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Anogenital herpes is one of the most prevalent sexually transmitted infections worldwide. It has several clinical manifestations, from cases of primary herpes infection to recurrent forms, among them chronic mucocutaneous herpes. This presentation is rare, characterized by a duration of more than four weeks, usually associated with immunosuppression and resistance to classic anti-herpetic treatment. The present study presents a series of ten cases of chronic mucocutaneous herpes with a discussion about its clinical, laboratory, and therapeutic aspects.

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Abstract Anogenital herpes is one of the most prevalent sexually transmitted infections worldwide. It has several clinical manifestations, from cases of primary herpes infection to recurrent forms, among them chronic mucocutaneous herpes. This presentation is rare, characterized by a duration of more than four weeks, usually associated with immunosuppression and resistance to classic anti-herpetic treatment. The present study presents a series of ten cases of chronic mucocutaneous herpes with a discussion about its clinical, laboratory, and therapeutic aspects.

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Background: Umbilical endometriosis or Villar's nodule is uncommon. Incidence goes up to 0.5-1.2% of all patients with endometriosis. As far as 2012, only 109 cases of umbilical endometriosis have been reported worldwide, there is no incidence reports in Mexico. Clinically, it's a solitary node, solid and well defined, colored red, blue or black and it's ocassionally accompanied by bleeding and dysmenorrhea. The treatment can be medical or surgical and it consists of painkillers, and hormonal suppression using GnRH analogues, hormonal contraceptives, danazol or progesterone. Surgical treatment consists in complete resection of the umbilical lesion. The aim of this paper is to present a clinical report case and have a bibliographic review of this pathology. Clinical case: A 34 year-old patient comes to the clinic due to severe umbilical pain of some months, associated with enlargement, swelling and cyclic menstrual bleeding. Escision of the lesion is performed and sent to pathology having the diagnosis of umbilical endometriosis. There is no evidence of endometriosic implants under laparoscopic control. Conclusions: Regards of being a rare pathology, umbilical endometriosis must be taken as a differential diagnosis in patients with umbilical lesions associated with menstrual cycle pain.

Introducción: La endometriosis umbilical o "nódulo de Villar" es poco común. La incidencia varía entre 0.5-1.2% de todas las pacientes con endometriosis. Hasta el año 2012 solo se habían reportado 109 casos de endometriosis umbilical en el mundo; en México hasta el momento, no hay incidencia reportada. Clínicamente se presenta como una tumoración o nódulo solitario, sólido y bien delimitado, de coloración rojo, azul o negro, en ocasiones se acompaña de sangrado y dolor asociado al ciclo menstrual. Puede ser tratada de manera médica o quirúrgica.El tratamiento médico consiste en administración de analgésicos y supresión hormonal utilizando análogos de GnRH, anticonceptivos hormonales, danazol o progestágenos. El tratamiento quirúrgico consiste en resección completa de la lesión umbilical. El obejtivo de este trabajo es presentar el caso clínico y realizar una revisión bibliográfica sobre la endometriosis umbilical primaria, debido a que es una patología inusual. Caso clínico: Presentamos a una paciente de 34 años que acude por presentar dolor umbilical de varios meses de evolución, asociado con aumento de volumen, tumefacción y sangrado cíclico relacionado al ciclo menstrual. Se realiza exéresis de la lesión enviándola a Patología para su estudio definitivo, reportando endometriosis umbilical. Sin presencia de implantes endometriósicos en cavidad abdominal buscados de manera intencional por laparoscopia. Conclusiones: A pesar de ser una entidad poco frecuente, la endometriosis umbilical debe siempre de sospecharse como diagnóstico diferencial en pacientes con lesiones en la región, que presentan dolor asociado al ciclo menstrual.

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Schistosoma hematobium infection is an endemic parasitic disease in Africa, which is frequently associated with urinary schistosomiasis. The parasite infection causes epithelial changes and disruption, facilitating the infection by the human papilloma virus and human immunodeficiency virus (HIV). The authors report the case of a 44-year-old African HIV-positive woman who presented an abnormal routine Pap smear. Colposcopy examination revealed dense acetowhite micropapillary epithelium covering the ectocervix, iodine-negative, an erosion area in endocervical canal, and atypical vessels. Histologic examination of the surgical specimens showed numerous calcified schistosome eggs (probably S. hematobium) and a high-grade cervical intraepithelial neoplasia. The relation between S. hematobium infection and bladder cancer is well known; however, this relationship with cervical cancer remains controversial. The symptoms of schistosomiasis of the female genital tract are rather non-specific, and are often misdiagnosed with other pelvic diseases. The familiarity of health professionals with schistosomiasis of the female genital tract is less than expected, even in endemic regions. Therefore, great awareness of this differential diagnosis in routine gynecological practice is of paramount importance.

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Objetivo - Avaliar a prevalência de câncer de colo do útero e infecções genitais em mulheres atendidas no serviço de saúde pública de Goiânia-GO. O exame de Papanicolaou é o método utilizado para detecção das lesões intraepiteliais e neoplásicas da cérvice uterina, tendo importante papel na prevenção do câncer do colo do útero e no diagnóstico das infecções genitais. Métodos - Estudo retrospectivo dos laudos dos exames citopatológicos das mulheres atendidas nas Unidades de Atenção Básica em Saúde (UABS) de Goiânia-GO, entre 03/2006 a 05/2008. Os esfregaços citológicos foram analisados no Centro de Análises Clínicas Rômulo Rocha da Faculdade de Farmácia da Universidade Federal de Goiás (CACRR/FF/UFG). Resultados - Um total de 15.615 mulheres foi incluído no estudo. A mediana de idade foi de 33 anos (14-93 anos), a maioria (57,6%) tinha entre 20 e 39 anos e 6,6% (n=1.034) eram < 20 anos de idade. Mais de 50% dos casos de infecção entre adultas e adolescentes eram causados por Gardnerella vaginalis e 13,6% por Trichomonas vaginalis. Entre mulheres mais jovens (20-39 anos),16,9% das infecções foi causada por Candida sp. Aproximadamente 7,6% dos esfregaços avaliados apresentaram alterações celulares, sendo 4,9% células escamosas atípicas de significado indeterminado/lesão intraepitelial escamosa de baixo grau (ASC-US/LSIL) para as mulheres entre 20-29 anos e 2,6% células escamosas atípicas com possível lesão de alto grau/lesão intraepitelial escamosa de alto grau e células glandulares atípicas (ASC-H/+) para mulheres entre 20 e 49 anos. Conclusão - Lesões graves em mulheres jovens chamam atenção para a necessidade de políticas de saúde pública que reforcem a importância do Papanicolaou para a prevenção do colo de útero.

Objective - To correlate the prevalence of cervical cancer and genital infections with the age of women treated at public health service of Goiânia-GO. Papanicolaou test is the method used for detection of intraepithelial and neoplastic lesions in the uterine cervix, playing an important role in cervical cancer prevention and helping in female genital infections'diagnosis. Methods - Women's cytopathological tests were analyzed at Health Care Units from Goiânia-GO, between 03/2006 and 05/2008. Smears were analyzed at Clinical Analysis Laboratory Rômulo Rocha, at Pharmacy Faculty of the Federal University of Goiás. Results - The total of 15.615 women were included in this study. The median age was 33 years (14-93 years), 57.6% were between 20 and 39 years of age and 6.6% were adolescents <20 years of age. More than 50% of cases of infection among adults and adolescents were caused by Gardnerella vaginalis, followed by 13.6% by Trichomonas vaginalis and to 16.9% by Candida sp. Approximately, 7.6% of smears evaluated showed cellular alterations, and 4.9% atypical squamous cells of undetermined significance/squamous intraepithelial lesion of low grade (ASC-US/LSIL) for women aged 20-29 years and 2.6% atypical squamous cells can damage high-grade/squamous intraepithelial lesion high-grade and atypical glandular cells (ASC-H/+) for women aged 20-49 years. Conclusion - Serious injuries in young women draw attention to the need for public health policies that reinforce the importance of the Papanicolaou test for cervical cancer prevention.

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Lipschütz Ulcer, or ulcus vulvae acutum, is a rare and probably underdiagnosed entity that usually presents as an acute painful vulvar ulcer in young women. The etiology is unknown, although recent reports have associated it with the Epstein-Barr virus. The diagnosis is made by exclusion after ruling out sexually transmitted diseases, autoimmune causes, trauma, and other etiologies of genital ulcerations. We report a case of a young woman who developed flu-like symptoms and painful vulvar ulcers. Complementary examinations ruled out sexually transmitted diseases and the other usual causes of genital ulcers; lesions healed with no sequelae or recurrences. This case represents a rare important differential diagnosis of genital ulceration.

A Úlcera de Lipschütz, ou ulcus vulvae acutum, é uma entidade rara mas provavelmente subdiagnosticada, que se apresenta como úlcera vulvar aguda dolorosa numa mulher jovem. A etiologia é desconhecida embora relatos recentes a tenham associado à primo-infecção pelo vírus Epstein-Barr. O diagnóstico é estabelecido após exclusão de doenças sexualmente transmissíveis, causas autoimunes, traumáticas e outras etiologias de úlceras genitais. Relatamos o caso de uma jovem que desenvolveu quadro gripal e dolorosas úlceras genitais. Os exames complementares excluiram doenças sexualmente transmissíveis e as outras causas habituais de ulceração genital. As lesões cicatrizaram sem sequelas e sem recorrências. Este caso representa um diagnóstico diferencial importante e raro de ulceração genital.

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OBJETIVO: Avaliar os aspectos epidemiológicos e clínicos de pacientes ginecológicas atendidas nas redes privada e pública de saúde. MÉTODOS: Estudo de corte transversal, no qual foram estudados prontuários de 243 pacientes (122 pacientes no serviço público e 121 no privado), de janeiro de 2007 a janeiro de 2008. Excluíram-se os prontuários de pacientes grávidas, com sangramento genital, histórico de uso de cremes ou géis vaginais em intervalos inferiores há 15 dias e pacientes que tiveram relação sexual em prazo inferior a cinco dias da consulta avaliada. A análise dos dados foi realizada com recursos de processamento estatístico do software Stata, versão 9.2, considerando-se o nível de significância de 5 por cento. RESULTADOS: A média de idade das pacientes foi de 27±12 anos entre pacientes da rede pública, e de 25,9±10,4 anos na rede particular, não havendo diferença estatística entre estas médias (F=0,5 e p=0,4). As pacientes da rede pública apresentaram escolaridade mais baixa (p<0,001), eram preferencialmente do lar (p<0,001), iniciaram vida sexual mais precocemente, tiveram maior número de parceiros (p<0,001), de gestações (p<0,001) e de partos (p=0,004) e utilizavam principalmente a camisinha como método contraceptivo (p=0,013). Não houve diferença estatística em relação aos antecedentes de doenças sexualmente transmissíveis, ao diagnóstico de candidíase, vaginose bacteriana, tricomoníase ou neoplasia. CONCLUSÕES: As pacientes da rede pública de saúde apresentam maior número de gestações e partos. São, em geral, donas de casa, com baixa escolaridade, iniciam vida sexual mais precocemente e com maior número de parceiros. Entretanto, não houve diferença entre os grupos quando se avaliaram doenças mamárias, infecções ginecológicas ou neoplasias de colo uterino, o que sugere que o nível socioeconômico não é o único elemento no determinismo da doença e, por isso, outras variáveis devem ser avaliadas.

PURPOSE: To evaluate the epidemiological and clinical aspects of gynecological patients seeking care in the private and public health networks. METHODS: In this cross-sectional study we analyzed the records of 243 patients (122 public service patients and 121 private service ones), from January 2007 to January 2008. We excluded records of pregnant patients with vaginal bleeding, history of using vaginal creams or gels at intervals of less than 15 days and patients who had sexual intercourse within less than five days before their visit and with incomplete clinical data. Data were analyzed statistically using the Stata software, version 9.2, with a 5 percent level of significance. RESULTS: The mean age of the patients attending the public health service was 27±12 years-old and 25.9±10.4 years-old for patients attending the private health service, with no statistical difference between means (F=0.5 and p=0.4). Patients attending the public health service had lower education (p<0.001), they were preferentially housewives (p<0.001), began sexual life early, had a greater number of partners (p<0.001), of pregnancies (p<0.001) and of deliveries (p=0.004), and mainly used the condom as a contraceptive method (p=0.013). There was no statistical difference between groups regarding the history of sexual transmitted diseases, diagnosis of candidiasis, bacterial vaginosis, trichomoniasis, or neoplasia. CONCLUSIONS: Patients attending the public health service have a higher number of pregnancies and births. They are usually housewives with low educational level, their sex life begins early, and they have more partners. However, there was no difference between groups when evaluating breast diseases, gynecological infections, or cancer of the cervix, which suggests that socioeconomic status is not the only element in the determination of the disease and, therefore, other variables should be evaluated.

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Os autores apresentam imagens de duas formas clínicas mais frequentes da Donovanose, em ambos sexos. A donovanose é considerada uma doença sexualmente transmissível, endêmica nas regiões tropicais e semitropicais do globo. Apresentam também imagens de duas lâminas: uma da pesquisa direta (corpúsculos de Donovan, dentro de grandes células mononucleadas coradas de vermelho pelo Giemsa) e outra de achados histológicos típicos (formato de alfinete dentro do histiócito).

The authors present images of two of the most common clinical forms of granuloma inguinale (donovanosis) in males and females. Donovanosis is considered a sexually transmitted disease that is endemic in tropical and subtropical regions of the world. Two microscopic images are also shown, one of a direct smear (the presence of Donovan bodies within large mononuclear cells identified using Giemsa stain) and the other of typical histological findings (rod-shaped Donovan bodies within a mononuclear histiocyte).

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Se expone la causa de las lesiones en los genitales externos según 3 grandes grupos clasificatorios y se indican en cada caso las manifestaciones clínicas más importantes y los medios de diagnóstico específicos. Se muestra una guía práctica para el correcto enfoque diagnóstico y la conducta que debe seguir el médico de la familia.

The cause of the geniatalia lesions is exposed according to three large classificatory groups. The most important clinical manifestations as well as the specific diagnostic tools are indicated for each case. A practical guide for the proper diagnostic approach and for the behavior the family physician should follow is shown.

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Se realiza una revisión de las principales afecciones y problemas de interés para la atención primaria en la ginecología infantojuvenil, con énfasis en los aspectos preventivos y diagnósticos de éstas.

A review of the main affectations and problems of interest for primary health care in pediatric and adolescent gynecology is made, emphasizing the preventive and diagnostic aspects of them.