 2023, including 138 PrEP users in a STI clinic. Participants were tested for STIs every three months. Unscheduled visits were performed for those with STI-related symptoms or for people who were notified for an STI by a sexual partner. We performed a survival analysis of repeated events, estimating the cumulative incidence (CI) and incidence rate (IR). RESULTS: The overall CI by quarterly screening was 8.3 (95% CI: 7.6-9.1) infections per person over six years, with a decreasing trend. The most frequently diagnosed pathogen was Neisseria gonorrhoeae, with a IR of 0.76 (95% CI: 0.68-0.84). If the frequency of screening is reduced to every six months, the IR of STIs is reduced by (95% CI: 0.5-0.66) infections per user per year, and at 12 months by 0.82 (95% CI: 0.73-0.89). In the case of no pharyngeal or urethral screening, IR is reduced by 0.37 (95% CI: 0.32-0.42) infections per person per year and in those over 35 years of age by 0.33 (95% CI: 0.25-0.4). Eliminating unscheduled visits, the reduction in IR is 0.33 (95% CI: 0.24-0.42). CONCLUSIONS: The incidence of STIs among PrEP users is high, especially in the rectum, but it does not increase over time. STI screening could be optimised reducing the frequency of pharyngeal and urethral testing, particularly in those over 35 years of age. It is essential to redistribute health resources for unscheduled visits, which have been shown to be the most cost-effective screening.

Development of a Questionnaire on Knowledge, Habits, and Attitudes on Sexually Transmitted Infections in Teenagers and Young Adults. / [Artículo traducido] Generación de un cuestionario sobre conocimientos, hábitos y actitudes sobre infecciones de transmisión sexual en adolescentes y adultos jóvenes.

Communication with teenagers who are significantly affected by sexually transmitted infections (STIs) is essential for the sake of prevention. The aim of this study is to develop a specific questionnaire for surveying the degree of knowledge, behavior, and attitudes of current teenagers and young adults on STIs to come up with the proper training tools. We conducted the study following the Delphi method, a 2-round critical assessment score (from 1 to 9) of all domains and items. Only domains and items with median scores ≥8 were selected. A total of 8 panelists were involved in this survey. After establishing a median score ≥8, a total of 14 domains and 40 items were eventually selected. This is the first questionnaire ever conducted to study the knowledge, habits, and attitudes of contemporary teenagers and young adults on STIs, and stands as a valuable tool for future training on STI prevention in teenagers and young adults.

Evaluation of health status of transgender sex workers in Turkey: A qualitative study.

OBJECTIVE: Sex workers can be disadvantaged in terms of overall health due to challenging living and working conditions. This research aimed to evaluate the health status and experiences related to sexually transmitted infections (STDs) of unregistered transgender sex workers in Turkey. DESIGN: It employed a phenomenological qualitative research design. SITE: Data were collected in Istanbul between March 2021 and November 2021. PARTICIPANTS: Data were collected through in-depth interviews involving 24 people (19 sex workers and 5 physicians). METHODS: Key statements were listed during data analysis, and clusters of meanings were formed based on these statements. The participants' statements were used for contextual and structural descriptions. RESULTS: Sex workers suffer from chronic illnesses such as asthma, chronic obstructive pulmonary disease (COPD), diabetes, allergic diseases, and neurological disorders. Among the health issues affecting them, the most notable ones are STDs, psychological problems, and the risk of suicide. Sex workers also face a dilemma between choosing public hospitals and private hospitals. Majority of sex workers undergo regular testing for STDs, with the frequency varying from person to person. Reasons for not undergoing regular testing include lack of social security coverage, financial constraints, lack of information, and feeling undervalued. Some individuals are being subjected to mandatory testing. CONCLUSIONS: It is recommended that sex workers who seek and request healthcare services should be provided with detailed information and education, particularly regarding psychological problems and STDs.

Educación sexual, conocimiento de ITS y conductas protectoras/de riesgo en personas entre 18 y 30 años / Sex education, knowledge of STIs and protective/risk behaviors in people between 18 and 30 years of age

Introducción: Las infecciones de transmisión sexual (ITS) se adquieren principalmente por el contacto sexual y pueden afectar a personas de cualquier edad, sin embargo los adolescentes son el grupo etario más afectado, por tanto es probable que sus conductas sean más de riesgo que protectoras. Objetivo: El objetivo de la investigación es determinar la relación entre el nivel de educación sexual y el conocimiento sobre ITS y las conductas de riesgo y protectoras en los jóvenes. Método: Investigación de diseño analítico, estudio de tipo descriptivo, transversal con datos de tipo cuantitativos, con una muestra de 130 hombres y mujeres, considerando 10 personas por edad desde los 18 a los 30 años. Resultados: No existe relación estadísticamente significativa entre la educación sexual y las conductas de riesgo y/o protectores (p > 0,05), ni tampoco entre la educación sexual y el uso del preservativo, tanto interno como externo (p > 0,05). Conclusión: A pesar de tener educación sexual, no todas las personas utilizan de forma frecuente los anticonceptivos de barrera y principalmente es sorprendente el poco uso del condón de vagina en la población en general, siendo las personas de orientación heterosexual las que lo utilizan menos.

Introduction: Sexually transmitted infections (STIs) are mainly acquired through sexual contact and can affect people of any age; however, adolescents are the most affected age group, therefore, it is likely that their behaviors are more risky than protective. Objective: The objective of the research is to determine the relationship between the level of sexual education and knowledge about STIs and risk and protective behaviors in young people. Method: Analytical design research, descriptive, cross-sectional study with quantitative data, with a sample of 130 men and women, considering 10 people by age from 18 to 30 years. Results: There is no statistically significant relationship between sexual education and risk and/or protective behaviors (p > 0.05) nor between sexual education and condom use, both internal and external (p > 0.05). Conclusion: Despite having sexual education, not all people use frequently barrier contraceptives and, mainly, the little use of the vaginal condom in the general population is surprising, with people of heterosexual orientation being those that use it less.

AEDV Expert Consensus Document on the Organization of a Multidisciplinary Unit for Patients With or at Risk of Venereal Infections. / Documento de expertos de la Academia Española de Dermatología y Venereología sobre la organización de una unidad multidisciplinar de atención a pacientes con o en riesgo de infecciones venéreas.

Over the past few years, venereal or sexually transmitted infections (STIs) have been on the rise worldwide requiring additional specialized monographic consultations to specifically treat STIs. Therefore, the Spanish Academy of Dermatology and Venereology (AEDV) Research Working Group on STIs and HIV has drafted this document with the necessary requirements in terms of infrastructure, personnel, technology, specific materials for sample collection, and needs for current therapeutic options. Strict emphasis is placed on the protection of patient privacy. A health care circuit model is outlined too. Additionally, a section has been included on contact tracking and reporting, key elements for the effective prevention and control of STIs. These clinical practice guidelines seek to establish a clinical action framework adapted to the current challenges posed by STIs and HIV in the dermatology, venereology, and multidisciplinary settings.

[Management of sexually transmitted diseases in primary care (II). Genital ulcers. Vulvovaginitis. Human papilloma virus]. / Manejo en atención primaria de las infecciones de transmisión sexual (II). Lesión ulcerada genital. Vulvovaginitis. Virus del papiloma humano.

In this paper we approach three clinical syndromes with different microbial agents that cause sexually transmitted diseases (STD) with a common condition: the symptomatology is in the genital area. Some of these microbial agents are transmitted strictly sexually, but not all. In this section we will discuss about vulvovaginitis, genital ulcers and human papilloma virus, three syndromes which have increased their incidence in recent years and primary care must know its management: diagnosis, correct treatment, controls, and study of sexual contacts. The optimal approach is as important as knowing how to recommend prevention of STD, contact study and screening for other infections that can be present at the same time although asymptomatically.

Development of a Questionnaire on Knowledge, Habits, and Attitudes on Sexually Transmitted Infections in Teenagers and Young Adults.

Communication with teenagers who are significantly affected by sexually transmitted infections (STIs) is essential for the sake of prevention. The aim of this study is to develop a specific questionnaire for surveying the degree of knowledge, behavior, and attitudes of current teenagers and young adults on STIs to come up with the proper training tools. We conducted the study following the Delphi method, a 2-round critical assessment score (from 1 to 9) of all domains and items. Only domains and items with median scores ≥8 were selected. A total of 8 panelists were involved in this survey. After establishing a median score ≥8, a total of 14 domains and 40 items were eventually selected. This is the first questionnaire ever conducted to study the knowledge, habits, and attitudes of contemporary teenagers and young adults on STIs, and stands as a valuable tool for future training on STI prevention in teenagers and young adults.

Spanish Academy of Dermatology and Venereology (AEDV) expert recommendations for the management of sexual transmitted parasitosis. Scabies, and pediculosis pubis. / Recomendaciones de expertos de la Academia Española de Dermatología (AEDV) para el manejo de las ectoparasitosis de transmisión sexual. Escabiosis y pediculosis púbica.

Sexually transmitted infections are communicable diseases where the pathogen is transmitted through sexual contact. The Sexually Transmitted Infections Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) is engaged in the drafting of documents to guide dermatologists and health care personnel who treat Spanish patients with these infections. This document analyzes the epidemiological, clinical, therapeutic, and control characteristics of 2 sexually transmitted parasitosis: scabies due to Sarcoptes scabiei var. hominis, and pubic pediculosis due to Phthirus pubis. Both parasitoses share a sort of mixed spread through sexual and community transmission regardless of the route through which the infection was initially acquired. This specific feature creates particularities in the management and control of the infestation.

Conductas sexuales de riesgo relacionadas con las infecciones de transmisión sexual en una comunidad shuar de Taisha, Ecuador

Objetivo: Describir conductas sexuales de riesgo relacionadas con las infecciones de transmisión sexual (ITS) en una comunidad shuar de Taisha, Ecuador. Metodología: Estudio descriptivo-transversal, con base en la teoría transcultural de Leininger. Participaron 215 adultos de ambos sexos, mayores de 18 años. Se utilizó un cuestionario validado por expertos, con método Delphi. El análisis relacional usó la prueba de X2. Resultados: De la muestra, 153 mujeres y 62 hombres, el 99.1 % se identificó como heterosexual; 79.1 % indicó que su actividad sexual se inició en la preadolescencia, siendo lo más frecuente de tipo genital; 16.3 % reveló haber presentado alguna vez una ITS; 29.3 % ha tenido relaciones sexuales bajo efecto del alcohol o sustancias afrodisíacas, de los que 6 % indicó utilizar preservativo. El 60 % respondió que no lo usa porque no sabe cómo y por sentir menos placer; 36.7 % refirió tener relaciones sexuales fortuitas y, en ellas, 73 % sin usar preservativo. No hubo asociación significativa entre las conductas sexuales y la edad de las personas. Conclusión: El escaso uso de preservativo, relaciones sexuales fortuitas sin protección, inicio temprano y actividad sexual bajo efecto alcohol o sustancias afrodisíacas resultaron ser prácticas de riesgo para contraer una infección de transmisión sexual en esta comunidad indígena. Se necesita tender puentes, desde el sistema de salud hasta las comunidades, para implementar programas de prevención, diagnóstico y tratamiento en estadios tempranos para detección, educación, apoyo y control. El modelo de enfermería transcultural y el trabajo interdisciplinario permiten conocer los principios, valores y cosmovisión de los integrantes de la comunidad.

Objetivo: Descrever os comportamentos sexuais de risco relacionados às doenças sexualmente transmissíveis (DST) em uma comunidade shuar em Taisha, Equador. Metodologia: Estudo descritivo-transversal, com base na teoria transcultural de Leininger. Participaram 215 adultos de ambos os sexos, com mais de 18 anos de idade. Foi utilizado um questionário validado por especialistas por meio do método Delphi. A análise relacional usou o teste X2. Resultados: Da amostra, 153 mulheres e 62 homens, 99,1 % se identificaram como heterossexuais; 79,1% indicaram que sua atividade sexual começou na pré-adolescência, mais frequentemente do tipo genital; 16,3 % revelaram já ter tido uma DST; 29,3 % tiveram relações sexuais sob o efeito de álcool, dos quais 6 % indicaram usar preservativo. Sessenta por cento disseram que não usam preservativos porque não sabem como usar e porque sentem menos prazer; 36,7 % relataram ter feito sexo casual, sendo 73 % deles sem usar preservativo. Não houve associação significativa entre o comportamento sexual e a idade. Conclusão: Constatou-se que o baixo uso de preservativos, o sexo casual desprotegido, o início precoce e a atividade sexual sob efeito do álcool ou substâncias afrodisíacas resultaram ser práticas de risco para contrair uma doença sexualmente transmissível nessa comunidade indígena. É necessário construir pontes entre o sistema de saúde e as comunidades para implementar programas de prevenção, diagnóstico e tratamento em estágios iniciais para detecção, educação, apoio e controle. O modelo de enfermagem transcultural e o trabalho interdisciplinar nos permitem conhecer os princípios, os valores e a visão de mundo dos membros da comunidade.

Objective: To describe risky sexual behaviours related to sexually transmitted infections (STIs) in a Shuar community of Taisha, Ecuador. Methodology: Descriptive-cross-sectional study, based on Leininger's cross-cultural theory. A total of 215 adults of both sexes over 18 years of age participated. A questionnaire validated by experts was used, with Delphi method. The relational analysis used the X2 test. Results: Of the sample, 153 women and 62 men, 99.1 % identified themselves as heterosexual; 79.1 % indicated that their sexual activity began in preadolescence, most frequently of the genital type; 16.3 % reported having ever had an STI; 29.3 % had had sexual relations while intoxicated, of which 6 % reported using a condom. The 60 % percent responded that they do not use condoms because they do not know how and because they feel less pleasure; 36.7 % reported having casual sex, 73 % of them without using a condom. There was no significant association between sexual behaviors and age. Conclusion: The scarce use of condoms, incidental unprotected sex, early onset and sexual activity under the influence of alcohol or aphrodisiac substances were found to be risk practices for contracting a sexually transmitted infection in this indigenous community. There is a need to build bridges from the health system to the communities to implement prevention, diagnosis and treatment programs in early stages for detection, education, support and control. The transcultural nursing model and the interdisciplinary work allow knowing the principles, values and cosmovision of the community members.

Utilidad de la implementación de un método molecular automatizado en el diagnóstico de agentes causales de infecciones de transmisión sexual / Usefulness of the implementation of an automated molecular method in the diagnosis of causal agents of sexually transmitted infections / Utilidade da implementação de um método molecular automatizado no diagnóstico de agentes causais de infecções sexualmente transmissíveis

Resumen Se presentan los resultados obtenidos en los primeros meses desde la implementación del diagnóstico de agentes causales de infecciones de transmisión sexual (ITS) por PCR en tiempo real en un sistema automatizado. Se estudiaron 46 muestras endocervicales y 39 muestras de uretra masculina, por examen microscópico en fresco, coloración de Gram, cultivo en agar sangre, agar Thayer Martin, galerías miniaturizadas para investigar Ureaplasma spp. y Mycoplasma hominis (Mycoplasma IST3, bioMérieux, Francia) y PCR múltiple para Neisseria gonorrhoeae, Chlamydia trachomatis . Trichomonas vaginalis (BDMaxTM System, Becton Dickinson, EE.UU.). Mediante PCR múltiple se detectó un agente vinculado a ITS en el 48,7% de las muestras uretrales y en el 21,7% de las muestras endocervicales, además de 5 casos de coinfección. El 18,8% de las infecciones se diagnosticaron sólo por PCR. Estos datos demuestran que mediante PCR se optimizó el diagnóstico de ITS en personas de ambos sexos.

Abstract The results obtained in the first months after the implementation of the diagnosis of causative agents of sexually transmitted infections (STIs) by real- time PCR in an automated system are presented. Forty-six endocervical samples and 39 male urethral samples were studied by fresh microscopic examination, Gram staining, blood agar culture, Thayer Martin agar, miniaturised galleries to investigate Ureaplasma spp. and Mycoplasma hominis (Mycoplasma IST3, bioMérieux, France), and multiplex PCR for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis (BDMaxTM System, Becton Dickinson, USA). Using multiplex PCR, an agent linked to STIs was detected in 48.7% of the urethral samples and in 21.7% of the endocervical samples, in addition to 5 cases of coinfection. A total of 18.8% of the infections were diagnosed only by PCR. These data show that PCR optimised the diagnosis of STIs in people of both sexes.

Resumo São apresentados os resultados obtidos nos primeiros meses a partir da implementação do diagnóstico de agentes causadores de infecções sexualmente transmissíveis (ISTs) por PCR em tempo real em um sistema automatizado. Quarenta e seis amostras endocervicais e 39 amostras uretrais masculinas foram estudadas por exame microscópico fresco, coloração de Gram, cultura de ágar sangue, ágar Thayer Martin, galerias miniaturizadas para investigar Ureaplasma spp. e Mycoplasma hominis (Mycoplasma IST3, bioMérieux, França) e PCR múltiplo para Neisseria gonorrhoeae, Chlamydia trachomatis e Trichomonas vaginalis (BDMaxTM System, Becton Dickinson, EUA). Utilizando PCR múltiplo, um agente ligado a IST foi detectado em 48,7% das amostras uretrais e em 21,7% das amostras endocervicais, além de 5 casos de coinfecção; 18,8% das infecções foram diagnosticadas apenas por PCR. Esses dados mostram que através do PCR foi otimizado o diagnóstico de IST em pessoas de ambos os sexos.

Diferencias epidemiológicas y clínicas en pacientes VIH positivas antes y durante la pandemia covid-19 / Epidemiological and clinical differences in HIV positive patients before and during the Covid-19 Pandemic

Con la llegada de la pandemia por COVID-19 en el año 2020, múltiples diagnósticos y tratamientos de diversas enfermedades quedaron relegados por el impacto del síndrome respiratorio agudo causado por el nuevo coronavirus (SARS-CoV-2) en los sistemas de salud. Teniendo en cuenta la coexistencia de la pandemia por el virus de inmunodeficiencia humana (VIH) y la provocada por el virus SARS-Cov-2, el objetivo del presente trabajo fue recolectar información de un Hospital de Enfermedades Infecciosas de la Ciudad de Buenos Aires y analizar cómo repercutió la pandemia por SARS-CoV-2 en el diagnóstico de las enfermedades que afectan a la población VIH positiva y, a su vez, comparar el estado clínico al ingreso y egreso de las pacientes en el período pre pandemia y durante la misma. Para esto se analizaron 100 epicrisis correspondientes a la sala 16 de internación de mujeres con complicaciones de la enfermedad VIH/SIDA que fueron asistidas en el período entre Enero del 2020 y Julio del 2021, y 74 epicrisis de pacientes internadas en ese mismo sitio en los siete meses previos. Se tuvieron en cuenta múltiples variables como el motivo de ingreso, conocimiento o no del diagnóstico de VIH, indicación de tratamiento antirretroviral y cumplimiento del mismo, antecedentes patológicos de las pacientes, presencia de enfermedades marcadoras de SIDA e infecciones de transmisión sexual, entre otras. Al comparar los datos entre pre-pandemia y pandemia se evidencia que esta última afectó a la población VIH positiva, en aspectos que van desde el retraso en el diagnóstico de la infección por el retrovirus, el inicio o reinicio de los tratamientos antirretrovirales y diferencias en los múltiples diagnósticos de egreso, incrementándose las consultas por trastornos respiratorios y neurológicos. A todo esto se añadieron las dificultades del personal médico para brindar una buena atención dado por el colapso del sistema sanitario que se hizo presente en dicho contexto. Por otra parte, destacar la importancia de la confección correcta y completa de las historias clínicas para lograr una mejor calidad de atención médica

With the arrival of the COVID-19 pandemic in 2020, many diagnoses and treatments of various diseases were relegated due to the impact of the acute respiratory syndrome caused by the novel coronavirus (SARS-CoV-2) in health systems. Taking into account the coexistence of the human immunodeficiency virus (HIV) pandemic and that caused by the SARS-CoV-2 virus, the objective of this study was to collect information from an Infectious Disease Hospital in the City of Buenos Aires and analyze the impact of the SARS-CoV-2 pandemic on the diagnosis of diseases that affect the HIV-positive population. Also, was compared the clinical status at admission and discharge of patients in the pre-pandemic period and during the same. For this, 100 epicrisis (clinical summaries) corresponding to 16 women who were hospitalized in the period between January 2020 and July 2021 were analyzed, and 74 epicrisis from patients hospitalized during the seven previous months. Multiple variables were considered, such as the reason for admission, whether or not there was knowledge of the HIV diagnosis, the presence of antiretroviral treatment and compliance with it, the patient's clinical history, the presence of marker AIDS diseases and sexually transmitted infections. When comparing the data between both periods, it can be clearly observed that the pandemic generated by SARS-CoV-2 affected the population with HIV, in aspects ranging from the delay in the diagnosis of the retroviral infection, the start or restart of antiretroviral treatments and differences in the multiple discharge diagnoses, especially those involvement the respiratory and the central nervous systems, that added new difficulties to the medical staff due to the saturation of the health system. The importance of the correct and complete preparation of medical records is highlighted in order to achieve better clinical care

Human intestinal spirochetosis: an entity associated with sexual transmitted infections.

INTRODUCTION: Human intestinal spirochetosis (HIE) is a poorly studied clinical entity with variable clinical manifestations. However, in recent years it has gained special relevance because an increasing number of cases have been described in people living with HIV (PWH) and in patients with a history of sexually transmitted infections (STI) or immunosuppression. METHODS: Retrospective review of all HIE cases identified in a tertiary level hospital (Hospital Universitario la Paz, Madrid) between 2014 and 2021. RESULTS: 36 Cases of HIE were identified. Most cases corresponded to males (94%) with a median age of 45 years. 10 patients (29.4%) were PWH and 20 (56%) were men who had sex with men. Although the clinical manifestations were very heterogeneous, the most frequent was chronic diarrhea (47%), and up to 25% of the subjects had clinical proctitis. 39% percent of patients had been diagnosed with an STI in the previous two years, this characteristic being more frequent in PWH (90% vs. 28%; p < 0.01) than in patients without HIV infection. The STI most frequently associated with a diagnosis of HIE was syphilis (31%). CONCLUSION: HIE is frequently diagnosed with other STIs and affects mostly men who have sex with men, which supports that this entity could be considered as a new STI.

[Epidemiological situation of post-pandemic sexually transmitted infections in Catalonia, Spain]. / Situación epidemiológica de las infecciones de transmisión sexual pospandemia en Cataluña, España.

BACKGROUND: The growing trend of STIs in recent years was altered after the outbreak of the SARS-CoV-2 pandemic. OBJECTIVES: Describe the impact of the SARS-CoV-2 pandemic on STI declarations received during the pre-pandemic to pandemic period and estimate the number of STI cases expected for the pandemic period. MATERIAL AND METHODS: Descriptive analysis of STI declarations received during the pre-pandemic (2018-2019) and pandemic (2020-2021) periods. The influence of the number of positive cases of SARS-CoV-2 with the number of positive cases of STIs during the months of the pandemic was studied using a correlation model. Using the Holt-Wilson time series model, an estimate was made of the number of STI cases expected for the pandemic period. RESULTS: The global incidence rate for all STIs in 2020 decreased by 18.3% compared to 2019. Chlamydia and syphilis presented a greater reduction in their incidence from 2019 to 2020 of 22.7% and 20.9%, respectively and 9.5% and 2.5% for gonorrhea and LGV. Estimates showed that in 2020 there would have been 44.6% more STIs than those declared. The proportions according to sex, country of birth and sexual orientation changed significantly in chlamydia and gonorrhea. CONCLUSIONS: The measures adopted for the prevention of SARS-CoV-2 infections were able to achieve an initial decrease in STI cases in 2020, however, this change was not maintained during 2021, which ended with higher incidences recorded to date.

Validation of the Scale of Perceived Risk of Sexually Transmitted Infections in Middle-aged and Older Adults

Background: Middle-aged and older adults often mistakenly underestimate the risk to which they are exposed when they engage in risky sexual behaviors. Furthermore, a reliable and valid measurement of the construct is necessary to capture its scope and meaning. Objective: To validate the structure of the Perceived Risk Scale for STIs in middle-aged and older adults, identify their perceived risk of STIs, and identify their relationship with some sociodemographic characteristics. Methods: The sample was composed of 295 middle-aged and older adults. A virtual online sampling was used. Males and females aged 50 years and older, sexually active in the last 12 months, were included. To measure the perceived risk of STIs, the scale of perceived risk for human immunodeficiency virus (HIV) was adapted, and a confirmatory factor analysis of the proposed three-factor structure was carried out. Results: The proposed structure of the scale was found to present acceptable adjustment rates (X 2= 48.283, p <.001; CFI = .962, RMSEA = .079, GFI = .963, TLI = .938). 28.1% of the participants presented low perceived risk; 46.8%, medium perceived risk; and 25.1%, high perceived risk. Association between marital status and perceived risk of STIs was identified. Conclusion: The Perceived Risk Scale for STIs is a reliable and valid instrument for capturing perceived risk of STIs in middle-aged and older adults. An appropriate measurement is considered important to accurately examine the relationship between perceived risk and behavior.

Antecedentes: Los adultos de mediana y tercera edad suelen subestimar erróneamente el riesgo al que se exponen cuando realizan conductas sexuales de riesgo, además, es necesaria una medición fiable y válida del constructo para captar su alcance y significado. Objetivo: Validar la estructura de la Escala de Riesgo Percibido a las ITS en adultos de mediana y tercera, identificar su riesgo percibido a las ITS e identificar su relación con algunas características sociodemográficas. Métodos: La muestra estuvo compuesta por 295 adultos de mediana y tercera edad. Se utilizó un muestreo virtual en línea. Se incluyeron hombres y mujeres de 50 años o más, se-xualmente activos en los últimos 12 meses. Para medir el riesgo percibido a las ITS se adaptó la escala de riesgo percibido al Virus de Inmunodeficiencia Humana (VIH) y se realizó un análisis factorial confirmatorio de la estructura propuesta conformada por tres factores. Resultados: Se comprobó que la estructura propuesta de la escala presentaba mostró índices de ajuste aceptables (X2 = 48.283, p <.001; CFI = .962, RMSEA = .079, GFI = .963, TLI = .938). El 28.1% de los participantes presentó un riesgo percibido bajo, el 46.8% un riesgo percibido medio y el 25.1% un riesgo percibido alto. Se identificó la asociación entre el estado civil y el riesgo percibido de ITS. Conclusiones: La Escala de Riesgo Percibido de ITS es un instrumento fiable y válido para captar el riesgo percibido a las ITS en adultos de mediana y tercera edad. Se considera importante una medición adecuada para examinar con precisión la relación entre el riesgo percibido y la conducta.