We conducted a cross-sectional study to assess sexual and drug use risk in 161 children and youth in street circumstances in Porto Alegre, Brazil. Median age was 14 and 79% were male. Overall, 59% reported ever having had sex; a significantly higher proportion of males (66%) compared to females (30%). Overall, 39% reported illicit drug use in the last year, and only 1.2% reported injection drug use. In multivariate analyses, correlates of unsafe sex included younger age of sexual debut, and having a steady sex partner. Independent correlates of illicit drug use included lack of family contact, increased hours in the street daily, having had an HIV test, and older age. A high proportion of children and youth in street circumstances reported high risk sex and drug exposures, confirming their vulnerability to HIV/STD. Services Centers, such as where this research was carried out, offer an opportunity for interventions.

This study describes the first national surveillance of gonococcal AMR in Brazil, which was quality assured according to WHO standards. The high resistance to ciprofloxacin (which promptly informed a revision of the Brazilian sexually transmitted infection treatment guideline), emerging resistance to azithromycin and decreasing susceptibility to extended-spectrum cephalosporins necessitate continuous surveillance of gonococcal AMR and ideally treatment failures, and increased awareness when prescribing treatment in Brazil.

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To determine the prevalence of sexually transmitted and blood-borne infections among incarcerated adolescents in Salvador, Brazil, we interviewed 300 incarcerated youth aged 11-18 years to participate in a physical examination and to provide a blood sample to test for HIV-1, hepatitis B and C viruses exposure, human T-cells lymphotrophic virus, and syphilis. Overall prevalence was anti-HIV, 0.34%; anti-HBc, 11.1%; HBsAg, 2.4%; anti-HCV, 6.4%; HTLV, 1.09%; and syphilis, 3.4%. The majority (86.3%) reported a history of sexual activity; 27% had never used condoms. Girls also reported previous pregnancy (35%), abortion (26%) and sexual abuse (74%). Many youth reported a family history of alcohol abuse (56%), illicit drug use (24.7%), or legal problems (38%). Serological results show that youth in Salvador are at high risk for blood-borne and sexually transmitted infections. Policies to reduce the risk and impact of these infections should be a requisite part of health care for incarcerated youth.

The purpose of this study was to associate oral hygiene frequency and presence of visible biofilm in the primary dentition. The sample consisted of 90 children, aged up to 4 years old, outpatients of the University Hospital of the Rio de Janeiro State University. The examinations were carried out in a dental office by a single trained examiner who was aided by an assistant. The parents answered a structured questionnaire about oral hygiene methods and frequency. Two biofilm indices, one simplified (BF1) and the other conventional (BF2), were used. BF1 classifies biofilm as absent, thin or thick, in anterior and/or posterior teeth, and provides a score for the patient, whereas BF2 classifies biofilm as absent or present, provides scores for three surfaces of each tooth and the final score is the percentage of tooth surfaces with biofilm. More than half of the parents (51 - 56.7%) reported they cleaned their child's teeth at least twice a day, while 7 (7.8%) had never cleaned their child's teeth. BF1 revealed that 12.2% (11) of the children had no visible biofilm, 37.8% (34) had thin biofilm in anterior and/or posterior teeth, 27.8% (25) had thick biofilm in anterior or posterior teeth and 22.2% (20) had thick biofilm in both anterior and posterior teeth. BF2 revealed a mean value of 21.8% (s.d. 16.5). No statistically significant correlations were found between oral hygiene frequency and the two biofilm indices (p > 0.05), indicating that oral hygiene frequency was not associated to oral hygiene quality in the evaluated sample.

STDs are a significant public health problem in Brazil. A primary control strategy is the immediate treatment of symptomatic individuals. When services are unavailable, STD patients seek care in alternative settings. Probably the most frequently used settings are commercial pharmacies, where pharmacy clerks provide treatment, although Brazilian law prohibits selling antibiotics without prescription. Our objective was to evaluate prescribing practices by pharmacy clerks for STDs. We performed a cross-sectional study. Trained medical students visited 62 pharmacies in the city of Porto Alegre during March 2002. These were randomly chosen from a list of 863 registered pharmacies. The students presented to the pharmacy complaining of dysuria and urethral discharge. After obtaining a prescription, or not, they asked for additional instructions to be followed. Immediately after leaving the premises, the instructions were anonymously recorded. Of the 62 pharmacies visited, a clerk in 56 (90.3%, 95% confidence interval [CI]: 80.1%-96.4%) provided a prescription. Most frequently prescribed drugs were ampicillin with probenecide (29/51.8%) and rosoxacin (11/19.6%). Ministry of Health-recommended treatment was not suggested by any of the clerks. Forty-six additional recommendations were given. The use of condoms was the most frequent additional advice (42/46). Prescribing by pharmacy clerks is very prevalent in Porto Alegre. This may represent a lost opportunity for more comprehensive prevention effort (counselling, partner management, and diagnosing other STDs). Additionally, the most frequently prescribed drugs are not recommended by international or national health authorities for treatment of STDs, and none of these drugs covers chlamydia. We conclude that pharmacy clerks are a potentially important source of STD treatment and control but that their practices are in need of vast improvement.

Objectives Neisseria gonorrhoeae antimicrobial resistance (AMR) surveillance is imperative internationally, but only eight (22.9%) countries in the WHO Region of the Americas reported complete AMR data to the WHO Global Gonococcal Antimicrobial Surveillance Program (WHO GASP) in 2016. Genomic studies are ideal for enhanced understanding of gonococcal populations, including the spread of AMR strains. To elucidate the circulating gonococcal lineages/sublineages, including their AMR determinants, and the baseline genomic diversity among gonococcal strains in Brazil, we conducted WGS on 548 isolates obtained in 2015–16 across all five macroregions in Brazil. Methods A total of 548 gonococcal isolates cultured across Brazil in 2015–16 were genome sequenced. AMR was determined using agar dilution and/or Etest. Genome sequences of isolates from Argentina (n = 158) and the 2016 WHO reference strains (n = 14) were included in the analysis. Results We found 302, 68 and 214 different NG-MAST, MLST and NG-STAR STs, respectively. The phylogenomic analysis identified one main antimicrobial-susceptible lineage and one AMR lineage, which was divided into two sublineages with different AMR profiles. Determination of NG-STAR networks of clonal complexes was shown as a new and valuable molecular epidemiological analysis. Several novel mosaic mtrD (and mtrR and mtrE) variants associated with azithromycin resistance were identified. Conclusions We describe the first genomic baseline data to support the Brazilian GASP. The high prevalence of resistance to ciprofloxacin, tetracycline and benzylpenicillin, and the high number of isolates with mosaic penA and azithromycin resistance mutations, should prompt continued and strengthened AMR surveillance, including WGS, of N. gonorrhoeae in Brazil.