Background
Sexually transmitted infections (STI) are a global public health problem. Urethritis are among the most common STIs, and can cause several complications and facilitate the transmission of the HIV virus.
Objectives
To investigate the main etiologic agents of urethritis in 170 men treated at Fundação Alfredo da Matta.
Methods
To identify the agents, urethral exudate and urine were collected. Gram and culture tests were performed in Thayer-Martin medium for
Neisseria gonorrhoeae
and polymerase chain reaction for
Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Ureaplasma urealyticum, Ureaplasma parvum, Mycoplasma hominis, Mycoplasma genitalium,
and herpes simplex types 1 and 2.
Results
N. gonorrhoeae
were identified in 102 (60.0%) patients,
C. trachomatis
in 50 (29.4%),
U. urealyticum
in 29 (17.0%),
M. genitalium
in 11 (6.5 %),
U. parvum
in ten (5.9%), and
M. hominis
in seven (4.1%). Herpes simplex type 2 was diagnosed in 24 (21.6%) of the 111 patients who underwent PCR for this pathogen. In 69 cases there was co-infection; the most frequent were:
N. gonorrhoeae
and
C. trachomatis
in 21 (14.7%) patients;
N. gonorrhoeae
and
C. trachomatis
in 21 (12.4%) patients;
N. gonorrhoeae
and herpes simplex type 2 in 11 (6.5%), and
N. gonorrhoeae
and
U. urealyticum
in nine (5.3%).
Study limitations
Not relevant.
Conclusion
N. gonorrhoeae, C. trachomatis, U. urealyticum
, and herpes simplex type 2 were the pathogens most frequently identified in the present study. The main coinfection found was
N. gonorrhoeae
and
C. trachomatis
.
T. vaginalis
and herpes simplex type 1 were not identified in any of the patients.
Leprosy has a large spectrum of clinical manifestations, including necrotizing skin lesions and joint complaints that sometimes mimic a primary rheumatic disease, confounding the correct diagnosis and treatment. Herein, the authors report two cases of women with leprosy, respectively virchowian and dimorphic forms, presenting initially with purple-reddish skin lesions, evolving with necrosis and ulceration, livedo reticularis, joint pain, oligoarthritis, myalgia, and leg edema. The differential diagnosis with systemic lupus erythematosus (SLE) and systemic vasculitis such as polyarteritis nodosa (PAN) is discussed.
Leprosy is a systemic disease with predominant involvement of skin and nerves; articular manifestations are common and, in some cases, represent the initial complaint. We describe the case of a female patient with borderline leprosy, which manifested, initially, with symmetric polyarthritis, cutaneous ulcerative lesions on the lower limbs, and systemic manifestations mimicking rheumatic disease. The authors emphasize the importance of the differential diagnosis of the systemic, joint and, cutaneous involvement of leprosy with rheumatic diseases.
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