The obtained results indicate that sexual dysfunction is associated with HAM/TSP in women infected with HTLV-1 of reproductive age. Lima Lopes Martins A, Rios Grassi MF, de Aquino Firmino A, et al. Human T-Lymphotropic Virus-1-Associated Myelopathy/Tropical Spastic Paraparesis Is Associated With Sexual Dysfunction in Infected Women of Reproductive Age. Sex Med 2018;6:324-331.

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RESUMO Objetivo: Conhecer as vulnerabilidades vivenciadas por adolescentes e adultas jovens infectadas pelo Papilomavírus Humano atendidas em um centro de referência em Feira de Santana - Bahia. Método: Estudo qualitativo, realizado entrevista semiestruturada com 20 adolescentes e adultas jovens, no período de novembro de 2020 a fevereiro de 2021. Para análise dos dados, utilizaram-se a Análise de Conteúdo proposta por Bardin e o software Iramuteq. Resultados: A descoberta da infecção realça a incompreensão sobre o adoecimento, o medo, o desespero e a culpa, dimensões individuais e coletivas que apontam para o baixo conhecimento sobre o Papilomavírus Humano. Considerações finais: Faz-se necessário a implementação de políticas públicas para minimizar os riscos, pelo conhecimento e enfrentamento às infecções sexualmente transmissíveis, bem como estratégias de promoção da saúde e decisões compartilhadas para o processo de mudança de comportamento em adolescentes e adultas jovens.

Background Human T-lymphotropic virus type-1 (HTLV-1) causes a variety of sicca symptoms, including xeroderma, xerostomia, and xerophthalmia. Aim We sought to evaluate vaginal dryness via the degree of perceived vaginal lubrication, vaginal hormonal cytology, and direct measurements of vaginal wetting. Methods The research was designed as a cross-sectional study. Vaginal dryness was assessed by scores in the lubrication domain of the Female Sexual Function Index (FSFI) questionnaire and the Vaginal Maturation Index (VMI) determined by vaginal hormonal cytology, as well as the measurement of vaginal lubrication using Schirmer strips placed at the anterior vaginal wall. Medians (25th-75th percentiles) were calculated for each group and compared using a nonparametric Kruskal-Wallis test and the Dunn-Bonferroni post hoc method. Outcomes Outcomes were detection of the presence of vaginal dryness in women who were infected or noninfected with HTLV-1. Results HTLV-1–infected women (n = 72, 57 asymptomatic and 15 with HTLV-1–associated myelopathy/tropical spastic paraparesis [HAM/TSP]) and uninfected women (n = 49) were studied. Women with HAM/TSP had significantly lower FSFI lubrication scores than asymptomatic and uninfected women (P = .032). In addition, women with HAM/TSP had significantly lower VMI compared with the asymptomatic and uninfected groups (P = .027 and P = .039, respectively). Clinical Implications The results of this study show a reduction in vaginal lubrication in HTLV-1-infected women diagnosed with HAM/TSP compared with asymptomatic and uninfected women. Strengths and Limitations The lack of a gold standard test for the diagnosis of vaginal dryness and the fact that no assessment of vaginal pH was performed were limitations of this study. The strength of the study was the comprehensive assessment of vaginal dryness from several perspectives: subjective (perception of vaginal lubrication according to the vaginal lubrication domain of the FSFI), hormonal (vaginal hormonal cytology to assess local hormone status), and the degree of vaginal moisture (direct measurement of vaginal dryness with an instrument, the Schirmer strip, already used to measure the presence of dry eye). Conclusion HTLV-1-infected women with HAM/TSP have decreased vaginal lubrication compared with asymptomatic and uninfected women after adjusting for age.

Background: The prevalence of human T-lymphotropic virus type-1 (HTLV-1) infection is higher in women, and sexual intercourse has been described as an important route of male-to-female transmission. The present study aimed to quantify HTLV-1 proviral load (PVL) in vaginal fluid, and to investigate correlations with PVL in peripheral blood mononuclear cells (PBMCs). In addition, cytopathological alterations and vaginal microbiota were evaluated. Methods: HTLV-1-infected women were consecutively recruited at a multidisciplinary center for HTLV patients in Salvador, Brazil. All women underwent gynecological examinations to obtain cervicovaginal fluid and venipuncture for blood collection. PVL, as measured by real-time quantitative polymerase chain reaction (RT–qPCR), was expressed as the number of copies of HTLV-1/106 cells in blood and vaginal fluid samples. Light microscopy was used to assess cervicovaginal cytopathology and vaginal microbiota. Results: In the 56 included women (43 asymptomatic carriers and 13 diagnosed with HTLV-1-associated myelopathy/tropical spastic paraparesis—HAM/TSP), mean age was 35.9 (SD ± 7.2) years. PVL was higher in PBMCs (median: 23,264 copies/106 cells; IQR: 6776–60,036) than in vaginal fluid (451.9 copies/106 cells; IQR: 0–2490) (p < 0.0001). PVL in PBMCs was observed to correlate directly with PVL in vaginal fluid (R = 0.37, p = 0.006). PVL was detected in the vaginal fluid of 24 of 43 (55.8%) asymptomatic women compared to 12 of 13 (92.3%) HAM/TSP patients, p = 0.02. Cytopathologic analyses revealed no differences between women with detectable or undetectable PVL. Conclusion: HTLV-1 proviral load is detectable in vaginal fluid and correlates directly with proviral load in peripheral blood. This finding suggests that sexual transmission of HTLV-1 from females to males may occur, as well as vertical transmission, particularly in the context of vaginal delivery.

Objective: To know the vulnerabilities experienced by adolescents and young adults infected by the Human Papillomavirus attended at a reference center in Feira de Santana - Bahia. Method: Qualitative study, carried out with a semi-structured interview with 20 adolescents and young adults, from November 2020 to February 2021. For data analysis, the Content Analysis proposed by Bardin and the software Iramuteq were used. Results: The discovery of the infection highlights the misunderstanding about illness, fear, despair and guilt, individual and collective dimensions that point to little knowledge about the Human Papillomavirus. Final considerations: It is necessary to implement public policies to minimize risks, through knowledge and confrontation of sexually transmitted infections, as well as health promotion strategies and shared decisions for the process of behavior change in adolescents and young adults.

Background: The prevalence of human T-lymphotropic virus type-1 (HTLV-1) infection is higher in women, and sexual intercourse has been described as an important route of male-to-female transmission. The present study aimed to quantify HTLV-1 proviral load (PVL) in vaginal fluid, and to investigate correlations with PVL in peripheral blood mononuclear cells (PBMC). Methods: HTLV-1-infected women were consecutively recruited at a multidisciplinary center for HTLV patients in Salvador-Brazil. All women underwent gynecological examinations to obtain cervicovaginal fluid and venipuncture for blood collection. PVL, as measured by real-time quantitative polymerase chain reaction (RT-qPCR), was expressed as the number of copies of HTLV-1/106 cells in blood and vaginal fluid samples. Light microscopy was used to assess cervicovaginal cytopathology and vaginal microbiota. Results: In the 56 included women (43 asymptomatic carriers and 13 diagnosed with HTLV-associated myelopathy/tropical spastic paraparesis-HAM/TSP), mean age was 35.9 (SD±7.2) years. PVL was higher in PBMCs [median: 23,264 copies/106 cells (IQR: 7,420 - 64,371)] than in vaginal fluid [451.9 copies/106 cells (IQR: 0 - 2,672)] (p&lt;0.0001). PVL in PBMCs was observed to correlate directly with PVL in vaginal fluid (R=0.32, p=0.01). PVL was undetectable in vaginal fluid samples from 20 women (35.7%), most of whom were asymptomatic (19/20). Cytopathologic analyses revealed no differences between women with detectable or undetectable PVL. Conclusion: HTLV-1 proviral load is detectable in vaginal fluid and correlates directly with proviral load in peripheral blood. This finding suggests that sexual transmission of HTLV-1 from female to male may occur and vertical transmission, particularly in the context of vaginal delivery.

Na formação do profissional médico, o processo de ensino/aprendizagem da Pediatria/Hebiatria e Ginecologia/Obstetrícia, enquanto especialidades básicas, constitui requisito fundamental para a atuação necessária e eficiente em Atenção Primária à Saúde. Portanto, além de um requisito primordial, a capacitação nessas especialidades se apresenta como um desafio para as Instituições de Ensino Superior/IES, independente do nível de desenvolvimento social e do país onde essas práticas possam ser planejadas e desenvolvidas. O presente artigo tem como objetivo descrever a experiência desenvolvida pelos docentes e alunos do curso de medicina da UEFS, no cumprimento das atividades teórico-práticas dessas especialidades integrantes dos componentes curriculares das Práticas Integradas Ensino Serviço e Comunidade III e IV (PIESC III e IV), no período entre 2013 a 2016. São relatados procedimentos teórico-práticos, anamnese, exame físico, raciocínio diagnóstico, que permeiam o atendimento clínico. O processo de ensino/aprendizagem é analisado à luz das Diretrizes Curriculares Nacionais de 2014, com identificação de facilidades e dificuldades enfrentadas pelas equipes. Considera-se que as atividades das PIESC III e IV vêm cumprindo seus objetivos no que concerne ao processo de ensino/aprendizagem da Clinica Ampliada em Pediatria e Ginecologia, para atuação profissional, no nível da Atenção Primária à Saúde.