INTRODUÇÃO: Infecções pelo HIV, HBV, HCV e Treponema pallidum encontram no sistema prisional um ambiente favorável para suas propagações e representam grave problema de saúde pública. Neste estudo buscamos conhecer o perfil epidemiológico dos reeducandos de uma unidade prisional e a dinâmica do seu comportamento associado às infecções estudadas. Foram medidas as prevalências dessas infecções e suas coinfecções, investigados os potenciais fatores de risco, assim como medido o padrão de uso de drogas no presídio com ênfase no crack. MÉTODOS: Estudo epidemiológico transversal realizado de fevereiro a dezembro de 2007, na Penitenciária I de São Vicente. Realizada uma análise descritiva utilizando medidas de frequência, médias e desvio padrão. Foram considerados apenas os diagnósticos sorológicos para definição das infecções. Utilizado o OR (odds ratio) como medida de associação com nível de significância de 5% (?). Utilizada a regressão logística para estimar OR ajustado por algumas variáveis. RESULTADOS: Participaram das entrevistas 546 (84,1%) reeducandos e 514 (94,1%) realizaram as sorologias. Apresentaram um perfil jovem com idade média de 29,8 anos. 52,0% (283) referiram relacionamento conjugal com média de dois filhos. Declararam ser de cor parda 51,5% (280). O tempo médio de prisão foi de 10,5 anos. As prevalências identificadas foram: HIV 1,8% [IC95% = 0,1- 3,3], HBV 21,0% [IC95% = 17,8-25,1], HCV 5,3% [IC95% = 3,5-7,6], e 5,3% [IC95% =3,5-7,6] para a infecção pelo Treponema pallidum. Os fatores de risco associados com a infecção pelo HIV foram: uso de droga injetável (OR=15,38), > 30 anos (OR=13,3), uso de cocaína na vida (OR= 5,36) e uso de crack na vida (OR= 5,21). Nas análises multivariadas as variáveis que se mantiveram associadas com o HBV foram: uso de droga injetável (OR=3,36), ter referido DST (OR= 2,28), > de 30 anos (OR=1,86) e mais de cinco anos de prisão (OR= 2,17); com o HCV foram: uso de droga injetável (OR=9,65), uso de maconha na prisão (OR=2,91) e idade >30 anos (OR=8,41); com o Treponema pallidum foram: relação homossexual (OR=11,92) e ter referido sífilis (OR=10,88). As prevalências das coinfecções foram: 0,8% [IC95%= 0,2-2,0] para HIV/HBV, 1,4% [IC95%=0,5-2,8], para HBV/Treponema pallidum, 1,8% [IC95%= 0,8-3,3] para HBV/HCV, e para a tripla infecção 0,4% [IC95%= 0,5-1,4]. Confirmaram o uso de crack na vida 25,0% (136) dos entrevistados. Idade média de início de uso de drogas ilícitas foi de 15,4 anos. Na prisão, o uso de álcool foi relatado por 8,4% (45), tabaco por 62,0% (318), maconha por 36,5 % (194), cocaína por 9,0% (48), e crack por 11,7% (15), sendo seu uso diário referido por 2,3% (3). Uso de drogas injetáveis na vida foi referido por 5,9% (32) e nenhum uso nos últimos seis meses. As situações de violência relacionadas com drogas para 14,3% (28) foram de ameaças de morte, 16,7% (57) agressões físicas e 27,3% (3) sofreram agressão sexual. Para 15,8% (30) o crack esteve relacionado com estas situações. O seu uso com outras drogas foi referido por 41,5% (54). CONCLUSÃO: As prevalências encontradas na população confinada continuam maiores que as observadas na população geral. O consumo de drogas e praticas sexuais desprotegidas foram mantidas no período de confinamento. O tempo de confinamento mostrou-se fator importante na análise de risco. Os fatores de riscos identificados aparecem como importantes indicadores para a estruturação de estratégias de controle dessas infecções junto à população confinada. / INTRODUCTION: Infection by HIV, HBV, HCV and Treponema pallidum are common in the prison system due to an environment favorable to their propagation and represent a serious public health problem. This study aims to understand the epidemiological profile of the inmates in a prison unit and the behaviors associated with the infectious diseases studied. We estimated the prevalence of these infections and their co-infections, investigated potential risk factors, as well as identified the pattern of drug use in prison, especially crack use. METHODS: A cross-sectional epidemiological study conducted from February to December 2007 at the São Vicente Penitentiary . A descriptive analysis using frequency measures, means and standard deviations was conducted. We considered only the setting for serological diagnosis of infections. Odds ratio (OR) with a significance level of 5% (?) was used as a measure of association and a logistic regression was applied to estimate adjusted OR for some variables. RESULTS: A total of 546 prisoners were interviewed (84.1%). Of these, 514 (94.1%) underwent serological analysis. Results showed a profile of young men with an average age of 29.8 years. Fifty-two percent (283) reported marital relationship with an average of two children, and 51.5% (280) reported being of mixed ethnicity. The average time of arrest was 10.5 years. The prevalences were identified: HIV 1.8% [95% CI = 0.1 - 3.3], HBV 21.0% [95% CI 17.8 to 25.1], HCV 5.3% [95% CI = 3.5 to 7.6] and 5.3% [95% CI = 3.5 to 7.6] for infection with Treponema pallidum. The risk factors associated with HIV infection were injected-drug use (OR = 15.38), > 30 years (OR = 13.3), cocaine use (OR = 5.36) and use of crack during lifetime (OR = 5.21). According to multivariate analyzes, variables associated with HBV were: injected-drug use (OR = 3.36), reported any STD (OR = 2.28), > 30 years (OR = 1.86) and more than five years in prison (OR = 2.17); the variables associated with HCV were: injected-drug use (OR = 9.65), marijuana use in prison (OR = 2.91) and age> 30 years (OR = 8.41); the variables associated with Treponema pallidum were: homosexual intercourse (OR = 11.92) and have referred syphilis (OR = 10.88). The prevalence of co-infections were 0.8% [95% CI = 0.2 to 2.0] for HIV / HBV, 1.4% [95% CI = 0.5 to 2.8] for HBV / Treponema pallidum, 1.8% [95% CI = 0.8 to 3.3] for HBV / HCV infection and for the triple infection 0.4% [95% CI = 0.5 to 1.4]. Average age of onset of illicit drug use was 15.4 years. The use of crack during lifetime was reported by 25.0% (136) of respondents. In prison, alcohol use was reported by 8.4% (45), tobacco by 62.0% (318), marijuana by 36.5% (194), 9.0% for cocaine (48), and crack by 11.7% (15), with the daily use of crack reported by 2.3% (3). Injected-drug use during lifetime was reported by 5.9% (32), but no use in the last six months was reported. Drug-related violence episodes reported were death threats 14.3% (28), 16.7% (57) assaults and 27.3% (3) suffered sexual assault. To 15.8% (30) of the respondents, crack use was associated with violence episodes. The use of crack-cocaine in association with other drugs was reported by 41.5% (54). CONCLUSION: The prevalence found in the confined population is still larger than those observed in the general population. Drug use and unprotected sexual practices were maintained during the period of confinement. The confinement time proved to be an important factor in the analysis of risk of infection. The identified risk factors appear to be important indicators for developing strategies to control these infections in the prison environment.

INTRODUÇÃO: Infecções pelo HIV, HBV, HCV e Treponema pallidum encontram no sistema prisional um ambiente favorável para suas propagações e representam grave problema de saúde pública. Neste estudo buscamos conhecer o perfil epidemiológico dos reeducandos de uma unidade prisional e a dinâmica do seu comportamento associado às infecções estudadas. Foram medidas as prevalências dessas infecções e suas coinfecções, investigados os potenciais fatores de risco, assim como medido o padrão de uso de drogas no presídio com ênfase no crack. MÉTODOS: Estudo epidemiológico transversal realizado de fevereiro a dezembro de 2007, na Penitenciária I de São Vicente. Realizada uma análise descritiva utilizando medidas de frequência, médias e desvio padrão. Foram considerados apenas os diagnósticos sorológicos para definição das infecções. Utilizado o OR (odds ratio) como medida de associação com nível de significância de 5% (?). Utilizada a regressão logística para estimar OR ajustado por algumas variáveis. RESULTADOS: Participaram das entrevistas 546 (84,1%) reeducandos e 514 (94,1%) realizaram as sorologias. Apresentaram um perfil jovem com idade média de 29,8 anos. 52,0% (283) referiram relacionamento conjugal com média de dois filhos. Declararam ser de cor parda 51,5% (280). O tempo médio de prisão foi de 10,5 anos. As prevalências identificadas foram: HIV 1,8% [IC95% = 0,1- 3,3], HBV 21,0% [IC95% = 17,8-25,1], HCV 5,3% [IC95% = 3,5-7,6], e 5,3% [IC95% =3,5-7,6] para a infecção pelo Treponema pallidum. Os fatores de risco associados com a infecção pelo HIV foram: uso de droga injetável (OR=15,38), > 30 anos (OR=13,3), uso de cocaína na vida (OR= 5,36) e uso de crack na vida (OR= 5,21). Nas análises multivariadas as variáveis que se mantiveram associadas com o HBV foram: uso de droga injetável (OR=3,36), ter referido DST (OR= 2,28), > de 30 anos (OR=1,86) e mais de cinco anos de prisão (OR= 2,17); com o HCV foram: uso de droga injetável (OR=9,65), uso de maconha na prisão (OR=2,91) e idade >30 anos (OR=8,41); com o Treponema pallidum foram: relação homossexual (OR=11,92) e ter referido sífilis (OR=10,88). As prevalências das coinfecções foram: 0,8% [IC95%= 0,2-2,0] para HIV/HBV, 1,4% [IC95%=0,5-2,8], para HBV/Treponema pallidum, 1,8% [IC95%= 0,8-3,3] para HBV/HCV, e para a tripla infecção 0,4% [IC95%= 0,5-1,4]. Confirmaram o uso de crack na vida 25,0% (136) dos entrevistados. Idade média de início de uso de drogas ilícitas foi de 15,4 anos. Na prisão, o uso de álcool foi relatado por 8,4% (45), tabaco por 62,0% (318), maconha por 36,5 % (194), cocaína por 9,0% (48), e crack por 11,7% (15), sendo seu uso diário referido por 2,3% (3). Uso de drogas injetáveis na vida foi referido por 5,9% (32) e nenhum uso nos últimos seis meses. As situações de violência relacionadas com drogas para 14,3% (28) foram de ameaças de morte, 16,7% (57) agressões físicas e 27,3% (3) sofreram agressão sexual. Para 15,8% (30) o crack esteve relacionado com estas situações. O seu uso com outras drogas foi referido por 41,5% (54). CONCLUSÃO: As prevalências encontradas na população confinada continuam maiores que as observadas na população geral. O consumo de drogas e praticas sexuais desprotegidas foram mantidas no período de confinamento. O tempo de confinamento mostrou-se fator importante na análise de risco. Os fatores de riscos identificados aparecem como importantes indicadores para a estruturação de estratégias de controle dessas infecções junto à população confinada. / INTRODUCTION: Infection by HIV, HBV, HCV and Treponema pallidum are common in the prison system due to an environment favorable to their propagation and represent a serious public health problem. This study aims to understand the epidemiological profile of the inmates in a prison unit and the behaviors associated with the infectious diseases studied. We estimated the prevalence of these infections and their co-infections, investigated potential risk factors, as well as identified the pattern of drug use in prison, especially crack use. METHODS: A cross-sectional epidemiological study conducted from February to December 2007 at the São Vicente Penitentiary . A descriptive analysis using frequency measures, means and standard deviations was conducted. We considered only the setting for serological diagnosis of infections. Odds ratio (OR) with a significance level of 5% (?) was used as a measure of association and a logistic regression was applied to estimate adjusted OR for some variables. RESULTS: A total of 546 prisoners were interviewed (84.1%). Of these, 514 (94.1%) underwent serological analysis. Results showed a profile of young men with an average age of 29.8 years. Fifty-two percent (283) reported marital relationship with an average of two children, and 51.5% (280) reported being of mixed ethnicity. The average time of arrest was 10.5 years. The prevalences were identified: HIV 1.8% [95% CI = 0.1 - 3.3], HBV 21.0% [95% CI 17.8 to 25.1], HCV 5.3% [95% CI = 3.5 to 7.6] and 5.3% [95% CI = 3.5 to 7.6] for infection with Treponema pallidum. The risk factors associated with HIV infection were injected-drug use (OR = 15.38), > 30 years (OR = 13.3), cocaine use (OR = 5.36) and use of crack during lifetime (OR = 5.21). According to multivariate analyzes, variables associated with HBV were: injected-drug use (OR = 3.36), reported any STD (OR = 2.28), > 30 years (OR = 1.86) and more than five years in prison (OR = 2.17); the variables associated with HCV were: injected-drug use (OR = 9.65), marijuana use in prison (OR = 2.91) and age> 30 years (OR = 8.41); the variables associated with Treponema pallidum were: homosexual intercourse (OR = 11.92) and have referred syphilis (OR = 10.88). The prevalence of co-infections were 0.8% [95% CI = 0.2 to 2.0] for HIV / HBV, 1.4% [95% CI = 0.5 to 2.8] for HBV / Treponema pallidum, 1.8% [95% CI = 0.8 to 3.3] for HBV / HCV infection and for the triple infection 0.4% [95% CI = 0.5 to 1.4]. Average age of onset of illicit drug use was 15.4 years. The use of crack during lifetime was reported by 25.0% (136) of respondents. In prison, alcohol use was reported by 8.4% (45), tobacco by 62.0% (318), marijuana by 36.5% (194), 9.0% for cocaine (48), and crack by 11.7% (15), with the daily use of crack reported by 2.3% (3). Injected-drug use during lifetime was reported by 5.9% (32), but no use in the last six months was reported. Drug-related violence episodes reported were death threats 14.3% (28), 16.7% (57) assaults and 27.3% (3) suffered sexual assault. To 15.8% (30) of the respondents, crack use was associated with violence episodes. The use of crack-cocaine in association with other drugs was reported by 41.5% (54). CONCLUSION: The prevalence found in the confined population is still larger than those observed in the general population. Drug use and unprotected sexual practices were maintained during the period of confinement. The confinement time proved to be an important factor in the analysis of risk of infection. The identified risk factors appear to be important indicators for developing strategies to control these infections in the prison environment.

No description available.

Yaws is a skin debilitating disease caused by Treponema pallidum subspecies pertenue with most cases reported in children. World Health Organization (WHO) aims at total eradication of this disease through mass treatment of suspected cases followed by an intensive follow-up program. However, effective diagnosis is pivotal in the successful implementation of this control program. Recombinase polymerase amplification (RPA), an isothermal nucleic acid amplification technique offers a wider range of differentiation of pathogens including those isolated from chronic skin ulcers with similar characteristics such as Haemophilus ducreyi (H. ducreyi). We have developed a RPA assay for the simultaneous detection of Treponema pallidum (T. pallidum) and H. ducreyi (TPHD-RPA). The assay demonstrated no cross-reaction with other pathogens and enable detection of T. pallidum and H. ducreyi within 15 min at 42 °C. The RPA assay was validated with 49 clinical samples from individuals confirmed to have yaws by serological tests. Comparing the developed assay with commercial multiplex real-time PCR, the assay demonstrated 94% and 95% sensitivity for T. pallidum and H. ducreyi, respectively and 100% specificity. This simple novel TPHD-RPA assay enables the rapid detection of both T. pallidum and H. ducreyi in yaws-like lesions. This test could support the yaws eradication efforts by ensuring reliable diagnosis, to enable monitoring of program success and planning of follow-up interventions at the community level.

Les hommes ayant des relations sexuelles avec d'autres hommes (HARSAH) ont un risque accru d'infections sexuellement transmissibles (IST). Les données sur les IST chez les HARSAH sont rares au Bénin. Cette étude visait à évaluer la prévalence et les facteurs associés à Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) et Treponema pallidum (TP) chez 204 HARSAH VIH-négatifs de Cotonou au Bénin initiant la prophylaxie préexposition en prévention du VIH. Un questionnaire a été complété et un médecin a réalisé un examen physique des participants. Des échantillons de sang, anaux, pharyngés et urinaires ont été prélevés. Les prévalences des IST ont été présentées avec un intervalle de confiance à 95% et la régression de Poisson a permis d'identifier leurs déterminants. La prévalence était de 18,6%, 15,2%, 9,8% et 27,9% pour CT, NG tous sites confondus, NG anorectal et l'infection par NG ou CT (NG/CT) respectivement. Les IST étaient généralement asymptomatiques (84,2% pour NG/CT) et de localisation extra-génitale (61,4% pour NG/CT). Un seul cas de syphilis non confirmée a été observé. En analyse multivariée, le fait d'avoir moins de 25 ans, de ne pas être célibataire et d'avoir plus de quatre partenaires féminines étaient associés à CT et NG/CT alors qu'un faible revenu mensuel était associé à NG/CT seulement. Le jeune âge, le sexe anal réceptif et ne pas avoir de rapports sexuels payants étaient associés à NG. Seul, le sexe anal réceptif était associé à NG anorectal. Les infections à NG et à CT sont fréquentes chez les HARSAH VIH-négatifs de Cotonou au Bénin. Leur caractère asymptomatique et extra-génital rend la prise en charge syndromique inefficace et le dépistage aux sites anal et pharyngé nécessaire. La syphilis est rare chez ces HARSAH. Les interventions de contrôle et de prévention des IST devraient cibler particulièrement les jeunes HARSAH et leurs partenaires sexuelles féminines. / Men who have sex with men (MSM) are at increased risk of sexually transmitted infections (STIs). Data on STIs among MSM are scarce in Benin. This study aimed to assess the prevalence and factors associated with Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Treponema pallidum (TP) among 204 HIV-negative MSM in Cotonou, Benin initiating pre-exposure prophylaxis (PrEP) for HIV prevention. A questionnaire was completed, and participants underwent a physical examination by a physician. Blood, anal, pharyngeal, and urinary samples were collected. Prevalences are presented with a 95% confidence interval. Poisson regression was used to determine factors associated with STIs. The prevalence was 18.6%, 15.2%, 9.8% and 27.9% for CT, NG-all sites, anorectal NG, and infection by either NG or CT (NG/CT) respectively. STIs were generally asymptomatic (84.2% for NG/CT) and of extra-genital location (61.4% for NG/CT). Only one case of unconfirmed syphilis was observed. In multivariate analysis, younger age, not being single, having more than four female sexual partners were associated with CT and NG/CT while lower monthly income was associated with NG/CT alone. Younger age, receptive anal sex and paid sex were associated with NG. Only receptive anal sex was associated with anorectal NG. NG and CT infections are common among HIV-negative MSM in Cotonou, Benin. Their asymptomatic and extra-genital nature makes syndromic management ineffective and screening at anal and pharyngeal sites necessary. Syphilis is rare among these MSM. STI control and prevention interventions should target young MSM and their female sexual partners.

Submitted by Cleide Dantas (cleidedantas@ufpa.br) on 2014-02-13T12:08:13Z No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_SoroepidemiologiaChlamydiaTrachomatis.pdf: 714575 bytes, checksum: 150b98376e7d5179deaf87cc15123665 (MD5) / Approved for entry into archive by Ana Rosa Silva (arosa@ufpa.br) on 2014-04-16T14:00:20Z (GMT) No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_SoroepidemiologiaChlamydiaTrachomatis.pdf: 714575 bytes, checksum: 150b98376e7d5179deaf87cc15123665 (MD5) / Made available in DSpace on 2014-04-16T14:00:20Z (GMT). No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_SoroepidemiologiaChlamydiaTrachomatis.pdf: 714575 bytes, checksum: 150b98376e7d5179deaf87cc15123665 (MD5) Previous issue date: 2010 / As bactérias do gênero Chlamydia estão associadas à diversas doenças, como cegueira, infecções genitais e pneumonia. Existem poucos dados sobre como a Chlamydia e o Treponema pallidum afetam indígenas na Amazônia brasileira. Este estudo objetivou determinar a soroprevalência das infecções pela Chlamydia trachomatis, Chlamydia pneumoniae e Treponema pallidum nas aldeias indígenas Bakajá, Apyterewa, Xingu e Mrotdidjãm, no município de Altamira, Pará, Brasil. O estudo incluiu 270 amostras de sangue coletadas no ano de 2007. A detecção de anticorpos das classes IgM e IgG anti-Chlamydia foi realizada empregando-se o ensaio imunoenzimático (ELISA), e selecionada de forma aleatória amostragem de 36, entre os positivos, para determinar a sorotipagem pela microimunofluorescência. Para detecção de anticorpos anti-T. pallidum foi utilizado um teste treponêmico (ELISA) e as amostras positivas foram submetidas a um teste não treponêmico (RPR). A prevalência geral de anticorpos anti-Chlamydia foi de 26,7%, com prevalência de 100% para C. trachomatis entre as amostras testadas pela MIF. Para a C. pneumoniae a prevalência foi de 61,1% e a prevalência de anticorpos contra Treponema pallidum foi baixa. As bactérias do estudo circulam nas comunidades indígenas da Amazônia brasileira estudada, o que requer uma resposta urgente das autoridades de saúde pública, pois estas bactérias podem causar doenças graves, mas são sensíveis a tratamento específico, quando diagnosticadas adequadamente. / Bacteria from the genius Chlamydia are associated with several diseases including blindness, reproductive tract infections and pneumonias. There is little data about Chlamydia and Treponema pallidum affects on native Indian population in the Brazilian Amazon region. This study determined the prevalence of infections by Chlamydia trachomatis, Chlamydia pneumoniae and Treponema pallidum in Altamira, Para- Brazil among the native Indian populations Bakaja, Apyretewa, Mrotidjam, Xingu and included 270 plasma samples collected in 2007; they were tested using an enzyme immunoassay (ELISA) for the detection of IgM and IgG antibodies to Chlamydia and random samples (36) was chosen from the positives for serotyping through a microimmunofluorescence assay (MIF). Antibodies anti-Treponema were detected using a treponemal (ELISA) test and the positive samples were subjected to a non-treponemal test (RPR). The overall prevalence of antibodies to Chlamydia was 26.7% with a 100% prevalence of C. trachomatis tested through MIF. Prevalence of antibodies to C.pneumoniae was 61.1% and the prevalence of antibodies to T. pallidum was low. This study of bacteria circulating in the Brazilian Amazon indigenous communities confirms that it is necessary for an urgent response from public health authorities, because these bacteria’s can cause serious illness. With adequate diagnoses these bacteria’s can be treated because they are sensitive to specific treatment.

Submitted by Cleide Dantas (cleidedantas@ufpa.br) on 2014-02-13T12:18:42Z No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_SoroepidemiologiaChlamydiaTrachomatisChlamydia.pdf: 2065401 bytes, checksum: 1da33c9028340a826d8e01d04fe2f763 (MD5) / Approved for entry into archive by Ana Rosa Silva (arosa@ufpa.br) on 2014-04-22T13:32:53Z (GMT) No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_SoroepidemiologiaChlamydiaTrachomatisChlamydia.pdf: 2065401 bytes, checksum: 1da33c9028340a826d8e01d04fe2f763 (MD5) / Made available in DSpace on 2014-04-22T13:32:54Z (GMT). No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_SoroepidemiologiaChlamydiaTrachomatisChlamydia.pdf: 2065401 bytes, checksum: 1da33c9028340a826d8e01d04fe2f763 (MD5) Previous issue date: 2009 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A Chlamydia trachomatis e o Treponema pallidum compartilham com o HIV uma importante forma de transmissão: a via sexual. Por conta do comprometimento imunológico dos portadores de HIV, a C. pneumoniae pode apresentar um papel potencial em infecções respiratórias. Este trabalho objetivou a descrição da soroprevalência destes três agentes em portadores de HIV do Estado do Pará, Brasil. Entre setembro de 2007 a junho de 2008, foram coletadas 430 amostras de portadores de HIV em Belém, Pará. Estas foram submetidas a um ELISA para detecção de anticorpo IgG e IgM anti-Chlamydia e, dentre os positivos, uma amostragem aleatória foi escolhida e submetida à microimunofluorescência para sorotipagem. Para a detecção de anticorpos anti-Treponema pallidum foi feito um teste não treponêmico (RPR) e um teste treponêmico (ELISA). Os resultados obtidos foram analisados pelo teste do χ2. A prevalência geral de anticorpos anti-Chlamydia foi 64,2% (51,6% para IgG e 4% para IgM). A sorotipagem mostrou uma alta prevalência de C. trachomatis (100% tanto para IgG como IgM), e C. pneumoniae (73,5% IgG e 70,5% IgM), sendo que houve uma larga disseminação dos sorotipos que causam infecções genitais da Chlamydia trachomatis. A prevalência geral de anticorpos contra o Treponema pallidum foi de 34,9%, sendo que 7,3% apresentaram resultado laboratorial indicativo de sífilis. As variáveis que apresentaram associação com a infecção por Chlamydia e Treponema pallidum foram: o gênero masculino, maior idade, baixa escolaridade, número de parceiros por semana, a prática de sexo anal, homossexualismo/bissexualismo, uso de droga não-endovenosa, histórico de IST. Faz-se necessário tanto a conscientização como o monitoramento da população, para impedir a transmissão destes agentes e para a melhoria da qualidade de vida dos indivíduos portadores de HIV. / Chlamydia trachomatis and Treponema pallidum share the sexual route of transmission with HIV-1. In consequence of the compromise of the immune response among HIV-1 carriers, C. pneumoniae is a potential harassment in respiratory infections. The present study intended the description of the seroprevalence of those three agents among 430 HIV-1 infected persons residing in the State of Para, Brazil, attended at the State Reference Unit (URE-DIPE), between September 2007 to June 2008. Plasma samples were tested using an enzyme immuno assay for the detection of IgM and IgG antibodies to Chlamydia and those which elicited positive results were ramdomly selected for serotyping through a microimmunofluorescence assay. Antibodies to T. pallidum were detected using a flocculation reaction (RPR) and an enzyme immunoassay. Results were compared statistically using the Chi square test (χ2). The general prevalence to Chlamydia was 64.2% (51.6% IgG reactivity and 4% to IgM). Serotyping showed 100% reactivity to C. trachomatis (for both IgG and IgM), a high prevalence to C. pneumoniae (73.5% IgG and 70.5% to IgM) and a large distribution of reactivity to strains of C. trachomatis which cause genital infections. Prevalence of antibodies to T. pallidum was 34.9% and 7.3% showed laboratory evidence of syphilis. Infection with both pathogens were associated to several characteristics which included: higher prevalence among males, high age, low number of study years, high number of sexual partners, anal sexual relations, homosexual/bisexual habits, use of non injecting drugs and the history of sti. It is necessary not only the individual attention for prevention, but also the continuous monitoring to block transmission and the improvement of the well being of HIV-1 infected persons.

CONTEXTE La syphilis est une maladie ré-émergente depuis 2000. Son traitement est simple, mais son diagnostic est complexe. La technique d’amplification génique de Treponema pallidum (Tp-PCR) existe depuis 1990 mais le CDC l’a incluse dans sa définition de cas en janvier 2014. OBJECTIFS 1) Evaluer la performance diagnostique de la Tp-PCR à différents stades cliniques et milieux biologiques. 2) Mesurer la sensibilité, spécificité et les valeurs prédictives de la Tp-PCR en fonction de 3 groupes de référence dans des ulcères récents. 3) Comparer les performances des 2 principales cibles de Tp-PCR.MATÉRIEL ET MÉTHODES Premièrement, une revue systématique et méta-analyse des études publiées depuis 1990 ont été menées. Ensuite une étude multicentrique prospective a été conduite dans 5 villes européennes pendant 2 ans chez des patients avec un ulcère oro-génital. Tous ont reçu le test de référence local et 2 Tp-PCRs dans l’ulcère (gène tpp47 vs. polA). Les valeurs de sensibilité, spécificité et valeurs prédictives de la Tp-PCR ont été calculées comparativement au fond noir (FN), à la sérologie et à un gold standard amélioré. La concordance des 2 cibles a été évaluée par un coefficient kappa.RÉSULTATS PRINCIPAUX La méta-analyse conclut que la Tp-PCR a une meilleure performance dans les ulcères récents. L’étude clinique montre que la Tp-PCR décrit une meilleure performance comparativement au gold standard amélioré et a même une meilleure sensibilité que le FN. Les 2 cibles ont la même valeur diagnostique et une concordance quasi parfaite. CONCLUSIONS La Tp-PCR ciblant tpp47 ou polA est cliniquement utile pour diagnostiquer une syphilis primaire et pourrait même remplacer le FN sous certaines conditions. / BACKGROUND Syphilis has re-emerged in at-risk populations since 2000. Although the treatment of syphilis is simple, its diagnosis remains challenging. Treponema pallidum Polymerase Chain Reaction (Tp-PCR) has been used in the diagnosis of syphilis since 1990 but it is included in the case definition of the CDC since January 2014. OBJECTIVES 1) To assess the accuracy of Tp-PCR in various biological specimens and syphilis stages. 2) To measure its diagnostic performance (sensitivity, specificity and predictive values) in ulcers from early syphilis compared to three groups of reference. 3) To compare the accuracy of the two most currently used targets: tpp47 and polA genes.METHODS We conducted a systematic review and meta-analysis of all studies published from 1990. We implemented a multicentre, prospective, observational study in 5 European cities between 09/2011 and 09/2013 among patients with an oral or genital ulcer suggestive of syphilis. All patients were tested with traditional reference tests plus 2 Tp-PCRs (tpp47 and polA). We estimated the sensitivity, specificity and predictive values of Tp-PCR compared to darkfield microscopy (DFM), serology and an enhanced gold standard. We used the kappa coefficient to assess the agreement between the 2 targets.MAIN RESULTST p-PCR had the best accuracy in ulcers from early syphilis. Tp-PCR performed better when compared to the enhanced gold standard and had a higher sensitivity than DFM. The 2 Tp-PCRs had a similar accuracy and an almost perfect agreement.CONCLUSIONS Tp-PCR targeting either tpp47 or polA is clinically useful to confirm an early syphilis in smears and could even replace DFM under specific conditions.