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Introduction: The genital infection by the human papillomavirus (HPV) can result in a sexually transmitted disease associated with precursor lesions for carcinogenesis in the genital tract. In recent years, evidence was accumulated defining HPV as the etiologic agent of cervical cancer; however, the etiology of penile cancer is still open and lacks studies. This study aims to contribute to the epidemiologic knowledge regarding the prevalence of this virus in malignant lesions of the male genital tract, using the DNA microarray assay, a technique that allows the simultaneous detection of up to 32 different HPV genotypes. Objective: The aim of this study was to investigate the presence of HPV in penile malignant lesions, to genotype HPV, when present, to correlate the HPV infection and its genotypes with the histopathological data. Methods: A total of 112 penile cancer samples was collected in a cross-sectional study. The detection methodology consisted of (1) detecting the presence of HPV DNA by the polymerase chain reaction (PCR) technique with generic primers, (2) genotyping the HPV using the DNA microarray assay, and (3) correlation of the histopathology, tumor invasiveness, and the dispersion of malignant cells by the lymph nodes with the presence of HPV. Results: The HPV prevalence was 57.1% (64). The most prevalent genotype was the HPV16 (32.8%), followed by HPV6 (23.4%); HPV18, HPV35, and HPV45 (12.5%); HPV31 (10.9%); and HPV70 (7.8%). Of the HPV-positive samples, 25% were mixed infections. Conclusion: The role of the HPV infection was significant within the multifactorial etiology of penile cancer. There was statistical significance between the lesion invasiveness and the presence of high-risk HPV infection. Thus, genotype surveillance can promote a better understanding of the role of HPV genotypes in male cancer development, and the DNA microarray assay proved to be an efficient tool for both the epidemiological study and the diagnostics of the HPV.

Introduction: HPV infection causes cancer at several anatomical sites. However, the infection’s natural history in non-cervical sites is understudied. Objective: To evaluate oral and anogenital HPV infections, correlating HPV prevalence rates and genotypes with site of infection and risk factors. Methods: In the present study, 351 samples from oral, genital, and anal sites of 117 patients were investigated by using PCR MY09/11 detection, followed by genotyping with RFLP. Results: HPV DNA prevalence was 89.7% (105/117) in genital lesions, 53.8% (63/117) in oral samples, and 58.9% (69/117) in anal samples. Regarding the risk factors associated with HPV in genital lesions, statistically significant rates for oral (p=0.039) and anal sex practices (p=0.0000012) were found. For oral samples, a relevant correlation concerning oral contraceptive use (p=0.039), tobacco smoking (p=0.036), and alcohol use (p=0.0075) were observed; whereas in anal samples, higher risk for HPV infection in patients who reported non-exclusive sexual partners (p=0.013) were found. The presence of viral DNA in all the three sites concurrently was observed in 36.8% of the cases (43/117). Among them, 18% (21/117) presented concordant HPV genotypes, diverging from the literature, and thus corroborating that there is still much to learn about HPV natural history, since different biological behaviors are expected within different populations. Differences in anatomy and physiology of the studied sites can determine different prevalence rates of infection by diverse genotypes. Conclusion: Due to the high prevalence of HPV DNA in extragenital sites, further studies are required to define aspects of HPV natural history among different human anatomical sites.

Human papillomavirus (HPV) can cause genital warts and HPV-related cancer.People living with human immunodeficiency virus (HIV)are more symptomatic for HPV infections.Campos dos Goytacazes,a municipality of Rio de Janeiro,introduced the quadrivalent HPV vaccine (4vHPV)for HIV-positive women four years before initiation of a public vaccination program.This study analyzed the prevalence of HPV infection in HIV-positive women and the variables associated with infectionTwo groups were evaluated:group 1,with Pap smear and HPV-negative polymerase chain reaction (PCR);group 2, individuals with at least one positive result for HPV in PCR or pap smear.PCR was performed in endocervical samples using generic primers, and the LCD-Array Kit was used for genotyping.Univariate and multivariate analyzes were performed.Results in 109 women (Group 1 n = 70; group 2 n = 39)showed an overall HPV prevalence of 36%.Results also showed that 88% (n = 23) and 96% (n = 25)of typed viruses (total of typed viruses n = 26)were included in 4vHPV and 9vHPV (nonavalent HPV),respectively.In univariate analysis,age less than 45 years, a high number of sexual partners,and HIV-viral load were risk factors for infection.However, a CD4 indicator was associated with protection.Although HIV infection is generally related to multiple and rare types of HPV,this study showed that a vast majority of the HPV types found are included in 4vHPV.Considering that age less than 45 years is a risk factor, the use of 4vHPV in Brazil should be extended in the public vaccination program to HIV seropositive women up to age 45 years

Penile cancer is a relatively rare neoplasia in developed countries, with significant morbidity and mortality in developing countries. Penile cancer can be subdivided into human papillomavirus (HPV)-positive and HPV-negative cases. Worldwide, the HPV prevalence in penile cancer samples is around 50%, and HPV16 is the most prevalent genotype. Although HPV is an important factor for cancer development, other oncogenic factors may be associated with carcinogenesis. Some of these factors can be infectious, such as the Epstein-Barr virus (EBV), as well as the Merkel cell polyomavirus (MCPyV). The prevalence rates of nearly 50% for both HPV and EBV infections indicate an important role of these viruses in penile tissue malignancy, reinforcing the idea of a multifactorial etiology of the disease. Although the HPV role is better understood, EBV is thought to facilitate persistence, integration, and mutations. Recent studies on the Merkel cell polyomavirus have not shown a relevant prevalence in penile cancer samples, but its presence indicates the opportunistic infectious potential of this virus. Regarding HPV-negative cases, the literature suggests a link with younger age and epigenetic alterations, mainly through the p16INK4a pathway. Recently, several biomarkers that might act as prognostic tools (e.g., Ki-67, squamous cell carcinoma antigen, among others) have been proposed, but the results remain controversial. In addition, other risk factors have also been associated with penile carcinogenesis, such as the presence of phimosis, noncircumcision, chronic inflammation, and number of sexual partners. Further studies are needed to develop tools for early detection and epidemiological surveillance of penile cancer.

Introdução/objetivos: Infecções pelo ZIKV ocasionalmente podem desencadear um amplo espectro de malformações congênitas, coletivamente denominados de Síndrome da Zika Congênita. Um número restrito de estudos descreve a imunidade na infecção pelo ZIKV durante a gravidez, tanto em modelos experimentais, como em pacientes. Desta forma, buscamos determinar se a resposta imunológica de memória específica ao ZIKV, 2 a 3 anos após a infecção primária, desenvolvida por mães infectadas durante a gravidez e de seus filhos expostos ao vírus por via transplacentária é efetiva e duradoura. Métodos: A resposta efetora de linfócitos T de vinte e uma mães e dezoito crianças foi avaliada por ELISPOT de IFN- γ e citometria de fluxo após estimulação com megapools de ZIKV. Resultados: Como principais achados, observamos uma alta frequência de linfócitos T CD4+ de perfil Th2 efetora/memória e de linfócitos T CD8+ de perfil Th1 naive, seguida de linfócitos T CD8+ de perfil Tc2 efetora/memória nas mães e crianças, indicando que essas células estariam, de alguma forma, auxiliando a resposta imune humoral de mães e crianças com histórico de infecção pelo ZIKV. Observamos ainda, que a capacidade de degranulação e produção de IFN-γ pelos linfócitos T CD4+ foram detectadas nos três grupos de pacientes mesmo após 2-3 anos de infecção, indicando que os linfócitos T CD4+ mantém um perfil de memória de longa duração. Por outro lado, as habilidades de degranulação e produção de IFN-γ pelos linfócitos T CD8+ foram ausentes ou baixos nos três grupos de pacientes após o mesmo período, indicando que os linfócitos T CD8+ mantém um perfil de memória de curta duração quando comparado aos T CD4+. Por fim, demonstramos que os linfócitos T CD4+ TEMRA são os principais produtores de IFN-γ. Conclusão: É importante relembrar que embora não estejamos estudando a infecção aguda na gestação, nossos dados refletem um imprint do que provavelmente ocorreu na infecção aguda. Desta forma, nosso estudo descreve pontos importantes de relevância imunológica, clínica e epidemiológica, particularmente em relação aos linfócitos T CD8+ de memória específicos ao ZIKV que são gerados, mas mantidos por um curto período. Também evidenciarmos que as respostas de linfócitos T específicas ao ZIKV nas mães parecem não ter sido diferenciadas na fase aguda e que, portanto, não estariam relacionadas ao desfecho clínico dos bebês.

Little is known about penile carcinogenesis. The aim of this study was to evaluate the prevalence of HPV and EBV, and the methylation status of p16ink4a in penile cancer samples, and to contribute to the understanding of the mechanisms responsible for penile cancer development. HPV DNA was detected in 63.6% of 122 cases, with HPV16 being the most prevalent type. EBV DNA was detected in 47.7%, with EBV-1 being the most prevalent type. HPV/EBV co-infections were found in 27.3% of the cases. Hypermethylation in p16ink4a was detected in 64.5% of 110 tested cases. An association between the absence of HPV absence and p16ink4a hypermethylation was also found. Death and/or progressive disease was associated with grade (P = 0.001), T stage (P

CpG methylation at early promoter of HPV16 DNA, in the 3' end of the Long Control Region (3'LCR), has been associated to the presence of episomal forms of viral genome and, consequently, intact E1 and E2 ORFs. The DNA methylation would block the access of E2 viral protein to the E2 binding sites at early-promoter. However, is still unclear if methylation at 3'LCR of HPV16 DNA can also vary depending of other tumor characteristics in addition to viral DNA physical state. In this study, we evaluate whether the methylation level at the five CpG located at 3'LCR of HPV16 is associated to patient age and E1 and/or E2 ORFs integrity. DNA pyrosequencing was used to measure the methylation level in 69 invasive cervical cancer samples obtained from biopsies of patients attended at Brazilian National Institute of Cancer (INCA). PCR amplifications were performed to assess disruption status of E1 and E2 genes of HPV16. The methylation average per sample ranged widely, from

Non-melanoma skin cancers (NMSC) share similar risk factors with other virus-related cancers, despite the lack of proved causal association between viral infection and NMSC development. We investigated the presence of Merkel cell polyomavirus (MCPyV), Epstein-Barr virus (EBV), and human papillomavirus (HPV) DNA in 83 NMSC fresh-frozen and 16 non-cancerous skin biopsies and evaluated viral infection according to demographical data, histopathological diagnosis, and ultraviolet exposure. Our results showed that 75% of NMSC biopsies were positive for at least one out of three viruses, whereas only 38% of non-cancerous skin biopsies were positive (p = 0.02). Notably, HPV detection was frequent in NMSC (43%) and nearly absent (one sample, 6.7%) in non-cancerous biopsies (p = 0.007). MCPyV was associated with sites of higher exposure to ultraviolet radiation (p = 0.010), while EBV was associated with a compromised immune system (p = 0.032). Our study showed that HPV was strongly associated with NMSC while EBV and MCPyV with other risk factors. Though further studies are required to elucidate the role of viral infection in NMSC development and management, this study supports the possible role of oncogenic viruses in skin cancers, especially HPV.

Background Arboviruses (Zika, dengue and chikungunya) represent a major risk for pregnant women, especially because their vertical transmission can lead to neurological damage in newborns. Early diagnosis can be difficult due to similar clinical presentation with other congenital infections that are associated with congenital abnormalities. Objectives To investigate the circulation of arboviruses and other pathogens responsible for congenital infections, reporting clinical aspects and geographic distribution of maternal rash in a metropolitan region of Rio de Janeiro (Brazil). Methods Cross-sectional study with pregnant women presenting rash attended at the Exanthematic Diseases Unit (Niteroi, Rio de Janeiro) from 2015 to 2018. Diagnosis of arboviruses was performed by real-time PCR (RT-qPCR) and laboratorial screening for syphilis, toxoplasmosis, rubella, cytomegalovirus and HIV was assessed. Demographic data was used for georeferencing analysis. Findings We included 121 pregnant women, of whom Zika virus was detected in 45 cases (37.2%), chikungunya in 33 (27.3%) and dengue in one (0.8%). Five patients presented syphilis, and we observed one case each of listeria, cytomegalovirus, and a syphilis-toxoplasmosis case. Similarity of clinical symptoms was observed in all groups; however, 84.8% of patients with chikungunya presented arthralgia. Following the decline of Zika cases, chikungunya infection was mostly observed during 2017–2018. Considering pregnant women infected with arboviruses and other infections, 41% resided in urban slums, mostly in Niteroi. Main conclusions Simultaneous circulation of arboviruses and other agents responsible for congenital infections were observed; however, we did not identify co-infections between arboviruses. In this scenario, we emphasize the importance of adequate prenatal care to provide an accurate diagnosis of maternal rash.

SUMMARY OBJECTIVE: Human papillomavirus (HPV) is the most prevalent sexually transmitted virus in the world and is associated with an increased risk of cervical cancer. The most effective approach to cervical cancer control continues to be screening through the preventive Papanicolaou test (Pap test). This study analyzes the knowledge of university students of health science programs as well as undergraduate courses in other areas of knowledge on important questions regarding HPV. METHOD: Four hundred and seventy-three university students completed a questionnaire assessing their overall knowledge regarding HPV infection, cervical cancer, and the Pap test. A descriptive analysis is presented, and multivariate analysis using logistic regression identified factors associated with HPV/cervical cancer information. RESULTS: Knowledge was higher for simple HPV-related and Pap test questions but was lower for HPV interrelations with genital warts and cervical cancer. Being from the health science fields and having high income were factors associated with greater knowledge. Only the minority of the participants recognized all the situations that increased the risk of virus infection presented in the questionnaire. CONCLUSIONS: These findings highlight the need for educational campaigns regarding HPV infection, its potential as a cervical cancer agent and the forms of prevention available. RESUMO OBJETIVO: O papilomavírus humano (HPV) é o vírus sexualmente transmissível mais prevalente no mundo, estando a infecção por este agente associada a um aumento do risco do câncer de colo uterino. A abordagem mais eficaz para o controle desse tipo de câncer continua sendo a triagem por meio do exame preventivo (Papanicolaou). Este estudo analisa o conhecimento de estudantes universitárias de cursos da área da saúde, bem como cursos de graduação de outras áreas do conhecimento com relação a questões importantes sobre o HPV. MÉTODO: Quatrocentas e setenta e três estudantes universitárias responderam a um questionário que avaliava os conhecimentos sobre a infecção pelo HPV, o câncer de colo do útero e o exame preventivo. Após análise descritiva, foi feita a análise multivariada por regressão logística para identificação dos fatores associados à informação sobre o HPV/câncer de colo do útero. RESULTADOS: O conhecimento das universitárias foi maior para questões simples relacionadas ao HPV e ao exame preventivo, mas foi menor para as correlações do HPV com verrugas genitais e com o câncer de colo do útero. Ser aluna da área da saúde e ter alta renda foram fatores associados ao maior conhecimento. Somente uma minoria das participantes reconheceu todas as situações que aumentavam o risco de infecção pelo HPV apresentadas no questionário. CONCLUSÃO: Os resultados evidenciam a necessidade de realização de campanhas educativas sobre a infecção pelo HPV, do seu potencial como agente de câncer do colo uterino e as formas de prevenção disponíveis.

Objective:To analyze the presence of HPV-DNA and TIMP-2 gene methylation in cervical precursor and invasive lesions, aswell as to study the associations among the latter, the presence of HPV-DNA, and the clinical evolution of such lesions. Methods:Cross-sectional study that includes 49 biopsy or brush smear samples from women with a normal cer-vix, LSIL, HSIL, microinvasive carcinoma and invasive carcinoma. The presence of HPV-DNA and specificmethyl-ation was analyzed using PCR. Thirty-eight biopsy samples for HSIL, microinvasive carcinoma and frank invasive carcinoma as well as 11 brush smear samples for LSIL and normal cervices were analyzed. Results:TIMP-2 gene methylation was detected in 86.8% (33/38) of the samples fromthe group with lesions and 50% (4/8) of the normal samples (p= 0.03). HPV-DNA was detected in 81.6% (31/38) of the samples from the group with lesions and 25% (2/8) of the normal samples (p= 0.003). HPV-DNA wasmore frequent in the meth-ylated samples (50%), and the group with methylation had a higher risk of unfavorable evolution than the group without methylation; however, such observations were not statistically significant (p=0.19). Conclusion:TIMP-2genemethylationand thepresenceofHPV-DNAwere characteristic of thegroupwithcervical lesions. Methylation was not associated with the presence of HPV-DNA or an unfavorable clinical evolution.

Introduction Studies have shown that persistent infection by high risk human papillomavirus (HR-HPV), especially type 16, is responsible for cervical cancer development. For the development of a malignant phenotype, several mechanisms are involved, among them the process of epigenetic DNA methylation, which results in gene silencing, leading to abrogation of cell cycle control, escape from senescence, and induction of proliferation, that therefore can collaborate in carcinogenesis. Understanding how the epidemiological factors can influence the mechanism of methylation related to infection of the HR-HPV is an unclear situation to be unveiled. The objective of this study was to evaluate the infections caused by HPV16 in patients attended at Gynaecology Institute, of UFRJ, in the period between 2012 and 2013, considering aspects of methylation in host gene pINK4a. Methods The cervical smears were submitted to the detection of HPV DNA by Polimerase Chain Reaction (PCR) using primers MY09/11, genotyped with primers for the E6 gene of HPV16, evaluated the methylation of the host pINK4a gene by Nested-MSP technique, and collected epidemiological data, which included socio-demographic and behavioural factors of each patient; and, the data of the diagnostic test that served as reference, the cytopathology. Results Our results showed nearly 76% of the studied samples presented some degree of gene pINK4amethylated, while 24% were unmethylated. The results showed statistical significance for the correlation of the cytopathology with sexarca (p=0.05657), smoking (p=0.0317), pregnancies (p=5938e-05), parity (p=0.004425) and number of partners (p=0.0242). The p16 gene methylation correlations that showed statistical significance were pregnancy (p=0.02725), parity (p=0.01414),and typing (p=0.008121). Conclusion We have found that the presence of HPV16 is associated with a greater chance of methylation of p16 in the lesions. Although, we also observed that the methylation of p16 gene is increasingly accompanying the severity of lesions, but without statistical relevance.

Introduction HPV infection causes cancer at several anatomical sites. However, the natural history of the infection in non-cervical sites have been understudied, especially at the oral epithelium. Methods In our study, we investigated 351 samples from three different sites of 117 patients, searching for HPV By generic and specific PCR and Microarray, and related risk factors. Results HPV DNA prevalence was 89.5% (105/117) in the genital lesions, 53.8% (63/117) in oral samples and 59% (69/117) in anal samples. Regarding the risk factors associated with HPV in the genital lesions, we found statistically significant rates for oral (p=0.039) and anal sex practices (p=0.0000012). For oral samples, we observed a relevant correlation concerning oral contraceptive use (p=0.039), tobacco smoking (p=0.036) and alcohol use (p=0.0075) while in anal samples, we found higher risk for HPV infection in patients relating non-exclusive sexual partners (p=0.013). The presence of viral DNA in all the three sites was observed in 36.8% of the cases (43/117). Among them, 18% (21/117) presented concordant HPV genotypes, diverging from the literature, corroborating that there is still much to learn about HPV natural history, since different biological behaviours are expected within different populations. Conclusion In our study we also evaluated if the detection of oral HPV would suggest an infection in the anogenital tract. Nevertheless, our results showed only 36.8% of correlation pointing out that it is not suitable as a an auxiliary biomarker for HPV anogenital infections.

Little is known about penile carcinogenesis. The aim of this study was to evaluate the prevalence of HPV and EBV, and the methylation status of p16

SUMMARY High-risk human papillomavirus (hr-HPV) infection is necessary but not sufficient for cervical cancer development. Recently, P16INK4A gene silencing through hypermethylation has been proposed as an important cofactor in cervical carcinogenesis due to its tumor suppressor function. We aimed to investigate P16INK4A methylation status in normal and neoplastic epithelia and evaluate an association with HPV infection and genotype. This cross-sectional study was performed with 141 cervical samples from patients attending Hospital Moncorvo Filho, Rio de Janeiro. HPV detection and genotyping were performed through PCR and P16INK4A methylation by nested-methylation specific PCR (MSP). HPV frequency was 62.4% (88/141). The most common HPV were HPV16 (37%), HPV18 (16.3%) and HPV33/45(15.2%). An upward trend was observed concerning P16INK4A methylation and lesion degree: normal epithelia (10.7%), low grade lesions (22.9%), high grade (57.1%) and carcinoma (93.1%) (p < 0.0001). A multivariate analysis was performed to evaluate an association between methylation, age, tobacco exposure, HPV infection and genotyping. A correlation was found concerning methylation with HPV infection (p < 0.0001), hr-HPV (p = 0.01), HSIL (p < 0.0007) and malignant lesions (p < 0.0001). Since viral infection and epigenetic alterations are related to cervical carcinoma, we suggest that P16INK4A methylation profile maybe thoroughly investigated as a biomarker to identify patients at risk of cancer. RESUMO É reconhecido que infecções por papilomavírus humanos de alto risco (HPV) são causa necessária, mas não suficiente para o desenvolvimento do câncer cervical. Recentemente, estudos de silenciamento gênico apontaram que a hipermetilação do gene p16INK4A é importante co-fator para a carcinogênese cervical, eliminando a função supressora de tumor da proteína p16 em lesões malignas. Entretanto poucos estudos avaliaram a relação da metilação com a progressão da doença. Nosso objetivo foi investigar o padrão de metilação do gene P16INK4A em diferentes graus de lesão cervical e sua associação com a infecção por diferentes tipos de HPV. Nosso estudo de corte transversal avaliou 141 amostras cervicais de pacientes atendidas no Hospital Moncorvo Filho, Rio de Janeiro. A detecção e tipagem do HPV foi realizada pela técnica de reação em cadeia da polimerase (PCR), e a metilação do gene P16INK4A pela PCR-metilação específica em formato nested (MSP). A frequência de HPV foi de 62,4% (88/141). O tipo mais prevalente foi o HPV16 (37%), seguido pelo HPV18 (16,3%) e HPV33/45 (15,2%). Curva ascendente foi observada quanto ao padrão de metilação do gene P16INK4A e o grau da lesão: a metilação foi identificada em somente 10,7% das amostras de epitélio normal, em 22,9% das lesões de baixo grau, em 57,1% das lesões de alto grau e em 93,1% dos carcinomas (p < 0,0001). Foram feitas análises univariada e multivariada a fim de correlacionar metilação, idade, exposição ao tabaco, infecção e genótipo de HPV. Foi encontrada correlação da metilação com a infecção pelo HPV (p < 0,0001), genótipos de alto risco (p = 0,01), lesões de alto grau (p < 0,0007) e câncer (p < 0,0001). Uma vez que infecções pelo HPV e alterações epigenéticas mostraram forte associação estatística com o carcinoma cervical, sugerimos que estes padrões de metilação possam ser avaliados como potenciais biomarcadores, combinados à detecção dos HPV oncogênicos para identificação de pacientes em risco de câncer.

Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine cancer, with approximately 80% of cases associated with Merkel cell polyomavirus (MCPyV). The lack of information concerning its occurrence in non-MCC immunosuppressed populations led to the investigation of MCPyV DNA in saliva and oral biopsies from 60 kidney allograft recipients and 75 non-transplanted individuals (control group). In contrast to herpesviruses, which was also investigated (CMV, HHV-6A, and B, HHV-7) MCPyV was detected predominantly in patients with oral lesions (gingivitis and/or periodontitis) of both transplanted and non-transplanted groups (P = 0.016) and in the saliva of the transplanted group (P = 0.009). MCPyV co-detection with CMV (P = 0.048), and HHV-6 (P = 0.020) in the saliva of transplanted patients requires further investigation on a possible role of co-infection. J Med. Virol. 85:2016–2019, 2013. © 2013 Wiley Periodicals, Inc.

Human papillomavirus infection, a sexually transmitted disease studied mainly in women due to its link to uterine cervical carcinoma, has become a health problem in men also, mainly by the significant increase of the prevalence and incidence of anal intraepithelial neoplasia and anal carcinoma in specific groups, such as men who have sex with men, HIV- seropositive and immunocompromised. The anal carcinoma, as cervical cancer, is associated with highrisk oncogenic HPV in 90% of cases, with HPV 16 as the predominant, followed by HPV 18. This fact occurs in a moment when there are no management protocols for HPV infection in the anal area, either preventive, diagnostic or therapeutic, and without an unique specialty that embraces the problem of HPV anogenital infection in men as does the gynecology for women, causing a dispersion of expertise. Added to this, there are still many doubts in the medical and general population about prophylactic vaccination for HPV in boys, and the absence of its distribution in a public health scale in most countries that still wait for statistical calculations to justify its use.

The Family Medical Program is a health care system in the Rio de Janeiro state. Women’s health services offered by the Family Medical Program include preventive exams and screening, family planning, and prenatal follow-up. Although cervical cancer screening is offered, barriers to care still hinder the full success of the program, and we are attempting to identify these barriers. We undertook a cross-sectional and prospective study involving 351 women who were referred to the Family Medical Program between March 2009 and November 2010. Demographic data were obtained through a structured household questionnaire. The dependent variable was defined as the non-realization of the Pap smear test following the protocol of the Health Ministry. Cervical samples for screening were collected after clinical examination. Women who had undergone Pap smear testing at least once every 3 years comprised 282 of the participants (80.3 %). Most of the women had normal or inflammatory cytology (96.3 %). Illiteracy and the absence of symptomatic episodes of sexually transmitted disease were independent barriers to having cancer screening at regular intervals. Illiterate women were more likely to be older, not to be using any contraceptive method, and on average had more than two children, more than four pregnancies, and more than two abortions. Embarrassment was the greatest barrier to seeking professional care reported by all women, regardless of level of educational attainment. Other important barriers to seeking care and/or screening included time constraints, due to work or childcare. This study indicates that the Family Medical Program effectively provides cervical cancer screening coverage for its eligible population, at the level mandated by the WHO and the Brazilian Health Ministry. Fully 96.3 % of the women in our study had normal or benign inflammation on cytology. Understanding of barriers to care-seeking behavior that limit program adherence is one way to facilitate communication between providers and patients regarding the benefits of cancer screening.

Penile cancer is a potentially mutilating disease. Although its occurrence is relatively rare worldwide, penile cancer rates can be high in developing countries. A few studies have been conducted on the involvement of human papillomavirus (HPV) in penile carcinoma, which have found HPV present in 30-70% of penile malignant lesions, with a higher prevalence of HPV 16 and 18. It has been assumed that cofactors, such as Epstein-Barr virus (EBV) infections, may play a role in the progression of penile neoplasia. The aim of this study was to determine HPV and EBV prevalence in 135 penile malignant lesions from Brazilian men through the use of MY09/11 polymerase chain reaction (PCR), type-specific PCR and restriction fragment length polymorphism analysis. HPV prevalence among the men tested was 60.7%. Of the men who tested positive, 27 presented with HPV 16 (29.7%), five with HPV 18 (5.5%), 21 with HPV 45 (23.1%) and nine with HPV 6 (9.9%). Seven mixed infections were detected (9.2%), while 11 cases remained untyped (13.4%). Regarding EBV positivity, 46.7% of the samples contained EBV DNA with EBV-1 as the most prevalent type (74.6%). More than 23% of the men were co-infected with both HPV and EBV, while 35% presented exclusively with HPV DNA and 20% presented only with EBV DNA. Penile carcinoma aetiology has not been fully elucidated and the role of HPV and EBV infections individually or synergistically is still controversial. Hence, more studies are needed to determine their possible role in carcinogenesis.

The aim of this study was to determine the prevalence and relationship of human papillomavirus (HPV) genotypes in cervical samples from 140 human immunodeficiency virus (HIV)-seropositive women routinely attending an outpatient public gynecological service in the state of Rio de Janeiro, Brazil. MY09/11 consensus primers were used to detect generic HPV DNA. HPV typification was performed by restriction fragment length polymorphism analysis following polymerase chain reaction amplification. The overall HPV prevalence was 60.0%. The identification of 24 different HPV genotypes including uncommon types was performed. A9 oncogenic genotypes were present in 54.02% of HIV-positive women. Abnormal cervical lesions, the time since HIV diagnosis and the number of sexual partners contributed independently to the high oncogenic HPV prevalence. The oncogenic and non-oncogenic group were similarly affected by risk factors in contrast to negative HPV women. The frequency of multiple infections was 20%; furthermore, all of them presented at least one oncogenic type. The analyzed sample represents an epidemiological source of uncommon infection. Due to high HPV prevalence, more frequent cytological screening and/or liberal colposcopic evaluations should be performed in HIV-positive patients.

INTRODUCTION: The aim of this work was to survey HPV information from a random population of young women from Rio de Janeiro, Brazil. METHODS: This cross-sectional study included cervical samples from 241 female students. To determine human papillomavirus status, polymerase chain reaction amplification was performed. HPV typing was determined by restriction fragment length polymorphism analysis. Demographic data, life style, sexual and gynecological history were obtained through use of a structured questionnaire. RESULTS: The average age of the women was 19.6 years-old (SD=3.4 years). HPV prevalence was 27.4%. Nineteen different HPV genotypes were detected, including 13 high risk types. HPV 16 was the most prevalent type (6.2%), followed by 31 (4.1 %) and 66 (3.7%). Most of the oncogenic types belonged to the A9 species (28/48). The frequency of women infected by at least one oncogenic type was significantly higher than those only infected by low risk types (18.7% versus 7.5%). Cervical changes were detected in 12.5% of the sample and were significantly linked to infection with HPV types of the A9 species. Demographic variables, sexual initiation, or number of sexual partners were not associated with HPV prevalence, variety of HPV genotypes or oncogenic types. CONCLUSIONS: The relative frequency of HPV genotypes other than vaccine types in young females should be taken into account when evaluating vaccination strategies. Due to the high prevalence of HPV infection among the population studied, implementation of sex education in schools, promotion of condom use and an organized screening program to prevent cervical cancer must be encouraged for this age group.

We investigated human papillomavirus (HPV) infection in two female populations from diverse socio-economic strata from the state of Rio de Janeiro and we also investigated the possible co-factors related to infection and the progression to cancer. In Group I, the reference group of this study, 10.7% of the patients presented HPV infection, as detected by generic PCR, while in Group II (low socio-demographic conditions) HPV was detected in 31.1% of the samples. HPV16 was the most prevalent virus type found in both Groups I and II (5.3% and 10%, respectively), followed by HPV 18 (1.3% and 4.7%, respectively). Although only a small sample was analysed, we detected differences among the groups regarding the rates of HPV infection, HPV types, age, ethnicity, familial income, schooling, marital status, parity, tobacco smoking and oral contraceptive use. For Group I, the Papanicolaou test was the most powerful independent factor associated with HPV status, followed by an age of under 30 years old, the number of sexual partners and black ethnicity. Our data are in agreement with the co-factors that are typically described for the developed world. For Group II, the Pap test was also the most relevant variable that was analysed, but the history of other sexually transmitted diseases and the use of alcohol were additional factors that were implicated in infection. These findings point out the need for the development of general and specific strategies for HPV screening of all Brazilian women.

The relationship between severe-grade cervical lesions and clusters of human papillomavirus (HPV) genotypes in a taxonomic classification was surveyed in 232 women with previous abnormal cytology. HPV co-infections were clustered according to phylogenetic criteria. Multiple infections were detected in 22.0% of the entire sample. Clade A10 (represented by HPV-6 and HPV-11) appeared more frequently in multiple infections than clade A9, which was represented by five of the most common high-risk types, including HPV-16. Although HPV-16 was the most frequent genotype, it was not more prevalent in multiple infections. Abortion and two or more sexual partners were risk-factors associated with HPV co-infections. Severe cervical dysplasia was associated with co-infections with oncogenic types from different clades, with the association being significant for the high-risk clades A7 and A9.

We assess the prevalence of human papillomavirus (HPV) and cofactors for cervical severe disease, as contribution for vaccine strategies at the right moment in which Brazilian health authorities have approved an anti-HPV vaccine. A case-control study was undertaken with 201 women who attended a public health service with previous abnormal cytology. The HPV status was ascertained by consensus primers My09/11 and typed by 6, 11, 16, 18, 31, 33, 35, and 58 specific primers. Patients diagnosed with high-grade squamous intraepithelial lesions (HSIL) and cervical cancer were referred as cases (n = 84). Patients with normal/inflammatory cervix or carrying benign cervical lesions were included in controls (n = 117). The overall prevalence of HPV infection was 75.6%, with 91.7% among cases. In spite of HPV 16 being the most frequent type (53.3%), 27.6% of infections were attributed to nonvaccine types. High-risk HPV were strongly associated to older women (OR = 6.7). Otherwise, age at the first intercourse (OR = 7.10), three or more parities (OR = 3.05), abortion episodes (OR = 4.80), and smoking (OR = 3.83) conferred a heavy effect in younger women. Among mediators affecting the progress from HSIL to cancer, age played the main role in easing the progression (OR = 1.09, P = 0.002) followed by education level (OR = 4.20, P = 0.066). White ethnia showed to be a protective factor (OR = 0.32, P = 0.055). Predictors from HPV exposure to malignant disease include demographic and behavioral factors. Public policies such as improvement of education and continued prevention campaigns might contribute to reduce this picture. This work also gives background, in identifying a target population, for implementing future vaccine strategies.

There has been increasing interest in understanding the natural history of HPV and the diseases that it causes in men. HPV infection is strongly associated with penile cancer, lack of neonatal circumcision and phimosis. We investigated the incidence of HPV infection in asymptomatic men and patients with phimosis.We assessed 110 asymptomatic men and 30 patients who underwent circumcision due to phimosis. DNA was extracted from swabbed samples collected from asymptomatic men and from foreskin samples collected at circumcision. Polymerase chain reaction using consensus primers for detecting HPV-MY09/11 was performed to detect generic HPV DNA. HPV genotyping was done by polymerase chain reaction amplification with primers for the E6 gene DNA sequences HPV6, HPV11, HPV16, HPV18, HPV31, HPV33, HPV35, HPV45 and HPV58.HPV was present in 46.66% of patients with phimosis, of whom 50% had high risk HPV genotypes. Of asymptomatic cases 16.36% were HPV positive but only 1 sample showed high risk HPV. We detected a significantly high rate of HPV genital infection in patients presenting with phimosis compared with asymptomatic men (p = 0.00167). The prevalence of high risk HPV genotypes in patients with phimosis was also statistically significant (p = 0.0004).We found a robust association between phimosis and the genital HPV prevalence in men and a significant frequency of high risk HPV. Other studies are needed to investigate the occurrence of factors that can increase the incidence of penile carcinoma and determine its impact on female genital infection in cervical cancer.

SUMMARY The aim of this study was to investigate the association of EBV and HPV with gingivitis and/or periodontitis according to the immunologic status. To this end, 74 oral biopsies from transplanted and non-transplanted individuals with the abovementioned oral manifestations were submitted to a screening by PCR for both viruses. According to the results, EBV was strongly associated with gingivitis and/or periodontitis in transplanted individuals (p = 0.011) but not HPV (p = 0.766). EBV-HPV co-detections did not enhance the presence of tissue injury as well. Although a causal relationship was not investigated in this study, the higher frequency of these two oncoviruses in lesion tissues must be investigated in follow-up studies, especially among immunocompromised individuals.

Background Human papillomavirus (HPV) is a highly prevalent sexually transmitted virus causing cytological alterations that precede cervical cancer. Approximately 130 genotypes have been sequenced. Low-grade squamous intraepithelial lesions (LSIL) are the most frequent cytological alteration and have an uncertain behavior. Objectives To analyze the frequency of HPV types in LSIL and their association with the regression, persistence or progression of these lesions. Methods A cohort study of forty patients with LSIL cytology was conducted from December 2007 to March 2011. The follow-up lasted two years and included cytology and colposcopy. HPV detection was performed using PCR, and genotyping was performed using PCR-specific and RFLP techniques. Results DNA-HPV was detected in 87% (35/40) of the cases, with oncogenic HPV accounting for 76%; type 16 in 32% (11/35) and type 18 in 20%. LSIL regression, persistence and progression rates at the end of the study were 60%, 23% and 17%, respectively. There was 50% regression in lesions in the high oncogenic risk group (types 16 and 18). Conclusion HPV 16 was the most frequent genotype found in LSIL. The persistence and progression of the LSIL were related to the persistence of oncogenic HPV. The longer the follow-up time, the lower the LSIL persistence rate and the higher its regression rate; the progression rate remained stable. In addition to the presence of oncogenic HPV, other factors are necessary for the progression of LSIL.

This article reports the HPV status and cervical cytological abnormalities in patients attended at public and private gynecological services from Rio de Janeiro State. It also comments the performance of each HPV DNA tests used. A set of 454 women from private health clinics was tested by routine Capture Hybrid II HPV DNA assay. Among these, 58.4% presented HPV and nearly 90% of them were infected by high risk HPV types. However, this group presented few premalignant cervical lesions and no invasive cervical cancer was registered. We also studied 220 women from low income class attended at public health system. They were HPV tested by polymerase chain reaction using My09/11 primers followed by HPV typing with E6 specific primers. The overall HPV prevalence was 77.3%. They also showed a high percentage of high squamous intraepithelial lesion-HSIL (26.3%), and invasive cervical carcinoma (16.3%). HPV infection was found in 93.1% and 94.4% of them, respectively. The mean ages in both groups were 31.5 and 38 years, respectively. In series 1, HPV prevalence declined with age, data consistent with viral transient infection. In series 2, HPV prevalence did not decline, independent of age interval, supporting not only the idea of viral persistence into this group, but also regional epidemiological variations in the same geographic area. Significant cytological differences were seen between both groups. Normal and benign cases were the most prevalent cytological findings in series 1 while pre-malignant lesions were the most common diagnosis in the series 2. HPV prevalence in normal cases were statistically higher than those from series 1 (p < 0.001), indicating a higher exposure to HPV infection. Women from both samples were referred for previous abnormal cytology. However, socio-demographic evidence shows that women from series 1 have access to treatment more easily and faster than women from series 2 before the development of pre-malignant lesions. These data provides baseline support for the role of social inequalities linked to high risk HPV infection leading to cervical cancer. Broadly screening programs and the development of safe and effective vaccines against HPV would diminish the toll of this disease that affect mainly poor women. Este artigo analisa a infecção por HPV e anormalidades citológicas cervicais encontradas em pacientes atendidas em serviços ginecológicos dos sistemas de saúde público e privado do estado do Rio de Janeiro. O trabalho também avalia os testes utilizados para detecção de DNA do HPV em cada população estudada. Um grupo de 454 mulheres oriundas de serviços da rede privada de saúde foi testado por Captura do Híbrido II. Destas, 58,4% apresentaram infecção por HPV e cerca de 90% delas estavam infectadas por HPV de alto risco. Este grupo, entretanto, apresentava poucos casos de lesões cervicais pré-malígnas e nenhum caso de câncer. Estudamos, também, 220 mulheres de baixo nível econômico atendidas no serviço de saúde pública que foram testadas para HPV pela reação da polimerase em cadeia utilizando-se os oligonucleotídeos My09/My11. A identificação dos tipos foi efetuada por amplificação com oligonucleotídeos específicos para a região E6 do genoma viral. A prevalência de HPV nesta população foi de 77.3%, observando-se uma alta porcentagem de casos de neoplasias intraepiteliais cervicais de alto grau (26,3%) e de carcinoma cervical invasivo (16,3%). A infecção por HPV foi achada em, respectivamente, 93,1% e 94,4% destes casos. A média de idade em ambos os grupos era de 31,5 e 38 anos, respectivamente. Na série 1, a prevalência da infecção por HPV decresce com a idade, enquanto na série 2 ela não desaparece, dando suporte não só à idéia de persistência viral neste grupo, mas também a variações epidemiológicas na mesma área geográfica. Diferenças significativas foram vistas nos dois grupos. Casos normais e benignos foram incidentes na série 1, enquanto as lesões malígnas predominaram na série 2. Ao contrário, casos normais infectados por HPV eram prevalentes na série 2 (p < 0.001), indicando maior exposição ao vírus. Embora as mulheres de ambos os grupos tenham sido incluídas no estudo por apresentarem citologia anormal, evidências sócio-demográficas demonstram que mulheres da série 1 tem acesso mais fácil e rápido ao tratamento do que as mulheres da série 2 antes que as lesões pré-malígnas se desenvolvam. Estes resultados fornecem dados sobre o papel das desigualdades sociais associadas à infecção por HPV de alto risco na progressão do câncer cervical. Programas de prevenção abrangentes e o desenvolvimento de vacinas eficazes e seguras contra o HPV poderiam reduzir o tributo desta doença que afeta principalmente mulheres pobres.

Human Papillomavirus (HPV) infection is the main cause of cervical cancers and cervical intraepithelial neoplasias (CIN) worldwide. Consequently, it would be useful to evaluate HPV testing to screen for cervical cancer. Recently developed, the second-generation Hybrid Capture (HCA II) test is a non-radioactive, relatively rapid, liquid hybridization assay designed to detect 18 HPV types, divided into high and low-risk groups. We evaluated 1055 women for HPV infection with the HCA II test. Five hundred and ten (48.3%) of these women had HPV infection; 60 (11.8%) had low cancer-risk HPV DNA; 269 (52.7%) had high-risk HPV types and 181 (35.5%) had both groups. Hence, 450 women (88.2%) in this HPV-infected group had at least one high risk HPV type, and were therefore considered to be at high risk for cancer. Among the group with Papanicolaou (Pap) test results, the overall prevalence of HPV DNA was 58.4%. Significant differences in HPV infection of the cervix were detected between Pap I (normal smears) and Pap IV (carcinomas) (p

CONTEXT: Persistent infection with high risk human papillomavirus (HPV) has been linked to cervical carcinoma. Integration of viral DNA into host cell DNA is essential for this cancer development, promoting disruption of the HPV E2 gene, thus leading to unregulated increases in E6 and E7 proteins and inactivating the products of p53 and Rb tumor suppressor genes. OBJECTIVE: To investigate HPV 16 infection in cervical lesions, physical state of viral DNA and p53 gene alterations in a group of women attending a public health service. DESIGN: Prospective, non-controlled, transversal study. SETTING: Gynecological clinic of the School od Medicine, Universidade Federal Fluminense. SAMPLE: 43 consective patients with cervical lesions referred to our service. MAIN MEASUREMENTS: Cases were classified via cytology/histology as normal, HPV infection, condyloma, low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL) and carcinoma. HPV infection was studied via polymerase chain reaction (PCR) using two PCR primer sets, to determine DNA integration. p53 gene changes were investigated by single-strand conformation polymorphism (SSCP) analysis. RESULTS: One normal case, 7 HPV infections, 6 condylomas, 7 LSIL, 14 HSIL and 8 cancers were found, with 95% positive for HPV genome when tested using both L1 and E6 primers. HPV 16 was most prevalent (73.1%). HPV 16 DNA was integrated within the host genome in 3 LSIL. One LSIL progressed to HSIL by 13 months after first diagnosis. Among HPV 16-positive HSIL cases, 50% contained integrated viral DNA. HPV 16 E2 gene disruption was seen in 7 cancers (87.5%). Only smal-cell carcinoma showed intact HPV 16 E2 gene. Abnormal p53 bands detected by PCR/SSCP were observed in 4 cases: 2 squamous carcinoma with parametrium (exon 8) and two cervical intraepithelial neoplasia (CIN) III (exons 5 and 7). All cases presented HPV 16 E2 gene loss. CONCLUSIONS: The sample had a high rate of high-risk HPV detected in benign and malignant lesions; high cervical cancer burden; HPV 16 DNA integration in all except one case of cancer; p53 gene changes in CIN III and in invasive cancer cases associated with DNA integration. CONTEXTO: A infecção persistente por papilomavírus humano (HPV) de alto risco tem sido associada ao carcinoma cervical. Uma fase obrigatória no desenvolvimento deste câncer é a integração do DNA viral ao DNA das células hospedeiras. A integração viral promove a degradação do gene E2 do papilomavírus humano e leva a um aumento descontrolado das proteínas E6 e E7. Estas proteínas virais de HPVs oncogênicos inativam os produtos dos genes supressores de tumor p53 e Rb. Inativação da proteína p53 é o resultado de vários fatores incluindo mutação no gene para p53. OBJETIVO: Investigar lesões cervicais associadas à infecção por papilomavírus humano, o estado físico do DNA viral e alterações no gene para p53 em um grupo de mulheres atendidas em um serviço público de saúde. TIPO DE ESTUDO: prospectivo, não-controlado. LOCAL: Serviço de Patologia Cervical, Ambulatório de Ginecologia da Faculdade de Medicina, Universidade Federal Fluminense. PARTICIPANTES: 43 mulheres atendidas em consulta ambulatorial de rotina para prevenção às lesões cervicais. VARIÁVEIS ESTUDADAS: Pela citologia/histologia os casos foram classificados como normal, infecção por papilomavírus humano, condiloma, lesão cervical de baixo graus, lesão cervical de alto grau e carcinoma. A presença de papilomavírus humano foi detectada por reação de polimerase em cadeia (PCR) utilizando-se dois pares de oligonucleotídeos. Para determinar a integração do DNA viral, usaram-se oligonucleotídeos específicos para o gene E2 do tipo HPV 16 que amplificam um fragmento de 1.026 pares de base. Alterações no gene para p53 foram investigadas por polimorfismo conformacional da fita simples. RESULTADOS: Foi detectado um caso de cérvice normal, sete infecções por papilomavírus humano, seis condilomas, sete lesões cervicais de baixo graus, 14 de alto grau e oito carcinomas. O estudo revelou que 14 mulheres sem queixas de doença genital eram portadoras de lesões de vários tipos incluindo três lesões cervicais de alto grau e um caso de carcinoma in situ. 95% das pacientes foram positivas para a presença do genoma de HPV quando testadas para os genes L1 e E6, com prevalência do HPV tipo 16 (73.1%). Detectamos DNA do HPV 16 integrado ao genoma hospedeiro em três dos sete casos de lesões cervicais de baixo grau. Entretanto, um destes pacientes progrediu a lesão cervical de alto grau 13 meses após o primeiro diagnóstico. Entre os casos de lesão cervical de alto grau positivos para HPV 16, 50% continham o DNA viral no estado integrado foi encontrado. A falta do gene E2 do HPV 16 foi observada em sete dos carcinomas (87.5%) e somente no carcinoma de células pequenas foi detectado o gene E2. Bandas anormais do gene p53 detectadas por PCR/SSCP foram observadas em quatro casos: dois carcinomas escamosos com envolvimento do paramétrio (exon 8) e dois casos de NIC III (exons 5 e 7, respectivamente). Todos os casos apresentaram perda do gene E2 do HPV 16. CONCLUSÕES: A amostra analisada tinha alta taxa de HPV de alto risco detectada tanto em lesões benignas como em lesões malignas; alto índice de câncer cervical; integração do DNA do HPV 16 em quase todos os casos de câncer com uma exceção; alterações no gene para p53 em NIC III e em câncer invasivo associadas à integração do DNA.

INTRODUCTION: Exanthem subitum is a classical rash disease of early childhood caused by human herpesvirus 6B (HHV-6B). However, the rash is frequently misdiagnosed as that of either measles or rubella. METHODS: In this study, a nested multiplex polymerase chain reaction (PCR) was used to diagnose HHV-6B primary infection, differentiate it from infections caused by HHV-6A and compare it to antibody avidity tests. The samples were separated into case group and control group according to the results of the indirect immunofluorescence assay (IFA) technique. RESULTS: From the saliva samples analyzed, HHV-6A DNA was detected in 3.2% of the case group and in 2.6% of the control group. Regarding HHV-6B, PCR detected viral DNA in 4.8% of the case group and in 1.3% of the control group. Among the serum samples studied, a frequency of 1.7% was determined for HHV-6A in the case group and 1.2% in the control group. PCR did not detect HHV-6B DNA in serum samples. The sensitivity and specificity of the PCR technique ranged from 0% to 4.8% and 97.5% to 100%, respectively, compared to IFA. CONCLUSIONS: The PCR technique was not suitable for diagnosing primary infection by HHV-6B in children with exanthematic disease and should not substitute the IFA.

Background DNA methylation is the most important epigenetic change involved in the control of gene expression in human cells. Methylation of the p16INK4a gene occurs early in the development of cervical cancer. Low-grade squamous intraepithelial lesions (LSILs) are prevalent, and their behavior is variable. Objective To identify the HPV DNA type, detect the methylation status of the p16INK4A gene, and analyze their association with the cytological evolution of LSIL over a period of two years. Methods We conducted a cohort study with 40 participants. Cervical scrapings were collected for cytological and molecular analysis. HPV DNA detection and typing were performed by means of polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Methylation-specific PCR was performed to detect methylation. Results HPV DNA was detected in 87% of the cases, and type 16 was the most frequent type. Methylation was detected in 11% of the cases and did not exhibit a significant correlation with the HPV type. Unfavorable cytological evolution exhibited a significant association with the presence of methylation. Conclusion HPV 16 was the most frequently detected type of HPV in LSIL. Methylation of the p16INK4A gene was infrequent and occurred independent of the presence of HPV DNA. Methylation of the p16INK4a gene exhibited a significant correlation with persistence/progression of LSIL.

Our study comprises a cases series of 71 men attending a dermatology clinic in Brazil during an 18-month period with anogenital HPV infection. Clinical manifestations, laboratory findings and sociodemographic factors were evaluated. Biopsy samples were subjected to histopathological analysis, generic and type-specific viral identification, and p16 INK4a quantification. The average age at diagnosis was 33 years. We observed little variation in identified viral types (HPVs 6, 11, 16 and 53), despite the inclusion of 16 HIV+ patients. The presence of high-risk HPV was associated with receptive anal sex (p

Hepatitis B virus (HBV) has a low endemicity in Rio de Janeiro, Brazil. Sexual transmission must play an important role in this virus, but the prevalence and risk factors have never been properly investigated. The aim of this paper is to determine the prevalence and risk factors for HBV infection in patients attending a Sexually Transmitted Diseases Clinic of the Universidade Federal Fluminense, from the State of Rio de Janeiro, Brazil. In a retrospective study, HBV seroprevalence was investigated in 440 patients. Serum of each patient was assayed for antibodies against hepatitis B core antigen (anti-HBc), hepatitis B surface antigen (HBsAg) and antibodies against hepatitis B surface antigen (anti-HBs). Demographic and risk factor data were extracted from clinic notes. The overall seroprevalence of exposure markers for HBV (anti-HBc, HBsAg and anti-HBs) were 13%, 3.4% and 8.5% respectively. Homo/bisexual behaviour, anal intercourse, HIV infection, positive serology for syphilis and blood transfusion were predictors of the HBV exposure. Among demographic data, age and place of birth were associated with the anti-HBc seropositivity.

Merkel cell polyomavirus (MCPyV) large T antigen (LT-ag) is frequently found truncated in Merkel cell carcinomas (MCC) and it is considered a major tumor-specific signature. Nonetheless, the biological role of LT-ag nontruncated mutations is largely unknown. In this study, MCPyV LT-ag second exon from 11 non-MCC oral samples and NCBI sequences derived from different anatomical sites were studied from the genetic and structural standpoint. As expected, the LT-ag mutation profile was influenced by the geographical origin of the sample, although nonsynonymous mutations were more frequent in lesional tissues. Our in silico study suggests that the mutations found would not significantly affect protein functions, regardless of sample category. This work presents a thorough investigation of the structural and functional properties of LT-ag nontruncated mutations in MCPyV. Our results sustain the geographical influence of the MCPyV genetic profile, but do not discard genetic tissue specificities. Further investigation involving other genetic segments in healthy and lesional tissues are necessary to improve our knowledge on MCPyV pathogenesis.

HPV infection and associated diseases in the male population has assumed importance, especially because of the increase in incidence of anal carcinoma. The recognition that man is no longer mere infection vector for this disease is still poorly discussed, and can result in diagnostic losses and further increase in anogenital disease morbidity. In this study, we aimed to present a case of an atypical anogenital lesion caused by HPV infection in a HIV(-) male patient. Clinical exam showed perianal lesion. This lesion has been misdiagnosed and treated as herpes and candidiasis for almost ten years, when ulceration was observed, followed by purulent secretion. Histopathology showed intraepithelial neoplasia constituted by atypical keratinocytes, loss of polarity and corneal pearls compatible with Bowen’s disease. Specific PCR showed HPV 16 DNA in both episomal and integrated forms. Successful treatment was achieved by radiotherapy. The knowledge about the behavior of anogenital HPV infection in men is still unclear, even for high-risk groups such as MSM (men who have sex with men) and HIV seropositive. Therefore, several patients have been maintained without diagnosis, being regarded as sources of infection and even suffering from high-grade lesions with clinical unsatisfactory outcomes. Our goal with this case report is to contribute to the dissemination of an emerging problem, stimulating discussion and the search for new tools of early recognition and treatment of male anogenital lesions. DOI: http://dx.doi.org/10.17525/vrr.v18i1-2.64

Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine cancer, with approximately 80% of cases associated with Merkel cell polyomavirus (MCPyV). The lack of information concerning its occurrence in non-MCC immunosuppressed populations led to the investigation of MCPyV DNA in saliva and oral biopsies from 60 kidney allograft recipients and 75 non-transplanted individuals (control group). In contrast to herpesviruses, which was also investigated (CMV, HHV-6A, and B, HHV-7) MCPyV was detected predominantly in patients with oral lesions (gingivitis and/or periodontitis) of both transplanted and non-transplanted groups (P=0.016) and in the saliva of the transplanted group (P=0.009). MCPyV co-detection with CMV (P=0.048), and HHV-6 (P=0.020) in the saliva of transplanted patients requires further investigation on a possible role of co-infection.

Esophageal squamous cell papilloma (ESCP) is a prevalent lesion worldwide, with increasing occurrence rates. The possible role of Human Papillomavirus (HPV) in the etiology of such lesions has aroused the interest on elucidating its natural history. In this report we studied an esophageal papilloma from a 27 year old female patient. HPV DNA was detected by generic PCR using MY09/11 primers and RFLP revealed the presence of HPV70, usually associated to benign genital lesions. Hypermethylation of p16 INK4A gene was also investigated, due to its relation to malignant transformation and a hypermethylation pattern was detected in the host gene. Except for recurrent dysphasia, risk factors were not recorded: cigarette smoking, alcohol abuse, esophageal reflux or infected sexual partner. Since ESCP may have malignant potential, HPV detection and typing are useful tools in terms of follow-up. Besides that epigenetic events may represent additional risk for malignant transformation and thus can be a complementary biomarker. DOI: http://dx.doi.org/10.17525/vrr.v17i1-2.61

CONTEXT: Alterations of the p53 tumor suppressor gene are correlated with a critical step in the development of many human cancers.The tumor suppressor gene functions include regulation of the cell cycle and the cellular response to DNA damage, initiation of DNA repair and replication, induction of apoptosis and promotion of cell differentiation. CASE REPORT: Smears from ten cases of cervical lesions were analyzed for status of exons 5-8 of the p53 gene using PCR/SSCP. HPV infection was also screened by the PCR method using two PCR primer sets. Changes in the p53 gene were observed in a case of squamous carcinoma and a case of asymptomatic cervical intraepithelial neoplasia grade III (CIN III). High-risk HPV was detected in both cases showing that HPV infection and p53 mutation are not exclusive events.

In this study, we have sought to verify the prevalence ofhuman herpesviruses 6 and 7 (HHV-6, HHV-7) in the saliva of renal transplanted patients from Rio de Janeiro State, Brazil, and compare results with those of healthy subjects, since Roseolovirus DNA detection in body fluids from transplanted patients has been associated with often misdiagnosed chronic symptoms, organ rejection and even death. The studied group was composed by 120 individuals: 60 were renal transplanted patients and 60 were healthy subjects attending the Hospital Universitario Pedro Ernesto, for odontological follow-up. Saliva specimens were submitted to a multiplex nested polymerase chain reaction (PCR) to detect the presence of HHV-6A, HHV-6B and HHV-7. The total Roseolovirus DNA prevalence was 56.7% for transplanted patients and 23.3% for healthy individuals (p

In this study, we aimed to evaluate virus shedding in the saliva of healthy adults from the metropolitan region of the city of Rio de Janeiro, Brazil, in order to verify the prevalence of both human herpesviruses 6 and 7 (HHV-6, HHV-7). The studied group comprised 182 healthy individuals at Pedro Ernesto University Hospital, who were being seen for annual odontologic revisions. Saliva specimens were subjected to a multiplex polymerase chain reaction (PCR) to detect the presence of HHV-6A, HHV-6B and HHV-7. The total Roseolovirus DNA prevalence was 22.4%. The PCR detected a HHV-6 prevalence of 9.8%, with HHV-6A detected in 7.1% of the samples and HHV-6B in 2.7%. HHV-7 DNA was revealed in 12.6% of the studied cases. Multiple infections caused by HHV-6A and 7 were found in 2.1% of the samples. No statistical differences were observed regarding age, but for HHV-7 infection, an upward trend was observed in female patients. Compared to studies from other countries, low prevalence rates of herpesvirus DNA were detected in saliva from the healthy individuals in our sample. PCR methodology thus proved to be a useful tool for Roseolovirus detection and it is important to consider possible geographic and populations differences that could explain the comparatively low prevalence rates described here.

Summary The appearance and persistence of IgM antibodies were studied by MAC-ELISA in 926 confirmed cases of dengue virus type 1 infection. Assays performed on acute and convalescent patient sera revealed that IgM antibodies appeared during the early phase of disease (day 2) and persisted for three months after onset. MAC-ELISA proved to be a valuable early diagnosis test when compared with haemagglutination inhibition.

Sexually transmitted diseases (STDs) are common reasons for seeking medical assistance. Media campaigns on STD/AIDS assume that exposure to risky sexual practices is greater during Carnival. The objective of this study was to analyze the temporal distribution of first appointments in a STD clinic from January 1993 to December 2005 to verify whether there is a seasonal increase in STD after Carnival.A total of 2,646 medical records with a diagnosis of gonorrhea, syphilis, or trichomoniasis were selected among patients seeking medical assistance in the STD Unit of Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil. Statistical analysis was performed using month-to-month and year-to-year standardized average number of appointments during 13 years, in addition to smoothed time-series data using the Lowess method and the deterministic moving average method.July and August exhibited the largest number of gonorrhea and syphilis diagnoses, and June and July of trichomoniasis diagnoses. Gonorrhea had its peak value in May, with a falling trend until August. A constant number of syphilis diagnoses was observed between May and August, with smaller numbers in January and February and peak values in November. The seasonal pattern for trichomoniasis diagnosis showed peak values in July, with a consistent falling trend until December and an increase from January on.Carnival has no influence on the increase in the occurrence of gonorrhea, syphilis, and trichomoniasis in patients attending a STD clinic in Niterói, Rio de Janeiro, Brazil.