RESS and SBMT jointly publish guidelines for sexually transmitted diseases

The special edition of RESS is a joint publication with the Journal of the Brazilian Society of Tropical Medicine (RSBMT)

The special edition of Epidemiology and Health Services: journal of the Brazilian Unified Health System (RESS), vol .30, published in partnership with the Journal of the Brazilian Society of Tropical Medicine (RSBMT), brings 18 articles dealing with diagnosis, treatment and surveillance of sexually transmitted infections (STIs) that are covered in the Clinical Protocol and Therapeutic Guidelines (PCDT) for comprehensive care for people affected by these infections. Published by the Health Surveillance Secretariat of the Ministry of Health in 2020, the PCDT-IST was prepared based on scientific evidence and validated in discussions with specialists. The main objective of the articles is to provide information based on the best evidence for professionals involved in the care of people with STIs.

The General Coordinator for the Development of Epidemiology in Services (CGDEP) of the Department of Strategic Coordination of Health Surveillance (DAEVS) of the Health Surveillance Secretariat of the Ministry of Health (SVS/MS), and also, Executive Editor of RESS, Dra. Fátima Sonally Sousa Gondim, recognizes that the importance of the special issue on IST. For her, the articles in this issue, which present epidemiological and clinical aspects of STIs, with emphasis on guidance on diagnosis, treatment, surveillance, prevention and control of the disease, are essential for professionals working within the scope of the Unified Health System (SUS).

The special edition of RESS is a joint publication with the Revista da Sociedade Brasileira de Medicina Tropical (RSBMT), within the scope of the partnership signed between the two magazines, with simultaneous publication in three languages (Portuguese, Spanish and English). For Dr. Isis Carvalho, editor of RESS, the simultaneous publication of the Special Number on STI in RESS and in RSBMT represents an initiative of great relevance to expand the reach of the content to health professionals and managers involved in the care of people with STI, about the best practice based on the most up-to-date scientific evidence.

Editor of RSBMT, Dr. Dalmo Correia Filho, emphasizes that the technical cooperation agreement between the Journal of the Brazilian Society of Tropical Medicine and the Journal Epidemiology and Health Services is an important instrument that allows the expansion and dissemination of quality technical-scientific information giving visibility to this content and helping professionals involved with these diseases. For him, this joint publication, which is one of the goals of the cooperation term, will undoubtedly guide from the approach of clinical and laboratory diagnosis to the treatment and follow-up with STI surveillance and prophylaxis in the most affected populations throughout Brazil . “I also highlight the performance of RESS publishers, Dra. Isis Carvalho and Dr. Fátima Sonally Sousa Gondim, as well as the guest editor, Professor Dr. Carlos Henrique Costa, who played a key role in the entire peer review and review process, in addition to reviewing English, in both magazines. Without this proficient and extremely dedicated participation of these editors of the two journals, this work would certainly not have been successful”, he concludes.

Regarding the activity plan to be developed based on technical cooperation, the editor of RSBMT details that there are goals to be met, one of which is the implementation of new methodologies to improve the editorial process of both jounals. According to him, this has been done in conjunction with some standardization of instruments and modalities that can be incorporated into the peer review process. From there comes the second goal, the joint publication of consensus and technical reports, whose target audience is service professionals in the community in three languages. Another goal is to strengthen strategies for the dissemination and promotion of scientific writing, which have been carried out through pre-congress courses within the Brazilian Congress of Tropical Medicine  (MEDTROP). “The online dissemination of technical and scientific content on the website of both journals also deserves full recognition, in addition to the course for scientific editors in Brazil and abroad and the courses for reviewers of scientific journals with support from the Brazilian Association of Scientific Editors (ABEC) and the Committee on Publication Ethics (COPE). These two journals are part of the Scientific Electronic Library Online (SciELO) collection and follow good science practices and move towards taking on some open science practices”, points out Dr. Correia.

STIs are among the most common public health problems worldwide

Data from the 2020 HIV/AIDS Epidemiological Bulletin, from the Department of Chronic Condition Diseases and Sexually Transmitted Infections of the Health Surveillance Secretariat of the Ministry of Health (DCCI/SVS/MS) point out that, in 2019, 41.919 cases of HIV were reported in the Notifiable Diseases Information System (Sinan). Last year, 13.677 cases of HIV were reported (until 30/06/2020). Bulletin data also shows that in 2019, 37.308 AIDS cases were diagnosed. According to the Bulletin, since the year 2012, there has been a decrease in the rate of AIDS detection in Brazil, from 21.9/100 thousand inhabitants (2012) to 17.8/100 thousand inhabitants in 2019, representing a decrease of 18.7%. Although there has been a decrease in AIDS cases in almost the entire country, especially in recent years, part of this reduction may be related to the identification of data transfer problems between the spheres of SUS management, which can cause a difference in the total of cases between the municipal, state and federal HIV/AIDS databases. The decline in the number of cases may also be due to a delay in the notification and feeding of Sinans databases, due to the local mobilization of health professionals caused by the pandemic of COVID-19. In Brazil, from 2000 to June 2020, 134,328 HIV-infected pregnant women were notified, of which 8,312 in 2019, with a detection rate of 2,8/100 thousand live births. STIs among young people are also of concern. Data from the Epidemiological Bulletin revealed an increase of 64.9% in STIs between the age group of 15 to 19 years and 74.8% for those of 20 to 24 years, between 2009 and 2019.

The editorial Comprehensive care for People with Sexually Transmitted Infections of the special edition highlights that care for people with STI, and other health conditions, should reflect the best scientific evidence available, combined with inseparable contextual factors: the professionals experience, individual characteristics and the potential of the health system. Still according to him, the systematization of the diagnosis and treatment of these people requires, therefore, that the recommendations are organized and accessible to health professionals and that they receive training and have appropriate working conditions, allowing people to take care of other people. The article points out that the process of making recommendations based on scientific evidence also depends on professionals trained to locate and interpret the evidence, and on well-conducted scientific research, free of conflicts of interest, that respond appropriately to the questions that arise in clinical practice. According to the text, from the elaboration of recommendations based on scientific evidence to their incorporation, there are barriers that limit full adherence. Its adoption goes through a culture change that values science and professionals for care. Finally, the article points out that situations that lack evidence can be prioritized for research within the scope of SUS. The practice of elaborating and implementing evidence-based recommendations allows this culture to be established, with feedback from the process in a virtuous learning cycle.

(The opinion article Public policies on sexually transmitted infections in Brazil presents a brief history of public policies to tackle STIs in Brazil. It also addresses gaps and challenges to be considered by the country when formulating and implementing forthcoming policies. According to the publication, challenges and gaps remain to be overcome in the formulation and implementation of public policies on STIs in Brazil. In this context, there is a permanent need to strengthen the role of primary health care in comprehensive care for people with STIs and their sexual partners; ensure adequate vaccination coverage against HPV infection, viral hepatitis A and B; promote health information, education and communication; expand access to STI testing and treatment, focusing on the most vulnerable populations; notify sexual partners; and to qualify the approach of aspects of sexual health by health professionals, in addition to the screening of asymptomatic patients, prevention, clinical and laboratory management and surveillance of cases of sexually transmitted infection.

STIs persist as a worldwide public health problem. Since the 1990s, gonorrhea, syphilis and chlamydia have been increasing in prevalence. According to data released by the World Health Organization (WHO), in 2019, more than one million new cases of four sexually transmitted infections are contracted every day. This amounts to more than 376 million new annual cases of four diseases: chlamydia, gonorrhea, trichomoniasis and syphilis. On average, one in 25 people in the world has at least one of these STIs. Among the various factors that have facilitated this increase, globalization has been predominant. Antimicrobial resistance has narrowed the therapeutic range, mainly for gonorrhea and Mycoplasma genitalium. But luckily there is a lot of science involved in the prevention and treatment of HIV and other STIs since the 1980s. Anything that is not effective ceases to be used, while what is promising is better studied.