Chlamydia trachomatis lower genital tract infection and spontaneous preterm birth: a case-control study nested in the BRISA cohort

Introduction: Chlamydia trachomatis (CT) is a sexually transmitted bacterium that is highly prevalent in young patients. Chlamydial infections during the gestational period have been associated with adverse obstetric outcomes, such as spontaneous preterm birth (sPTB). However, results in the literature are inconclusive. Objective: To evaluate the association between CT infection and sPTB. Methods: This was a case-control study nested in the cohort of the prospective Brazilian Ribeirão Preto and São Luís birth cohort study. Pregnant patients were recruited in private and public health clinics in São Luís and Ribeirão Preto, Brazil. At the gestational age of 20-25 weeks, cervicovaginal fluid samples were collected for the diagnosis of CT using a polymerase chain reaction. Plasma levels of Transforming Growth Factor-α (TGF- α), Interferon-γ (IFN- γ), Interleukin-10 (IL-10), IL-13, IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, Tumor Necrosis Factor-α (TNF- α), and TNF-β were measured using a multiplex assay. Results: Of the 561 pregnant patients evaluated, 121 had sPTB and 440 had a full-term delivery (control group). According to our results, CT infection was not associated with sPTB (odds ratio, 1.13; 95% confidence interval, 0.50–2.56); however, it was more frequent among younger patients (p=0.0078), unmarried patients (p=0.0144), and those with multiple sexual partners (p=0.0299). There were no significant differences in the immune mediators between patients with sPTB or full-term deliveries, or between patients with or without a CT infection. Conclusion: In conclusion, CT infection was not associated with sPTB in our study. However, its correlation with younger pregnant patients suggests that these patients require careful clinical management.

Chikungunya associated vulvitis: case report and literature review

Introduction: Chikungunya virus is spreading worldwide due to migration and globalization and could be presented with systemic and with unusual symptoms. Objective: To report a case of virus-transmitted infection detected in a woman during the gynecological examination at a vulvar clinic. Case report: A 73-year-old Caucasian woman attended a vulvar clinic because of dyspareunia and vulvar burning. Ulcers were observed on labia minora and perineum. A Chikungunya was diagnosed by seroconversion in paired specimens. She was prescribed prednisolone 40 mg once a day for 10 days. After oral steroid treatment, the woman had no body rashes or lesions on her genitals. Conclusion: This study emphasized that rare signs of unusual vulvitis with ulcers could be associated with Chikungunya infection.

Knowledge about sexually transmitted infections among users of a testing and counseling center

Introduction: Sexually Transmitted Infections (STI) are configured as a public health problem, carrying a stigma, and often making the individual more vulnerable to other diseases. The perception of vulnerability does not motivate a preventive behavior towards STIs. Objective: To evaluate knowledge about STIs in relation to sociodemographic aspects and sexual and reproductive behaviors. Methods: This descriptive study was conducted in 2018 with 772 users of the voluntary Testing and Counseling Center (TCC) of Uberaba/MG, and included a questionnaire on their knowledge regarding STIs, addressing specific aspects of HIV, HPV, herpes, gonorrhea, chlamydia, hepatitis B and syphilis. Furthermore, data on the sexual and reproductive behavior of users was collected. Results: The study included 201 men and 571 women, of which 334 were pregnant. Less knowledge about STIs was observed among pregnant women, adolescents and the elderly people. Questions about chlamydia represented the highest rate of errors (75.9%) among respondents, while syphilis was the STI with greater knowledge (79.5% of the correct answers). Most participants reported they had never used condoms (60.5%) and identified “will not get any STI” as the main reason for not using them (52.7%). There were no significant associations between the degree of knowledge of STIs and sexual behavior. Conclusion: Among the population, especially teenagers and elderly people, there is a relevant lack of knowledge when it comes to STIs. Promoting universal access to diagnosis and prevention of STIs, as well as holistic care for vulnerable and at-risk populations, remain as challenges to be overcome.

Syphilis on the big screen: an audiovisual representation of the health-disease process

Introduction: In addition to its entertainment role, cinema has a strong relationship with history and a significant social appeal, as it provides the possibility of discussing the matters of society in a dynamic way. Important historical facts such as wars, technological development and pandemics have become recurrent themes on the screens, since they impact various social groups. By the same token, the theme of sexually transmitted infections has been extensively explored in motion pictures, portraying the origins of diseases, their impact on the social environment, and how the health-disease process unfolds. Objective: This study aimed to perform a critical analysis of audiovisual works that bring syphilis in its plot, in order to identify and discuss the evolution of the health-disease process throughout history, as well as its representation in the cinematic perspective. Methods: A descriptive analysis of audiovisual works was carried out along with a bibliographic search. Results: The corpus of the study consisted of four films, the feature films: “La Pelle”, by Liliana Cavani; “Miss Evers’ Boys”, by Joseph Sargent; “Heleno: O Príncipe Maldito”, by José Henrique Fonseca; and “Dr. Ehrlich's Magic Bullet”, by William Dieterle. In all four works, we have different perspectives of the same health problem, but in different scenarios. Conclusion: Reflecting about these scenarios, as well as the real world, helps us to understand and search for what each of the represented groups’ needs in order to face the disease more objectively and effectively.

Hospitalizations of the elderly for reasons related to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infection, Rondônia, Brazil, 2010-2018

Introduction: For the elderly, cultural factors and social paradigms predispose to the rejection of condom use, which favors human immunodeficiency virus (HIV) transmission. The North region was the last area for the spread of HIV in Brazil. Rondônia, although with a slight decline in the HIV detection rate in recent years, is still among the states with high mortality rate due to HIV/acquired immunodeficiency syndrome (AIDS) in Brazil. Objective: To describe the demographic and clinical characteristics of the elderly patients who were hospitalized for reasons related to HIV infection in the state of Rondônia, Brazil. Methods: Descriptive study of secondary data recorded from 2010 to 2018. The cause of hospitalization was identified in the field referring to the main and secondary diagnoses of the hospitalization authorization form. Results: Between 2010 and 2018, Rondônia recorded 1,073,932 hospitalizations for any cause in the state’s public hospitals. Out of these, 183,803 (17.1%) were of elderly patients over 60 years of age and 249 (0.13%) were due to HIV/AIDS. There was a progressive increase in the number of hospitalizations during the study period, as well as a predominance of younger elderly men (67.1±6.0 years old). The mean length of hospitalizations was 21.3±21.1 days and 57 (24.1%) elderly patients died. Conclusion: Despite all the progress made in HIV prevention and treatment, the state of Rondônia still has a progressive increase in hospitalizations of elderly people for reasons related to HIV/AIDS. HIV transmission prevention strategies should be emphasized in the elderly population in the state.

Congenital infections (syphilis and human immunodeficiency virus) in a federal hospital in Rio de Janeiro

Introduction: Congenital infections are related to a higher risk of morbidity and mortality in the neonatal period and can cause serious complications in the newborn. Among the sexually transmitted infections (IST) present in this group, syphilis and vertical exposure to the human immunodeficiency virus (HIV) are still a challenge in the 21st century. Objective: To evaluate the prevalence of congenital syphilis and exposure to HIV among congenital infections. Methods: Cross-sectional, analytical study with data collected from medical records of newborns admitted to the Conventional Neonatal Intermediate Care Unit, Kangaroo and Joint Accommodation, in the database of the service of the Federal Hospital from Bonsucesso, from January 2015 to December 2018. Results: During the study, 2,202 newborns were discharged from the hospital and 474 were positive for congenital infection (21.8%). In cases of congenital infection, congenital syphilis (398–84%) and maternal HIV infection (40–8,4%) were the most frequently encountered clinical situations. The relationship between prenatal care and the absence of congenital infection was evident. Among the newborns, 117 (5.3%) were premature, 352 (16.3%) were older than 37 weeks and 95 (23.7%) had low birth weight. Conclusion: Congenital infection was one of the main causes of neonatal morbidity; syphilis and HIV had the highest prevalence, being associated with reducible deaths when adequate care is provided for women during pregnancy. Perinatology services demand a great effort in order to manage these avoidable and undesirable situations.

Human trafficking, health care systems and sexually transmitted infections

Introduction: Data about the increase in human trafficking around the world are worrisome. Although there is legislation on the subject, its scope does not cover all forms and victims of trafficking. Thus, many women, children and men remain in a vulnerable situation. Objective: The purpose of this paper was to elucidate and understand, based on the literature, the relationship between human trafficking, health care systems and the increase in sexually transmitted diseases, and also to point out what is being done to combat the problem. Methods: A documentary research was conducted through an integrative review for the period from 2010 to 2020. The literature search was carried out on the basis of the CAPES journals portal using the keywords “human trafficking”, “sexually transmitted diseases”, “health care systems” and “education”. Results: The results obtained indicated that the absence of access to information, health care and education are intrinsic to the process of illegal immigration and the destination of women and children for exploitation, whether sexual, for organ removal or forced labor, and that situations of violence, absence of health care or education and coercion, among others, are common both for the conditions of trafficking and for the conditions of the increase in sexually transmitted diseases. Conclusion: Given the information obtained, it is concluded that more research must be carried out together with the agencies that investigate and apply current laws to determine what are the most effective measures to combat human trafficking. Furthermore, we highlight the need for information on policies and projects that are able to reach vulnerable populations, with the promotion of education, health care and better living conditions.

Epidemiological overview of AIDS in elderly people in the state of Santa Catarina from 2008 to 2018

Introduction: In recent years there has been an increase in the number of AIDS diagnoses in the general population, with a significant growth among elderly individuals. Objective: To analyze the epidemiological situation of AIDS in the elderly population and its temporal trend in the Santa Catarina State. Methods: Ecological study, conducted with the elderly (≥60 years) living in Santa Catarina, who were diagnosed with AIDS and notified in the Brazilian Information System for Notifiable Diseases (SINAN) from 2008 to 2018. The incidence rate according to sex, age group and health macro-region was calculated, as well as the time trend, through linear regression. Race/skin color and scholarity were analyzed by proportion in relation to the total. Results: 1,365 cases were notified from 2008 to 2018. There was an increase in cases from 6,7/100.000 in 2008 to 23,1 in 2018 (1,77% yearly), higher among men aged 60 to 69 and living in the area of Florianópolis. Conclusion: there was an increase in AIDS notifications among the elderly in the state.

Evaluation of Chlamydia trachomatis and HR-HPV infection in women living with HIV: a cross-sectional study

Introduction: Infections caused by Chlamydia trachomatis (CT) and Human Papilloma Virus (HPV) are among the most prevalent sexually transmitted infections (STIs) worldwide. CT infection in women living with the human immunodeficiency virus (HIV) can facilitate HIV transmission by increasing HIV shedding in cervicovaginal secretions. The prevalence of Human papillomavirus (HPV) infection is higher in women living with HIV when compared to HIV-negative women, even when comparing those with the same sociodemographic characteristics. Generally, they have a high viral load and a higher persistence of viral infection, which increases the risk of developing premalignant and malignant lesions in the lower genital tract. Objective: To evaluate the frequency of CT and High-Risk HPV (HR-HPV) infection among women living with HIV and the association with sociodemographic, behavioral and clinical characteristics. Methods: Cross-sectional study carried out with a population of 66 non-pregnant women aged between 18 and 70 years living with HIV and/or acquired immunodeficiency syndrome (AIDS) at the Hospital Universitário Antônio Pedro, Universidade Federal Fluminense (UFF), Niterói (RJ), Brazil, between the period of March 1, 2018 and October 31, 2018. A standardized questionnaire was applied including sociodemographic and behavioral characteristics, and clinical information (use of oral contraceptives, Antiretroviral Therapy (ART), cluster of differentiation 4 (CD4) cell count, and viral load). Endocervical samples were collected for CT (COBAS 4800® system, Roche) and HPV (COBAS® HPV test, Roche) detection. Fisher's Exact Test was used to assess the association between variables. Regression analyses were performed using the logistic model in order to identify the factors associated with the outcomes of interest. Results: A frequency of 1.5% for CT and 21.2% for HR-HPV was found. Age was the single factor that presented statistical significance associated with HR-HPV infection. Conclusion: Our study showed that some women living with HIV promote risky behavior which could facilitate the acquisition of other STIs, such as HPV and CT infection. Some of them, with detected viral load, were not using condoms even with HIV-negative partners. These results may suggest that in addition to treatment and follow-up of women living with HIV, STIs counseling and guidance may play an important role in the control of STIs in this population.