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Resel Folkersma, R. Vozmediano Chicharro, R. González López, J. Jiménez Calvo, G. Escribano Patiño, G. Conde Santos, M. Puyol Pallás, J.L. Gago Ramos, B. Madurga Patuel" "autores" => array:9 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Resel Folkersma" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Vozmediano Chicharro" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "González López" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Jiménez Calvo" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Escribano Patiño" ] 5 => array:2 [ "nombre" => "G." "apellidos" => "Conde Santos" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Puyol Pallás" ] 7 => array:2 [ "nombre" => "J.L." "apellidos" => "Gago Ramos" ] 8 => array:2 [ "nombre" => "B." 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A review of the ideal diagnostic method" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "523" "paginaFinal" => "528" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. Leos-Alvarado, J. Llaca-Díaz, A. Flores-Aréchiga, F. Pérez-Chávez, N. Casillas-Vega" "autores" => array:5 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Leos-Alvarado" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Llaca-Díaz" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Flores-Aréchiga" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Pérez-Chávez" ] 4 => array:4 [ "nombre" => "N." "apellidos" => "Casillas-Vega" "email" => array:1 [ 0 => "nestor.casillas.vega@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Departamento de Patología Clínica, Monterrey, Mexico" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uretritis masculina. Una revisión del método ideal de diagnóstico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Urethritis</span><p id="par0005" class="elsevierStylePara elsevierViewall">Male urethritis is an inflammation of the urethra and periurethral glands, almost always of infectious origin and of sexual transmission. About 50% of cases are manifested by a urethral discharge that can be purulent, mucopurulent, serous, and even hemorrhagic. When the inflammation is less important, there is no flow, and less specific symptoms occur such as urethral pruritus, urination, dysuria, frequency.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Urethritis is broadly classified as gonococcal or non-gonococcal.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The most frequent microorganisms responsible are <span class="elsevierStyleItalic">Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum,</span> and <span class="elsevierStyleItalic">Ureaplasma parvum</span>.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> However, the causes of urethritis can involve more than one pathogen.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Epidemiology</span><p id="par0010" class="elsevierStylePara elsevierViewall">Sexually transmitted infections constitute an epidemic of enormous physical, psychological, and economic consequences. According to the Center for Disease Control and Prevention, it is estimated that 19 million new cases occur every year, half of them in the age group of 15–24 years.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In male urethritis, the prevalence of the responsible microorganisms is 33.7% <span class="elsevierStyleItalic">C. trachomatis</span>, 17% <span class="elsevierStyleItalic">N. gonorrhoeae</span>, 12% <span class="elsevierStyleItalic">Mycoplasma</span> spp. and 5% <span class="elsevierStyleItalic">Ureaplasma</span> spp.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Causes of urethritis</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Chlamydia trachomatis</span><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">C. trachomatis</span> is a mandatory intracellular bacterium whose D to K serotypes are the cause of sexually transmitted infectious urethritis. <span class="elsevierStyleItalic">C. trachomatis</span> is distinguished from other bacteria by their obligatory intracellular development. The transmission is only sexual. The incubation lasts an average of 10–15 days although it is very variable, from some days to several months and even sometimes it is impossible to specify.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Between 20%−50% of non-gonococcal urethritis is caused by <span class="elsevierStyleItalic">C. trachomatis</span>. Among infected patients, 50% is symptomatic. In this case, a moderate and intermittent clear flow (20%–60%) or urethral symptoms without flow (25%–50%) often observed. More rarely, a purulent discharge (15%–30%) is observed. <span class="elsevierStyleItalic">C. trachomatis</span> may be the cause of non-specific balanitis located in the perimetric zone in the form of slightly edematous erythema. 50%–75% of young adult orchiepididymitis is caused by <span class="elsevierStyleItalic">C. trachomatis</span>, which makes it the most frequent complication, probably due to the high prevalence of <span class="elsevierStyleItalic">C. trachomatis</span> infections and its often asymptomatic character, the complication by an orchiepididymitis in approximately 5%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Neisseria gonorrhoeae</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">N. gonorrhoeae</span> is a gram-negative bacterium in the form of mainly intracellular diplococci. The transmission is only sexual. The incubation period is short, 2–5 days. The gonococcus is very contagious, it causes very impressive acute urethritis in the male with the purulent greenish-yellow urethral flow and marks dysuria. There is no fever, but there may be inguinal adenopathies. 90%–100% of urethritis due to gonococci is accompanied by a urethral discharge that is almost always more purulent (70%) than clear (30%). In less than 10% of the cases, only functional signs are observed without flow and, exceptionally (less than 1% of the cases), the patients are asymptomatic.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">N. gonorrhea</span> is associated with several serious urogenital complications in men.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Without diagnosis or treatment, gonococcal urethritis can be complicated by acute prostatitis and acute orchiepididymitis, more rarely with subacute septicemia, sometimes with cowperitis, with abscesses on both sides of the foreskin frenum (known as tysonitis), that can fistulize and less frequent, with balanitis. Gonococcal conjunctivitis is the reflection of transport manipulation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Mycoplasma genitalium</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M. genitalium</span> is a recently discovered mycoplasma. Mycoplasmas are prokaryotic microorganisms of the Mollicutes class, close to bacteria. Characterized by their absence of wall. It isolated in 9%−25% of patients with urethritis compared to 6%–9% of controls. It is involved in urethritis with the abundant flow, whether they are acute gonococcal, chronic or recurrent asymptomatic carriers are rare.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The presence of <span class="elsevierStyleItalic">M. genitalium</span> has a high correlation with the presence of numerous polymorphonuclear cells in the urethral swab or the first urine stream. These elements are strong enough to think that <span class="elsevierStyleItalic">M. genitalium</span> is a pathogen of the male urethra. As in the case of the other mycoplasmas, the limit between being a saprophyte carrier and pathogenicity is nevertheless difficult to establish.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> The association between <span class="elsevierStyleItalic">M. genitalium</span> infections and active anal relations suggests the possibility of an anorectal reservoir.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Mycoplasma hominis</span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M. hominis</span> does not play a large role in the pathogenesis of urethritis. <span class="elsevierStyleItalic">M. hominis</span> frequently identified in the genitourinary tract.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In general, it is known as a commensal species but can act as a pathogen under special conditions. As in an immunocompromised state. In general, the colonization rate of <span class="elsevierStyleItalic">M. hominis</span> in the urogenital tract is 4%–13% in men.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,10</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Ureaplasma urealyticum</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">U. urealyticum</span> has been recognized as a pathogen in non-gonococcal urethritis since the 1950s. However, <span class="elsevierStyleItalic">U. urealyticum</span> is frequently isolated from the urethra of healthy men, and some studies have reported that there is no significant difference in its prevalence among men with non-gonococcal urethritis and men without non-gonococcal urethritis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, there are some reports in which <span class="elsevierStyleItalic">U. urealyticum</span> serves as a cause of persistent non-gonococcal urethritis, as well as the appearance of urethritis after autoinoculation of cultures of <span class="elsevierStyleItalic">U. urealyticum</span>, and this supports the pathogenicity of this microorganism.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a> For this reason, <span class="elsevierStyleItalic">U. urealyticum</span> is sometimes recognized as a pathogen and sometimes as a commensal organism; in contrast, there seems to be an association with chronic urethritis. <span class="elsevierStyleItalic">U. urealyticum</span> is never responsible for orchiepididymitis and rarely for prostatitis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,10</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Ureaplasma parvum</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">U. parvum</span> are commensal organisms in the genitourinary tract of sexually active men. Ureaplasma infection is strongly associated with urethritis, prostatitis, epididymitis, endometritis, chorioamnionitis, miscarriage, and prematurity. Low birth weight, but the exact role of these agents in man infertility remains a controversial issue.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Asymptomatic patient</span><p id="par0050" class="elsevierStylePara elsevierViewall">Sexually transmitted infections may have atypical symptoms, and some patients have no symptoms. Asymptomatic patients in the community who can serve as a reservoir of sexually transmitted infections.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> This represents one of the main health problems related to reproductive and sexual function, constituting one of the main causes of infertility. Other associated complications include epididymitis, orchitis, vaginitis, pelvic inflammatory disease, and ectopic pregnancy.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Diagnosis</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Purpose</span><p id="par0055" class="elsevierStylePara elsevierViewall">Diagnostic tests in sexually transmitted diseases can serve several purposes: diagnosis, screening of high-risk groups, treatment monitoring, epidemiological surveillance, outbreak investigation, validation of syndromic management in countries with few resources, detection of resistance patterns, ensure quality in laboratory tests, and research.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Evolution of diagnosis</span><p id="par0060" class="elsevierStylePara elsevierViewall">In the last three decades, diagnoses of sexually transmitted diseases depended almost exclusively on traditional methods, such as culture, enzyme immunoassay, and fluorescent antibody staining, until the appearance of molecular techniques.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The culture has been used as a reference in the diagnosis of sexually transmitted diseases, due to its sensitivity, specificity, and low cost. The results obtained by this technique are closely related to the type of sample used, the correct handling and transportation of it. However, to deliver a definitive diagnosis, it is necessary to perform biochemical tests or immunological techniques.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> During the decade of the 80's new diagnostic techniques appeared, which stood out for not requiring cultures, such as immunofluorescence, enzyme immunoassay (EIA) and hybridization with DNA probes. These techniques require a high number of microorganisms (between 104 and 107), so their sensitivity is approximately 70%.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Unlike culture methods and immunological techniques, Nucleic acid amplification (NAAT) can detect a low number of microorganisms (between 10 and 102), achieving a specificity of 95% and a sensitivity of 90%–95%. Makes it possible to detect a greater number of infections compared to culture methods and immunological techniques.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,16</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Multiple-PCR is a variant of PCR that uses more than one set of primers, and in this way the amplification of DNA fragments of agents belonging to the same genus is achieved, using for this purpose primers designed in areas with a wide heterogeneity, usually from intergenic spacer regions, ensuring that the amplified fragments have different sizes, which allows the different species to be identified through a simple agarose gel electrophoresis.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,21</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Multiplex PCR has a high sensitivity, specificity and reproducibility combined with the ability to identify a wider range of human pathogens in a rapid format this helps to reduce labor costs and reagents,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,24,25</span></a> also allows the use of non-invasive samples, for example urine samples of first urination or vaginal swabs auto-recollected by the patient, which are not suitable for less sensitive methods, such as culture and antigen.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,21</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Multiplex PCR is the fastest and most sensitive technique for the diagnosis of gonococcal and non-gonococcal urethritis. It can be recommended, especially in suspicious patients who remain negative by conventional methods.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Diagnostic technique by the microorganism</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Chlamydia trachomatis</span><p id="par0085" class="elsevierStylePara elsevierViewall">For the detection of <span class="elsevierStyleItalic">C. trachomatis</span>, the culture technique was the reference for the diagnosis for many years. It is a long (3–7 days), difficult, expensive, and painful study (endo-urethral sample of 3−4 cm taken by scraping the epithelium with a plastic swab).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In this method, you cannot use semen or urine samples due to its cytotoxicity, and it is not sensitive enough to rule out accessory gland infections.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The culture technique has a sensitivity of 50%–80% and specificity of 100%.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> In practice, the rapid tests available are direct immunofluorescence on the slide (30–40 min) or immunoenzymatic tests (3–4 h). However, they require a painful endo-urethral sample.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Direct immunofluorescence has a sensitivity of 80%–85% and specificity of 99%, and Enzyme Immunoassay has a sensitivity of 53%–76% and a specificity of 95%. The Hybridization technique has a sensitivity of 53%–76% and specificity of 95%.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Currently, the FDA recommends the use of NAAT; this is thanks to the collection of less invasive samples, such as urine. And that they have achieved a sensitivity of 93.8% and specificity of 100%; with them it has been possible to detect 20%–50% more infections than with the culture technique,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> it is most current variant the PCR-M has a sensitivity of 100% and specificity of 100%.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,16,25,27</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Neisseria gonorrhoeae</span><p id="par0095" class="elsevierStylePara elsevierViewall">The culture on chocolate agar (Thayer-Martin medium in cooked blood, in an atmosphere rich in CO2, with or without added antibiotics), confirms the diagnosis in 24−48 h and allows an antibiogram to be performed with beta-lactamase. It is carried out from the urethral flow or, in its absence, taking an endo-urethral sample with a cotton swab.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The culture has the sensitivity of 80%–95% and a specificity of 100%,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> The diagnosis that continues to be the reference test is based on the direct study of the smear of the urethral flow made with a cotton swab or a plastic handle, spread on a slide and colored in methylene blue or Gram stain. This study is very easy to perform.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The gram stain has a sensitivity of 90%–95% and specificity of 95%–100%, on the other hand, the diagnosis by hybridization has a sensitivity of 92%–96% and specificity of 98.8%–99%.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> The detection of <span class="elsevierStyleItalic">N. gonorrhea</span> by PCR has resulted with high values ​​of sensitivity (95%) and specificity (99%) and a considerable decrease in detection time compared to traditional culture and gram staining.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,28</span></a> The most current PCR-M variant has a sensitivity of 100% and specificity of 100%.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,16,25,29</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Mycoplasmas and ureaplasmas</span><p id="par0100" class="elsevierStylePara elsevierViewall">The species <span class="elsevierStyleItalic">M. genitalium, M. hominis, U. urealyticum,</span> and <span class="elsevierStyleItalic">U. parvum</span> are microorganisms belonging to the Mollicutes class, are considered extremely difficult for their multiplication in vitro, both for the nutritional requirements for their multiplication, and for their marked sensitivity to pH changes, temperature, osmotic pressure, ultraviolet rays, surfactants, antibodies and complement, a fact that makes isolation by bacteriological culture difficult.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The culture of Ureaplasmas and <span class="elsevierStyleItalic">M. hominis</span> requires a time of 2–5 days and up to 8 weeks for <span class="elsevierStyleItalic">M. genitalium</span>. For these reasons, molecular biology techniques, and particularly M-PCR has been applied for the detection of these species in men with non-gonococcal urethritis, can detect the infectious agent in less than 8 h.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Having a high sensitivity and specificity, <span class="elsevierStyleItalic">M. genitalium</span> (100%/100%), <span class="elsevierStyleItalic">M. hominis</span> (100% / 99%), <span class="elsevierStyleItalic">U. urealyticum</span> and <span class="elsevierStyleItalic">U. parvum</span> both with a sensitivity of 98% and specificity of 97%.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,16,25</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the main pathogens that cause urethritis, the frequency, the different collection samples for identification, and the different diagnostic methods, showing the sensitivity and specificity of each test.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Types of clinical samples for diagnosis</span><p id="par0110" class="elsevierStylePara elsevierViewall">The detection techniques mentioned above use invasive clinical samples such as blood serum and exudates of urethral, ​​endocervical, vaginal, anal, pharyngeal, ulcers, and non-invasive samples such as urine. The serum samples are used in the diagnosis of <span class="elsevierStyleItalic">C. trachomatis</span>; they are intended to find antibodies developed by the body in response to infection.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> Exudates are the preferred clinical samples for the detection of sexually transmitted infections. They are harvested using calcium alginate or Dacron tones, and a Stuart-Amies type transport medium is used. The ideal is to use several consecutive samples to try to obtain a greater amount of exudate. Its advantages are its low cost; they do not produce traumatism and provoke little disagreement; however, the cells can be captured in their fibers. Another collection technique is the aspiration and scraping of the lesion using a scalpel at the place where the clinical sample will be taken.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Urine is the only non-invasive clinical sample in the diagnosis and detection of sexually transmitted diseases and is used mainly for molecular techniques. The patient can take it privately and without risk of mistake in obtaining it. The results obtained by using this type of sample are comparable to the use of urethral and cervical exudates.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Complications</span><p id="par0115" class="elsevierStylePara elsevierViewall">In the absence of rapid diagnostic tests, sexually transmitted infections are treated with empirical antibiotic regimens, this is associated with the excessive use of broad-spectrum antibiotics, which has important implications for the development of bacterial resistance, hospitalizations, inadequate or inappropriate antimicrobial treatment, and late administration.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Male urethritis without treatment progresses to epididymitis, orchitis, and infertility. This infection can also be transmitted sexually to women causing vaginitis, pelvic inflammatory disease, infertility, and increased incidence of ectopic pregnancy.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> It is estimated that 15% of male infertility is related to the infection of the genital tract,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> affecting the complete spermatogenesis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0120" class="elsevierStylePara elsevierViewall">The diagnosis of sexually transmitted diseases has evolved rapidly due to the difficulties encountered when taking samples by invasive procedures and especially by the low amount of antigens and copies of the microorganism present in the sample. Makes detection and diagnosis difficult employing traditional methods such as immunofluorescence, enzyme immunoassay, and hybridization. At present, it is possible to detect and diagnose sexually transmitted diseases not only through microbiological cultures and immunological techniques but also through molecular techniques.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,26</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Clinical syndromes such as urethritis are rarely specific for a single microorganism, so screening strategies should allow multiple agents to be considered. Multiple molecular diagnoses can provide a complete assessment of the etiology of the disease and accelerate microbial identification in 6–24 h.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Multiplex PCR is the fastest and most sensitive technique for the diagnosis of gonococcal and non-gonococcal urethritis.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Early detection and timely initiation of definitive treatment can be beneficial in the prevention of complications of sexually transmitted diseases, such as epididymitis, orchitis, infertility, pelvic inflammatory disease, ectopic pregnancy,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> in addition to inhibiting its transmission, and if reducing the economic burden of health care.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres1397253" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1280284" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1397252" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1280285" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Urethritis" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Epidemiology" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Causes of urethritis" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Chlamydia trachomatis" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Neisseria gonorrhoeae" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Mycoplasma genitalium" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Mycoplasma hominis" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Ureaplasma urealyticum" ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "Ureaplasma parvum" ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Asymptomatic patient" ] ] ] 7 => array:3 [ "identificador" => "sec0055" "titulo" => "Diagnosis" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Purpose" ] ] ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Evolution of diagnosis" ] 9 => array:3 [ "identificador" => "sec0070" "titulo" => "Diagnostic technique by the microorganism" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0075" "titulo" => "Chlamydia trachomatis" ] 1 => array:2 [ "identificador" => "sec0080" "titulo" => "Neisseria gonorrhoeae" ] 2 => array:2 [ "identificador" => "sec0085" "titulo" => "Mycoplasmas and ureaplasmas" ] ] ] 10 => array:2 [ "identificador" => "sec0090" "titulo" => "Types of clinical samples for diagnosis" ] 11 => array:2 [ "identificador" => "sec0095" "titulo" => "Complications" ] 12 => array:2 [ "identificador" => "sec0100" "titulo" => "Conclusions" ] 13 => array:2 [ "identificador" => "sec0105" "titulo" => "Conflicts of interest" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-07-31" "fechaAceptado" => "2019-11-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1280284" "palabras" => array:6 [ 0 => "Sexually transmitted disease" 1 => "Male urethritis" 2 => "<span class="elsevierStyleItalic">Chlamydia trachomatis</span>" 3 => "<span class="elsevierStyleItalic">Mycoplasma genitalium</span>" 4 => "<span class="elsevierStyleItalic">Trichomonas vaginalis</span>" 5 => "<span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1280285" "palabras" => array:6 [ 0 => "Enfermedad de transmisión sexual" 1 => "Uretritis masculina" 2 => "<span class="elsevierStyleItalic">Chlamydia trachomatis</span>" 3 => "<span class="elsevierStyleItalic">Mycoplasma genitalium</span>" 4 => "<span class="elsevierStyleItalic">Trichomonas vaginalis</span>" 5 => "<span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Male urethritis is an inflammation of the urethra and the periurethral glands; it is widely classified as gonococcal or non-gonococcal. The most frequent microorganisms responsible are <span class="elsevierStyleItalic">Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum,</span> and <span class="elsevierStyleItalic">Ureaplasma parvum</span>.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In the last three decades, the diagnosis of sexually transmitted diseases depended almost exclusively on traditional methods, such as culture, enzyme immunoassay, fluorescent antibody staining, and hybridization, until the appearance of molecular techniques.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Clinical syndromes such as urethritis are rarely specific for a single microorganism, so screening strategies should allow multiple agents to be considered. Multiplex PCR is the fastest and most sensitive technique for the diagnosis of gonococcal and non-gonococcal urethritis.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Male urethritis without treatment is one of the main health problems related to reproductive and sexual function, constituting one of the main causes of infertility. The objective of this mini-review was to analyze the epidemiology, causes, diagnosis, and complications of male urethritis.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La uretritis masculina es una inflamación de la uretra y las glándulas periuretrales; a grandes rasgos, se clasifica como gonocócica o no gonocócica. Los microorganismos responsables más frecuentes son <span class="elsevierStyleItalic">Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum</span> y <span class="elsevierStyleItalic">Ureaplasma parvum.</span></p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En las últimos tres décadas, el diagnóstico de las enfermedades de transmisión sexual dependía casi exclusivamente de métodos tradicionales como el cultivo, el inmunoensayo enzimático, la tinción de anticuerpos fluorescentes y la hibridación, hasta la reciente aparición de técnicas moleculares.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los síndromes clínicos como la uretritis rara vez son específicos de un solo microorganismo, por lo que las estrategias de selección deben permitir que se consideren múltiples agentes. La PCR Múltiple es la técnica más rápida y sensible para el diagnóstico de la uretritis gonocócica y no gonocócica.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La uretritis masculina no tratada es uno de los principales problemas de salud relacionados con la función reproductiva y sexual, constituyendo una de las principales causas de infertilidad. El objetivo de esta pequeña revisión es analizar la epidemiología, las causas, el diagnóstico y las complicaciones de la uretritis masculina.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Leos-Alvarado C, Llaca-Díaz J, Flores-Aréchiga A, Pérez-Chávez F, Casillas-Vega N. Uretritis masculina. Una revisión del método ideal de diagnóstico. Actas Urol Esp. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.acuro.2019.11.008">https://doi.org/10.1016/j.acuro.2019.11.008</span></p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">DFA, Direct Immunofluorescence Assay; EIA, Enzyme Immunoassay; NAAT, Nucleic Acid Amplification Test.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Etiologic Agent \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnostic Test \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Optimal Sample \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sensibility \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Specificity \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Chlamydia trachomatis</span></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20%−5%<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immunochromatography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urethral swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gram urethra (with symptoms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85–98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95–99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gram urethra (without symptoms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rectal swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45–70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85–87 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Culture<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50–80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DFA<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80–85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EIA<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53–76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NAAT<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Neisseria gonorrhoeae</span></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10%–30%<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Culture<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urethral swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80–95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gram urethra<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90–95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95–100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NAAT<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rectal swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mycoplasma genitalium</span></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9%−25%<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NAAT<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,16,25</span></a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urethral swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mycoplasma hominis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4%−13%<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NAAT<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,16,25</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urethral swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Ureaplasma urealyticum</span></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9%−40%<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NAAT<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,16,25</span></a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urethral swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Ureaplasma parvum</span></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5%–10%<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NAAT<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,16,25</span></a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urethral swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2397982.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Laboratory Diagnosis of Pathogens Associated With Urethritis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uretritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. Chaine" 1 => "M. Janier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "EMC-Dermatol." "fecha" => "2010" "volumen" => "44" "paginaInicial" => "1" "paginaFinal" => "10" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedades de transmisión sexual en elhombre" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "O. Aynaud" 1 => "N. Dupin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "EMC-Urol." "fecha" => "2003" "volumen" => "35" "paginaInicial" => "1" "paginaFinal" => "17" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Simultaneous identification of 14 genital micro-organisms in urine by use of a multiplex PCR-based reverse lineblot assay" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.L. McKechnie" 1 => "R. Hillman" 2 => "D. Couldwell" 3 => "F. Kong" 4 => "E. Freedman" 5 => "H. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.00120-09" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol." "fecha" => "2009" "volumen" => "47" "paginaInicial" => "1871" "paginaFinal" => "1877" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19357202" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Moleculardetection of potential sexually transmitted pathogens in semenand urine specimens of infertile and fertile males" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.A. Abusarah" 1 => "Z.M. Awwad" 2 => "E. Charvalos" 3 => "A.A. Shehabi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Diagn Micro-Biol Infect Dis." 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