Epidemiological surveillance of Human Papillomavirus (HPV) genotypes in oral and genital tracts and the impact of HPV vaccination on male university students from Rio de Janeiro state, Brazil / Vigilância Epidemiológica dos genótipos de papilomavírus humano (HPV) nos tratos oral e genital e o impacto da vacinação em estudantes universitários do sexo masculino do estado do Rio de Janeiro, Brasil

Introduction: Human Papillomavirus (HPV) infections are of significant concern in men, given its potential impact on their health and the risk of transmission to partners. Understanding and addressing this infection in men is crucial to evaluate the effectiveness of vaccination in reducing HPV-related diseases. Objective: To assess the impact of HPV vaccination, potential genotype shifts, and adverse effects, through a prospective study conducted with male university students. Methods:The study involved 286 volunteers who were examined at Sexually Transmitted Disease Clinics at the Universidade Federal Fluminense in Niterói, Rio de Janeiro, Brazil. The HPV prevalence was evaluated using generic PCR, genotyped by DNA microarray and monitored adverse effects. Results: The findings of this study revealed the absence of moderate or severe adverse effects. Genetic shifts were observed, including the disappearance of oncogenic HPV types 16 and 18. Surprisingly, even after completing the full vaccine regimen, students still harbored HPV11 in the oral tract. Furthermore, persistent HPV 6 and 11 infections were identified in three students, who had pre-existing infections prior to vaccination, at the follow-up visit. Multivariate analysis uncovered independent associations, notably an increased risk of HPV infection in the oral tract among men who have sex with men. HPV prevalence rates remained low both before and after the vaccination scheme (T0: 14.7%, T1: 8.7%). Even after the full vaccination scheme, the prevalence remained similar at T2 (14.6%), with no statistically significant differences recorded. HPV11 emerged as the most prevalent type throughout the study, followed by HPV6. Vaccine genotypes were detected in a significant proportion of samples at T0 (85.4%), T1 (89.5%), and T2 (100%). Conclusion: Overall, this study suggests that vaccination may represent a promising approach to reducing HPV-related health risks. These findings shed light on the potential benefits and challenges of HPV vaccination, emphasizing the need for continued monitoring and vaccination efforts

Introdução: As infecções por papilomavírus humano (HPV) são de grande preocupação em homens, dada sua possível influência na saúde deles e no risco de transmissão para parceiros. Compreender e abordar essa infecção em homens é fundamental para avaliar a eficácia da vacinação na redução de doenças relacionadas ao HPV. Objetivo: Avaliar o impacto da vacinação contra o HPV, possíveis alterações genotípicas e efeitos adversos, por meio de um estudo prospectivo realizado em estudantes universitários do sexo masculino. Métodos: O estudo envolveu 286 voluntários examinados em Clínicas de Doenças Sexualmente Transmissíveis na Universidade Federal Fluminense, em Niterói, Rio de Janeiro, Brasil. A prevalência do HPV foi avaliada por polymerase chain reaction (PCR) genérico e genotipada por microarranjo de DNA, e foram monitorados os efeitos adversos. Resultados: Os resultados deste estudo revelaram a ausência de efeitos adversos moderados ou graves. Observaram-se mudanças genéticas, incluindo o desaparecimento dos tipos oncogênicos do HPV 16 e 18. Surpreendentemente, mesmo após a conclusão do esquema completo de vacinação, os estudantes ainda abrigavam o HPV 11 na cavidade oral. Além disso, foram identificadas infecções persistentes pelo HPV 6 e 11 em três estudantes que já tinham infecções preexistentes antes da vacinação e na visita de acompanhamento. A análise multivariada revelou associações independentes, especialmente um aumento no risco de infecção pelo HPV na cavidade oral em homens que têm relações sexuais com homens. As taxas de prevalência do HPV permaneceram baixas tanto antes quanto depois do esquema de vacinação (T0: 14,7%, T1: 8,7%). Mesmo após a conclusão do esquema de vacinação, a prevalência permaneceu semelhante em T2 (14,6%), sem diferenças estatisticamente significativas registradas. O HPV 11 emergiu como o tipo mais prevalente ao longo do estudo, seguido pelo HPV 6. Genótipos da vacina foram detectados em uma proporção significativa de amostras em T0 (85,4%), T1 (89,5%) e T2 (100%). Conclusão: No geral, este estudo sugere que a vacinação pode representar uma abordagem promissora para a redução dos riscos à saúde relacionados ao HPV. Esses achados lançam luz sobre os benefícios e desafios potenciais da vacinação contra o HPV, enfatizando a necessidade de monitoramento contínuo e esforços de vacinação

Chatbot, ChatGPT: artificial intelligence and/or business intelligence and/or robotic untruths, for now / Chatbot, ChatGPT: inteligência artificial e/ou inteligência comercial e/ou inverdades robotizadas, por enquanto

The authors, like most humans on the planet at all times, go through many profound transformations throughout their lives. Let's imagine hominids starting to master fire more than a million years ago. Inventing the wheel, writing, navigating the seas, inventing the light bulb, motor vehicles, Santos Dumont's plane, telex, teleradiography, and so many other things that for each era, it was unimaginable such an advance would be incorporated into daily of human life. Today, in 2023, we are facing a computerized conversation through the world wide web, the internet. For now, called artificial intelligence ­ AI, chatbot. How much will this technology add benefits in the health area? When will this technology spread untruths? How much will people blindly follow the information and experience huge gains and marked problems, side effects? In these dialogues with the various chatbots already being made available, free or with payment of monthly fees, can these computer programs, after several human-AI arguments, write that, for the situations presented in a given conversation, suicide is plausible conduct? The concerns of the authors are concerns that are valid in March 2023. The editorial tests conversations. And time will show us how to learn, teach, live together, and transform this artificial intelligence

Mpox transmitted through sexual intercourse: three case reports

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

Introdução: Em 2022, muitos países, como o Brasil, experimentaram surtos de mpox (anteriormente chamada de monkeypox) em pessoas sexualmente ativas com múltiplos parceiros sexuais. Objetivo: Relatar casos de pacientes diagnosticados com mpox. Métodos: Relatar três casos de pacientes com diagnóstico de mpox atendidos no Setor de Doenças Sexualmente Transmissíveis (DST) da Universidade Federal Fluminense (UFF). Resultados: Relatam-se três casos de pacientes adultos jovens que procuraram espontaneamente o Setor de DST da UFF com feridas na região anogenital, boca e outras partes do corpo. Esses casos incluem um homem de 28 anos (HIV positivo) que apresentava lesões no pênis e no corpo, um homem de 34 anos com úlceras perianais e adenopatia e um homem de 40 anos com úlceras dolorosas no pênis. Conclusão: O artigo fornece informações sobre os sintomas, transmissão e prevenção da mpox, destacando a necessidade de detecção precoce, diagnóstico e tratamento imediato para conter e prevenir a propagação da doença. Os casos apresentados apresentam todas as características de uma doença sexualmente transmissível.

Management of early-stage triple-negative breast cancer: recommendations of a panel of experts from the Brazilian Society of Mastology.

BACKGROUND: Triple-negative breast cancer (TNBC) is a heterogenous subtype involving different patterns of behavior and clinical course, demanding a complex, individualized sequence of treatment. The knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology regarding TNBC were evaluated and a consensus regarding management and treatment was reached. METHODS: Affiliates completed a survey involving 44 objective questions. In addition, a specialist meeting was held with 27 experts and 3 ad hoc consultants. The panelists completed the survey before and after brainstorming. Answers achieving 70% of agreement were considered consensual. The chi-square test was used to compare answers between panelists and affiliates and the Kappa coefficient to calculate agreement. RESULTS: Consensus among the panelists increased from 26 (59.1%) to 32 questions (72.7%) following brainstorming (p = 0.17), including 7/10 questions on systemic treatment. Among the affiliates, consensus was achieved for 24 questions (54.5%), resulting in moderate agreement (κ = 0.445). Neoadjuvant chemotherapy should be indicated for almost all cases (except cT1a-b N0) and should include platinum agents. When indicated, immunotherapy is part of the standard of care. The panel reaffirmed the concept of no ink on tumor as indicative of adequate margins and the possibility of sentinel lymph node biopsy for cN1 patients who become cN0 following neoadjuvant therapy. Controversies remain on combining immunotherapy with capecitabine/olaparib in pertinent cases. CONCLUSION: Expert consensus was achieved for > 70% of the questions, with moderate agreement between panelists and affiliates. Educational interventions on systemic breast cancer treatment affected decision-making in 60% of the questions.

Impact of the COVID-19 Pandemic on Cancer Staging: An Analysis of Patients With Breast Cancer From a Community Practice in Brazil.

PURPOSE: A nationwide lockdown was enforced in Brazil starting in March 2020 because of the COVID-19 pandemic when cancer screening activities were reduced. In this study, we evaluated the impact of the COVID-19 pandemic on breast cancer (BC) diagnosis. METHODS: We extracted data from the medical records of patients age older than 18 years who were diagnosed with BC and started treatment or follow-up in private oncology institutions in Brazil between 2018 and 2021. The primary objective was to compare the stage distribution during the COVID-19 pandemic (2020-2021) with a historical prepandemic control cohort (2018-2019). Early BC was defined as stage I-II and advanced disease as stage IV. RESULTS: We collected data for 11,753 patients with an initial diagnosis of BC, with 6,493 patients in the pandemic (2020-2021) and 5,260 patients in the prepandemic period (2018-2019). We observed a lower prevalence of early-stage BC (63.6% v 68.4%) and a higher prevalence of advanced-stage BC (16.9 v 12.7%), after the onset of the pandemic (both P < .01). This pattern was similar for both estrogen receptor-positive/human epidermal growth factor receptor 2-negative and human epidermal growth factor receptor 2-positive tumors: significantly decreased in the early stage from 69% to 67% and 68% to 58%, respectively, and a considerable increase in advanced-stage disease from 13% to 15% and 13% to 20%, respectively. For triple-negative BC, there was a significantly higher percentage of patients with advanced-stage disease during the pandemic (17% v 11%). Overall, age 50 years or older and postmenopausal status were associated with a greater risk of advanced stage at diagnosis during the pandemic period. CONCLUSION: We observed a substantial increase in the number of cases of advanced-stage BC in Brazil during the COVID-19 pandemic.

Evaluation of infrared thermography with a portable camera as a diagnostic tool for peripheral arterial disease of the lower limbs compared with color Doppler ultrasonography.

Introduction: We aimed to evaluate whether infrared thermography (IRT) with a portable camera is a useful tool for diagnosing or screening peripheral arterial disease of the lower limbs (PAD-LL) when compared with the traditional method of color Doppler ultrasonography. Material and methods: The study enrolled 90 volunteers: 45 who were diagnosed with PAD-LL (PAD-LL group) and 45 who did not have a diagnosis of PAD-LL (control group). The diagnosis was made using color Doppler ultrasonography, and the results were compared with those of IRT. Results: The IRT-based procedure evaluated in this study had a sensitivity of 97.62% and a specificity of 91.67% for PAD-LL diagnosis compared to color Doppler ultrasonography. The method was limited for diagnosing PAD-LL manifesting above the knees (suprapopliteal PAD-LL). Our results also suggest that the ankle-brachial index is an important predictor of PAD-LL, with a sensitivity of 91.17% and a specificity of 75% at a value of ≤ 0.9. Current or previous smoking habits, higher body mass index, and the presence of diabetes mellitus were significantly elevated in the PAD-LL group. Conclusions: Our results indicate that IRT is an efficient and low-cost method for screening and diagnosing PAD-LL, particularly infrapopliteal PAD-LL manifesting below the knees. However, further studies are required to establish the validity of this technique.

Acute Limb Ischemia After Self-Injection of Crushed Morphine Tablets into the Radial Artery: Role of Infrared Thermography in the Assessment of Tissue Perfusion.

BACKGROUND This article presents a case involving complications after intentional injection of crushed tablets into the arterial circulation, its diagnosis, and the treatment adopted. The diagnosis process illustrates the potential of techniques based on thermal imaging as tools to assess tissue perfusion. Inadvertent intravenous injection of crushed tablets is more common, but there are few reports on arterial circulation, and no studies were found on the self-injection of crushed morphine tablets, particularly into the radial artery. CASE REPORT A 51-year-old man with alcoholism and a history of illegal drug usage intentionally self-injected 3 crushed morphine tablets into his right radial artery. The patient progressed with compartment syndrome, requiring decompressive fasciotomy of the right forearm and ischemia of the right fingers, which were amputated. He presented with rhabdomyolysis and required dialysis. The patient agreed to full heparinization, corticotherapy, and the use of nitroglycerin and prostaglandin E1. Due to the progression of the necrotic area, the patient underwent proximal phalanx excision and surgical reconstruction of the right-hand remnant. CONCLUSIONS The injection of morphine tablets into circulation caused severe complications, which led to the excision of the proximal phalanx and the surgical reconstruction of the remnant of the right hand. In the present case, infrared thermography proved to be an effective method in assessing tissue perfusion.

The fight against sexually transmitted infections cannot stop in the COVID-19 era: a brazilian experience in online training for sexually transmitted infections guidelines / A luta contra as infecções sexualmente transmissíveis não pode parar na era COVID-19: experiência brasileira em treinamento on-line para diretrizes em infecções sexualmente transmissíveis

Introduction: The Brazilian Ministry of Health had planned face-to-face workshops for professional training about the Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections for the year 2020. Due to the COVID-19 pandemic, the workshops were cancelled, and a new strategy was adopted: virtual meetings, called Webinars ­ Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections 2020. Objective: To report the experience at the Ministry of Health in online training about the clinical protocol and therapeutic guidelines for comprehensive care for people sexually transmitted infections for health professionals in 2020. Methods: The webinars were held in partnership with the Brazilian Society of Sexually Transmitted Diseases and the Pan American Health Organization. Each chapter of the Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections ­ 2020 was converted into a webinar, with the participation of at least three experts, two speakers, and a moderator. Results: In total, 16 webinars were presented, covering topics such as sexually transmitted infections surveillance, prevention, diagnosis, treatment, public policies, and sexual violence. The initiative had more than 77,000 hits, with an average of 4,900 hits per webinar and the topic "syphilis" being the most accessed. The event reached all 27 federative units of Brazil, as well as 27 other countries. About 500 questions were received from the audience and answered during the sessions and/or through a document published later on by the Ministry of Health. Conclusion: Given the high number of hits and inquiries received, we can conclude that health professionals remained engaged in the topic of sexually transmitted infections during the pandemic. This experience shows the great potential of innovative methods for distance learning to promote continuing education, including a series of webinars aimed at strengthening the fight against sexually transmitted infections.

Introdução: O Ministério da Saúde do Brasil planejou para o ano de 2020 oficinas presenciais para capacitação profissional sobre o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis. Em função da pandemia de COVID-19, as oficinas foram canceladas, optando-se pela estratégia de encontros virtuais, denominados Webinares ­ Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis ­ 2020. Objetivo: Descrever a experiência do Ministério da Saúde em capacitações on-line para profissionais de saúde no contexto dos Webinares ­ Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis ­ 2020. Métodos: Os webinares foram realizados em parceria com a Sociedade Brasileira de Doenças Sexualmente Transmissíveis e Organização Pan-Americana da Saúde. Cada capítulo do Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis ­ 2020 foi convertido em um webinar, com a participação de pelo menos três especialistas, sendo dois palestrantes e um moderador. Resultados: No total, foram apresentados 16 webinares, que abordaram temas como vigilância, prevenção, diagnóstico, tratamento das infecções sexualmente transmissíveis, políticas públicas e violência sexual. Foram mais de 77 mil acessos, com média de 4.900 acessos por webinar, sendo a que a sífilis foi a temática mais acessada. O evento alcançou todos as 27 unidades federativas do Brasil, bem como outros 27 países. Cerca de 500 perguntas foram recebidas, as quais foram respondidas durante as sessões e/ou por meio de um documento publicado pelo Ministério da Saúde. Conclusão: Dado o elevado número de acessos e questionamentos recebidos, conclui-se que os profissionais da saúde permaneceram engajados no tema infecções sexualmente transmissíveis durante a pandemia. Essa experiência demonstrou o grande potencial de métodos inovadores de ensino à distância para promoção da educação permanente, como a realização de uma série de webinares, visando ao fortalecimento do combate às infecções sexualmente transmissíveis.

Human Papillomavirus infection in oral and anogenital sites: prevalence and rates of concordance / Infecção pelo Papilomavírus Humano em regiões orais e anogenitais: prevalência e taxa de concordância

Introduction: HPV infection causes cancer at several anatomical sites. However, the infection's natural history in non-cervical sites is understudied. Objective: To evaluate oral and anogenital HPV infections, correlating HPV prevalence rates and genotypes with site of infection and risk factors. Methods: In the present study, 351 samples from oral, genital, and anal sites of 117 patients were investigated by using PCR MY09/11 detection, followed by genotyping with RFLP. Results: HPV DNA prevalence was 89.7% (105/117) in genital lesions, 53.8% (63/117) in oral samples, and 58.9% (69/117) in anal samples. Regarding the risk factors associated with HPV in genital lesions, statistically significant rates for oral (p=0.039) and anal sex practices (p=0.0000012) were found. For oral samples, a relevant correlation concerning oral contraceptive use (p=0.039), tobacco smoking (p=0.036), and alcohol use (p=0.0075) were observed; whereas in anal samples, higher risk for HPV infection in patients who reported non-exclusive sexual partners (p=0.013) were found. The presence of viral DNA in all the three sites concurrently was observed in 36.8% of the cases (43/117). Among them, 18% (21/117) presented concordant HPV genotypes, diverging from the literature, and thus corroborating that there is still much to learn about HPV natural history, since different biological behaviors are expected within different populations. Differences in anatomy and physiology of the studied sites can determine different prevalence rates of infection by diverse genotypes. Conclusion: Due to the high prevalence of HPV DNA in extragenital sites, further studies are required to define aspects of HPV natural history among different human anatomical sites.

Introdução: As infecções causadas pelos papilomavírus humanos (HPV) são responsáveis pelo desenvolvimento de cânceres em diversos sítios anatômicos humanos. Entretanto, a história natural da infecção em sítios que não a cérvice uterina não é muito clara. Objetivo: Avaliar infecções orais, genitais e anais por HPV, correlacionando taxas de prevalência do vírus e seus genótipos aos sítios de infecção e a fatores de risco sócio-demográficos. Métodos: Em nosso estudo, investigamos 351 amostras coletadas dos sítios oral, genital e anal de 117 pacientes, por meio da técnica de PCR MY09/11, seguida de genotipagem por RFLP. Todos os pacientes apresentavam lesões genitais benignas. Resultados: A prevalência do HPV foi de 89,7% (105/117) nas lesões genitais, 53,8% (63/117) nas amostras orais e 58,9% (69/117) nas amostras anais. Em relação aos fatores de risco associados à infecção genital, encontramos diferenças estatísticas significativas para prática de sexo oral (p=0,039) e sexo anal (p=0,0000012). Já para as amostras orais, observamos importante correlação entre infecção e uso de contraceptivo oral (p=0,039), tabagismo (p=0,036) e uso de álcool (p=0,0075) enquanto nas amostras anais, alto risco de infecção pelo HPV foi associado a pacientes relatando parceiros sexuais não exclusivos (p=0,013). A presença do DNA viral simultaneamente nos três sítios estudados foi observada em 36,8% dos casos (43/117). Desses, 18% (21/117) apresentaram genótipos concordantes, diferindo da literatura, na qual há grande disparidade de descrições. Conclusão: Há a necessidade de novos estudos a fim de esclarecer a história natural do HPV em sítios extragenitais em diferentes populações, avaliando características anatômicas e fisiológicas com o intuito de esclarecer diferentes taxas de infecção por genótipos do HPV e diferentes processos de doença.

Syphilis, history, science, and arts: syphilis history calendar / Sífilis, história, ciência e artes: calendário da história da sífilis / Sífilis, historia, ciencia y artes: calendario de la historia de la sífilis

Introduction: Syphilis is a very old disease involved by many mysteries. From its origins to the reason why even having simple and effective diagnosis and treatment for more than half a century, it remains, in 2021, as a public health problem practically all over the world. Be it in high-developing countries as well as in developing ones. Objective: To relate and describe, with dating, by day, month and year, in a calendar model, events and important characters that involve studies and quotes about syphilis. Methods: We used the prior personal knowledge of health professionals and researchers, who have worked in the field of sexually transmitted diseases for decades, combined with the search on the Internet, often on Wikipedia and Google, about events and characters involving subjects and publications about syphilis. Results: After several analyses and researches, we listed 68 facts and characters from around the world, including several Brazilians. Conclusion: At a time (2020 and 2021) where the subject, worldwide, on a daily basis, is SARS-CoV-2/COVID-19, this unprecedented publication on facts and characters involving syphilis can be a milestone so that, in addition to technical and scientific knowledge, the academic community realizes the anthropological, sociological, and cultural wealth that involves an entity that is much more than an infectious disease, such as syphilis.

Introdução: Sífilis é uma doença muito antiga envolvida por muitos mistérios. Desde a sua origem até o porquê de mesmo tendo diagnóstico e tratamento simples e eficazes há mais de meio século, se mantém, em 2021, como um problema de saúde pública em praticamente todo o mundo. Seja em países de alto desenvolvimento como naqueles em desenvolvimento. Objetivo: Relacionar e descrever, com datação, por dia, mês e ano, em um modelo de calendário, acontecimentos e personagens marcantes que envolvem estudos e citações sobre a sífilis. Métodos: Usamos o conhecimento prévio pessoal, de profissionais de saúde, de pesquisadores, com atuações na área das doenças sexualmente transmissíveis há décadas, aliado a busca na internet, muitas das vezes em Wikipédia e Google, sobre acontecimentos e personagens que envolvem assuntos e publicações sobre sífilis. Resultados: Depois de várias análises e pesquisas relacionamos 68 fatos e personagens de âmbito mundial, sendo vários brasileiros. Conclusão: Em uma época (2020 e 2021) onde o assunto, em todo o mundo, diuturnamente, é SARS-CoV-2/COVID-19 esta inédita publicação sobre fatos e personagens que envolvem sífilis pode ser um marco para que, além de conhecimentos técnicos e científicos, a comunidade acadêmica se dê conta da riqueza antropológica, sociológica, cultural que envolve uma entidade que é muito mais que uma doença infectocontagiosa, como a sífilis.

Introducción: La sífilis es una enfermedad muy antigua envuelta por muchos misterios. Desde sus orígenes hasta el motivo por el cual aun teniendo un diagnóstico y tratamiento sencillo y eficaz desde hace más de medio siglo, sigue siendo, en 2021, un problema de salud pública prácticamente en todo el mundo. Tanto en países de alto desarrollo como en países en desarrollo. Objetivo: Relacionar y describir, con datación, por día, mes y año, en un modelo de calendario, eventos y personajes importantes que involucran estudios y citas sobre la sífilis. Métodos: Utilizamos el conocimiento personal previo de profesionales e investigadores de la salud, que han trabajado en el campo de las enfermedades de transmisión sexual durante décadas, combinado con la búsqueda en Internet, a menudo en Wikipedia y Google, sobre eventos y personajes que involucran temas y publicaciones sobre sífilis. Resultados: Después de varios análisis e investigaciones, enumeramos 68 hechos y personajes de todo el mundo, incluidos varios brasileños. Conclusión: En un momento (2020 y 2021) donde el tema, a nivel mundial, a diario, es el SARS-CoV-2/COVID-19, esta publicación sin precedentes sobre hechos y personajes relacionados con la sífilis puede ser un hito para que, además Para el conocimiento técnico y científico, la comunidad académica se da cuenta de la riqueza antropológica, sociológica y cultural que involucra a una entidad que es mucho más que una enfermedad infecciosa, como la sífilis.

Brazilian Protocol for Sexually Transmitted Infections, 2020: congenital syphilis and child exposed to syphilis.

The topics of congenital syphilis and children exposed to syphilis compose the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Such document was elaborated based on scientific evidence and validated in discussions with specialists. This article provides guidelines for syphilis in pregnant women and congenital syphilis clinical management, emphasizing the vertical transmission of Treponema pallidum prevention. Epidemiological and clinical aspects of these infections are presented and recommendations for managers in the programmatic and operational management of syphilis. The article also includes guidelines for health professionals in screening, diagnosing, and treating people with sexually transmitted infections and their sex partners, in addition to strategies for surveillance actions, prevention, and control of the disease. Most congenital syphilis cases arise from test failures in prenatal care or inadequate or no treatment of maternal syphilis.

Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis.

The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care of People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020, includes updates concerning acquired syphilis. The document comprises rapid test use, safety and efficacy of benzathine benzylpenicillin, case follow-up, neurosyphilis clinical and laboratory management, approaching sex partners, assistance and monitoring of diagnosed pregnant women, and syphilis and HIV co-infection specificities, as well as a case notification summary. Health managers and professionals must be continuously trained so as to integrate care and surveillance, to strengthen actions for efficient control of syphilis, to broaden the search for sex partners, and to expand access of most vulnerable populations to health services. Most people with syphilis are asymptomatic; this contributes to the maintenance of the transmission chain. Without adequate treatment of pregnant women with syphilis, severe consequences can occur, such as miscarriage, prematurity, low birth weight, natimortality, and congenital syphilis.

[Brazilian Protocol for Sexually Transmitted Infections 2020: congenital syphilis and child exposed to syphilis]. / Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: sífilis congênita e criança exposta à sífilis.

The topics of congenital syphilis and children exposed to syphilis are part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article provides guidelines for clinical management of both syphilis in pregnant women and also congenital syphilis, emphasizing prevention of vertical transmission of Treponema pallidum. Epidemiological and clinical aspects of these infections are presented, as well as recommendations for health service managers regarding the programmatic and operational management of syphilis. The article also includes guidelines for health professionals on screening, diagnosing and treating people with sexually transmitted infections and their sex partners, in addition to strategies for syphilis surveillance, prevention and control actions.

Os temas sífilis congênita e criança exposta à sífilis compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo apresenta orientações para o manejo clínico da sífilis em gestantes e da sífilis congênita, enfatizando a prevenção da transmissão vertical do Treponema pallidum. Nele estão contemplados aspectos epidemiológicos e clínicos desses agravos, bem como recomendações aos gestores no manejo programático e operacional da sífilis. Também se incluem orientações para os profissionais de saúde na triagem, diagnóstico e tratamento das pessoas com infecções sexualmente transmissíveis e suas parcerias sexuais, além de estratégias para ações de vigilância, prevenção e controle da doença.

Los temas sífilis congénita y niños expuestos a la sífilis componen el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Tal documento fue elaborado con base en evidencia científica y validado en discusiones con especialistas. Este artículo presenta directrices para el manejo clínico de la sífilis en mujeres embarazadas y de la sífilis congénita, con énfasis en la prevención de la transmisión vertical del Treponema pallidum. Se contemplan aspectos epidemiológicos y clínicos de la infección, así como recomendaciones para gestores en la gestión programática y operativa de la sífilis. También se incluyen directrices para profesionales de la salud en la detección, diagnóstico y tratamiento de personas con infecciones de transmisión sexual y sus parejas sexuales, además de estrategias para acciones de vigilancia, prevención y control de la enfermedad.

[Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis]. / Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: sífilis adquirida.

The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020, includes the update on acquired syphilis. The document comprises rapid tests use, safety and efficacy of the administration of benzathine benzylpenicillin, follow-up of cases, clinical and laboratory management of neurosyphilis, approach to sexual partnerships, assistance and monitoring of diagnosed pregnant women, and specificities of syphilis and HIV co-infection, as well as a summary of the notification of cases. It is necessary to train health managers and professionals on a continuous basis, with a view to integrating care and surveillance, strengthening effective syphilis control actions, increasing the search for sexual partnerships, and expanding the access of the most vulnerable populations to health services.

O Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020, contempla a atualização sobre sífilis adquirida. O documento apresenta a utilização de testes rápidos, a segurança e a eficácia da administração da benzilpenicilina benzatina, o seguimento dos casos, o manejo clínico e laboratorial da neurossífilis, a abordagem de parcerias sexuais, a assistência e o acompanhamento de gestantes diagnosticadas e as especificidades da coinfecção sífilis e HIV, além de uma síntese sobre a notificação dos casos. É necessário capacitar gestores e profissionais de saúde de forma contínua, com vistas à integração entre assistência e vigilância, ao fortalecimento de ações efetivas de controle da sífilis, à abrangência da busca de parcerias sexuais e ao amplo acesso de populações mais vulneráveis aos serviços de saúde.

El Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020, incluye la actualización sobre la sífilis adquirida. El documento comprende las pruebas rápidas, la seguridad y eficacia de la administración de bencilpenicilina benzatina, el seguimiento de casos, el manejo clínico y de laboratorio de la neurosífilis, el enfoque de las parejas sexuales, la asistencia y seguimiento de embarazadas diagnosticadas y las especificidades de la coinfección sífilis y VIH, bien como un resumen de la notificación de casos. Es necesario capacitar a los gestores y profesionales de la salud de manera continua, con miras a integrar la atención y la vigilancia, a fortalecer las acciones efectivas de control de la sífilis, a expandir la búsqueda de las parejas sexuales y a ampliar el acceso de las poblaciones más vulnerables a los servicios de salud.

Human papillomavirus prevalence, genomic diversity and related risk factors in HIV-positive women from a countryside city in the state of Rio de Janeiro.

Human papillomavirus (HPV) can cause genital warts and HPV-related cancer.People living with human immunodeficiency virus (HIV)are more symptomatic for HPV infections.Campos dos Goytacazes,a municipality of Rio de Janeiro,introduced the quadrivalent HPV vaccine (4vHPV)for HIV-positive women four years before initiation of a public vaccination program.This study analyzed the prevalence of HPV infection in HIV-positive women and the variables associated with infectionTwo groups were evaluated:group 1,with Pap smear and HPV-negative polymerase chain reaction (PCR);group 2, individuals with at least one positive result for HPV in PCR or pap smear.PCR was performed in endocervical samples using generic primers, and the LCD-Array Kit was used for genotyping.Univariate and multivariate analyzes were performed.Results in 109 women (Group 1 n = 70; group 2 n = 39)showed an overall HPV prevalence of 36%.Results also showed that 88% (n = 23) and 96% (n = 25)of typed viruses (total of typed viruses n = 26)were included in 4vHPV and 9vHPV (nonavalent HPV),respectively.In univariate analysis,age less than 45 years, a high number of sexual partners,and HIV-viral load were risk factors for infection.However, a CD4 indicator was associated with protection.Although HIV infection is generally related to multiple and rare types of HPV,this study showed that a vast majority of the HPV types found are included in 4vHPV.Considering that age less than 45 years is a risk factor, the use of 4vHPV in Brazil should be extended in the public vaccination program to HIV seropositive women up to age 45 years.