Posts filed under ‘Infecciones de transmision sexual’

Behavioral Sexual Risk-Reduction Counseling in Primary Care to Prevent Sexually Transmitted Infections – An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force

Annals of Internal Medicine Sept.23, 2014

Elizabeth A. O’Connor, PhD; Jennifer S. Lin, MD, MCR; Brittany U. Burda, MPH; Jillian T. Henderson, PhD; Emily S. Walsh, MPH; and Evelyn P. Whitlock, MD, MPH

From Kaiser Permanente Center for Health Research, Portland, Oregon.


Sexually transmitted infections (STIs) are common and preventable.


To update a previous systematic review about the benefits and harms of sexual risk-reduction counseling to prevent STIs for the U.S. Preventive Services Task Force.

Data Sources

Selected databases from January 2007 through October 2013, manual searches of references lists and grey literature, and studies from the previous review.

Study Selection

English-language fair- or good-quality trials conducted in adolescents or adults.

Data Extraction

One investigator abstracted data and a second checked the abstraction. Study quality was dual reviewed.

Data Synthesis

31 trials were included: 16 were newly published (n = 56 110) and 15 (n = 14 214) were from the previous review. Most trials targeted persons at increased risk for STIs based on sociodemographic characteristics, risky sexual behavior, or history of an STI. High-intensity (>2 hours) interventions reduced STI incidence in adolescents (odds ratio, 0.38 [95% CI, 0.24 to 0.60]) and adults (odds ratio, 0.70 [CI, 0.56 to 0.87]). Lower-intensity interventions were generally not effective in adults but some approaches were promising. Although moderate-intensity interventions may be effective in adolescents, data were very sparse. Reported behavioral outcomes were heterogeneous and most likely to show a benefit with high-intensity interventions at 6 months or less. No consistent evidence was found that sexual risk-reduction counseling was harmful.


Low-risk populations and male adolescents were underrepresented. Reliability of self-reported behavioral outcomes was unknown.


High-intensity counseling on sexual risk reduction can reduce STIs in primary care and related settings, especially in sexually active adolescents and in adults at increased risk for STIs.

Primary Funding Source

Agency for Healthcare Research and Quality.


September 26, 2014 at 8:23 am

Immunosuppression in Patients with Chronic Hepatitis B.

Curr Hepatol Rep. 2014 Jun 21;13:235-244. eCollection 2014.

Seetharam A1, Perrillo R2, Gish R3.
Author information
1Banner Transplant and Advanced Liver Disease Center, Phoenix, AZ USA ; University of Arizona College of Medicine, Phoenix, AZ USA.
2Hepatology Division, Baylor University Medical Center, Dallas, TX USA ; Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX USA.
3St. Joseph’s Hospital Medical Center/Liver Center, Phoenix, AZ USA ; 6022 La Jolla Mesa Drive, San Diego, CA 92037 USA.
After hepatitis B virus (HBV) infection, HBV DNA persists in minute amounts in hepatocyte nuclei even in individuals with “resolved” infection.

Viral replication and development of liver disease depend on the balance between viral mechanisms promoting persistence and host immune control. Patients with active or inactive disease or resolved HBV infection are at risk for reactivation with immunosuppressive therapy use.

HBV reactivation varies from a clinically asymptomatic condition to one associated with acute liver failure and death. We review recent studies on HBV reactivation during immunomodulatory therapies for oncologic, gastroenterological, rheumatic, and dermatologic disorders.

Risk calculation should be determined through HBV screening and assessment of immunosuppressive therapy potency. We also discuss monitoring for reactivation, prophylactic antiviral therapy, and treatment of reactivation.

Prophylactic antiviral treatment is needed for all HBsAg carriers and selected patients who have anti-HBc without HBsAg and is critical for preventing viral reactivation and improving outcomes.

August 19, 2014 at 12:17 pm

Making serological diagnosis of syphilis more accurate.

Indian J Sex Transm Dis. 2014 Jan;35(1):70-1.


Archana BR1, Prasad SR1, Beena PM1, Okade R2.

Author information

1Department of Microbiology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India.

2Department of Dermatology and Venereology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India.



August 19, 2014 at 12:15 pm

Current standards for diagnosis and treatment of syphilis: selection of some practical issues, based on the European (IUSTI) and U.S. (CDC) guidelines.

Postepy Dermatol Alergol. 2013 Aug;30(4):203-10.


Pastuszczak M1, Wojas-Pelc A.

Author information

1Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland. Head: Prof. Anna Wojas-Pelc MD, PhD.


Syphilis continues to be an important epidemiologic problem. For a few years a steady increase in the incidence of this sexually transmitted disease has been observed. Advances in medical science obligate the doctor to use only such diagnostic and therapeutic approaches that are scientifically proven. Based on the European (IUSTI) and U.S. (CDC) guidelines, in this manuscript, we present some selected practical issues concerning diagnosis and treatment of syphilis. We truly hope that the present review will help all doctors taking care of syphilitic patients to systematize the current knowledge.


August 19, 2014 at 12:13 pm

Sexually transmitted infections in older populations

Current Opinion in Infectious Diseases Feb 2013 V.26 N.1 P.80–85

Poynten, I. Marya; Grulich, Andrew E.a; Templeton, David J.a,b

aKirby Institute, University of New South Wales, Sydney

bRPA Sexual Health, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia

Correspondence to Dr Mary Poynten, Kirby Institute, The University of New South Wales, Sydney, NSW 2052, Australia. Tel: +61 2 93850937; fax: +61 2 93850920; e-mail:

Purpose of review

People are living longer and healthier lives. In recent years, there has been a focus on recognition of ongoing sexual activity among older adults and leading from this, the potential for an increase in diagnoses of sexually transmitted infections (STIs). Data on STI rates, sexual behaviour and factors affecting susceptibility to STIs are discussed.

Recent findings

There is limited published literature in this field and few recent longitudinal studies of STI acquisition in people older than 50 years. Although there is evidence of an increase in incidence, STIs remain rare in older compared with younger populations. Compared with their heterosexual counterparts, older men who have sex with men are at higher risk of incident HIV and some other STIs. The HIV epidemic is ageing as a result of increasing life span and acquisition of HIV at older ages. Improved longevity, evolving societal norms and physiological changes may place older people at risk of HIV and other STIs.


Routine STI screening is not warranted in all older people. Education and prevention strategies for all people at greater risk of HIV, regardless of age are required. Age-appropriate interventions designed to impart knowledge and provide the requisite skills needed to reduce STI risk in older age would be beneficial.




August 18, 2014 at 4:27 pm

Syphilitic Gumma

N Engl J of Medic Aug.14, 2014 V.371 P.667-667



  1. Cherniak and M. Silverman

A 45-year-old woman presented to an outreach clinic in rural Uganda with a 1-year history of a progressively enlarging ulcerated mass on the hard palate (Panel A). The mass had initially been painless but more recently had become painful and was causing difficulty in speaking and swallowing. She had received a diagnosis of cancer and was attempting to sell her home to pay for surgical resection. She had no history of syphilitic symptoms or treatment. The results on Treponema pallidum hemagglutination assay were positive for syphilis; nontreponemal testing was not locally available. Serologic analysis for human immunodeficiency virus was negative. Tertiary syphilis with an oral gumma was diagnosed. The patient was treated with three intramuscular injections of 2.4 million units of penicillin G benzathine at 1-week intervals. At follow-up 2 months after the end of treatment, there was resolution of the mass and symptoms (Panel B). In the oral cavity, gummas may occur as masses on the hard palate or tongue that frequently ulcerate….


August 15, 2014 at 10:08 pm

Syphilis Predicts HIV Incidence Among Men and Transgender Women Who Have Sex With Men in a Preexposure Prophylaxis Trial

Clin Infect Dis 2014 June 16 

Marc M. Solomon1,2, Kenneth H. Mayer4,5, David V. Glidden2, Albert Y. Liu3, Vanessa M. McMahan1, Juan V. Guanira6, Suwat Chariyalertsak7, Telmo Fernandez8, and Robert M. Grant1,2 for the iPrEx Study Teama

+ Author Affiliations

1The Gladstone Institutes

2University of California

3Bridge HIV, San Francisco Department of Public Health, California

4Fenway Health, Beth Israel Deaconess Medical Center, Fenway Institute

5Harvard Medical School, Boston, Massachusetts

6Investigaciones Medicas en Salud, Lima, Peru

7Research Institute for Health Sciences and Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Thailand

8Fundacion Ecuatoriana Equidad, Guayaquil, Ecuador

Correspondence: Marc M. Solomon, MD, MPH, 1650 Owens St, 5th Floor, San Francisco, CA 94158 (

Syphilis infection may potentiate transmission of human immunodeficiency virus (HIV). We sought to determine the extent to which HIV acquisition was associated with syphilis infection within an HIV preexposure prophylaxis (PrEP) trial and whether emtricitabine/tenofovir (FTC/TDF) modified that association.


The Preexposure Prophylaxis Initiative (iPrEx) study randomly assigned 2499 HIV-seronegative men and transgender women who have sex with men (MSM) to receive oral daily FTC/TDF or placebo. Syphilis prevalence at screening and incidence during follow-up were measured. Hazard ratios for the effect of incident syphilis on HIV acquisition were calculated. The effect of FTC/TDF on incident syphilis and HIV acquisition was assessed.


Of 2499 individuals, 360 (14.4%) had a positive rapid plasma reagin test at screening; 333 (92.5%) had a positive confirmatory test, which did not differ between the arms (FTC/TDF vs placebo, P = .81). The overall syphilis incidence during the trial was 7.3 cases per 100 person-years. There was no difference in syphilis incidence between the study arms (7.8 cases per 100 person-years for FTC/TDF vs 6.8 cases per 100 person-years for placebo, P = .304). HIV incidence varied by incident syphilis (2.8 cases per 100 person-years for no syphilis vs 8.0 cases per 100 person-years for incident syphilis), reflecting a hazard ratio of 2.6 (95% confidence interval, 1.6–4.4; P < .001). There was no evidence for interaction between randomization to the FTC/TDF arm and incident syphilis on HIV incidence.


In HIV-seronegative MSM, syphilis infection was associated with HIV acquisition in this PrEP trial; a syphilis diagnosis should prompt providers to offer PrEP unless otherwise contraindicated.


July 19, 2014 at 10:26 am

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