Brazilian Journal of Sexually Transmitted Diseases Sociedade Brasileira de Doenças Sexualmente Transmissíveis en-US Brazilian Journal of Sexually Transmitted Diseases 2177-8264 Prevalence and epidemiologic transition of sexually transmitted infections in a Brazilian dermatologic clinic (2012-2019) <p>LETTERS TO THE EDITOR</p> Vítor Cercal de Oliveira Arthur Cesar dos Santos Minato Mariana Mathias Morita Júlia Ferreira de Oliveira Letícia Yumi Ishimoto Bianca Latance da Cruz Maria Vitória Yuka Messias Nakata Lais Gonçalves Moreira Hélio Amante Miot Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-03-31 2022-03-31 34 10.5327/DST-2177-8264-20223402 Eulogy to Dr. Gisela del Pino: …To hold my teacher in this art equal to my own parents <p>As the article is a letter to the editor, it does not have an abstract.</p> MAURO RAMOS Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-06-20 2022-06-20 34 10.5327/DST-2177-8264-20221189 Monkeypox: A New Epidemic Threat with Behavioral Components of Physical Intimacy? <p>Given the context of a possible epidemic and the possibility of a pandemic caused by monkeypox, this may be a pathology related to sexual transmission. It is relevant to question and demand from national and international health authorities which measures to adopt to contain the disease and not repeat the mistakes of previous situations.</p> Julia Sampaio de Souza Morais Roberto de Souza Salles Ivo Castelo Branco Coêlho Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-06-10 2022-06-10 34 10.5327/DST-2177-8264-2022341205 Dear fellow readers of the scientific journal Jornal Brasileiro de DST <p>Letther to the editor</p> Miguel Tilli Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-03-31 2022-03-31 34 10.5327/DST-2177-8264-20223403 HIV diagnosis in Brazil: the impact of the COVID-19 pandemic <p>Letter to the editors</p> Nelson Pereira Marques Nádia Carolina Teixeira Marques Daniella Reis Barbosa Martelli Edson Gomes de Lucena Eduardo Araújo de Oliveira Hercílio Martelli Júnior Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-02-22 2022-02-22 34 10.5327/DST-2177-8264-20223401 Anal cancer and its similarities with cervical cancer – the rescue of forgotten studies <p>Letter to the editor</p> José Eleutério Junior Luciano Silveira Pinheiro Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-04-25 2022-04-25 34 10.5327/DST-2177-8264-20223406 Lipohypertrophy and nutritional profile among people living with HIV in Southern Brazil <p><strong>ABSTRACT: </strong><strong>Introduction:</strong> People living with the human immunodeficiency virus (HIV) are generally overweight or have an altered body composition as compared to healthy individuals, showing a change in nutritional profile over time. <strong>Objective: </strong>The aim of the study was to characterize the nutritional status, estimate the prevalence of lipodystrophy, and examine the association between lipohypertrophy and lipid profile alterations, and other clinical data of HIV-infected individuals. <strong>Methods:</strong> This was a cross-sectional study on male and female subjects living with HIV, treated at a specialized outpatient clinic, aged 18 years old and over, whether using the antiretroviral therapy or not. <strong>Results:</strong> The sample consisted of 420 people with a mean age of 43.8 years (standard deviation 11.7). The length of time of the HIV infection averaged 74.6 months, and 91% of the respondents were on antiretroviral therapy. Lipodystrophy prevalence was 35.7%. Of these, 82 (54.7%) presented lipohypertrophy, 61 (40.7%) had lipoatrophy and 7 (4.6%) had a mixed syndrome. Female gender, body mass index, fat percentage, waist circumference and waist-hip ratio were positively associated with the presence of lipohypertrophy (p&lt;0.001). High mean total cholesterol (p=0.015) and LDL fraction (p=0.028) also showed a statistically significant association with lipohypertrophy. The sampled participants had a nutritional profile compatible with overweight or obesity. No association was found between lipohypertrophy and ART and the therapy duration. <strong>Conclusion:</strong> Considering the consequences of overweight as a cause of various pathological conditions, preventive measures and interventions are highly recommended for this population.</p> Fabiana Schuelter-Trevisol Helena Caetano Gonçalves e Silva Maricele Almeida da Silva Chaiana Esmeraldino Mendes Marcon Richard Ferreira Sene Daisson José Trevisol Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-07-25 2022-07-25 34 10.5327/DST-2177-8264-2022341195 The fight against sexually transmitted infections cannot stop in the COVID-19 era: a brazilian experience in online training for sexually transmitted infections guidelines <p><strong><em>Introduction</em></strong><strong>:</strong> The Brazilian Ministry of Health had planned face-to-face workshops for professional training about the Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections for the year 2020. Due to the COVID-19 pandemic, the workshops were cancelled, and a new strategy was adopted: virtual meetings, called Webinars—Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections 2020. <strong><em>Objective</em></strong><strong>:</strong> To report the experience at the Ministry of Health in online training about the clinical protocol and therapeutic guidelines for comprehensive care for people sexually transmitted infections for health professionals in 2020. <strong><em>Methods</em></strong><strong>:</strong> The webinars were held in partnership with the Brazilian Society of Sexually Transmitted Diseases and the Pan American Health Organization. Each chapter of the Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections—2020 was converted into a webinar, with the participation of at least three experts, two speakers, and a moderator. <strong><em>Results</em></strong><strong>:</strong> In total, 16 webinars were presented, covering topics such as sexually transmitted infections surveillance, prevention, diagnosis, treatment, public policies, and sexual violence. The initiative had more than 77,000 hits, with an average of 4,900 hits per webinar and the topic “syphilis” being the most accessed. The event reached all 27 federative units of Brazil, as well as 27 other countries. About 500 questions were received from the audience and answered during the sessions and/or through a document published later on by the Ministry of Health. <strong><em>Conclusion</em></strong><strong>:</strong> Given the high number of hits and inquiries received, we can conclude that health professionals remained engaged in the topic of sexually transmitted infections during the pandemic. This experience shows the great potential of innovative methods for distance learning to promote continuing education, including a series of webinars aimed at strengthening the fight against sexually transmitted infections.</p> <p>&nbsp;</p> Pâmela Cristina Gaspar Adriano Santiago Dias dos Santos Lutigardes Bastos Santana Mayra Gonçalves Aragón Nádia Maria da Silva Machado Miguel Angel Aragón López Mauro Romero Leal Passos Gerson Fernando Mendes Pereira Angélica Espinosa Miranda Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-05-04 2022-05-04 34 10.5327/DST-2177-8264-20223404 Anal cancer: an essay on etiology, risk conditions, vulnerability, and care of carriers <p><strong>&nbsp;</strong><strong><em>Introduction</em></strong><strong>:</strong> The incidence of anal cancer is influenced by individual factors and socially determined conditions of vulnerability. In Brazil, it has increased in recent decades. A probable explanation for the growing incidence is the low coverage of screening and prevention programs. <strong><em>Objective</em></strong><strong>:</strong> The aim of this study was to reflect on risk factors, the need for early diagnosis, and care of people with anal cancer and to associate social vulnerability in the understanding of illness and care in the Unified Health System (SUS). <strong><em>Methods</em></strong><strong>:</strong> This is a systematic literature review with consultations carried out in open electronic databases: SciELO, Digital Library of Theses and Dissertations, and CAPES Publications Portal. The descriptors used were “anal cancer,” “anal cytology,” “anal cancer precursor lesions,” “primary prevention,” “integrality in health,” and “public health policies.” <strong><em>Results</em></strong><strong>: </strong>Ensuring access to services is a common guideline in the literature. Based on the recovered references, two axes of analysis were built: in the first, ideas to reflect on care with collective health approaches were systematized, mainly on the etiology, biological risk factors, and conditions of vulnerability for cancer development to which the subjects are exposed. In the second, ideas to propose care technologies are put forward, with evidence from similar protocols and policies, especially the “Cervical Cancer Control Program,” which deals with a pathology with cytohistological and etiological similarities, risk factors, diagnostic techniques, and skilled health professionals. <strong><em>Conclusion</em></strong><strong>:</strong> The reviewed sources point to the possibility of incorporating, as a SUS policy, large-scale actions of prevention, screening, and early diagnosis, to qualify and expand the initiatives of promotion and care. The professional cytotechnologist can be a decisive factor in the implementation of the care policy, expanding assistance to the population and qualifying the services.</p> William Pereira Santos Nathália Barbosa do Espírito Santo Mendes Alcindo Antônio Ferla Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-07-04 2022-07-04 34 10.5327/DST-2177-8264-20223409 Limitation of cytology and the impact on reduction of cervical cancer <p>Introduction: Cervical cancer is the third most common malignant tumor in the female population and the fourth cause of death from cancer in women in<br>Brazil. The squamocolumnar junction and the transformation zone concentrate 90% of pre-invasive and invasive cervical lesions. Objective: To evaluate<br>the prevalence of cytology without cells of the squamocolumnar junction and feasibility of active search. Methods: Cross-sectional study at a university<br>hospital between 2017 and 2018. The prevalence of cytology without squamocolumnar junction cells was calculated. A convenience sample was obtained<br>and mean age and relationship with presence of transformation zone cells were calculated. An active search was performed and cytology collected, with<br>estrogen preparation if indicated. Medical records of the other women were analyzed. Results: Squamocolumnar junction cells were not found in 28.84%<br>of samples. Mean age was 53 years, without association with presence of squamocolumnar junction cells (p=0.409). Seventy-six women returned, 36 of<br>which (47.37%) used estrogen. Level 2 or 3 cervical intraepithelial neoplasia, microinvasive carcinoma or cancer was not identified. A total of 134 medical<br>records were analyzed; only 36 women (26.87%) completed screening. Conclusions: The presence of squamocolumnar junction cells indicates quality of<br>cytology; the use of es</p> Daniela da Silva Alves Monteiro Isabel Cristina Chulvis do Val Guimarães Susana Cristina Aidé Viviani Fialho Caroline Alves de Oliveira Martins Luis Guillermo Coca Velarde Priscila Loyola Campos Izabel Cristina dos Santos Teixeira Julia Sampaio de Souza Morais Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-05-16 2022-05-16 34 10.5327/DST-2177-8264-20223405 HIV, Hepatitis B, Hepatitis C, and Syphilis: prevalence and serodiscordance between women and their partners <p><strong><em>Introduction:</em> </strong>The prevention of vertical transmission of sexually transmitted diseases is the object of research by several authors, who reinforce the importance of knowing the serological status of a woman’s sexual partner.<strong> <em>Objective:</em></strong> To evaluate the prevalence and serodiscordance of HIV, hepatitis B, hepatitis C, and syphilis infections among women admitted to a maternity hospital in southern Brazil and their partners. <strong><em>Methods:</em></strong> 350 women and their partners were interviewed in a service-based cross-sectional study conducted from August 16 to November 23, 2018. <strong><em>Results:</em></strong> 4.0% of the women and 4.3% of the men had one of the infections studied. Among women, 2.0% already knew they were HIV positive, 2.0% had a positive rapid test for syphilis and there was no positive result for hepatitis B or C. A total of 299 (85.4%) partners were located. Of these, 293 (98.0%) agreed to answer the study questionnaire. Of all men interviewed, 281 (95.9%) agreed to undergo an rapid test. Among men, 1.4% already knew they were HIV positive and 0.4% had chronic hepatitis B disease. There was a similar percentage of men with a positive rapid test for syphilis and hepatitis C (1.4%). Regarding couples, 6.8% had some positive test. Most of the positive test subjects were in a serodiscordant relationship (16 serodiscordant couples and 3 positive concordant couples). <strong><em>Conclusion:</em></strong> These results reinforce the importance of testing men to prevent the infection of a negative partner and the vertical transmission of sexually transmitted infections. The high acceptance, by men, to undergo an rapid test at the time of the woman’s hospitalization demonstrated the viability of this strategy in the maternity ward.</p> Aline Scherer Mariângela Freitas da Silveira Bruno Pereira Nunes Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-08-02 2022-08-02 34 10.5327/DST-2177-8264-2022341194 Cost utility of penicillin use in primary care for the prevention of complications associated with syphilis <p>Introduction: Despite penicillin being the drug of choice for the treatment of syphilis, many pregnant women who test positive for syphilis do not receive the drug as recommended by the Ministry of Health, contributing to the increase in costs associated with congenital syphilis. Objective: This study aims to estimate the incremental cost-effectiveness ratio of administering at least one dose of 2.4 million IU of benzathine penicillin in the first trimester of pregnancy as soon as the result of a positive rapid treponemal test performed during antenatal care in primary care units of the Brazilian National Health System. Methods: An analytical model was proposed based on a decision tree. The perspective of the analysis was the one used in The Brazilian National Health System. The clinical outcomes were abortion, prematurity, neonatal death, stillbirth, and congenital syphilis, estimated in terms of disability-adjusted life-years. Only direct costs were considered. Deterministic and probabilistic sensitivity analyses were performed. Results: The model predicted that the most efficient strategy is the one that includes the administration of penicillin in primary care for cases of gestational syphilis. This strategy is more effective, although more costly. The cost per disability-adjusted life-years averted with the use of this strategy was estimated at R$49.79 (US$ 10.67).<br>Conclusion: The prenatal strategy in primary care units that includes the administration of penicillin to pregnant women with syphilis during the first trimester of pregnancy has the greatest potential to be cost-effective.</p> Roberto Carlos Lyra da Silva Antonio Augusto de Freitas Peregrino Regina Rocco Lilian Reinaldi Ribeiro Daniel Aragão Machado Carlos Roberto Lyra da Silva Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-06-13 2022-06-13 34 10.5327/DST-2177-8264-20223408 Time trend and causes of HIV/AIDS mortality in the state of Santa Catarina, 2010–2019 <p><strong>Introduction:</strong> Although the acquired immunodeficiency syndrome (AIDS) has no cure, antiretroviral treatment has considerably increased the survival of people living with the disease or with the human immunodeficiency virus (HIV), reducing the incidence of opportunistic infections in these patients. Thus, this treatment changed mortality rates and diversified the causes of death, including reasons related to increased longevity, such as chronic non-communicable diseases, common in the uninfected population. Therefore, the current epidemiological transition motivated us to study the death profile of people with HIV/AIDS in the state of Santa Catarina. <strong>Objective:</strong> To investigate case characteristics, as well as the time trend and distribution of deaths, among people with HIV/AIDS in Santa Catarina between 2010 and 2019. <strong>Methods:</strong> In this ecological, epidemiological study, we consulted all death records from the Santa Catarina Mortality Information System that had HIV/AIDS among the causes and occurred between 2010 and 2019. <strong>Results: </strong>A total of 5,174 death records were analyzed. In the period, the mean mortality rate among people with HIV/AIDS was 7.64 deaths per 100 thousand inhabitants (95% confidence interval — 95%CI 6.61–8.67) — 8.99 in 2010 and 6.06 in 2019 —, showing a downward trend of 0.38% per year. <strong>Conclusion:</strong> We identified a downward trend in mortality. Deaths were concentrated on the coast, in more populous cities. Furthermore, the finding of improper completion of the death certificate points to the need to invest in improving the training of professionals responsible for this document.</p> Braulio Sambaquy Escobar Escobar Ilda Vaica Armando Cunga Cunga Gabriel Oscar Cremona Parma Parma Betine Pinto Moehlecke Iser Iser Fabiana Schuelter-Trevisol Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-07-25 2022-07-25 34 10.5327/DST-2177-8264-2022341186 Lactobacillus crispatus dominance in the vaginal microbiome reduces the occurrence of spontaneous preterm birth in women with a short cervical length <p>Introduction: The majority of pregnant women with a short cervix will deliver at term and, thus, may unnecessarily receive advanced monitoring and<br>treatment. It is still necessary to define more accurately which sub-population of women with a short cervix is at elevated risk for early delivery. Objective:<br>To determine if vaginal microbiome composition influenced the rate of spontaneous preterm birth in women with a short cervical length. Methods: In an<br>exploratory, observational prospective study, vaginal secretions were obtained from 591 women at 21–24 week gestation. Vaginal microbiome composition<br>was determined by analyzing the V1–V3 region of the bacterial 16S ribosomal RNA gene. Results: Lactobacillus crispatus was numerically dominant in<br>the vagina in 41.7% of subjects, followed by L. iners in 32% and Gardnerella vaginalis in 12%. In women whose cervix was ≤25mm, the sensitivity to<br>predict an spontaneous preterm birth was 11.8%. However, when L. crispatus was not the dominant vaginal bacterium, this sensitivity increased to 81.8%.<br>Similarly, in women with a cervical length ≤30mm, the sensitivity to predict an spontaneous preterm birth increased from 21.7 to 78.3% when L. crispatus<br>was not the dominant vaginal bacterium. In women with a prior spontaneous preterm birth and a cervix ≤25 or ≤30mm, L. crispatus dominance was also<br>associated with a reduced rate of spontaneous preterm birth in the current pregnancy (p&lt;0.001). Conclusion: In pregnant women with a cervix ≤25mm or<br>≤30mm, the risk for an spontaneous preterm birth is increased if L. crispatus is not dominant in the vagina.</p> Antonio Fernandes Moron Steven Sol Witkin Iara Moreno Linhares Alan Roberto Hatanaka Stéphanno Gomes Pereira Sarmento Marcelo Santucci França Francisco Herlânio Costa Carvalho Rosiane Mattar Larry Jay Forney Copyright (c) 2022 Brazilian Journal of Sexually Transmitted Diseases 2022-05-19 2022-05-19 34 10.5327/DST-2177-8264-20223407