Influence of gender on clinical presentation, management practices and outcomes of ocular syphilis.

Ocular syphilis is a re-emerging inflammatory eye disease with a clear gender imbalance, disproportionately affecting men. We investigated the impact of gender on the presentation, management practices and clinical outcomes of this condition. Data generated from a study of patients consecutively diagnosed with ocular syphilis who attended a subspecialist uveitis service at one of four hospitals in Brazil over a 30-month period were disaggregated for analysis by gender. Two-hundred and fourteen eyes (161 men and 53 women) of 127 patients (96 men and 31 women) were included. Posterior uveitis was the most common presentation in both men and women (80.1% vs. 66.7%, p > 0.05), but men were significantly more likely to have vitritis as a feature of their disease (49.4% versus 28.8%, p = 0.019). Three eyes of women had nodular anterior scleritis (p = 0.015). Men were more likely to undergo a lumbar puncture to assess for neurosyphilis (71.9% vs. 51.6%, p = 0.048), but men and women undergoing a lumbar puncture were equally likely to have a cerebrospinal fluid abnormality (36.2% vs. 25.0%, p = 0.393). All patients were treated with aqueous penicillin G or ceftriaxone, and there was a trend towards more men receiving adjunctive systemic corticosteroid treatment as part of their management (65.2% vs. 46.7%, p = 0.071). There were no significant differences in the age of presentation, bilaterality of disease, anatomical classification of uveitis, initial or final visual acuity, and rates of ocular complications between men and women. Our findings indicate that ocular syphilis has comparable outcomes in men and women, but that there are differences in the type of ocular inflammation and management practices between the genders.

Clinical characteristics and outcomes of people living with HIV and ocular syphilis during the COVID-19 health emergency.

BACKGROUND: The global shift in healthcare during the COVID-19 pandemic led to challenges in the care of people living with HIV. METHODS: We conducted a retrospective study that aimed to delineate sociodemographic, clinical characteristics and outcomes, of people living with HIV diagnosed with ocular syphilis. RESULTS: Fifty-three people living with HIV were identified with ocular syphilis. Thirty-eight (71.6%) presented ocular symptoms. Twenty-three (43.3%) underwent lumbar puncture, 5 (9.4%) were positive for neurosyphilis. Forty-seven (88.6%) received treatment, 32 (68%) received standard treatment with aqueous crystalline penicillin G, and 15 (31.9%) were treated with alternative regimens due to the impossibility of hospitalization. Six (11.3%) individuals were lost to follow-up and/or did not receive treatment. Eighteen (56.2%) out of 32 individuals in the aqueous crystalline penicillin G group experienced serological response, 5 (15.6%) experienced treatment failure, and 9 (28.1%) were lost to follow-up. In the alternative therapy group, 12 out of 15 individuals (80%) experienced serological response. One (6.7%) experienced treatment failure, and 2 (13.3%) were lost to follow-up. CONCLUSIONS: During the COVID-19 health emergency in Mexico, alternative treatments for ocular syphilis demonstrated favorable clinical outcomes amid challenges in accessing hospitalization.

Doubts about the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service.

This cross-sectional study aims to describe doubts regarding the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service. All teleconsultations (TCs) offered through TelessaúdeRS-UFRGS to primary health care (PHC) services in the state of Rio Grande do Sul between 2018 and 2021 involving syphilis in pregnancy were included. A total of 356 (TCs) were analyzed. The main doubts about syphilis during pregnancy raised by primary care professionals were related to the need for retreatment (35%), diagnostic definition (23%) and initial treatment (16%). In addition, 95% of TCs were suitable for diagnosing and treating syphilis based on the 2020 Brazilian Ministry of Health guideline. This study suggests that TCs can identify failures in the diagnosis and treatment of public health problems and support decision making in PHC involving syphilis in pregnancy.

Typing of Treponema pallidum in a Brazilian sample and follow-up of treatment using molecular assays.

Syphilis remains a significant public health concern, with serological assays being the primary method for diagnosis. However, molecular techniques have proven to be reliable tools for the diagnosis and understanding of the transmission dynamics of Treponema pallidum infection. This study aimed to evaluate the efficacy of syphilis treatment using molecular assays, perform Enhanced Centers for Disease Control and Prevention (ECDC) typing, and analyze resistance (macrolide and doxycycline) in the T. pallidum isolate. PCR assay amplified treponemal DNA only from the lesion sample, whereas qPCR was able to amplify DNA in both lesion and blood samples before treatment. Throughout the treatment follow-up, qPCR effectively did not identify treponemal DNA in the blood for up to one to two weeks after treatment. ECDC typing revealed the genotype 14 e/g in the Brazilian T. pallidum isolate, and the presence of the A2058G mutation in 23 S rRNA gene, indicating macrolide resistance. Although, the G1058C mutation in 16 S rRNA gene was not detected. Notably, qPCR demonstrated its potential for diagnosing T. pallidum in blood samples, even when the treponemal DNA levels were low, enabling more accurate and sensitive diagnosis and guiding better syphilis therapy. In addition, to the best of our knowledge, this study represents the first identification of subtype 14 e/g and azithromycin resistance in a Brazilian T. pallidum isolate.

Presentaciones de la sífilis anorrectal: la gran simuladora / Anorectal syphilis presentations: the great pretender

Antecedentes: La sífilis es una infección sexualmente transmisible sistémica crónica que afecta a docenas de millones de personas al año. A nivel anorrectal, su manifestación polimórfica obliga al diagnóstico diferencial con enfermedades anorrectales benignas y malignas. Objetivo: Describir las diferentes presentaciones de la sífilis anorrectal a propósito de 5 casos clínicos. Método: Estudio observacional, retrospectivo, descriptivo. Resultados: La mayoría de los pacientes fueron VIH positivos en edad sexual activa. Las manifestaciones registradas, al igual que las reportadas en la bibliografía fueron las fisuras, úlceras perianales y pseudotumores. Conclusiones: La sífilis es considerada "la gran simuladora". En la localización anorrectal se requiere una alta sospecha diagnóstica para diferenciarla de presentaciones similares de otras enfermedades anales benignas, la enfermedad inflamatoria intestinal y el cáncer anorrectal, con el fin de evitar el consiguiente riesgo de sobretratamiento. (AU)

Background: Syphilis is a chronic systemic sexually transmitted infection that affects tens of millions of people annually. At the anorectal level, its polymorphic manifestation requires differential diagnosis with benign and malignant anorectal diseases. Objective: To review the presentation of anorectal syphilis from 5 clinical cases. Methods: Observational, retrospective, descriptive study. Results: Most of the patients were HIV positive in sexually active age. The manifestations recorded and reported in the literature were fissures, perianal ulcers, and pseudotumors. Conclusions: Syphilis is considered "the great pretender". In anorectal syphilis, a high diagnostic suspicion is needed to differentiate it from similar presentations due to other anal conditions, inflammatory bowel disease, and anorectal cancer, to avoid the consequent risk of overtreatment. (AU)

[Syphilis in Argentina]. / Sífilis en Argentina.

Syphilis is a disease preventable through sexual protection barriers, and curable with a simple treatment. Despite this, between 2010 and 2019, its incidence almost tripled in Argentina, reaching 56.1/100 000. The most affected are young people (15-24 years old), with a higher percentage of women, especially among pregnant women, in whom it increased from 2.3% to 5.8%, with a peak of 7.7% between 15 and 24 years old. Cases of secondary or tertiary syphilis, detected by control tests, are on the rise. The increase in syphilis is linked to HIV. For this reason, rapid detection tests must be carried out jointly at the first level of care, which facilitates access to the diagnosis and treatment of positive cases, with the corresponding guidance and control. Treatment with penicillin, for which no resistance has been found, is the key component of control. Doxycillin is also used (not in pregnant women), or ceftriaxone. The resistance of Treponema pallidum to azithromycin is increasing, so its use should be avoided. In 2022, 696 cases of congenital syphilis were reported. The national rate is 1.3 per 1000 live births. The majority of reported cases come from the public sector. Maternal syphilis is, in low-income areas, the most common cause of stillbirths. Strict application of existing regulations, strengthening the primary care system, and prevention during pregnancy can contribute to controlling and eliminating the syphilis problem in Argentina.

La sífilis es una enfermedad prevenible mediante barreras de protección sexual, y curable por un sencillo tratamiento. A pesar de esto, entre 2010 y 2019, su incidencia casi se triplicó en Argentina, alcanzando 56.1/100 000. Los más afectados son los jóvenes (15-24 años), con mayor porcentaje de mujeres, especialmente entre las embarazadas, en que aumentó de 2.3% a 5.8%, con un pico de 7.7% entre 15 y 24 años. Los casos de sífilis secundaria o terciaria, detectados por pruebas de control, están en aumento. El aumento de sífilis va unido al HIV. Por ello las pruebas rápidas de detección deben hacerse conjuntamente en el primer nivel de atención, lo que facilita el acceso al diagnóstico y al tratamiento de los casos positivos, con la orientación y control correspondientes. El tratamiento con penicilina, para la que no se ha hallado resistencia, es el componente clave del control. También se usa doxicilina (no en embarazadas), o ceftriaxona. Está aumentando la resistencia del Treponema pallidum a la azitromicina, por lo que debe evitarse su empleo. En 2022 se notificaron 696 casos de sífilis congénita. La tasa de nacional es 1.3 por 1000 nacidos vivos. La mayoría de los casos notificados provienen del sector público. La sífilis materna es, en áreas de bajos recursos, la causa más común de nacidos muertos. La aplicación estricta de las normas existentes, el fortalecimiento del sistema de atención primaria, y la prevención durante el embarazo, pueden contribuir a controlar y eliminar el problema de la sífilis en Argentina.

[Syphilis: uncommon presentation forms]. / Sífilis: formas de presentación poco frecuentes.

Uncommon forms of syphilis exist, among which neurosyphilis, otosyphilis, and ocular syphilis are included. Neurosyphilis is the infection of the central nervous system caused by Treponema pallidum. The clinical manifestations of neurosyphilis are diverse and include early, late, and atypical forms. Syphilis can affect virtually any ocular structure and can occur at any stage of the disease, as well as otosyphilis. The diagnosis of these conditions is often challenging. However, it is important to consider them as a differential diagnosis, as most of these clinical manifestations are reversible with appropriate antibiotic treatment. A case series study of patients diagnosed with neurosyphilis, otosyphilis, and ocular syphilis, who were admitted to a tertiary-level hospital, is here presented: syphilitic meningitis with cranial nerve involvement, and seizures (case 1), ocular syphilis (case 2), general paresis (case 3), and tabes dorsalis (case 4). Half of the patients presented bilateral sensorineural hearing loss; and also half of the patients had reactive VDRL in cerebrospinal fluid. All were treated with aqueous penicillin G, and in two of these cases, ceftriaxone was chosen to complete ambulatory treatment. One patient had an unfavorable outcome and died (case 1); another was lost in follow-up (case 4); one completely resolved his symptoms (case 2); and another one experienced symptom relapse six months after treatment (case 3).

Existen formas de presentación poco frecuentes de sífilis, dentro de las cuales se incluyen la neurosífilis, otosífilis y sífilis ocular. La neurosífilis es la infección del sistema nervioso central por Treponema pallidum. Las manifestaciones clínicas de neurosífilis son variadas e incluyen formas tempranas, tardías y atípicas. Además, la sífilis puede comprometer prácticamente cualquier estructura ocular, en cualquier etapa de la enfermedad, como así también la otosífilis. El diagnóstico de estas entidades suele ser dificultoso. Sin embargo, resulta importante considerarlas como diagnósticos diferenciales, ya que la mayoría de estas manifestaciones son reversibles con tratamiento antibiótico adecuado. Se presenta una serie de casos de pacientes con diagnóstico de neurosífilis, otosífilis y sífilis ocular, que cursaron internación en un hospital de tercer nivel: meningitis sifilítica con compromiso de pares craneales y convulsiones (caso 1), sífilis ocular (caso 2), paresis general (caso 3) y tabes dorsalis (caso 4). La mitad de los pacientes presentó hipoacusia neurosensorial bilateral. El 50% presentó VDRL reactiva en líquido cefalorraquídeo. Todos fueron tratados con penicilina G sódica y en el 50% se optó por el uso de ceftriaxona como modalidad para finalizar el tratamiento en internación domiciliaria. Respecto a la evolución de los pacientes, uno de ellos falleció como consecuencia del cuadro de neurosífilis (caso 1), otro se perdió en el seguimiento (caso 4) mientras que, de los dos restantes, el caso 3 presentó recaída de su enfermedad a los 6 meses del tratamiento y el caso 2 resolvió ad integrum su sintomatología.

[Ocular syphilis: alert for clinicians and ophthalmologists]. / Sífilis ocular: alerta para clínicos y oftalmólogos.

Syphilis is an infectious disease caused by the spirochete Treponema pallidum. It can cause ocular compromise at any stage, in immunocompetent or immunocompromised patients. Even though the ocular form is not frequent, due to the increase in the incidence of syphilis in recent years, it is mandatory to take it into consideration as a differential diagnosis in visual disorders. The most common clinical presentation is uveitis. Diagnosis is based on the presence of clinical signs and symptoms consistent with ophthalmologic involvement in a patient with syphilis. The CSF study should be performed on a clinical basis, to rule out concomitant neurological involvement. We present 5 cases of ocular syphilis, its clinical manifestations, treatment and evolution.

La sífilis es una enfermedad infecciosa causada por la espiroqueta Treponema pallidum. Puede producir compromiso ocular en cualquier estadio, en pacientes inmunocompetentes o inmunocomprometidos. Si bien la frecuencia de presentación de la forma ocular no es alta, debido al aumento de la incidencia de sífilis en los últimos años, es necesario tenerla en cuenta como diagnóstico diferencial en los trastornos visuales. La presentación clínica más frecuente es la uveítis. Se objetiva ante la presencia de signos y síntomas clínicos consistentes con afectación oftalmológica en un paciente con sífilis. El estudio del LCR debe realizarse ante la sospecha clínica, para descartar compromiso neurológico concomitante. Comunicamos 5 casos de sífilis ocular, sus manifestaciones clínicas, tratamiento y evolución.

Vision-related quality of life in patients treated for ocular syphilis.

Multiple studies have showed negative impact of non-infectious uveitis on quality of life (QoL). Less is understood regarding life experiences in patients with infectious uveitis. We investigated vision-related QoL in individuals who had recovered from ocular syphilis. 32 adults treated for ocular syphilis at a uveitis service in Brazil completed the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), and a comprehensive ophthalmic examination was performed. Medical records were reviewed to confirm resolution of ocular inflammation for 3 months pre-enrolment, and collect clinical data. The NEI VFQ-25 composite score was low overall (75.5 ± 19.8, mean ± standard deviation), and subscale scores varied from relative lows of 59.1 ± 39.6 (driving) and 60.9 ± 24.5 (mental health), to relative highs of 84.8 ± 21.8 (ocular) and 89.1 ± 21.0 (color vision). Adults aged over 40 years and those with a final visual acuity of 20/50 or worse had significantly lower mean composite and subscale scores. Other clinical characteristics-including gender, HIV co-infection, and type of uveitis-did not significantly influence scores. Our findings, taken in context with previous observations that prompt recognition achieves better vision outcomes, suggest early treatment may improve QoL after recovery from ocular syphilis.

Prevalencia de sífilis gestacional y congénita en una maternidad pública de Montevideo, Uruguay, en los años 2018 y 2019 / Prevalence of gestational and congenital syphilis in a public maternity hospital in Montevideo, Uruguay, in 2018 and 2019

INTRODUCCIÓN: Pese a que la sífilis congénita es prevenible, la transmisión materno infantil es un problema de salud mundial. OBJETIVO: Determinar la prevalencia de sífilis gestacional activa y la prevalencia de sífilis congénita en el período comprendido entre 1 de enero de 2018 y 31 de diciembre de 2019 en la maternidad de referencia del sector público de Uruguay. METODOLOGÍA: Trabajo observacional, descriptivo y transversal. RESULTADOS: Se revisaron 11.949 historias clínicas siendo seleccionadas 107 pacientes en el año 2018 y 142 pacientes en el año 2019 que cumplían criterios de inclusión. La prevalencia calculada de sífilis gestacional fue de 20,8 cada 1.000 mujeres embarazadas (249/11.949), la incidencia de sífilis congénita fue de 1,0 cada 1.000 nacidos vivos (12/11.949). La mortalidad en ambos períodos fue de 0%. CONCLUSIONES: La prevalencia de sífilis gestacional aumentó en el período 2018-2019. Esta tendencia es consonante con el aumento de la prevalencia mundial. La prevalencia obtenida de 20,8 cada 1.000 mujeres embarazadas es alta de forma comparativa con los datos nacionales, a diferencia de la incidencia de sífilis congénita (1,0/1.000) inferior a las nacionales que oscilaban de 1,4 a 2,2 cada 1.000 nacidos vivos en los últimos años.

BACKGROUND: Although congenital syphilis is preventable, mother-to-child transmission is a worldwide health problem. AIM: To determine the prevalence of active gestational syphilis and the prevalence of congenital syphilis in the period between January 1, 2018 and December 31,2019 in the reference maternity unit of the public sector of Uruguay. METHODS: Observational, descriptive and cross-sectional work. RESULTS: 11,949 medical records were analyzed, 107 patients were selected in 2018 and 142 patients in 2019 who met the inclusion criteria. The calculated prevalence of gestational syphilis was 20.8 per 1000 pregnant women (249/11949), the incidence of congenital syphilis was 1.0 per 1,000 live births (12/11949). Mortality was 0% in both periods. CONCLUSIONS: The prevalence of gestational syphilis increased in the 2018-2019 period. This trend is consistent with the increase in prevalence worldwide. The prevalence obtained 20.8 per 1,000 pregnant women is high compared to national data, unlike the incidence of congenital syphilis (1.0/1,000) lower than the national ones that ranged from 1.4 to 2.2 per 1,000 live births in recent years.

Educational intervention improves knowledge and adherence to treatment amongst puerperal women with syphilis: randomized clinical trial.

BACKGROUND: Gestational syphilis requires early detection and proper treatment to prevent negative maternal-fetal outcomes. This study aimed to evaluate the effectiveness of an educational intervention on treatment adherence and knowledge about syphilis in postpartum women with positive Treponema pallidum results. METHODS: A randomized, parallel, and open clinical trial was conducted with 64 postpartum women who tested positive for T. pallidum, assigned to two groups (1:1 ratio). The Intervention Group (IG) received an educational intervention on syphilis, including an explanatory leaflet and hands-on demonstrations, along with standard guidelines. The Control Group (CG) received standard guidelines alone. Pre-test and post-test assessments were conducted to measure knowledge and treatment adherence. Statistical analyses included descriptive and inferential methods, assessing group homogeneity using the Chi-square or Fishers exact test. The interventions effectiveness was determined using relative risk, and pre- and post-test scores were compared using the independent t test. RESULTS: The post-test revealed improvements in knowledge scores for general knowledge, treatment, and prevention domains (p < .05). The IG demonstrated an increase in post-test knowledge scores (p = .001), with association between post-test scores and treatment adherence (p = .001). CONCLUSION: The educational intervention on syphilis improved knowledge and treatment adherence in postpartum women with syphilis.

Sífilis na gravidez e adequabilidade de tratamento: análise das pacientes atendidas em uma maternidade / Syphilis in pregnancy and suitability of treatment: analysis of patients seen at a maternity hospital

Objetivo: Avaliar a adequabilidade do tratamento de sífilis gestacional e fatores associados ao tratamento inadequado. Métodos: Estudo de coorte. Pacientes realizaram testes rápidos para sífilis e responderam ao questionário estruturado. A normalidade dos dados foi analisada com Kolmogorov-Smirnov. Para associação entre adequação do tratamento e fatores sociodemográficos e clínicos, foi executado o teste Exato de Fisher. Teste t de Student para amostras independentes foi executado para comparar o número de consultas pré-natal entre pacientes que apresentaram ou não adequação ao tratamento. Foi executada regressão logística para avaliar em que medida a adequação e a efetividade ao tratamento poderiam ser adequadamente previstas por número de consultas pré-natal. O nível de significância foi 5%. O projeto foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: Participaram 560 pacientes. Trinta e três foram diagnosticadas com sífilis, e 29 foram adequadamente tratadas. Houve associação entre adequação do tratamento e consultas pré-natal. Os achados do teste t de Student corroboram os resultados encontrados no teste Exato de Fisher. O modelo de regressão demonstrou que mulheres que fazem pré-natal têm maior chance de tratamento adequado. Conclusão: O pré-natal aumenta a chance de tratamento adequado para sífilis na gestação

Objective: To assess the adequacy of treatment for gestational syphilis and factors associated with inadequate treatment. Methods: Cohort study. Patients underwent rapid tests for syphilis and answered the structured questionnaire. Data normality was analyzed using Kolmogorov-Smirnov. For the association between treatment adequacy and sociodemographic and clinical factors, Fisher's exact test was performed. Student's t test for independent samples was performed to compare the number of prenatal visits between patients who were or were not fit for treatment. Logistic regression was performed to assess the extent to which treatment adequacy and effectiveness could be adequately predicted by prenatal visit number. The significance level was 5%. The project was approved by the Ethics and Research Committee. Results: 560 patients participated. 33 were diagnosed with syphilis, 29 were adequately treated. There was an association between treatment adequacy and prenatal consultation. The student's t test findings corroborate those found in Fisher's Exact test. The regression model showed that women who undergo prenatal care have a greater chance of adequate treatment. Conclusion: Prenatal care increases the chance of adequate treatment for syphilis during pregnancy

A case of monkeypox coinfection with syphilis in an Ecuadorian HIV positive young male.

The current Monkeypox (MPXV) outbreak has put evidence the worrisome trend of an increased prevalence of other sexually transmitted infections (STDs) particularly in the group of Men who have sex with men (MSM). This phenomenon is illustrated through the case of a 24-year-old male living with HIV that after attending a party where potentially unprotected sex was performed developed a painful popular perianal rash. Laboratory examinations performed confirmed the presence of an acute MPXV infection and primary syphilis, receiving pain relief medication and antibiotics with a rapid control of both illnesses. As in many cases during this outbreak, his HIV status was well controlled and thus a further understanding of the sexual practices in the MSM should help design more adequate interventions to prevent the spread of this and other more conventional STIs.

Barreiras e facilitadores do enfrentamento de HIV/aids e sífilis por venezuelanas residentes no Brasil / Barriers and facilitators to confronting HIV/aids and syphilis experienced by Venezuelan women living in Brazil / Factores facilitadores y barreras que tienen las mujeres venezolanas residentes en Brasil respecto de la infección por el VIH/sida y la sífilis

RESUMO Objetivo. Descrever a percepção de mulheres venezuelanas sobre o acesso aos serviços de saúde, ao diagnóstico e ao tratamento de HIV/aids e sífilis no Brasil. Métodos. Trata-se de um estudo descritivo e exploratório, com abordagem qualitativa, realizado no período de fevereiro a maio de 2021 nos municípios de Manaus, estado do Amazonas, e Boa Vista, estado de Roraima. As entrevistas com as participantes foram transcritas na íntegra, com levantamento de temas a partir de análise de conteúdo. Resultados. Foram entrevistadas 40 mulheres (20 em Manaus e 20 em Boa Vista). A partir da transcrição e tradução das falas, foram identificadas duas categorias de análise de conteúdo: barreiras de acesso aos serviços de saúde, com quatro subcategorias — idioma, custos com saúde, reações adversas ao medicamento e pandemia de covid-19; e facilitadores do acesso, com quatro subcategorias — Sistema Único de Saúde, Política Nacional de Atenção Integral à Saúde da Mulher, Política Nacional de Assistência Social e relação entre profissional de saúde e usuária do Sistema Único de Saúde. Conclusão. Os resultados mostraram a necessidade de elaborar estratégias para mitigar as dificuldades enfrentadas pelas mulheres migrantes da Venezuela residentes no Brasil quanto ao diagnóstico e tratamento de HIV/aids e sífilis, indo além do amparo à saúde garantido pela lei.

ABSTRACT Objective. To describe the perception of Venezuelan women regarding access to health care, diagnosis, and treatment of HIV/aids and syphilis in Brazil. Method. This is a descriptive, exploratory study employing a qualitative approach, performed from February to May 2021 in the municipalities of Manaus, state of Amazonas, and Boa Vista, state of Roraima. The interviews with participants were fully transcribed, with identification of themes based on content analysis. Results. Forty women were interviewed (20 in Manaus and 20 in Boa Vista). Following transcription and translation of the accounts, two analytical categories were identified: barriers to healthcare access, with four subcategories — language, cost, adverse drug reactions, and COVID-19 pandemic; and facilitators of healthcare access, again with four subcategories — Unified Health System (SUS), National Policy of Comprehensive Women's Health, National Social Assistance Policy, and relationship between healthcare professionals and SUS users. Conclusion. The results showed the need to design strategies to mitigate the difficulties faced by migrant women from Venezuela living in Brazil regarding the diagnosis and treatment of HIV/aids and syphilis, going beyond the healthcare support guaranteed by law.

RESUMEN Objetivo. Describir la percepción de las mujeres venezolanas sobre el acceso a los servicios de salud, al diagnóstico y al tratamiento de la infección por el VIH/sida y la sífilis en Brasil. Métodos. Se trata de un estudio descriptivo y exploratorio, con enfoque cualitativo, realizado entre febrero y mayo del 2021 en los municipios de Manaos, estado de Amazonas, y Boa Vista, estado de Roraima. Las entrevistas con las participantes se transcribieron en su totalidad, y se exploraron los puntos de interés según el análisis del contenido. Resultados. Se entrevistaron 40 mujeres (20 en Manaos y 20 en Boa Vista). A partir de la transcripción y la traducción de las conversaciones, se establecieron dos categorías para el análisis del contenido: las barreras de acceso a los servicios de salud (subcategorías: idioma, costos relacionados con la salud, reacciones adversas a los medicamentos y pandemia de COVID-19); y los factores facilitadores del acceso (cuatro subcategorías: Sistema Único de Salud, Política nacional de Atención Integral a la Salud de la Mujer, Política Nacional de Asistencia Social y relación entre los profesionales de salud y las usuarias del Sistema Único de Salud). Conclusión. Los resultados mostraron la necesidad de formular estrategias para mitigar las dificultades que enfrentan las mujeres migrantes de Venezuela residentes en Brasil en relación con el diagnóstico y el tratamiento de la infección por el VIH/sida y la sífilis, más allá de la protección de la salud garantizada por la ley.

Sífilis secundaria en un paciente con VIH / Secondary Syphilis in a Patient with HIV

Introducción: La sífilis y la infección por virus de inmunodeficiencia humana comparten los mismos grupos de alto riesgo y formas de transmisión, por lo que la coinfección es común. La historia natural y las manifestaciones clínicas de la sífilis pueden modificarse por la infección concomitante por VIH, que puede progresar rápidamente desde la sífilis primaria a la sífilis terciaria. Objetivo: Describir las manifestaciones clínicas, análisis de laboratorio y tratamiento de un paciente que vive con el virus de inmunodeficiencia humana con coinfección de sífilis secundaria, una condición infrecuente. Caso clínico: Paciente de 30 años quien acude a consulta en el contexto de alopecia sifilítica a nivel del cuero cabelludo, cejas y pestañas, hipocromía en zona escrotal y perineal; la sífilis es considerada la gran simuladora, lo cual dificulta el diagnóstico y tratamiento. Se confirma el diagnóstico de sífilis secundaria. Conclusiones: Mediante un caso clínico de un paciente que vive con el virus de inmunodeficiencia humana y con coinfección de sífilis, se describe la afectación de manifestaciones clínicas poco habituales como la alopecia sifilítica en región del cuero cabelludo, cejas y pestañas, entre otras(AU)

Introduction: Syphilis and human immunodeficiency virus infection share the same high-risk groups and transmission ways; therefore, coinfection is common. The natural history and clinical manifestations of syphilis can be modified by concomitant HIV infection, which can rapidly progress from primary to tertiary syphilis. Objective: To describe the clinical manifestations, laboratory tests and treatment of a patient living with human immunodeficiency virus and co-infected with secondary syphilis, being such a rare condition. Clinical case: A 30-year-old patient attended consultation for presenting of syphilitic alopecia of the scalp, eyebrows and eyelashes, as well as hypochromia in the scrotal and perineal area; syphilis is considered as the great simulator, which makes diagnosis and treatment difficult. The diagnosis of secondary syphilis is confirmed. Conclusions: Through the clinical case of a patient living with human immunodeficiency virus and syphilis coinfection, the condition is described of unusual clinical manifestations such as syphilitic alopecia in the scalp, eyebrows and the eyelashes region, among others(AU)

[Syphilitic chancre in the mouth: an unusual location. Case report]. / Chancro sifilítico en la boca: localización poco frecuente. Reporte de un caso.

Background: Syphilis is an infectious disease caused by the spirochete Treponema pallidum, transmitted mainly by direct contact with the lesion. Primary syphilis usually presents with a chancre at the site of infection, which is highly contagious and resolves without treatment. The aim of this article is to illustrate an unusual location of a syphilitic chancre, in order to consider this diagnosis within the approach to patients with oral ulcers. Clinical case: a 30-year-old man who presented a dermatosis located in the left labial commissure, characterized by a painless ulcer of 1 cm in diameter of 20 days of evolution. The patient has a history of HIV/AIDS. A punch biopsy of the dermatosis was performed, with a histopathological report compatible with syphilitic chancre and a negative VDRL result. He was treated with penicillin G benzathine showing improvement. Conclusions: Primary syphilis is characterized by the development of the syphilitic chancre, which is the first manifestation of syphilis in up to 60% of cases. Extragenital presentation is rare, with only 12-14% of all cases, and of these between 40-70% occur in the mouth, being the lips the most frequent location. Oral manifestations can represent a diagnostic challenge due to its wide spectrum of clinical presentations.

Introducción: la sífilis es una enfermedad infecciosa causada por la espiroqueta Treponema pallidum, transmitida principalmente por contacto directo con la lesión. La sífilis primaria generalmente se presenta con un chancro en el sitio de la infección, el cual es altamente contagioso y se resuelve sin tratamiento. El objetivo de este trabajo es ilustrar una localización poco común de un chancro sifilítico, ya que conocer la existencia de presentaciones poco frecuentes permitirá favorecer su sospecha al abordar las causas de úlceras orales. Caso o casos clínicos: hombre de 30 años de edad, el cual presenta una dermatosis localizada en la comisura labial izquierda, caracterizada por una úlcera no dolorosa de 1 cm de diámetro de 20 días de evolución. El paciente tiene antecedente de VIH/SIDA. Se realizó biopsia en sacabocados de la dermatosis, siendo el informe histopatológico compatible con chancro sifilítico y resultado de VDRL negativo. Fue tratado con penicilina G benzatínica, con lo que presentó mejoría. Conclusiones: la sífilis primaria se caracteriza por la aparición del chancro sifilítico, el cual es la primera manifestación de la sífilis hasta en el 60% de los casos. La presentación extragenital es rara, con solo un 12-14% de todos los casos y, de estos, entre un 40-70 % se presentan en la boca, siendo los labios la localización más frecuente. Las manifestaciones orales pueden representar un desafío diagnóstico debido a su amplio espectro de presentaciones clínicas.

Factors associated with inadequate treatment of syphilis during pregnancy: an integrative review.

OBJECTIVES: to analyze the evidence available in literature on factors associated with inadequate treatment of syphilis in pregnant women. METHODS: an integrative review, carried out in the LILACS, CINAHL, Web of Science, Scopus, PubMed and EMBASE databases, with controlled descriptors therapeutic and prenatal syphilis. RESULTS: nine publications composed the interpretative analysis, in which low education, income and maternal age, temporary lack of medication and HIV infection were associated with inadequate treatment of syphilis during pregnancy, in addition to delay or absence of prenatal care and receiving the 1st dose of penicillin, lack of tests or treatment less than 30 days before childbirth, and partners' low compliance with treatment. FINAL CONSIDERATIONS: among the main factors associated with inadequate treatment, clinical and sociodemographic aspects stand out, as well as failures in drug dispensing, prescription and monitoring of treatment of pregnant women and their partners by the health system.

[Lymphogranuloma venerous genital in men who have sex with men: a non-imported case report in Chile]. / Linfogranuloma venéreo genital en un hombre que tiene sexo con hombre: reporte de caso no importado en Chile.

Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by Chlamydia trachomatis bacteria. In the past years, it has emerged as a relevant infectious agent, mainly affecting men who have sex with men (MSM), frequently associated with other sexually transmitted infections as human immunodeficiency virus (HIV) and syphilis. Even though genital lesions correspond to the classical presentation of LGV, nowadays anorectal syndrome is more frequently reported. We present a MSM patient, HIV infected, being treated with antiretroviral drugs, with a history of recurrent genital herpes, also recently treated for a syphilis in a latent stage. He had no recent trips. He referred inguinal fistulized enlarged lymph nodes, associated with a painful genital ulcer, he denied anorectal or systemic symptoms. He had been treated with multiple antibiotic and antiviral drugs, with no clinical response. Molecular studies from the content of the fistulized lymph node identified C. trachomatis. The patient received doxycycline for 6 weeks, showing good clinical response.