Valdir Monteiro Pinto

Sexually transmitted disease/HIV risk behaviour among women who have sex with women

Objective:To analyse the epidemiological aspects of sexually transmitted diseases (STD) among women who have sex with women (WSW) in São Paulo, Brazil. Method:A cross-sectional study with interviews and analysis of clinical and gynaecological tests in women, by means of a convenience sample. Characteristics were gathered according to age, sociobehavioural profile, reproductive life and sexuality. Results:The study included 145 women. They started sexual activity at an average age of 16.9 years, and 23.4% of them had had heterosexual relations during the preceding year, with a relatively low frequency of condom use. In sexual relations with women, 54.5% used condoms when they shared sex toys. A previous STD was reported by 38% of them. The following STD were diagnosed: trichomonas (3.8%), bacterial vaginosis (33.8%), fungi (25.6%), Chlamydia (1.8%), hepatitis B (7%), hepatitis C (2.1%), abnormal Pap smear (7.7%), human papillomavirus (6.2%) and HIV (2.9%). Conclusion:In this study, many WSW did not report a single risk behaviour, but often reported a combination of several potential risk factors. Therefore, one cannot speak of high or low-risk behaviour for STD/HIV, but rather of multiple-risk behaviour. It is evident that there is a need for healthcare professionals to be correctly informed and sensitive towards the healthcare of WSW.

Prevalência da infecção por clamídia e gonococo em gestantes de seis cidades brasileiras

PURPOSE This paper has aimed at estimating the prevalence of infections by Chlamydia trachomatis and by Neisseria gonorrhoeae in pregnant women from six Brazilian cities, identifying its association with socio-economical and demographic variables. METHODS This study has been part of a multicentric nationwide transversal research, with samples of pregnant women attended from 2004 to 2005 in basic attention pre-natal services from six Brazilian cities (Manaus, Fortaleza, Goiânia, Rio de Janeiro, São Paulo and Porto Alegre). Cervico-vaginal samples have been collected from all the pregnant women, and have afterwards been submitted to the hybrid capture technique in order to identify chlamydia and gonococcus. Socio-demographic, medical, sexual and obstetric information have been collected through specific questionnaires. The Odds Ratio (OR) has been used to evaluate risk factors associated to infection by gonorrhea and chlamydia. Statistical analysis has been done with the t-Student, chi2 and Fishers exact tests. RESULTS Three thousand and three pregnant women with an average age of 23.8 years old (+/-6.9) took part in the study. Infection prevalence by chlamydia and gonococcus were 9.4 and 1.5, respectively. Ten per cent of the pregnant women with chlamydia have presented gonococcus simultaneously. The risk of presenting one of those infections was two times higher for the women under 20. The infection main predictors have been: age under 20, race/black, single/separated and report of over one partner in the previous year. CONCLUSIONS This study has observed high prevalence of infection by Chlamydia trachomatis and by Neisseria gonorrhoeae in Brazilian pregnant women. The main risk factor for the infection has been to be under 20 years old.

Chlamydia trachomatis prevalence and risk behaviors in parturient women aged 15 to 24 in Brazil.

Background: Chlamydia trachomatis (CT) is a sexually transmitted infection having repercussions on reproductive health and impact on the fotus. Our goal was to estimate the prevalence of and risk factors for CT in young parturient women in Brazil. Methods: A national cross-sectional study of parturient women, aged 15 to 24 years, attending Brazilian public hospitals was performed in 2009. Participants answered a questionnaire including demographic, behavioral, and clinical data. A sample of urine was collected and screened for CT and Neisseria gonorrhoeae (NG), using polymerase chain reaction COBAS Amplicor CT/NG (Roche Molecular Systems, Branchburg, NJ). Results: A total of 2400 women were selected and 2071 (86.3%) participated in the study. Mean age was 20.2 years (standard deviation = 2.7). Prevalence rates of CT and NG were 9.8% (95% confidence interval [CI]: 8.5–11.1) and 1.0% (95% CI: 0.6%–1.4%), respectively. Four percent of women infected with CT also had NG infection. CT associated factors were: being younger (15–19 years old) (odds ratio [OR] = 1.6 [95% CI: 1.15–2.17]); first sexual intercourse before 15 years of age (OR = 1.4 [95% CI: 1.04–6.24]); having more than 1 sexual partner in lifetime (OR = 1.6 [95% CI: 1.13–2.26]); Pap smear screening more than 1 year (OR = 1.5 [95% CI: 1.08–2.05]); and NG infection (OR = 7.6 [95% CI: 3.05–19.08]). Conclusions: This study shows a high prevalence of CT infection among young pregnant women in Brazil. We suggest that CT screening should be included as part of antenatal care routine in this group in Brazil.

Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infection in men attending STD clinics in Brazil

INTRODUCTION The study aimed to assess the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections and identify demographic, behavioral and clinical factors correlated with such infections in men attending six sexually transmitted disease clinics in Brazil. METHODS Multicentric, cross-sectional study performed among men attending STD clinics in Brazil. The study included STD clinics in six cities distributed throughout the five geographic regions of Brazil in 2005. Patients provided 20 ml of first catch urine for testing for NG and CT by DNA-PCR. RESULTS A total of 767 (92.9%) men were included in the study. The mean age was 26.5 (SD 8.3) years-old. Prevalence of Chlamydia infection was 13.1% (95%CI 10.7%-15.5%) and gonorrhea was 18.4% (95%CI 15.7%-21.1%). Coinfection prevalence was 4.4% (95%CI 2.95%-5.85%) in men who sought attendance in STI clinics. Factors identified as associated with C. trachomatis were younger age (15-24) [OR=1.4 (95%CI 1.01-1.91)], present urethral discharge [OR=4.8 (95%CI 1.52-15.05)], genital warts [OR=3.0 (95%CI 1.49-5.92)] and previous history of urethral discharge [OR=2.4 (95%CI 1.11-5.18)]. Variables associated with gonorrhea were younger age (15 to 24) [OR=1.5 (95%CI 1.09-2.05)], presence of urethral discharge [OR=9.9 (95%CI 5.53-17.79)], genital warts [OR=18.3 (95%CI 8.03-41.60)] and ulcer present upon clinical examination [OR=4.9 (95%CI 1.06-22.73)]. CONCLUSIONS These findings have important implications for education and prevention actions directed toward men at risk of HIV/STD. A venue-based approach to offer routine screening for young men in STD clinics should be stimulated.

Associação de conhecimento sobre DST e grau de escolaridade entre conscritos em alistamento ao Exército Brasileiro. Brasil, 2007

Foi descrito o conhecimento dos alistados no Exercito Brasileiro, em relacao as DST segundo escolaridade. Foi utilizado questionario autoaplicavel com caracteristicas demograficas, modos transmissao, comportamento sexual e preferencia de acesso a informacoes sobre DST em amostra com representatividade nacional, 2007. As variaveis associadas a menor escolaridade foram: ter 19-20 anos [OR = 1,2(IC95%:1,18-1,32)], relatar que a transmissao de DST pode ser por: ingestao de alimento contaminado [OR = 2,2(IC95%:1,96-2,55)], tomar banho em rios/praias [OR = 1,5(IC95%:1,27-1,88)], picada de mosquitos [OR = 1,5(IC95%:1,38-1,65)], inicio de atividade sexual antes de 14 anos de idade [OR = 1,4(IC95%: 1,33-1,55)]. As variaveis com associacao inversa a baixa escolaridade foram: auto declarado branco [OR = 0,9(IC95%: 0,82-0,91)]; afirmar que a transmissao das DST pode ser por: compartilhar seringas/agulhas [OR = 0,7(IC95%: 0,62-0,78)]; transmissao materna, no parto e amamentacao [OR = 0,6(IC95%: 0,58-0,69)]; usar preservativo no ultimo coito [OR = 0,8(IC95%: 0,71-0,85)]; ser HSH [OR = 0,7 (IC95%: 0,60-0,92); e reconhecer o nao uso do preservativo como aumento do risco de transmissao [OR = 0,4(IC 95%: 0,37-0,51)]. Dada a baixa escolaridade associada ao menor conhecimento, aponta para necessidade de acoes educativas destinadas a essa populacao, que se encontra em situacao mais vulneravel.

Approach in sexually transmitted diseases.

Nowadays, sexually transmitted diseases are one of the most common public health issues. Among its consequences are the possibility of transmission from mother to baby - which may cause miscarriages and congenital disease, male and female infertility, and the increase of HIV infection risk. Therefore, the main goal of these guidelines is to contribute to the improvement of the treatment for sexually transmitted diseases patients by presenting to the medical community how todays science stands on the matter and also what the recommendation for diagnosing and treating a patient are.

Prevalence of and risk factors for syphilis in Brazilian armed forces conscripts.

Objective The aim of this study was to describe the prevalence of syphilis by geographical region and the frequency of behaviours and symptoms related to sexually transmitted diseases (STD). Methods A cross-sectional study was performed with Brazilian conscripts in 2007. They answered a self-administered questionnaire on demographic issues, sexual practices, condom use and STD symptoms. They had a blood sample collected for a syphilis test. Results A total of 35 460 conscripts answered the questionnaire and 75.5% reported previous sexual intercourse. Overall syphilis prevalence was 0.53% (95% CI 0.45% to 0.61%). By geographical region: northern (0.85%), northeast (0.82%), midwest (0.49%), southeast (0.34%) and southern region (0.26%). The final logistic regression model showed an association among having had syphilis and being 17 years old (OR 1.3; 95% CI 1.05 to 1.73), having up to 8 years of schooling (OR 1.5; 95% CI 1.03 to 2.22), living in the northern/northeast region (OR 1.2; 95% CI 1.04 to 1.36), being men who have sex with men (OR 4.5; 95% CI 2.59 to 7.81), reporting a previous history of STD (OR 2.7; 95% CI 1.03 to 6.99) and genital ulcers (OR 2.6; 95% CI 1.59 to 4.26). Conclusions Addressing young people at the time of military enlistment may be a good time to consider new strategies for accessing and counselling this population, thus allowing the implementation of a more appropriate healthcare policy.

Risk factors for syphilis in young women attending a family health program in Vitoria Brazil.

BACKGROUND The high prevalence of STDs among women indicates the need to implement approaching techniques, case detection and prevention of new cases. OBJECTIVES To describe the frequency of risk factors for syphilis and assess attitudes towards sexual risk in a population of young women in Vitória, ES. METHODS Cross-sectional, population-based study, performed in Vitória. Interviews were held and VDRL and MHA-TP were investigated in blood samples. RESULTS Among the 904 eligible women (18-29 years) sampled from the Family Health Program (FHP), 11 were diagnosed with syphilis, a prevalence of 1.2% (CI95% 0.5-1.9). Median age was 23 years (interquartile range 20-26 years); 65.7% of participants were in high school or college and 85.4% lived with their family or sexual partner. Factors associated with syphilis included: lower educational level (<8 years of schooling) [Adjusted Odds Ratio aOR=4.3 (CI 95% 1.01-17.99)]; >1 lifetime sexual partners [(aOR) =6.50 (CI95% 1.37-30.82)], and history of a previously diagnosed STD [aOR=10.3 (CI95% 2.37-44.33)]. Two thirds (67.7%) of the women surveyed agreed that it is not easy to tell their sexual partner they do not want to have sex without condoms; 52.3% thought it is difficult to use condoms in all sexual intercourses, and 36.2% said they cannot do anything if their partner refuses to use condoms. CONCLUSIONS Using the FHP as an approach to perform routine VDRL can contribute to decreasing the vulnerability of these women and help control congenital syphilis.

Nova definição de casos de sífilis congênita para fins de vigilância epidemiológica no Brasil, 2004

.A definicao de caso em epidemiologia constitui-se em uma dessas estrategias, possibilitando aidentificacao de individuos que apresentam um agravo ou doenca de interesse de forma a padronizarcriterios para o monitoramento das condicoes de saude e para a descricao da ocorrencia desseevento. O objetivo principal e tornar comparaveis os criterios diagnosticos que regulam a entradade casos no sistema, tanto no nivel nacional quanto internacional

Trichomonas vaginalis infection among young pregnant women in Brazil

Our goal was to determine the prevalence of Trichomonas vaginalis and its associated risk factors in parturient women aged 15-24 years attending Brazilian public maternity units. Participants answered a demographic, behavioral, and clinical data questionnaire. A sample of urine was screened for T. vaginalis. A total 299 women participated in this study. The prevalence rate of T. vaginalis was 7.7% (95% CI: 4.7-10.7%). The factors associated with T. vaginalis were use of illicit drugs [OR=4.70 (95% CI: 1.63-13.56, p=0.004)] and not attending antenatal care [OR=5.15 (95% CI: 1.15-23.25, p=0.032)]. These data demonstrate that it is important to discuss how to include routine screening for T. vaginalis during antenatal care in Brazil.