AEDV Expert Recommendations on the Management of Suppurative Sexually Transmitted Infections. / Recomendaciones de expertos de la AEDV sobre el manejo de infecciones venéreas supurativas.

The incidence of sexually transmitted infections (STIs) is increasing in Spain. Suppurative STIs are one of the most frequent reasons for consultation in specialized centers. The reason for suppurative STIs is multiple and their empirical treatment varies with the currently growing problem of antimicrobial resistance. Dermatologists are trained and prepared to treat these diseases, but their correct management requires active knowledge of national and international guidelines. The present document updates, reviews and summarizes the main expert recommendations on the management and treatment of these STIs.

[Primary care management of sexually transmitted infections (I). Epidemiology. Secreting syndrome]. / Manejo en atención primaria de las infecciones de transmisión sexual (I). Epidemiología. Síndrome secretor.

These days sexually transmitted infections (STIs) are important public health problems not only due to their high prevalence, but also because they require early diagnosis and treatment to avoid complications. In recent years, there has been an exponential increase in cases of infections caused by Chlamydia trachomatis and gonococcus in the population under 25years of age. In addition, an increase in the incidence of syphilis and hepatitisC (HCV) has also been detected, especially in men who have sex with other men (MSM). Genital herpes continues to be the second most frequent STI in the world, behind condyloma acuminata, and the first cause of genital ulcer among Spain in the sexually active population. A decrease in reported HIV cases was observed during 2020, but almost half of these new cases had a late diagnosis (<350CD4cell/µL). Current guidelines recommend offering STI annual screening to populations at risk or more often depending on the risk. STIs can appear in the form of syndromes, such as secretory syndrome (urethritis, proctitis, and cervicitis) or ulcerated syndrome (ulcers). The STIs that can cause secretory syndrome are mainly caused by Neisseria gonorrhoeae and C.trachomatis, which co-infect up to 40% of cases, and also cause urethritis, cervicitis or proctitis depending on where they are located. Gonococcus has an incubation period of 2-7days and Chlamydia 2-6weeks, and they are diagnosed using PCR and/or culture (the last one only valid for gonococcus) of samples collected according to sexual activities. Empirical treatment to cover both germs will be accomplished with ceftriaxone, 1g single intramuscular dose plus doxycycline 100mg every 12h orally for 7days, or azithromycin 1g single dose orally (we will use azithromycin only if we suspect a poor compliance with treatment, difficulty in going to the control or in pregnancy). Likewise, whenever we diagnose an STI firstly, we must offer advice and health education in order to promote the adoption of safe sexual behaviours and the correct use of barrier methods. Secondly, we must also screen for other STIs (HIV, syphilis, hepatitisB, and hepatitisA andC depending on the risk), offer HBV and HAV vaccination if it is appropriate, and finally study and treat all sexual partners from the previous 3months.

[Neisseria meningitidis and the increase of oral sex. A case report]. / Neisseria meningitidis y el aumento del sexo oral. A propósito de un caso.

Urethritis is an entity characterized by dysuria and purulent urethral discharge, generally acquired sexually. Neisseria gonorrhoeae is one of the most frequently responsible microorganisms. Neisseria meningitidis is a gram-negative diplococcus usually isolated in the pharynx, that occasionally causes meningococcal meningitis, being unusual it's isolation in the anogenital area where it could be a genitourinary pathogen. We present the case of a 25-years-old heterosexual male who, after a heterosexual intercourse with an occasional non-professional partner, including oral and vaginal sex, presented with symptoms of urethritis, orienting to a sexually transmitted infection. The bacteriological culture for N. gonorrhoeae was negative and the PCR for Chlamydia trachomatis was positive. Subsequently, the lab reported a positive bacteriological culture for sero-group C N. meningitidis, sensitive to ceftriaxone and a negative PCR for N. gonorrhoeae. N. meningitidis is the main cause of bacterial meningitis, but genomic studies have suggested that alleles of nitrate reductase, factor-H biding protein and capsule are associated with N. meningitidis isolation in genitourinary infections. Transmission from the oropharynx to the urethra through orogenital contact in unprotected oral sex has been widely proven. N. meningitidis prevalence as the cause of the urethritis is low, and the asymptomatic carriers in the urethra are extremely rare. PCR is a method for the N. gonorrhoeae and C.trachomatis diagnoses, but it does not detect N. meningitidis. The gonorrhoea diagnosis is based on an increased number of polymorphonuclear cells, with intracellular gram-negative diplococci in Gram' stain of urethral discharge. In our case, the gram-negative diplococcus seen in the stain was a meningococcus. Urethritis due to N. meningitidis is indistinguishable from the secondary to N. gonorrhoeae, mimicking it even microscopically, only the epidemiology varies. The conventional bacteriological culture continues to be essential for a correct diagnosis.

Clinical significance of isolation of Haemophilus no ducreyi in genital samples. Systematic review.

INTRODUCTION AND OBJECTIVES: Currently, the microbiological diagnosis of genital infections is carried out with molecular methods, which allow the detection of less frequent etiological agents but with potential pathogenic importance, such as Haemophilus spp. The objective of this review is to analyse and highlight the clinical importance of the isolation of Haemophilus spp. in genital and rectal infections, excluding Haemophilus ducreyi. MATERIAL AND METHODS: A systematic review was carried out based on an exhaustive search of the publications included in the MEDLINE database up to August 5, 2021, on the presence of Haemophilus spp. in genital and rectal infections, excluding H. ducreyi. RESULTS: After reviewing what was described in the literature, Haemophilus spp. (excluding H. ducreyi: HSNOD) was detected in 2397 episodes of genital infection, the most frequently isolated species being H. influenzae and H. parainfluenzae. Most of the episodes (87,6%) are constituted by single isolation. There is a slight predominance in women (48,3%) where it can cause vaginitis, salpingitis, endometritis or complications during pregnancy. In men, the clinical picture usually corresponds to urethritis. Most of the samples correspond to vaginal and urethral exudates, with a minority representation at the rectal level (2.3%). CONCLUSION: HSNOD plays a relevant pathogenic role in episodes of genital infection, so microbiological diagnostic protocols must include methods that allow their detection, as well as include them in the etiological spectrum of this type of clinical picture.

Haemophilus urethritis in males: A series of 30 cases.

INTRODUCTION AND OBJECTIVES: Pathogens such as Haemophilus spp. have been associated with non-gonococcal urethritis, but their role is unproven. To describe the clinical characteristics and therapeutic outcomes in male patients diagnosed with Haemophilus spp. urethritis. METHODS: We carried out a retrospective study of all patients who presented to our hospital (in either the emergency department or the outpatient clinic) between July 2016 and April 2018 in whom Haemophilus spp. was isolated in the urethral samples. We enrolled 30 men with Haemophilus spp.-positive urethritis, including coinfections with Neisseria gonorrhoeae and Chlamydia trachomatis. Clinical, laboratory, demographic, and behavioral data were obtained by reviewing medical histories. RESULTS: The mean age of the patients was 36.6 years (range 21-87). Seventeen patients (63%) reported being exclusively heterosexual. Three patients (10%) were HIV infected, all of them with an undetectable viral load. The most common clinical presentation was mucopurulent urethral discharge, in 13 patients (43%). The antibiotic treatment achieved a complete clinical resolution in 73%. CONCLUSIONS: Haemophilus urethritis affected men regardless of their sexual orientation or HIV status. Unprotected oral sex may play a role in its transmission. The limitations of the study preclude verification of the pathogenic role of Haemophilus spp. in acute urethritis, but clinical response after antibiotic treatment suggests that Haemophilus spp. can play such a role.

Male urethritis. A review of the ideal diagnostic method. / Uretritis masculina. Una revisión del método ideal de diagnóstico.

Male urethritis is an inflammation of the urethra and the periurethral glands; it is widely classified as gonococcal or non-gonococcal. The most frequent microorganisms responsible are Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum. In the last three decades, the diagnosis of sexually transmitted diseases depended almost exclusively on traditional methods, such as culture, enzyme immunoassay, fluorescent antibody staining, and hybridization, until the appearance of molecular techniques. Clinical syndromes such as urethritis are rarely specific for a single microorganism, so screening strategies should allow multiple agents to be considered. Multiplex PCR is the fastest and most sensitive technique for the diagnosis of gonococcal and non-gonococcal urethritis. Male urethritis without treatment is one of the main health problems related to reproductive and sexual function, constituting one of the main causes of infertility. The objective of this mini-review was to analyze the epidemiology, causes, diagnosis, and complications of male urethritis.

Haemophilus Species Isolated in Urethral Exudates as a Possible Causative Agent in Acute Urethritis: A Study of 38 Cases. / Aislamiento de Haemophilus spp. en exudados uretrales como posible agente etiológico de uretritis aguda: estudio de 38 casos.

INTRODUCTION: The incidence of urethritis due to Haemophilus species is increasing. The main aim of this study was to describe the clinical and microbiological characteristics of patients with this form of urethritis. A secondary aim was to discuss the adequacy of treatments in patients with different types of antibiotic resistance. MATERIAL AND METHODS: We studied patients with a microbiologically confirmed diagnosis of urethritis seen at the Sexually Transmitted Infections Unit of our hospital between July 2015 and July 2018. We selected all patients in whom Haemophilus species were isolated on chocolate agar. Antibiotic resistance was tested using the disk-diffusion method. Cross-sectional data were collected prospectively during outpatient visits. RESULTS: Haemophilus species were isolated in 33.6% of cases. The most common clinical manifestation was urethral discharge (57.6%); 60% of the patients were men who have sex with men and in this subgroup Haemophilus species were significantly more common than either Neisseria or Chlamydia species. Haemophilus species were found in isolation in 39.5% of patients and the most common one was Haemophilus parainfluenzae (isolated in 84.2% of cases). In total, 34.2% of patients were resistant to azithromycin and 26.3% were resistant to both azithromycin and tetracycline. Empirical treatment achieved clinical and microbiologic cure in 11 of the patients who were not lost to follow-up (n=17; 44.7%). The remaining 6 patients required treatment with a new antibiotic. CONCLUSIONS: Haemophilus species are a new cause of nongonococcal urethritis, whose incidence is rising, particularly in men who have sex with men who engage in unprotected oral sex. The clinical manifestations are similar to those seen in gonococcal urethritis. Eradication of infection must be confirmed due to the high rate of antibiotic resistance associated with Haemophilus species.

Staphylococcus epidermidis productor de biofilm como causa de uretritis en el sexo masculino

Introducción: La emergencia de Staphylococcus epidermidis como patógeno oportunista está relacionada a su capacidad de formación de biofilm. Objetivo: Identificar Staphylococcus epidermidis productor de biofilm como causa de uretritis en el sexo masculino, en el laboratorio de Microbiología del Centro Provincial de Higiene, Epidemiología y Microbiología Guantánamo durante el año 2019. Método: Se realizó una investigación observacional, descriptiva y transversal en el laboratorio antes mencionado, con un universo de estudio conformado por 48 pacientes ambulatorios del sexo masculino con diagnóstico clínico de uretritis realizado por al médico de familia y que acudieron al laboratorio de Microbiología de dicho centro con indicación de exudado uretral con cultivo. Las variables estudiadas fueron: producción de las enzimas coagulasa, catalasa y oxidasa, crecimiento en agar manitol salado, sensibilidad de la novobiocina, producción de biofilm y resistencia a los antimicrobianos. Los resultados de las muestras fueron vaciados en una base de datos y fueron procesados con el programa SPSS versión 11.5. Resultados: Se identificó Staphylococcus epidermidis productor de biofilm como causa de uretritis en los 48 pacientes del sexo masculino estudiados. Este microorganismo mostró resistencia nula o disminuida frente a ciprofloxacina, norfloxacina, amikacina, gentamicina, amoxicilina con sulbactam, cotrimoxazol y tetraciclina. Conclusiones: Staphylococcus epidermidis emerge como patógeno oportunista frecuente en pacientes del sexo masculino con diagnóstico clínico de uretritis, con significativa resistencia a los antibióticos betalactámicos no combinados con inhibidores de la betalactamasa.

Introduction: Staphylococcus epidermidis as an opportunistic pathogen and its ability to form biofilm has become an emergency situation. Objective: To identify biofilm-producing Staphylococcus epidermidis as a cause of urethritis in males. Study performed throughout 2019 in the Microbiología Lab of the Centro Provincial de Higiene, Epidemiología y Microbiología Lab in Guantánamo. Method: An observational, descriptive and cross-sectional study was carried out at the aforementioned lab, envolving a total of 48 male outpatients with a clinical diagnosis of urethritis certified by the family physician, attended in the Microbiology laboratory with their respective urethral discharge culture indication. The variables studied were as follow: coagulase, catalase and oxidase enzyme production test, growth of mannitol salt agar, novobiocin sensitivity, biofilm production and antimicrobial resistance. The sampling results were introduced in a database and processed with the software SPSS version 11.5. Results: Biofilm-producing Staphylococcus epidermidis was identified as the cause of urethritis in the 48 male patients involved in the study. This microorganism showed cero or low resistance to ciprofloxacin, norfloxacin, amikacin, gentamicin, amoxicillin-sulbactam combination, cotrimoxazole and tetracycline. Conclusions: Staphylococcus epidermidis emerges as a common opportunistic pathogen in male patients with a clinical diagnosis of urethritis, with significant resistance to beta-lactam antibiotics not combined with beta-lactamase inhibitors.

Introdução: O surgimento do Staphylococcus epidermidis como patógeno oportunista está relacionado à sua capacidade de formação de biofilme. Objetivo: Identificar Staphylococcus epidermidis, produtor de biofilme como causador de uretrite em homens, no laboratório de Microbiologia do Centro Provincial de Higiene, Epidemiología y Microbiología Guantánamo durante o ano de 2019. Método: Investigação observacional, descritiva e transversal. realizado no referido laboratório, tendo como universo de estudo 48 doentes ambulatórios do sexo masculino com diagnóstico clínico de uretrite feito pelo médico de família e que compareceram ao laboratório de Microbiologia do referido centro com indicação de exsudato uretral com cultura. As variáveis estudadas foram: produção das enzimas coagulase, catalase e oxidase, crescimento em ágar manitol salgado, sensibilidade à novobiocina, produção de biofilme e resistência a antimicrobianos. Os resultados das amostras foram digitados em um banco de dados e processados no programa SPSS versão 11.5. Resultados: O Staphylococcus epidermidis produtor de biofilme foi identificado como a causa da uretrite nos 48 pacientes masculinos estudados. Este microrganismo não apresentou ou apresentou resistência reduzida contra ciprofloxacino, norfloxacino, amicacina, gentamicina, amoxicilina com sulbactam, cotrimoxazol e tetraciclina. Conclusões: Staphylococcus epidermidis surge como um patógeno oportunista frequente em pacientes do sexo masculino com diagnóstico clínico de uretrite, com resistência significativa a antibióticos beta-lactâmicos não combinados com inibidores de beta-lactamase.

Uretritis por haemophilus influenzae. primer reporte de caso en paraguay

Introducción: La uretritis es el síndrome más frecuente en el contexto de infección de transmisión sexual (ITS). Caso clínico: Paciente masculino de 26 años, bisexual, acude a una Clínica Comunitaria, por cuadro de un día de perdida espontánea y continua de secreción uretral, más disuria y adenomegalia izquierda. Niega fiebre y otros síntomas. Observación: última exposición sexual, oral insertiva, homosexual, casual y desprotegida, 7 días previos a sintomatología. Se solicitan testeos rápidos para ITS, orina simple, frotis y cultivo de exudado uretral. Se administra tratamiento empírico dual combinando y paciente evoluciona favorablemente. Informe de cultivo de exudado uretral positivo, aislándose Haemophilus influenzae. Discusión: La uretritis por H. influenzae es poco frecuente, presumiblemente adquirida por prácticas orogenitales desprotegidas. Es estadísticamente significativa en población HSH (hombres que tienen sexo con hombres). En Paraguay no se tienen datos sobre agentes etiológicos de uretritis infecciosa en varones, de allí la importancia del reporte.

Introduction: Urethritis is the most common syndrome in the context of sexually transmitted infection (STI). Clinical case: Patient of 26-year-old cis man, bisexual, attended a Community Clinic, complaining of one day of spontaneous and continuous loss of urethral secretion, plus dysuria and left adenomegaly. He denies fever and other symptoms. Observation: last sexual, oral insertive exposure, homosexual, casual and unprotected, 7 days prior to symptoms. Rapid tests for STIs, simple urine, smear and culture of urethral exudate are requested. Combined dual empirical treatment was administered and the patient progressed favorably. Positive urethral exudate culture report, isolating Haemophilus influenzae. Discussion: H. influenzae urethritis is rare, presumably acquired by unprotected oral practices. It is statistically significant in the MSM population (men who have sex with men). In Paraguay there is no data on etiological agents of infectious urethritis in men, hence the importance of the report.

Characterization of sexually transmitted infections, their pharmacological treatment, and recurrence in a Colombian population / Caracterización de las infecciones de transmisión sexual, su tratamiento farmacológico y la recurrencia en una población colombiana

Abstract | Introduction: Sexually transmitted infections are a public health problem worldwide. Their inadequate antimicrobial management has been associated with a higher risk of recurrence. Objective: To characterize the main sexually transmitted infections, the adherence to clinical practice guidelines, and the factors associated with recurrence in Colombia. Materials and methods: We conducted an observational study to identify the main sexually transmitted infections, the sociodemographic variables, and the pharmacological management in a patient cohort from a population database of 6.5 million people affiliated with the Colombian health system. We made a multivariate analysis to identify the variables associated with recurrence. Results: We detected 3,158 patients with a mean age of 41.8 ± 14.5 years, of whom 63.1% were men. We found 4.030 episodes of sexually transmitted infections, predominantly urethral syndrome (27.5%). Only 13.6% of patients with urethral syndrome, ulcerative syndrome, or genital warts were managed in compliance with clinical practice guidelines and 20.6% were dispensed condoms; 16.7% of patients had recurrences and being male (OR=1.32; 95%CI 1.08-1.63), <30 years old (OR=1.72; 95%CI 1.40-2.13), being treated in municipalities other than capital cities (OR=1.43; 95%CI 1.06-1.94), and having received inadequate treatment for the first episode (OR=1.93; 95%CI 1.52-2.39) were associated with recurrence. Conclusions: The majority of patients with sexually transmitted infections were not treated in compliance with clinical practice guidelines and those who did not have adequate management had a higher risk of recurrence.

Resumen | Introducción. Las infecciones de transmisión sexual constituyen actualmente un problema de salud pública en el mundo. Su inadecuado tratamiento antimicrobiano se ha relacionado con un mayor riesgo de recurrencias. Objetivo. Caracterizar las principales infecciones de transmisión sexual, el cumplimiento de las guías de práctica clínica de Colombia y los factores asociados con las recurrencias. Materiales y métodos. Se hizo un estudio observacional para determinar las principales infecciones de transmisión sexual, las variables sociodemográficas y el tratamiento farmacológico en una cohorte de pacientes registrados en una base de datos poblacional de 6,5 millones de personas afiliadas al Sistema de Salud de Colombia. Se hizo un análisis multivariado para establecer las variables asociadas con las recurrencias. Resultados. Se detectaron 3.158 pacientes; su edad media era de 41,8 ±14,5 años y 63,1 % de ellos correspondía a hombres; se encontraron 4.030 episodios de infecciones de transmisión sexual con predominio del síndrome uretral (27,5 %). El 13,6 % de los pacientes con síndrome uretral, ulceroso o con verrugas genitales se manejó según las guías de práctica clínica. El 20,6 % tenía acceso a condones y el 16,7 % presentó recurrencias. Ser hombre (OR=1,32; IC95% 1,08-1,63), tener <30 años (OR=1,72; IC95% 1,40-2,13), ser tratado en municipios distintos a ciudades capitales (OR=1,43; IC95% 1,06-1,94) y haber recibido un tratamiento inadecuado en el primer episodio (OR=1,93; IC95% 1,52-2,39) fueron factores asociados con las recurrencias. Conclusiones. La mayoría de los pacientes con infecciones de transmisión sexual no fueron tratados según las guías de práctica clínica y quienes no tuvieron un manejo adecuado presentaban mayor riesgo de recurrencias.

El diagnóstico de Infecciones de Transmisión Sexual por la técnica de biología molecular es la mejor estrategia para su diagnóstico oportuno y específico. Un caso clínico / The diagnosis of Sexually Transmitted Infections by the molecular biology technique is the best strategy for its timely and specific diagnosis. A clinical case

Resumen Se presenta el caso de un paciente a quien se le diagnosticó una Infección de Transmisión Sexual (ITS) por la técnica de PCR múltiple y en quién se logró por esta técnica, detectar cuatro agentes diferentes simultáneamente: Neisseria gonorreae, Mycoplasma hominis, Ureaplasma urealyticum/parvum y Trichomonas vaginalis, situación esta, que no hubiera sido posible utilizando el procedimiento estándar.

Summary Here we report the case of a patient with a Sexually Transmitted Disease (STI) in whom four different agents were detected by a multiple PCR technique: Neisseria gonorreae, Mycoplasma hominis, Ureaplasma urealyticum / parvum and Trichomonas vaginalis. This detection of multiple agents would not have been possible using conventional procedures.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecções que causam corrimento uretral / Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause urethral discharge / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infecciones que causan secreción uretral

Este artigo aborda as infecções que causam corrimento uretral, tema que compõe o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. As uretrites, quando não tratadas de maneira correta, ou quando o microrganismo desenvolve resistência ao tratamento empregado, podem causar danos graves e até irreversíveis à saúde. Os níveis de resistência antimicrobiana que esses agentes têm desenvolvido são considerados uma emergência global em saúde pública. Neste artigo, são apresentados aspectos epidemiológicos e clínicos, recomendações sobre diagnóstico e tratamento e estratégias para as ações de vigilância, prevenção e controle das infecções que causam corrimento uretral, com a finalidade de contribuir com gestores e profissionais de saúde para a qualificação da assistência.

This article approach infections that cause urethral discharge, theme which is part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020. These guidelines were prepared based on scientific evidence and validated in discussions with experts. When urethritis is not treated correctly, or when the microorganism develops antimicrobial resistance, it can cause serious and even irreversible health damage. It is noteworthy that the high levels of antimicrobial resistance developed by pathogens that causes urethritis comprises a global emergency in public health. This article presents epidemiological and clinical aspects, recommendations on diagnostic and treatment, and strategies for surveillance, prevention and control actions of infections that cause urethral discharge, with the purpose of contributing with managers and health professionals to care qualification.

El artículo trata de las infecciones que causan secreción uretral, tema que hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento se elaboró con base en evidencias científicas y se validó en discusiones con expertos. Las uretritis, cuando no tratadas correctamente o cuando el microorganismo desarrolla resistencia al tratamiento, puede ocasionar daños graves a la salud. Los niveles de resistencia antimicrobiana que estos agentes desarrollan son considerados una emergencia de salud pública. En este artículo, se presentan aspectos epidemiológicos y clínicos, recomendaciones para el diagnóstico y tratamiento y estrategias para acciones de monitoreo epidemiológico, prevención y control de las infecciones que causan secreción uretral, a fin de contribuir con gestores y personal de salud para la cualificación de la asistencia.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecções que causam corrimento uretral / Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause urethral discharge / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infecciones que causan secreción uretral

Resumo Este artigo aborda as infecções que causam corrimento uretral, tema que compõe o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. As uretrites, quando não tratadas de maneira correta, ou quando o microrganismo desenvolve resistência ao tratamento empregado, podem causar danos graves e até irreversíveis à saúde. Os níveis de resistência antimicrobiana que esses agentes têm desenvolvido são considerados uma emergência global em saúde pública. Neste artigo, são apresentados aspectos epidemiológicos e clínicos, recomendações sobre diagnóstico e tratamento e estratégias para as ações de vigilância, prevenção e controle das infecções que causam corrimento uretral, com a finalidade de contribuir com gestores e profissionais de saúde para a qualificação da assistência.

Abstract This article approach infections that cause urethral discharge, theme which is part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020. These guidelines were prepared based on scientific evidence and validated in discussions with experts. When urethritis is not treated correctly, or when the microorganism develops antimicrobial resistance, it can cause serious and even irreversible health damage. It is noteworthy that the high levels of antimicrobial resistance developed by pathogens that causes urethritis comprises a global emergency in public health. This article presents epidemiological and clinical aspects, recommendations on diagnostic and treatment, and strategies for surveillance, prevention and control actions of infections that cause urethral discharge, with the purpose of contributing with managers and health professionals to care qualification.

Resumen El artículo trata de las infecciones que causan secreción uretral, tema que hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento se elaboró con base en evidencias científicas y se validó en discusiones con expertos. Las uretritis, cuando no tratadas correctamente o cuando el microorganismo desarrolla resistencia al tratamiento, puede ocasionar daños graves a la salud. Los niveles de resistencia antimicrobiana que estos agentes desarrollan son considerados una emergencia de salud pública. En este artículo, se presentan aspectos epidemiológicos y clínicos, recomendaciones para el diagnóstico y tratamiento y estrategias para acciones de monitoreo epidemiológico, prevención y control de las infecciones que causan secreción uretral, a fin de contribuir con gestores y personal de salud para la cualificación de la asistencia.

Infecciones en varones por gardnerella vaginalis- revisión bibliográfica

Introducción: Gardnerella vaginalis ha sido aislada de orina, semen, descarga uretral, hisopos endouretrales, rectales y del prepucio, en algunos casos asociada a manifestaciones clínicas; se han descrito uretritis y balanopostitis con diversos porcentajes. Los hallazgos en frotis rectal, semen y prepucio deben interpretarse cuidadosamente para otorgarles significado clínico. Ha quedado demostrado que el hombre la adquiere de sus parejas sexuales y en su forma cohesiva. Objetivo: Explorar el papel patógeno de G. vaginalis como causa de infección en los hombres. Método: La estrategia de búsqueda se realizó en: PubMed/ Medline, Scopus Cochrane Library, SciELO Lilacs, Redalyc; Google Scholar con proveedores como: EB-SCO y tesauros MeSH y DeCS. Resultados: Las diferentes publicaciones indicaron detección de G. vaginalis en muestras uretrales con reportes desde 1,5 %, 4,2 % hasta 14 % con manifestaciones clínicas de uretritis. Otros reportes indican 4,5 %, 5 %, 6,3 %, 7,2 % y 14,5 % sin uretritis. Dos estudios de infecciones del tracto urinario presentan porcentajes de 30,8 % y 67 % de G. vaginalis en hombres con síntomas urinarios. G vaginalis se reporta en frotis rectal, semen e hisopados del prepucio, pero sin clara atribución de etiología patógena. Conclusión: Es recomendable la búsqueda de G. vaginalis en hombres con uretritis no gonocócica, balanopostitis, e infecciones del tracto urinario por su probable significado patógeno, mientras que su papel en semen en pacientes con infertilidad y en el frotis rectal, requiere más estudios de investigación.

Introduction: Gardnerella vaginalis has been isolated from urine, semen, urethral discharge, and endourethral, rectal, and foreskin swabs, in some cases associated with clinical manifestations. Urethritis and balanoposthitis have been described in different percentages. Rectal swab, semen, and foreskin findings must be carefully interpreted for clinical significance. It has been demonstrated that man acquires it from her sexual partners in its cohesive form. Objective: To explore the role of G. vaginalis as a cause of infections in men. Method: Bibliography was searched through PubMed/ Medline, Scopus Cochrane Library, SciELO Lilacs, Redalyc; Google Scholar, and providers like EBSCO and thesauros MeSH y DeCS. Results: Several publications show the detection of G. vaginallis in urethral samples with reports of 1,5%, 4,2%, even 14% of urethritis. Some other reports show a 4,5%, 5%, 6,3%, 7,2% and 14,5% without urethritis. Two studies of urinary tract infections show a 30,8% and 67% of G. vaginalis in men with urinary symptoms. G. vaginalis is reported in rectal smears, semen, and foreskin swabs but without clear attribution of pathogenic etiology. Conclusion: The search for G. vaginalis in men with non-gonococcal urethritis, balanoposthitis, or urinary tract infections is recommended due to its probable pathogenic significance, while its role in patients with infertility and rectal smears requires further investigation, due to the presence in semen.

Uretritis gonocócica / Gonococal urethritis

La uretritis gonocócica es uno de los síndromes más comunes relacionados con la transmisión sexual. Hay diversos factores que influyen en que no se conozca su cifra real de ocurrencia; en primer lugar, el estigma social que representan estas infecciones, y en segundo, la automedicación, por lo que la cifra de casos puede ser más del doble de lo reportado en las estadísticas oficiales. Las mucosas de los órganos genitales constituyen la principal vía de entrada de la Neisseria gonorrhoeae . Este es un microorganismo que no sobrevive por mucho tiempo fuera de su hospedero, el ser humano, y sólo se transmite de persona a persona por contacto directo y por colonizar a las células del epitelio columnar de la uretra y del cérvix, así como la mucosa de garganta y recto. La manifestación más común de gonorrea es la uretritis, pero en mujeres es frecuente un curso subclínico o la cervicitis. En ellas, la gonorrea puede llevar al desarrollo de enfermedad pélvica inflamatoria, mientras que en los hombres puede producir estenosis uretral, epididimitis y prostatitis aguda o crónica. También los recién nacidos, hijos de mujeres con gonorrea, pueden desarrollar una infección conjuntival. El tratamiento actualmente recomendado incluye fluoroquinolonas, cefalosporinas de tercera generación, espectinomicina y azitromicina; sin embargo, el fenómeno de resistencia antimicrobiana contra varios de estos agentes ha sido identificado en diversos países. El patrón de resistencia antimicrobiana es mayor en países en que no existe una regulación adecuada para el uso de antimicrobianos.

Gonococcal urethritis is one of the most common syndromes related to sexual transmission. There are many factors that influence that its actual occurrence be unknown, like the social stigma that represent this infection and the self-medication; so the number of cases of gonococcal urethritis can be more than twice that are reported to the official statistics. The mucous membranes of the genital organs constitute the main route of entry of Neisseria gonorrhoeae . This is a microorganism that cannot survive for long time outside the host, is only transmitted from person to person by direct contact and colonize the columnar epithelium cells of the urethra and cervix, as well as the mucous membrane of the throat and rectum. The most common manifestation of gonorrhea is urethritis, but in women the course is often subclinical or manifested by cervicitis. In women gonorrhea can lead to pelvic inflammatory disease, while in men it can produce urethral stenosis, epididymitis and acute or chronic prostatitis. The newborn children of women with gonorrhea may develop a conjunctival infection. Treatment currently recommended includes fluoroquinolones, cephalosporins of third generation, spectinomycin, and azithromycin. However, antimicrobial resistance against several of these agents has been identified in various countries. The rate of antimicrobial resistance is greater in countries where there is no regulation for the use of antimicrobials.

Guía de práctica clínica para el manejo sindrómico de los pacientes con infecciones de transmisión sexual y otras infecciones del tracto genital - 2013 / Clinical practice guideline for syndromic management of patients with sexually transmitted infections and other genital tract infections - 2013

Objetivo: reducir la variabilidad de la práctica en el manejo de las infecciones del tracto genital y de las infecciones de transmisión sexual; apoyar a los profesionales de la salud que atienden pacientes con ITG/ITS, con la más reciente evidencia respecto a la efectividad y seguridad de las intervenciones para la prevención primaria, secundaria y terciaria, y generar indicadores de implementación de la guía y de su impacto en la salud pública.Materiales y métodos: se constituyó un equipo desarrollador en el que participaron diferentes profesionales de la salud y representantes de pacientes. Se formularon preguntas clínicas relevantes y se realizó una búsqueda en repositorios nacionales e internacionales de Guías. Se evaluaron las Guías disponibles en cuanto a su calidad y aplicabilidad. Dado que ninguna guía cumplió con los criterios de adaptación, se decidió el desarrollo de una Guía de Novo. Se realizó una búsqueda de revisiones sistemáticas y metaanálisis, ensayos clínicos y estudios observacionales en las bases de datos pubmed, ovid, embase, cochrane y lilacs. Se elaboraron las tablas de evidencia y las recomendaciones con la aproximación grade por metodología de consenso formal e informal.Resultados: se presenta la “Guía de práctica clínica” con las recomendaciones y la evidencia de soporte para la prevención, el diagnóstico, tratamiento en cuanto a efectividad y seguridad, y seguimiento de los síndromes de: cervicitis, uretritis, úlcera genital, flujo vaginal, inflamación escrotal y bubón inguinal. Conclusiones: como recomendación central de implementación se plantea el manejo del paciente por medio de la dosis única y tratamiento expedito del compañero cuando sea posible. La Guía deberá actualizarse en tres años.

Objective: To reduce practice variability in the management of genital tract infections and sexually transmitted infections, and provide healthcare practitioners that care for patients with GTIs/STDs with the most recent evidence on the effectiveness and safety of the interventions for primary, secondary and tertiary prevention; and to create indicators to track the implementation of the guideline and its impact on public health. Materials and methods: A development team was set up with the participation of different healthcare professionals and patient representatives. Relevant clinical questions were asked and a search was conducted in the national and international guideline repositories. The existing guidelines were evaluated for quality and applicability. Considering that none of the guidelines met the criteria for adoption, it was decided to develop a de novo guideline. A search of systematic reviews and meta-analysis, clinical trials and observational studies was conducted in the pubmed, ovid, embase, cochrane and lilacs databases. Evidence tables and recommendations were prepared using the grade approach on the basis of the informal and formal consensus methodology. Results: The “Clinical Practice Guideline” is presented, including the recommendations and support evidence for prevention, diagnosis and treatment in terms of effectiveness and safety, and follow-up of cervicitis, urethritis, genital ulcer, vaginal discharge, scrotal inflammation and inguinal bubo. Conclusions: The core recommendation for implementation is patient management using a single dose and expedite treatment of the partner whenever possible. The Guideline must be updated in three years.

Agentes etiológicos de uretritis infecciosa masculina en pacientes que concurren a laboratorios de Asunción / Etiological aspects o male infectious urethritis in patients attending laboratories of Asuncion

Esta investigación se efectuó para ampliar el conocimiento sobre los agentes etiológicos de la uretritis masculina en Asunción; se basó en una revisión retrospectiva de las fichas clínicas de 619 pacientes que acudieron con propósitos diagnósticos a tres laboratorios privados y a un laboratorio público de Asunción. La edad promedio ± DE fue de37,6±15,2 años (rango 0-91 años), 373 pacientes concurrieron a Meyer Lab, 166 al laboratorio San Roque, 68 al laboratorio de Santa Clara y 12 al laboratorio de Microbiología del IICS. En total se procesaron muestras de orina de 289 pacientes, secreción uretral de 326 y en 4 pacientes tanto orina como secreción uretral. Las indicaciones médicas fueron búsqueda de Neisseria gonorrhoeae en 295 pacientes, Chlamydia trachomatis en 256, Ureaplasma urealyticum en 264, Mycoplasma hominis en199. Se demostró la presencia de N. gonorrhoeae en el 6,4% de los casos, C. trachomatisen el 3,5%, U. urealyticum 11,5% y M. hominis 2,5%. A pesar de que se halló un franco predominio de la forma no gonocóccica, considerando las limitaciones que tiene el estudio por su carácter retrospectivo, es necesario realizar estudios prospectivos con mayor número de muestras para establecer con certeza la prevalencia de los agentes etiológicosde las uretritis infecciosas en el varón, incluyendo búsqueda de otros agentes infecciosos. Es necesario disponer de datos sobre uretritis en otros grupos socio económicos e investigar aspectos como la frecuencia en nuestro medio del síndrome de uretritis postgonocóccica (UPG) y de cepas de N. gonorrhoeae productoras de β lactamasa.

This study was carried out in order to contribute to the knowledge of the etiological agents of male urethritis in Asunción. It is based on a retrospective review of clinical records of 619 patients from one public and three private laboratories in Asunción. Theage mean ± SD was 37.6 ± 15.2 years (range 0-91 years); 373 patients were from Meyer Lab, 166 from San Roque Laboratory, 68 from Santa Clara Laboratory and twelve from the Laboratory of Microbiology of the IICS. Urine samples from 289 patients, urethra secretion from 326 and both types of samples from 4 patients were studied. Diagnosis of Neisseria gonorrhoeae was requested for 295 patients, Chlamydia trachomatis for 256,Ureaplasma urealyticum for 264, Mycoplasma hominis for 199. Presence of N. gonorrhoeae was demonstrated in 6.4% of the cases, C. trachomatis in 3.5%, U. urealyticum in 11.5% and M. hominis in 2.5%. Even though there was a clear predominance of non-gonococcal urethritis, considering the limitation of this study due to its retrospective nature, prospective studies with larger samples are necessary toestablish with certainty the prevalence of the etiological agents of male infectious urethritis, including the search of other infectious agents. It is also necessary to have data about urethritis in other socioeconomic groups and investigate aspects such as thefrequency of post-gonococcal urethritis syndrome (PGU) and beta-lactamase producing N. Gonorrhoeae strains in our area.

Actitudes terapéuticas manejo sindrómico de las infecciones de transmisión sexual / Therapeutic attitudes: syndromic handling of sexually transmitted infections

En el presente artículo tratamos acerca de los gérmenes causantes de las infecciones de transmisión sexual (ITS), sus manifestaciones clínicas y revisamos los nuevos tratamientos; en especial, el llamado Manejo Sindrómico que es tratar con antibióticos combinados los síntomas de las ITS con el fin de combatir a los agentes causales más frecuentes.

The current article is about causing germs of Sexually Transmitted Infections (STI), its clinical manifestations and to review the new treatment concepts; moreover, the so called syndromic management that is to treat with combined antibiotics the STI symptoms so as to fight the biggest causations.(au)