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Aetiological molecular identification of sexually transmitted infections that cause urethral discharge syndrome and genital ulcer disease in Brazilian men: a nationwide study
  1. Maria Luiza Bazzo1,2,
  2. Hanalydia de Melo Machado1,2,
  3. Jessica Motta Martins1,2,
  4. Marcos André Schörner1,2,
  5. Ketlyn Buss1,2,
  6. Fernando Hartmann Barazzetti1,2,
  7. Pamela Cristina Gaspar3,
  8. Alisson Bigolin3,
  9. Adele Benzaken4,5,
  10. Simone Veloso Faria de Carvalho6,
  11. Lidiane da Fonseca Andrade7,
  12. William Antunes Ferreira8,
  13. François Figueiroa9,
  14. Rafael Mialski Fontana10,
  15. Miralba Freire de Carvalho Ribeiro da Silva11,
  16. Roberto José Carvalho Silva12,
  17. Luiz Fernando Aires Junior13,
  18. Lis Aparecida de Souza Neves14,
  19. Angelica Espinosa Miranda3,15,
  20. Brazilian-GASP Network3,16
  1. 1 Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
  2. 2 Pharmacy Post Graduate Program, Molecular Biology, Microbiology and Serology Laboratory-LBMMS, Florianópolis, Brazil
  3. 3 Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis, Secretariat of Health Surveillance, Ministry of Health, Brasília, Distrito Federal, Brazil
  4. 4 Leônidas e Maria Deane Institute Fiocruz Amazonas, Manaus, Amazonas, Brazil
  5. 5 AIDS Healthcare Foundation, Los Angeles, California, USA
  6. 6 Belo Horizonte Municipal Health Secretariat, Belo Horizonte, Brazil
  7. 7 Asa Sul Polyclinic, Brasilia, Brazil
  8. 8 Alfredo da Matta Foundation for Tropical Dermatology and Venereology, Manaus, Brazil
  9. 9 Man's Clinic-AIDS Health Foundation, Recife, Brazil
  10. 10 Curitiba Municipal Health Secretariat, Curitiba, Brazil
  11. 11 Specialized State Center in Diagnosis, Care and Research, Salvador, Brazil
  12. 12 STI/AIDS Reference and Training Center, São Paulo, Brazil
  13. 13 Reference Center for Infectious Diseases, São José dos Campos, Brazil
  14. 14 Ribeirão Preto Municipal Health Secretariat, Ribeirão Preto, Brazil
  15. 15 Federal University of Espirito Santo, Vitoria, Brazil
  16. 16 Brazilian GASP, Florianópolis, Brazil
  1. Correspondence to Dr Maria Luiza Bazzo, Federal University of Santa Catarina, Florianópolis, 88037380, Santa Catarina, Brazil; m.l.bazzo{at}


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.

Objectives 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.

Conclusion 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.

  • urethritis
  • disease transmission, infectious
  • molecular biology
  • genital diseases, male
  • diagnosis

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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  • Handling editor Jane S Hocking

  • Collaborators Members of Brazilian-GASP Network: Simone Veloso Faria de Carvalho, Maria Rita Rabelo Costa, Luciane Guimarães Dias, Joana D’arc Pinheiro Feitosa, Mariana Isabella Maciel Sibele Corrêa Neto, Elly Rodrigo Porto, Lidiane da Fonseca Andrade, Glaura Regina de Castro e Caldo Lima, Maria Luiza Bazzo, Felipe de Rocco, Fernando Hartmann Barazzetti, Guilherme Kerber, Hanalydia de Melo Machado, Jéssica Motta Martins, Ketlyn Buss, Mara Cristina Scheffer, Marcos André Schörner, Ronaldo Zonta, Maria Rita Castilhos Nicola, Maria Cristina Cecconi, Barbara Suely Souza de Noronha, Cleiby Andrade dos Santos, Francinete Motta Lopes, Jairo de Souza Gomes, Jamile Izan Lopes Palhesta Júnior, Paulo Tadeu Cavalcante Saif, Willian Antunes Ferreira, Miralba Freire de Carvalho Ribeiro da Silva, André Maurício Costa Ramos, Roberto José Carvalho da Silva, Rafael Mialski, Keite da Silva Nogueira, Mônica Baumgardt Bay, Erianna Yadja Lucina de Macedo, Juliana Cintra Campos, Luiz Fernando Aires Junior, Larissa de Oliveira Camargo, Lis Aparecida de Souza Neves, Ana Paula Luchetta Paes, Felipe Barufaldi, Henrique Dib Oliveira Reis, Luiz Sérgio D’Oliveira Rocha, Marta Inês Cazentini Ribeiro, Paulo da Silva, François José de Figueiroa, Anesia Maria Siqueira Barbosa, Ana Albertina Araujo, Maria Goretti Varejão, Fernanda Garnier de França Mendes, Valdelucia Oliveira Cavalcanti, Paulo Gabriel Lima Ribeiro, Bruno Ishigami, Lucas Caheté.

  • Contributors MLB designed and conducted the study and data analysis, wrote and revised the manuscript and is guarantor for this manuscript. HdMM conducted the study, performed sample and data analysis, and wrote and revised the manuscript. JMM and MAS conducted the study, performed sample tests and data analysis, and revised the manuscript. KB and FHB performed sample analysis. PCG, AEM and ABi conducted the study, and wrote and revised the manuscript. ABe designed the study and revised the manuscript. LdFA, FF, MFdCRdS, RJCS, LFAJ, LAdSN, RMF and WAF coordinated the sites of sample collection as well as performed sample collection. Brazilian-GASP Network collaborators performed sample collection and/or laboratory assessments.

  • Funding The study was supported by the Brazilian Ministry of Health, through its Department of HIV/AIDS, tuberculosis, Viral Hepatitis and Sexually Transmitted Infections.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.