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1.
BMC Public Health ; 20(1): 480, 2020 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-32276624

RESUMO

BACKGROUND: Screening for sexually transmitted infection (STI) especially HIV as early detection and treatment have been financially supported under the Thai Universal Coverage (UC) scheme since 2009 (THB140 for HIV). However, the implementation has not been evidence-based, strategic risk-based, nor economically evaluated whereas husbands who accompanied the pregnant women are likely to have a lower risk than those who did not come along. This study is aimed to determine the husband's willingness-to-pay (WTP) for his HIV and syphilis screening tests and potential factors affecting STI screenings at the antenatal care (ANC) clinic of a tertiary hospital in Thailand. METHODS: A pilot open-ended interview was conducted among 50 participants to estimate the mean and standard deviation of WTP prices for HIV and syphilis screening tests. A questionnaire was developed to obtain demographics, STI knowledge and screening history, as well as two contingent valuation methods (bidding and payment scale), using the mean WTP prices identified from the pilot study as a starting WTP with »SD step-up/down. The survey of 200 randomly selected husbands of pregnant women was conducted at King Chulalongkorn Memorial Hospital from April to June 2018. Descriptive statistics and logistic regression were used for data analysis. RESULTS: During the study period, 597 pregnant women received their first ANC. Of 368 accompanying husbands, 200 were enrolled in the study. Their median age was 31 (IQR 27-36) years old and 67% had a first child. Eighty-eight percent of the participants were willing to test for the STIs. Based on the bidding method, WTP prices for HIV and syphilis screening tests were US$14.5 (IQR 12.4-14.5) and US$9.7 (IQR 10-12), respectively. The payment scale method suggested approximately three-quarters of the WTP prices from the bidding method. CONCLUSIONS: The husbands who accompanied their pregnant wives to the ANC clinic showed positive behaviors according to the propitious selection theory. They tend to cooperate well with STI testing and are willing to pay at least two times the price of the STI screening tests. The financial support to promote STI screenings should be reconsidered to cover other groups with higher sexual behavior risks and less WTP.


Assuntos
Financiamento Pessoal , Infecções por HIV/prevenção & controle , Programas de Rastreamento/economia , Cônjuges/psicologia , Sífilis/prevenção & controle , Adulto , Instituições de Assistência Ambulatorial , Feminino , Humanos , Masculino , Projetos Piloto , Gravidez , Cuidado Pré-Natal , Cônjuges/estatística & dados numéricos , Inquéritos e Questionários , Tailândia , Cobertura Universal do Seguro de Saúde
3.
J Glob Health ; 10(1): 010504, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32280458

RESUMO

Background: Countdown to 2030 (CD2030) tracks progress in the 81 countries that account for more than 90% of under-five child deaths and 95% of maternal deaths in the world. In 2017, CD2030 identified syphilis screening and treatment during antenatal care (ANC) as priority indicators for monitoring. Methods: Country-reported data in the UNAIDS Global AIDS Monitoring System (GAM) system were used to evaluate four key syphilis indicators from CD2030 countries: (1) maternal syphilis screening and (2) treatment coverage during ANC, (3) syphilis seroprevalence among ANC attendees, and (4) national congenital syphilis (CS) case rates. A cascade analysis for CD2030 countries with coverage data for the number of women attending at least 4 antenatal care visits (ANC4), syphilis testing, seroprevalence and treatment was performed to estimate the number of CS cases that were attributable to missed opportunities for syphilis screening and treatment during antenatal care. Results: Of 81 countries, 52 (64%) reported one or more values for CS indicators into the GAM system during 2016-2017; only 53 (65%) had maternal syphilis testing coverage, 41 (51%) had screening positivity, and 40 (49%) had treatment coverage. CS case rates were reported by 13 (16%) countries. During 2016-2017, four countries reported syphilis screening and treatment coverage of ≥95% consistent with World Health Organization (WHO) targets. Sufficient data were available for 40 (49%) of countries to construct a cascade for data years 2016 and 2017. Syphilis screening and treatment service gaps within ANC4 resulted in an estimated total of 103 648 adverse birth outcomes with 41 858 of these occurring as stillbirths among women attending ANC4 (n = 31 914 408). Women not in ANC4 (n = 25 619 784) contributed an additional 67 348 estimated adverse birth outcomes with 27 198 of these occurring as stillbirths for a total of 69 056 preventable stillbirths attributable to syphilis in these 40 countries. Conclusion: These data and findings can serve as an initial baseline evaluation of antenatal syphilis surveillance and service coverage and can be used to guide improvement of delivery and monitoring of syphilis screening and treatment in ANC for these priority countries.


Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Sífilis/diagnóstico , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Programas de Rastreamento , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal , Sífilis/epidemiologia , Sífilis/prevenção & controle , Sífilis Congênita/diagnóstico , Sífilis Congênita/epidemiologia , Sífilis Congênita/prevenção & controle , Organização Mundial da Saúde
4.
Dermatol Online J ; 26(2)2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-32239891

RESUMO

Dermatomyositis is an auto-immune inflammatory myopathy that primarily affects the skin and muscle and can be triggered by exposure to various environmental factors. We present a patient with active syphilis infection who developed dermatomyositis and discuss the significance of anti-NXP2 autoantibody positivity.


Assuntos
Adenosina Trifosfatases/imunologia , Doenças Autoimunes/etiologia , Proteínas de Ligação a DNA/imunologia , Dermatomiosite/etiologia , Pele/patologia , Sífilis/complicações , Adulto , Autoanticorpos/sangue , Doenças Autoimunes/patologia , Dermatomiosite/imunologia , Dermatomiosite/patologia , Humanos , Masculino
5.
BMC Infect Dis ; 20(1): 273, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32264923

RESUMO

BACKGROUND: Syphilis has been associated with an increase in HIV RNA and a temporary decline in CD4 T cell counts in people living with HIV who are not receiving antiretroviral treatment (ART), and may be associated with a transient HIV RNA rebound in those who are receiving ART. Our case is the first to highlight the risk of a multidrug-resistant HIV viral rebound during the course of early syphilis even if antiretroviral drug concentrations are within the therapeutic range. CASE PRESENTATION: This 50-year-old HIV-1-positive male patient with concomitant early syphilis presented with an HIV RNA rebound (8908 copies/mL) during a scheduled visit to our clinic. He was receiving a stable ART regimen consisting of darunavir/cobicistat plus dolutegravir, and had a 15-year history of viral suppression. Good short-term drug adherence could be inferred as liquid chromatography tandem mass spectrometry showed that his trough antiretroviral drug concentrations were within the therapeutic range: darunavir 2353 ng/mL (minimum effective concentration > 500 ng/mL) and dolutegravir 986 ng/mL (minimum effective concentration > 100 ng/mL). A plasma RNA genotype resistance test revealed wild-type virus in the integrase region and protease region (PR), but extensive resistance in the reverse transcriptase (RT) region (M41L, E44D, D67N, K70R, M184V, L210W and T215Y). Phylogenetic analysis of next-generation sequences (used to investigate the presence of minor viral variants), the PR and RT sequences from plasma HIV RNA and pro-viral DNA extracted from peripheral blood mononuclear cells during the viral rebound, and a Sanger sequence obtained during a previous virological failure suggested clonal viral expression because the previous PR resistance mutations had been lost or had not been archived in pro-viral DNA. CONCLUSIONS: This case shows that early syphilis may cause an HIV RNA rebound in patients under stable virological control with the potential of transmitting an extensively drug-resistant virus.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Darunavir/uso terapêutico , Farmacorresistência Viral Múltipla/genética , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , HIV-1/genética , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Sífilis/complicações , Coinfecção , Infecções por HIV/virologia , Humanos , Leucócitos Mononucleares/virologia , Masculino , Pessoa de Meia-Idade , Filogenia , RNA Viral/sangue , Minorias Sexuais e de Gênero , Sífilis/microbiologia , Treponema pallidum , Carga Viral/efeitos dos fármacos
8.
Artigo em Inglês | MEDLINE | ID: mdl-32236386

RESUMO

The aim of study was to assess the prevalence of Treponema pallidum and HIV infection in Amerindian people (Mbya Guarani) over the age of 11 in Puerto Iguazu (Argentina) and to describe the contact tracking of cases. The method was a cross-sectional study in the Mbya Guarani people living in three villages of Puerto Iguazu (community A, pop. 1,146; community B, pop. 369; and community C, pop. 149). Participants were randomly invited to participate in the survey and in blood testing. Of the 551 participants, 48 were infected by T. pallidum (8.71%; 95% confidence interval [CI] 7.38-10.04). The infection prevalence decreased with age, standing at 9.66% in the 11-19 age group, 8.42% in 20-39 age group and 4.54% in people aged 40 and older. We tracked 130 contacts for the 48 T. pallidum cases; 39/40 (97.5%) sexual contacts tested positive for syphilis. Among the 90 children born to infected mothers, 76 aged 18 months or older tested negative, while 8/14 younger children were still at risk for congenital syphilis. There were four cases of HIV infection (0.72%, 95% CI 0.31-1.13). Prevalence of T. pallidum infection and HIV infection are relevant in this indigenous community of Argentina, representing a public health concern.


Assuntos
Busca de Comunicante/estatística & dados numéricos , Infecções por HIV/epidemiologia , Índios Sul-Americanos/estatística & dados numéricos , Sífilis/epidemiologia , Adolescente , Adulto , Argentina/epidemiologia , Criança , Estudos Transversais , Feminino , Seguimentos , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Humanos , Lactente , Masculino , Prevalência , Estudos Soroepidemiológicos , Sífilis/diagnóstico , Sífilis/transmissão , Adulto Jovem
10.
Rev Soc Bras Med Trop ; 53: e20190199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187335

RESUMO

INTRODUCTION: The number of syphilis cases among pregnant women in Brazil has increased. This study aimed to analyze the temporal trend of syphilis indicators among pregnant women in Northeast Brazil. METHODS: A time-series study was performed. RESULTS: We observed an increase in the detection rate of syphilis among pregnant women, those aged 15-19 years, and those of brown ethnicity. A strong correlation was observed between the detection rate of syphilis and family health strategy coverage. CONCLUSIONS: Despite an increase in primary care coverage, The increase in cases of syphilis among pregnant women is still considered a challenge.


Assuntos
Medicina de Família e Comunidade/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal , Sífilis/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Feminino , Humanos , Gravidez , Fatores Socioeconômicos , Análise Espaço-Temporal , Adulto Jovem
12.
Rev Bras Epidemiol ; 23: e200012, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32130400

RESUMO

INTRODUCTION: Syphilis is a sexually transmitted disease, easy to diagnose and treat, but whose incidence is increasing in Brazil. This study estimated the prevalence of the non-performance of serological tests for syphilis during prenatal care, in addition to evaluating its trend and identifying its associated factors in the municipality of Rio Grande, Rio Grande do Sul, Southern Brazil. METHODS: This is a cross-sectional survey that included all pregnant women living in this municipality who gave birth between January 1 and December 31, 2007, 2010, and 2013. A single standardized questionnaire was administered to the mothers within 48 hours of delivery, while they were still in the maternity ward. We used the χ2 test for proportions and linear trend, and Poisson regression with robust adjustment in the multivariate analysis. The effect measure adopted was prevalence ratio (PR). RESULTS: Among the 7,351 mothers who had at least one prenatal visit, the prevalence of non-performance of serological tests for syphilis in the three years studied was 2.9% (95% confidence interval - 95%CI 2.56 - 3.33), with 3.3% (95%CI 2.56 - 3.97) in 2007, 2.8% (95%CI 2.20 - 3.52) in 2010, and 2.7% (95%CI 2.12 - 3.38) in 2013. Black mothers, those with low household income and schooling, and who had few prenatal visits showed higher PR of non-performance of this test. DISCUSSION: The prevalence of non-performance has virtually not changed in the period, and women with high-risk pregnancy showed a greater probability of not undergoing the test. CONCLUSIONS: This municipality needs to reach mothers with lower socioeconomic status, restructure the local health services, and enhance their operationalization to improve the quality of prenatal care.


Assuntos
Cuidado Pré-Natal/métodos , Sorodiagnóstico da Sífilis/estatística & dados numéricos , Sífilis/diagnóstico , Sífilis/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Análise Multivariada , Distribuição de Poisson , Gravidez , Gravidez de Alto Risco , Prevalência , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
15.
BMC Infect Dis ; 20(1): 165, 2020 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-32087699

RESUMO

BACKGROUND: Treponema pallidum (T. pallidum) infection evokes significant immune responses, resulting in tissue damage. The immune mechanism underlying T. pallidum infection is still unclear, although microRNAs (miRNAs) have been shown to influence immune cell function and, consequently, the generation of antibody responses during other microbe infections. However, these mechanisms are unknown for T. pallidum. METHODS: In this study, we performed a comprehensive analysis of differentially expressed miRNAs in healthy individuals, untreated patients with syphilis, patients in the serofast state, and serologically cured patients. miRNAs were profiled from the peripheral blood of patients obtained at the time of serological diagnosis. Then, both the target sequence analysis of these different miRNAs and pathway analysis were performed to identify important immune and cell signaling pathways. Quantitative reverse transcription-polymerase chain reaction (RT-PCR) was performed for microRNA analysis. RESULTS: A total of 74 differentially regulated miRNAs were identified. Following RT-qPCR confirmation, three miRNAs (hsa-miR-195-5p, hsa-miR-223-3p, hsa-miR-589-3p) showed significant differences in the serofast and serologically cured states (P < 0.05). One miRNA (hsa-miR-195-5p) showed significant differences between untreated patients and healthy individuals. CONCLUSIONS: This is the first study of miRNA expression differences in peripheral blood mononuclear cells (PBMCs) in different stages of T. pallium infection. Our study suggests that the combination of three miRNAs has great potential to serve as a non-invasive biomarker of T. pallium infections, which will facilitate better diagnosis and treatment of T. pallium infections.


Assuntos
Leucócitos Mononucleares/metabolismo , MicroRNAs/genética , Sífilis/sangue , Transcriptoma/genética , Treponema pallidum/imunologia , Biomarcadores , Perfilação da Expressão Gênica , Humanos , MicroRNAs/imunologia , Prognóstico , Reação em Cadeia da Polimerase em Tempo Real , Testes Sorológicos , Sífilis/diagnóstico , Sífilis/microbiologia , Treponema pallidum/isolamento & purificação
17.
BMC Infect Dis ; 20(1): 129, 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32046662

RESUMO

BACKGROUND: Syphilis is a sexually transmitted infection (STI) transmitted from person to person mainly by sexual intercourse or through vertical transmission during pregnancy. Female sex workers (FSWs) are exposed especially to syphilis infection, and besides all the efforts to control the spread of STIs, syphilis prevalence is still rising, mainly occurring in low-income countries. This study aimed to investigate the syphilis prevalence, demographic characteristics and sexual habits among FSWs in the Amazon region of Brazil. METHODS: A cross-sectional study was carried out including 184 FSWs from 3 countryside cities of the state of Pará, Amazon region of Brazil. A venereal disease research laboratory test and an indirect immunoenzyme assay to test antibodies against Treponema pallidum were used for screening syphilis infection, while sexual habits and demographic data information were collected through a semi-structured questionnaire. Data was analyzed comparing groups with/without syphilis. Poisson regression models were used to estimate the reasons of prevalence (RP). RESULTS: The overall prevalence of syphilis was 14.1% (95% CI = 9.8-17.8). FSWs had between 15 and 56 years of age, most were unmarried (65.7%), had attended less than 8 years of formal education (64.1%), had between 10 and 20 partners per week (64.1%), and reported no previous history of STIs (76.1%) and regular use of condom (52.7%). Low level of education attending up to the primary school (RP adjusted = 3.8; 95% CI = 1.4-9.2) and high frequency of anal sex during the past year (RP adjusted = 9.3; 95% CI = 3.5-28.7) were associated with a higher prevalence of syphilis. CONCLUSIONS: A high prevalence of syphilis among FSWs in the Brazilian Amazon region was identified, showing that syphilis is more likely to be transmitted in FSW working in low-income areas, which is attributed to the low level of education. Anal intercourse was found as a risk factor associated with syphilis. Health programs focused on risk populations appear as a rational way to control syphilis spread, which is a rising problem in Brazil and in other several countries.


Assuntos
Profissionais do Sexo/estatística & dados numéricos , Sífilis/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Cidades/estatística & dados numéricos , Preservativos/estatística & dados numéricos , Estudos Transversais , Escolaridade , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Sífilis/diagnóstico , Sorodiagnóstico da Sífilis , Treponema pallidum/imunologia , Adulto Jovem
18.
Hautarzt ; 71(4): 275-283, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32025745

RESUMO

BACKGROUND: Sexually transmitted infections (STIs) in the anorectal region are disproportionally detected in risk populations such as men who have sex with men (MSM). However, due to changes in sexual behaviour they are increasingly diagnosed in heterosexual individuals. Due to the recent implementation of oral HIV pre-exposure prophylaxis together with lack of condom use, a further rise in STIs is expected. OBJECTIVES: This review addresses epidemiology, clinical picture, diagnostic pitfalls and current therapy guidelines of "classical" bacterial STIs involving the anorectum. CONCLUSIONS: STI manifestations in the anal region are frequently nonspecific or asymptomatic so that the diagnosis may be missed. In an endoscopic examination of the rectum, they can even mimic inflammatory bowel disease or malignancy. Therefore, knowledge of possible symptoms of bacterial STIs in this area is helpful for early diagnosis. Coinfections with other STIs are common and should prompt a search of other pathogens including HIV and hepatitis B/C.


Assuntos
Doenças do Ânus/diagnóstico , Coinfecção/diagnóstico , Doenças Retais/diagnóstico , Comportamento Sexual , Doenças Sexualmente Transmissíveis , Sexo sem Proteção , Doenças do Ânus/epidemiologia , Doenças do Ânus/terapia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/terapia , Coinfecção/epidemiologia , Feminino , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Gonorreia/terapia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Heterossexualidade , Homossexualidade Masculina , Humanos , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/epidemiologia , Linfogranuloma Venéreo/terapia , Masculino , Doenças Retais/epidemiologia , Doenças Retais/terapia , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/terapia , Sífilis/diagnóstico , Sífilis/epidemiologia , Sífilis/terapia
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