Descrição Geral: Infeções Sexualmente Transmissíveis

Epidemiologia

• 26 milhões de novas ISTs diagnosticadas em 2018 nos Estados Unidos
• Grupos de doentes de alto risco:
  • Adolescentes e adultos jovens de 15 a 24 anos (responsáveis por 50% das novas ISTs em 2018)
  • Homens que fazem sexo com homens (HSH)
  • Minorias raciais e étnicas
• O HSV-2 e a sífilis aumentam o risco de infeção pelo VIH.
• As ISTs podem resultar em consequências sérias para a reprodução e efeitos adversos para a saúde a longo prazo.
• ISTs que devem ser notificadas às secretarias estaduais de saúde:
  • Sífilis
  • Cancroide
  • VIH
  • Gonorreia
  • Clamídia

Etiologia

As infeções são principalmente transmitidas por via sexual, que pode incluir sexo vaginal, anal ou oral desprotegido.

Bacteriana

• Cancroide ( Haemophilus ducreyi Haemophilus ducreyi A species of Haemophilus that appears to be the pathogen or causative agent of the sexually transmitted disease, chancroid. Haemophilus)
• Clamídia e linfogranuloma venéreo ( Chlamydia trachomatis Chlamydia trachomatis Type species of Chlamydia causing a variety of ocular and urogenital diseases. Chlamydia)
• Gonorreia ( Neisseria gonorrhoeae Neisseria gonorrhoeae A species of gram-negative, aerobic bacteria primarily found in purulent venereal discharges. It is the causative agent of gonorrhea. Neisseria)
• Granuloma inguinal ou donovanose ( Klebsiella Klebsiella Klebsiella are encapsulated gram-negative, lactose-fermenting bacilli. They form pink colonies on MacConkey agar due to lactose fermentation. The main virulence factor is a polysaccharide capsule. Klebsiella pneumoniae is the most important pathogenic species. Klebsiella granulomatis)
• Mycoplasma genitalium Mycoplasma genitalium A species of gram-negative bacteria originally isolated from urethral specimens of patients with non-gonococcal urethritis. In primates it exists in parasitic association with ciliated epithelial cells in the genital and respiratory tracts. Mycoplasma
• Sífilis ( Treponema pallidum Treponema pallidum The causative agent of venereal and non-venereal syphilis as well as yaws. Treponema)

Vírica

• Herpes simplex Herpes Simplex A group of acute infections caused by herpes simplex virus type 1 or type 2 that is characterized by the development of one or more small fluid-filled vesicles with a raised erythematous base on the skin or mucous membrane. It occurs as a primary infection or recurs due to a reactivation of a latent infection. Congenital TORCH Infections (vírus herpes simplex Herpes Simplex A group of acute infections caused by herpes simplex virus type 1 or type 2 that is characterized by the development of one or more small fluid-filled vesicles with a raised erythematous base on the skin or mucous membrane. It occurs as a primary infection or recurs due to a reactivation of a latent infection. Congenital TORCH Infections, HSV HSV Herpes simplex virus (HSV) is a double-stranded DNA virus belonging to the family Herpesviridae. Herpes simplex virus commonly causes recurrent infections involving the skin and mucosal surfaces, including the mouth, lips, eyes, and genitals. Herpes Simplex Virus 1 and 2 tipos 1 e 2)
• Vírus da hepatite B:
  • Transmissão sexual
  • Outros modos de transmissão: exposição a sangue/produtos sanguíneos, de mãe para filho
• VIH
  • Transmissão sexual
  • Outros modos de transmissão: exposição a sangue/produtos sanguíneos, amamentação
• HPV HPV Human papillomavirus (HPV) is a nonenveloped, circular, double-stranded DNA virus belonging to the Papillomaviridae family. Humans are the only reservoir, and transmission occurs through close skin-to-skin or sexual contact. Human papillomaviruses infect basal epithelial cells and can affect cell-regulatory proteins to result in cell proliferation. Papillomavirus (HPV)
  • IST mais MAIS Androgen Insensitivity Syndrome comum no mundo
  • Verrugas genitais: HPV-6 e 11
  • Lesões intraepiteliais escamosas anogenitais: associadas a 15 tipos, sendo o HPV-16 o mais MAIS Androgen Insensitivity Syndrome comum

Parasitas

• Pediculose púbica ou piolho de caranguejo (Pthirus pubis)
• Tricomoníase ( Trichomonas Trichomonas A genus of parasitic flagellate eukaryotes distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. Nitroimidazoles vaginalis)

Apresentação Clínica

ISTs bacterianas

ISTs víricas

ISTs parasitárias

Diagnóstico

Abordagem diagnóstica

História sexual completa:

• Número de parceiros
• Tipos de práticas sexuais
• Tipos de proteções utilizadas, se houver
• História prévia de ISTs
• História prévia de gravidez
• Historial de vacinação:
  • Hepatite A/B
  • HPV HPV Human papillomavirus (HPV) is a nonenveloped, circular, double-stranded DNA virus belonging to the Papillomaviridae family. Humans are the only reservoir, and transmission occurs through close skin-to-skin or sexual contact. Human papillomaviruses infect basal epithelial cells and can affect cell-regulatory proteins to result in cell proliferation. Papillomavirus (HPV)
• Historial de viagens

Exame objetivo focado ao problema:

• Cabeça, olhos, ouvidos, nariz, garganta (HEENT, pela sigla em inglês): Examinar a mucosa oral e os lábios, procurando exantemas ou úlceras.
• Exame abdominopélvico: Avaliar a presença de dor abdominal inferior ou pélvica.
• Exame geniturinário:
  • Palpação dos gânglios inguinais, procurando nódulos.
  • Exame genital para avaliação de exantemas, úlceras, exsudado, verrugas
  • Masculino: exame testicular para avaliar tumefação, dor

Testes Testes Gonadal Hormones específicos

A amostra é obtida do(s) local(is) com infeção/lesão, que pode(m) incluir a área anogenital, gânglios e oral.

Doença bacteriana:

• Cancroide:
  • Cultura de úlceras genitais
  • Descartar etiologias comuns para úlcera(s) genital(is): herpes e sífilis
• Clamídia:
  • Melhor teste: teste de amplificação de ácido nucleico (NAAT, pela sigla em inglês) (o PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR) é um método comum.)
  • A cultura tem uma utilidade limitada.
• Gonorreia:
  • Melhor teste: NAAT
  • Coloração de Gram (microscopia)
  • Culturas (uretral, vaginal, faríngea, retal)
• Granuloma inguinal (donovanose):
  • Biópsia de tecido
  • Observam-se corpos de Donovan (corpos de inclusão citoplasmáticos com coloração bipolar Bipolar Nervous System: Histology) na anatomia patológica
• Linfogranuloma venéreo: NAAT
• Mycoplasma genitalium Mycoplasma genitalium A species of gram-negative bacteria originally isolated from urethral specimens of patients with non-gonococcal urethritis. In primates it exists in parasitic association with ciliated epithelial cells in the genital and respiratory tracts. Mycoplasma: NAAT
• Sífilis:
  • Testes Testes Gonadal Hormones não treponémicos: reagina plasmática rápida e VDRL VDRL Treponema
  • Teste confirmatório: absorção de anticorpos treponémicos fluorescentes (FTA-ABS, pela sigla em inglês)

Doença vírica:

• HSV-1 e 2:
  • Melhor teste: PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR)
  • Sorologia
  • Cultura vírica
  • Esfregaço de Tzanck
• VIH:
  • Rastreio: imunoensaio que deteta anticorpos HIV-1 HIV-1 The type species of lentivirus and the etiologic agent of aids. It is characterized by its cytopathic effect and affinity for the T4-lymphocyte. HIV Infection and AIDS e HIV-2 HIV-2 An HIV species related to HIV-1 but carrying different antigenic components and with differing nucleic acid composition. It shares serologic reactivity and sequence homology with the simian lentivirus simian immunodeficiency virus and infects only t4-lymphocytes expressing the CD4 phenotypic marker. HIV Infection and AIDS e o antigénio HIV-1 HIV-1 The type species of lentivirus and the etiologic agent of aids. It is characterized by its cytopathic effect and affinity for the T4-lymphocyte. HIV Infection and AIDS p24
  • Teste confirmatório: imunoensaio de antigénio/anticorpo reativo
  • Infeção aguda: carga vírica de ARN do VIH
• HPV HPV Human papillomavirus (HPV) is a nonenveloped, circular, double-stranded DNA virus belonging to the Papillomaviridae family. Humans are the only reservoir, and transmission occurs through close skin-to-skin or sexual contact. Human papillomaviruses infect basal epithelial cells and can affect cell-regulatory proteins to result in cell proliferation. Papillomavirus (HPV):
  • Detetado em amostras do colo do útero (como parte do rastreio do cancro do colo do útero)
  • Também testado em biópsias orofaríngeas
• Hepatite B:
  • Marcadores sorológicos (por exemplo, antigénio de superfície e anticorpo da hepatite B)
  • PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR) (ADN VHB)

Doença parasitária:

• Trichomonas Trichomonas A genus of parasitic flagellate eukaryotes distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. Nitroimidazoles vaginalis:
  • A microscopia (montagem húmida) mostra tricomonas móveis.
  • PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR)
  • Cultura vaginal
  • Citologia cervical
• Pthirus púbis:
  • Visualização de piolhos ou lêndeas (ovos de piolhos) por exame direto ou microscópico dos fios de cabelo

Tratamento

ISTs bacterianas

ISTs víricas

ISTs parasitárias

Prevenção

• Rastreio de ISTs
• Aconselhamento sobre práticas sexuais seguras:
  • Educação sobre os comportamentos que aumentam o risco de ISTs.
  • Medidas preventivas (por exemplo, uso de preservativo)
  • Importância de tratar os parceiros
• Vacinação:
  • Hepatite B
  • HPV HPV Human papillomavirus (HPV) is a nonenveloped, circular, double-stranded DNA virus belonging to the Papillomaviridae family. Humans are the only reservoir, and transmission occurs through close skin-to-skin or sexual contact. Human papillomaviruses infect basal epithelial cells and can affect cell-regulatory proteins to result in cell proliferation. Papillomavirus (HPV)
• Profilaxia:
  • Profilaxia antirretrovírica pré-exposição contra o VIH ( HIV HIV Anti-HIV Drugs PrEP)
  • Profilaxia antirretrovírica pós-exposição contra o VIH (administrada dentro de 72 horas)
• A terapêutica supressora do HSV HSV Herpes simplex virus (HSV) is a double-stranded DNA virus belonging to the family Herpesviridae. Herpes simplex virus commonly causes recurrent infections involving the skin and mucosal surfaces, including the mouth, lips, eyes, and genitals. Herpes Simplex Virus 1 and 2 reduz a transmissão da infeção para o parceiro não infetado.