Abstract：
BACKGROUND: Little is known about the aetiology of urethral discharge syndrome (UDS) and genital ulcer disease (GUD) in Brazil due to limited access to laboratory tests and treatment based mainly on the syndromic approach.
OBJECTIVE: To update Brazilian treatment guidelines according to the current scenario, the first nationwide aetiological study for UDS and GUD was performed.
METHODS: Male participants with urethral discharge (UD) and/or genital ulcer (GU) reports were enrolled. Sample collection was performed by 12 sentinel sites located in the five Brazilian regions. Between 2018 and 2020, 1141 UD and 208 GU samples were collected in a Universal Transport Medium-RT (Copan). A multiplex quantitative PCR kit (Seegene) was used to detect UD: Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), M. hominis (MH), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Ureaplasma parvum (UP), U. urealyticum (UU) and another kit to detect GU: cytomegalovirus (CMV), Haemophilus ducreyi (HD), herpes simplex virus type 1 (HSV1), herpes simplex virus type 2 (HSV2), lymphogranuloma venereum (LGV), Treponema pallidum (TP) and varicella-zoster virus (VZV).
RESULTS: In UD samples, the frequency of pathogen detection was NG: 78.38%, CT: 25.6%, MG: 8.3%, UU: 10.4%, UP: 3.5%, MH: 3.5% and TV: 0.9%. Coinfection was assessed in 30.9% of samples, with 14.3% of NG/CT coinfection. The most frequent pathogen identified in GU was HSV2, present in 40.8% of the samples, followed by TP at 24.8%, LGV and CMV at 1%, and HSV1 at 0.4%. Coinfection of TP/HSV2 was detected in 4.4% of samples. VZV and HD were not detected. In 27.7% of the GU samples, no pathogen was detected.
CONCLUSIONS: This study provided the acquisition of unprecedented data on the aetiology of UDS and GUD in Brazil, demonstrated the presence of a variety of pathogens in both sample types and reaffirmed the aetiologies known to be most prevalent globally.
OBJECTIVE: To update Brazilian treatment guidelines according to the current scenario, the first nationwide aetiological study for UDS and GUD was performed.
METHODS: Male participants with urethral discharge (UD) and/or genital ulcer (GU) reports were enrolled. Sample collection was performed by 12 sentinel sites located in the five Brazilian regions. Between 2018 and 2020, 1141 UD and 208 GU samples were collected in a Universal Transport Medium-RT (Copan). A multiplex quantitative PCR kit (Seegene) was used to detect UD: Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), M. hominis (MH), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Ureaplasma parvum (UP), U. urealyticum (UU) and another kit to detect GU: cytomegalovirus (CMV), Haemophilus ducreyi (HD), herpes simplex virus type 1 (HSV1), herpes simplex virus type 2 (HSV2), lymphogranuloma venereum (LGV), Treponema pallidum (TP) and varicella-zoster virus (VZV).
RESULTS: In UD samples, the frequency of pathogen detection was NG: 78.38%, CT: 25.6%, MG: 8.3%, UU: 10.4%, UP: 3.5%, MH: 3.5% and TV: 0.9%. Coinfection was assessed in 30.9% of samples, with 14.3% of NG/CT coinfection. The most frequent pathogen identified in GU was HSV2, present in 40.8% of the samples, followed by TP at 24.8%, LGV and CMV at 1%, and HSV1 at 0.4%. Coinfection of TP/HSV2 was detected in 4.4% of samples. VZV and HD were not detected. In 27.7% of the GU samples, no pathogen was detected.
CONCLUSIONS: This study provided the acquisition of unprecedented data on the aetiology of UDS and GUD in Brazil, demonstrated the presence of a variety of pathogens in both sample types and reaffirmed the aetiologies known to be most prevalent globally.
摘要：
背景：由于主要基于综合征方法的实验室检查和治疗的机会有限，巴西对尿道放电综合征（UDS）和生殖器溃疡（GUD）的病因知之甚少。
目的：根据当前方案更新巴西治疗指南，对UDS和GUD进行了首次全国范围内的病原学研究.
方法：纳入有尿道放电（UD）和/或生殖器溃疡（GU）报告的男性参与者。位于巴西五个地区的12个前哨地点进行了样品收集。在2018年至2020年之间，在通用运输介质RT（Copan）中收集了1141个UD和208个GU样本。用多重定量PCR试剂盒(Seegene)检测UD:沙眼衣原体(CT),生殖支原体（MG），人马(MH)，淋病奈瑟菌（NG），阴道毛滴虫（电视），细小脲原体(UP),解脲支原体（UU）和另一种检测GU的试剂盒：巨细胞病毒（CMV），杜克雷嗜血杆菌(HD),单纯疱疹病毒1型（HSV1），单纯疱疹病毒2型（HSV2），性病淋巴肉芽肿（LGV），梅毒螺旋体（TP）和水痘-带状疱疹病毒（VZV）。
结果：在UD样本中，病原体检测频率为NG：78.38%，CT:25.6%,MG:8.3%,UU：10.4%，UP:3.5%,MH：3.5％和电视：0.9％。在30.9%的样本中评估了共感染，有14.3%的NG/CT合并感染。在GU中鉴定出的最常见的病原体是HSV2，存在于40.8％的样品中，其次是TP，为24.8%，LGV和CMV为1%，和HSV1为0.4%。在4.4%的样本中检测到TP/HSV2共感染。未检测到VZV和HD。在27.7%的GU样本中，未检测到病原体。
结论：这项研究为巴西UDS和GUD的病因学提供了前所未有的数据，证明了两种样本类型中存在多种病原体，并重申了已知在全球最普遍的病因。
目的：根据当前方案更新巴西治疗指南，对UDS和GUD进行了首次全国范围内的病原学研究.
方法：纳入有尿道放电（UD）和/或生殖器溃疡（GU）报告的男性参与者。位于巴西五个地区的12个前哨地点进行了样品收集。在2018年至2020年之间，在通用运输介质RT（Copan）中收集了1141个UD和208个GU样本。用多重定量PCR试剂盒(Seegene)检测UD:沙眼衣原体(CT),生殖支原体（MG），人马(MH)，淋病奈瑟菌（NG），阴道毛滴虫（电视），细小脲原体(UP),解脲支原体（UU）和另一种检测GU的试剂盒：巨细胞病毒（CMV），杜克雷嗜血杆菌(HD),单纯疱疹病毒1型（HSV1），单纯疱疹病毒2型（HSV2），性病淋巴肉芽肿（LGV），梅毒螺旋体（TP）和水痘-带状疱疹病毒（VZV）。
结果：在UD样本中，病原体检测频率为NG：78.38%，CT:25.6%,MG:8.3%,UU：10.4%，UP:3.5%,MH：3.5％和电视：0.9％。在30.9%的样本中评估了共感染，有14.3%的NG/CT合并感染。在GU中鉴定出的最常见的病原体是HSV2，存在于40.8％的样品中，其次是TP，为24.8%，LGV和CMV为1%，和HSV1为0.4%。在4.4%的样本中检测到TP/HSV2共感染。未检测到VZV和HD。在27.7%的GU样本中，未检测到病原体。
结论：这项研究为巴西UDS和GUD的病因学提供了前所未有的数据，证明了两种样本类型中存在多种病原体，并重申了已知在全球最普遍的病因。
