RESUMO
RESUMEN Fundamento: las infecciones de transmisión sexual afectan en especial a la población adolescente dada su vulnerabilidad biológica y psicológica, tienen consecuencias severas en la salud sexual y reproductiva. Objetivo: determinar la incidencia de infecciones de transmisión sexual en la Consulta Infanto-Juvenil. Métodos: se realizó un estudio observacional, descriptivo y transversal, cuyo universo fueron las 50 pacientes con infecciones de transmisión sexual que asistieron a Consulta Infanto-Juvenil del Policlínico de Especialidades Pediátricas de la provincia Camagüey, durante el período de estudio. Las variables estudiadas fueron: edad, estado civil, tipo de infección de transmisión sexual, asociación con otras, orientación sexual y factores predisponentes, los que comprendían: conducta sexual de riesgo, cervicitis y antecedentes de otras infecciones de transmisión sexual. La información obtenida fue procesada mediante el programa estadístico SPSS para Microsoft Excel 2017. Los métodos empleados fueron estadística descriptiva de distribución de frecuencias absolutas y relativas. Los resultados se expusieron en tablas. Resultados: predominaron las pacientes de 13 a 15 años de edad, solteras y heterosexuales. La candidiasis vaginal fue la afección más diagnosticada. Casi la mitad no presentaban otras infecciones de transmisión sexual y el condiloma acuminado fue la más asociada. Los factores predisponentes que prevalecieron fueron: antecedentes de infección de transmisión sexual y conducta sexual de riesgo, en esta última predominaron las relaciones sexuales tempranas y cambio frecuente de pareja. Conclusiones: los resultados del estudio evidencian la necesidad de realizar acciones educativas para que los adolescentes puedan vivir una sexualidad sana.
ABSTRACT Background: sexually transmitted infections are one of the most risks among young population due to their biological and psychological vulnerability. They have deep consequences in sexual and reproductive health. Objective: to determine the incidence of sexually transmitted infections in child and adolescent consultation. Methods: an observational, descriptive, transversal study was conducted whose universe were all patients with diagnosis of sexually transmitted infections who attended child and adolescent consultation of pediatric specialty clinic, Camagüey, from September 1st, 2017 to August 31st, 2018, they were 50. The variables studied were: age groups, marital status, type of sexually transmitted infection, association with other sexually transmitted infections, predisposed factors for acquisition (sexual risk behavior, cervicitis and antecedents of former sexually transmitted infections), and sexual preferences. The information obtained was processed using the statistical package SPSS for Microsoft Excel 2017. The methods used were descriptive statistics distribution of absolute and relative frequencies. The results were presented in tables. Results: the most affected age group was between 13 to 15 years, singles and heterosexual. Vaginal candidiasis was predominated, followed by genital warts. About half of the patients have not transmitted infections consociated. Genital warts were the most consociated. The risk factors that prevailed were antecedents of former sexually transmitted infections and sexually risky sexual behavior. In the last one predominated early sexual life and frequent change of partner. Conclusions: these results show the necessity of sexual education for the adolescents to have a healthy sexuality.
RESUMO
OBJECTIVES: This is a randomized controlled clinical trial comparing Photodynamic Therapy (PDT) and the application of trichloracetic acid (TAA) in the treatment of HPV condyloma in the perianal and vulva regions. Design, Randomised controlled, open label, trial. They were allocated to each treatment following randomization by a computer program. SETTING: Women Health Ambulatory in São Carlos city, São Paulo State in the Brazil. PARTICIPANTS: 36 patients evaluated. 31 patients fulfilled the study requirements. INTERVENTION: Photodynamic Therapy (PDT) versus trichloracetic acid (TAA). The PDT protocol used the prodrug methyl aminolevulinate incubated for 3 hours and irradiation at 630 nm (100 J/cm²). In the treatment using TAA, warts received a small amount of acid using a cotton swab. Both treatments were repeated weekly until the lesions disappeared completely or until 10 sessions were completed. MAIN OUTCOME MEASURE: Clinical analysis. Follow-up between 12 and 30 months after the complete treatment. RESULTS: A total of 16 patients were treated with PDT and 15 patients with TAA. A complete response rate of 60% for TAA and 63% for PDT, with a recurrence rate of 33% for TAA and 0% for PDT. CONCLUSION: PDT appears not only to treat lesions due to physical destruction of condyloma and subclinical lesions, but also to modulate the immune system and/or also to decrease the local viral load, suggesting a lower recurrence compared to the TAA group.
Assuntos
Condiloma Acuminado , Infecções por Papillomavirus , Fotoquimioterapia , Ácido Aminolevulínico/uso terapêutico , Brasil , Condiloma Acuminado/tratamento farmacológico , Feminino , Humanos , Infecções por Papillomavirus/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Ácido Tricloroacético/uso terapêuticoRESUMO
O artigo aborda a infecção pelo papilomavírus humano (human papillomavirus, HPV), tema constitutivo do Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde. Tal documento foi elaborado com base em evidências científicas e validado em discussões e consenso entre especialistas. São apresentados aspectos epidemiológicos e clínicos, bem como orientações para os gestores e profissionais de saúde no diagnóstico, tratamento e prevenção da infecção pelo HPV. Este tema representa importante problema de saúde pública, haja vista essa infecção sexualmente transmissível ser a mais prevalente no mundo, capaz de desencadear o processo oncogênico do câncer do colo uterino, além de possibilitar a ocorrência de verrugas anogenitais. Neste artigo, são apresentadas informações importantes para o conhecimento do HPV, estratégias de ação para a prevenção e controle da infecção, uma assistência de qualidade e tratamento efetivo da doença.
This article addresses human papillomavirus (HPV) infection, this being 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, as well as guidelines for health service managers and health workers about diagnosing and treating people with papillomavirus infection. This theme is an important public health problem, since it is the most prevalent sexually transmitted infection in the world, capable of triggering the oncogenic process of cervical cancer, as well as the possibility anogenital warts occurring. Important information is presented for gaining knowledge about HPV, as well as action strategies for infection prevention and control, provision of quality care and effective treatment of the disease.
El tema del papilomavirus humano (PVH) es uno de los capítulos del Protocolo Clínico y Conductas Terapéuticas para la Atención Integral a Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil. Este documento fue desarrollado en base a evidencia científica y validado en discusiones con especialistas. Se presentan aspectos epidemiológicos y clínicos, así como guías para gestores y profesionales de la salud en el diagnóstico, tratamiento y prevención de la infección por papilomavirus. Este tema constituye uno de los principales problemas de salud pública, pues además de ser la infección transmitida sexualmente más prevalente en todo el mundo, puede tener implicaciones para el proceso oncogénico del cáncer de cuello uterino y la posibilidad de presentar verrugas anogenitales. Se presenta información sobre estrategias de acciones de prevención y control, las cuales son importantes para entender el problema, ofrecer asistencia de calidad y tratamiento efectivo.
Assuntos
Humanos , Feminino , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/epidemiologia , Brasil/epidemiologia , Condiloma Acuminado , Neoplasias do Colo do Útero/prevenção & controle , Protocolos Clínicos , Alphapapillomavirus/patogenicidadeRESUMO
Resumo O artigo aborda a infecção pelo papilomavírus humano (human papillomavirus, HPV), tema constitutivo do Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde. Tal documento foi elaborado com base em evidências científicas e validado em discussões e consenso entre especialistas. São apresentados aspectos epidemiológicos e clínicos, bem como orientações para os gestores e profissionais de saúde no diagnóstico, tratamento e prevenção da infecção pelo HPV. Este tema representa importante problema de saúde pública, haja vista essa infecção sexualmente transmissível ser a mais prevalente no mundo, capaz de desencadear o processo oncogênico do câncer do colo uterino, além de possibilitar a ocorrência de verrugas anogenitais. Neste artigo, são apresentadas informações importantes para o conhecimento do HPV, estratégias de ação para a prevenção e controle da infecção, uma assistência de qualidade e tratamento efetivo da doença.
Abstract This article addresses human papillomavirus (HPV) infection, this being 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, as well as guidelines for health service managers and health workers about diagnosing and treating people with papillomavirus infection. This theme is an important public health problem, since it is the most prevalent sexually transmitted infection in the world, capable of triggering the oncogenic process of cervical cancer, as well as the possibility anogenital warts occurring. Important information is presented for gaining knowledge about HPV, as well as action strategies for infection prevention and control, provision of quality care and effective treatment of the disease.
Resumen El tema del papilomavirus humano (PVH) es uno de los capítulos del Protocolo Clínico y Conductas Terapéuticas para la Atención Integral a Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil. Este documento fue desarrollado en base a evidencia científica y validado en discusiones con especialistas. Se presentan aspectos epidemiológicos y clínicos, así como guías para gestores y profesionales de la salud en el diagnóstico, tratamiento y prevención de la infección por papilomavirus. Este tema constituye uno de los principales problemas de salud pública, pues además de ser la infección transmitida sexualmente más prevalente en todo el mundo, puede tener implicaciones para el proceso oncogénico del cáncer de cuello uterino y la posibilidad de presentar verrugas anogenitales. Se presenta información sobre estrategias de acciones de prevención y control, las cuales son importantes para entender el problema, ofrecer asistencia de calidad y tratamiento efectivo.
Assuntos
Feminino , Humanos , Infecções Sexualmente Transmissíveis , Neoplasias do Colo do Útero , Infecções por Papillomavirus , Alphapapillomavirus , Brasil/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/epidemiologiaRESUMO
RESUMEN Fundamento: el tumor de Buschke-Löwenstein es un condiloma acuminado gigante mayor de 10 cm más frecuente en hombres, por lo que el tratamiento de elección debe ser siempre quirúrgico. Objetivo: describir un caso de condiloma acuminado gigante. Presentación del caso: paciente masculino blanco de 54 años de edad, que acudió a consulta con formaciones papilomatosis con aspecto de coliflor de consistencia blanda y húmedas, en ambas regiones inguinales; del lado derecho de 13 cm de diámetro y de 19 cm la izquierda y en la raíz del pene y región perianal de 2 cm, asociadas a dolor de ligera intensidad en miembros inferiores y fetidez ocasional. Se le realizaron estudios preoperatorios incluidos serología y VIH no reactivos. Se operó, realizándole exéresis y cierre con colgajo cutáneo abdominal. Evolucionó estable clínicamente, aunque presentó una infección de la herida quirúrgica donde se reportó Escherichia coli, sensible a gentamicina; cumplió con el tratamiento y egresó sin complicaciones posteriores. Conclusiones: el tumor de Buschke-Löwenstein se considera en la actualidad como una forma de carcinoma verrucoso, no presenta atipias celulares, descrito como benigno, pero un tercio de los casos puede malignizar. No obstante, por las frecuentes recidivas, es considerado por algunos autores como un tumor maligno. A pesar de existir varios tratamientos, es el quirúrgico el de mejores resultados.
ABSTRACT Background: the Buschke-Löwenstein tumor is a giant acuminate condyloma larger than 10 cm, more frequent in men, so the treatment of choice must always be surgical. Objective: to describe a case of giant acuminate condylomata. Case report: 54-year-old white male patient, who came with papillomatosis formations with soft and moist consistency of cauliflower, in both inguinal regions; on the right side of 13 centimeters in diameter and 19 centimeters on the left and at the root of the penis and perianal region of 2 centimeters, associated with pain of slight intensity in the lower limbs and occasional fetidity. Preoperative studies including non-reactive serology and HIV were performed. He underwent surgery, performing excision and closure with abdominal skin flap. He evolved clinically stable, although he presented an infection of the surgical wound where Escherichia Coli, gentamicin sensitive, was reported; he complied with treatment and left without further complications. Conclusions: Buschke-Löwenstein tumor is currently considered as a form of verrucous carcinoma, it does not present cellular atypia, described as benign, but one third of the cases can be maligne. Despite frequent recurrences, some authors consider it as a malignant tumor. Despite the existence of several treatments, the surgical treatment is the one with the best results.
RESUMO
BACKGROUND: Anogenital warts are the leading sexually transmitted infection in patients seeking care at specialized clinics. They may display a vast array of forms, according to the interaction of the virus with the host's immunity. Cellular immunity is the epithelium's main form of defense against the virus, involving an active participation of the Langerhans cells and pro-inflammatory cytokines such as TNF-α. OBJECTIVE: To assess the epithelial immune response of anogenital warts in males, according to the number of lesions presented. METHODS: This is a prospective, cross-sectional study carried out at the dermatology outpatient clinic in a tertiary hospital. We included male patients over 18 years of age without comorbidities who had anogenital condylomata and no previous treatments.In order to evaluate the local epithelial immunity, the lesions were quantified, then removed and employed in CD1a immunohistochemistry assays for assessing the morphometry and morphology of Langerhans cells; TNF-α; reaction was used for determining cytokine positivity in the epithelium. RESULTS: 48 patients were included in the study. There was no statistically significant difference as to the number of Langerhans cells, in their morphology, or the presence of TNF-α. However, patients presenting with more Langerhans cells in the lesions had cells with a star-like and dendritic morphology, whereas in those with a lower cell count had cells with a rounded morphology and no dendrites (p<0.001). STUDY LIMITATIONS: Small number of patients analyzed. CONCLUSION: There was no difference in epithelial immunity between patients having few or many anogenital condyloma lesions as measured by the morphology and morphometry of Langerhans cells and TNF-α; positivity. Such an assessment employing immunity markers differing from the usual ones is expected to yield useful results.
Assuntos
Doenças do Ânus/imunologia , Condiloma Acuminado/imunologia , Doenças dos Genitais Masculinos/imunologia , Células de Langerhans/patologia , Fator de Necrose Tumoral alfa/análise , Doenças do Ânus/patologia , Condiloma Acuminado/patologia , Estudos Transversais , Células Dendríticas/imunologia , Células Dendríticas/patologia , Doenças dos Genitais Masculinos/patologia , Humanos , Imuno-Histoquímica , Células de Langerhans/imunologia , Masculino , Estudos Prospectivos , Valores de Referência , Fator de Necrose Tumoral alfa/imunologiaRESUMO
Abstract Background: Anogenital warts are the leading sexually transmitted infection in patients seeking care at specialized clinics. They may display a vast array of forms, according to the interaction of the virus with the host's immunity. Cellular immunity is the epithelium's main form of defense against the virus, involving an active participation of the Langerhans cells and pro-inflammatory cytokines such as TNF-α. Objective: To assess the epithelial immune response of anogenital warts in males, according to the number of lesions presented. Methods: This is a prospective, cross-sectional study carried out at the dermatology outpatient clinic in a tertiary hospital. We included male patients over 18 years of age without comorbidities who had anogenital condylomata and no previous treatments.In order to evaluate the local epithelial immunity, the lesions were quantified, then removed and employed in CD1a immunohistochemistry assays for assessing the morphometry and morphology of Langerhans cells; TNF-α; reaction was used for determining cytokine positivity in the epithelium. Results: 48 patients were included in the study. There was no statistically significant difference as to the number of Langerhans cells, in their morphology, or the presence of TNF-α. However, patients presenting with more Langerhans cells in the lesions had cells with a star-like and dendritic morphology, whereas in those with a lower cell count had cells with a rounded morphology and no dendrites (p < 0.001). Study limitations: Small number of patients analyzed. Conclusion: There was no difference in epithelial immunity between patients having few or many anogenital condyloma lesions as measured by the morphology and morphometry of Langerhans cells and TNF-α; positivity. Such an assessment employing immunity markers differing from the usual ones is expected to yield useful results.
Assuntos
Humanos , Masculino , Doenças do Ânus/imunologia , Condiloma Acuminado/imunologia , Células de Langerhans/patologia , Fator de Necrose Tumoral alfa/análise , Doenças dos Genitais Masculinos/imunologia , Doenças do Ânus/patologia , Valores de Referência , Células Dendríticas/imunologia , Células Dendríticas/patologia , Imuno-Histoquímica , Condiloma Acuminado/patologia , Células de Langerhans/imunologia , Estudos Transversais , Estudos Prospectivos , Fator de Necrose Tumoral alfa/imunologia , Doenças dos Genitais Masculinos/patologiaRESUMO
O tumor de Buschke-Lowenstein (TBL) é variante extremamente rara do condiloma acuminado que, apesar de manifestar-se clinicamente por lesões de grandes proporções, apresenta comportamento biológico e características histológicas benignas. Existem diversas abordagens terapêuticas disponíveis, muitas delas apoiando-se em abordagens cirúrgicas extensas e mutilantes. Apresentamos dois casos de pacientes com TBL tratados com podofilina tópica, cujas respostas terapêuticas foram extremamente favoráveis em ambos os casos.
Buschke-Lowenstein tumor (BLT) is an extremely rare variant of condylomata acuminata that despite being clinically presented by large lesions, presents a benign biological behavior and histological characteristics. There are a number of therapeutic approaches available, many of which rely on extensive and mutilating surgical procedures. We present two cases of patients with BLT treated with topical podophyllin whose therapeutic responses were extremely favorable in both cases.
RESUMO
O condiloma acuminado é causado pelo DNA-vírus, que pertence ao grupo papovavírus. Em menores de três anos, a transmissão tende a não ser por abuso sexual, mas, sim, de maneira vertical. Não existe consenso para o tratamento das verrugas anogenitais em crianças. O método escolhido é individualizado para o paciente, sendo a preferência por tratamentos menos traumáticos, com menor sequela. Embora ainda existam algumas restrições ao uso do imiquimode em menores de 12 anos, estudos já mostram o sucesso desta terapêutica nesta faixa etária. Será descrito um caso tratado com imiquimode creme a 5%, com resolução das lesões preexistentes
DNA-virus, which belongs to the papillomavirus group, causes Condylomata acuminata. In children under 3 years of age, transmission tends not to be due to sexual abuse but rather vertically. There is no consensus for the treatment of anogenital warts in children. The chosen method is individualized for each patient, preferring less traumatic treatments, with fewer sequelae. Although there are still some restrictions on the imiquimod use in children under 12, studies have already shown this therapy's success in this age group. We report a case treated with 5% imiquimod cream with the resolution of pre-existing lesions.
RESUMO
Introduction: Genital warts are benign lesions caused by sexual transmission of human papillomavirus types 6 and 11, with significant impact on healthcare resource use and patients' quality of life. Objective: To describe the epidemiology of genital warts in adults visiting a physician office for any reason, physician practice patterns, and healthcare resource use and costs in Colombia. Methods: Participants were a convenience sample of 53 physicians in 5 specialties: primary care (15), gynecology (24), urology (12), proctology (1), and dermatology (1). Physicians completed a survey and daily log of all patients 18-60 years old seen over 10 days in their practices in 2016-2017. The physician survey recorded genital warts consultation and management patterns. The daily log recorded patient demographic information and genital warts diagnosis. Results: Among 6,393 patients logged by physicians, the genital warts prevalence was 2.03% (95%CI 1.692.38) and incidence 1.30% (95%CI 1.021.58). Primary care physicians referred most of their genital warts cases for treatment (female: mean 63.3%, SD=44.8; male: mean 58.3%, SD=43.8). Treatment of non-resistant episodes (<6-month duration) lasted an average of 37.4 days (SD=29.4) and required an average of 4.0 (SD=1.9) office visits for females and 3.0 (SD=1.7) for males. The overall mean cost of an episode of care was USD558.13 (SD=507.30). Conclusion: Genital warts cases reported by most participant physicians were mainly direct-consult, but patients were typically treated by specialists. Much of the genital warts health care utilization and costs reported could be prevented by immunization with the quadrivalent or nonavalent HPV vaccine.
Introdução: As verrugas genitais são lesões benignas, de transmissão sexual, causadas pelo papilomavírus humano tipos 6 e 11 e que causam impacto significativo no uso de recursos de saúde e na qualidade de vida dos pacientes. Objetivo: Descrever a epidemiologia das verrugas genitais em adultos que buscaram atendimento médico ambulatorial por qualquer motivo, incluindo padrões de prática médica, uso de recursos de saúde e custos na Colômbia. Métodos: foi utilizada uma amostra de conveniência composta por 53 médicos em 5 especialidades: clínico geral (15), ginecologia (24), urologia (12), proctologia (1) e dermatologia (1). Os médicos completaram um questionário e registros diários de todos os pacientes com idade entre 18 e 60 anos atendidos durante 10 dias em seus consultórios em 2016-2017. O questionário registrou os padrões de prática médica e de tratamento de verrugas genitais. Os registros diários continham informações demográficas do paciente e o diagnóstico de verrugas genitais. Resultados: Entre 6.393 atendimentos médicos, a prevalência das verrugas genitais foi de 2,03% (IC95% 1,692,38) e a incidência de 1,30% (IC95% 1,021,58). Os clínicos gerais encaminharam a maioria dos pacientes com verrugas genitais para tratamento (mulheres: média de 63,3%, DP=44,8; homens: média de 58,3%, DP=43,8). O tratamento dos casos não-persistentes (<6 meses de duração) durou em média 37,4 dias (DP=29,4) e requereu uma média de 4,0 (DP=1,9) consultas para mulheres e 3,0 (DP=1,7) para homens. O custo médio geral do tratamento foi de US$ 558,13 (SD=507,30). Conclusão: Os casos de verrugas genitais relatados pela maioria dos médicos participantes derivaram-se principalmente de atendimentos primários e os pacientes foram tratados geralmente por especialistas. Grande parte da utilização de recursos e custos relacionados a verrugas genitais poderia ser evitada pela imunização com a vacina papilomavírus humano 4-valente ou 9-valente.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Verrugas/epidemiologia , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Verrugas/economia , Verrugas/virologia , Aceitação pelo Paciente de Cuidados de Saúde , Incidência , Prevalência , Custos de Cuidados de Saúde , Colômbia/epidemiologia , Doenças dos Genitais Femininos/economia , Doenças dos Genitais Femininos/virologia , Doenças dos Genitais Masculinos/economia , Doenças dos Genitais Masculinos/virologiaRESUMO
ABSTRACT Aim: to evaluate the presence of subclinical HPV-induced anal lesions with anal cytology, High-Resolution Anoscopy (HRA) and HPV genotyping by polymerase chain reaction (PCR) in the follow-up of treated condylomata acuminata (CA). Methods: seventy-nine male patients were included. One month after anal CA eradication, the patients underwent brush samples collection for anal cytology and PCR, and HRA with biopsy of acetowhite lesions. These methods were compared within all patients and between groups, according to Human Immunodeficiency Virus (HIV) infection status: HIV-negative; HIV-positive with TCD4 count above and below 350 cells/mm3. Results: the most frequent HPV types were 6 and 16. HPV DNA was isolated in 92%. HIV infection was associated with a higher number of oncogenic HPV types (p=0.038). All patients with negative PCR had negative HRA and cytology. There were no differences in cytological, HRA or histopathological findings between groups. Conclusion: the association of the findings of cytopathology, HRA and genotyping of HPV refined the diagnosis of HPV-induced lesions. The degree of immunodeficiency was not associated with increase in remnant HPV-induced anal lesions.
RESUMO Objetivo: avaliar a presença de lesões anais subclínicas HPV-induzidas com citologia anal, colposcopia anal e genotipagem de HPV por reação em cadeia da polimerase (PCR) no seguimento de condilomas anais tratados. Método: foram incluídos 79 pacientes do sexo masculino. Após um mês da erradicação de lesões condilomatosas anais, os participantes voltaram em consulta para coleta de amostras com escova para citologia anal e PCR, e colposcopia anal com biópsia de lesões acetobrancas. Os métodos de detecção das lesões foram comparados entre os pacientes e entre grupos, de acordo com o status de infecção pelo vírus da imunodeficiência humana (HIV): HIV-negativo; HIV-positivo com TCD4 acima ou abaixo de 350 células/mm3. Resultados: os tipos de HPV mais frequentes foram 6 e 16. Infecção pelo HIV foi associada a maior número de tipos de HPV oncogênicos (p=0,038). Todos os pacientes com PCR negativo apresentaram colposcopia e citologia negativos. Não houve diferença nos achados citológico, colposcópico ou histopatológico entre grupos. Conclusão: a associação dos achados citopatológico, colposcópico e PCR melhorou a acurácia do diagnóstico de lesões anais HPV-induzidas. O grau de imunodeficiência não foi associado a maior frequência de lesões anais HPV-induzidas remanescentes.
Assuntos
Humanos , Masculino , Neoplasias do Ânus , Papillomaviridae/genética , Condiloma Acuminado , Infecções por Papillomavirus , Canal Anal , DNA , Infecções por HIV , Reação em Cadeia da Polimerase , Seguimentos , GenótipoRESUMO
RESUMEN Introducción: se ha identificado un incremento de pacientes pediátricos con condilomas acuminados. Objetivo: evaluar la efectividad de los medicamentos homeopáticos en el tratamiento de los condilomas acuminados en niños de un mes a 18 años, en hospital pediátrico pinareño entre los años 2014 y 2015. Métodos: se realizó un estudio descriptivo longitudinal y prospectivo a un universo muestral de 33 niños, remitidos por el Dermatólogo a la consulta de Medicina Bioenergética y Natural del Hospital Pediátrico Provincial Docente Pepe Portilla de Pinar del Río, Cuba, durante los años 2014-2015, seguidos de forma evolutiva hasta el 2018. Se les aplicaron medicamentos homeopáticos seleccionados de forma tópica y sistémica. Resultados: no existió predominio de sexo, la edad más representada fue de 13-18 años, y la localización más frecuente fue genital con morfología clínica predominante coliflor, el modo de transmisión más frecuente fue por contacto sexual. En cuatro pacientes se corroboró abuso sexual, en el resto de los casos por hetero inoculación. La evolución fue satisfactoria con la aparición de lesiones en el tercer año de su seguimiento. Conclusiones: las verrugas ano genitales son un reto para el pediatra y el dermatólogo pedíatra, sobre todo sus mecanismos de transmisión. Los medicamentos homeopáticos resultaron eficaces en el tratamiento de los condilomas acuminados en niños.
ABSTRACT Introduction: an increase in pediatric patients with condyloma acuminata has been identified. Objective: to assess the effectiveness of homeopathic medicines in the treatment of condyloma acuminata in children from 1 month to 18 years at Pepe Portilla Pediatric Provincial Teaching Hospital in Pinar del Río between the years 2014 and 2015. Methods: a longitudinal and prospective descriptive study was carried out on a sampling target group of 33 children, referred by the Dermatologist to the Bioenergetic and Natural Medicine consultation at Pepe Portilla Pediatric Provincial Teaching Hospital in Pinar del Río, Cuba, during the years 2014-2015, performing a follow-up until 2018. Topical and systemic homeopathic medicines were chosen to apply to them. Results: there was no predominance of gender, the age most represented was 13-18 years, and the most frequent location was genital regions, predominantly cauliflower clinical morphology, the most frequent type of transmission was by sexual contact. In four patients sexual abuse was corroborated, in the rest of the cases by hetero inoculation, the evolution was satisfactory with the appearance of lesions in the third year of their follow-up. Conclusions: genital-anal warts are a challenge for the pediatricians and pediatric dermatologists; basically because of their mechanisms of transmission. Homeopathic medicines were effective in the treatment of condyloma acuminata in children.
RESUMO
Introduction: Human papillomavirus types 6 and 11 cause 90% of genital warts. Although the epidemiology of cervical cancer and the distribution of human papillomavirus genotypes have been investigated in Ecuador, little is known about the occurrence of genital warts. Objective: To estimate the incidence and prevalence of genital warts among patients routinely presenting at the practice of physicians, describe the demographics of genital warts cases and highlight the physician specialties that treat genital warts, including patterns of consultation and referral in Ecuador. Methods: Participants were a convenience sample of physicians who treat and/or diagnose genital warts in their practices. Physicians completed a daily log, recording the demographics and diagnosis of genital warts in all patients aged 18 to 60 years seen over 10 days in their practices. Physicians then completed a survey recording their practice characteristics and referral patterns of genital warts. Results: A sample of 105 physicians of different specialties participated in the study. Among 12,133 patients, the prevalence of genital warts was 5.5%, and the incidence, 3.7%. Prevalence was 6.9% in men, peaking at 12.6% in those aged from 25 to 29 years old. Prevalence was 5.1% for females, peaking at 6.5% in those aged from 30 to 34 years old. Most women were seen in direct consultations (75%) rather than by referral ones (24%). Most physicians (72%) treated females with genital warts, except for primary care physicians, who referred most cases (88%). Conclusion: Cases of genital warts are frequently encountered by physicians in Ecuador and are typically treated by specialists rather than primary care physicians.
Introdução: Os tipos 6 e 11 do papilomavírus humano causam 90% das verrugas genitais. Embora a epidemiologia do câncer do colo do útero e a distribuição dos genótipos do papilomavírus humano tenham sido investigadas no Equador, pouco se sabe sobre a ocorrência das verrugas genitais. Objetivo: Estimar a incidência e a prevalência das verrugas genitais em pacientes atendidos rotineiramente na clínica médica, descrever os dados demográficos dos casos de verrugas genitais e determinar as especialidades médicas que tratam as verrugas genitais, incluindo os padrões de consulta e encaminhamento no Equador. Métodos: Foi realizada uma amostragem por conveniência com médicos que tratavam e/ou diagnosticam verrugas genitais em sua clínica médica. Os médicos registraram as suas atividades cotidianas em um diário, anotando dados demográficos e diagnóstico de verrugas genitais de todos os pacientes com idade entre 18 e 60 anos atendidos durante 10 dias em suas clínicas. Posteriormente, os médicos responderam a uma pesquisa sobre as características da conduta tomada e os padrões de encaminhamento médico das verrugas genitais. Resultados: Uma amostra de 105 médicos de diferentes especialidades participou do estudo. Entre 12.133 pacientes, a prevalência de verrugas genitais foi de 5,5% e a incidência foi de 3,7%. A prevalência foi de 6,9% no sexo masculino, atingindo o valor máximo de 12,6% na faixa etária de 25 a 29 anos. A prevalência foi de 5,1% para o sexo feminino, alcançando 6,5% entre 30 e 34 anos. Na maior parte dos casos, as mulheres foram tratadas predominantemente pelo médico que realizou o primeiro atendimento (75%) e não por meio de encaminhamento a outra especialidade (24%). A maioria dos médicos (72%) tratou mulheres com verrugas genitais, exceto os médicos de atenção primária, que em geral encaminharam os casos (88%). Conclusão: Casos de verrugas genitais são frequentemente diagnosticados por médicos no Equador e são mais frequentemente tratados por especialistas do que por médicos de atenção primária.
Assuntos
Humanos , Papillomaviridae , Sexo , Verrugas , Medicina Clínica , Neoplasias do Colo do Útero , EquadorRESUMO
Introduction: Anogenital warts are one of the major clinical manifestations of the Human Papillomavirus (HPV). Case reports in children have grown in the last decades; however, there are still difficulties in determining the virus epidemiology and the best therapy for this age group. Objective: To report a case of recurrent vulvar condyloma in a sexually abused infant who presented complete resolution of the lesions after the use of topical imiquimod. Methods: Data research and medical record review were performed in addition to a qualitative study consisted of a wide literature appreciation on the subject. Results: After undergoing extensive therapy, the patient was successfully treated using topical imiquimod. Conclusion: Observation of this particular case suggests that imiquimod may be a safe and effective therapeutic alternative for the treatment of condyloma in the pediatric population. However, theoretical foundations for such conduct are scarce. Thus, the need for further studies on the subject is reinforced.
Introdução: As verrugas anogenitais constituem uma das principais manifestações clínicas da infecção pelo vírus do Papiloma Humano (HPV). Relatos de casos em crianças têm crescido nas últimas décadas; contudo, ainda há dificuldades em determinar a epidemiologia do vírus e definir a melhor terapêutica para essa faixa etária. Objetivo: Relatar um caso de condiloma vulvar recorrente em uma lactente abusada sexualmente que apresentou resolução completa das lesões após o uso de imiquimode tópico. Métodos: Foi realizado levantamento de dados e revisão de prontuário, além de estudo qualitativo composto por apreciação ampla da literatura acerca do tema em questão. Resultados: Depois de ser submetido à extensa terapêutica, a paciente foi tratada com sucesso utilizando imiquimode tópico. Conclusão: A observação desse caso específico sugere que o imiquimode pode ser uma alternativa terapêutica segura e eficaz para o tratamento de condiloma na população pediátrica. Entretanto, embasamentos teóricos para tal conduta são escassos. Assim, reforça-se a necessidade do desenvolvimento de mais estudos sobre a temática.
Assuntos
Humanos , Papiloma , Papillomaviridae , Condiloma Acuminado , Verrugas , Lactente , InfecçõesRESUMO
Introduction: Giant condylomata acuminata, also known as Buschke-Lowenstein tumor is a rare form of tumor of the anogenital condylomata acuminata, which is a sexually transmitted infection (STI) caused by the human papillomavirus (HPV). Objective: To report a case of giant condylomata acuminata in an immunocompetent patient. Case report: The patient was referred to the Outpatient Clinic for Sexually Transmitted Infections and AIDS at a public hospital in the city of Vitória, Espírito Santo State, Brazil, reporting the onset of progressive growth verrucous lesions on the external genitalia for four months. The patient underwent surgical ablation, and giant condylomata diagnostic confirmation was obtained through histopathology. She was treated with 5% imiquimod cream in routine applications for eight consecutive weeks to avoid recurrence and was also vaccinated for HPV after the procedure. Conclusion: Surgery excision is the treatment of choice in extensive genital condylomata lesions to exclude malignancy. Imiquimod use as adjuvant therapy for reducing recurrence seems to be adequate.
Introdução: O condiloma acuminado gigante, também conhecido tumor de Buschke-Lowenstein, é uma apresentação rara do condiloma acuminado anogenital, que é uma infecção sexualmente transmissível (IST) causada pelo papilomavírus humano (HPV). Objetivo: Relatar um caso de condiloma acuminado gigante em uma paciente imunocompetente. Relato de caso: A paciente foi encaminhada para o ambulatório de infecções sexualmente transmissíveis e AIDS de um hospital público na cidade de Vitória, Espírito Santo, Brasil, relatando o aparecimento de lesões verrucosas de crescimento progressivo na genitália externa por quatro meses. A paciente foi submetida à exérese cirúrgica e a confirmação diagnóstica de condiloma gigante foi obtida através da histopatologia. Ela foi medicada com imiquimode creme a 5% em aplicações rotineiras por oito semanas consecutivas para evitar recorrências e foi também vacinada contra o HPV após o procedimento. Conclusão: Exérese cirúrgica é o tratamento de escolha em lesões condilomatosas extensas para excluir malignidade. O uso de Imiquimode como terapia adjuvante para redução de recidivas mostrou-se adequado.
Assuntos
Humanos , Condiloma Acuminado , Infecções Sexualmente Transmissíveis , Tumor de Buschke-Lowenstein , Síndrome da Imunodeficiência Adquirida , Imiquimode , GenitáliaRESUMO
Abstract: Objective: To determine external genital lesion (EGL) incidence -condyloma and penile intraepithelial neoplasia (PeIN)- and genital HPV-genotype progression to these EGLs. Materials and methods: Participants (healthy males 18-74y from Cuernavaca, Mexico, recruited 2005-2009, n=954) underwent a questionnaire, anogenital examination, and sample collection every six months; including excision biopsy on suspicious EGL with histological confirmation. Linear array assay PCR characterized 37 high/low-risk HPV-DNA types. EGL incidence and cumulative incidence were calculated, the latter with Kaplan-Meier. Results: EGL incidence was 1.84 (95%CI=1.42-2.39) per 100-person-years (py); 2.9% (95%CI=1.9-4.2) 12-month cumulative EGL. Highest EGL incidence was found in men 18-30 years: 1.99 (95%CI=1.22-3.25) per 100py. Seven subjects had PeIN I-III (four with HPV16). HPV11 most commonly progresses to condyloma (6-month cumulative incidence=44.4%, 95%CI=14.3-137.8). Subjects with high-risk sexual behavior had higher EGL incidence. Conclusion: In Mexico, anogenital HPV infection in men is high and can cause condyloma. Estimation of EGL magnitude and associated healthcare costs is necessary to assess the need for male anti-HPV vaccination.
Resumen: Objetivo: Determinar incidencia de lesiones genitales externas (LGE) -condiloma y neoplasia intraepitelial del pene (NIP)- y progresión de genotipos de VPH a LGE. Material y métodos: Se aplicaron cuestionarios, examen anogenital y recolección de muestras cada seis meses a hombres sanos (18-74 años, de Cuernavaca, México, reclutados 2005-2009, n=954) con biopsia y confirmación histológica. Se caracterizaron 37 tipos de ADN-VPH; se calculó incidencia de LGE (cumulativa con Kaplan-Meier). Resultados: Incidencia de LGE=1.84 (IC95%=1.42-2.39) por 100-persona-años (pa); 2.9% (IC95%=1.9-4.2) LGE acumulativa a 12 meses. Mayor incidencia de LGE entre hombres 18-30 años; 1.99 (IC95%=1.22-3.25) por 100pa. Siete sujetos tuvieron NIP I-III. VPH-11 más comúnmente progresa a condiloma (incidencia acumulativa a seis meses=44.4%, IC95%=14.3-137.8). Los sujetos con comportamiento sexual de alto riesgo tuvieron mayor incidencia de LGE. Conclusiones: En México la infección anogenital con VPH es alta y puede causar condiloma. La estimación de magnitud de LGE y los costos sanitarios asociados se necesita para evaluar la necesidad de vacunación contra VPH en hombres.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Infecções por Papillomavirus/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Biópsia , Consumo de Bebidas Alcoólicas/epidemiologia , Carcinoma in Situ/epidemiologia , Fumar/epidemiologia , Condiloma Acuminado/epidemiologia , Incidência , Estudos Prospectivos , Inquéritos e Questionários , Circuncisão Masculina/estatística & dados numéricos , Distribuição por Idade , Progressão da Doença , Sexo sem Proteção , Papillomavirus Humano 11/isolamento & purificação , Papillomavirus Humano 16/isolamento & purificação , México/epidemiologiaRESUMO
Abstract: The oncogenic role of high-risk HPV in anogenital, head and neck, and cervical cancer is well recognized, but not in skin cancer in the general population. Some authors have demonstrated their appearance mainly on the hands and feet, particularly in the area of the nail bed, which could be due to contamination with HPV types from anogenital regions. Here, we describe a case of genital HPV associated with SCC on the nose tip in an immunocompetent young man, which was confirmed by histopathological findings and in situ hybridization. The importance of this report is to highlight the potential role of HPV in the etiology of skin cancer in an immunocompetent individual.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/virologia , Carcinoma de Células Escamosas/virologia , Neoplasias Nasais/virologia , Infecções por Papillomavirus/complicações , Imunocompetência , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologia , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/patologia , Neoplasias Nasais/imunologia , Neoplasias Nasais/patologia , Infecções por Papillomavirus/patologia , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/virologiaRESUMO
Fue efectuado un estudio descriptivo, longitudinal y prospectivo, en el Policlínico Universi-tario "Marta Abreu ", en la ciudad de Santa Clara, provincia Villa Clara, Cuba, en el período comprendido desde abril del 2011 hasta diciembre del año 2012, con el objetivo de caracteri-zar la relación clínico-epidemiológica en pacientes portadores de la infección por condiloma acuminado. Los pacientes que acudieron a la consulta dermatológica del policlínico, tres mil trescientos cincuenta y cuatro (3 354), representaron el universo y la muestra tomada estuvo integrada por 49 afectados con diagnóstico clínico de condiloma acuminado, la cual estuvo determinada a través del método de muestreo de conveniencia. Se obtuvo la información del cuestionario (Anexo I); aplicado a los pacientes con diagnóstico clínico de condiloma acumi-nado, del Departamento de Estadísticas, las Historias Clínicas Individuales y Entrevistas, revistas científicas y de las fuentes actualizadas del internet. El condiloma acuminado, llama-do por lo general verruga genital o verruga venérea, es considerado como la ITS más frecuen-te y ocupa el segundo lugar en importancia tras el VIH/SIDA. Según el estudio realizado, la infección por condiloma acuminado predominó en las edades entre 20 y 29 años; sexo mas-culino e inicio las relaciones sexuales en edades tempranas a los 15 o 17 años; uso eventual del condón y múltiples parejas sexuales en el año. Predominó el tratamiento tópico a través de la podofilina al 25% y la evolución fue insatisfactoria.
A descriptive, longitudinal and prospective study was carried out at the Policlínico Universi-tario "Marta Abreu", in the city of Santa Clara, province of Villa Clara, Cuba, in the period from April 2011 to December 2012. It aimed to characterize the clinical-epidemiological relationship in patients with condyloma acuminatum infection. Three thousand three hundred fifty four (3 354) patients who were attended in the dermatological consultation represented the universe; the sample taken of 49 affected patients with clinical diagnosis of condyloma acuminatum was determined through the method of convenience sampling. The information was collected from the questionnaire(Annex I) applied to patients with a clinical diagnosis of condyloma acuminatum, from the Department of Statistics, Individual Clinical Stories and Interviews, scientific journals and updated Internet sources. The condyloma acuminatum (usually called genital wart or venereal wart) is considered the most frequent STI and ranks second in importance after HIV / AIDS. Infection by condyloma acuminatum in the ages between 20 and 29 years, male sex, initiation of sexual relations at an early age at 15 or 17 years old, eventual use of the condom, and multiple sexual partners in the year predominated according to the study conducted. Topical treatment with podophyllin at 25% predominated and the evolution was unsatisfactory.
Assuntos
Humanos , Condiloma Acuminado/epidemiologia , Infecções Sexualmente Transmissíveis , Dermatologia , PrevalênciaRESUMO
RESUMEN: El objetivo de este estudio fue reportar un caso clínico donde se realizó el manejo quirúrgico de múltiples condilomas de la mucosa oral en un paciente infectado por Virus de Inmunodeficiencia Humana (VIH) bajo Terapia Antirretroviral de Gran Actividad (TARGA). Hombre de 58 años en tratamiento por infección con VIH en TARGA hace 17 años, que acude al Servicio de Cirugía Maxilofacial del Hospital Barros Luco-Trudeau con múltiples lesiones verruciformes ubicadas en margen y cara dorsal de lengua, cara interna de ambas mejillas y labio inferior. Se realizó escisión quirúrgica de las lesiones de labio, cara dorsal de lengua y cara interna de mejilla del lado derecho, obteniéndose el diagnóstico histopatológico de condiloma. Tras 2 meses de realizar la cirugía se obtuvo recurrencia. La recurrencia de las lesiones puede originarse por la recrudescencia del virus latente adyacente al lecho quirúrgico y, por ello, deben considerarse otras alternativas de tratamiento. Por el impacto en la función, estética, potencial de contagio y malignización, es necesario su tratamiento.
ABSTRACT: The objective of this study was to report a clinical case in which surgical management of multiple condylomas in the oral mucosa was performed in a patient infected by Human Immunodeficiency Virus (HIV) who is under highly active antiretroviral therapy (HAART). A 58-yearold man, under HAART for 17 years for HIV infection, was admitted at the Maxillofacial Surgery Service at the Hospital Barros Luco-Trudeau as he was experiencing multiple verrucous lesions located on the lateral margin and dorsum of the tongue, as well as on the inner face of both cheeks and the lower lip. A surgical excision of the lesions on the lip, dorsum of the tongue and inner face of the right cheek was performed, where the histopathological diagnosis of condyloma was obtained. There was a recurrence two months after surgery. Recurrence of the lesions may be due to the recrudescence of the latent virus adjacent to the surgical bed and, therefore, other treatment alternatives should be considered. Treatment is necessary due to the impact on the function, aesthetics, and the potential to become contagious and malignant.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Língua/virologia , Condiloma Acuminado/virologia , Terapia Antirretroviral de Alta Atividade/métodos , Fotomicrografia , Condiloma Acuminado/cirurgia , Condiloma Acuminado/diagnóstico , Infecções por HIV/virologia , Mucosa Bucal/virologiaRESUMO
Abstract: Background: In this study, cases with suspected urethral condylomata acuminata were examined by dermoscopy, in order to explore an effective method for clinical. Objective: To study the application of dermoscopy image analysis technique in clinical diagnosis of urethral condylomata acuminata. Methods: A total of 220 suspected urethral condylomata acuminata were clinically diagnosed first with the naked eyes, and then by using dermoscopy image analysis technique. Afterwards, a comparative analysis was made for the two diagnostic methods. Results: Among the 220 suspected urethral condylomata acuminata, there was a higher positive rate by dermoscopy examination than visual observation. Study limitations: Dermoscopy examination technique is still restricted by its inapplicability in deep urethral orifice and skin wrinkles, and concordance between different clinicians may also vary. Conclusion: Dermoscopy image analysis technique features a high sensitivity, quick and accurate diagnosis and is non-invasive, and we recommend its use.