Abstract Objectives: To determine the incidence and risk of adverse obstetric and neonatal outcomes according to SARS-CoV-2 infection severity in pregnant women. Method: Open prospective study of pregnant women tested for SARS-CoV-2 by serological and molecular assays during pregnancy or delivery in two hospitals in Sao Paulo, Brazil from April 12, 2020, to February 28, 2021. Five groups were considered for analysis: C0, negative COVID-19 results and no COVID-19 symptoms; C1, positive COVID-19 results, and no symptoms; C2, positive COVID-19 results with mild symptoms; C3, positive COVID-19 results with moderate symptoms; and C4, positive COVID-19 results with severe symptoms. The association between obstetric and neonatal outcomes and COVID-19 severity was determined using multivariate analysis. Results: 734 eligible pregnant women were enrolled as follows: C0 (n = 357), C1 (n = 127), C2 (n = 174), C3 (n = 37), and C4 (n = 39). The following pregnancy and neonatal outcomes were associated with severe COVID-19: oligohydramnios (adjusted Odds Ratio [aOR] = 6.18; 95% CI 1.87‒20.39), fetal distress (aOR = 4.01; 95% Confidence Interval [CI] 1.84‒8.75), preterm birth (aOR = 5.51; 95% CI 1.47‒20.61), longer hospital stay (aOR = 1.66; 95% CI 1.36‒2.02), and admission to the neonatal intensive care unit (aOR = 19.36; 95% CI, 5.86‒63.99). All maternal (n = 6, 15.4%, p < 0.001) and neonatal (n = 5, 12.5%, p < 0.001) deaths and most fetal deaths (n = 4, 9.8%, p < 0.001) occurred in C4 group. Moderate COVID-19 was associated with oligohydramnios (aOR = 6.23; 95% CI 1.93‒20.13) and preterm birth (aOR = 3.60; 95% CI 1.45‒9.27). Mild COVID-19 was associated with oligohydramnios (aOR=3.77; 95% CI 1.56‒9.07). Conclusion: Adverse pregnancy and neonatal outcomes were associated with maternal symptomatic COVID-19 status, and risk increased with disease severity. HIGHLIGHTS COVID-19 increases the rates of adverse pregnancy and neonatal outcomes. Serious cases are associated with oligohydramnios, fetal distress, prematurity, neonatal ICU admission, maternal and neonatal deaths. The maternal clinical status dictates obstetric and neonatal outcomes.

ABSTRACT This study conducted among transgender women in São Paulo, Brazil assessed the acceptability and suitability of screening sexually transmitted infections (STIs), such as Chlamydia trachomatis and Neisseria gonorrhoeae, by sampling multiple anatomical sites (i.e. urethral, anorectal, oropharyngeal, and neovaginal), and utilizing self- or provider-collection methods. First, a convenience sample of 23 cohort participants were recruited during a scheduled study visit between October and November 2018. Data collection was through a short investigator-led quantitative survey in Portuguese, and included presentation of investigator-designed, gender-neutral instructional diagrams to guide self-sampling. Three supplemental focus group discussions (FGDs) with a total of 30 participants guided by semi-structured script were conducted in Portuguese between September and October 2019. All participants reported being assigned male sex at birth and self-identified with a feminine gender identity at time of study. All survey respondents (100%; n = 23) indicated willingness to provide samples for STI screening during a future study visit. Preference was for self-collection of urine samples (83%; n = 19), urethral swabs (82%; n = 18), and anorectal swabs (77%; n = 17). A lower preference for self-collection of oropharyngeal swabs (48%; n = 11) was observed. Most respondents (78%; n = 18) indicated that they would not prefer specimens to be collected by a health professional, mainly due to ‘more privacy’ (72%; n = 13). All respondents indicated that they would feel comfortable to provide a self-collected sample based on instructional diagrams shown. In FGDs, although the collection by a health professional was described as a technically safer option for some participants, there was a preference for self-collection to avoid discomfort and embarrassment in exposing the body. Overall, this sub-study suggested acceptability among transgender women of introducing self-sampling for etiological diagnosis of STIs from potential infection sites. Uptake and usability will be explored further in a cross-sectional STI prevalence study of transgender women in Brazil.

ABSTRACT Zika virus (ZIKV) clinical presentation and frequency/duration of shedding need further clarification. Symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil, were investigated regarding clinical characteristics, shedding in body fluids, and serodynamics. Ninety-four of 235 symptomatic patients (Site A: 58%; Site B: 16%) had Real-Time PCR-confirmed ZIKV infection; fever, headache and gastrointestinal symptoms were less frequent, and rash was more frequent compared to ZIKV-negative patients. Real-Time PCR in serum had worse performance compared to plasma, while urine had the highest sensitivity. Shedding in genital fluids and saliva was rare. IgM positivity was the highest <14 days after the symptoms onset (86%), decreasing >28 days (24%); IgG positivity increased >14 days (96%) remaining positive in 94% of patients >28 days. ZIKV prevalence varied importantly in two neighboring cities during the same transmission season. Urine Real-Time PCR can improve diagnostic sensitivity; serum testing is less useful. Accurate serological tests are needed to improve diagnosis and surveillance.

ABSTRACT Background: Zika virus (ZIKV) sexual transmission and prolonged viral shedding in semen have been previously reported, suggesting a strong viral affinity for genital tissues. A transient impact of ZIKV on male fertility was shown in animal and human studies. Methods: Adult male patients with confirmed ZIKV infection diagnosed in the city of Araraquara, Brazil during the epidemic season of 2016 were invited one year after the acute infection to respond to a questionnaire of genital symptoms and to provide a semen sample for molecular ZIKV testing and spermogram analysis, as well as a serum sample for hormonal testing. Results: 101 of 187 tested patients had positive ZIKV RT-PCR in plasma and/or urine samples (54%, 72 women and 29 men). Of 15 adult male participants for whom telephone contact was successful, 14 responded to the questionnaire of genital symptoms and six consented to provide a semen sample at a median of 12 months after the acute infection. We report abnormal spermogram results from patients one year after confirmed ZIKV infection. Conclusions: Our findings suggest a possible long-term detrimental effect of ZIKV infection on human male fertility that has to be further explored in well-characterized samples from cohort studies conducted in ZIKV-endemic areas.

OBJECTIVE: Sexually transmitted infection (STI) services were offered by the nongovernmental organization Médecins Sans Frontières-Holland in Banteay Meanchey province, Cambodia, between 1997 and 1999. These services targeted female sex workers but were available to the general population. We conducted an evaluation of the operational performance and costs of this real-life project. METHODS: Effectiveness outcomes (syndromic cure rates of STIs) were obtained by retrospectively analysing patients' records. Annual financial and economic costs were estimated from the provider's perspective. Unit costs for the cost-effectiveness analysis included the cost per visit, per partner treated, and per syndrome treated and cured. FINDINGS: Over 30 months, 11 330 patients attended the clinics; of these, 7776 (69%) were STI index patients and only 1012 (13%) were female sex workers. A total of 15 269 disease episodes and 30 488 visits were recorded. Syndromic cure rates ranged from 39% among female sex workers with genital ulcers to 74% among men with genital discharge; there were variations over time. Combined rates of syndromes classified as cured or improved were around 84-95% for all syndromes. The total economic costs of the project were US$ 766 046. The average cost per visit over 30 months was US$ 25.12 and the cost per partner treated for an STI was US$ 50.79. The average cost per STI syndrome treated was US$ 48.43, of which US$ 4.92 was for drug treatment. The costs per syndrome cured or improved ranged from US$ 46.95-153.00 for men with genital ulcers to US$ 57.85-251.98 for female sex workers with genital discharge. CONCLUSION: This programme was only partly successful in reaching its intended target population of sex workers and their male partners. Decreasing cure rates among sex workers led to relatively poor cost-effectiveness outcomes overall despite decreasing unit costs.

OBJETIVO: Entre 1997 y 1999 la organización no gubernamental Médicos Sin Fronteras de Holanda ofreció servicios contra las infecciones de transmisión sexual (ITS) en la provincia camboyana de Banteay Meanchey. Aunque dirigidos a las profesionales del sexo, los servicios estaban disponibles también para la población general. Realizamos una evaluación del rendimiento operacional y de los costos de este proyecto aplicado a la vida real. MÉTODOS: Los resultados de eficacia (tasas de curación sindrómica de las ITS) se obtuvieron analizando retrospectivamente los historiales de los pacientes. Los costos financieros y económicos anuales se estimaron desde la perspectiva del proveedor. Los costos unitarios para el análisis de la costoeficacia incluyeron el costo por visita, el costo por pareja tratada, y el costo por síndrome tratado y curado. RESULTADOS: A lo largo de 30 meses, asistieron a los consultorios 11 330 pacientes; de éstos, 7776 (69%) eran pacientes índice de ITS, y sólo 1012 (13%) eran trabajadoras sexuales. Se registraron en total 15 269 episodios de enfermedad y 30 488 visitas. Las tasas de curación sindrómica se situaron entre un 39% en las profesionales del sexo con úlceras genitales y un 74% en los hombres con exudado genital; hubo variaciones a lo largo del tiempo. Las tasas combinadas de síndromes clasificados como curados o mejorados fueron de aproximadamente 84%-95% para todos los síndromes. El costo económico total del proyecto fue de US$ 766 046. El costo medio por visita durante los 30 meses fue de US$ 25,12, y el costo por pareja tratada de una ITS, de US$ 50,79. El costo medio por síndrome de ITS tratado fue de US$ 48,43, cantidad de la cual US$ 4,92 se destinó a tratamiento farmacológico. Los costos por síndrome curado o mejorado oscilaron entre US$ 46,95-153,00 para los hombres con úlceras genitales y US$ 57,85-251,98 para las profesionales del sexo con flujo vaginal. CONCLUSIÓN: El programa consiguió sólo parcialmente su objetivo de llegar a toda la población destinataria prevista de prostitutas y sus parejas. La disminución de las tasas de curación entre las profesionales del sexo conllevó unos resultados generales relativamente decepcionantes en términos de costoeficacia pese a la disminución de los costos unitarios.

OBJECTIF: L'organisation non gouvernementale Médecins Sans Frontières Hollande a proposé des services destinés à contrer les infections sexuellement transmissibles (IST) dans la province du Banteay Meanchey, au Cambodge, de 1997 à 1999. Ces services visaient les prostituées, mais étaient aussi à la disposition de la population générale. Il a été procédé à une évaluation des performances opérationnelles et des coûts de ce projet en situation réelle. MÉTHODES: On a obtenu des résultats mesurant l'efficacité de l'intervention (taux de guérison syndromique des IST) en analysant rétrospectivement les dossiers des patients. On a aussi estimé les coûts financiers et économiques du point de vue du prestataire. Les coûts unitaires utilisés pour l'analyse coût-efficacité incluaient les coûts par visite, par partenaire traité et par syndrome traité et guéri. RÉSULTATS: Sur 30 mois, 11330 patients se sont rendus au dispensaire, dont 7776 (69%) cas initiaux d'IST et seulement 1012 (13%) prostituées. Au total, les responsables du projet ont enregistré 15 269 épisodes pathologiques et 30 488 visites. Les taux de guérison syndromique allaient de 39% chez les prostituées présentant des ulcères génitaux à 74 % chez les hommes souffrant d'écoulement génital, avec des variations au cours du temps. Les taux cumulés de syndromes classés comme guéris ou améliorés se situaient autour de 84 à 95% pour l'ensemble des syndromes. Le coût économique total du projet s'élevait à US $ 766 046. Sur les 30 mois, le coût moyen par visite était de US $ 25,12 et le coût par partenaire traité pour une IST se montait à US $ 50,79. Le coût moyen par syndrome de type IST traité était de US $ 48,43, dont US $ 4,92 pour le traitement médicamenteux. Le coût par syndrome guéri ou amélioré allait de US $ 46,95 - 153,00 pour un homme présentant un ulcère génital à US $ 57,85 - 251,98 pour une prostituée souffrant d'écoulement génital. CONCLUSION: Ce programme n'a réussi que partiellement à atteindre la population cible constituée par les prostituées et leurs partenaires masculins. Globalement, la diminution des taux de guérison parmi les prostituées a amené le rapport coût/efficacité à une valeur relativement médiocre, malgré la baisse des coûts unitaires.