The incidence of sexually transmitted diseases has been on the rise in our setting for decades. These infections represent not only an individual problem, but also a problem of public health. Therefore, the management of STDs involves reducing community incidence, which means that common issues in the clinical practice such as failure to attend may become a more complex problem, which adds to the difficult and delicate task of locating sexual contacts that would benefit from screening and the appropriate treatment. On the other hand, STDs have direct legal implications in cases of underage patients, or suspected sexual assault. Therefore, the correct handling of these scenarios requires knowledge of the legal framework that regulates them. Dermatologists are clinically trained and prepared to deal with these conditions. Nonetheless, the legal issues involved are often difficult to solve. This document stands as a simple reference guide to help solve the main legal issues we may encounter in a consultation when dealing with STDs.

OBJECTIVE: SARS-CoV-2 is more easily spread by close contact, which is inherent to sexual intercourse. People with, or at risk for, sexually transmitted infections (STIs) may therefore have higher rates of COVID-19. The aim of this study was to estimate SARS-CoV-2 antibody seroprevalence in people seen at a dedicated STI clinic, compare our findings to the estimated seroprevalence in the local general population, and study factors associated with SARS-CoV-2 infection in this setting.
METHODS: Cross-sectional observational study including consecutive patients older than 18 years of age who had not yet been vaccinated against COVID-19 and who underwent examination or screening at a dedicated municipal STI clinic in March and April 2021. We ordered rapid SARS-CoV-2 serology and collected information on demographic, social, and sexual variables, STI diagnoses, and history of symptoms compatible with SARS-CoV-2 infection.
RESULTS: We studied 512 patients (37% women). Fourteen (24.2%) had a positive SARS-CoV-2 test. Variables associated with positivity were use of FFP2 masks (odds ratio 0.50) and a higher-than-average number of sexual partners (odds ratio 1.80). Use of FFP2 masks was not randomly distributed in this sample.
CONCLUSIONS: Sexually active members of the population in this study had a higher incidence of SARS-CoV-2 infection than the general population. The main route of infection in this group appears to be respiratory, linked to close contact during sexual encounters; sexual transmission of the virus is probably limited.

OBJECTIVE: SARS-CoV-2 is more easily spread by close contact, which is inherent to sexual intercourse. People with, or at risk for, sexually transmitted infections (STIs) may therefore have higher rates of COVID-19. The aim of this study was to estimate SARS-CoV-2 antibody seroprevalence in people seen at a dedicated STI clinic, compare our findings to the estimated seroprevalence in the local general population, and study factors associated with SARS-CoV-2 infection in this setting.
METHODS: Cross-sectional observational study including consecutive patients older than 18 years of age who had not yet been vaccinated against COVID-19 and who underwent examination or screening at a dedicated municipal STI clinic in March and April 2021. We ordered rapid SARS-CoV-2 serology and collected information on demographic, social, and sexual variables, STI diagnoses, and history of symptoms compatible with SARS-CoV-2 infection.
RESULTS: We studied 512 patients (37% women). Fourteen (24.2%) had a positive SARS-CoV-2 test. Variables associated with positivity were use of FFP2 masks (odds ratio 0.50) and a higher-than-average number of sexual partners (odds ratio 1.80). Use of FFP2 masks was not randomly distributed in this sample.
CONCLUSIONS: Sexually active members of the population in this study had a higher incidence of SARS-CoV-2 infection than the general population. The main route of infection in this group appears to be respiratory, linked to close contact during sexual encounters; sexual transmission of the virus is probably limited.

OBJECTIVE: Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system.
METHODS: Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups.
RESULTS: Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians.
CONCLUSIONS: STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.

OBJECTIVE: Predominantly sexually transmitted infections (PSTIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the Spanish national health service and private practices.
METHODS: Observational cross-sectional study of 2 periods. We described the diagnoses made in outpatient dermatology clinics obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Codes of the International Classification of Diseases, Tenth Revision, were used to select all 36 relevant diagnoses in the 2 periods. The diagnoses were classified into 12 groups.
RESULTS: Only 3.16% of diagnoses corresponded to PSTIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum infestation, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the national health service. In private practice, the diagnoses usually came after referrals from other physicians.
CONCLUSIONS: PSTIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, even considering that diagnoses of molluscum contagiosum inflate the overall estimate of such conditions. The failure to include centers specializing in PSTIs in the DIADERM random sample of dermatologists partly explains the survey\'s underestimation of these diseases in the specialty. A clear effort to promote use of specialized clinics should be made.

BACKGROUND: Sexually Transmitted Infections remain a major public health concern worldwide. Although traditionally considered treatable, the emergence of Neisseria gonorrhoeae resistance to antimicrobials is currently a serious problem. The goal of this study was to evaluate the incidence and trends of antimicrobial resistance over the last 10 years in N. gonorrhoeae isolates from a Portuguese Centre.
METHODS: Laboratorial confirmed N. gonorrhoeae infections diagnosed between 2009 and 2018 were evaluated. Susceptibilities to penicillin, tetracycline, ciprofloxacin, azithromycin and cefotaxime were studied, along with demographic and clinical characteristics.
RESULTS: From 2009 to 2018, 440 cases of N. gonorrhoeae infection were diagnosed in our center, with a significant yearly increase (p<0.05). Most cases occurred in males (97.9%), with a median age of 25 years. In 88.7% of the cases, treatment with ceftriaxone plus azithromycin was used. Resistances to penicillin, tetracycline and ciprofloxacin remained high throughout the study period.
CONCLUSIONS: Antimicrobial resistance of N. gonorrhoeae appeared shortly after the introduction of antimicrobials. To combat this problem, improved surveillance and more studies combining susceptibility and epidemiological data are needed. In our population, N. gonorrhoeae remains highly susceptible to the antibiotics currently recommended for its treatment, whereas ciprofloxacin, azithromycin (in monotherapy) and penicillin should be avoided as empirical treatment.

Syphilis has become a serious issue for human immunodeficiency virus (HIV)-infected patients worldwide in recent years; however, the studies related to HIV coinfection and syphilis reinfections in Istanbul, Turkey, are limited. Our objective was to determine the seroprevalence of syphilis among HIV-infected men in the city which has one of the highest HIV prevalence rates in Turkey. Two hundred and forty four (244) HIV-positive men were evaluated at Istanbul Medical Faculty, Department of Medical Microbiology from March to June 2018. Serum samples were screened for the presence of antibodies against Treponema pallidum using the chemiluminescent microparticle immunoassay (CMIA). Samples found to be positive were investigated with the rapid plasma reagin (RPR) test and the T. pallidum hemagglutination assay (TPHA). The patients completed a questionnaire for sociodemographic data. The mean age was found to be 41.8 years; 35.6% were men who have sex with men (MSM). The overall seroprevalence of syphilis among the patients was 19.3%. MSM had a significantly higher seroprevalence than heterosexual patients (28.7%). In Turkey, there is a high seroprevalence of syphilis in HIV-infected patients, MSM being the most affected group. Therefore, HIV-infected patients should be screened for syphilis at least annually and should be informed about sexually transmitted diseases (STDs).

OBJECTIVE: Since June 2016, there have been outbreaks of hepatitis A in various European countries, mainly affecting men who have sex with men (MSM). The aim of this study was to assess their clinical and epidemiological impact in Cantabria, Spain.
METHODS: We retrospectively collected all cases of hepatitis A diagnosed in Cantabria between January 2013 and September 2018. We compared 2 periods: January 2013-May 2016 and June 2016-September 2018.
RESULTS: A total of 156 cases were diagnosed, observing an increase in the incidence starting in October 2016. With regard to 2013-2016, we observed a higher proportion of men (50.0% vs. 84.5%; p=.012) with a predominance of the homosexual orientation (80.6%) and a higher rate of sexual transmission (0% vs. 48.3%; p=.061) for the patients in the 2016-2018 period. From the clinical standpoint, all cases of severe hepatitis occurred during this latter period.
CONCLUSIONS: Our results reaffirm the high clinical and epidemiological impact of the epidemic outbreak in Cantabria and emphasizes the need for optimising the current prevention measures against hepatitis A.

Sexually transmitted infections of the rectum and anus (STI-RA) mainly affect men who have sex with men (MSM). The incidence of STI-RA among them has increased in recent years.
Retrospective study in patients with diagnoses of STI-RA in an STI unit during the years 2014 and 2015. Epidemiological, clinical and microbiological data were collected.
We included 95 patients, all of whom were MSM; 88.42% were HIV+; 67.17% did not use a condom during their most recent sexual intercourse; 17.91% had had sex with sex workers and 72.22% had used drugs during sexual intercourse during the previous year. A percentage of 32.92 reported symptoms that had lasted longer than 30 days. Lymphogranuloma venereum (LGV) was diagnosed in 54.73% of the patients. All patients who presented with proctitis and perianal ulcers were diagnosed with LGV infection. All those who presented perianal ulcers without proctitis were diagnosed with syphilis.
All the patients affected by STI-RA were MSM, most of them HIV+, had engaged in high-risk sexual behaviour and had suffered prolonged symptomatology. Clinical and microbiological characteristics of STI-AR could help adjust the empiric therapy.

BACKGROUND: Over the last few years, oral and pharyngeal signs and symptoms due to oral sex have increased significantly. However, no review articles related to this subject have been found in the medical literature. The objective of our study was to identify otorhinolaryngological manifestations associated with orogenital/oroanal contact, both in adults and children, in the context of consensual sex or sexual abuse.
METHODS: We performed a review of the medical literature on otorhinolaryngological pathology associated with oral sex published in the last 20 years in the PubMed database.
RESULTS: Otorhinolaryngological manifestations secondary to oral sex practice in adults can be infectious, tumoral or secondary to trauma. The more common signs and symptoms found in the literature were human papillomavirus infection (above all, condyloma acuminata and papilloma/condyloma), oral or pharyngeal syphilis, gonococcal pharyngitis, herpes simplex virus infection and pharyngitis from Chlamydia trachomatis. The incidence of human papillomavirus -induced oropharyngeal carcinoma has dramatically increased. In children past the neonatal period, the presence of condyloma acuminatus, syphilis, gonorrhoea or palatal ecchymosis (the last one, unless justified by other causes) should make us suspect sexual abuse.
CONCLUSIONS: Sexual habits have changed in the last decades, resulting in the appearance of otorhinolaryngological pathology that was rarely seen previously. For this reason, it is important for primary care physicians to have knowledge about the subject to perform correct diagnosis and posterior treatment. Some sexual abuse cases in children may also be suspected based on the knowledge of the characteristic oropharyngeal manifestations secondary to them.