Comportamiento de las principales infecciones de transmisión sexual bacterianas durante la pandemia por SARS-CoV-2 / Epidemiologic Profile of the Main Bacterial Sexually Transmitted Infections During the SARS-CoV-2 Pandemic

Introducción y objetivo Entre 2020-2021 hemos sufrido una pandemia por el virus SARS-CoV-2. Debido a los cambios sociales por la pandemia, nos hemos propuesto estudiar el comportamiento epidemiológico de las principales infecciones de transmisión sexual (ITS) bacterianas (clamidia, gonorrea y sífilis) durante este periodo y compararlo con periodos previos. Material y método Se recogieron las muestras mensuales de clamidia, gonorrea y sífilis entre los años 2018-2021 y las muestras positivas mensuales de SARS-CoV-2 entre los años 2020-2021 del Hospital General Universitario de Valencia, analizadas por técnica PCR Multiplex. Se recogieron datos clínicos y demográficos de los pacientes con ITS. Resultados Durante los años 2020-2021 (pandemia) se diagnosticaron más casos de ITS total (664) que durante los años 2018-2019 (prepandemia) (570), con tasas de incidencia superiores y tasas de positividad similares. Se ha observado una correlación cronológica negativa entre las muestras positivas de SARS-CoV-2 y las muestras positivas de ITS. La edad media de los pacientes con diagnóstico de clamidia, gonorrea y sífilis fue de 29,64 (IC 95% 19,33-41,14), 30,86 (IC 95% 20,24-42,45) y 37,04 (IC 95% 26,01-51,00) años, respectivamente. El número de casos de clamidia en varones ha aumentado un 13,85% (IC 95% 6,39-21,08; p=0,0003) en los años de pandemia. Conclusión Durante los años de pandemia, ha existido una correlación negativa entre los casos de SARS-CoV-2 y los casos de ITS, con más casos de clamidia en varones. Las ITS han aumentado en los 2 últimos años, por lo que son un importante problema de salud en la población joven y adulta que merece especial atención. (AU)

Introduction and objective The SARS-CoV-2 pandemic brought about social changes in 2020 and 2021. The aim of this study was to evaluate the epidemiologic profiles of the main sexually transmitted infections (STIs) of bacterial origin (chlamydia, gonorrhea, and syphilis) diagnosed during this period and compare them to findings from previous years. Material and methods Drawing on data from Hospital General Universitario in Valencia, Spain, we recorded the number of chlamydia, gonorrhea, and syphilis cases diagnosed monthly by multiplex PCR in 2018-2021 and the number of PCR-confirmed SARS-CoV-2 cases diagnosed monthly in 2020-2021. We also collected clinical and demographic information on all patients diagnosed with STIs during the years studied. Results The total number of STIs diagnosed increased from 570 in 2018-2019 to 664 in 2020-2021. PCR positivity rates were similar in the 2 periods, but the incidence rates were higher during the pandemic. The chronologic correlation between SARS-CoV-2 and STI positivity was negative. Mean age at diagnosis was 29.64 years (95% CI, 19.33-41.14) for chlamydia, 30.86 years (95% CI, 20.24-42.45) for gonorrhea, and 37.04 years (95% CI, 26.01-51.00) for syphilis. The number of men diagnosed with chlamydia increased by 13.85% (95% CI, 6.39-21.08; P=.0003) during the pandemic. Conclusions We observed a negative correlation between SARS-CoV-2 infections and STIs during the pandemic and an increase in chlamydia cases among men. STI cases rose during 2020-2021, indicating that they remain a significant problem that needs to be addressed in young and adult populations. (AU)

[Translated article] Epidemiologic Profile of the Main Bacterial Sexually Transmitted Infections During the SARS-CoV-2 Pandemic / Comportamiento de las principales infecciones de transmisión sexual bacterianas durante la pandemia por SARS-CoV-2

Background and objective The COVID-19 pandemic brought about social changes in 2020 and 2021. The aim of this study was to evaluate the epidemiologic profiles of the main sexually transmitted infections (STIs) of bacterial origin (chlamydia, gonorrhea, and syphilis) diagnosed during this period and compare them to findings from previous years. Material and methods Drawing on data from Hospital General Universitario in Valencia, Spain, we recorded the number of chlamydia, gonorrhea, and syphilis cases diagnosed monthly by multiplex polymerase chain reaction (PCR) in 2018–2021 and the number of PCR-confirmed SARS-CoV-2 cases diagnosed monthly in 2020–2021. We also collected clinical and demographic information on all patients diagnosed with STIs during the years studied. Results The total number of STIs diagnosed increased from 570 in 2018–2019 to 664 in 2020–2021. PCR positivity rates were similar in the 2 periods, but the incidence rates were higher during the pandemic. The chronologic correlation between SARS-CoV-2 and STI positivity was negative. Mean age at diagnosis was 29.64 years (95% CI, 19.33–41.14 years) for chlamydia, 30.86 years (95% CI, 20.24–42.45 years) for gonorrhea, and 37.04 years (95% CI, 26.01–51.00 years) for syphilis. The number of men diagnosed with chlamydia increased by 13.85% (95% CI, 6.39–21.08; p=.0003) during the pandemic.Conclusions We observed a negative correlation between SARS-CoV2 infections and STIs during the pandemic and an increase in chlamydia cases among men. STI cases rose during 2020–2021, indicating that they remain a significant problem that needs to be addressed in young and adult populations. (AU)

Introducción y objetivo Entre 2020-2021 hemos sufrido una pandemia por el virus SARS-CoV-2. Debido a los cambios sociales por la pandemia, nos hemos propuesto estudiar el comportamiento epidemiológico de las principales infecciones de transmisión sexual (ITS) bacterianas (clamidia, gonorrea y sífilis) durante este periodo y compararlo con periodos previos. Material y métodos Se recogieron las muestras mensuales de clamidia, gonorrea y sífilis entre los años 2018-2021 y las muestras positivas mensuales de SARS-CoV-2 entre los años 2020-2021 del Hospital General Universitario de Valencia, analizadas por técnica PCR Multiplex. Se recogieron datos clínicos y demográficos de los pacientes con ITS. Resultados Durante los años 2020-2021 (pandemia) se diagnosticaron más casos de ITS total (664) que durante los años 2018-2019 (prepandemia) (570), con tasas de incidencia superiores y tasas de positividad similares. Se ha observado una correlación cronológica negativa entre las muestras positivas de SARS-CoV-2 y las muestras positivas de ITS. La edad media de los pacientes con diagnóstico de clamidia, gonorrea y sífilis fue de 29,64 (IC 95% 19,33-41,14), 30,86 (IC 95% 20,24-42,45) y 37,04 (IC 95% 26,01-51,00) años, respectivamente. El número de casos de clamidia en varones ha aumentado 13,85% (IC 95% 6,39-21,08; p=0,0003) en los años de pandemia. Conclusiones Durante los años de pandemia ha existido una correlación negativa entre los casos de SARS-CoV-2 y los casos de ITS, con más casos de clamidia en varones. Las ITS han aumentado en los dos últimos años, por lo que son un importante problema de salud en la población joven y adulta que merece especial atención. (AU)

Epidemiologic Profile of the Main Bacterial Sexually Transmitted Infections During the SARS-CoV-2 Pandemic. / Comportamiento de las principales infecciones de transmisión sexual bacterianas durante la pandemia por SARS-CoV-2.

INTRODUCTION AND OBJECTIVE: The SARS-CoV-2 pandemic brought about social changes in 2020 and 2021. The aim of this study was to evaluate the epidemiologic profiles of the main sexually transmitted infections (STIs) of bacterial origin (chlamydia, gonorrhea, and syphilis) diagnosed during this period and compare them to findings from previous years. MATERIAL AND METHODS: Drawing on data from Hospital General Universitario in Valencia, Spain, we recorded the number of chlamydia, gonorrhea, and syphilis cases diagnosed monthly by multiplex PCR in 2018-2021 and the number of PCR-confirmed SARS-CoV-2 cases diagnosed monthly in 2020-2021. We also collected clinical and demographic information on all patients diagnosed with STIs during the years studied. RESULTS: The total number of STIs diagnosed increased from 570 in 2018-2019 to 664 in 2020-2021. PCR positivity rates were similar in the 2 periods, but the incidence rates were higher during the pandemic. The chronologic correlation between SARS-CoV-2 and STI positivity was negative. Mean age at diagnosis was 29.64 years (95% CI, 19.33-41.14) for chlamydia, 30.86 years (95% CI, 20.24-42.45) for gonorrhea, and 37.04 years (95% CI, 26.01-51.00) for syphilis. The number of men diagnosed with chlamydia increased by 13.85% (95% CI, 6.39-21.08; P=.0003) during the pandemic. CONCLUSIONS: We observed a negative correlation between SARS-CoV-2 infections and STIs during the pandemic and an increase in chlamydia cases among men. STI cases rose during 2020-2021, indicating that they remain a significant problem that needs to be addressed in young and adult populations.

Modificación de la prevalencia de genotipos del virus del papiloma humano en los condilomas acuminados tras la instauración de la vacuna profiláctica / Changes in the Prevalence of Human Papillomavirus Genotypes in Genital Warts Since the Introduction of Prophylactic Vaccines

Introducción El condiloma acuminado está causado por el virus del papiloma humano (VPH), cuyos genotipos se han descrito tradicionalmente como de bajo y alto riesgo (AR) oncogénico. Clásicamente, los genotipos más frecuentes son el 6, el 11, el 16 y el 18, incluidos en las dos primeras vacunas desarrolladas. Nuestro objetivo es valorar cambios en la prevalencia de estos genotipos tras 10 años desde la instauración de la vacuna profiláctica en nuestro medio. Material y métodos Se trata de un estudio observacional descriptivo retrospectivo realizado en la UITS de un Servicio de Dermatología entre enero de 2016 y junio de 2019, seleccionando posteriormente a los pacientes diagnosticados de condilomas acuminados. Resultados Se han diagnosticado 362 pacientes con condilomas acuminados, realizándose genotipado en 212 pacientes (58,6%). Se han detectado 32 genotipos distintos, siendo los más frecuentes el 6, el 11, el 16 y el 42. En el 93,9% la detección de VPH fue positiva, detectándose hasta 299 genotipos, lo que corresponde a 1,5 por paciente. En el 26,6% de pacientes se detectaron más de un genotipo distinto de VPH. En el 24,1% se detectó al menos un genotipo de AR. No se observó asociación estadísticamente significativa entre la presencia de un genotipo de AR y las variables estudiadas. En el 91,4% de las lesiones se aisló al menos uno de los cuatro genotipos cubiertos por las dos primeras vacunas desarrolladas. Conclusiones La prevalencia de los genotipos de VPH incluidos en las dos primeras vacunas profilácticas desarrolladas ha disminuido. La implicación de al menos uno de los cuatro genotipos más frecuentes se ha mantenido estable con respecto a hace 10 años. Las infecciones por múltiples genotipos y la presencia de al menos un genotipo de AR oncogénico ha aumentado ligeramente (AU)

Background and objective Genital warts are caused by the human papillomavirus (HPV), whose genotypes have traditionally been classified as low risk or high risk (oncogenic). The first 2 prophylactic vaccines included the most common genotypes at the time: HPV-6, HPV-11, HPV-16, and HPV-18. The aim of this study was to evaluate the prevalence of HPV types in our setting 10 years after the introduction of HPV vaccines. Material and methods Descriptive, observational, retrospective study of patients diagnosed with genital warts at the sexually transmitted infection unit of a dermatology department between January 2016 and June 2019. Results In total, 362 patients were diagnosed with genital warts during the study period, and 212 (58.6%) underwent genotyping. Thirty-two distinct HPV types were observed, the most common being HPV-6, HPV-11, HPV-16, and HPV-42. HPV DNA was detected in 93.9% of the samples analyzed, and there were 299 genotypes (mean, 1.5 per patient). Overall, 26.6% of patients had more than a single HPV genotype, while 24.1% had at least 1 high-risk type. No significant associations were found between the presence of high-risk HPV types and any of the study variables. At least 2 of the 4 HPV types targeted in the original vaccines were detected in 94.1% of lesions. Conclusions Compared to 10 years ago, the prevalences of HPV types included in the first 2 prophylactic vaccines have decreased, while the proportion of patients with at least 1 of the 4 most common types has remained unchanged. We also observed a slight increase in infections with multiple HPV types or at least 1 high-risk type (AU)

[Translated article] Changes in the Prevalence of Human Papillomavirus Genotypes in Genital Warts Since the Introduction of Prophylactic Vaccines / Modificación de la prevalencia de genotipos del virus del papiloma humano en los condilomas acuminados tras la instauración de la vacuna profiláctica

Background and objective Genital warts are caused by the human papillomavirus (HPV), whose genotypes have traditionally been classified as low risk or high risk (oncogenic). The first 2 prophylactic vaccines included the most common genotypes at the time: HPV-6, HPV-11, HPV-16, and HPV-18. The aim of this study was to evaluate the prevalence of HPV types in our setting 10 years after the introduction of HPV vaccines. Material and methods Descriptive, observational, retrospective study of patients diagnosed with genital warts at the sexually transmitted infection unit of a dermatology department between January 2016 and June 2019. Results In total, 362 patients were diagnosed with genital warts during the study period, and 212 (58.6%) underwent genotyping. Thirty-two distinct HPV types were observed, the most common being HPV-6, HPV-11, HPV-16, and HPV-42. HPV DNA was detected in 93.9% of the samples analyzed, and there were 299 genotypes (mean, 1.5 per patient). Overall, 26.6% of patients had more than a single HPV genotype, while 24.1% had at least 1 high-risk type. No significant associations were found between the presence of high-risk HPV types and any of the study variables. At least 2 of the 4 HPV types targeted in the original vaccines were detected in 94.1% of lesions. Conclusions Compared to 10 years ago, the prevalences of HPV types included in the first 2 prophylactic vaccines have decreased, while the proportion of patients with at least 1 of the 4 most common types has remained unchanged. We also observed a slight increase in infections with multiple HPV types or at least 1 high-risk type (AU)

Introducción El condiloma acuminado está causado por el virus del papiloma humano (VPH), cuyos genotipos se han descrito tradicionalmente como de bajo y alto riesgo (AR) oncogénico. Clásicamente, los genotipos más frecuentes son el 6, el 11, el 16 y el 18, incluidos en las dos primeras vacunas desarrolladas. Nuestro objetivo es valorar cambios en la prevalencia de estos genotipos tras 10 años desde la instauración de la vacuna profiláctica en nuestro medio. Material y métodos Se trata de un estudio observacional descriptivo retrospectivo realizado en la UITS de un Servicio de Dermatología entre enero de 2016 y junio de 2019, seleccionando posteriormente a los pacientes diagnosticados de condilomas acuminados. Resultados Se han diagnosticado 362 pacientes con condilomas acuminados, realizándose genotipado en 212 pacientes (58,6%). Se han detectado 32 genotipos distintos, siendo los más frecuentes el 6, el 11, el 16 y el 42. En el 93,9% la detección de VPH fue positiva, detectándose hasta 299 genotipos, lo que corresponde a 1,5 por paciente. En el 26,6% de pacientes se detectaron más de un genotipo distinto de VPH. En el 24,1% se detectó al menos un genotipo de AR. No se observó asociación estadísticamente significativa entre la presencia de un genotipo de AR y las variables estudiadas. En el 91,4% de las lesiones se aisló al menos uno de los cuatro genotipos cubiertos por las dos primeras vacunas desarrolladas. Conclusiones La prevalencia de los genotipos de VPH incluidos en las dos primeras vacunas profilácticas desarrolladas ha disminuido. La implicación de al menos uno de los cuatro genotipos más frecuentes se ha mantenido estable con respecto a hace 10 años. Las infecciones por múltiples genotipos y la presencia de al menos un genotipo de AR oncogénico ha aumentado ligeramente (AU)

Changes in the Prevalence of Human Papillomavirus Genotypes in Genital Warts Since the Introduction of Prophylactic Vaccines. / Modificación de la prevalencia de genotipos del virus del papiloma humano en los condilomas acuminados tras la instauración de la vacuna profiláctica.

BACKGROUND AND OBJECTIVE: Genital warts are caused by the human papillomavirus (HPV), whose genotypes have traditionally been classified as low risk or high risk (oncogenic). The first 2 prophylactic vaccines included the most common genotypes at the time: HPV-6, HPV-11, HPV-16, and HPV-18. The aim of this study was to evaluate the prevalence of HPV types in our setting 10 years after the introduction of HPV vaccines. MATERIAL AND METHODS: Descriptive, observational, retrospective study of patients diagnosed with genital warts at the sexually transmitted infection unit of a dermatology department between January 2016 and June 2019. RESULTS: In total, 362 patients were diagnosed with genital warts during the study period, and 212 (58.6%) underwent genotyping. Thirty-two distinct HPV types were observed, the most common being HPV-6, HPV-11, HPV-16, and HPV-42. HPV DNA was detected in 93.9% of the samples analyzed, and there were 299 genotypes (mean, 1.5 per patient). Overall, 26.6% of patients had more than a single HPV genotype, while 24.1% had at least 1 high-risk type. No significant associations were found between the presence of high-risk HPV types and any of the study variables. At least 2 of the 4 HPV types targeted in the original vaccines were detected in 94.1% of lesions. CONCLUSIONS: Compared to 10 years ago, the prevalences of HPV types included in the first 2 prophylactic vaccines have decreased, while the proportion of patients with at least 1 of the 4 most common types has remained unchanged. We also observed a slight increase in infections with multiple HPV types or at least 1 high-risk type.

El resurgir del linfogranuloma venéreo, una enfermedad que el dermatólogo debería conocer / Resurgence of Lymphogranuloma Venereum: A Disease Dermatologists Need to Know About

El linfogranuloma venéreo (LGV) es una infección de transmisión sexual (ITS) producida por los serovares L1, L2 y L3 de la bacteria Chlamydia trachomatis y cuya incidencia está en aumento. Presentamos una serie de 8 pacientes diagnosticados en nuestra unidad de ITS del servicio de dermatología. La edad de nuestros pacientes es menor que en otras series publicadas y el síntoma más frecuente de presentación es la tumoración adenopática inguinal. El dermatólogo debe conocer esta enfermedad y realizar una correcta toma de muestras para un diagnóstico preciso y un tratamiento precoz (AU)

The incidence of lymphogranuloma venereum (LGV) —a sexually transmitted infection (STI) produced by the L1, L2, and L3 serovars of Chlamydia trachomatis— is increasing. The 8 patients in this case series were diagnosed with LGV in the STI unit of our dermatology department. Our patients were younger than those in previously published case series, and on presentation they most often complained of tumorous masses (lymphadenopathy) in the groin. Dermatologists should be familiar with this disease. Samples must be taken correctly to ensure an accurate diagnosis and early treatment (AU)

Resurgence of Lymphogranuloma Venereum: A Disease Dermatologists Need to Know About. / El resurgir del linfogranuloma venéreo, una enfermedad que el dermatólogo debería conocer.

The incidence of lymphogranuloma venereum (LGV) -a sexually transmitted infection (STI) produced by the L1, L2, and L3 serovars of Chlamydia trachomatis- is increasing. The 8 patients in this case series were diagnosed with LGV in the STI unit of our dermatology department. Our patients were younger than those in previously published case series, and on presentation they most often complained of tumorous masses (lymphadenopathy) in the groin. Dermatologists should be familiar with this disease. Samples must be taken correctly to ensure an accurate diagnosis and early treatment.

Puntos blanquecinos como clave diagnóstica de condilomas planos: reporte de 5 casos / Whitish Dots Provide the Key to Diagnosing Condyloma Lata: A Report of 5 Cases

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Asociación entre penfigoide ampolloso e inhibidores de la dipeptidilpeptidasa-4: estudio de cohortes retrospectivo / Association Between Bullous Pemphigoid and Dipeptidyl Peptidase 4 Inhibitors: A Retrospective Cohort Study

ANTECEDENTES: La asociación entre los inhibidores de la dipeptidil peptidasa 4 (iDPP-4) y el penfigoide ampolloso (PA) se ha demostrado en varios estudios. El objetivo principal de este estudio era estimar el uso del tratamiento con iDPP-4i en pacientes diagnosticados de PA en nuestro entorno. MATERIAL Y MÉTODOS: Seleccionamos pacientes diagnosticados histológicamente de PA en nuestro departamento entre octubre de 2015 y octubre de 2018. Realizamos una revisión retrospectiva para evaluar los datos clínicos-epidemiológicos y los patrones de inmunofluorescencia directa (IFD). RESULTADOS: De los 70 pacientes diagnosticados con PA durante el período de estudio, el 50% eran diabéticos y el 88,57% de ellos estaban siendo tratados con un iDPP-4 en el momento del diagnóstico de PA. El iDPP-4 más frecuente era la linagliptina (utilizada en el 18,6% de los pacientes), seguida de la vildagliptina (el 17,1%). La mediana de tiempo de latencia entre el inicio del tratamiento con iDPP-4 y el diagnóstico de PA fue de 27,5 meses, siendo de 16 meses para la linagliptina y 39 meses para la vildagliptina (log Rank < 0,01). La IFD fue negativaUn resultado negativo de DIF fue significativamente más común en pacientes que no fueron tratados con un DPP-4i. El patrón DIF más fuertemente (y significativamente) asociado con el tratamiento con DPP-4i fueron los depósitos lineales de inmunoglobulina G a lo largo de la unión dermoepidérmica. El tratamiento con DPP-4i se retiró en el 87% de los pacientes y el 96% de ellos logró una respuesta completa. CONCLUSIÓN: El tratamiento con DPP-4i es muy común en pacientes con BP en nuestro entorno. El período de latencia entre el inicio del tratamiento y el inicio de la PA parece ser más corto con linagliptina que con otros tipos de gliptinas. Los pacientes que reciben tratamiento con DPP-4i pueden mostrar patrones DIF diferentes a los que no reciben tratamiento

BACKGROUND: The association between dipeptidyl peptidase 4 inhibitors (DPP-4i) and bullous pemphigoid (BP) has been demonstrated in several studies. The main aim of this study was to estimate the use of DPP-4i treatment in patients diagnosed with BP in our setting. METHODS: We selected patients histologically diagnosed with BP in our department between October 2015 and October 2018 and performed a retrospective chart review to assess clinical and epidemiological data and direct immunofluorescence (DIF) patterns. RESULTS: Of the 70 patients diagnosed with BP during the study period, 50% were diabetic and 88.57% of these were being treated with a DPP-4i when diagnosed with BP. The most common DPP-4i was linagliptin (used in 18.6% of patients), followed by vildagliptin (17.1%). The median latency period between initiation of DPP-4i treatment and diagnosis of BP was 27.5 months for all treatments, 16 months for linagliptin, and 39 months for vildagliptin (log rank < 0.01). A negative DIF result was significantly more common in patients not being treated with a DPP-4i. The DIF pattern most strongly (and significantly) associated with DPP-4i treatment was linear immunoglobulin G deposits along the dermal-epidermal junction. DPP-4i treatment was withdrawn in 87% of patients and 96% of these achieved a complete response. CONCLUSIONS: DPP-4i treatment is very common in patients with BP in our setting. The latency period between start of treatment and onset of BP seems to be shorter with linagliptin than with other types of gliptins. Patients receiving DPP-4i treatment may show different DIF patterns to those not receiving treatment

Utilidad de las nuevas pruebas treponémicas automatizadas en el diagnóstico de la sífilis precoz. A propósito de 15 casos / Usefulness of New Automated Treponemal Tests in the Diagnosis of Early Syphilis: A Series of 15 Cases

INTRODUCCIÓN: La sífilis es una infección de transmisión sexual (ITS) producida por el Treponema pallidum subespecie pallidum, bacteria difícil de cultivar por lo que se requieren técnicas serológicas para su diagnóstico. La aparición de nuevas pruebas treponémicas (PT) automatizadas ha supuesto un cambio en el algoritmo diagnóstico de la sífilis, el cual tradicionalmente se iniciaba con una prueba no treponémica (PNT). Presentamos 15 casos de sífilis primarias detectadas gracias a la utilización de las nuevas PT automatizadas y realizamos una revisión de las técnicas microbiológicas en el diagnóstico de la sífilis precoz. MATERIAL Y MÉTODOS: Se recogieron todos los casos de sífilis diagnosticados en nuestro servicio desde enero de 2013 hasta septiembre de 2018. Se seleccionaron los pacientes con PNT negativas, Rapid Plasma Reagin (RPR) en particular. RESULTADOS: De un total de 158 pacientes diagnosticados de sífilis en este periodo, 15 presentaron PNT (RPR) negativas y de estos 15, todos excepto uno presentaron PT positivas. Catorce casos eran varones, con un rango de edad desde 22 a 60 años. Además, a 8 pacientes se les realizó reacción en cadena de la polimerasa (PCR) del exudado de la úlcera, siendo en todos ellos positiva. Los 15 pacientes fueron tratados con una dosis única de penicilina G benzatina 2,4 MUI. CONCLUSIÓN: resaltamos la utilidad de las nuevas técnicas serológicas automatizadas, Chemiluminiscence Inmunoassay (CLIA) y Automated Treponema Pallidum Enzime linked Inmunoassay (EIA) y apoyamos su implantación como pruebas de screening en el diagnóstico de sífilis, dado su sensibilidad diagnóstica, su rapidez y su bajo coste

BACKGROUND: Syphilis is a sexually transmitted infection caused by Treponema pallidum, subspecies pallidum. As these bacteria are difficult to culture, syphilis must be diagnosed by serologic testing. The introduction of automated treponemal tests has led to changes in the traditional diagnostic algorithm for syphilis, which began with a nontreponemal test. We present 15 cases of primary syphilis detected using these new tools and review the microbiologic techniques used for the diagnosis of early syphilis. MATERIAL AND METHODS: We examined all cases of syphilis diagnosed in our department between January 2013 and September 2018 and selected patients with negative nontreponemal (rapid plasma reagin [RPR]) tests. RESULTS: Of the 158 patients diagnosed with syphilis during the study period, 15 had a negative RPR test, and 14 of them had a positive treponemal test. Fourteen of the patients were men and ages ranged from 22 to 60 years. Polymerase chain reaction was used to detect T pallidum in the lesion exudate from 8 patients and was positive in all cases. The 15 patients were treated with a single injection of 2.4 million units of benzathine penicillin G. CONCLUSIÓN: Chemiluminescence immunoassays and T pallidum automated enzyme-linked immunoassays are useful in the diagnosis of early syphilis, and we believe that they should be adopted as screening tools given their diagnostic sensitivity, speed, and low cost

Infecciones genitales por virus herpes tipo 1 y virus herpes tipo 2 en Valencia, España: estudio observacional retrospectivo / Genital Infection With Herpes Simplex Virus Type 1 and Type 2 in Valencia, Spain: A Retrospective Observational Study

INTRODUCCIÓN Y OBJETIVO: Se ha constatado un cambio en la epidemiología del herpes genital en los últimos años con un aumento de la incidencia del virus herpes (VHS) tipo 1. El objetivo de nuestro estudio es analizar las características clínico-epidemiológicas de los pacientes diagnosticados de un herpes genital. MATERIAL Y MÉTODOS: Se diseñó un estudio observacional retrospectivo donde se incluyeron todos los pacientes diagnosticados de herpes genital entre enero de 2016 y enero de 2019 en una Unidad de Infecciones de Transmisión Sexual (ITS) en Valencia, España. RESULTADOS: Se diagnosticaron 895 ITS, de las cuales 126 fueron un herpes genital (14%), 68 (54%) en mujeres y 58 (46%) en hombres. En 110 de ellos (87,3%) se confirmó el herpes genital por la detección de ADN viral por técnicas moleculares. Se diagnosticaron 52 casos de VHS tipo 1 (47,3%) y 58 casos de VHS tipo 2 (52,7%). En el 69,5% de los hombres se detectó el VHS tipo 2, mientras que en el 59,3% de las mujeres se detectó el VHS tipo 1. La edad media de las mujeres diagnosticadas de VHS tipo 1 fue de 26 años, mientras que la de las mujeres diagnosticadas de VHS tipo 2 fue de 34 años (p = 0,015). Las recurrencias de las lesiones en los pacientes con VHS tipo 1 y VHS tipo 2 fue del 13% y del 40%, respectivamente. CONCLUSIÓN: Destacamos un aumento de la prevalencia del VHS tipo 1 en nuestro medio como agente causante de herpes genital, especialmente en mujeres jóvenes. Esto tiene un valor pronóstico importante dado el menor riesgo de recurrencias que tiene

INTRODUCTION AND OBJECTIVE: The epidemiology of genital herpes has changed in recent years with an increase in the incidence of herpes simplex virus type 1 (HSV-1) infection. The aim of this study was to analyze the clinical and epidemiological characteristics of patients diagnosed with genital herpes. MATERIAL AND METHODS: A retrospective observational study was designed. All patients diagnosed with genital herpes between January 2016 and January 2019 in a Sexually Transmitted Infections Unit (ITS) in Valencia, Spain, were included. RESULTS: We identified 895 STI diagnoses. Of these, 126 (14%) were genital herpes; 68 (54%) of these cases were in women and 58 (46%) in men. Diagnosis was confirmed by molecular detection of HSV DNA in 110 cases (87.3%). Of these, 52 were cases of HSV-1 infection (47.3%) and 58 were HSV-2 infection (52.7%). HSV-2 was more common in men (69.5%), while HSV-1 was more common in women (59.3%). In the subgroup of women, mean age at diagnosis was 26 years for HSV-1 and 34 years for HSV-2 (P = .015). Recurrent genital herpes rates were 13% for HSV-1 and 40% for HSV-2. CONCLUSIONS: There has been an increase in the number of cases of genital herpes caused by HSV-1 in our setting, with young women in particular being affected. This has important prognostic implications because genital herpes caused by HSV-1 is less likely to recur

Usefulness of New Automated Treponemal Tests in the Diagnosis of Early Syphilis: A Series of 15 Cases. / Utilidad de las nuevas pruebas treponémicas automatizadas en el diagnóstico de la sífilis precoz. A propósito de 15 casos.

BACKGROUND: Syphilis is a sexually transmitted infection caused by Treponema pallidum, subspecies pallidum. As these bacteria are difficult to culture, syphilis must be diagnosed by serologic testing. The introduction of automated treponemal tests has led to changes in the traditional diagnostic algorithm for syphilis, which began with a nontreponemal test. We present 15 cases of primary syphilis detected using these new tools and review the microbiologic techniques used for the diagnosis of early syphilis. MATERIAL AND METHODS: We examined all cases of syphilis diagnosed in our department between January 2013 and September 2018 and selected patients with negative nontreponemal (rapid plasma reagin [RPR]) tests. RESULTS: Of the 158 patients diagnosed with syphilis during the study period, 15 had a negative RPR test, and 14 of them had a positive treponemal test. Fourteen of the patients were men and ages ranged from 22 to 60 years. Polymerase chain reaction was used to detect T pallidum in the lesion exudate from 8 patients and was positive in all cases. The 15 patients were treated with a single injection of 2.4 million units of benzathine penicillin G. CONCLUSION: Chemiluminescence immunoassays and T pallidum automated enzyme-linked immunoassays are useful in the diagnosis of early syphilis, and we believe that they should be adopted as screening tools given their diagnostic sensitivity, speed, and low cost.

Association Between Bullous Pemphigoid and Dipeptidyl Peptidase 4 Inhibitors: A Retrospective Cohort Study. / Asociación entre penfigoide ampolloso e inhibidores de la dipeptidilpeptidasa-4: estudio de cohortes retrospectivo.

BACKGROUND: The association between dipeptidyl peptidase 4 inhibitors (DPP-4i) and bullous pemphigoid (BP) has been demonstrated in several studies. The main aim of this study was to estimate the use of DPP-4i treatment in patients diagnosed with BP in our setting. METHODS: We selected patients histologically diagnosed with BP in our department between October 2015 and October 2018 and performed a retrospective chart review to assess clinical and epidemiological data and direct immunofluorescence (DIF) patterns. RESULTS: Of the 70 patients diagnosed with BP during the study period, 50% were diabetic and 88.57% of these were being treated with a DPP-4i when diagnosed with BP. The most common DPP-4i was linagliptin (used in 18.6% of patients), followed by vildagliptin (17.1%). The median latency period between initiation of DPP-4i treatment and diagnosis of BP was 27.5 months for all treatments, 16 months for linagliptin, and 39 months for vildagliptin (log rank < 0.01). A negative DIF result was significantly more common in patients not being treated with a DPP-4i. The DIF pattern most strongly (and significantly) associated with DPP-4i treatment was linear immunoglobulin G deposits along the dermal-epidermal junction. DPP-4i treatment was withdrawn in 87% of patients and 96% of these achieved a complete response. CONCLUSIONS: DPP-4i treatment is very common in patients with BP in our setting. The latency period between start of treatment and onset of BP seems to be shorter with linagliptin than with other types of gliptins. Patients receiving DPP-4i treatment may show different DIF patterns to those not receiving treatment.

Genital Infection With Herpes Simplex Virus Type 1 and Type 2 in Valencia, Spain: A Retrospective Observational Study. / Infecciones genitales por virus herpes tipo 1 y virus herpes tipo 2 en Valencia, España: estudio observacional retrospectivo.

INTRODUCTION AND OBJECTIVE: The epidemiology of genital herpes has changed in recent years with an increase in the incidence of herpes simplex virus type 1 (HSV-1) infection. The aim of this study was to analyze the clinical and epidemiological characteristics of patients diagnosed with genital herpes. MATERIAL AND METHODS: A retrospective observational study was designed. All patients diagnosed with genital herpes between January 2016 and January 2019 in a Sexually Transmitted Infections Unit (ITS) in Valencia, Spain, were included. RESULTS: We identified 895 STI diagnoses. Of these, 126 (14%) were genital herpes; 68 (54%) of these cases were in women and 58 (46%) in men. Diagnosis was confirmed by molecular detection of HSV DNA in 110 cases (87.3%). Of these, 52 were cases of HSV-1 infection (47.3%) and 58 were HSV-2 infection (52.7%). HSV-2 was more common in men (69.5%), while HSV-1 was more common in women (59.3%). In the subgroup of women, mean age at diagnosis was 26 years for HSV-1 and 34 years for HSV-2 (P=.015). Recurrent genital herpes rates were 13% for HSV-1 and 40% for HSV-2. CONCLUSIONS: There has been an increase in the number of cases of genital herpes caused by HSV-1 in our setting, with young women in particular being affected. This has important prognostic implications because genital herpes caused by HSV-1 is less likely to recur.

La sífilis sigue sin control sanitario en nuestra sociedad: ¿qué debemos hacer los dermatólogos? / Syphilis Epidemic Still Uncontrolled in our Society: What Should Dermatologists Do?

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