Luiz Jorge Fagundes

Assessment of the rapid test based on an immunochromatography technique for detecting anti-Treponema pallidum antibodies

A rapid test based on an immunochromatography assay - Determine Syphilis TP (Abbott Lab.) for detecting specific antibodies to Treponema pallidum was evaluated against serum samples from patients with clinical, epidemiological and serological diagnosis of syphilis, patients with sexually transmitted disease other than syphilis, and individuals with negative serology for syphilis. The Determine test presented the sensitivity of 93.6%, specificity of 92.5%, and positive predictive value and negative predictive value of 95.2% and 93.7%, respectively. One serum sample from patient with recent latent syphilis showed a prozone reaction. Determine is a rapid assay, highly specific and easy to perform. This technique obviates the need of equipment and its diagnostic features demonstrate that it may be applicable as an alternative assay for syphilis screening under some emergency conditions or for patients living in remote localities.

Treatment of genital warts in men with potassium hydroxide.

SIR, Genital human papillomavirus infection is highly prevalent in sexually active young men. Therapies for genital warts are generally recommended based on considerations of efficacy, adverse events, cost and recurrence rates. Potassium hydroxide (KOH) is a strong alkali that has been found to be effective, safe and well tolerated in the treatment of molluscum contagiosum in children, due to its ability to dissolve keratin and deeply penetrate the skin. We report a study evaluating the safety and efficacy of patient-applied 5% KOH for the treatment of genital warts in sexually active men. This prospective, open-label study was approved by the University of São Paulo General Hospital Institutional Review Board. All patients signed an informed consent form. Male patients over 18 years with one or more genital warts and without any treatment during the last 3 months were included in this trial. Exclusion criteria were urethral or perianal lesions, and giant condylomata. Patients with immunosuppression, a positive serology for human immunodeficiency virus, syphilis or active hepatitis B or C were also excluded. Patients were taught how to apply a KOH 5% aqueous solution on every single lesion using a toothpick with cotton wrapped around the tip. They were further instructed to use the medication once daily until mild inflammation was observed. Follow-up visits occurred weekly for 2 months or until clearance of all lesions, and then, 1 month later to check for recurrences. At each visit, the number of lesions, local reactions and systemic effects were recorded. If new lesions developed during the study, these were also treated and included in the data. In total, 35 patients aged 18–49 years (mean 29Æ3) were included. Genital warts were present on the glans, foreskin, scrotal area and penile shaft (Fig. 1a). The number of lesions ranged from one to 15 (mean 5Æ2) and size ranged from 0Æ3 to 2 cm (mean 1Æ1). All patients experienced mild inflammation (erythema and oedema) and reduction in the number of warts during the first week of treatment. Superficial erosions were present in 56%, stinging in 22% and hypopigmentation in 9% of treated patients. The period of treatment until patients were wart-free ranged from 1 to 8 weeks (mean 3Æ3). Thirty-two patients (91%) completed the study. Two patients did not return after the first visit. One patient developed a urethral lesion during the third week of treatment and was excluded from the trial. One patient had persistent lesions after 2 months of treatment, and threepatients presentednew lesions at the1-month follow-up visit. All four of these patients were considered treatment failures (12Æ5%). At the end of the trial, 87Æ5% of treated patients were completely wart free with no recurrences (Fig. 1b). Alkaline substances are strongly basic, yielding hydroxide ions (OH) in solution. KOH is a strong alkali widely used to visualize fungi in microscopic preparations of skin, hair and nail scrapings. KOH is mainly a mild irritant, i.e. one that does not cause a severe skin reaction due to brief contact. The present study was designed to evaluate the efficacy and safety of self-applied KOH topical solution in the treatment of genital warts. Two previous studies demonstrated the efficacy and safety of KOH in the treatment of molluscum contagiosum in children. In the first study, a home, parent-applied topical 10% aqueous KOH solution applied twice daily showed promising results with clearance of lesions in 91% of patients, although severe stinging and burning was reported. A second study, using 5% KOH solution, proved to be as effective as the 10% solution, but with fewer local side-effects. (a)

Perfil epidemiológico de mulheres com vaginose bacteriana, atendidas em um ambulatório de doenças sexualmente transmissíveis, em São Paulo, SP

BACKGROUND- Bacterial vaginosis is an important disease on account of its high prevalence as well as the obstetrical and gynecological complications. OBJECTIVE- To present an epidemiological profile of patients diagnosed with bacterial vaginosis seen at an outpatient clinic in the city of Sao Paulo, Brazil, described according to socio-demographic and clinical variables. METHODS- A cross-sectional descriptive study was performed by collecting data from the medical records of 658 females, seen from January, 1999 to December, 2004. Our study took into account age, ethnicity, marital status, schooling, sexual preference, number of partners and associated sexual diseases. RESULTS- The prevalence observed was 29%. Regarding the profile of women with bacterial vaginosis, the highest ratio of cases occurred in adolescents aged 10 to 19 years old (40%), black women (37.1%), widows (62.5%), women who have not graduated from high school (39.5%), heterosexual women (29.5%), women with two or more sexual partners in the last 30 days (50%) and in the last five years (35.3%). The concomitant association with other sexually transmitted diseases was found in 35% of cases. CONCLUSION- The distribution of bacterial vaginosis in patients according to age, ethnicity, number of sexual partners and associated sexual diseases was similar to that described in the literature. The observed ratio was within values of other studies (10 to 36%).

Thiamphenicol in the treatment of chancroid. A study of 1,128 cases

Thiamphenicol, an aminic derivate of hydrocarbilsulfonil propandiol, was used for the treatment of 1,171 chancroid bearing patients. Each patient was medicated with 5.0 g of granulated thiamphenicol, orally, in a single dose, and was reevaluated 3, 7 and 10 days after the treatment. Ten patients (0.89%) did not respond to the proposed treatment. 133 patients presented healed ulcers after 3 days of treatment, 976 patients healed chancres on the seventh day after the treatment, and 39 patients took 10 days to present healed chancres. The results of this study indicate that the rate of patients that were cured, the low incidence of side effects, and the practicality of administration make of thiamphenicol an excellent choice for the treatment of chancroid.

Evaluation of the in vitro activity of six antimicrobial agents against Neisseria gonorrhoeae

Use of antimicrobials for the treatment of gonorrhea started in 1930 with the utilization of sulfonamides. With the years other drugs were used for its treatment such as penicillin, tetracycline, spectinomycin, and others. Although highly specific in the beginning, these drugs, with time did not show anymore the expected therapeutic results because of aspects of chromosomal and plasmid-mediated resistance. The purpose of this study was to evaluate the susceptibility of Neisseria gonorrhoeae strains to six drugs used for its treatment (penicillin, tetracycline, cefoxitin, thiamphenicol, spectinomycin and ofloxacin) by the determination of minimal inhibitory concentrations of these drugs. We concluded that drugs, such as cefoxitin, thiamphenicol and spectinomycin still are excellent pharmacological agents for the treatment of gonorrhea. Penicillin, although still efficient, needs more attention regarding its use, as well as ofloxacin, because of the emergence of resistant strains. Tetracycline and its derivatives should be strongly contraindicated for the treatment of gonorrhea.

Neisseria gonorrhoeae: resistencia cromossomica a tetraciclina em Sao Paulo, Brasil

BACKGROUND: The use of antimicrobials in the treatment of gonorrhoea started in 1930 with sulphonamides. Subsequently other drugs, such as tetracycline and its derivatives, were indicated for treating gonorrhoea. Therapeutic response to these drugs has tended to decline due to chromossomal and plasmidic resistance. However, tetracycline as a monotherapy or in association with other drugs is still prescribed for treating gonorrhea in Brazil. This justifies the need for a critical analysis in order to evaluate the sensitivity of gonococcus to this drug. OBJETIVE: Evaluate the real incidence of chromosomal resistance of Neisseria gonorrhoeae strains to tetracycline in our environment. METHOD: Analysis of the minimal inhibitory concentration in agar dilution. RESULTS: The chromosomal resistance to tetracycline was detected in 40.3% of all analyzed strains. CONCLUSIONS: This finding condemns the use of tetracycline as a mono or combined therapy for the treatment of gonorrhoea in our environment.

A prospective, open, comparative study of 5% potassium hydroxide solution versus cryotherapy in the treatment of genital warts in men

BACKGROUND Genital warts are caused by human papillomavirus infection and represent one of the most common sexually transmitted diseases. Many infections are transient but the virus may recur, persist, or become latent. To date, there is no effective antiviral treatment to eliminate HPV infection and most therapies are aimed at the destruction of visible lesions. Potassium hydroxide is a strong alkali that has been shown to be safe and effective for the treatment of genital warts and molluscum contagiosum. Cryotherapy is considered one of the most established treatments for genital warts. No comparative trials have been reported to date on the use of potassium hydroxide for genital warts. OBJECTIVE A prospective, open-label, randomized clinical trial was conducted to compare topical potassium hydroxide versus cryotherapy in the treatment of genital warts affecting immunocompetent, sexually active men. METHODS Over a period of 10 months, 48 patients were enrolled. They were randomly divided into two groups and selected on an alternative basis for either potassium hydroxide therapy or cryotherapy. While response to therapy did not differ substantially between both treatment modalities, side effects such as local pain and post-treatment hypopigmentation were considerably more prevalent in the groups treated using cryotherapy. RESULT In our study, potassium hydroxide therapy proved to be at least as effective as cryotherapy and offered the benefit of a better safety profile. CONCLUSION Topical 5% potassium hydroxide presents an effective, safe, and low-cost treatment modality for genital warts in men and should be included in the spectrum of therapies for genital warts.

P1.44 Molecular typing and detection of macrolide resistence in treponema pallidum dna from patients with primary syphilis in são paulo,brazil

Introduction Syphilis is a globally occurring sexually transmitted disease caused by Treponema pallidum, a non-cultured in vitro bacterium. Molecular typing of Treponema pallidum strains isolated from patients are useful for investigating the molecular epidemiologic patterns, diversity of strains and antimicrobial resistance patterns.To date, there was no data on the circulating or prevalent subtype in Brazil. In this study we aimed to determine T. pallidum strain diversity and analyse for the mutation associated with macrolide resistance from patients with primary syphilis attended at CSEGPS. Methods We analysed 24 samples of primary lesion collected from patients attended at CSEGPS between 2013 and 2015. DNA was extracted with DNeasy kit (Qiagen). Standard PCR targeting tpp47 and polA genes was used for screening. Molecular typing was performed by CDC established methods, by determination of the 60 bp repeats within the arp gene, and RFLP analysis of tpr subfamily II genes (E, G and J). Completed by sequence analysis of a variable region of the tp0548 gene. The 23S rDNA mutation was analysed by DNA sequencing of PCR product. Results: T. pallidum DNA was detected in samples from 15 patients. Among 12 specimes typed, subtype found were 14d/g (6), 14d/d (5) and 12b/d (1). From 10 samples analysed for 23 rDNA mutation, all showed A2058-G, no mutation was detected at A2059. One case presented a different subtype in re-infection. The first was 14d/g and the second was 14d/d. Conclusion: T. pallidum detected in the samples of patients with primary syphilis are of subtypes 14d/g, 14d/d and 12b/d. The macrolide resistance mutation A2058-G was detected in all samples analysed. T. pallidum subtyping discriminated re-infection.