RESUMO
Rollet's Mixed Chancre is a clinical presentation of sexually transmitted infections (STI), involving the coexistence of Haemophilus ducreyi and Treponema pallidum at the same site of infection. Here, we report a case of Rollet's Mixed Chancre in a 32-year-old Brazilian woman. On physical examination she presented with a unilateral bubo measuring approximately 5 × 3 centimeters in diameter, in association with an ulcerated lesion that evolved for 10 days at the inguinal region. She was successfully treated at a health unit with antibiotics. Rollet's Mixed Chancre, though uncommon, poses diagnostic challenges. This case highlights the importance of considering rare STI manifestations. Moreover, comprehensive STI screening and adherence to treatment guidelines are essential for effective management and prevention of further transmission.
RESUMO
Abstract Genital ulcers (GUs) represent a diagnostic challenge and can be secondary to neoplastic and inflammatory processes of different causes. Among those of infectious etiology, there are sexually transmitted infections (STIs), a very frequent reason for seeking the health service. The most common agents are herpes simplex virus and Treponema pallidum and, more rarely, Haemophilus ducreyi, Klebsiella granulomatis and Chlamydia trachomatis. A careful dermatological examination offers important diagnostic elements; however, atypical manifestations are very common. Distinctive characteristics of ulcers to look out for include their margin, edge, bottom, and base. Regional lymph node chain alterations should be evaluated regarding their number, size, mobility, consistency, inflammation, and pain on palpation. Diagnostic tests have variable sensitivity and specificity, and molecular tests are currently considered the reference exams. The rapid immunochromatographic tests represented a significant advance, as they can be performed with blood obtained from the digital pulp, offer results in up to 30 minutes, and do not require a laboratory structure. The treatment of persons affected by GU/STIs must be immediate, as it aims to prevent complications, as well as reduce transmission. It is not always considered that people with GUs/STIs have varying degrees of depression, anxiety, and self-reproach, with an impact on relationships. Establishing a bond and trusting the professional is essential for adherence to treatment and preventive measures that must be discussed individually.
RESUMO
Genital ulcers (GUs) represent a diagnostic challenge and can be secondary to neoplastic and inflammatory processes of different causes. Among those of infectious etiology, there are sexually transmitted infections (STIs), a very frequent reason for seeking the health service. The most common agents are herpes simplex virus and Treponema pallidum and, more rarely, Haemophilus ducreyi, Klebsiella granulomatis and Chlamydia trachomatis. A careful dermatological examination offers important diagnostic elements; however, atypical manifestations are very common. Distinctive characteristics of ulcers to look out for include their margin, edge, bottom, and base. Regional lymph node chain alterations should be evaluated regarding their number, size, mobility, consistency, inflammation, and pain on palpation. Diagnostic tests have variable sensitivity and specificity, and molecular tests are currently considered the reference exams. The rapid immunochromatographic tests represented a significant advance, as they can be performed with blood obtained from the digital pulp, offer results in up to 30 minutes, and do not require a laboratory structure. The treatment of persons affected by GU/STIs must be immediate, as it aims to prevent complications, as well as reduce transmission. It is not always considered that people with GUs/STIs have varying degrees of depression, anxiety, and self-reproach, with an impact on relationships. Establishing a bond and trusting the professional is essential for adherence to treatment and preventive measures that must be discussed individually.
Assuntos
Cancroide , Doenças dos Genitais Masculinos , Infecções Sexualmente Transmissíveis , Sífilis , Genitália , Humanos , Masculino , ÚlceraRESUMO
As infecções que causam úlcera genital são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo aborda a síndrome clínica de úlcera genital causada por infecções sexualmente transmissíveis e seus agentes etiológicos mais comuns: Treponema pallidum (sífilis), vírus herpes simples 2 (herpes genital) e vírus herpes simples 1 (herpes perioral), Haemophilus ducreyi (cancroide), Chlamydia trachomatis sorotipos L1, L2 e L3 (linfogranuloma venéreo) e Klebsiella granulomatis (donovanose). São apresentados aspectos epidemiológicos e clínicos dessas infecções, bem como orientações para seu diagnóstico e tratamento, além de estratégias para as ações de vigilância, prevenção e controle, com a finalidade de subsidiar gestores e profissionais de saúde na qualificação da assistência.
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 (venereal lymphogranuloma), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections are presented, as well as guidelines for their diagnosis and treatment, in addition to strategies for surveillance, prevention and control actions, with the purpose of supporting health managers and professionals in the qualification of care.
El tema de las infecciones que causan úlcera genital hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento fue elaborado con base en evidencias científicas y validado en discusiones con especialistas. Este artículo trata del síndrome de úlcera genital clínica provocada por infecciones de transmisión sexual, con sus agentes etiológicos más comunes: Treponema pallidum (sífilis), virus del herpes simple-1 (herpes genital) y virus del herpes simple-2 (herpes perioral), Haemophilus ducreyi (chancro blando), Chlamydia trachomatis, serotipos L1, L2 y L3 (linfogranuloma venéreo), y Klebsiella granulomatis (donovanosis). Se presentan aspectos epidemiológicos y clínicos de esas infecciones, bien como pautas para su diagnóstico y tratamiento, además de estrategias para acciones de monitoreo epidemiológico, prevención y control, a fin de contribuir con gestores y personal de salud en la cualificación de la asistencia.
Assuntos
Humanos , Masculino , Feminino , Úlcera/terapia , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Cancroide/terapia , Infecções Sexualmente Transmissíveis/terapia , Genitália/patologia , Brasil/epidemiologia , Herpes Genital/terapia , Linfogranuloma Venéreo/terapia , Sífilis/terapia , Protocolos Clínicos , Granuloma Inguinal/terapiaRESUMO
Resumo As infecções que causam úlcera genital são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo aborda a síndrome clínica de úlcera genital causada por infecções sexualmente transmissíveis e seus agentes etiológicos mais comuns: Treponema pallidum (sífilis), vírus herpes simples 2 (herpes genital) e vírus herpes simples 1 (herpes perioral), Haemophilus ducreyi (cancroide), Chlamydia trachomatis sorotipos L1, L2 e L3 (linfogranuloma venéreo) e Klebsiella granulomatis (donovanose). São apresentados aspectos epidemiológicos e clínicos dessas infecções, bem como orientações para seu diagnóstico e tratamento, além de estratégias para as ações de vigilância, prevenção e controle, com a finalidade de subsidiar gestores e profissionais de saúde na qualificação da assistência.
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 (venereal lymphogranuloma), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections are presented, as well as guidelines for their diagnosis and treatment, in addition to strategies for surveillance, prevention and control actions, with the purpose of supporting health managers and professionals in the qualification of care.
Resumen El tema de las infecciones que causan úlcera genital hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento fue elaborado con base en evidencias científicas y validado en discusiones con especialistas. Este artículo trata del síndrome de úlcera genital clínica provocada por infecciones de transmisión sexual, con sus agentes etiológicos más comunes: Treponema pallidum (sífilis), virus del herpes simple-1 (herpes genital) y virus del herpes simple-2 (herpes perioral), Haemophilus ducreyi (chancro blando), Chlamydia trachomatis, serotipos L1, L2 y L3 (linfogranuloma venéreo), y Klebsiella granulomatis (donovanosis). Se presentan aspectos epidemiológicos y clínicos de esas infecciones, bien como pautas para su diagnóstico y tratamiento, además de estrategias para acciones de monitoreo epidemiológico, prevención y control, a fin de contribuir con gestores y personal de salud en la cualificación de la asistencia.
Assuntos
Humanos , Cancroide , Infecções Sexualmente Transmissíveis , Úlcera , Brasil/epidemiologia , Infecções Sexualmente Transmissíveis/terapia , Infecções Sexualmente Transmissíveis/epidemiologia , GenitáliaRESUMO
Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum and has shown a significant increase in recent decades. It may be associated with other STIs such as soft chancre or chancroid, which is an uncommon infection in Brazil. The presence of ulcerated genital lesions is associated with a higher risk of HIV transmission. An accurate clinical and laboratory diagnosis of genital ulcer disease is essential for the appropriate treatment of pregnant women, in order to avoid congenital syphilis, a severe complication of mother-to-child vertical transmission. We report the case of a woman in the third trimester of pregnancy with Rollet's mixed chancre and describe the clinical and laboratory diagnosis, as well as the treatment of these diseases in pregnancy. We emphasize the importance of training health professionals on early diagnosis and treatment in order to avoid mother-to-child transmission.
Assuntos
Cancro/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Adulto , Antibacterianos/uso terapêutico , Brasil , Cancro/tratamento farmacológico , Cancro/patologia , Feminino , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Penicilina G Benzatina/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Sífilis/diagnósticoRESUMO
Chancroid is a sexually transmitted infection (STI) caused by the Gram-negative bacterium Haemophilus ducreyi The control of chancroid is difficult and the only current available treatment is antibiotic therapy; however, antibiotic resistance has been reported in endemic areas. Owing to recent outbreaks of STIs worldwide, it is important to keep searching for new treatment strategies and preventive measures. Here, we applied reverse vaccinology and subtractive genomic approaches for the in silico prediction of potential vaccine and drug targets against 28 strains of H. ducreyi We identified 847 non-host homologous proteins, being 332 exposed/secreted/membrane and 515 cytoplasmic proteins. We also checked their essentiality, functionality and virulence. Altogether, we predicted 13 candidate vaccine targets and three drug targets, where two vaccines (A01_1275, ABC transporter substrate-binding protein; and A01_0690, Probable transmembrane protein) and three drug targets (A01_0698, Purine nucleoside phosphorylase; A01_0702, Transcription termination factor; and A01_0677, Fructose-bisphosphate aldolase class II) are harboured by pathogenicity islands. Finally, we applied a molecular docking approach to analyse each drug target and selected ZINC77257029, ZINC43552589 and ZINC67912117 as promising molecules with favourable interactions with the target active site residues. Altogether, the targets identified here may be used in future strategies to control chancroid worldwide.
Assuntos
Proteínas de Bactérias , Cancroide , Genoma Bacteriano , Ilhas Genômicas , Vacinas Anti-Haemophilus , Haemophilus ducreyi , Fatores de Virulência , Proteínas de Bactérias/genética , Proteínas de Bactérias/imunologia , Proteínas de Bactérias/metabolismo , Cancroide/genética , Cancroide/imunologia , Cancroide/prevenção & controle , Vacinas Anti-Haemophilus/genética , Vacinas Anti-Haemophilus/imunologia , Vacinas Anti-Haemophilus/metabolismo , Haemophilus ducreyi/genética , Haemophilus ducreyi/imunologia , Haemophilus ducreyi/metabolismo , Haemophilus ducreyi/patogenicidade , Humanos , Vacinologia , Fatores de Virulência/genética , Fatores de Virulência/imunologia , Fatores de Virulência/metabolismoRESUMO
A study was conducted in São Paulo, Brazil, to compare azithromycin with thiamphenicol for the single-dose treatment of chancroid. In all, 54 men with chancroid were tested. The etiology was determined by clinical characterization and direct bacterioscopy with Gram staining. None of the patients had positive serology or dark-field examination indicating active infection with Treponema pallidum. Genital infections due to Neisseria gonorrhoeae and herpes simplex virus were excluded by polymerase chain reaction testing. For 54 patients with chancroid, cure rates with single-dose treatment were 73 percent with azithromycin and 89 percent with thiamphenicol. HIV seropositivity was found to be associated with treatment failure (p=0.001). The treatment failed in all HIV positive patients treated with azithromycin (p=0.002) and this drug should be avoided in these co-infected patients. In the view of the authors, thiamphenicol is the most indicated single-dose regimen for chancroid treatment.
Assuntos
Humanos , Masculino , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Cancroide/tratamento farmacológico , Tianfenicol/administração & dosagem , Estudos de Coortes , Estudos Prospectivos , Falha de TratamentoRESUMO
As doenças sexualmente transmissíveis estão entre os problemas de saúde pública mais comuns em todo o mundo. Entre suas consequências estão a infertilidade feminina e masculina, a transmissão de mãe para filho, determinando perdas gestacionais ou doença congênita, e o aumento do risco para a infecção pelo HIV. Dessa forma, este guideline tem o objetivo de contribuir para melhorar a qualidade de atenção às pessoas com infecções sexualmente transmissíveis mais frequentes no Brasil, trazendo de forma didática e concreta o estado atual dos conhecimentos para os dermatologistas e médicos em geral que atuam no atendimento dessas pessoas e as principais recomendações para o diagnóstico e tratamento das doenças sexualmente transmissíveis mais recorrentes.
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 today's science stands on the matter and also what the recommendation for diagnosing and treating a patient are.