Abstract Background: Syphilis in its different phases may be a difficult diagnosis in clinical and histopathological grounds. Objectives: The present study objectives were to evaluate the detection and tissue distribution of Treponema pallidum in skin lesions of syphilis. Methods: A blinded diagnostic accuracy study was performed with immunohistochemistry and Warthin-Starry silver staining in skin samples from patients with syphilis and other diseases. Patients attended two tertiary hospitals between 2000 and 2019. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were calculated for the association between immunohistochemistry positivity and clinical-histopathological variables. Results: Thirty-eight patients with syphilis and their 40 biopsy specimens were included in the study. Thirty-six skin samples were used as non-syphilis controls. The Warthin-Starry technique was unable to accurately demonstrate bacteria in all samples. Immunohistochemistry showed spirochetes only in skin samples from patients with syphilis (24/40) with 60% sensitivity (95% CI 44.8-75.2). Specificity was 100% and accuracy, 78.9% (95% CI 69.8-88.1). Most cases had spirochetes in both dermis and epidermis and there was a high bacterial load. Study limitations: Correlation between immunohistochemistry and clinical or histopathological characteristics was observed but was limited statistically due to the small sample size. Conclusions: Spirochetes were promptly seen in an immunohistochemistry protocol, which can contribute to the diagnosis of syphilis in skin biopsy samples. On the other hand, the Warthin-Starry technique showed to be of no practical value.

Resumo Neste trabalho é analisada a construção coletiva de um discurso pedagógico realizado por preceptores do campo da saúde que passaram por um processo de formação pedagógica. Preceptores são profissionais que, em sua prática clínica, atuam como educadores, acompanhando discentes e residentes em formação. O artigo é constituído por duas partes: A Prática da Preceptoria em Saúde, em que se trata de sua definição, problemas e desafios, apontando um curso de formação como uma estratégia educacional relevante; e Análise Crítica do Discurso, em que se usa metodologia homônima para se debruçar sobre as sínteses coletivas dos preceptores, no sentido de melhor entender os discursos presentes em seus textos e avaliar a apropriação dos conteúdos trabalhados. Constatou-se que, ao mesmo tempo em que a produção discursiva coletiva é um exercício pedagógico enriquecedor, também é um processo desafiador que demanda paciência e dedicação das partes envolvidas para se alcançar o objetivo proposto.

Abstract This article analyzes the collective construction of pedagogical discourse by preceptors that underwent a pedagogical training program. Preceptors are health professionals who act in their clinical practice as educators, instructing students and residents. The first section discusses the field main definitions, problems and challenges, and argues for the relevance of pedagogical training for preceptors. The second section uses Critical Discourse Analysis to investigate the preceptors' collective synthesis produced in the training final stages. The article shows that while the collective discursive production is an enriching pedagogical exercise, it is also a challenging process that requires patience and dedication of those involved to achieve the training goals.