Sífilis congênita no Brasil: atualização de conceitos e desafios do tratamento na neonatologia / Congenital syphilis in Brazil: updating concepts and treatment challenges in neonatology

A sífilis, também chamada de lues, é uma infecção sistêmica, tratável, causada pela espiroqueta Treponema pallidum (T. pallidum). A transmissão desta bactéria ocorre principalmente pelo contato sexual, mas também pode ser transmitida verticalmente durante a gestação para o feto, via transplacentária ou via canal de parto ­ com lesão ativa ­ em casos de mãe com sífilis não tratada ou tratada de forma inadequada, de acordo com o Ministério da Saúde. A ausência do tratamento precoce, pode levar à cronificação da doença, com gravidade variável e sequelas irreversíveis; assim como na gestante pode haver maior risco de abortamento, prematuridade, óbito fetal ou do recém-nascido (RN) e de desenvolvimento de sífilis congênita (SC). A lues ainda consiste em um problema da saúde pública brasileira e vem se apresentando de forma crescente no país, nos últimos cinco anos, devido ao maior número de testes rápidos realizados para diagnóstico, à redução do uso de preservativos e da distribuição de penicilina na atenção primária. Consequentemente, há um aumento da incidência de SC e de RN expostos à sífilis, levando ao tratamento inadequado e, muitas vezes, desnecessário para a condição clínica apresentada por esse bebê. É de tamanha importância diferenciar ambos os casos, uma vez que apresentam condutas distintas e causam grande impacto na vida deste RN e da sua família. O público-alvo consiste em profissionais médicos, assistentes e residentes, que prestam assistência direta aos pacientes do setor da neonatologia do HSPM. Diante disso, baseado nas diretrizes terapêuticas do Ministério da Saúde (MS) do Brasil e na revisão integrativa de literaturas atualizadas, este trabalho objetiva atualizar conceitos relacionados à SC, diferenciar SC do RN exposto à sífilis, padronizar o manejo clínico na maternidade e, consequentemente, reduzir as taxas da incidência e prevalência da SC no país, assim como reduzir os impactos ocasionados por condutas inadequadas no manejo clínico desses pacientes. Palavras-chave: Sífilis. Lues. Sífilis congênita. Manejo clínico. Neonatologia.

Argentina y Uruguay: una comparación de la tasa de mortalidad por enfermedades de transmisión sexual en personas de 50 años y más durante los quinquenios 1997-2001 y 2010-2014 / Argentina and Uruguay: a comparison of the mortality rate from sexually transmitted diseases in persons aged 50 and over during the five-year periods 1997-2001 and 2010-2014

Resumen Objetivo: analizar comparativamente el comportamiento de la mortalidad por enfermedades de transmisión sexual (ETS) en la población de 50 años y más de Argentina y Uruguay, en los últimos 20 años y en el marco de la Agenda 2030 para el Desarrollo Sostenible. Métodos: se calculan tasas de mortalidad específicas por sexo, grupo de edad y causa para los quinquenios 1997-2001 y 2010-2014, con base en información proveniente de las Naciones Unidas. Resultados: ambos países registran en general un descenso de la mortalidad femenina y un aumento de la mortalidad masculina por ETS. Además, coinciden en la caída de la mortalidad por tumores de cuello uterino (principal causa asociada al virus de papiloma humano, VPH) y en el aumento de la atribuida al VIH/SIDA y otros tumores ligados al VPH. Como contrapartida, presentan diferencias en la dinámica de la mortalidad por hepatitis aguda tipo B, sífilis y por tumores de vulva. Conclusiones: el hecho de que algunas tasas específicas de mortalidad por ETS aumenten y otras disminuyan pero mantengan sus valores elevados, evidencia que los países deben redoblar los esfuerzos en relación al acceso a la información por parte de la población estudiada; el uso del preservativo como método de prevención de las ETS; el acceso a controles, pruebas de diagnóstico y tratamiento de los casos afectados; el incremento de la capacidad de los sistemas de salud para dar respuesta oportuna a las demandas de las personas mayores, y el fortalecimiento del sistema de información oficial para la toma de decisiones acertadas.

Abstract Objective: to analyze comparatively mortality from to sexually transmitted diseases (STDs) in the population aged 50 and over from Argentina and Uruguay, during the last 20 years and in the context of the 2030 Agenda for Sustainable Development. Methods: based on information from the United Nations, specific mortality rates are calculated by sex, age group and cause for the quinquennium 1997-2001 and 2010-2014. Results: Considering STDs in general, female mortality decreases and male mortality increases not only in Argentina but also in Uruguay. In addition, mortality due to cervical cancer (mainly associated with human papillomavirus, HPV) decreases; and mortality from to HIV/AIDS and other HPV-related cancers rises in both countries. On the other hand, there are differences between countries in the variation of mortality due to acute hepatitis B, syphilis and vulvar cancer. Conclusions: taking into account the variation of some specific mortality rates under study, countries should redouble their efforts regarding the access to information by the population aged 50 or over; the use of condoms as a method for preventing the transmission of STDs; the access to early diagnosis and treatment programmes; the improving of health systems to respond ageing-related needs timely; and the strengthening of health information systems for making the right decisions.

Rethinking Risk: Prospect Theory Application in Health Message Framing Research.

Although prospect theory conceptualizes risk as uncertainty, health message framing research based on the theory typically conceptualizes risk as severity. This study reports the results of two experiments designed to explore these alternative conceptualizations of risk and their effect on health decision making. Participants (N1 = 768, N2 = 532) were randomly assigned to one of four conditions that presented a hypothetical scenario of a sexually transmitted disease (STD) outbreak. The conditions were defined by message prompt (deadly vs. easily curable STD) and response option frame (gain vs. loss). Participants selected which of two programs (certain outcome vs. uncertain outcome) they would prefer to combat the outbreak. Across both experiments, participants expressed strong preferences for certain (low risk) outcomes in the gain-framed conditions and no preferences in the loss-framed conditions. These differences held regardless of the consequence severity of the scenario. We discuss the theoretical and practical implications of these results and offer directions for future research.

Burden of Sexually Transmitted Infections in Iran from 1990 to 2010: Results from the Global Burden of Disease study 2010.

BACKGROUND: The present study describes the epidemiological status of sexually transmitted infections (STIs) in Iran based on the Global Burden of Disease study 2010 (the GBD 2010), and compares this with those of other neighboring countries. METHODS: The burden of STIs from 1990 to 2010 in Iran was derived from a systematic study, namely the GBD 2010, which was conducted by the Institute for Health Metrics and Evaluation (IHME). Using a model-based estimation, Disability Adjusted Life Years (DALYs) were calculated on the basis of the prevalence of STIs. The GBD 2010 used disability weights, and a mortality rate that was obtained from the vital registration system of Iran. We review the results of the GBD 2010 estimations for STIs in Iran. RESULTS: The trend of DALYs attributable to STIs (107.3 and 26.47 per 100,000 people in 1990 and 2010, respectively) and deaths (1.13 and 0.12 per 100,000 people in 1990 and 2010, respectively) decreased dramatically in Iran during the last two decades. The majority of individuals affected by STI DALYs were aged 1 - 4 and 20 - 24 years. CONCLUSION: Since the majority of DALYs attributed to STIs were observed among those aged 1 - 4 years and young people, the economic burden of STIs will remain high in Iran. Therefore, effective evidence-based planning is critical to allocate the essential budget for utilizing treatment and prevention approaches.

Proctitis en varón con relaciones sexuales con hombres e infectado por el virus de la inmunodeficiencia humana / Proctitis in an HIV-infected male who have sex with men

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Los experimentos de Sífilis y otras infecciones de transmisión Sexual en Guatemala, 1946-1948, ¿un dilema ético y político para Guatemala y el mundo? / The experiments of Syphilis and other sexually transmitted infections in Guatemala, 1946-1948, an ethical and political dilemma for Guatemala and the world?

En Guatemala se llevaron a cabo experimentos por entidades de salud de Estados Unidos de Norte América, inoculando infecciones de transmisión sexual (gonorrea, sífilis y cancroide) a poblaciones vulnerables con el objetivo de generar un modelo humano para estudio de este tipo de enfermedades. Estos experimentos permanecieron ocultos durante 64 años, cuando la Dra. Susan Reverby los descubrió al revisar los archivos de quien fuera el investigador de los mismos, Dr. John C. Cutler. Fueron inoculados 1308 personas y reportadas fallecidas 83. Al hacerse pública esta nefasta noticia, se condenaron los hechos acontecidos entre 1946-1948 por múltiples organizaciones y el gobierno, nombrándose una Comisión Presidencial en Guatemala y por su parte el gobierno de Estados Unidos también conformó una Comisión Presidencial. Los informes y dictámenes de ambas Comisiones coinciden en que se violaron los principios éticos y morales, que la desigualdad social y racismo existente en esa época fueron condicionantes muy importantes, que lo acontecido puede ser catalogado como crímenes de lesa humanidad y que las personas que planificaron, aprobaron, condujeron, facilitaron y financiaron estos experimentos son moralmente culpables. A la fecha no se ha otorgado ningún resarcimiento a los afectados o familiares, ni compensación alguna a Guatemala...(AU)

In Guatemala, experiments were carried out by health entities in the United States of America, inoculating sexually transmitted infections (gonorrhea, syphilis and canker) into vulnerable populations with the aim of generating a human model for the study of this type of disease. These experiments remained hidden for 64 years, when Dr. Susan Reverby discovered them by reviewing the files of whoever was their researcher, Dr. John C. Cutler. 1308 people were inoculated and 83 were reported deceased. When this ominous news was made public, the events occurred between 1946-1948 by multiple organizations and the government were condemned, a Presidential Commission was appointed in Guatemala and for its part the government of the United States also formed a Presidential Commission. The reports and opinions of both Commissions agree that ethical and moral principles were violated, that the social inequality and racism that existed at that time were very important conditions, that what happened can be classified as crimes against humanity and that the people who planned , approved, conducted, facilitated and financed these experiments are morally culpable. To date no compensation has been granted to those affected or relatives, nor any compensation to Guatemala ... (AU)

Mortality from sexually transmitted diseases in reproductive-aged women: United States, 1999-2010.

OBJECTIVES: I estimated the sexually transmitted disease-related mortality among US reproductive-aged women from 1999 to 2010. METHODS: I estimated mortality from National Center for Health Statistics' Multiple Cause of Death data. I defined reproductive age as 15 to 44 years. For diseases partially caused by sexual transmission, I estimated the proportion attributable to sexual transmission from the literature. To calculate mortality rates, I estimated number of deaths from each disease and Census Bureau population for reproductive-aged women for 1999 to 2010. RESULTS: From 1999 to 2010, the cumulative sexually transmitted disease-related mortality rate decreased by 49%, from 5.3 to 2.7 deaths per 100 000. The primary contributors were HIV and human papilloma virus infections. Mortality from sexually transmitted HIV infection decreased by 62%, from 3.4 to 1.3 deaths per 100 000. Mortality from human papilloma virus-associated gynecologic cancers decreased by 19%, from 1.6 deaths per 100 000 in 1999 to 1.3 deaths per 100 000 in 2010. CONCLUSIONS: Screening and treatment for sexually transmitted diseases may reduce mortality. Research is needed to determine whether sexually transmitted disease-related morbidity among reproductive-aged women has decreased over the past decade.

Impact of interventions targeting unhealthy alcohol use in Kenya on HIV transmission and AIDS-related deaths.

BACKGROUND: HIV remains a major cause of preventable morbidity and mortality in Kenya. The effects of behaviors that accompany unhealthy alcohol consumption are a pervasive risk factor for HIV transmission and progression. Our objective was to estimate the portion of HIV infections attributable to unhealthy alcohol use and to evaluate the impact of hypothetical interventions directed at unhealthy alcohol use on HIV infections and deaths. METHODS: We estimated outcomes over a time horizon of 20 years using a computer simulation of the Kenyan population. This computer simulation integrates a compartmental model of HIV transmission with a mechanistic model of HIV progression that was previously validated in sub-Saharan Africa. Integration of the transmission and progression models allows simultaneous consideration of alcohol's effects on HIV transmission and progression (e.g., lowering antiretroviral adherence may increase transmission risk by elevating viral load, and may simultaneously increase progression by increasing the likelihood of AIDS). The simulation considers important aspects of heterogeneous sexual mixing patterns, including assortativeness of partners by age and activity level, age-discordant relationships, and high activity subgroups. Outcomes included number of new HIV infections, number of AIDS deaths, and infectivity (number of new infections per infected person per year). RESULTS: Our model estimated that the effects of behaviors accompanying unhealthy alcohol consumption are responsible for 13.0% of new HIV infections in Kenya. An alcohol intervention with effectiveness similar to that observed in a published randomized controlled trial of a cognitive-behavioral therapy-based intervention in Kenya (45% reduction in unhealthy alcohol consumption) could prevent nearly half of these infections, reducing their number by 69,858 and reducing AIDS deaths by 17,824 over 20 years. Estimates were sensitive to assumptions with respect to the magnitude of alcohol's underlying effects on condom use, antiretroviral therapy adherence, and sexually transmitted infection prevalence. CONCLUSIONS: A substantial number of new HIV infections in Kenya are attributable to unhealthy alcohol use. An alcohol intervention with the effectiveness observed in a published randomized controlled trial has the potential to reduce infections over 20 years by nearly 5% and avert nearly 18,000 deaths related to HIV.

A equipe de saude na atencao integral ao adolescente vivendo com HIV/AIDS / El equipo de salud en la atención integral al adolescente que vive con VIH/SIDA / The healthcare team in integral care for adolescents living with HIV/AIDS

OBJECTIVE: This qualitative field study was conducted in the Sexually Transmitted Disease Specialized Care Service of the Vila dos Comerciários Health Center of Porto Alegre, Brazil. It aims to determine the work of the multidisciplinary healthcare team when providing integral care to adolescents living with HIV/AIDS. METHODS: Semi-structured interviews were conducted with the multidisciplinary team. RESULTS: Results provided two analytical categories: The multidisciplinarity and The integrality of the care. CONCLUSION: The performance of this study allowed the actors involved to reflect on their practices and on integrality as a guiding principle for healthcare actions, considering multidisciplinary teamwork and its reflection on the care provided to adolescents living with HIV/AIDS.

Trata-se de uma pesquisa de campo qualitativa realizada no Serviço de Atendimento Especializado em Doenças Sexualmente Transmissíveis do Centro de Saúde da Vila dos Comerciários, em Porto Alegre/RS. Teve como objetivo identificar a atuação da equipe multiprofissional de saúde na atenção integral ao adolescente vivendo com HIV/AIDS. MÉTODOS: Utilizou-se a entrevista semiestruturada com a equipe multiprofissional de saúde. RESULTADOS: Dos resultados emergiram duas categorias analíticas: A multiprofissionalidade e A integralidade da atenção. CONCLUSÃO: O desenvolvimento deste estudo permitiu aos atores envolvidos a reflexão sobre suas práticas e sobre a integralidade como princípio norteador das ações em saúde, considerando o trabalho em equipe multiprofissional e o reflexo deste na atenção ao adolescente vivendo com HIV/AIDS.

OBJETIVO: Se trata de una investigación de campo cualitativa, realizada en el Servicio de Atención Especializada en Enfermedades de Transmisión Sexual, del Centro de Salud de la Vila dos Comerciários, en Porto Alegre/RS. Tiene por objetivo identificar la actuación del equipo multiprofesional de salud en atención integral al adolescente que vive con VIH/SIDA. MÉTODOS: Se utilizó la entrevista semiestructurada con el equipo multiprofesional de salud. Resultados: Emergieron dos categorías analíticas: la multiprofesionalidad y la integralidad de la atención. CONCLUSIÓN: El desarrollo de este estudio permitió a los actores involucrados reflexionar sobre sus prácticas y sobre la integralidad como principio para nortear las acciones en salud, considerando el trabajo en equipo multiprofesional y el reflejo de éste en la atención al adolescente que vive con VIH/SIDA.

Factores que intervienen en el uso correcto y sistemático del condón, relacionados con la percepción de riesgo, según estudiantes universitarios panameños / Factors involved in the correct and consistent use of condoms, related to the perception of risk, according to Panamanian university students

En casi todas las sociedades, se les da diferente valoración a los hombres y a las mujeres, en especial en lo relacionado con la salud sexual y reproductiva. Son muchos los aspectos en los que la sexualidad y el género se entrelazan y pueden llevar la desigualdad hasta los rincones más íntimos y privados de la vida cotidiana...

Herpes simplex virus and pregnancy: a review of the management of antenatal and peripartum herpes infections.

Genital herpes is one of the most common sexually transmitted infections, affecting 1 in 6 people in the United States. Women are twice as likely to be infected as men and infections in women of reproductive age carry the additional risk of vertical transmission to the neonate at the time of delivery. Neonatal herpes infections can be devastating with up to 50% mortality for disseminated herpes simplex virus (HSV) infections in the newborn. Rates of transmission are affected by the viral type of HSV infection and whether the infection around delivery is primary or recurrent. Current management approaches decrease rates of active lesions at the time of delivery and thereby cesarean deliveries, but have not been shown to decrease the incidence of neonatal herpes infections. More research is needed to better elucidate the risk factors for transmission to the neonate and to improve our current management methodology to further decrease vertical transmission. In this review, we will discuss management of antenatal and peripartum herpes infections, considerations for mode of delivery, and the course of neonatal HSV infections.

Morbilidad materno neonatal por infecciones de transmisión sexual y sus complicaciones, en gestantes que acuden al Hospital Materno Infantil "Germán Urquidi" en el último trimestre del año 2010 / Maternal and neonatal morbidity sexually transmitted infections and complications in pregnant women attending the Maternal and Child Hospital Urquidi Germain in the last quarter of 2010

La Organización Mundial de la Salud (OMS) estima que 1 de cada 20 personas en el mundo padece una Infección de Transmisión Sexual (ITS) al año.La tasa de ITS en Bolivia en el año 2000 fue de 56.000 casos (14 por 1000 habitantes en edad fértil) en los servicios públicos de salud .Las infecciones de transmisión sexual se encuentran entre las causas de morbimortalidad materna y perinatal más importantes en gestantes. Las complicaciones graves de las infecciones de transmisión sexual provocan embarazo ectópico, enfermedad pélvica inflamatoria, durante el embarazo; parto prétermino, aborto espontáneo, muerte fetal e infecciones congénitas.Por estas razones, se realizó una investigacion retrospectiva, transversal y descriptiva, con una muestra de 130 gestantes que corresponden al último trimestre de 2010.Los resultados reflejan que las ITS más frecuentes fueron la sífilis, condiloma acuminado, VIH-Sida, candidiasis y vaginosis bacteriana, también se encontraron lesiones ginecológicas asociadas a ITS como ser la colpitis, colpocervicitis, cervicitis y vulvovaginitis, lo que refleja el caracter crónico de las ITS.Las complicaciones más frecuentes son las fetoneonatales como ser el óbito fetal, parto pretérmino, bajo peso al nacer, sífilis congénita y sospecha del VIH, las madres presentaron complicaciones en menor frecuencia, destacando la ruptura prematura de membrana, abortos, abortos habituales e infecciones pelvicas inflamatorias en porcentajes bajos

siRNA-based topical microbicides targeting sexually transmitted infections.

Sexually transmitted infections (STIs) are a major cause of morbidity and mortality worldwide. Although a vaccine is available for HPV, no effective vaccines exist for the HIV-1 and HSV-2 viral pathogens, and there are no cures for these infections. Furthermore, recent setbacks in clinical trials, such as the failure of the STEP trial to prevent HIV-1 infection, have emphasized the need to develop alternative approaches to interrupt the transmission of these pathogens. One alternative strategy is represented by the use of topically applied microbicides, and such agents are being developed against various viruses. RNAi-based microbicides have recently been demonstrated to prevent HSV-2 transmission, and may be useful for targeting multiple STIs. In this review, microbicides that are under development for the prevention of STIs are described, with a focus on topically applied microbicidal siRNAs.

Fantome Island lock hospital and aboriginal venereal disease sufferers 1928-45.

In this article the Queensland government's response to suspected and confirmed cases of venereal disease amongst the state's Aboriginal population is examined through the micro history of Fantome Island lock hospital, which operated between 1928 and 1945. This history offers an interesting case study into the complexities of medical and racial segregation in twentieth century Queensland. While other scholars have positioned Fantome Island lock hospital as a justifiable attempt to control syphilis and gonorrhoea infections amongst the Queensland Aboriginal population, I propose a different interpretation and argue that white perceptions of Aboriginal sexuality and health contributed to government depictions of an Aboriginal venereal disease 'epidemic.' I demonstrate that disease diagnosis was still highly problematic prior to World War II and was differentially applied across different sub-populations.

Puerto Rican injection drug users: Prevention implications in Massachusetts and Puerto Rico.

This study examines whether place of residence is a factor associated with reporting a positive HIV/AIDS, Hepatitis C (HCV), or Sexually Transmitted Disease (STD) status in a sample of 400 injection drug users (IDUs) residing on the Island of Puerto Rico (N=139) and in western Massachusetts (N=261). Logistic regression models revealed that IDUs residing in western Massachusetts were 66% less likely to be HIV positive compared to IDUs residing in Puerto Rico (p<.000) while IDUs residing in western Massachusetts were about 67% less likely to have a positive STD status than those residing in Puerto Rico (p<.000). Place of residence was not significantly associated with HCV status. Results indicate the need to develop prevention programs tailored to the unique socio-cultural context of Puerto Rican IDUs residing on the Island of Puerto Rico whose circumstances differ from those in the mainland US. To reduce drug use, HIV/AIDS, HCV, and STDs among Puerto Ricans in both locales, the Capacity Enhancement Model is proposed in order to develop more effective prevention programs.

New sexually transmitted infections among adolescent girls infected with HIV.

OBJECTIVES: Although the prevalence of sexually transmitted infections (STIs) among girls infected with HIV has been reported, the incidence of STI diagnoses has not been well documented. The objectives of this study were to examine (1) incident STI diagnoses and (2) the association between viral load (VL) and incident STI diagnosis among HIV-infected adolescent girls in care. METHODS: This was a prospective longitudinal 18-month study of girls enrolled in the Adolescent HIV trials network. Cox proportional hazard modelling was performed to evaluate the incidence of STI by baseline viral load. RESULTS: The mean (SD) age of participants was 20.6 (2.0) years, viral load of participants was 66,917 (165,942) copies/ml and median viral load was 7,096 copies/ml. The incidence of STIs for the entire cohort was 1.4 per 100 person-months. During the 18-month follow-up period, there were no significant differences in the STI incidence between the high and low viral load groups (hazard ratio (HR) = 0.86, 95% CI 0.37 to 1.95) There was also no significant association between STI incidence and log-transformed viral load (HR = 1.10, 95% CI 0.92 to 1.3). CONCLUSIONS: Adolescent girls with HIV infection continue to acquire sexually transmitted infections after diagnosis. This analysis does not suggest that VL is a critical factor in STI acquisition over time. Additional work exploring the role of other contextual factors on STI acquisition among HIV-infected adolescent girls is warranted.