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Brazilian Protocol for Sexually Transmitted infections 2020: approaching sexually active individuals

Abstract

This article aims to present concepts and clinical practices recommended to approach people with active sex life. These concepts are an integral part of the recommendations of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections (STI), published by the Ministry of Health of Brazil in 2020. The article proposes a comprehensive approach to sexuality for health promotion. It presents significant aspects of the communication process that must develop, without prejudice and judgment, focusing on sexual and reproductive health. It also highlights relevant points about the exercise of sexuality at specific stages of life, recommending assessment of risks and vulnerabilities and screening for STI and condom use. In this way, it is possible to contribute to exercise their sexuality fully, responsibly, and safely.

Keywords:
Sexuality; Sexually transmitted infections; Disease prevention; Diagnosis screening programs; Clinical protocols; Surveillance

Highlighted excerpt:

Sexual health is the physical, emotional, mental, and social wellbeing associated with the exercise of sexuality, with sexual and reproductive rights considered fundamental.

FOREWORD

This article aims at updating the chapter on Sexual Health: an approach centered on sexually active individuals of the Clinical Protocol and Therapeutical Guidelines (PDCT) for Comprehensive Care for People with Sexually Transmitted Infections (STI) 202011. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Protocolo clínico e diretrizes terapeuticas para atenção integral às pessoas com infecções sexualmente transmissíveis (IST) [Internet]. Brasília: Ministério da Saúde; 2020 [cited 2020 out 29]. 248 p. Available from: http://www.aids.gov.br/pt-br/pub/2015/protocolo-clinico-e-diretrizes-terapeuticas-para-atencao-integral-pessoas-com-infeccoes .
http://www.aids.gov.br/pt-br/pub/2015/pr...
. We highlight the main thematic points: the communication in approaching sexual health, sexuality in specific life stages, assessment of risks and vulnerabilities, STI tracing, and condom use. We made adaptations in the chapter items to make it more adequate regarding issues of other STIs different from HIV, as it has a specific clinical protocol22. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Protocolo clínico e diretrizes terapêuticas para manejo da infecção pelo HIV em adultos [Internet]. Brasília: Ministério da Saúde ; 2018 [cited 2020 out 29]. Available from: http://www.aids.gov.br/pt-br/pub/2013/protocolo-clinico-e-diretrizes-terapeuticas-para-manejo-da-infeccao-pelo-hiv-em-adultos .
http://www.aids.gov.br/pt-br/pub/2013/pr...
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The PDCT was published by the Health Surveillance Department of the Brazilian Ministry of Health, based on official recommendations and discussions with experts. The National Committee approved it for Technology Incorporation to the Unified Health System (Conitec) in 201833. Brasil. Ministério da Saúde. Portaria MS/GM nº 42, de 5 de outubro de 2018. Torna pública a decisão de aprovar o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis (IST) no âmbito do Sistema Único de Saúde - SUS [Internet]. Diário Oficial da União, Brasília (DF), 2018 out 8 [cited 2020 out 29];Seção 1:88. Available from: http://conitec.gov.br/images/Protocolos/PCDT_DoencaChagas.pdf .
http://conitec.gov.br/images/Protocolos/...
. It proposes a sensitive approach to sexuality, aiming at improving the health of sexually active individuals.

INTRODUCTION

Sexual and reproductive rights are considered fundamental, together with the rights to life, food, health, housing, and education for the complete exercise of citizenship44. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Saúde sexual e reprodutiva [Internet]. Brasília: Ministério da Saúde ; 2013 [cited 2020 out 29]. 300 p. (Cadernos de Atenção Básica, n. 26). Available from: https://bvsms.saude.gov.br/bvs/publicacoes/saude_sexual_saude_reprodutiva.pdf .
https://bvsms.saude.gov.br/bvs/publicaco...
. The right of individuals and couples of all sexual orientations to have their sexual health preserved is recognized. Sexual health is defined as the physical, emotional, mental, and social wellbeing associated with the exercise of sexuality and not just the lack of sexual infections, disorders, or diseases55. Naciones Unidas - ONU. Informe de la Conferencia Internacional sobre la población y el desarrollo: el Cairo, 5 a 13 de septiembre de 1994 [Internet]. Nueva York: Naciones Unidas, 1995 [cited 2020 out 7]. Available from: https://www.unfpa.org/sites/default/files/pub-pdf/icpd_spa.pdf .
https://www.unfpa.org/sites/default/file...
. It is considered an essential component for promoting human development66. Coleman E. What is sexual health? Articulating a sexual health approach to HIV prevention for men who have sex with men. AIDS Behav [Internet]. 2011 Apr [cited 2020 Oct 29];15(Suppl. 1):S18-24. Available from: https://doi.org/10.1007/s10461-011-9909-y.
https://doi.org/10.1007/s10461-011-9909-...
. It implies the exercise of safe and healthy sexual experiences without coercion, discrimination, or violence77. World Health Organization - WHO. Defining sexual health: report of a technical consultation on sexual health [Internet]. Geneva: WHO; 2006 [cited 2020 Oct 29]. 35 p. Available from: https://www.who.int/reproductivehealth/publications/sexual_health/defining_sexual_health.pdf .
https://www.who.int/reproductivehealth/p...
. Finally, sex is understood as one of the essential dimensions of sexuality, not limited to genitality or reproduction88. Creusa T, Negreiros M. Sexualidade e gênero no envelhecimento. Alceu [Internet]. 2004 jul-dez [cited 2020 out 29];5(9):77-86. Available from: http://revistaalceu-acervo.com.puc-rio.br/media/alceu_n9_negreiros.pdf .
http://revistaalceu-acervo.com.puc-rio.b...
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COMMUNICATION IN THE APPROACH TO SEXUAL HEALTH

The communication process plays a significant role in the improvement of the professional-patient relationship and, as a consequence, for the adherence to the recommendations and treatment99. Wei D, Xu A, Wu X. The mediating effect of trust on the relationship between doctor-patient communication and patients' risk perception during treatment. Psych J [Internet]. 2020;9(3):383-91. Available from: https://doi.org/10.1002/pchj.327.
https://doi.org/10.1002/pchj.327...
. Health professionals can be unprepared and feel embarrassed when it comes to approaching patients regarding STI and sexuality1010. Rocha AFB, Araújo MAL, Miranda AE, Leon RGP, Silva Junior GB, Vasconcelos LDPG. Management of sexual partners of pregnant women with syphilis in northeastern Brazil - a qualitative study. BMC Health Serv Res [Internet]. 2019 Jan [cited 2020 Oct 29];19(1):65. Available from: https://doi.org/10.1186/s12913-019-3910-y.
https://doi.org/10.1186/s12913-019-3910-...
. The offer of adequate training could minimize such embarrassment and contribute to qualifying such professionals' performance, aiming to make them familiar with the different concepts of gender, sexual orientation, and identity.

Health services must promote environments favorable to the dialog and embrace the different dimensions of the exercise of sexuality by sexually active individuals. We recommend a gradual approach, advancing from general aspects to the most specific ones1111. Carrió FB. Entrevista clínica: habilidades de comunicação para profissionais de saúde. Porto Alegre: Artmed; 2012. 346 p.. Adequate approach to sexuality must encompass guidelines on prevention and identification of risk factors and vulnerabilities, sexual practices, and behaviors that favor STI contamination.

To establish an association of trust, we need a clear and transparent approach, adequate to receptivity and the life context of the persons, which must be recognized as active individuals in the care process1010. Rocha AFB, Araújo MAL, Miranda AE, Leon RGP, Silva Junior GB, Vasconcelos LDPG. Management of sexual partners of pregnant women with syphilis in northeastern Brazil - a qualitative study. BMC Health Serv Res [Internet]. 2019 Jan [cited 2020 Oct 29];19(1):65. Available from: https://doi.org/10.1186/s12913-019-3910-y.
https://doi.org/10.1186/s12913-019-3910-...
. All services must favor the development of autonomy of the subjects for identifying solutions to their demands. The approach must take place free from prejudiced attitudes, labels, and stigmatization, understanding sexuality as part of the culture and the historical, social, and life context of each individual44. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Saúde sexual e reprodutiva [Internet]. Brasília: Ministério da Saúde ; 2013 [cited 2020 out 29]. 300 p. (Cadernos de Atenção Básica, n. 26). Available from: https://bvsms.saude.gov.br/bvs/publicacoes/saude_sexual_saude_reprodutiva.pdf .
https://bvsms.saude.gov.br/bvs/publicaco...
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We recommend to the professional to assure that the person is comfortable to talk about such themes, informing them that those are questions made routinely in the healthcare service, regardless of sex, sexual orientation, age, professional activity, and marital status. Emphasis should be placed on the secrecy and confidentiality of information1212. Toskin I, Bakunina N, Gerbase AC, Blondeel K, Stephenson R, Baggaley R, et al. A combination approach of behavioural and biomedical interventions for prevention of sexually transmitted infections. Bull World Health Organ [Internet]. 2020;98(6):431-4. Available from: http://dx.doi.org/10.2471/BLT.19.238170.
https://doi.org/10.2471/BLT.19.238170...
,1313. Kee JWY, Khoo HS, Lim I, Koh MYH. Communication skills in patient-doctor interactions: learning from patient complaints. Health Prof Educ [Internet]. 2018 Jun [cited 2020 Oct 29];4(2):97-106. Available from: https://doi.org/10.1016/j.hpe.2017.03.006.
https://doi.org/10.1016/j.hpe.2017.03.00...
General guidelines on communication can be found in Figure 1.

FIGURE 1:
General guidelines for approach to sexuality by healthcare staff.

Telemedicine has currently been gaining ground in disclosing information, promotion and prevention, expanding the scope of healthcare services, especially in a continental country with regions that are hard to reach. Useful communication techniques in servicing people with STI are also needed in telemedicine1414. Machado FSN, Carvalho MAP, Mataresi A, Mendonça ET, Cardoso LM, Yogi MS, et al. Use of telemedicine technology as a strategy to promote health care of riverside communities in the Amazon: experience with interdisciplinary work, integrating NHS guidelines. Ciênc Saúde Coletiva [Internet]. 2010;15(1):247-54. Available from: https://doi.org/10.1590/S1413-81232010000100030.
https://doi.org/10.1590/S1413-8123201000...
. For this reason, it is necessary to incorporate its use in the service to people with STI, respecting the ethical limits and current recommendations regarding data storage, handling and transmission, as well as confidentiality, privacy and the guarantee of professional secrecy1515. Conselho Federal de Medicina (BR). Resolução CFM nº 2.228/2019. Revoga a Resolução CFM nº 2.227 e reestabelece a Resolução CFM nº 1.643/2002, que define e disciplina a prestação de serviços através da Telemedicina [Internet]. Diário Oficial da União , Brasília (DF), 2019 mar 6 [cited 2020 out 29];Seção I:91. Available from: https://www.in.gov.br/materia/-/asset_publisher/Kujrw0TZC2Mb/content/id/65864894
https://www.in.gov.br/materia/-/asset_pu...
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SEXUALITY IN SPECIFIC LIFE STAGES

Adolescence is a period of significant biological, psychological and social transformations. Physical alterations, social interactions and the awakening of new interests reflect fast and profound changes that characterize this life stage. The way adolescents express and live sexuality is influenced by the quality of emotional and affective associations experienced with relevant people in childhood, integration with peers, transformation arising from growth and development, the start of reproductive capacity, beliefs, moral patterns, myths, and taboos, as well as the traditions of the family or society in which they are inserted1616. Organização Pan-Americana da Saúde - OPAS. Organização Mundial da Saúde - OMS. Saúde e sexualidade de adolescentes. Construindo equidade no SUS. [Internet]. Brasília: Ministério da Saúde ; 2017 [cited 2020 out 29]. 71 p. Available from: http://portalarquivos.saude.gov.br/images/PDF/2017/maio/05/LIVRO-SAUDE-ADOLESCENTES.PDF .
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In this stage, values, attitudes, habits, and behaviors are being formed, transformed, and consolidated, making adolescents more vulnerable, mainly because parents or guardians, school, and even health staff tend not to approach the aspects regarding the exercise of sexuality. Therefore, many times adolescents start their sexual lives without due orientation1717. Minstério do Planejamento, Desenvolvimento e Gestão (BR). Instituto Brasileiro de Geografia e Estatística - IBGE. Pesquisa nacional de saúde do escolar 2015 [Internet]. Rio de Janeiro: IBGE; 2016 [cited 2020 out 29]. 132 p. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv97870.pdf .
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Healthcare services can play a fundamental role, disclosing to adolescents information contributing to the awakening of a healthy sexual life and prevention of STI and unintended pregnancy. Such orientation must be based on dialog, allowing for autonomy and responsible attitudes1818. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Protocolo clínico e diretrizes terapêuticas para prevenção da transmissão vertical de HIV, sífilis e hepatites virais [Internet]. Brasília: Ministério da Saúde ; 2019 [cited 2020 out 29]. 248 p. Available from: http://www.aids.gov.br/pt-br/pub/2015/protocolo-clinico-e-diretrizes-terapeuticas-para-prevencao-da-transmissao-vertical-de-hiv .
http://www.aids.gov.br/pt-br/pub/2015/pr...
. The approach must comply with confidentiality and privacy principles, indispensable for trust and respect between adolescents and health professionals1919. Sociedade Brasileira de Pediatria - SBP. Departamento Científico de Adolescência. Consulta do adolescente: abordagem clínica, orientações éticas e legais como instrumentos ao pediatra: manual de orientação [Internet]. Rio de Janeiro: SBP; 2019 [cited 2020 out 29]. Available from: https://www.sbp.com.br/fileadmin/user_upload/21512c-MO_-_ConsultaAdolescente_-_abordClinica_orientEticas.pdf .
https://www.sbp.com.br/fileadmin/user_up...
. It also must take place from the point of view of comprehensive care, providing access to different technologies associated with combined prevention1616. Organização Pan-Americana da Saúde - OPAS. Organização Mundial da Saúde - OMS. Saúde e sexualidade de adolescentes. Construindo equidade no SUS. [Internet]. Brasília: Ministério da Saúde ; 2017 [cited 2020 out 29]. 71 p. Available from: http://portalarquivos.saude.gov.br/images/PDF/2017/maio/05/LIVRO-SAUDE-ADOLESCENTES.PDF .
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During gestation, sexual relations do not pose a risk to pregnancy, except in unique obstetric situations (membrane rupture, cervical insufficiency, short cervix, or premature delivery). However, we should not ignore the possibility of a pregnant woman getting an STI that harms the gestation's prognosis, or vertically transmitting the disease. For this reason, healthcare staff must approach routine questions associated with the sexual health of pregnant women and their sexual partners and offer HIV, syphilis, and hepatitis B and C tests in prenatal care1818. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Protocolo clínico e diretrizes terapêuticas para prevenção da transmissão vertical de HIV, sífilis e hepatites virais [Internet]. Brasília: Ministério da Saúde ; 2019 [cited 2020 out 29]. 248 p. Available from: http://www.aids.gov.br/pt-br/pub/2015/protocolo-clinico-e-diretrizes-terapeuticas-para-prevencao-da-transmissao-vertical-de-hiv .
http://www.aids.gov.br/pt-br/pub/2015/pr...
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Older adults presented an increase in the number of HIV and syphilis cases over the last years, drawing attention to the role of sexuality in this age group2020. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. HIV/Aids | 2019. Bol Epidemiol [Internet]. 2019 dez [cited 2020 out 29];especial. Available from: http://www.aids.gov.br/pt-br/pub/2019/boletim-epidemiologico-de-hivaids-2019
http://www.aids.gov.br/pt-br/pub/2019/bo...
,2121. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Sífilis | 2019. 2019 out [cited 2020 out 29];especial. Available from: http://www.aids.gov.br/pt-br/pub/2019/boletim-epidemiologico-sifilis-2019 .
http://www.aids.gov.br/pt-br/pub/2019/bo...
. There are essential aspects that increase vulnerability, as lower genital lubrication in women, and male erection difficulty2020. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. HIV/Aids | 2019. Bol Epidemiol [Internet]. 2019 dez [cited 2020 out 29];especial. Available from: http://www.aids.gov.br/pt-br/pub/2019/boletim-epidemiologico-de-hivaids-2019
http://www.aids.gov.br/pt-br/pub/2019/bo...

21. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Sífilis | 2019. 2019 out [cited 2020 out 29];especial. Available from: http://www.aids.gov.br/pt-br/pub/2019/boletim-epidemiologico-sifilis-2019 .
http://www.aids.gov.br/pt-br/pub/2019/bo...
-2222. Aguiar RB, Leal MCC, Marques APO. Knowledge and attitudes about sexuality in the elderly with HIV. Ciênc Saúde Coletiva [Internet]. 2020 [cited 2020 Oct 29];25(6):2051-62. Available from: https://doi.org/10.1590/1413-81232020256.18432018.
https://doi.org/10.1590/1413-81232020256...
. Besides, it is a generation that was not sexually initiated with safe sex.

RISK ASSESSMENT, VULNERABILITIES, AND STI TRACING

In risk assessment for STI in sexually active individuals, we recommend investigating structured questions, identifying factors associated with sexual practices and behaviors, and alcohol and drug use. From the contents obtained, it is possible to make an adequate assessment for risk management and identify opportunities for recommending preventive actions. The professional must individually provide the attendance, and in a private environment11. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Protocolo clínico e diretrizes terapeuticas para atenção integral às pessoas com infecções sexualmente transmissíveis (IST) [Internet]. Brasília: Ministério da Saúde; 2020 [cited 2020 out 29]. 248 p. Available from: http://www.aids.gov.br/pt-br/pub/2015/protocolo-clinico-e-diretrizes-terapeuticas-para-atencao-integral-pessoas-com-infeccoes .
http://www.aids.gov.br/pt-br/pub/2015/pr...
,1616. Organização Pan-Americana da Saúde - OPAS. Organização Mundial da Saúde - OMS. Saúde e sexualidade de adolescentes. Construindo equidade no SUS. [Internet]. Brasília: Ministério da Saúde ; 2017 [cited 2020 out 29]. 71 p. Available from: http://portalarquivos.saude.gov.br/images/PDF/2017/maio/05/LIVRO-SAUDE-ADOLESCENTES.PDF .
http://portalarquivos.saude.gov.br/image...
,2323. Ministério da Saúde (BR). Nota Técnica no 04, de 3 de abril de 2017. O direito de adolescentes serem atendidos nas UBS desacompanhados dos pais ou responsáveis e as ocasiões em que é necessária a presença de pais ou responsável. [Internet]. Brasília: Ministério da Saúde ; 2017 [cited 2020 out 29]. Available from: https://central3.to.gov.br/arquivo/494626 /.
https://central3.to.gov.br/arquivo/49462...
. Figure 2 presents questions for the attendance towards risk assessment.

FIGURE 2:
Routine service questions for assessment of the risk of sexually transmitted infections.

Risk assessment can guide STI tracing. After identifying clinical cases, it is crucial to call and treat the sexual partnerships, aiming to interrupt the chain of infection, prevent complications, and avoid reinfections11. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Protocolo clínico e diretrizes terapeuticas para atenção integral às pessoas com infecções sexualmente transmissíveis (IST) [Internet]. Brasília: Ministério da Saúde; 2020 [cited 2020 out 29]. 248 p. Available from: http://www.aids.gov.br/pt-br/pub/2015/protocolo-clinico-e-diretrizes-terapeuticas-para-atencao-integral-pessoas-com-infeccoes .
http://www.aids.gov.br/pt-br/pub/2015/pr...
. In Brazil, the PDCT recommends screening asymptomatic subgroups11. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Protocolo clínico e diretrizes terapeuticas para atenção integral às pessoas com infecções sexualmente transmissíveis (IST) [Internet]. Brasília: Ministério da Saúde; 2020 [cited 2020 out 29]. 248 p. Available from: http://www.aids.gov.br/pt-br/pub/2015/protocolo-clinico-e-diretrizes-terapeuticas-para-atencao-integral-pessoas-com-infeccoes .
http://www.aids.gov.br/pt-br/pub/2015/pr...
to identify and treat infected individuals earlier, looking to prevent STI dissemination and their complications2424. Gérvas J, Fernández MP. Uso y abuso del poder médico para definir enfermedad y factor de riesgo, en relación con la prevención cuaternaria. Gac Sanit [Internet]. 2006 Dec [cited 2020 Oct 29];20(Suppl. 3):66-71. Available from: https://doi.org/10.1157/13101092.
https://doi.org/10.1157/13101092...
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European guidelines recommend managing sexual partners of people with STI, indicating emotional support and contact identification and notification, through a strategy guided by pattern operational procedure for control, monitoring, treatment, and report of cases2525. Tiplica GS, Radcliffe K, Evans C, Gomberg M, Nandwani R, Rafila A, et al. 2015 European guidelines for the management of partners of persons with sexually transmitted infections. J Eur Acad Dermatol Venereol [Internet]. 2015 [cited 2020 Oct 29];29(7):1251-7. Available from: https://doi.org/10.1111/jdv.13181.
https://doi.org/10.1111/jdv.13181...
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Brazil presents a trend of HIV and syphilis increase in the population between 13 and 29 years of age2020. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. HIV/Aids | 2019. Bol Epidemiol [Internet]. 2019 dez [cited 2020 out 29];especial. Available from: http://www.aids.gov.br/pt-br/pub/2019/boletim-epidemiologico-de-hivaids-2019
http://www.aids.gov.br/pt-br/pub/2019/bo...
,2121. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Sífilis | 2019. 2019 out [cited 2020 out 29];especial. Available from: http://www.aids.gov.br/pt-br/pub/2019/boletim-epidemiologico-sifilis-2019 .
http://www.aids.gov.br/pt-br/pub/2019/bo...
. For this reason, it recommends the annual tracing of such infections in people up to 30 years old who are sexually active. Other diseases are screened depending on population groups and sexual practices that expose people to more significant risks. Figure 3 presents recommendations for tracing people in any age group.

FIGURE 3:
Tracing indication for sexually transmitted infections according to population subgroups.

It is important to trace some infections, such as chlamydia and gonococcus, aiming at preventing pelvic inflammatory disease that, even if asymptomatic, can reduce chances of pregnancy2626. Wiesenfeld HC, Hillier SL, Meyn LA, Amortegui AJ, Sweet RL. Subclinical pelvic inflammatory disease and infertility. Obstet Gynecol [Internet]. 2012 Jul [cited 2020 Oct 29];120(1):37-43. Available from: https://doi.org/10.1097/aog.0b013e31825a6bc9
https://doi.org/10.1097/aog.0b013e31825a...
. In Brazil, screening for chlamydia infections is recommended for pregnant women younger than 30 years old due to the high prevalence of infection in this age group2727. Pinto VM, Szwarcwald CL, Baroni C, Stringari LL, Inocencio LA, Miranda AE. Chlamydia trachomatis prevalence and risk behaviors in parturient women aged 15 to 24 in Brazil. Sex Transm Dis [Internet]. 2011 Oct [cited 2020 Oct 29];38(10):957-61. Available from: https://doi.org/10.1097/olq.0b013e31822037fc.
https://doi.org/10.1097/olq.0b013e318220...
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Figure 3 presents recommendations for tracing STI according to population subgroups, as proposed by the PDCT for Comprehensive Care for People with STI 202011. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Protocolo clínico e diretrizes terapeuticas para atenção integral às pessoas com infecções sexualmente transmissíveis (IST) [Internet]. Brasília: Ministério da Saúde; 2020 [cited 2020 out 29]. 248 p. Available from: http://www.aids.gov.br/pt-br/pub/2015/protocolo-clinico-e-diretrizes-terapeuticas-para-atencao-integral-pessoas-com-infeccoes .
http://www.aids.gov.br/pt-br/pub/2015/pr...
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CONDOM USE

Using female, or male condoms is a preventive strategy that should be offered to sexually active people, in order to reduce the risk of HIV and other STI transmission and prevent pregnancy2828. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis, do HIV/Aids e das Hepatites Virais. Prevenção combinada do HIV: bases conceituais para profissionais, trabalhadores(as) e gestores(as) de saúde [Internet]. Brasília: Ministério da Saúde ; 2017 [cited 2020 out 29]. 123 p. Available from: http://www.aids.gov.br/pt-br/pub/2017/prevencao-combinada-do-hiv-bases-conceituais-para-profissionais-trabalhadoresas-e-gestores .
http://www.aids.gov.br/pt-br/pub/2017/pr...
. Despite the low adherence and acceptance of the female condom, it is deemed necessary in situations where it is difficult for the women to negotiate the use of the male condom2929. Gomes VLO, Fonseca ADF, Jundi MG, Severo TP. Percepções de casais heterossexuais acerca do uso da camisinha feminina. Esc Anna Nery [Internet]. 2011 Jan-Mar [cited 2020 Oct 20];15(1)22-30. Available from: https://doi.org/10.1590/S1414-81452011000100004
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The offer of condoms must take place without the quantity restrictions and without requiring identification documents. Figure 4 presents the guidelines for conservation and correct use of male and female condoms. They should be part of the healthcare staff's approach in all services, especially highly vulnerable individuals.

FIGURE 4:
Use and adequate conservation of male and female condom.

CONCLUDING REMARKS

Healthcare professionals must incorporate sexuality into services to sexually active individuals, mainly those with STI complaints. This approach must develop, without prejudice and judgment, with a focus on sexual and reproductive health. In this way, it is possible to contribute to exercise their sexuality fully, responsibly, and safely. The right preventive approach can favor the decrease of STIs and their consequences.

ACKNOWLEDGMENTS

The authors acknowledge the substantial contribution of this article by the technical group of specialists responsible for developing the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care (PDCT) for People with Sexually Transmitted Infections (STI) 2020.

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Publication Dates

  • Publication in this collection
    17 May 2021
  • Date of issue
    2021

History

  • Received
    01 Feb 2021
  • Accepted
    10 Mar 2021
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