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BACKGROUND: Little is known about the aetiology of urethral discharge syndrome (UDS) and genital ulcer disease (GUD) in Brazil due to limited access to laboratory tests and treatment based mainly on the syndromic approach. OBJECTIVES: To update Brazilian treatment guidelines according to the current scenario, the first nationwide aetiological study for UDS and GUD was performed. METHODS: Male participants with urethral discharge (UD) and/or genital ulcer (GU) reports were enrolled. Sample collection was performed by 12 sentinel sites located in the five Brazilian regions. Between 2018 and 2020, 1141 UD and 208 GU samples were collected in a Universal Transport Medium-RT (Copan). A multiplex quantitative PCR kit (Seegene) was used to detect UD: Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), M. hominis (MH), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Ureaplasma parvum (UP), U. urealyticum (UU) and another kit to detect GU: cytomegalovirus (CMV), Haemophilus ducreyi (HD), herpes simplex virus type 1 (HSV1), herpes simplex virus type 2 (HSV2), lymphogranuloma venereum (LGV), Treponema pallidum (TP) and varicella-zoster virus (VZV). RESULTS: In UD samples, the frequency of pathogen detection was NG: 78.38%, CT: 25.6%, MG: 8.3%, UU: 10.4%, UP: 3.5%, MH: 3.5% and TV: 0.9%. Coinfection was assessed in 30.9% of samples, with 14.3% of NG/CT coinfection. The most frequent pathogen identified in GU was HSV2, present in 40.8% of the samples, followed by TP at 24.8%, LGV and CMV at 1%, and HSV1 at 0.4%. Coinfection of TP/HSV2 was detected in 4.4% of samples. VZV and HD were not detected. In 27.7% of the GU samples, no pathogen was detected. CONCLUSION: This study provided the acquisition of unprecedented data on the aetiology of UDS and GUD in Brazil, demonstrated the presence of a variety of pathogens in both sample types and reaffirmed the aetiologies known to be most prevalent globally.

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ABSTRACT Purpose Our objective was to investigate the prevalence of SWA, associated factors, relationship with STIs, and behavioral aspects in men attended at Referral Centers for STIs and acquired immunodeficiency syndrome (AIDS)/CR-STI/AIDS in northeast Brazil. Materials and Methods In this cross-sectional study, a questionnaire with sociodemographic, clinical, sexual and SWA practices information was applied to 400 men attended at two CR-STI/AIDS in Northeast Brazil on the years of 2018 and 2019. Clinical and laboratory diagnoses of STIs were confirmed in medical records. Logistic regression models were performed to identify the independent predictors for SWA. Results The prevalence of SWA over total samples was 15.00%. Of the participants, 239 (59.75%) of the participants were diagnosed with STIs, and of these 37 (15.48%) reported SWA. Most men practiced SWA in adolescence, being the last episode more than 20 years ago, usually with asinine and mules, in vaginal route and without a condom. SWA practitioners have higher percentages of occurrence of some viral STIs. SWA was associated with increasing age, history of residence in a rural area with remained over 12 years, married or widowed/separated, heterosexuals, with less than 7 years of study, Catholics, with hepatitis B, former user of alcoholic beverages and smokers, with a history of STI and intercourse with sex workers. Conclusion SWA practices increase STIs vulnerability. The association between hepatitis B and SWA highlights the importance of educational campaigns and conclusive studies on the topic.

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PURPOSE: Our objective was to investigate the prevalence of SWA, associated factors, relationship with STIs, and behavioral aspects in men attended at Referral Centers for STIs and acquired immunodeficiency syndrome (AIDS)/CR-STI/AIDS in northeast Brazil. MATERIALS AND METHODS: In this cross-sectional study, a questionnaire with sociodemographic, clinical, sexual and SWA practices information was applied to 400 men attended at two CR-STI/AIDS in Northeast Brazil on the years of 2018 and 2019. Clinical and laboratory diagnoses of STIs were confirmed in medical records. Logistic regression models were performed to identify the independent predictors for SWA. RESULTS: The prevalence of SWA over total samples was 15.00%. Of the participants, 239 (59.75%) of the participants were diagnosed with STIs, and of these 37 (15.48%) reported SWA. Most men practiced SWA in adolescence, being the last episode more than 20 years ago, usually with asinine and mules, in vaginal route and without a condom. SWA practitioners have higher percentages of occurrence of some viral STIs. SWA was associated with increasing age, history of residence in a rural area with remained over 12 years, married or widowed/separated, heterosexuals, with less than 7 years of study, Catholics, with hepatitis B, former user of alcoholic beverages and smokers, with a history of STI and intercourse with sex workers. CONCLUSION: SWA practices increase STIs vulnerability. The association between hepatitis B and SWA highlights the importance of educational campaigns and conclusive studies on the topic.

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Introdução: A doença de Milroy manifesta-se como linfedema de membros inferiores e região genital, o que provoca prejuízos físicos e sociais. Relato de Caso: Reporta-se um caso de linfedema penoescrotal severo em um paciente com doença de Milroy. Foi realizada a ressecção cirúrgica do tecido afetado e a reconstrução com retalhos locais e enxerto de pele. Discussão: A doença de Milroy é rara, de caráter autossômico dominante. Sua apresentação clínica é progressiva e decorre da hipoplasia dos vasos linfáticos dos membros inferiores. O tratamento em casos avançados é iminentemente cirúrgico. Conclusão: No caso apresentado, o tratamento cirúrgico é uma boa opção. O uso de retalho paraescrotal para escrotoplastia associado ao enxerto para cobertura do pênis proporciona bom resultado funcional.

Introduction: Milroy disease manifests itself as lymphedema of the lower limbs and genital region, which causes physical and social damage. Case Report: A case of severe-scrotal lymphedema in a patient with Milroy disease. Surgical resection of the affected tissue and reconstruction with local flaps and skin graft were performed. Discussion: Milroy disease is a rare autosomal dominant disease. The clinical presentation is progressive and results from hypoplasia of the lymphatic vessels of the lower limbs. Treatment in advanced cases is mainly surgical. Conclusion: In the case of a patient with Milroy disease and severe penoscrotal lymphedema, surgical treatment is a good option. The use of parascrotal flaps for scrotoplasty associated with a graft to recover the penis provides a good functional result.

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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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Abstract Genital lesions are an unusual presentation of American cutaneous leishmaniasis. Conditions such as disseminated cutaneous leishmaniasis and HIV infection may be associated with genital involvement. The authors present five cases of American cutaneous leishmaniasis with genital lesions and discuss the clinical and epidemiological aspects observed in this case series.

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Genital lesions are an unusual presentation of American cutaneous leishmaniasis. Conditions such as disseminated cutaneous leishmaniasis and HIV infection may be associated with genital involvement. The authors present five cases of American cutaneous leishmaniasis with genital lesions and discuss the clinical and epidemiological aspects observed in this case series.

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Resumen La presencia de una masa en la región escrotal comprende un amplio espectro de patologías, unas con mayor urgencia para el manejo que otras, dado el riesgo asociado de pérdida testicular o desarrollo de cáncer. Dentro de las posibilidades diagnósticas se encuentran las neoplasias, destacando las originadas en el epidídimo, con un 75% de casos de etiología benigna, correspondiendo un 9% al cistoadenoma papilar de epidídimo que sobresale por su baja frecuencia dado que en la literatura mundial existen aproximadamente 70 reportes publicados con escasos provenientes de literatura médica en castellano, en los que se incluye el presente caso expuesto en el que se confirma histopatológicamente un cistoadenoma papilar de epidídimo y se presenta una revisión del tema acerca del enfoque de un paciente con masa escrotal. Asimismo se resalta el hecho de que esta lesión puede asociarse con la enfermedad de Von Hippel Lindau, sobre todo en presentaciones bilaterales. MÉD.UIS. 2020;33(2):95-100.

Abstract The presence of a mass in the scrotal region comprises a wide spectrum of pathologies, some with greater urgency for management than others, given the associated risk of testicular loss or cancer development. Among the diagnostic possibilities are the neoplasms, highlighting those originating in the epididymis, with 75% of cases of benign etiology, 9% corresponding to the papillary cystadenoma of the epididymis that stands out for its low frequency given that in the world literature there are approximately 70 published reports with few from medical literature in Spanish, which include the present case presented in which a papillary cystadenoma of the epididymis is confirmed histopathologically and a review of the topic about the approach of a patient with scrotal mass is presented. Also the fact that this lesion can be associated with von Hippel Lindau disease, especially in bilateral presentations is highlighted. MÉD.UIS. 2020;33(2):95-100.

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SUMMARY OBJECTIVE We aimed to determine whether atherogenic dyslipidemia is associated with the disease and morbidity in our patients treated for Fournier's gangrene (FG). METHODS Sixty-two patients who were treated with the diagnosis of FG at our center between 2012 and 2017 were retrospectively screened. RESULTS The triglyceride values of the patients who required reconstructive surgery were statistically significantly higher than those of the patients for whom wound debridement and primary suturing was sufficient (p:0.001). A total of 65.7% of the patients had normal triglyceride values in the group in which wound debridement and primary suturing was sufficient, while this rate was 22.2% in the group of patients who needed reconstructive surgery; the difference was statistically significant (p: 0.002). The UFGSI score of those with triglyceride values higher than the normal range was statistically significantly higher (p:0.006). The cut-off point for the triglyceride value for which Fournier's gangrene was more morbid and the probability of reconstructive surgery need was significantly higher, i.e., >233mg. CONCLUSION Our study has demonstrated that atherogenic dyslipidemia, especially hypertriglyceridemia, is an important factor affecting morbidity and associated with high patient care costs after hospitalization and discharge in FG.

RESUMO OBJETIVO Nosso objetivo foi determinar se as dislipidemias aterogênicas estão associadas à doença e à morbidade em nossos pacientes tratados para a gangrena de Fournier (GF). MÉTODOS Sessenta e dois pacientes tratados com o diagnóstico de GF em nosso centro entre 2012 e 2017 foram selecionados retrospectivamente. RESULTADOS Os valores de triglicérides dos pacientes que necessitaram de cirurgia reconstrutiva foram estatisticamente significativamente maiores em comparação com aqueles dos pacientes nos quais o desbridamento da ferida e a sutura primária foram suficientes (p:0,001); 65,7% dos pacientes apresentaram valores normais de triglicérides no grupo em que desbridamento da ferida e sutura primária foram suficientes, enquanto que essa taxa foi de 22,2% no grupo de pacientes que necessitaram de cirurgia reconstrutiva, e a diferença foi estatisticamente significativa (p:0,002). O escore UFGSI daqueles com valores de triglicerídeos acima da faixa normal foi estatisticamente significativamente maior (p:0,006). O ponto de corte para o valor de triglicérides pelo qual a gangrena de Fournier era mais mórbida e a probabilidade de necessidade de cirurgia reconstrutiva era significativamente maior foi >233 mg. CONCLUSÃO Nosso estudo demonstrou que a dislipidemia aterogênica, especialmente a hipertrigliceridemia, é um fator importante que afeta a morbidade e os altos custos associados ao cuidado do paciente após hospitalização e alta na GF.

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