Revista da Sociedade Brasileira de Medicina Tropical, Volume: 54 Supplement 1, Published: 2021
  • Comprehensive care for people with sexually transmitted infections Editorial

    Galvão, Taís Freire; Costa, Carlos Henrique Nery; Garcia, Leila Posenato
  • Public policies on sexually transmitted infections in Brazil Letter

    Miranda, Angélica Espinosa; Freitas, Francisca Lidiane Sampaio; Passos, Mauro Romero Leal de; Lopez, Miguel Angel Aragón; Pereira, Gerson Fernando Mendes
  • Brazilian Protocol for Sexually Transmitted Infections 2020: epidemiological surveillance Consensus

    Domingues, Carmen Silvia Bruniera; Lannoy, Leonor Henriette de; Saraceni, Valeria; Cunha, Alessandro Ricardo Caruso da; Pereira, Gerson Fernando Mendes

    Abstract in English:

    Abstract This article summarizes the chapter on epidemiological surveillance of sexually transmitted infections (STI) that comprises the 2020 Clinical Protocol and Therapeutic Guidelines (PCDT) for Comprehensive Care for People with STI, published by the Health Surveillance Department of the Brazilian Ministry of Health. It presents some reflections on the new case definitions for surveillance of acquired syphilis, syphilis in pregnant women, and congenital syphilis. The 2020 PCDT-IST was elaborated grounded on scientific evidence and validated in discussions with specialists. Epidemiological and clinical aspects are addressed, and health service managers' guidelines regarding programmatic and operational management of these diseases are presented. Guidelines for health professionals on screening, diagnosing, and treating people with STI and their sex partners, in addition to strategies for surveillance, prevention, and control actions, are also published.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause cervicitis Consensus

    Miranda, Angélica Espinosa; Silveira, Mariângela Freitas da; Pinto, Valdir Monteiro; Alves, Geralda Carolina; Carvalho, Newton Sergio de

    Abstract in English:

    Abstract Infections that cause cervicitis are a topic presented in the "Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections", published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with experts. This article presents epidemiological and clinical aspects of infections that cause cervicitis and recommendations on screening, diagnosis, and treatment of affected people and their sexual partnerships. Also, it discusses strategies for surveillance, prevention, and control of these infections for health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections. Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cervicitis.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: HIV infection in adolescents and adults Consensus

    Pinto, Lauro Ferreira da Silva; Perini, Filipe de Barros; Aragón, Mayra Gonçalves; Freitas, Marcelo Araújo; Miranda, Angélica Espinosa

    Abstract in English:

    Abstract HIV infection is presented in the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Health professionals and managers must learn the signs and symptoms of HIV infection and know how to diagnose it to provide appropriate treatment and reduce complications. HIV infection has become a chronic disease. Its treatment includes addressing common comorbidities such as arterial hypertension, diabetes, and dyslipidemia, in addition to cardiac risk assessment, cancer prevention, and guidance on immunization. Initiation of treatment for HIV patients is recommended regardless of clinical or immunological criteria as adopted by the Ministry of Health since 2013. Lately, it has been simplified with more tolerable first-line medications and fewer drug interactions, making its management easy to implement, including by primary health care.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: infections causing vaginal discharge Consensus

    Carvalho, Newton Sergio de; Eleutério, José; Travassos, Ana Gabriela; Santana, Lutigardes Bastos; Miranda, Angélica Espinosa

    Abstract in English:

    Abstract The topic of vaginal discharge is one of the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Health Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The chapter has been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects associated with vaginal discharge conditions, as well as guidance to health service managers and health professionals. Screening, diagnosing, and treating these conditions, the main complaints among women seeking health services, caused by infectious or non-infectious factors, also are presented. Besides, information is presented on surveillance, prevention, and control actions to promote knowledge of the problem and provide quality care and effective treatment.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: congenital syphilis and child exposed to syphilis Consensus

    Domingues, Carmen Silvia Bruniera; Duarte, Geraldo; Passos, Mauro Romero Leal; Sztajnbok, Denise Cardoso das Neves; Menezes, Maria Luiza Bezerra

    Abstract in English:

    Abstract The topics of congenital syphilis and children exposed to syphilis compose the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Such document was elaborated based on scientific evidence and validated in discussions with specialists. This article provides guidelines for syphilis in pregnant women and congenital syphilis clinical management, emphasizing the vertical transmission of Treponema pallidum prevention. Epidemiological and clinical aspects of these infections are presented and recommendations for managers in the programmatic and operational management of syphilis. The article also includes guidelines for health professionals in screening, diagnosing, and treating people with sexually transmitted infections and their sex partners, in addition to strategies for surveillance actions, prevention, and control of the disease.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: sexually transmitted enteric infections Consensus

    Nahn, Edilbert Pelegrini; Oliveira, Eduardo Campos de; Barbosa, Marcelo Joaquim; Mareco, Thereza Cristina de Souza; Brígido, Helena Andrade

    Abstract in English:

    Abstract The sexually transmitted enteric infections topic is one of the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects of these infections and guidance for service managers on their programmatic and operational management. The aim is to assist health professionals with screening, diagnosis, and treatment of people with sexually transmitted enteric infections and their sexual partners, in addition to supporting strategies for their surveillance, prevention, and control.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: sexual violence Consensus

    Menezes, Maria Luiza Bezerra; Araújo, Maria Alix Leite; Santos, Adriano Santiago Dias dos; Gir, Elucir; Bermúdez, Ximena Pamela Díaz

    Abstract in English:

    Abstract This article addresses sexual violence, as part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. Guidance is provided in programmatic and operational management, focusing on the service network for people in situation of sexual violence, recommendations to health staff about pregnancy and viral and non-viral sexually transmitted infections prophylactic measures, in addition to surveillance action strategies. Sexual violence is an encompassing issue that includes wider areas than the health field. It involves conceptual and programmatic challenges for health staff, at the forefront of care for affected people and also to the implementation of prevention strategies addressed to the whole society.
  • Brazilian Protocol for Sexually Transmitted infections, 2020: pelvic inflammatory disease Consensus

    Menezes, Maria Luiza Bezerra; Giraldo, Paulo Cesar; Linhares, Iara Moreno; Boldrini, Neide Aparecida Tosato; Aragon, Mayra Gonçalves

    Abstract in English:

    Abstract Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an upper female genital tract acute infection due to canalicular spread of endogenous cervicovaginal microorganisms and especially the sexually transmitted microorganisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The main sequelae are chronic pelvic pain, infertility, and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment must start immediately after the clinical suspicion. Guidelines for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling sexual partners and special populations are described. Given the increased availability of the molecular biology techniques in Brazil, C. trachomatis and N. gonorrhoeae screening are recommended as a disease prevention strategy.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: human T-cell lymphotropic virus (HTLV) infection Consensus

    Rosadas, Carolina; Brites, Carlos; Arakaki-Sanchez, Denise; Casseb, Jorge; Ishak, Ricardo

    Abstract in English:

    Abstract This article addresses the Human T-lymphotropic virus (HTLV). This subject comprises the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. HTLV-1/2 infection is a public health problem globally, and Brazil has the largest number of individuals living with the virus. HTLV-1 causes several clinical manifestations of neoplasm (adult T-cell leukemia/lymphoma) and inflammatory nature, such as HTLV-1-associated myelopathy and other manifestations such as uveitis, arthritis, and infective dermatitis. These pathologies have high morbidity and mortality and negatively impact the quality of life of infected individuals. This review includes relevant information for health authorities professionals regarding viral transmission, diagnosis, treatment, and monitoring of individuals living with HTLV-1 and 2 in Brazil.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: Zika virus infection Consensus

    Duarte, Geraldo; Miranda, Angélica Espinosa; Bermudez, Ximena Pamela Diaz; Saraceni, Valeria; Martinez-Espinosa, Flor Ernestina

    Abstract in English:

    Abstract This article addresses the vector, sexual and vertical transmissions of the Zika virus, a topic covered in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Although in Brazil Zika virus is transmitted more predominantly by Aedes aegypti, the vertical and sexual transmission routes are of significant importance for reproductive health. Sexual transmission demands specific prophylactic interventions, including the use of male or female condoms, especially among couples in a risk situation and planning pregnancy. Vertical transmission is linked to severe structural abnormalities of the central nervous system, and there is still no vaccine or known pharmacological resources that can prevent it. As the disease is predominantly asymptomatic, failure to comply with the basic principles of care and guidelines associated with the spread of the infection transcends the severity of the disease's symptoms.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis Consensus

    Freitas, Francisca Lidiane Sampaio; Benzaken, Adele Schwartz; Passos, Mauro Romero Leal de; Coelho, Ivo Castelo Branco; Miranda, Angélica Espinosa

    Abstract in English:

    Abstract The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care of People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020, includes updates concerning acquired syphilis. The document comprises rapid test use, safety and efficacy of benzathine benzylpenicillin, case follow-up, neurosyphilis clinical and laboratory management, approaching sex partners, assistance and monitoring of diagnosed pregnant women, and syphilis and HIV co-infection specificities, as well as a case notification summary. Health managers and professionals must be continuously trained so as to integrate care and surveillance, to strengthen actions for efficient control of syphilis, to broaden the search for sex partners, and to expand access of most vulnerable populations to health services.
  • Brazilian Protocol for Sexually Transmitted infections 2020: approaching sexually active individuals Consensus

    Araujo, Maria Alix Leite; Uesono, Juliana; Machado, Nádia Maria da Silva; Pinto, Valdir Monteiro; Amaral, Eliana

    Abstract in English:

    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.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: syphilis diagnostic tests Consensus

    Gaspar, Pâmela Cristina; Bigolin, Álisson; Alonso, José Boullosa; Pereira, Esdras Daniel dos Santos; Bazzo, Maria Luiza

    Abstract in English:

    Abstract The recommendations for diagnostic tests for investigating syphilis are part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections and the Technical Manual for Syphilis Diagnosis, published by the Brazilian Ministry of Health. These recommendations were developed based on scientific evidence and discussions with a panel of experts. This article presents direct tests to detect Treponema pallidum in lesions and algorithms that combine treponemal and non-treponemal antibody tests to assist in syphilis diagnosis, with the aim of contributing to the efforts of health service managers and health professionals in qualifying health care. The article also covers the use of non-treponemal tests to investigate neurosyphilis and guidelines for interpreting non-treponemal antibody titers in monitoring the treatment and diagnosis of congenital syphilis, as well as prospects for innovations in diagnosis. The critical role of rapid immunochromatographic treponemal tests for public health and for addressing syphilis is also highlighted.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause urethral discharge Consensus

    Lannoy, Leonor Henriette de; Silva, Roberto José de Carvalho da; Nahn, Edilbert Pellegrini; Oliveira, Eduardo Campos de; Gaspar, Pâmela Cristina

    Abstract in English:

    Abstract This article approaches infections that cause urethral discharge. This theme is part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020. These guidelines were prepared based on scientific evidence and validated in discussions with experts. Urethritis can cause severe and even irreversible health damage when not properly treated, or when the microorganism develops antimicrobial resistance. It is noteworthy that the high levels of antimicrobial resistance grown by pathogens that cause urethritis comprises a global emergency in public health. This article presents epidemiological and clinical aspects, recommendations on diagnostic and treatment, and strategies for surveillance, prevention, and control actions for infections that cause urethral discharge, to contribute to managers' and health professionals' care qualification.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause genital ulcers Consensus

    Ramos, Mauro Cunha; Sardinha, José Carlos; Alencar, Herculano Duarte Ramos de; Aragón, Mayra Gonçalves; Lannoy, Leonor Henriette de

    Abstract in English:

    Abstract Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (lymphogranuloma venereum), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections and guidelines for their diagnosis and treatment are presented, including strategies for surveillance, prevention, and control actions to support health managers and professionals in the qualification of care.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: human papillomavirus (HPV) infection Consensus

    Carvalho, Newton Sergio de; Silva, Roberto José de Carvalho da; Val, Isabel Cristina do; Bazzo, Maria Luiza; Silveira, Mariângela Freitas da

    Abstract in English:

    Abstract This article addresses human papillomavirus (HPV) infection, one of the topics covered by the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects and guidelines for health service managers and health workers about diagnosing and treating people with papillomavirus infection. This theme is a significant public health issue since it is the most prevalent sexually transmitted infection globally, capable of triggering the oncogenic process of cervical cancer and the possibility of anogenital warts. Important information is presented for gaining knowledge about HPV and action strategies for infection prevention and control, provision of quality care, and effective treatment of the disease.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: viral hepatitis Consensus

    Duarte, Geraldo; Pezzuto, Paula; Barros, Tiago Dahrug; Mosimann, Gláucio; Martinez-Espinosa, Flor Ernestina

    Abstract in English:

    Abstract This article discusses viral hepatitis, a theme addressed by the Clinical Protocol and Therapeutic Guidelines to Comprehensive Care for People with Sexually Transmitted Infections and, more precisely, by the Clinical Protocols and Therapeutic Guidelines for Hepatitis B and Hepatitis C and Coinfections, published by the Brazilian Ministry of Health. Besides the broad spectrum of health impairment, hepatitis A, B, and C viruses also present different transmission forms, whether parenteral, sexual, vertical, or fecal-oral. Among the strategies suggested for the control of viral hepatitis, in addition to behavioral measures, are expanded diagnosis, early vaccination against hepatitis A and hepatitis B viruses, and access to available therapeutic resources. Considering vertical transmission of the hepatitis B and hepatitis C viruses, screening for pregnant women with chronic hepatitis B and C is an essential perinatal health strategy, indicating with precision those who can benefit from the prophylactic interventions.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: human T-cell lymphotropic virus (HTLV) infection Consensus

    Rosadas, Carolina; Brites, Carlos; Arakaki-Sanchez, Denise; Casseb, Jorge; Ishak, Ricardo

    Abstract in English:

    Abstract This article addresses the Human T-lymphotropic virus (HTLV). This subject comprises the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. HTLV-1/2 infection is a public health problem globally, and Brazil has the largest number of individuals living with the virus. HTLV-1 causes several clinical manifestations of neoplasm (adult T-cell leukemia/lymphoma) and inflammatory nature, such as HTLV-1-associated myelopathy and other manifestations such as uveitis, arthritis, and infective dermatitis. These pathologies have high morbidity and mortality and negatively impact the quality of life of infected individuals. This review includes relevant information for health authorities professionals regarding viral transmission, diagnosis, treatment, and monitoring of individuals living with HTLV-1 and 2 in Brazil.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: Zika virus infection Consensus

    Duarte, Geraldo; Miranda, Angélica Espinosa; Bermudez, Ximena Pamela Diaz; Saraceni, Valeria; Martinez-Espinosa, Flor Ernestina

    Abstract in English:

    Abstract This article addresses the vector, sexual and vertical transmissions of the Zika virus, a topic covered in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Although in Brazil Zika virus is transmitted more predominantly by Aedes aegypti, the vertical and sexual transmission routes are of significant importance for reproductive health. Sexual transmission demands specific prophylactic interventions, including the use of male or female condoms, especially among couples in a risk situation and planning pregnancy. Vertical transmission is linked to severe structural abnormalities of the central nervous system, and there is still no vaccine or known pharmacological resources that can prevent it. As the disease is predominantly asymptomatic, failure to comply with the basic principles of care and guidelines associated with the spread of the infection transcends the severity of the disease's symptoms.
  • Public policies on sexually transmitted infections in Brazil Letter

    Miranda, Angélica Espinosa; Freitas, Francisca Lidiane Sampaio; Passos, Mauro Romero Leal de; Lopez, Miguel Angel Aragón; Pereira, Gerson Fernando Mendes
  • Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis Consensus

    Freitas, Francisca Lidiane Sampaio; Benzaken, Adele Schwartz; Passos, Mauro Romero Leal de; Coelho, Ivo Castelo Branco; Miranda, Angélica Espinosa

    Abstract in English:

    Abstract The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care of People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020, includes updates concerning acquired syphilis. The document comprises rapid test use, safety and efficacy of benzathine benzylpenicillin, case follow-up, neurosyphilis clinical and laboratory management, approaching sex partners, assistance and monitoring of diagnosed pregnant women, and syphilis and HIV co-infection specificities, as well as a case notification summary. Health managers and professionals must be continuously trained so as to integrate care and surveillance, to strengthen actions for efficient control of syphilis, to broaden the search for sex partners, and to expand access of most vulnerable populations to health services.
  • Brazilian Protocol for Sexually Transmitted infections 2020: approaching sexually active individuals Consensus

    Araujo, Maria Alix Leite; Uesono, Juliana; Machado, Nádia Maria da Silva; Pinto, Valdir Monteiro; Amaral, Eliana

    Abstract in English:

    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.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: syphilis diagnostic tests Consensus

    Gaspar, Pâmela Cristina; Bigolin, Álisson; Alonso, José Boullosa; Pereira, Esdras Daniel dos Santos; Bazzo, Maria Luiza

    Abstract in English:

    Abstract The recommendations for diagnostic tests for investigating syphilis are part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections and the Technical Manual for Syphilis Diagnosis, published by the Brazilian Ministry of Health. These recommendations were developed based on scientific evidence and discussions with a panel of experts. This article presents direct tests to detect Treponema pallidum in lesions and algorithms that combine treponemal and non-treponemal antibody tests to assist in syphilis diagnosis, with the aim of contributing to the efforts of health service managers and health professionals in qualifying health care. The article also covers the use of non-treponemal tests to investigate neurosyphilis and guidelines for interpreting non-treponemal antibody titers in monitoring the treatment and diagnosis of congenital syphilis, as well as prospects for innovations in diagnosis. The critical role of rapid immunochromatographic treponemal tests for public health and for addressing syphilis is also highlighted.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause urethral discharge Consensus

    Lannoy, Leonor Henriette de; Silva, Roberto José de Carvalho da; Nahn, Edilbert Pellegrini; Oliveira, Eduardo Campos de; Gaspar, Pâmela Cristina

    Abstract in English:

    Abstract This article approaches infections that cause urethral discharge. This theme is part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020. These guidelines were prepared based on scientific evidence and validated in discussions with experts. Urethritis can cause severe and even irreversible health damage when not properly treated, or when the microorganism develops antimicrobial resistance. It is noteworthy that the high levels of antimicrobial resistance grown by pathogens that cause urethritis comprises a global emergency in public health. This article presents epidemiological and clinical aspects, recommendations on diagnostic and treatment, and strategies for surveillance, prevention, and control actions for infections that cause urethral discharge, to contribute to managers' and health professionals' care qualification.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause genital ulcers Consensus

    Ramos, Mauro Cunha; Sardinha, José Carlos; Alencar, Herculano Duarte Ramos de; Aragón, Mayra Gonçalves; Lannoy, Leonor Henriette de

    Abstract in English:

    Abstract Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (lymphogranuloma venereum), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections and guidelines for their diagnosis and treatment are presented, including strategies for surveillance, prevention, and control actions to support health managers and professionals in the qualification of care.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: viral hepatitis Consensus

    Duarte, Geraldo; Pezzuto, Paula; Barros, Tiago Dahrug; Mosimann, Gláucio; Martinez-Espinosa, Flor Ernestina

    Abstract in English:

    Abstract This article discusses viral hepatitis, a theme addressed by the Clinical Protocol and Therapeutic Guidelines to Comprehensive Care for People with Sexually Transmitted Infections and, more precisely, by the Clinical Protocols and Therapeutic Guidelines for Hepatitis B and Hepatitis C and Coinfections, published by the Brazilian Ministry of Health. Besides the broad spectrum of health impairment, hepatitis A, B, and C viruses also present different transmission forms, whether parenteral, sexual, vertical, or fecal-oral. Among the strategies suggested for the control of viral hepatitis, in addition to behavioral measures, are expanded diagnosis, early vaccination against hepatitis A and hepatitis B viruses, and access to available therapeutic resources. Considering vertical transmission of the hepatitis B and hepatitis C viruses, screening for pregnant women with chronic hepatitis B and C is an essential perinatal health strategy, indicating with precision those who can benefit from the prophylactic interventions.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause cervicitis Consensus

    Miranda, Angélica Espinosa; Silveira, Mariângela Freitas da; Pinto, Valdir Monteiro; Alves, Geralda Carolina; Carvalho, Newton Sergio de

    Abstract in English:

    Abstract Infections that cause cervicitis are a topic presented in the "Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections", published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with experts. This article presents epidemiological and clinical aspects of infections that cause cervicitis and recommendations on screening, diagnosis, and treatment of affected people and their sexual partnerships. Also, it discusses strategies for surveillance, prevention, and control of these infections for health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections. Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cervicitis.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: HIV infection in adolescents and adults Consensus

    Pinto, Lauro Ferreira da Silva; Perini, Filipe de Barros; Aragón, Mayra Gonçalves; Freitas, Marcelo Araújo; Miranda, Angélica Espinosa

    Abstract in English:

    Abstract HIV infection is presented in the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Health professionals and managers must learn the signs and symptoms of HIV infection and know how to diagnose it to provide appropriate treatment and reduce complications. HIV infection has become a chronic disease. Its treatment includes addressing common comorbidities such as arterial hypertension, diabetes, and dyslipidemia, in addition to cardiac risk assessment, cancer prevention, and guidance on immunization. Initiation of treatment for HIV patients is recommended regardless of clinical or immunological criteria as adopted by the Ministry of Health since 2013. Lately, it has been simplified with more tolerable first-line medications and fewer drug interactions, making its management easy to implement, including by primary health care.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: infections causing vaginal discharge Consensus

    Carvalho, Newton Sergio de; Eleutério, José; Travassos, Ana Gabriela; Santana, Lutigardes Bastos; Miranda, Angélica Espinosa

    Abstract in English:

    Abstract The topic of vaginal discharge is one of the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Health Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The chapter has been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects associated with vaginal discharge conditions, as well as guidance to health service managers and health professionals. Screening, diagnosing, and treating these conditions, the main complaints among women seeking health services, caused by infectious or non-infectious factors, also are presented. Besides, information is presented on surveillance, prevention, and control actions to promote knowledge of the problem and provide quality care and effective treatment.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: congenital syphilis and child exposed to syphilis Consensus

    Domingues, Carmen Silvia Bruniera; Duarte, Geraldo; Passos, Mauro Romero Leal; Sztajnbok, Denise Cardoso das Neves; Menezes, Maria Luiza Bezerra

    Abstract in English:

    Abstract The topics of congenital syphilis and children exposed to syphilis compose the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Such document was elaborated based on scientific evidence and validated in discussions with specialists. This article provides guidelines for syphilis in pregnant women and congenital syphilis clinical management, emphasizing the vertical transmission of Treponema pallidum prevention. Epidemiological and clinical aspects of these infections are presented and recommendations for managers in the programmatic and operational management of syphilis. The article also includes guidelines for health professionals in screening, diagnosing, and treating people with sexually transmitted infections and their sex partners, in addition to strategies for surveillance actions, prevention, and control of the disease.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: human papillomavirus (HPV) infection Consensus

    Carvalho, Newton Sergio de; Silva, Roberto José de Carvalho da; Val, Isabel Cristina do; Bazzo, Maria Luiza; Silveira, Mariângela Freitas da

    Abstract in English:

    Abstract This article addresses human papillomavirus (HPV) infection, one of the topics covered by the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects and guidelines for health service managers and health workers about diagnosing and treating people with papillomavirus infection. This theme is a significant public health issue since it is the most prevalent sexually transmitted infection globally, capable of triggering the oncogenic process of cervical cancer and the possibility of anogenital warts. Important information is presented for gaining knowledge about HPV and action strategies for infection prevention and control, provision of quality care, and effective treatment of the disease.
  • Brazilian Protocol for Sexually Transmitted Infections, 2020: sexually transmitted enteric infections Consensus

    Nahn, Edilbert Pelegrini; Oliveira, Eduardo Campos de; Barbosa, Marcelo Joaquim; Mareco, Thereza Cristina de Souza; Brígido, Helena Andrade

    Abstract in English:

    Abstract The sexually transmitted enteric infections topic is one of the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects of these infections and guidance for service managers on their programmatic and operational management. The aim is to assist health professionals with screening, diagnosis, and treatment of people with sexually transmitted enteric infections and their sexual partners, in addition to supporting strategies for their surveillance, prevention, and control.
  • Brazilian Protocol for Sexually Transmitted Infections 2020: sexual violence Consensus

    Menezes, Maria Luiza Bezerra; Araújo, Maria Alix Leite; Santos, Adriano Santiago Dias dos; Gir, Elucir; Bermúdez, Ximena Pamela Díaz

    Abstract in English:

    Abstract This article addresses sexual violence, as part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. Guidance is provided in programmatic and operational management, focusing on the service network for people in situation of sexual violence, recommendations to health staff about pregnancy and viral and non-viral sexually transmitted infections prophylactic measures, in addition to surveillance action strategies. Sexual violence is an encompassing issue that includes wider areas than the health field. It involves conceptual and programmatic challenges for health staff, at the forefront of care for affected people and also to the implementation of prevention strategies addressed to the whole society.
  • Brazilian Protocol for Sexually Transmitted infections, 2020: pelvic inflammatory disease Consensus

    Menezes, Maria Luiza Bezerra; Giraldo, Paulo Cesar; Linhares, Iara Moreno; Boldrini, Neide Aparecida Tosato; Aragon, Mayra Gonçalves

    Abstract in English:

    Abstract Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an upper female genital tract acute infection due to canalicular spread of endogenous cervicovaginal microorganisms and especially the sexually transmitted microorganisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The main sequelae are chronic pelvic pain, infertility, and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment must start immediately after the clinical suspicion. Guidelines for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling sexual partners and special populations are described. Given the increased availability of the molecular biology techniques in Brazil, C. trachomatis and N. gonorrhoeae screening are recommended as a disease prevention strategy.
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