Rapid diagnosis of sexually transmitted infections | Enfermedades Infecciosas y Microbiología Clínica (English Edition)

array:24 ["pii" => "S2529993X17301892" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2017.01.035" "estado" => "S300" "fechaPublicacion" => "2017-08-01" "aid" => "1658" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Enferm Infecc Microbiol Clin. 2017;35:444-50" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1174 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 961 "PDF" => 206 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0213005X17300241" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2017.01.004" "estado" => "S300" "fechaPublicacion" => "2017-08-01" "aid" => "1658" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Enferm Infecc Microbiol Clin. 2017;35:444-50" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 11977 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 10190 "PDF" => 1776 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "Formación médica continuada: Métodos de diagnóstico rápido en Microbiología Clínica" "titulo" => "Diagnóstico rápido de las infecciones de transmisión sexual" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "444" "paginaFinal" => "450" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Rapid diagnosis of sexually transmitted infections" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Otero-Guerra, Ana Fernández-Blázquez, Fernando Vazquez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Otero-Guerra" ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Fernández-Blázquez" ] 2 => array:2 [ "nombre" => "Fernando" "apellidos" => "Vazquez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2529993X17301892" "doi" => "10.1016/j.eimce.2017.01.035" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301892?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X17300241?idApp=UINPBA00004N" "url" => "/0213005X/0000003500000007/v1_201707160013/S0213005X17300241/v1_201707160013/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2529993X17301776" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2015.06.001" "estado" => "S300" "fechaPublicacion" => "2017-08-01" "aid" => "1362" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Enferm Infecc Microbiol Clin. 2017;35:451-60" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2141 "formatos" => array:3 [ "EPUB" => 10 "HTML" => 1655 "PDF" => 476 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Review article" "titulo" => "Management of infection and febrile neutropenia in patients with solid cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "451" "paginaFinal" => "460" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo de la infección y la neutropenia febril en el paciente con cáncer sólido" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3120 "Ancho" => 3172 "Tamanyo" => 412981 ] ] "descripcion" => array:1 [ "en" => "Action algorithm for the initial care of febrile neutropenia patients at the Emergency Department and evaluation of the risk of complications and treatment method, including the maximum desirable time for each of the actions. Adapted from: Bell MS, Scullen P, McParlan D, et al. Neutropenic sepsis guideline. In edition Northern Ireland Cancer Network 2010; 1–11. *It is not necessary to wait for an analytical confirmation of neutropenia in order to begin the evaluation; **clinical risk criteria: onset or deterioration of organ dysfunction, comorbidity, altered vital signs, clinical signs or symptoms, documented focal infection or analytical/imaging data. BP, blood pressure; CT, chemotherapy; HR, heart rate; iv, intravenous; MASCC, Multinational Association for Supportive Care in Cancer; po, per os; RR, respiratory rate; SaO2, oxygen saturation; SIRS, systemic inflammatory response syndrome." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José María Aguado, Juan Jesús Cruz, Juan Antonio Virizuela, Manuela Aguilar, Alberto Carmona, Javier Cassinello, Carlota Gudiol, Paula Jiménez Fonseca, Manuel Lizasoain, Francesc Marco, Isabel Ruiz, Maribel Ruiz, Miguel Salavert, David Vicente, Jordi Carratalà" "autores" => array:15 [ 0 => array:2 [ "nombre" => "José María" "apellidos" => "Aguado" ] 1 => array:2 [ "nombre" => "Juan Jesús" "apellidos" => "Cruz" ] 2 => array:2 [ "nombre" => "Juan Antonio" "apellidos" => "Virizuela" ] 3 => array:2 [ "nombre" => "Manuela" "apellidos" => "Aguilar" ] 4 => array:2 [ "nombre" => "Alberto" "apellidos" => "Carmona" ] 5 => array:2 [ "nombre" => "Javier" "apellidos" => "Cassinello" ] 6 => array:2 [ "nombre" => "Carlota" "apellidos" => "Gudiol" ] 7 => array:2 [ "nombre" => "Paula" "apellidos" => "Jiménez Fonseca" ] 8 => array:2 [ "nombre" => "Manuel" "apellidos" => "Lizasoain" ] 9 => array:2 [ "nombre" => "Francesc" "apellidos" => "Marco" ] 10 => array:2 [ "nombre" => "Isabel" "apellidos" => "Ruiz" ] 11 => array:2 [ "nombre" => "Maribel" "apellidos" => "Ruiz" ] 12 => array:2 [ "nombre" => "Miguel" "apellidos" => "Salavert" ] 13 => array:2 [ "nombre" => "David" "apellidos" => "Vicente" ] 14 => array:2 [ "nombre" => "Jordi" "apellidos" => "Carratalà" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213005X15002621" "doi" => "10.1016/j.eimc.2015.06.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X15002621?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301776?idApp=UINPBA00004N" "url" => "/2529993X/0000003500000007/v1_201707230042/S2529993X17301776/v1_201707230042/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2529993X1730179X" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2017.06.001" "estado" => "S300" "fechaPublicacion" => "2017-08-01" "aid" => "1371" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Enferm Infecc Microbiol Clin. 2017;35:441-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 700 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 446 "PDF" => 247 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Brief report" "titulo" => "Indigenous tropical spastic paraparesis in Madrid (Spain). Experience on screening of human T-lymphotropic virus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "441" "paginaFinal" => "443" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paraparesia espástica tropical autóctona en la Comunidad de Madrid. Experiencia en el cribado del virus linfotrópico de células T humanas tipo I" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1005 "Ancho" => 1660 "Tamanyo" => 60326 ] ] "descripcion" => array:1 [ "en" => "Distribution of different clinical and epidemiological criteria that motivate the screening of HTLV-I/II IgG antibodies at our centre. Positive HTLV-I cases are highlighted in the darker colour. LYS: lymphoproliferative syndrome; OTH: others; PDU: parenteral drug users; SDD: suspected demyelinating disease; SEA: routine screening in patients from endemic areas; SOD: screening in organ donors with risk factor; SPT: screening in pre-transplant patients with risk factor; SUH: routine screening in PDU and/or HIV+ patients; UJD: unjustified." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Manuel Ponce-Alonso, Ignacio del Corral-Corral, Marta Ortiz-Rivera, Carla Anciones-Martín, María Luisa Mateos-Lindemann" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Manuel" "apellidos" => "Ponce-Alonso" ] 1 => array:2 [ "nombre" => "Ignacio" "apellidos" => "del Corral-Corral" ] 2 => array:2 [ "nombre" => "Marta" "apellidos" => "Ortiz-Rivera" ] 3 => array:2 [ "nombre" => "Carla" "apellidos" => "Anciones-Martín" ] 4 => array:2 [ "nombre" => "María Luisa" "apellidos" => "Mateos-Lindemann" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213005X15002712" "doi" => "10.1016/j.eimc.2015.07.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X15002712?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X1730179X?idApp=UINPBA00004N" "url" => "/2529993X/0000003500000007/v1_201707230042/S2529993X1730179X/v1_201707230042/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Continuing medical education: Methods of rapid diagnosis" "titulo" => "Rapid diagnosis of sexually transmitted infections" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "444" "paginaFinal" => "450" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luis Otero-Guerra, Ana Fernández-Blázquez, Fernando Vazquez" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Luis" "apellidos" => "Otero-Guerra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Ana" "apellidos" => "Fernández-Blázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Fernando" "apellidos" => "Vazquez" "email" => array:1 [ 0 => "opsklins@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital de Cabueñes, Gijón, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Biología Funcional, Área de Microbiología, Facultad de Medicina, Oviedo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Fundación de Investigación Oftalmológica, Instituto Oftalmológico Fernández-Vega, Oviedo, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico rápido de las infecciones de transmisión sexual" ] ] "textoCompleto" => "IntroductionWorldwide, sexually transmitted infections (STIs) pose a significant morbidity and mortality burden as they compromise quality of life, sexual and reproductive health and newborn and child health. They also indirectly facilitate the transmission of the human immunodeficiency virus (HIV) and cause cell changes that precede some forms of cancer. The WHO provides data on a reality that seems far-removed from developed countries. Syphilis causes over 300,000 foetal and neonatal deaths per year and exposes another 215,000 children to premature death. It also estimates that 357 million new cases of four types of curable STIs are recorded every year: 131 million Chlamydia trachomatis (CT) infections, 78 million Neisseria gonorrhoeae (NG) infections, 6 million Treponema pallidum (TP) infections and 142 million Trichomonas vaginalis (TV) infections. Similarly, the human papillomavirus (HPV) is believed to be responsible for 530,000 cases of cervical and uterine cancer as well as 264,000 deaths. We also cannot forget the emergence of multidrug-resistant gonococcal strains that threaten us with untreatable gonorrhoea.While it is true that progress has been made, such as the reduction of mother-to-child syphilis transmission in developing countries, globally the prevalence of STIs remains the same or is even on the rise. Numerous factors contribute to this, but the treatment delay that arises while patients await a diagnostic result is particularly important. By means of a mathematical model, it has been shown that using a rapid diagnostic test with a sensitivity as low as 63% successfully improves the percentage of treated patients, compared to waiting for the result of a high-sensitivity test available at a second consultation, which many patients fail to attend.<a class="elsevierStyleCrossRef" href="#bib0195">1</a> As such, diagnostic tests that provide immediate results will facilitate the administration of aetiological treatments to a larger number of infected patients and new transmissions will be avoided by breaking the chain of infection.To that effect, it is necessary to reinforce the capacity of the laboratories and to also proceed with designing and implementing diagnostic tests at the point of care to facilitate systematic and early STI diagnosis of all suspected individuals, even if they are asymptomatic.In this review, we will present the latest rapid diagnostic techniques for the main STI- and vulvovaginitis-causing pathogens, though we will leave viral hepatitis and HIV to one side.History, concept and characteristics of the rapid tests in sexually transmitted infectionsIn STIs, diagnostic tests can serve several purposes: (a) diagnosis; (b) screening of high-risk groups; (c) treatment monitoring; (d) epidemiological surveillance; (e) investigation of outbreaks; (f) validation of syndrome management in countries with few resources; (g) detection of resistance patterns; (h) ensuring quality in laboratory tests; and (i) research.<a class="elsevierStyleCrossRef" href="#bib0200">2</a>The diagnostic tests used in STIs are: (a) direct microscopy; (b) culture; (c) antigen detection; (d) serology; (e) detection of microbial metabolites (whiff test, for example), and (f) molecular methods. All of these may be considered rapid at least in some of their forms, except culture.Rapid tests in STIs can be considered as such, or as point-of-care tests (POCTs). This review considers both types indiscriminately. POCTs can be defined as diagnostic tests that allow a diagnosis to be obtained and a treatment indicated at the same visit. The differences between them are detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> (adapted from Muralidhar<a class="elsevierStyleCrossRef" href="#bib0205">3</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Rapid tests/POCTs aimed at STI diagnosis must meet the following requirements established by the WHO<a class="elsevierStyleCrossRef" href="#bib0210">4</a>:ASSURED<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Affordable.</li><li class="elsevierStyleListItem" id="lsti0010">•Sensitive.</li><li class="elsevierStyleListItem" id="lsti0015">•Specific.</li><li class="elsevierStyleListItem" id="lsti0020">•User-friendly (few steps and minimum training).</li><li class="elsevierStyleListItem" id="lsti0025">•Rapid and robust (storable at room temperature, results in <30min).</li><li class="elsevierStyleListItem" id="lsti0030">•Equipment-free.</li><li class="elsevierStyleListItem" id="lsti0035">•Deliverable to end-users.</li></ul>POCTs must also comply with quality controls included in the tests and be environmentally safe and low cost.An important aspect is what users think the qualities of rapid tests/POCTs should be in STIs. In a study on focus groups, it was found that the qualities of a rapid test should be high sensitivity and specificity, a short procedure time and a low cost.<a class="elsevierStyleCrossRef" href="#bib0215">5</a>For POCTs, various types of technology are used<a class="elsevierStyleCrossRef" href="#bib0220">6</a>:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0040">a)Precipitation/agglutination reactions such as the RPR test for syphilis.</li><li class="elsevierStyleListItem" id="lsti0045">b)Immunochromatography in different test formats: (b1) lateral flow; (b2) multiple, e.g. HIV+syphilis, HIV+syphilis+HBV/HCV, treponemal test+non-treponemal test; (b3) using a flow assay such as dot-blot; (b4) with readers/scanners to eliminate observer bias, thereby increasing sensitivity and facilitating quantification.</li><li class="elsevierStyleListItem" id="lsti0050">c)Emerging technologies such as microfluidic assays (which detect multiple analytes such as HIV and syphilis) and loop-mediated isothermal amplification technology (LAMP), which achieves amplification using four primers and polymerase enzyme in a constant temperature reaction (60–65°C) and obtains results in less than 1h.</li></ul>POCTs were developed to complement centralisation in “core” laboratories, allowing for decentralised determinations that are available 24h a day, 365 days a year. They are usually combinations of syndrome-based microorganisms, can be collected by the patients themselves, do not require trained personnel and are rapid so as to enable decision-making. Of all of them, the STI tests are among those that have been proven cost-effective.<a class="elsevierStyleCrossRef" href="#bib0225">7</a>Irrespective of the terminology and discourse that may surround rapid tests or POCTs, in this review we include the types of tests we consider to be interchangeable, whether these are with or without equipment at the point of care or in a nearby laboratory, and which try to provide the fastest results possible.The rapid response laboratory in sexually transmitted infections and needs in different settings: primary care, emergency departments, STI clinics, reference laboratoriesLaboratory centralisation makes the presence of a rapid response laboratory difficult in our setting, but the following methods may be available in various working environments:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0055">a)Primary care: e.g. Gram stain and Amsel criteria for bacterial vaginosis.</li><li class="elsevierStyleListItem" id="lsti0060">b)Emergency departments: normally have a support laboratory.</li><li class="elsevierStyleListItem" id="lsti0065">c)STI clinic: the above methods, dark-field microscopy, urine sediment.</li><li class="elsevierStyleListItem" id="lsti0070">d)Reference laboratory: all rapid techniques.</li></ul>In developing countries, rapid tests/POCTs generate huge interest as they help to reduce the enormous disease burden that they endure. These tests allow a move away from syndromic treatments (targeted blindly and simultaneously at various pathogens causing the same syndrome) and a progression towards aetiological treatments (targeted specifically at the causal pathogen). The unnecessary use of antimicrobials and the emergence of resistances are avoided, costs are reduced and the chain of infection is broken more effectively. However, there are drawbacks, as aspects such as cost, the need for the refrigeration of reagents or electrical supply requirements (e.g. for a microscope) can mean that tests which prove very useful in one setting may be useless in another. As such, all of the ASSURED requirements are equally important.Rapid diagnostic tests in sexually transmitted infections and their evidence<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the rapid techniques for STIs (adapted from Aznar Martín et al.<a class="elsevierStyleCrossRef" href="#bib0230">8</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>CandidiasisMicroscopy and culture are the tests that should routinely be performed in symptomatic women (level of evidence III, grade B).<a class="elsevierStyleCrossRef" href="#bib0235">9</a> The microscopic observation of yeast in vaginal discharge by means of a wet mount or Gram stain examination has the advantage of being rapid, but has a low sensitivity (50%).Criteria for diagnosing vaginal candidiasis (level of evidence III, grade B)<a class="elsevierStyleCrossRef" href="#bib0240">10</a>:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0075">-Absence of fishy odour in the “whiff test”, using a potassium hydroxide solution on a speculum, and amine odour test on a slide, are supportive, since candidiasis does not usually coexist with bacterial vaginosis or TV infection, but they are not diagnostic.</li><li class="elsevierStyleListItem" id="lsti0080">-Presence of yeasts or pseudohyphae on the wet mount examination of vaginal discharge (40–60% sensitivity).</li><li class="elsevierStyleListItem" id="lsti0085">-Presence of yeasts or pseudohyphae on the Gram stain of vaginal discharge (up to 65% sensitivity).</li></ul>The BD Affirm VPIII™ system (Becton Dickinson, Franklin Lakes, New Jersey, United States) uses hybridisation to determine the presence of the genetic material of TV, Gardnerella vaginalis (GV) and certain Candida species (Candida albicans, Candida glabrata, Candida kefyr, Candida krusei, Candida parapsilosis and Candida tropicalis), with a Candida sensitivity of 85–90% and a specificity of >99%. Results are obtained in less than 1h.ChancroidAt present, the use of the PCR technique is indicated for the detection of Haemophilus ducreyi (HD), due to the low sensitivity of Gram staining (typical in “schools of fish” with small pleomorphic Gram-negative bacilli). In comparison to culture, microscopy has a sensitivity of 50%, and false positives are also common.<a class="elsevierStyleCrossRef" href="#bib0245">11</a> A multi-format PCR is available on the market for HD and TP.ChlamydiaThe majority of the diagnostic tests available are carried out in the laboratory and there may be a delay between collection and the result.The urethral Gram stain is the standard diagnostic test for nongonococcal urethritis, but is dependent on the observer and has a low specificity. As such, the use of flow cytometry is also currently being introduced to detect leukocyturia in urine as an inflammatory marker of nongonococcal urethritis (NGU) caused by CT and Mycoplasma genitalium (MG).<a class="elsevierStyleCrossRef" href="#bib0250">12</a>EIA-based POCTs have a low sensitivity, although new forms present sensitivities of 82–84% compared to nucleic acid amplification tests (NAATs).<a class="elsevierStyleCrossRefs" href="#bib0255">13,14</a>NAATs are the diagnostic benchmark but are generally carried out in the laboratory, taking several hours. New formats like isothermal NAATs (LAMP) are commercially available, offer good sensitivity (97.1%) and specificity (97.9%), and have an execution time of less than 1h. However, performing the techniques is complex and should be done by trained personnel; they therefore cannot be used as POCTs.New NAAT-based techniques (GeneXpert CT/NG, Cepheid, Sunnyvale, CA, United States) are appropriate for genital samples and reduce the time required to issue a result.<a class="elsevierStyleCrossRef" href="#bib0265">15</a> Extra-genital samples require additional validations.<a class="elsevierStyleCrossRef" href="#bib0270">16</a> Their sensitivity is very high (97–99%) as is their specificity (>99%), for endocervical, vaginal and urine samples.<a class="elsevierStyleCrossRef" href="#bib0275">17</a>Lymphogranuloma venereum (LGV)Diagnosis requires clinical suspicion and very specialised laboratory tests are necessary for confirmation. Firstly, the presence of CT must be seen in the lesions, usually using NAATs. The samples used are both genital and extra-genital: rectal, pharyngeal and urine.<a class="elsevierStyleCrossRef" href="#bib0280">18</a> Chlamydia-positive samples should be assessed a second time using a specific PCR reaction for LGV-producing chlamydia DNA. Typing techniques are also used, by means of RFLP or sequencing. In light of the above, no rapid detection method exists at present, although the GeneXpert PCR could meet these criteria. However, this is usually used in a second step, when the presence of chlamydia has already been detected.GonorrhoeaGonorrhoea diagnosis is established with the detection of NG at the infection site. The method to be used will depend on the patient's symptoms, transport conditions to the laboratory and the available tests.<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0090">a)Gram stain for urethritis: Gram staining is a rapid technique that is equally as sensitive as culture in symptomatic urethritis among men, though it has limited sensitivity in other areas. Examinations should be performed with a 1000× objective lens under oil immersion for at least 2min, checking for the presence of polymorphonuclear (PMN) leukocytes, a pink nucleus and a colourless cytoplasm, usually >4–5 PMN leukocytes per immersion field. If a urinary Gram stain is performed, it is advisable to collect the first 10–15ml from the first part of urination as well as to observe the sediment after centrifugation to check for the presence of ≥10 PMN leukocytes. Gonorrhoea appears as kidney-shaped, oval, Gram-negative cocci, in intra and extracellular pairs.<a class="elsevierStyleCrossRef" href="#bib0230">8</a> In urethral samples from symptomatic men, Gram staining offers a high sensitivity (90–95%) and facilitates immediate diagnosis (III, C).<a class="elsevierStyleCrossRef" href="#bib0285">19</a> The sensitivity of the same samples in asymptomatic men is distinctly lower (50–75%). Gram staining of rectal samples is not recommended in symptomatic patients or in urethral samples from women (III, C). It should also not be used on pharyngeal samples.The traditional criterion for determining the existence of urethritis is the observation of 4–5 PMN leukocytes with an immersion field objective lens and the presence or absence of Gram-negative diplococci, in both gonococcal or nongonococcal urethritis.<a class="elsevierStyleCrossRef" href="#bib0290">20</a> This criterion was based on the best sensitivity and specificity established with NG and CT cultures. However, with NAAT systems, it has been seen to be too strict for NGU, also considering variations between microscopists and the fact that sensitivity varies according to the grade of urethritis (low-grade cases present more false negatives). Considering there to be no urethritis with the presence of <5 PMN leukocytes causes 32% of CT-induced cases to go undetected, along with 37% caused by MG, 38% by adenovirus and 44% by herpes virus; it is thus deduced that this is not a good cut-off point for ruling out infection.<a class="elsevierStyleCrossRef" href="#bib0295">21</a> Various studies<a class="elsevierStyleCrossRefs" href="#bib0300">22–26</a> highlight that, in order to determine the existence of urethritis, a cut-off point of ≥5 PMN leukocytes is not very sensitive (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>), and that lowering it to ≥2 PMN leukocytes increases sensitivity (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0095">b)Methylene blue stain for urethritis: another aspect to take into account in stains is whether the Gram stain is superior to others. The Gram stain has been compared to the methylene blue stain and a mixture of methylene blue and crystal violet (4:1 parts),<a class="elsevierStyleCrossRefs" href="#bib0325">27,28</a> which favours the intra or extracellular examination of diplococci.The main advantage is that it takes less time to perform: 4min (Gram) versus 10–15s (methylene blue), with a sensitivity of 97.3%, a specificity of 99.6% and a concordance of 100%. Although the bacterial morphology cannot be seen with its stain characteristics in methylene blue, this is not important for examining the presence of PMN leukocytes and, thus, urethritis.</li><li class="elsevierStyleListItem" id="lsti0100">c)Gram stain for cervicitis: this is performed on cervical discharge and >10 PMN leukocytes with a 1000× objective lens is deemed to be suggestive of infection.</li><li class="elsevierStyleListItem" id="lsti0105">d)NAATs: NG detection with NAATs is more sensitive than culture and may be performed on a wide range of samples: urethral or urine in men, and endocervical or vaginal in women. Urine samples in women have a lower sensitivity and they are not an optimal sample (II, B).<a class="elsevierStyleCrossRef" href="#bib0335">29</a>In the rectum and pharynx, NAATs are more sensitive than culture, but positive samples should be confirmed with another NAAT that uses a different target (III, C).In any case, in their current formats, NAATs cannot be considered rapid tests, although the incorporation of the LAMP technique renders it adequate in terms of its rapidness, sensitivity and specificity. A LAMP technique by the same manufacturer is available on the market, with an identical format and characteristics to the one mentioned previously for chlamydia. However, although rapid (<1h), it cannot be used as a POCT due to its complexity.The GeneXpert CT/NG NAAT, with the characteristics cited in the “Chlamydia” section, presents excellent sensitivity (98–100%) and specificity (99.9%) in vaginal and endocervical samples as well as male urine, with lower results in urine samples from women.<a class="elsevierStyleCrossRef" href="#bib0275">17</a></li></ul>SyphilisRapid tests for diagnosing syphilis through the detection of antibodies have shown excellent results in prenatal syphilis screening, particularly in developing countries. Opportunities for accessing pregnant women are rare, and diagnosis—and, where applicable, treatment—have to be given at the time of the consultation. It is estimated that in Sub-Saharan Africa, where there is a syphilis seroprevalence of 8.3%, only 38% of pregnant women have access to neonatal screening, so half a million children are believed to die every year due to congenital syphilis sequelae.<a class="elsevierStyleCrossRef" href="#bib0220">6</a> With regard to the serological laboratory techniques used in developed countries that require a centrifuge, new immunochromatography techniques may be considered authentic POCTs given that they can be performed on whole blood obtained by finger prick, the reagents do not require refrigeration and they obtain results in 15–20min. Although they are easy to perform, the manufacturer's instructions must be strictly adhered to in order to guarantee accuracy. These techniques use recombinant antigens and capture specific treponemal antibodies, so the exclusive performance of this test leads to unnecessary treatments in previously treated and cured patients who continue to present lifelong treponemal antibodies. In such cases that come back positive during the initial screening period, referrals to reference laboratories would be ideal in order to determine the disease activity with non-treponemal tests. A dual POCT system that separately determines the presence of treponemal and non-treponemal antibodies is available on the market, offering diagnostic confirmation when both are positive. However, the lack of non-treponemal antibody quantification inhibits the determination of the initial titre for treatment control. Dual determination is also possible in the same antibody assay for syphilis and HIV.Things are very different in our setting, and serological tests are usually carried out in the context of other laboratory tests. An initial positive non-treponemal test result would be confirmed with another treponemal test, and the same is true in reverse; if we carry out an initial treponemal test (usually an EIA), we confirm a positive result with a non-treponemal test (reverse algorithm). These tests are performed in a scheduled manner in the laboratory.However, it is clear that in certain situations where an immediate diagnosis prevails over other considerations, the performance of an RPR test only requires one centrifuge, the reagent and the person responsible for performing the technique having the knowledge to do so.Dark-field microscopy requires a microscope with the aforementioned characteristics (which not all laboratories have) and a microscopist who is an expert in the technique, which is considerably complex for the observer. Non-genital samples, especially oral samples, may contain nonpathogenic treponemes that lead to false positives, so their use is not recommended. There is a IIA recommendation for performing dark-field microscopy on chancre samples, provided an expert microscopist and adequate equipment are available.<a class="elsevierStyleCrossRef" href="#bib0340">30</a>PCR techniques, on the other hand, may be used on oral and other extra-genital and genital samples, with a IA recommendation,<a class="elsevierStyleCrossRef" href="#bib0340">30</a> since commensal treponemes do not interfere with the technique. These techniques are only available at referral centres, but are not considered “rapid response” unless they are of the LAMP variety.TrichomoniasisA wet mount examination is easy to perform, rapid, low-cost and highly specific (98%), but has a low sensitivity (62–92%) and is dependent on the observer. To perform this test, a drop of urethral or vaginal discharge is mixed on a slide with a drop of 0.5% physiological saline solution at 37°C. A coverslip is then applied and it is observed under a microscope to check for the characteristic movements of trichomonas. The preparation should be examined within 10min of taking the sample, as the characteristic movement of the trichomonas parasite reduces after this time, thus hindering its identification.<a class="elsevierStyleCrossRef" href="#bib0345">31</a>As mentioned previously in the “Candidiasis” section, the BD Affirm VPIII™ system also determines the presence of TV, in this case with a sensitivity of 89.2% and a specificity of 99.3% compared to culture.Moreover, there are POCTs such as the OSOM Trichomonas Rapid Test (Sekisui Diagnostic, Hartwell Place, Lexington, United States), which determines the presence of the antigen and has shown a high sensitivity (80–94%) and specificity (95%). No instruments are required and it provides results in 30min, although it must be taken into account that false positives are possible (IIb, B).<a class="elsevierStyleCrossRef" href="#bib0350">32</a>Herpes simplex virus (HSV)There are various rapid techniques:<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0110">a)Optical microscopy. This technique is inadequate. Direct examination using the Tzanck or Papanicolaou smear has a limited sensitivity and is nonspecific. It does not differentiate between HSV-1 and 2, and Cowdry type A intranuclear inclusions are not exclusive to the HSV. Moreover, a negative result does not rule out the possibility of genital herpes.</li><li class="elsevierStyleListItem" id="lsti0115">b)Electron microscopy. This has fallen out of use as it requires concentrations of over 108virions/ml. It provides rapid results but has a limited sensitivity and requires equipment that is not widely available in clinical laboratories.</li><li class="elsevierStyleListItem" id="lsti0120">c)Direct immunofluorescence. HSV antigens can be detected with immunofluorescence or immunoenzyme techniques. These are rapid techniques with a sensitivity and specificity ranging from 70% to 90% in symptomatic patients. On direct samples, sensitivity reduces as the lesion develops over time. The use of monoclonal antibodies provides good specificity and facilitates the differentiation of HSV-1 and 2. It is currently used more as a complement to identify viruses in cell cultures.</li><li class="elsevierStyleListItem" id="lsti0125">d)NAATs are recommended for the diagnosis of genital herpes (Ib, A).<a class="elsevierStyleCrossRef" href="#bib0355">33</a> Detecting HSV DNA using PCR techniques increases detection by 11–71% compared to culture. It also allows for more lenient conditions than culture with regard to sample storage and transportation. It allows for the differentiation of HSV-1 and 2, which should be established in all new diagnoses (III, B). Positive results do not require confirmation.</li></ul>VaginosisVaginosis may be diagnosed on the basis of three sets of criteria (Amsel, Nugent or Ison) (II, B).<a class="elsevierStyleCrossRef" href="#bib0240">10</a>The Amsel clinical criteria<a class="elsevierStyleCrossRef" href="#bib0360">34</a> are based on the presence of three of the following signs or symptoms: (a) thin, homogeneous, white, uniform vaginal discharge that adheres to the vaginal walls; (b) vaginal pH >4.5; (c) fishy odour after adding 10% KOH to the sample; and (d) more than 20% clue cells in wet mount preparations (microscope with a 40× objective lens).It may be confirmed by objective microscopic criteria viewed in a Gram stain of vaginal discharge using the Nugent<a class="elsevierStyleCrossRef" href="#bib0365">35</a> score (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). This is considered the gold standard. The microbiological diagnosis of bacterial vaginosis is carried out using a Gram stain of vaginal discharge, determining the relative quantity of morphotypes characteristic of abnormal vaginal microbiota (Gram-positive and Gram-negative bacilli and curved bacteria) and the presence of clue cells (epithelial cells coated with Gram-positive and Gram-negative morphotypes with obscured borders). Stained cervical smears using the Papanicolaou method are not appropriate due to their low sensitivity.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>However, the BASHH guidelines recommend (grade C) the use of the Ison and Hay criteria,<a class="elsevierStyleCrossRef" href="#bib0370">36</a> as they reflect real microbiota possibilities better than the Nugent criteria.<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0130">Grade 0: Unrelated to bacterial vaginosis; epithelial cells only, with no Lactobacillus morphotypes. May indicate recent antibiotic use.</li><li class="elsevierStyleListItem" id="lsti0135">Grade 1 (normal): Lactobacillus morphotypes predominate.</li><li class="elsevierStyleListItem" id="lsti0140">Grade 2 (intermediate): mixed flora with some lactobacilli present, but Gardnerella or Mobiluncus morphotypes also present.</li><li class="elsevierStyleListItem" id="lsti0145">Grade 3 (bacterial vaginosis): predominantly Gardnerella and/or Mobiluncus morphotypes. Few or absent lactobacilli.</li><li class="elsevierStyleListItem" id="lsti0150">Grade 4: unrelated to bacterial vaginosis; only Gram-positive cocci observed, no lactobacilli.</li></ul>Commercial systems also exist, although some are not marketed in Spain:<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0155">OSOM BVBlue (Sekisui Diagnostic, Hartwell Place, Lexington, United States) measures sialidase levels.</li><li class="elsevierStyleListItem" id="lsti0160">Pip Activity TestCard (Litmus Concepts Inc, Santa Clara, California, United States) assesses proline aminopeptidase.</li><li class="elsevierStyleListItem" id="lsti0165">BD Affirm VPIII (Becton Dickinson, Franklin Lakes, New Jersey, United States) uses a DNA probe to detect high concentrations of GV, with a sensitivity of over 90% and a specificity of over 99%.</li><li class="elsevierStyleListItem" id="lsti0170">PCR-based systems have also been described but are not available on the market.</li></ul>Point-of-care tests (POCTs) and multiple platformsIn relation to POCTs, the most widely implemented tests at present are for HIV, followed by TP. As for gonorrhoea, the same problems regarding cross-reactions continue to arise, and there is limited experience with others, such as those used for the HPV or HSV.Multiple platforms are being developed, such as the one designed for nine pathogens by FilmArray (BioFire Diagnostics, Salt Lake City, Utah, United States), with promising initial results, though it is yet to be marketed.<a class="elsevierStyleCrossRef" href="#bib0375">37</a>Future of rapid tests in sexually transmitted infectionsSuccessfully controlling STIs will largely depend on the availability of aetiological diagnoses which, as well as being sensitive and specific, are rapid and allow immediate aetiological treatment. This is the n of the WHO in the Global health sector strategy on sexually transmitted infections, 2016–2021.<a class="elsevierStyleCrossRef" href="#bib0380">38</a>A rapid diagnosis can be achieved if there is a laboratory close to the point of care, with rapid techniques and personnel willing to perform these immediately. This may be possible at certain highly-specialised centres, but laboratory centralisation trends are heading in the opposite direction. Multiple PCRs that provide results in 1–2h may be an alternative here, including GeneXpert (Cepheid, Sunnyvale, CA, United States).It can also be achieved by providing points of care with basic laboratory materials (stain reagents, centrifuges and microscopes) and by training the clinic on their use. Although this is in place at some centres, its widespread implementation seems to be a challenge.Instead, the future of rapid diagnosis lies in the development and implementation of POCTs that allow the diagnosis of as many pathogens as possible (ideally in multiple formats) and that meet most of, if not all, the ASSURED criteria proposed by the WHO. We have rapid tests for syphilis and HIV but still lack genuinely rapid point-of-care tests that enable the diagnosis of highly prevalent and curable infections, such as those caused by CT, TV and NG, within a matter of minutes. Generally speaking, the available methods do not reach the sensitivity and specificity levels attained by PCR techniques.Among the most promising tests described in the literature, we can site the assay for CT with microwave accelerated metal enhanced fluorescence (MAMEF) technology, which provides results in 9min with a sensitivity of 82% and a specificity of 93%.39Moreover, hopes are high regarding microfluidic techniques, which are microsystems that incorporate assay operations and sample preparation on a chip, with the advantages being that they require very small quantities of sample, have a faster response time and are portable. Generally speaking, these techniques work well for antibody detection due to the abundance of target molecules. For other samples, such as urine or those obtained with a swab, the sample will require prior processing before it is added to the microsystem. This presents limitations for antigen detection due to few target molecules being found in the sample.The future also lies in determining the presence of antimicrobial resistances, which is especially important for NG and MG. Work on array and microfluidic formats is currently only being conducted at highly-specialised laboratories, although it would be ideal if they could be used at the point of care.Conflicts of interestNone." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres872695" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec861425" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres872694" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec861426" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "History, concept and characteristics of the rapid tests in sexually transmitted infections" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "The rapid response laboratory in sexually transmitted infections and needs in different settings: primary care, emergency departments, STI clinics, reference laboratories" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Rapid diagnostic tests in sexually transmitted infections and their evidence" "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Candidiasis" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Chancroid" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Chlamydia" ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "Lymphogranuloma venereum (LGV)" ] 4 => array:2 [ "identificador" => "sec0045" "titulo" => "Gonorrhoea" ] 5 => array:2 [ "identificador" => "sec0050" "titulo" => "Syphilis" ] 6 => array:2 [ "identificador" => "sec0055" "titulo" => "Trichomoniasis" ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Herpes simplex virus (HSV)" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Vaginosis" ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Point-of-care tests (POCTs) and multiple platforms" ] ] ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Future of rapid tests in sexually transmitted infections" ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-01-03" "fechaAceptado" => "2017-01-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec861425" "palabras" => array:3 [ 0 => "Point of care system" 1 => "Screening assay" 2 => "Sexually transmitted diseases" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec861426" "palabras" => array:3 [ 0 => "Sistemas de diagnóstico a la cabecera del enfermo" 1 => "Cribado de ITS" 2 => "Infecciones de transmisión sexual" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Sexually transmitted infections (STIs) are responsible for an enormous burden of morbidity and mortality. Worldwide, millions of cases of STIs, such as syphilis, chlamydia, or gonorrhoea occur every year, and there is now an increase in antimicrobial resistance in pathogens, such as gonococcus. Delay in diagnosis is one of the factors that justifies the difficulty in controlling these infections. Rapid diagnostic tests allow the introduction of aetiological treatment at the first visit, and also leads to treating symptomatic and asymptomatic patients more effectively, as well as to interrupt the epidemiological transmission chain without delay. The World Health Organisation includes these tests in its global strategy against STIs." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Las infecciones de transmisión sexual (ITS) suponen una importante carga de morbimortalidad. A nivel mundial todos los años se producen millones de casos de ITS como sífilis, infección por clamidias o gonococia, y actualmente se asiste a un incremento de la resistencia a los antimicrobianos en patógenos como el gonococo. La demora en el diagnóstico es uno de los factores que justifica la dificultad para controlar estas infecciones. Las pruebas de diagnóstico rápido permiten instaurar el tratamiento etiológico en la primera consulta, lo que lleva a tratar a más pacientes, tanto sintomáticos como asintomáticos, de forma más efectiva, e interrumpir sin demoras la cadena epidemiológica de transmisión. La OMS incluye estas pruebas en su estrategia mundial contra las ITS." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Otero-Guerra L, Fernández-Blázquez A, Vazquez F. Diagnóstico rápido de las infecciones de transmisión sexual. Enferm Infecc Microbiol Clin. 2017;35:444–450." ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "POCTs: point-of-care tests.Source: Adapted from Muralidhar.<a class="elsevierStyleCrossRef" href="#bib0205">3</a>" "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Rapid testing \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">POCTs \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Difficulty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Simple \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Simple (can be used in primary care) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><30min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><20–30min \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Electricity source \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, necessary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trained personnel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, necessary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Quality control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No, internal controls \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (more reliable) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1472711.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Differences between rapid tests and POCTs." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Se: sensitivity; Sp: specificity.Source: Adapted from Aznar Martín et al.<a class="elsevierStyleCrossRef" href="#bib0230">8</a>" "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganism/syndrome \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Test \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Se (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chlamydia trachomatis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Giemsa stain, Macchiavello-Gimenez stain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Immunochromatography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82–84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">GeneXpert CT/NG NAAT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97–99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neisseria gonorrhoeae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Endocervical Gram stain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45–65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90–99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pharyngeal and rectal Gram stains are not recommended \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Urethral Gram stain (with symptoms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90–95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95–99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Urethral Gram stain (asymptomatic) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50–75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85–87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">GeneXpert CT/NG NAAT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">98–100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">99.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Treponema pallidum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dark-field microscopy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80–90; 39–81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><100; 82–100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not for oral or rectal lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Direct immunofluorescence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90–95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Requires a fluorescence microscope and trained personnel \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Herpes simplex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RPR (non-treponemal antibodies) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73–100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79–98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Requires confirmation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tzanck smear \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No Sp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Depends on the no. of viral particles in lesions 70–90% Se if sufficient no. of cells \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haemophilus ducreyi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Direct immunofluorescence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70–90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Donovanosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gram stain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50–70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bacterial vaginosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Wright-Giemsa stain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40–50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Wet mount \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70–90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95–100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gram stain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60–80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95–100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">pH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75–80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60–70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">DNA probe (Affirm VPIII) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Rapid pH and Rapid Amine (FermCard) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80–90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85–90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Rapid PIP (G. vaginalis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80–85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90–92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Candida spp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BVBlue system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">91.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Wet mount \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40–60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Examination with KOH 10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54–80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trichomonas vaginalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">DNA probe (Affirm VPIII) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85–90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Wet mount \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62–92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">99–100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70% compared to PCR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Latex agglutination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OSOM Trichomonas Rapid Test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80–94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1472712.png" ] ] ] ] "descripcion" => array:1 [ "en" => "List of rapid tests for sexually transmitted infections." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "PMN: polymorphonuclear leukocytes." "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganism \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Janier et al., 1995<a class="elsevierStyleCrossRef" href="#bib0310">24</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Iwuji et al., 2008<a class="elsevierStyleCrossRef" href="#bib0315">25</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Orellana et al., 2012<a class="elsevierStyleCrossRef" href="#bib0305">23</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chlamydia trachomatis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ureaplasma urealyticum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1472713.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sensitivity of the Gram stain with ≥5 PMNs for Chlamydia trachomatis and Ureaplasma urealyticum." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "PMN: polymorphonuclear leukocytes; Se: sensitivity; Sp: specificity." "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of PMNs \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Se (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≥5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neisseria gonorrhoeae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chlamydia trachomatis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ureaplasma urealyticum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1472715.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sensitivity and specificity according to PMN threshold." ] ] 4 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Score \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gram-positive bacilli (Lactobacillus spp.) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Small Gram-negative bacilli (Gardnerella vaginalis) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Curved Gram-negative bacilli (Mobiluncus spp.) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4+ (>30morphotypes/field) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3+ (5–30morphotypes/field) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1+ (<1morphotype/field) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1+ 2+ (<5morphotypes/field) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2+ (1–4morphotypes/field) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2+ (1–4morphotypes/field) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3+ 4+ (>5morphotypes/field) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1+ (<1morphotype/field) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3+ (5–30morphotypes/field) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4+ (>30morphotypes/field) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1472714.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Interpretation of the Nugent criteria." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:38 [ 0 => array:3 [ "identificador" => "bib0195" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The rapid test paradox: when fewer cases detected lead to more cases treated: a decision analysis of tests for Chlamydia trachomatis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.L. Gift" 1 => "M.S. Pate" 2 => "E.W. Hook 3rd" 3 => "W.J. Kassler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Sex Transm Dis" "fecha" => "1999" "volumen" => "26" "paginaInicial" => "232" "paginaFinal" => "240" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10225593" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0200" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Principles of laboratory diagnosis of STIs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Kuypers" 1 => "C.A. Gaydos" 2 => "R.W. Peeling" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Sexually transmitted diseases" "paginaInicial" => "937" "paginaFinal" => "958" "edicion" => "4th ed." "serieFecha" => "2008" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0205" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular methods in the laboratory diagnosis of sexually transmitted infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Muralidhar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0253-7184.156686" "Revista" => array:6 [ "tituloSerie" => "Indian J Sex Transm Dis" "fecha" => "2015" "volumen" => "36" "paginaInicial" => "9" "paginaFinal" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26392648" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0210" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What's the point? How point of care STI tests can impact infected patients?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Huppert" 1 => "E. Hesse" 2 => "C.A. Gaydos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/POC.0b013e3181d2d8cc" "Revista" => array:6 [ "tituloSerie" => "Point Care" "fecha" => "2010" "volumen" => "9" "paginaInicial" => "36" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20401167" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0215" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perceptions of an ideal point-of-care test for sexually transmitted infections—a qualitative study of focus group discussions with medical providers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.-H. Hsieh" 1 => "M.T. Hogan" 2 => "M. Barnes" 3 => "M. Jett-Goheen" 4 => "J. Huppert" 5 => "A.M. Rompalo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0014144" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2010" "volumen" => "5" "paginaInicial" => "e14144" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21152386" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0220" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid tests for sexually transmitted infections (STIs): the way forward" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.W. Peeling" 1 => "K.K. Holmes" 2 => "D. Mabey" 3 => "A. Ronald" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/sti.2005.019349" "Revista" => array:7 [ "tituloSerie" => "Sex Transm Infect" "fecha" => "2006" "volumen" => "82" "numero" => "Suppl. 5" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16461590" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0225" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The point-of-care laboratory in clinical microbiology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Drancourt" 1 => "A. Michel-Lepage" 2 => "S. Boyer" 3 => "D. Raoult" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/CMR.00090-15" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Rev" "fecha" => "2016" "volumen" => "29" "paginaInicial" => "429" "paginaFinal" => "447" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27029593" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0230" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Procedimientos en Microbiología Clínica: 24. Diagnóstico microbiológico de las infecciones de transmisión sexual y otras infecciones genitales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Aznar Martín" 1 => "M.A. Blanco Galán" 2 => "J.A. Lepe Jiménez" 3 => "L. Otero Guerra" 4 => "F. Vázquez Valdés" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "fecha" => "2007" "paginaInicial" => "1" "paginaFinal" => "60" "editorial" => "SEIMC" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0235" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: https://www.bashhguidelines.org/media/1043/vvc-2007.pdf [consulted 05.12.16]" "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "United Kingdom national guideline on the management of vulvovaginal candidiasis" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2007" "editorial" => "Clinical Effectiveness Group British Association of Sexual Health and HIV" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0240" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European (IUSTI/WHO) guideline on the management of vaginal discharge, 2011" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "European IUSTI" "etal" => false "autores" => array:4 [ 0 => "J. Sherrard" 1 => "G. Donders" 2 => "D. White" 3 => "J.S. Jensen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1258/ijsa.2011.011012" "Revista" => array:6 [ "tituloSerie" => "Int J STD AIDS" "fecha" => "2011" "volumen" => "22" "paginaInicial" => "421" "paginaFinal" => "429" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21795415" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0245" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "UK national guideline for the management of Chancroid, 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. O’Farrell" 1 => "N. Lazaro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0956462414525940" "Revista" => array:6 [ "tituloSerie" => "Int J STD AIDS" "fecha" => "2014" "volumen" => "25" "paginaInicial" => "975" "paginaFinal" => "983" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25318857" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0250" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance evaluation of automated urine microscopy as a rapid, non-invasive approach for the diagnosis of non-gonococcal urethritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Pond" 1 => "A.V. Nori" 2 => "S. Patel" 3 => "K. Laing" 4 => "M. Ajayi" 5 => "A.J. Copas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/sextrans-2014-051761" "Revista" => array:6 [ "tituloSerie" => "Sex Transm Infect" "fecha" => "2015" "volumen" => "91" "paginaInicial" => "165" "paginaFinal" => "170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25614466" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0255" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New point of care Chlamydia Rapid Test—bridging the gap between diagnosis and treatment: Performance evaluation study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Mahilum-Tapay" 1 => "V. Laitila" 2 => "J.J. Wawrzyniak" 3 => "H.H. Lee" 4 => "S. Alexander" 5 => "C. Ison" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.39402.463854.AE" "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2007" "volumen" => "335" "paginaInicial" => "1190" "paginaFinal" => "1194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18055487" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0260" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparative effectiveness of a rapid point-of-care test for detection of Chlamydia trachomatis among women in a clinical setting" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W. Huang" 1 => "C.A. Gaydos" 2 => "M.R. Barnes" 3 => "M. Jett-Goheen" 4 => "D.R. Blake" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/sextrans-2012-050877" "Revista" => array:6 [ "tituloSerie" => "Sex Transm Infect" "fecha" => "2013" "volumen" => "89" "paginaInicial" => "104" "paginaFinal" => "114" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23335640" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0265" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance of the Cepheid CT/NG Xpert rapid PCR test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. Gaydos" 1 => "B. van der Pol" 2 => "M. Jett-Goheen" 3 => "M. Barnes" 4 => "N. Quinn" 5 => "C. Clarket" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.03461-12" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2013" "volumen" => "51" "paginaInicial" => "1666" "paginaFinal" => "1672" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23467600" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0270" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance of the GeneXpert CT/NG assay compared to that of the Aptima AC2 Assay for detection of rectal Chlamydia trachomatis and Neisseria gonorrhoeae by use of residual Aptima samples" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.D. Goldenberg" 1 => "J. Finn" 2 => "E. Sedudzi" 3 => "J.A. White" 4 => "C.Y.W. Tong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.01930-12" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2012" "volumen" => "50" "paginaInicial" => "3867" "paginaFinal" => "3869" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22993183" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0275" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review of point of care testing for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Herbst de Cortina" 1 => "C.C. Bristow" 2 => "D. Joseph Davey" 3 => "J.D. Klausner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Infect Dis Obstet Gynecol" "fecha" => "2016" "volumen" => "2016" "paginaInicial" => "438612" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0280" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2013 UK national guideline for the management of lymphogranuloma venereum: Clinical Effectiveness Group of the British Association for Sexual Health and HIV (CEG/BASHH) guideline development group" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "British Association for Sexual Health and HIV" "etal" => false "autores" => array:3 [ 0 => "J. White" 1 => "N. O’Farrell" 2 => "D. Daniels" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0956462413482811" "Revista" => array:6 [ "tituloSerie" => "Int J STD AIDS" "fecha" => "2013" "volumen" => "24" "paginaInicial" => "593" "paginaFinal" => "601" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23970591" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0285" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "UK national guideline for the management of gonorrhoea in adults, 2011" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Guideline Development Group; British Association for Sexual Health and HIV UK" "etal" => false "autores" => array:2 [ 0 => "C. Bignell" 1 => "M. Fitzgerald" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1258/ijsa.2011.011267" "Revista" => array:6 [ "tituloSerie" => "Int J STD AIDS" "fecha" => "2011" "volumen" => "22" "paginaInicial" => "541" "paginaFinal" => "547" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21998172" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0290" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sexually transmitted diseases treatment guidelines, 2015" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.A. Workowski" 1 => "G.A. Bolan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.15585/mmwr.rr6404a1" "Revista" => array:6 [ "tituloSerie" => "MMWR Recomm Rep" "fecha" => "2015" "volumen" => "64" "paginaInicial" => "1" "paginaFinal" => "137" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26632963" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0295" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.S. Bradshaw" 1 => "S.N. Tabrizi" 2 => "T.R. Read" 3 => "S.M. Garland" 4 => "C.A. Hopkins" 5 => "L.M. Moss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/499434" "Revista" => array:6 [ "tituloSerie" => "J Infect Dis" "fecha" => "2006" "volumen" => "193" "paginaInicial" => "336" "paginaFinal" => "345" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16388480" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0300" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chlamydial and gonococcal infection in men without polymorphonuclear leukocytes on Gram stain: implications for diagnostic approach and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W.M. Geisler" 1 => "S. Yu" 2 => "E.W. Hook 3rd." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Sex Transm Dis" "fecha" => "2005" "volumen" => "32" "paginaInicial" => "630" "paginaFinal" => "634" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16205305" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0305" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sensitivity of Gram stain in the diagnosis of urethritis in men" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Orellana" 1 => "M.L. Gómez-Lus" 2 => "D. Lora" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/sextrans-2011-050150" "Revista" => array:6 [ "tituloSerie" => "Sex Transm Infect" "fecha" => "2012" "volumen" => "88" "paginaInicial" => "284" "paginaFinal" => "287" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22308534" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0310" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Male urethritis with and without discharge: a clinical and microbiological study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Janier" 1 => "F. Lassau" 2 => "I. Casin" 3 => "P. Grillot" 4 => "C. Scieux" 5 => "A. Zavaro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Sex Transm Dis" "fecha" => "1995" "volumen" => "22" "paginaInicial" => "244" "paginaFinal" => "252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7482108" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0315" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic utility of urethral smears in predicting urethral chlamydia in HIV-infected men" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.C. Iwuji" 1 => "I. Reeves" 2 => "K. Nambiar" 3 => "D. Richardson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1258/ijsa.2008.008118" "Revista" => array:6 [ "tituloSerie" => "Int J STD AIDS" "fecha" => "2008" "volumen" => "19" "paginaInicial" => "741" "paginaFinal" => "743" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18931265" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0320" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recalibrating the Gram stain diagnosis of male urethritis in the era of nucleic acid amplification testing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.A. Rietmejer" 1 => "C.J. Mettenbrink" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/OLQ.0b013e3182354da3" "Revista" => array:6 [ "tituloSerie" => "Sex Transm Dis" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "18" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22183839" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0325" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In defence of methylene blue in diagnosing gonorrhoea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.L.M. Pattison" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Can Med Assoc J" "fecha" => "1983" "volumen" => "128" "paginaInicial" => "508" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6825014" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0330" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of methylene blue/gentian violet stain to Gram's stain for the rapid diagnosis of gonococcal urethritis in men" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.N. Taylor" 1 => "R.P. DiCarlo" 2 => "D.H. Martin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/OLQ.0b013e318225f7c2" "Revista" => array:6 [ "tituloSerie" => "Sex Transm Dis" "fecha" => "2011" "volumen" => "38" "paginaInicial" => "995" "paginaFinal" => "996" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21992973" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0335" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Bignell C, Ison C, FitzGerald M. United Kingdom national guidelines for gonorrhoea testing 2012. Clinical Effectiveness Group, British Association of Sexual Health and HIV. Available from: <a href="https://www.bashh.org/documents/4490.pdf">https://www.bashh.org/documents/4490.pdf</a> [consulted 15.12.16]." ] ] ] 29 => array:3 [ "identificador" => "bib0340" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "UK national guidelines on the management of syphilis 2015" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Kingston" 1 => "P. French" 2 => "S. Higgins" 3 => "O. McQuillan" 4 => "A. Sukthankar" 5 => "C. Stott" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0956462415624059" "Revista" => array:6 [ "tituloSerie" => "Int J STD AIDS" "fecha" => "2016" "volumen" => "27" "paginaInicial" => "421" "paginaFinal" => "446" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26721608" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0345" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "‘Shelf life’ of Trichomonas vaginalis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Kingston" 1 => "D. Bansal" 2 => "E.M. Carlin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1258/095646203321043228" "Revista" => array:6 [ "tituloSerie" => "Int J STD AIDS" "fecha" => "2003" "volumen" => "14" "paginaInicial" => "28" "paginaFinal" => "29" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12590789" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0350" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "United Kingdom national guideline on the management of Trichomonas vaginalis 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Sherrard" 1 => "C. Ison" 2 => "J. Moody" 3 => "E. Wainwright" 4 => "J. Wilson" 5 => "A. Sullivan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0956462414525947" "Revista" => array:6 [ "tituloSerie" => "Int J STD AIDS" "fecha" => "2014" "volumen" => "25" "paginaInicial" => "541" "paginaFinal" => "549" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24616117" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0355" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2014 UK national guideline for the management of anogenital herpes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Patel" 1 => "J. Green" 2 => "E. Clarke" 3 => "K. Seneviratne" 4 => "N. Abbt" 5 => "C. Evans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0956462415580512" "Revista" => array:6 [ "tituloSerie" => "Int J STD AIDS" "fecha" => "2015" "volumen" => "26" "paginaInicial" => "763" "paginaFinal" => "776" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25861804" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0360" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Amsel" 1 => "P.A. Totten" 2 => "C.A. Spiegel" 3 => "K.C. Chen" 4 => "D. Eschenbach" 5 => "K.K. Holmes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "1983" "volumen" => "74" "paginaInicial" => "14" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6600371" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0365" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.P. Nugent" 1 => "M.A. Krohn" 2 => "S.L. Hillier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "1991" "volumen" => "29" "paginaInicial" => "297" "paginaFinal" => "301" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1706728" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0370" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.A. Ison" 1 => "P.E. Hay" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Sex Transm Infect" "fecha" => "2002" "volumen" => "78" "paginaInicial" => "413" "paginaFinal" => "415" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12473800" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0375" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiplex PCR testing for nine different sexually transmitted infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.D. Kriesel" 1 => "A.S. Bhatia" 2 => "C. Barrus" 3 => "M. Vaughn" 4 => "J. Gardner" 5 => "R.J. Crisp" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0956462415615775" "Revista" => array:6 [ "tituloSerie" => "Int J STD AIDS" "fecha" => "2016" "volumen" => "27" "paginaInicial" => "1275" "paginaFinal" => "1282" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26538551" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0380" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blind evaluation of the microwave-accelerated metal-enhanced fluorescence ultrarapid and sensitive Chlamydia trachomatis test by use of clinical samples" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.H. Melendez" 1 => "J.S. Huppert" 2 => "M. Jett-Goheen" 3 => "E.A. Hesse" 4 => "N. Quinn" 5 => "C.A. Gaydos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.00980-13" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2013" "volumen" => "51" "paginaInicial" => "2913" "paginaFinal" => "2920" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23804384" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003500000007/v1_201707230042/S2529993X17301892/v1_201707230042/en/main.assets" "Apartado" => array:4 [ "identificador" => "63566" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Continuing medical education: Methods of rapid diagnosis in clinical microbiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003500000007/v1_201707230042/S2529993X17301892/v1_201707230042/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301892?idApp=UINPBA00004N"]

Statistics

Continuing medical education: Methods of rapid diagnosis

Rapid diagnosis of sexually transmitted infections

Diagnóstico rápido de las infecciones de transmisión sexual

Luis Otero-Guerraa, Ana Fernández-Blázquezb, Fernando Vazquezb,c,d,

Corresponding author

opsklins@gmail.com

Corresponding author.

a Servicio de Microbiología, Hospital de Cabueñes, Gijón, Spain

b Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, Spain

c Departamento de Biología Funcional, Área de Microbiología, Facultad de Medicina, Oviedo, Spain

d Fundación de Investigación Oftalmológica, Instituto Oftalmológico Fernández-Vega, Oviedo, Spain

Read

6097

Times
was read the article

1062

Total PDF

5035

Total HTML

Share statistics

 array:24 [
  "pii" => "S2529993X17301892"
  "issn" => "2529993X"
  "doi" => "10.1016/j.eimce.2017.01.035"
  "estado" => "S300"
  "fechaPublicacion" => "2017-08-01"
  "aid" => "1658"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica"
  "copyrightAnyo" => "2017"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Enferm Infecc Microbiol Clin. 2017;35:444-50"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1174
    "formatos" => array:3 [
      "EPUB" => 7
      "HTML" => 961
      "PDF" => 206
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0213005X17300241"
      "issn" => "0213005X"
      "doi" => "10.1016/j.eimc.2017.01.004"
      "estado" => "S300"
      "fechaPublicacion" => "2017-08-01"
      "aid" => "1658"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Enferm Infecc Microbiol Clin. 2017;35:444-50"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 11977
        "formatos" => array:3 [
          "EPUB" => 11
          "HTML" => 10190
          "PDF" => 1776
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Formaci&#243;n m&#233;dica continuada&#58; M&#233;todos de diagn&#243;stico r&#225;pido en Microbiolog&#237;a Cl&#237;nica</span>"
        "titulo" => "Diagn&#243;stico r&#225;pido de las infecciones de transmisi&#243;n sexual"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "444"
            "paginaFinal" => "450"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Rapid diagnosis of sexually transmitted infections"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Luis Otero-Guerra, Ana Fern&#225;ndez-Bl&#225;zquez, Fernando Vazquez"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Luis"
                "apellidos" => "Otero-Guerra"
              ]
              1 => array:2 [
                "nombre" => "Ana"
                "apellidos" => "Fern&#225;ndez-Bl&#225;zquez"
              ]
              2 => array:2 [
                "nombre" => "Fernando"
                "apellidos" => "Vazquez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2529993X17301892"
          "doi" => "10.1016/j.eimce.2017.01.035"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301892?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X17300241?idApp=UINPBA00004N"
      "url" => "/0213005X/0000003500000007/v1_201707160013/S0213005X17300241/v1_201707160013/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2529993X17301776"
    "issn" => "2529993X"
    "doi" => "10.1016/j.eimce.2015.06.001"
    "estado" => "S300"
    "fechaPublicacion" => "2017-08-01"
    "aid" => "1362"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "ssu"
    "cita" => "Enferm Infecc Microbiol Clin. 2017;35:451-60"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2141
      "formatos" => array:3 [
        "EPUB" => 10
        "HTML" => 1655
        "PDF" => 476
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>"
      "titulo" => "Management of infection and febrile neutropenia in patients with solid cancer"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "451"
          "paginaFinal" => "460"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Manejo de la infecci&#243;n y la neutropenia febril en el paciente con c&#225;ncer s&#243;lido"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 3120
              "Ancho" => 3172
              "Tamanyo" => 412981
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Action algorithm for the initial care of febrile neutropenia patients at the Emergency Department and evaluation of the risk of complications and treatment method&#44; including the maximum desirable time for each of the actions&#46; Adapted from&#58; Bell MS&#44; Scullen P&#44; McParlan D&#44; et al&#46; Neutropenic sepsis guideline&#46; In edition Northern Ireland Cancer Network 2010&#59; 1&#8211;11&#46; &#42;It is not necessary to wait for an analytical confirmation of neutropenia in order to begin the evaluation&#59; &#42;&#42;clinical risk criteria&#58; onset or deterioration of organ dysfunction&#44; comorbidity&#44; altered vital signs&#44; clinical signs or symptoms&#44; documented focal infection or analytical&#47;imaging data&#46; BP&#44; blood pressure&#59; CT&#44; chemotherapy&#59; HR&#44; heart rate&#59; iv&#44; intravenous&#59; MASCC&#44; Multinational Association for Supportive Care in Cancer&#59; po&#44; per os&#59; RR&#44; respiratory rate&#59; SaO<span class="elsevierStyleInf">2</span>&#44; oxygen saturation&#59; SIRS&#44; systemic inflammatory response syndrome&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jos&#233; Mar&#237;a Aguado, Juan Jes&#250;s Cruz, Juan Antonio Virizuela, Manuela Aguilar, Alberto Carmona, Javier Cassinello, Carlota Gudiol, Paula Jim&#233;nez Fonseca, Manuel Lizasoain, Francesc Marco, Isabel Ruiz, Maribel Ruiz, Miguel Salavert, David Vicente, Jordi Carratal&#224;"
          "autores" => array:15 [
            0 => array:2 [
              "nombre" => "Jos&#233; Mar&#237;a"
              "apellidos" => "Aguado"
            ]
            1 => array:2 [
              "nombre" => "Juan Jes&#250;s"
              "apellidos" => "Cruz"
            ]
            2 => array:2 [
              "nombre" => "Juan Antonio"
              "apellidos" => "Virizuela"
            ]
            3 => array:2 [
              "nombre" => "Manuela"
              "apellidos" => "Aguilar"
            ]
            4 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Carmona"
            ]
            5 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Cassinello"
            ]
            6 => array:2 [
              "nombre" => "Carlota"
              "apellidos" => "Gudiol"
            ]
            7 => array:2 [
              "nombre" => "Paula"
              "apellidos" => "Jim&#233;nez Fonseca"
            ]
            8 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Lizasoain"
            ]
            9 => array:2 [
              "nombre" => "Francesc"
              "apellidos" => "Marco"
            ]
            10 => array:2 [
              "nombre" => "Isabel"
              "apellidos" => "Ruiz"
            ]
            11 => array:2 [
              "nombre" => "Maribel"
              "apellidos" => "Ruiz"
            ]
            12 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "Salavert"
            ]
            13 => array:2 [
              "nombre" => "David"
              "apellidos" => "Vicente"
            ]
            14 => array:2 [
              "nombre" => "Jordi"
              "apellidos" => "Carratal&#224;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0213005X15002621"
        "doi" => "10.1016/j.eimc.2015.06.005"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X15002621?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301776?idApp=UINPBA00004N"
    "url" => "/2529993X/0000003500000007/v1_201707230042/S2529993X17301776/v1_201707230042/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2529993X1730179X"
    "issn" => "2529993X"
    "doi" => "10.1016/j.eimce.2017.06.001"
    "estado" => "S300"
    "fechaPublicacion" => "2017-08-01"
    "aid" => "1371"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Enferm Infecc Microbiol Clin. 2017;35:441-3"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 700
      "formatos" => array:3 [
        "EPUB" => 7
        "HTML" => 446
        "PDF" => 247
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>"
      "titulo" => "Indigenous tropical spastic paraparesis in Madrid &#40;Spain&#41;&#46; Experience on screening of human T-lymphotropic virus"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "441"
          "paginaFinal" => "443"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Paraparesia esp&#225;stica tropical aut&#243;ctona en la Comunidad de Madrid&#46; Experiencia en el cribado del virus linfotr&#243;pico de c&#233;lulas T humanas tipo I"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1005
              "Ancho" => 1660
              "Tamanyo" => 60326
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distribution of different clinical and epidemiological criteria that motivate the screening of HTLV-I&#47;II IgG antibodies at our centre&#46; Positive HTLV-I cases are highlighted in the darker colour&#46; LYS&#58; lymphoproliferative syndrome&#59; OTH&#58; others&#59; PDU&#58; parenteral drug users&#59; SDD&#58; suspected demyelinating disease&#59; SEA&#58; routine screening in patients from endemic areas&#59; SOD&#58; screening in organ donors with risk factor&#59; SPT&#58; screening in pre-transplant patients with risk factor&#59; SUH&#58; routine screening in PDU and&#47;or HIV&#43; patients&#59; UJD&#58; unjustified&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Manuel Ponce-Alonso, Ignacio del Corral-Corral, Marta Ortiz-Rivera, Carla Anciones-Mart&#237;n, Mar&#237;a Luisa Mateos-Lindemann"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Ponce-Alonso"
            ]
            1 => array:2 [
              "nombre" => "Ignacio"
              "apellidos" => "del Corral-Corral"
            ]
            2 => array:2 [
              "nombre" => "Marta"
              "apellidos" => "Ortiz-Rivera"
            ]
            3 => array:2 [
              "nombre" => "Carla"
              "apellidos" => "Anciones-Mart&#237;n"
            ]
            4 => array:2 [
              "nombre" => "Mar&#237;a Luisa"
              "apellidos" => "Mateos-Lindemann"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0213005X15002712"
        "doi" => "10.1016/j.eimc.2015.07.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X15002712?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X1730179X?idApp=UINPBA00004N"
    "url" => "/2529993X/0000003500000007/v1_201707230042/S2529993X1730179X/v1_201707230042/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Continuing medical education&#58; Methods of rapid diagnosis</span>"
    "titulo" => "Rapid diagnosis of sexually transmitted infections"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "444"
        "paginaFinal" => "450"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Luis Otero-Guerra, Ana Fern&#225;ndez-Bl&#225;zquez, Fernando Vazquez"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "Luis"
            "apellidos" => "Otero-Guerra"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Ana"
            "apellidos" => "Fern&#225;ndez-Bl&#225;zquez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:4 [
            "nombre" => "Fernando"
            "apellidos" => "Vazquez"
            "email" => array:1 [
              0 => "opsklins&#64;gmail&#46;com"
            ]
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Servicio de Microbiolog&#237;a&#44; Hospital de Cabue&#241;es&#44; Gij&#243;n&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Microbiolog&#237;a&#44; Hospital Universitario Central de Asturias&#44; Oviedo&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Departamento de Biolog&#237;a Funcional&#44; &#193;rea de Microbiolog&#237;a&#44; Facultad de Medicina&#44; Oviedo&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Fundaci&#243;n de Investigaci&#243;n Oftalmol&#243;gica&#44; Instituto Oftalmol&#243;gico Fern&#225;ndez-Vega&#44; Oviedo&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Diagn&#243;stico r&#225;pido de las infecciones de transmisi&#243;n sexual"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Worldwide&#44; sexually transmitted infections &#40;STIs&#41; pose a significant morbidity and mortality burden as they compromise quality of life&#44; sexual and reproductive health and newborn and child health&#46; They also indirectly facilitate the transmission of the human immunodeficiency virus &#40;HIV&#41; and cause cell changes that precede some forms of cancer&#46; The WHO provides data on a reality that seems far-removed from developed countries&#46; Syphilis causes over 300&#44;000 foetal and neonatal deaths per year and exposes another 215&#44;000 children to premature death&#46; It also estimates that 357 million new cases of four types of curable STIs are recorded every year&#58; 131 million <span class="elsevierStyleItalic">Chlamydia trachomatis</span> &#40;CT&#41; infections&#44; 78 million <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> &#40;NG&#41; infections&#44; 6 million <span class="elsevierStyleItalic">Treponema pallidum</span> &#40;TP&#41; infections and 142 million <span class="elsevierStyleItalic">Trichomonas vaginalis</span> &#40;TV&#41; infections&#46; Similarly&#44; the human papillomavirus &#40;HPV&#41; is believed to be responsible for 530&#44;000 cases of cervical and uterine cancer as well as 264&#44;000 deaths&#46; We also cannot forget the emergence of multidrug-resistant gonococcal strains that threaten us with untreatable gonorrhoea&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">While it is true that progress has been made&#44; such as the reduction of mother-to-child syphilis transmission in developing countries&#44; globally the prevalence of STIs remains the same or is even on the rise&#46; Numerous factors contribute to this&#44; but the treatment delay that arises while patients await a diagnostic result is particularly important&#46; By means of a mathematical model&#44; it has been shown that using a rapid diagnostic test with a sensitivity as low as 63&#37; successfully improves the percentage of treated patients&#44; compared to waiting for the result of a high-sensitivity test available at a second consultation&#44; which many patients fail to attend&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">1</span></a> As such&#44; diagnostic tests that provide immediate results will facilitate the administration of aetiological treatments to a larger number of infected patients and new transmissions will be avoided by breaking the chain of infection&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">To that effect&#44; it is necessary to reinforce the capacity of the laboratories and to also proceed with designing and implementing diagnostic tests at the point of care to facilitate systematic and early STI diagnosis of all suspected individuals&#44; even if they are asymptomatic&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this review&#44; we will present the latest rapid diagnostic techniques for the main STI- and vulvovaginitis-causing pathogens&#44; though we will leave viral hepatitis and HIV to one side&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">History&#44; concept and characteristics of the rapid tests in sexually transmitted infections</span><p id="par0025" class="elsevierStylePara elsevierViewall">In STIs&#44; diagnostic tests can serve several purposes&#58; &#40;a&#41; diagnosis&#59; &#40;b&#41; screening of high-risk groups&#59; &#40;c&#41; treatment monitoring&#59; &#40;d&#41; epidemiological surveillance&#59; &#40;e&#41; investigation of outbreaks&#59; &#40;f&#41; validation of syndrome management in countries with few resources&#59; &#40;g&#41; detection of resistance patterns&#59; &#40;h&#41; ensuring quality in laboratory tests&#59; and &#40;i&#41; research&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnostic tests used in STIs are&#58; &#40;a&#41; direct microscopy&#59; &#40;b&#41; culture&#59; &#40;c&#41; antigen detection&#59; &#40;d&#41; serology&#59; &#40;e&#41; detection of microbial metabolites &#40;whiff test&#44; for example&#41;&#44; and &#40;f&#41; molecular methods&#46; All of these may be considered rapid at least in some of their forms&#44; except culture&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Rapid tests in STIs can be considered as such&#44; or as point-of-care tests &#40;POCTs&#41;&#46; This review considers both types indiscriminately&#46; POCTs can be defined as diagnostic tests that allow a diagnosis to be obtained and a treatment indicated at the same visit&#46; The differences between them are detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> &#40;adapted from Muralidhar<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Rapid tests&#47;POCTs aimed at STI diagnosis must meet the following requirements established by the WHO<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a>&#58;</p><p id="par0045" class="elsevierStylePara elsevierViewall">ASSURED<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Affordable&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Sensitive&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Specific&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">User-friendly &#40;few steps and minimum training&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Rapid and robust &#40;storable at room temperature&#44; results in &#60;30<span class="elsevierStyleHsp" style=""></span>min&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Equipment-free&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Deliverable to end-users&#46;</p></li></ul></p><p id="par0085" class="elsevierStylePara elsevierViewall">POCTs must also comply with quality controls included in the tests and be environmentally safe and low cost&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">An important aspect is what users think the qualities of rapid tests&#47;POCTs should be in STIs&#46; In a study on focus groups&#44; it was found that the qualities of a rapid test should be high sensitivity and specificity&#44; a short procedure time and a low cost&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">For POCTs&#44; various types of technology are used<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a>&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">a&#41;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Precipitation&#47;agglutination reactions such as the RPR test for syphilis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">b&#41;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Immunochromatography in different test formats&#58; &#40;b1&#41; lateral flow&#59; &#40;b2&#41; multiple&#44; e&#46;g&#46; HIV<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>syphilis&#44; HIV<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>syphilis<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>HBV&#47;HCV&#44; treponemal test<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>non-treponemal test&#59; &#40;b3&#41; using a flow assay such as dot-blot&#59; &#40;b4&#41; with readers&#47;scanners to eliminate observer bias&#44; thereby increasing sensitivity and facilitating quantification&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">c&#41;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Emerging technologies such as microfluidic assays &#40;which detect multiple analytes such as HIV and syphilis&#41; and loop-mediated isothermal amplification technology &#40;LAMP&#41;&#44; which achieves amplification using four primers and polymerase enzyme in a constant temperature reaction &#40;60&#8211;65<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; and obtains results in less than 1<span class="elsevierStyleHsp" style=""></span>h&#46;</p></li></ul></p><p id="par0115" class="elsevierStylePara elsevierViewall">POCTs were developed to complement centralisation in &#8220;core&#8221; laboratories&#44; allowing for decentralised determinations that are available 24<span class="elsevierStyleHsp" style=""></span>h a day&#44; 365 days a year&#46; They are usually combinations of syndrome-based microorganisms&#44; can be collected by the patients themselves&#44; do not require trained personnel and are rapid so as to enable decision-making&#46; Of all of them&#44; the STI tests are among those that have been proven cost-effective&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Irrespective of the terminology and discourse that may surround rapid tests or POCTs&#44; in this review we include the types of tests we consider to be interchangeable&#44; whether these are with or without equipment at the point of care or in a nearby laboratory&#44; and which try to provide the fastest results possible&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">The rapid response laboratory in sexually transmitted infections and needs in different settings&#58; primary care&#44; emergency departments&#44; STI clinics&#44; reference laboratories</span><p id="par0125" class="elsevierStylePara elsevierViewall">Laboratory centralisation makes the presence of a rapid response laboratory difficult in our setting&#44; but the following methods may be available in various working environments&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">a&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Primary care&#58; e&#46;g&#46; Gram stain and Amsel criteria for bacterial vaginosis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">b&#41;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Emergency departments&#58; normally have a support laboratory&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">c&#41;</span><p id="par0140" class="elsevierStylePara elsevierViewall">STI clinic&#58; the above methods&#44; dark-field microscopy&#44; urine sediment&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">d&#41;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Reference laboratory&#58; all rapid techniques&#46;</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall">In developing countries&#44; rapid tests&#47;POCTs generate huge interest as they help to reduce the enormous disease burden that they endure&#46; These tests allow a move away from syndromic treatments &#40;targeted blindly and simultaneously at various pathogens causing the same syndrome&#41; and a progression towards aetiological treatments &#40;targeted specifically at the causal pathogen&#41;&#46; The unnecessary use of antimicrobials and the emergence of resistances are avoided&#44; costs are reduced and the chain of infection is broken more effectively&#46; However&#44; there are drawbacks&#44; as aspects such as cost&#44; the need for the refrigeration of reagents or electrical supply requirements &#40;e&#46;g&#46; for a microscope&#41; can mean that tests which prove very useful in one setting may be useless in another&#46; As such&#44; all of the ASSURED requirements are equally important&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Rapid diagnostic tests in sexually transmitted infections and their evidence</span><p id="par0155" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the rapid techniques for STIs &#40;adapted from Aznar Mart&#237;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Candidiasis</span><p id="par0160" class="elsevierStylePara elsevierViewall">Microscopy and culture are the tests that should routinely be performed in symptomatic women &#40;level of evidence III&#44; grade B&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">9</span></a> The microscopic observation of yeast in vaginal discharge by means of a wet mount or Gram stain examination has the advantage of being rapid&#44; but has a low sensitivity &#40;50&#37;&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Criteria for diagnosing vaginal candidiasis &#40;level of evidence III&#44; grade B&#41;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a>&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">-</span><p id="par0170" class="elsevierStylePara elsevierViewall">Absence of fishy odour in the &#8220;whiff test&#8221;&#44; using a potassium hydroxide solution on a speculum&#44; and amine odour test on a slide&#44; are supportive&#44; since candidiasis does not usually coexist with bacterial vaginosis or TV infection&#44; but they are not diagnostic&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">-</span><p id="par0175" class="elsevierStylePara elsevierViewall">Presence of yeasts or pseudohyphae on the wet mount examination of vaginal discharge &#40;40&#8211;60&#37; sensitivity&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">-</span><p id="par0180" class="elsevierStylePara elsevierViewall">Presence of yeasts or pseudohyphae on the Gram stain of vaginal discharge &#40;up to 65&#37; sensitivity&#41;&#46;</p></li></ul></p><p id="par0185" class="elsevierStylePara elsevierViewall">The BD Affirm VPIII&#8482; system &#40;Becton Dickinson&#44; Franklin Lakes&#44; New Jersey&#44; United States&#41; uses hybridisation to determine the presence of the genetic material of TV&#44; <span class="elsevierStyleItalic">Gardnerella vaginalis</span> &#40;GV&#41; and certain <span class="elsevierStyleItalic">Candida</span> species &#40;<span class="elsevierStyleItalic">Candida albicans</span>&#44; <span class="elsevierStyleItalic">Candida glabrata</span>&#44; <span class="elsevierStyleItalic">Candida kefyr</span>&#44; <span class="elsevierStyleItalic">Candida krusei</span>&#44; <span class="elsevierStyleItalic">Candida parapsilosis</span> and <span class="elsevierStyleItalic">Candida tropicalis</span>&#41;&#44; with a <span class="elsevierStyleItalic">Candida</span> sensitivity of 85&#8211;90&#37; and a specificity of &#62;99&#37;&#46; Results are obtained in less than 1<span class="elsevierStyleHsp" style=""></span>h&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Chancroid</span><p id="par0190" class="elsevierStylePara elsevierViewall">At present&#44; the use of the PCR technique is indicated for the detection of <span class="elsevierStyleItalic">Haemophilus ducreyi</span> &#40;HD&#41;&#44; due to the low sensitivity of Gram staining &#40;typical in &#8220;schools of fish&#8221; with small pleomorphic Gram-negative bacilli&#41;&#46; In comparison to culture&#44; microscopy has a sensitivity of 50&#37;&#44; and false positives are also common&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> A multi-format PCR is available on the market for HD and TP&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Chlamydia</span><p id="par0195" class="elsevierStylePara elsevierViewall">The majority of the diagnostic tests available are carried out in the laboratory and there may be a delay between collection and the result&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The urethral Gram stain is the standard diagnostic test for nongonococcal urethritis&#44; but is dependent on the observer and has a low specificity&#46; As such&#44; the use of flow cytometry is also currently being introduced to detect leukocyturia in urine as an inflammatory marker of nongonococcal urethritis &#40;NGU&#41; caused by CT and <span class="elsevierStyleItalic">Mycoplasma genitalium</span> &#40;MG&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">12</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">EIA-based POCTs have a low sensitivity&#44; although new forms present sensitivities of 82&#8211;84&#37; compared to nucleic acid amplification tests &#40;NAATs&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">NAATs are the diagnostic benchmark but are generally carried out in the laboratory&#44; taking several hours&#46; New formats like isothermal NAATs &#40;LAMP&#41; are commercially available&#44; offer good sensitivity &#40;97&#46;1&#37;&#41; and specificity &#40;97&#46;9&#37;&#41;&#44; and have an execution time of less than 1<span class="elsevierStyleHsp" style=""></span>h&#46; However&#44; performing the techniques is complex and should be done by trained personnel&#59; they therefore cannot be used as POCTs&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">New NAAT-based techniques &#40;GeneXpert CT&#47;NG&#44; Cepheid&#44; Sunnyvale&#44; CA&#44; United States&#41; are appropriate for genital samples and reduce the time required to issue a result&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">15</span></a> Extra-genital samples require additional validations&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a> Their sensitivity is very high &#40;97&#8211;99&#37;&#41; as is their specificity &#40;&#62;99&#37;&#41;&#44; for endocervical&#44; vaginal and urine samples&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Lymphogranuloma venereum &#40;LGV&#41;</span><p id="par0220" class="elsevierStylePara elsevierViewall">Diagnosis requires clinical suspicion and very specialised laboratory tests are necessary for confirmation&#46; Firstly&#44; the presence of CT must be seen in the lesions&#44; usually using NAATs&#46; The samples used are both genital and extra-genital&#58; rectal&#44; pharyngeal and urine&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">18</span></a> Chlamydia-positive samples should be assessed a second time using a specific PCR reaction for LGV-producing chlamydia DNA&#46; Typing techniques are also used&#44; by means of RFLP or sequencing&#46; In light of the above&#44; no rapid detection method exists at present&#44; although the GeneXpert PCR could meet these criteria&#46; However&#44; this is usually used in a second step&#44; when the presence of chlamydia has already been detected&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Gonorrhoea</span><p id="par0225" class="elsevierStylePara elsevierViewall">Gonorrhoea diagnosis is established with the detection of NG at the infection site&#46; The method to be used will depend on the patient&#39;s symptoms&#44; transport conditions to the laboratory and the available tests&#46;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">a&#41;</span><p id="par0230" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Gram stain for urethritis</span>&#58; Gram staining is a rapid technique that is equally as sensitive as culture in symptomatic urethritis among men&#44; though it has limited sensitivity in other areas&#46; Examinations should be performed with a 1000&#215; objective lens under oil immersion for at least 2<span class="elsevierStyleHsp" style=""></span>min&#44; checking for the presence of polymorphonuclear &#40;PMN&#41; leukocytes&#44; a pink nucleus and a colourless cytoplasm&#44; usually &#62;4&#8211;5 PMN leukocytes per immersion field&#46; If a urinary Gram stain is performed&#44; it is advisable to collect the first 10&#8211;15<span class="elsevierStyleHsp" style=""></span>ml from the first part of urination as well as to observe the sediment after centrifugation to check for the presence of &#8805;10 PMN leukocytes&#46; Gonorrhoea appears as kidney-shaped&#44; oval&#44; Gram-negative cocci&#44; in intra and extracellular pairs&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a> In urethral samples from symptomatic men&#44; Gram staining offers a high sensitivity &#40;90&#8211;95&#37;&#41; and facilitates immediate diagnosis &#40;III&#44; C&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">19</span></a> The sensitivity of the same samples in asymptomatic men is distinctly lower &#40;50&#8211;75&#37;&#41;&#46; Gram staining of rectal samples is not recommended in symptomatic patients or in urethral samples from women &#40;III&#44; C&#41;&#46; It should also not be used on pharyngeal samples&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">The traditional criterion for determining the existence of urethritis is the observation of 4&#8211;5 PMN leukocytes with an immersion field objective lens and the presence or absence of Gram-negative diplococci&#44; in both gonococcal or nongonococcal urethritis&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a> This criterion was based on the best sensitivity and specificity established with NG and CT cultures&#46; However&#44; with NAAT systems&#44; it has been seen to be too strict for NGU&#44; also considering variations between microscopists and the fact that sensitivity varies according to the grade of urethritis &#40;low-grade cases present more false negatives&#41;&#46; Considering there to be no urethritis with the presence of &#60;5 PMN leukocytes causes 32&#37; of CT-induced cases to go undetected&#44; along with 37&#37; caused by MG&#44; 38&#37; by adenovirus and 44&#37; by herpes virus&#59; it is thus deduced that this is not a good cut-off point for ruling out infection&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a> Various studies<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">22&#8211;26</span></a> highlight that&#44; in order to determine the existence of urethritis&#44; a cut-off point of &#8805;5 PMN leukocytes is not very sensitive &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; and that lowering it to &#8805;2 PMN leukocytes increases sensitivity &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">b&#41;</span><p id="par0240" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Methylene blue stain for urethritis</span>&#58; another aspect to take into account in stains is whether the Gram stain is superior to others&#46; The Gram stain has been compared to the methylene blue stain and a mixture of methylene blue and crystal violet &#40;4&#58;1 parts&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">27&#44;28</span></a> which favours the intra or extracellular examination of diplococci&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">The main advantage is that it takes less time to perform&#58; 4<span class="elsevierStyleHsp" style=""></span>min &#40;Gram&#41; versus 10&#8211;15<span class="elsevierStyleHsp" style=""></span>s &#40;methylene blue&#41;&#44; with a sensitivity of 97&#46;3&#37;&#44; a specificity of 99&#46;6&#37; and a concordance of 100&#37;&#46; Although the bacterial morphology cannot be seen with its stain characteristics in methylene blue&#44; this is not important for examining the presence of PMN leukocytes and&#44; thus&#44; urethritis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">c&#41;</span><p id="par0250" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Gram stain for cervicitis</span>&#58; this is performed on cervical discharge and &#62;10 PMN leukocytes with a 1000&#215; objective lens is deemed to be suggestive of infection&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">d&#41;</span><p id="par0255" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">NAATs</span>&#58; NG detection with NAATs is more sensitive than culture and may be performed on a wide range of samples&#58; urethral or urine in men&#44; and endocervical or vaginal in women&#46; Urine samples in women have a lower sensitivity and they are not an optimal sample &#40;II&#44; B&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">In the rectum and pharynx&#44; NAATs are more sensitive than culture&#44; but positive samples should be confirmed with another NAAT that uses a different target &#40;III&#44; C&#41;&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">In any case&#44; in their current formats&#44; NAATs cannot be considered rapid tests&#44; although the incorporation of the LAMP technique renders it adequate in terms of its rapidness&#44; sensitivity and specificity&#46; A LAMP technique by the same manufacturer is available on the market&#44; with an identical format and characteristics to the one mentioned previously for chlamydia&#46; However&#44; although rapid &#40;&#60;1<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; it cannot be used as a POCT due to its complexity&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">The GeneXpert CT&#47;NG NAAT&#44; with the characteristics cited in the &#8220;Chlamydia&#8221; section&#44; presents excellent sensitivity &#40;98&#8211;100&#37;&#41; and specificity &#40;99&#46;9&#37;&#41; in vaginal and endocervical samples as well as male urine&#44; with lower results in urine samples from women&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">17</span></a></p></li></ul></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Syphilis</span><p id="par0275" class="elsevierStylePara elsevierViewall">Rapid tests for diagnosing syphilis through the detection of antibodies have shown excellent results in prenatal syphilis screening&#44; particularly in developing countries&#46; Opportunities for accessing pregnant women are rare&#44; and diagnosis&#8212;and&#44; where applicable&#44; treatment&#8212;have to be given at the time of the consultation&#46; It is estimated that in Sub-Saharan Africa&#44; where there is a syphilis seroprevalence of 8&#46;3&#37;&#44; only 38&#37; of pregnant women have access to neonatal screening&#44; so half a million children are believed to die every year due to congenital syphilis sequelae&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a> With regard to the serological laboratory techniques used in developed countries that require a centrifuge&#44; new immunochromatography techniques may be considered authentic POCTs given that they can be performed on whole blood obtained by finger prick&#44; the reagents do not require refrigeration and they obtain results in 15&#8211;20<span class="elsevierStyleHsp" style=""></span>min&#46; Although they are easy to perform&#44; the manufacturer&#39;s instructions must be strictly adhered to in order to guarantee accuracy&#46; These techniques use recombinant antigens and capture specific treponemal antibodies&#44; so the exclusive performance of this test leads to unnecessary treatments in previously treated and cured patients who continue to present lifelong treponemal antibodies&#46; In such cases that come back positive during the initial screening period&#44; referrals to reference laboratories would be ideal in order to determine the disease activity with non-treponemal tests&#46; A dual POCT system that separately determines the presence of treponemal and non-treponemal antibodies is available on the market&#44; offering diagnostic confirmation when both are positive&#46; However&#44; the lack of non-treponemal antibody quantification inhibits the determination of the initial titre for treatment control&#46; Dual determination is also possible in the same antibody assay for syphilis and HIV&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Things are very different in our setting&#44; and serological tests are usually carried out in the context of other laboratory tests&#46; An initial positive non-treponemal test result would be confirmed with another treponemal test&#44; and the same is true in reverse&#59; if we carry out an initial treponemal test &#40;usually an EIA&#41;&#44; we confirm a positive result with a non-treponemal test &#40;reverse algorithm&#41;&#46; These tests are performed in a scheduled manner in the laboratory&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">However&#44; it is clear that in certain situations where an immediate diagnosis prevails over other considerations&#44; the performance of an RPR test only requires one centrifuge&#44; the reagent and the person responsible for performing the technique having the knowledge to do so&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Dark-field microscopy requires a microscope with the aforementioned characteristics &#40;which not all laboratories have&#41; and a microscopist who is an expert in the technique&#44; which is considerably complex for the observer&#46; Non-genital samples&#44; especially oral samples&#44; may contain nonpathogenic treponemes that lead to false positives&#44; so their use is not recommended&#46; There is a IIA recommendation for performing dark-field microscopy on chancre samples&#44; provided an expert microscopist and adequate equipment are available&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a></p><p id="par0295" class="elsevierStylePara elsevierViewall">PCR techniques&#44; on the other hand&#44; may be used on oral and other extra-genital and genital samples&#44; with a IA recommendation&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a> since commensal treponemes do not interfere with the technique&#46; These techniques are only available at referral centres&#44; but are not considered &#8220;rapid response&#8221; unless they are of the LAMP variety&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Trichomoniasis</span><p id="par0300" class="elsevierStylePara elsevierViewall">A wet mount examination is easy to perform&#44; rapid&#44; low-cost and highly specific &#40;98&#37;&#41;&#44; but has a low sensitivity &#40;62&#8211;92&#37;&#41; and is dependent on the observer&#46; To perform this test&#44; a drop of urethral or vaginal discharge is mixed on a slide with a drop of 0&#46;5&#37; physiological saline solution at 37<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; A coverslip is then applied and it is observed under a microscope to check for the characteristic movements of trichomonas&#46; The preparation should be examined within 10<span class="elsevierStyleHsp" style=""></span>min of taking the sample&#44; as the characteristic movement of the trichomonas parasite reduces after this time&#44; thus hindering its identification&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">31</span></a></p><p id="par0305" class="elsevierStylePara elsevierViewall">As mentioned previously in the &#8220;Candidiasis&#8221; section&#44; the BD Affirm VPIII&#8482; system also determines the presence of TV&#44; in this case with a sensitivity of 89&#46;2&#37; and a specificity of 99&#46;3&#37; compared to culture&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Moreover&#44; there are POCTs such as the OSOM Trichomonas Rapid Test &#40;Sekisui Diagnostic&#44; Hartwell Place&#44; Lexington&#44; United States&#41;&#44; which determines the presence of the antigen and has shown a high sensitivity &#40;80&#8211;94&#37;&#41; and specificity &#40;95&#37;&#41;&#46; No instruments are required and it provides results in 30<span class="elsevierStyleHsp" style=""></span>min&#44; although it must be taken into account that false positives are possible &#40;IIb&#44; B&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Herpes simplex virus &#40;HSV&#41;</span><p id="par0315" class="elsevierStylePara elsevierViewall">There are various rapid techniques&#58;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">a&#41;</span><p id="par0320" class="elsevierStylePara elsevierViewall">Optical microscopy&#46; This technique is inadequate&#46; Direct examination using the Tzanck or Papanicolaou smear has a limited sensitivity and is nonspecific&#46; It does not differentiate between HSV-1 and 2&#44; and Cowdry type A intranuclear inclusions are not exclusive to the HSV&#46; Moreover&#44; a negative result does not rule out the possibility of genital herpes&#46;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">b&#41;</span><p id="par0325" class="elsevierStylePara elsevierViewall">Electron microscopy&#46; This has fallen out of use as it requires concentrations of over 10<span class="elsevierStyleSup">8</span><span class="elsevierStyleHsp" style=""></span>virions&#47;ml&#46; It provides rapid results but has a limited sensitivity and requires equipment that is not widely available in clinical laboratories&#46;</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">c&#41;</span><p id="par0330" class="elsevierStylePara elsevierViewall">Direct immunofluorescence&#46; HSV antigens can be detected with immunofluorescence or immunoenzyme techniques&#46; These are rapid techniques with a sensitivity and specificity ranging from 70&#37; to 90&#37; in symptomatic patients&#46; On direct samples&#44; sensitivity reduces as the lesion develops over time&#46; The use of monoclonal antibodies provides good specificity and facilitates the differentiation of HSV-1 and 2&#46; It is currently used more as a complement to identify viruses in cell cultures&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">d&#41;</span><p id="par0335" class="elsevierStylePara elsevierViewall">NAATs are recommended for the diagnosis of genital herpes &#40;Ib&#44; A&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">33</span></a> Detecting HSV DNA using PCR techniques increases detection by 11&#8211;71&#37; compared to culture&#46; It also allows for more lenient conditions than culture with regard to sample storage and transportation&#46; It allows for the differentiation of HSV-1 and 2&#44; which should be established in all new diagnoses &#40;III&#44; B&#41;&#46; Positive results do not require confirmation&#46;</p></li></ul></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Vaginosis</span><p id="par0340" class="elsevierStylePara elsevierViewall">Vaginosis may be diagnosed on the basis of three sets of criteria &#40;Amsel&#44; Nugent or Ison&#41; &#40;II&#44; B&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a></p><p id="par0345" class="elsevierStylePara elsevierViewall">The Amsel clinical criteria<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">34</span></a> are based on the presence of three of the following signs or symptoms&#58; &#40;a&#41; thin&#44; homogeneous&#44; white&#44; uniform vaginal discharge that adheres to the vaginal walls&#59; &#40;b&#41; vaginal pH &#62;4&#46;5&#59; &#40;c&#41; fishy odour after adding 10&#37; KOH to the sample&#59; and &#40;d&#41; more than 20&#37; clue cells in wet mount preparations &#40;microscope with a 40&#215; objective lens&#41;&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">It may be confirmed by objective microscopic criteria viewed in a Gram stain of vaginal discharge using the Nugent<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">35</span></a> score &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; This is considered the gold standard&#46; The microbiological diagnosis of bacterial vaginosis is carried out using a Gram stain of vaginal discharge&#44; determining the relative quantity of morphotypes characteristic of abnormal vaginal microbiota &#40;Gram-positive and Gram-negative bacilli and curved bacteria&#41; and the presence of clue cells &#40;epithelial cells coated with Gram-positive and Gram-negative morphotypes with obscured borders&#41;&#46; Stained cervical smears using the Papanicolaou method are not appropriate due to their low sensitivity&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0355" class="elsevierStylePara elsevierViewall">However&#44; the BASHH guidelines recommend &#40;grade C&#41; the use of the Ison and Hay criteria&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">36</span></a> as they reflect real microbiota possibilities better than the Nugent criteria&#46;<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0130"><p id="par0360" class="elsevierStylePara elsevierViewall">Grade 0&#58; Unrelated to bacterial vaginosis&#59; epithelial cells only&#44; with no Lactobacillus morphotypes&#46; May indicate recent antibiotic use&#46;</p></li><li class="elsevierStyleListItem" id="lsti0135"><p id="par0365" class="elsevierStylePara elsevierViewall">Grade 1 &#40;normal&#41;&#58; <span class="elsevierStyleItalic">Lactobacillus</span> morphotypes predominate&#46;</p></li><li class="elsevierStyleListItem" id="lsti0140"><p id="par0370" class="elsevierStylePara elsevierViewall">Grade 2 &#40;intermediate&#41;&#58; mixed flora with some lactobacilli present&#44; but <span class="elsevierStyleItalic">Gardnerella</span> or <span class="elsevierStyleItalic">Mobiluncus</span> morphotypes also present&#46;</p></li><li class="elsevierStyleListItem" id="lsti0145"><p id="par0375" class="elsevierStylePara elsevierViewall">Grade 3 &#40;bacterial vaginosis&#41;&#58; predominantly <span class="elsevierStyleItalic">Gardnerella</span> and&#47;or <span class="elsevierStyleItalic">Mobiluncus</span> morphotypes&#46; Few or absent lactobacilli&#46;</p></li><li class="elsevierStyleListItem" id="lsti0150"><p id="par0380" class="elsevierStylePara elsevierViewall">Grade 4&#58; unrelated to bacterial vaginosis&#59; only Gram-positive cocci observed&#44; no lactobacilli&#46;</p></li></ul></p><p id="par0385" class="elsevierStylePara elsevierViewall">Commercial systems also exist&#44; although some are not marketed in Spain&#58;<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0155"><p id="par0390" class="elsevierStylePara elsevierViewall">OSOM BVBlue &#40;Sekisui Diagnostic&#44; Hartwell Place&#44; Lexington&#44; United States&#41; measures sialidase levels&#46;</p></li><li class="elsevierStyleListItem" id="lsti0160"><p id="par0395" class="elsevierStylePara elsevierViewall">Pip Activity TestCard &#40;Litmus Concepts Inc&#44; Santa Clara&#44; California&#44; United States&#41; assesses proline aminopeptidase&#46;</p></li><li class="elsevierStyleListItem" id="lsti0165"><p id="par0400" class="elsevierStylePara elsevierViewall">BD Affirm VPIII &#40;Becton Dickinson&#44; Franklin Lakes&#44; New Jersey&#44; United States&#41; uses a DNA probe to detect high concentrations of GV&#44; with a sensitivity of over 90&#37; and a specificity of over 99&#37;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0170"><p id="par0405" class="elsevierStylePara elsevierViewall">PCR-based systems have also been described but are not available on the market&#46;</p></li></ul></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Point-of-care tests &#40;POCTs&#41; and multiple platforms</span><p id="par0410" class="elsevierStylePara elsevierViewall">In relation to POCTs&#44; the most widely implemented tests at present are for HIV&#44; followed by TP&#46; As for gonorrhoea&#44; the same problems regarding cross-reactions continue to arise&#44; and there is limited experience with others&#44; such as those used for the HPV or HSV&#46;</p><p id="par0415" class="elsevierStylePara elsevierViewall">Multiple platforms are being developed&#44; such as the one designed for nine pathogens by FilmArray &#40;BioFire Diagnostics&#44; Salt Lake City&#44; Utah&#44; United States&#41;&#44; with promising initial results&#44; though it is yet to be marketed&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">37</span></a></p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Future of rapid tests in sexually transmitted infections</span><p id="par0420" class="elsevierStylePara elsevierViewall">Successfully controlling STIs will largely depend on the availability of aetiological diagnoses which&#44; as well as being sensitive and specific&#44; are rapid and allow immediate aetiological treatment&#46; This is the n of the WHO in the <span class="elsevierStyleItalic">Global health sector strategy on sexually transmitted infections&#44; 2016&#8211;2021</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a></p><p id="par0425" class="elsevierStylePara elsevierViewall">A rapid diagnosis can be achieved if there is a laboratory close to the point of care&#44; with rapid techniques and personnel willing to perform these immediately&#46; This may be possible at certain highly-specialised centres&#44; but laboratory centralisation trends are heading in the opposite direction&#46; Multiple PCRs that provide results in 1&#8211;2<span class="elsevierStyleHsp" style=""></span>h may be an alternative here&#44; including GeneXpert &#40;Cepheid&#44; Sunnyvale&#44; CA&#44; United States&#41;&#46;</p><p id="par0430" class="elsevierStylePara elsevierViewall">It can also be achieved by providing points of care with basic laboratory materials &#40;stain reagents&#44; centrifuges and microscopes&#41; and by training the clinic on their use&#46; Although this is in place at some centres&#44; its widespread implementation seems to be a challenge&#46;</p><p id="par0435" class="elsevierStylePara elsevierViewall">Instead&#44; the future of rapid diagnosis lies in the development and implementation of POCTs that allow the diagnosis of as many pathogens as possible &#40;ideally in multiple formats&#41; and that meet most of&#44; if not all&#44; the ASSURED criteria proposed by the WHO&#46; We have rapid tests for syphilis and HIV but still lack genuinely rapid point-of-care tests that enable the diagnosis of highly prevalent and curable infections&#44; such as those caused by CT&#44; TV and NG&#44; within a matter of minutes&#46; Generally speaking&#44; the available methods do not reach the sensitivity and specificity levels attained by PCR techniques&#46;</p><p id="par0440" class="elsevierStylePara elsevierViewall">Among the most promising tests described in the literature&#44; we can site the assay for CT with microwave accelerated metal enhanced fluorescence &#40;MAMEF&#41; technology&#44; which provides results in 9<span class="elsevierStyleHsp" style=""></span>min with a sensitivity of 82&#37; and a specificity of 93&#37;&#46;<span class="elsevierStyleSup">39</span></p><p id="par0445" class="elsevierStylePara elsevierViewall">Moreover&#44; hopes are high regarding microfluidic techniques&#44; which are microsystems that incorporate assay operations and sample preparation on a chip&#44; with the advantages being that they require very small quantities of sample&#44; have a faster response time and are portable&#46; Generally speaking&#44; these techniques work well for antibody detection due to the abundance of target molecules&#46; For other samples&#44; such as urine or those obtained with a swab&#44; the sample will require prior processing before it is added to the microsystem&#46; This presents limitations for antigen detection due to few target molecules being found in the sample&#46;</p><p id="par0450" class="elsevierStylePara elsevierViewall">The future also lies in determining the presence of antimicrobial resistances&#44; which is especially important for NG and MG&#46; Work on array and microfluidic formats is currently only being conducted at highly-specialised laboratories&#44; although it would be ideal if they could be used at the point of care&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0455" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres872695"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec861425"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres872694"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec861426"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "History&#44; concept and characteristics of the rapid tests in sexually transmitted infections"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "The rapid response laboratory in sexually transmitted infections and needs in different settings&#58; primary care&#44; emergency departments&#44; STI clinics&#44; reference laboratories"
        ]
        7 => array:3 [
          "identificador" => "sec0020"
          "titulo" => "Rapid diagnostic tests in sexually transmitted infections and their evidence"
          "secciones" => array:10 [
            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Candidiasis"
            ]
            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Chancroid"
            ]
            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Chlamydia"
            ]
            3 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Lymphogranuloma venereum &#40;LGV&#41;"
            ]
            4 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Gonorrhoea"
            ]
            5 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Syphilis"
            ]
            6 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Trichomoniasis"
            ]
            7 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Herpes simplex virus &#40;HSV&#41;"
            ]
            8 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Vaginosis"
            ]
            9 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Point-of-care tests &#40;POCTs&#41; and multiple platforms"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Future of rapid tests in sexually transmitted infections"
        ]
        9 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-01-03"
    "fechaAceptado" => "2017-01-05"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec861425"
          "palabras" => array:3 [
            0 => "Point of care system"
            1 => "Screening assay"
            2 => "Sexually transmitted diseases"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec861426"
          "palabras" => array:3 [
            0 => "Sistemas de diagn&#243;stico a la cabecera del enfermo"
            1 => "Cribado de ITS"
            2 => "Infecciones de transmisi&#243;n sexual"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sexually transmitted infections &#40;STIs&#41; are responsible for an enormous burden of morbidity and mortality&#46; Worldwide&#44; millions of cases of STIs&#44; such as syphilis&#44; chlamydia&#44; or gonorrhoea occur every year&#44; and there is now an increase in antimicrobial resistance in pathogens&#44; such as gonococcus&#46; Delay in diagnosis is one of the factors that justifies the difficulty in controlling these infections&#46; Rapid diagnostic tests allow the introduction of aetiological treatment at the first visit&#44; and also leads to treating symptomatic and asymptomatic patients more effectively&#44; as well as to interrupt the epidemiological transmission chain without delay&#46; The World Health Organisation includes these tests in its global strategy against STIs&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Las infecciones de transmisi&#243;n sexual &#40;ITS&#41; suponen una importante carga de morbimortalidad&#46; A nivel mundial todos los a&#241;os se producen millones de casos de ITS como s&#237;filis&#44; infecci&#243;n por clamidias o gonococia&#44; y actualmente se asiste a un incremento de la resistencia a los antimicrobianos en pat&#243;genos como el gonococo&#46; La demora en el diagn&#243;stico es uno de los factores que justifica la dificultad para controlar estas infecciones&#46; Las pruebas de diagn&#243;stico r&#225;pido permiten instaurar el tratamiento etiol&#243;gico en la primera consulta&#44; lo que lleva a tratar a m&#225;s pacientes&#44; tanto sintom&#225;ticos como asintom&#225;ticos&#44; de forma m&#225;s efectiva&#44; e interrumpir sin demoras la cadena epidemiol&#243;gica de transmisi&#243;n&#46; La OMS incluye estas pruebas en su estrategia mundial contra las ITS&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Otero-Guerra L&#44; Fern&#225;ndez-Bl&#225;zquez A&#44; Vazquez F&#46; Diagn&#243;stico r&#225;pido de las infecciones de transmisi&#243;n sexual&#46; Enferm Infecc Microbiol Clin&#46; 2017&#59;35&#58;444&#8211;450&#46;</p>"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">POCTs&#58; point-of-care tests&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>&#58; Adapted from Muralidhar&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a></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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Rapid testing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">POCTs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Difficulty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Simple&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Simple &#40;can be used in primary care&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;20&#8211;30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Electricity source&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#44; necessary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trained personnel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#44; necessary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Quality control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#44; internal controls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes &#40;more reliable&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1472711.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Differences between rapid tests and POCTs&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se&#58; sensitivity&#59; Sp&#58; specificity&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>&#58; Adapted from Aznar Mart&#237;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a></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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganism&#47;syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Se &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chlamydia trachomatis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Giemsa stain&#44; Macchiavello-Gimenez stain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Immunochromatography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#8211;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GeneXpert CT&#47;NG NAAT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#8211;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Endocervical Gram stain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#8211;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#8211;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pharyngeal and rectal Gram stains are not recommended&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Urethral Gram stain &#40;with symptoms&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#8211;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#8211;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Urethral Gram stain &#40;asymptomatic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#8211;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&#8211;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GeneXpert CT&#47;NG NAAT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98&#8211;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Treponema pallidum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dark-field microscopy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#8211;90&#59; 39&#8211;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;100&#59; 82&#8211;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not for oral or rectal lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Direct immunofluorescence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#8211;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Requires a fluorescence microscope and trained personnel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Herpes simplex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RPR &#40;non-treponemal antibodies&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#8211;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#8211;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Requires confirmation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tzanck smear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No Sp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Depends on the no&#46; of viral particles in lesions<br>70&#8211;90&#37; Se if sufficient no&#46; of cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Haemophilus ducreyi</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Direct immunofluorescence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#8211;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Donovanosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gram stain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#8211;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Bacterial vaginosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wright-Giemsa stain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#8211;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wet mount&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#8211;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#8211;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gram stain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#8211;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#8211;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#8211;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#8211;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DNA probe &#40;Affirm VPIII&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rapid pH and Rapid Amine &#40;FermCard&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#8211;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&#8211;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rapid PIP &#40;G&#46; vaginalis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#8211;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#8211;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Candida</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BVBlue system&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wet mount&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#8211;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Examination with KOH 10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#8211;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Trichomonas vaginalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DNA probe &#40;Affirm VPIII&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&#8211;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wet mount&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#8211;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99&#8211;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#37; compared to PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Latex agglutination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OSOM Trichomonas Rapid Test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#8211;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1472712.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">List of rapid tests for sexually transmitted infections&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">PMN&#58; polymorphonuclear leukocytes&#46;</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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Janier et al&#46;&#44; 1995<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Iwuji et al&#46;&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Orellana et al&#46;&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chlamydia trachomatis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Ureaplasma urealyticum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1472713.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sensitivity of the Gram stain with &#8805;5 PMNs for <span class="elsevierStyleItalic">Chlamydia trachomatis</span> and <span class="elsevierStyleItalic">Ureaplasma urealyticum</span>&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">PMN&#58; polymorphonuclear leukocytes&#59; Se&#58; sensitivity&#59; Sp&#58; specificity&#46;</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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of PMNs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Se &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#62;2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#8805;5</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chlamydia trachomatis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ureaplasma urealyticum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1472715.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Sensitivity and specificity according to PMN threshold&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gram-positive bacilli &#40;<span class="elsevierStyleItalic">Lactobacillus</span> spp&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Small Gram-negative bacilli &#40;<span class="elsevierStyleItalic">Gardnerella vaginalis</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Curved Gram-negative bacilli &#40;<span class="elsevierStyleItalic">Mobiluncus</span> spp&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#43; &#40;&#62;30<span class="elsevierStyleHsp" style=""></span>morphotypes&#47;field&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#43; &#40;5&#8211;30<span class="elsevierStyleHsp" style=""></span>morphotypes&#47;field&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#43; &#40;&#60;1<span class="elsevierStyleHsp" style=""></span>morphotype&#47;field&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#43; 2&#43; &#40;&#60;5<span class="elsevierStyleHsp" style=""></span>morphotypes&#47;field&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#43; &#40;1&#8211;4<span class="elsevierStyleHsp" style=""></span>morphotypes&#47;field&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#43; &#40;1&#8211;4<span class="elsevierStyleHsp" style=""></span>morphotypes&#47;field&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#43; 4&#43; &#40;&#62;5<span class="elsevierStyleHsp" style=""></span>morphotypes&#47;field&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#43; &#40;&#60;1<span class="elsevierStyleHsp" style=""></span>morphotype&#47;field&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#43; &#40;5&#8211;30<span class="elsevierStyleHsp" style=""></span>morphotypes&#47;field&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#43; &#40;&#62;30<span class="elsevierStyleHsp" style=""></span>morphotypes&#47;field&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1472714.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Interpretation of the Nugent criteria&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:38 [
            0 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The rapid test paradox&#58; when fewer cases detected lead to more cases treated&#58; a decision analysis of tests for <span class="elsevierStyleItalic">Chlamydia trachomatis</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;L&#46; Gift"
                            1 => "M&#46;S&#46; Pate"
                            2 => "E&#46;W&#46; Hook 3rd"
                            3 => "W&#46;J&#46; Kassler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Dis"
                        "fecha" => "1999"
                        "volumen" => "26"
                        "paginaInicial" => "232"
                        "paginaFinal" => "240"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10225593"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Principles of laboratory diagnosis of STIs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Kuypers"
                            1 => "C&#46;A&#46; Gaydos"
                            2 => "R&#46;W&#46; Peeling"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Sexually transmitted diseases"
                        "paginaInicial" => "937"
                        "paginaFinal" => "958"
                        "edicion" => "4th ed&#46;"
                        "serieFecha" => "2008"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular methods in the laboratory diagnosis of sexually transmitted infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46; Muralidhar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0253-7184.156686"
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Sex Transm Dis"
                        "fecha" => "2015"
                        "volumen" => "36"
                        "paginaInicial" => "9"
                        "paginaFinal" => "17"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26392648"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What&#39;s the point&#63; How point of care STI tests can impact infected patients&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Huppert"
                            1 => "E&#46; Hesse"
                            2 => "C&#46;A&#46; Gaydos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/POC.0b013e3181d2d8cc"
                      "Revista" => array:6 [
                        "tituloSerie" => "Point Care"
                        "fecha" => "2010"
                        "volumen" => "9"
                        "paginaInicial" => "36"
                        "paginaFinal" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20401167"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perceptions of an ideal point-of-care test for sexually transmitted infections&#8212;a qualitative study of focus group discussions with medical providers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46;-H&#46; Hsieh"
                            1 => "M&#46;T&#46; Hogan"
                            2 => "M&#46; Barnes"
                            3 => "M&#46; Jett-Goheen"
                            4 => "J&#46; Huppert"
                            5 => "A&#46;M&#46; Rompalo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0014144"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2010"
                        "volumen" => "5"
                        "paginaInicial" => "e14144"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21152386"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rapid tests for sexually transmitted infections &#40;STIs&#41;&#58; the way forward"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;W&#46; Peeling"
                            1 => "K&#46;K&#46; Holmes"
                            2 => "D&#46; Mabey"
                            3 => "A&#46; Ronald"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/sti.2005.019349"
                      "Revista" => array:7 [
                        "tituloSerie" => "Sex Transm Infect"
                        "fecha" => "2006"
                        "volumen" => "82"
                        "numero" => "Suppl&#46; 5"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16461590"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The point-of-care laboratory in clinical microbiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Drancourt"
                            1 => "A&#46; Michel-Lepage"
                            2 => "S&#46; Boyer"
                            3 => "D&#46; Raoult"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CMR.00090-15"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Rev"
                        "fecha" => "2016"
                        "volumen" => "29"
                        "paginaInicial" => "429"
                        "paginaFinal" => "447"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27029593"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Procedimientos en Microbiolog&#237;a Cl&#237;nica&#58; 24&#46; Diagn&#243;stico microbiol&#243;gico de las infecciones de transmisi&#243;n sexual y otras infecciones genitales"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Aznar Mart&#237;n"
                            1 => "M&#46;A&#46; Blanco Gal&#225;n"
                            2 => "J&#46;A&#46; Lepe Jim&#233;nez"
                            3 => "L&#46; Otero Guerra"
                            4 => "F&#46; V&#225;zquez Vald&#233;s"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "fecha" => "2007"
                        "paginaInicial" => "1"
                        "paginaFinal" => "60"
                        "editorial" => "SEIMC"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available from&#58; <span class="elsevierStyleInterRef" id="intr0010" href="https://www.bashhguidelines.org/media/1043/vvc-2007.pdf">https&#58;&#47;&#47;www&#46;bashhguidelines&#46;org&#47;media&#47;1043&#47;vvc-2007&#46;pdf</span> &#91;consulted 05&#46;12&#46;16&#93;"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "United Kingdom national guideline on the management of vulvovaginal candidiasis"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2007"
                        "editorial" => "Clinical Effectiveness Group British Association of Sexual Health and HIV"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European &#40;IUSTI&#47;WHO&#41; guideline on the management of vaginal discharge&#44; 2011"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "European IUSTI"
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Sherrard"
                            1 => "G&#46; Donders"
                            2 => "D&#46; White"
                            3 => "J&#46;S&#46; Jensen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1258/ijsa.2011.011012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J STD AIDS"
                        "fecha" => "2011"
                        "volumen" => "22"
                        "paginaInicial" => "421"
                        "paginaFinal" => "429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21795415"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "UK national guideline for the management of Chancroid&#44; 2014"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46; O&#8217;Farrell"
                            1 => "N&#46; Lazaro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0956462414525940"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J STD AIDS"
                        "fecha" => "2014"
                        "volumen" => "25"
                        "paginaInicial" => "975"
                        "paginaFinal" => "983"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25318857"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Performance evaluation of automated urine microscopy as a rapid&#44; non-invasive approach for the diagnosis of non-gonococcal urethritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Pond"
                            1 => "A&#46;V&#46; Nori"
                            2 => "S&#46; Patel"
                            3 => "K&#46; Laing"
                            4 => "M&#46; Ajayi"
                            5 => "A&#46;J&#46; Copas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/sextrans-2014-051761"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Infect"
                        "fecha" => "2015"
                        "volumen" => "91"
                        "paginaInicial" => "165"
                        "paginaFinal" => "170"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25614466"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New point of care <span class="elsevierStyleItalic">Chlamydia</span> Rapid Test&#8212;bridging the gap between diagnosis and treatment&#58; Performance evaluation study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Mahilum-Tapay"
                            1 => "V&#46; Laitila"
                            2 => "J&#46;J&#46; Wawrzyniak"
                            3 => "H&#46;H&#46; Lee"
                            4 => "S&#46; Alexander"
                            5 => "C&#46; Ison"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.39402.463854.AE"
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2007"
                        "volumen" => "335"
                        "paginaInicial" => "1190"
                        "paginaFinal" => "1194"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18055487"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparative effectiveness of a rapid point-of-care test for detection of <span class="elsevierStyleItalic">Chlamydia trachomatis</span> among women in a clinical setting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46; Huang"
                            1 => "C&#46;A&#46; Gaydos"
                            2 => "M&#46;R&#46; Barnes"
                            3 => "M&#46; Jett-Goheen"
                            4 => "D&#46;R&#46; Blake"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/sextrans-2012-050877"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Infect"
                        "fecha" => "2013"
                        "volumen" => "89"
                        "paginaInicial" => "104"
                        "paginaFinal" => "114"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23335640"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Performance of the Cepheid CT&#47;NG Xpert rapid PCR test for detection of <span class="elsevierStyleItalic">Chlamydia trachomatis</span> and <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;A&#46; Gaydos"
                            1 => "B&#46; van der Pol"
                            2 => "M&#46; Jett-Goheen"
                            3 => "M&#46; Barnes"
                            4 => "N&#46; Quinn"
                            5 => "C&#46; Clarket"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JCM.03461-12"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2013"
                        "volumen" => "51"
                        "paginaInicial" => "1666"
                        "paginaFinal" => "1672"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23467600"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Performance of the GeneXpert CT&#47;NG assay compared to that of the Aptima AC2 Assay for detection of rectal <span class="elsevierStyleItalic">Chlamydia trachomatis</span> and <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> by use of residual Aptima samples"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;D&#46; Goldenberg"
                            1 => "J&#46; Finn"
                            2 => "E&#46; Sedudzi"
                            3 => "J&#46;A&#46; White"
                            4 => "C&#46;Y&#46;W&#46; Tong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JCM.01930-12"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2012"
                        "volumen" => "50"
                        "paginaInicial" => "3867"
                        "paginaFinal" => "3869"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22993183"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic review of point of care testing for <span class="elsevierStyleItalic">Chlamydia trachomatis</span>&#44; <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>&#44; and <span class="elsevierStyleItalic">Trichomonas vaginalis</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Herbst de Cortina"
                            1 => "C&#46;C&#46; Bristow"
                            2 => "D&#46; Joseph Davey"
                            3 => "J&#46;D&#46; Klausner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Infect Dis Obstet Gynecol"
                        "fecha" => "2016"
                        "volumen" => "2016"
                        "paginaInicial" => "438612"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2013 UK national guideline for the management of lymphogranuloma venereum&#58; Clinical Effectiveness Group of the British Association for Sexual Health and HIV &#40;CEG&#47;BASHH&#41; guideline development group"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "British Association for Sexual Health and HIV"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; White"
                            1 => "N&#46; O&#8217;Farrell"
                            2 => "D&#46; Daniels"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0956462413482811"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J STD AIDS"
                        "fecha" => "2013"
                        "volumen" => "24"
                        "paginaInicial" => "593"
                        "paginaFinal" => "601"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23970591"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "UK national guideline for the management of gonorrhoea in adults&#44; 2011"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Guideline Development Group&#59; British Association for Sexual Health and HIV UK"
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Bignell"
                            1 => "M&#46; Fitzgerald"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1258/ijsa.2011.011267"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J STD AIDS"
                        "fecha" => "2011"
                        "volumen" => "22"
                        "paginaInicial" => "541"
                        "paginaFinal" => "547"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21998172"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sexually transmitted diseases treatment guidelines&#44; 2015"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46;A&#46; Workowski"
                            1 => "G&#46;A&#46; Bolan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.15585/mmwr.rr6404a1"
                      "Revista" => array:6 [
                        "tituloSerie" => "MMWR Recomm Rep"
                        "fecha" => "2015"
                        "volumen" => "64"
                        "paginaInicial" => "1"
                        "paginaFinal" => "137"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26632963"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiologies of nongonococcal urethritis&#58; bacteria&#44; viruses&#44; and the association with orogenital exposure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;S&#46; Bradshaw"
                            1 => "S&#46;N&#46; Tabrizi"
                            2 => "T&#46;R&#46; Read"
                            3 => "S&#46;M&#46; Garland"
                            4 => "C&#46;A&#46; Hopkins"
                            5 => "L&#46;M&#46; Moss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/499434"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "2006"
                        "volumen" => "193"
                        "paginaInicial" => "336"
                        "paginaFinal" => "345"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16388480"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chlamydial and gonococcal infection in men without polymorphonuclear leukocytes on Gram stain&#58; implications for diagnostic approach and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46;M&#46; Geisler"
                            1 => "S&#46; Yu"
                            2 => "E&#46;W&#46; Hook 3rd&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Dis"
                        "fecha" => "2005"
                        "volumen" => "32"
                        "paginaInicial" => "630"
                        "paginaFinal" => "634"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16205305"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sensitivity of Gram stain in the diagnosis of urethritis in men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Orellana"
                            1 => "M&#46;L&#46; G&#243;mez-Lus"
                            2 => "D&#46; Lora"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/sextrans-2011-050150"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Infect"
                        "fecha" => "2012"
                        "volumen" => "88"
                        "paginaInicial" => "284"
                        "paginaFinal" => "287"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22308534"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Male urethritis with and without discharge&#58; a clinical and microbiological study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Janier"
                            1 => "F&#46; Lassau"
                            2 => "I&#46; Casin"
                            3 => "P&#46; Grillot"
                            4 => "C&#46; Scieux"
                            5 => "A&#46; Zavaro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Dis"
                        "fecha" => "1995"
                        "volumen" => "22"
                        "paginaInicial" => "244"
                        "paginaFinal" => "252"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7482108"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic utility of urethral smears in predicting urethral chlamydia in HIV-infected men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;C&#46; Iwuji"
                            1 => "I&#46; Reeves"
                            2 => "K&#46; Nambiar"
                            3 => "D&#46; Richardson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1258/ijsa.2008.008118"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J STD AIDS"
                        "fecha" => "2008"
                        "volumen" => "19"
                        "paginaInicial" => "741"
                        "paginaFinal" => "743"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18931265"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recalibrating the Gram stain diagnosis of male urethritis in the era of nucleic acid amplification testing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;A&#46; Rietmejer"
                            1 => "C&#46;J&#46; Mettenbrink"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/OLQ.0b013e3182354da3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Dis"
                        "fecha" => "2012"
                        "volumen" => "39"
                        "paginaInicial" => "18"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22183839"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "In defence of methylene blue in diagnosing gonorrhoea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46;L&#46;M&#46; Pattison"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Can Med Assoc J"
                        "fecha" => "1983"
                        "volumen" => "128"
                        "paginaInicial" => "508"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6825014"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of methylene blue&#47;gentian violet stain to Gram&#39;s stain for the rapid diagnosis of gonococcal urethritis in men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;N&#46; Taylor"
                            1 => "R&#46;P&#46; DiCarlo"
                            2 => "D&#46;H&#46; Martin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/OLQ.0b013e318225f7c2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Dis"
                        "fecha" => "2011"
                        "volumen" => "38"
                        "paginaInicial" => "995"
                        "paginaFinal" => "996"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21992973"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Bignell C&#44; Ison C&#44; FitzGerald M&#46; United Kingdom national guidelines for gonorrhoea testing 2012&#46; Clinical Effectiveness Group&#44; British Association of Sexual Health and HIV&#46; Available from&#58; <a href="https://www.bashh.org/documents/4490.pdf">https&#58;&#47;&#47;www&#46;bashh&#46;org&#47;documents&#47;4490&#46;pdf</a> &#91;consulted 15&#46;12&#46;16&#93;&#46;"
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "UK national guidelines on the management of syphilis 2015"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Kingston"
                            1 => "P&#46; French"
                            2 => "S&#46; Higgins"
                            3 => "O&#46; McQuillan"
                            4 => "A&#46; Sukthankar"
                            5 => "C&#46; Stott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0956462415624059"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J STD AIDS"
                        "fecha" => "2016"
                        "volumen" => "27"
                        "paginaInicial" => "421"
                        "paginaFinal" => "446"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26721608"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#8216;Shelf life&#8217; of <span class="elsevierStyleItalic">Trichomonas vaginalis</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Kingston"
                            1 => "D&#46; Bansal"
                            2 => "E&#46;M&#46; Carlin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1258/095646203321043228"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J STD AIDS"
                        "fecha" => "2003"
                        "volumen" => "14"
                        "paginaInicial" => "28"
                        "paginaFinal" => "29"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12590789"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "United Kingdom national guideline on the management of <span class="elsevierStyleItalic">Trichomonas vaginalis</span> 2014"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Sherrard"
                            1 => "C&#46; Ison"
                            2 => "J&#46; Moody"
                            3 => "E&#46; Wainwright"
                            4 => "J&#46; Wilson"
                            5 => "A&#46; Sullivan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0956462414525947"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J STD AIDS"
                        "fecha" => "2014"
                        "volumen" => "25"
                        "paginaInicial" => "541"
                        "paginaFinal" => "549"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24616117"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2014 UK national guideline for the management of anogenital herpes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Patel"
                            1 => "J&#46; Green"
                            2 => "E&#46; Clarke"
                            3 => "K&#46; Seneviratne"
                            4 => "N&#46; Abbt"
                            5 => "C&#46; Evans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0956462415580512"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J STD AIDS"
                        "fecha" => "2015"
                        "volumen" => "26"
                        "paginaInicial" => "763"
                        "paginaFinal" => "776"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25861804"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nonspecific vaginitis&#46; Diagnostic criteria and microbial and epidemiologic associations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Amsel"
                            1 => "P&#46;A&#46; Totten"
                            2 => "C&#46;A&#46; Spiegel"
                            3 => "K&#46;C&#46; Chen"
                            4 => "D&#46; Eschenbach"
                            5 => "K&#46;K&#46; Holmes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "1983"
                        "volumen" => "74"
                        "paginaInicial" => "14"
                        "paginaFinal" => "22"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6600371"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;P&#46; Nugent"
                            1 => "M&#46;A&#46; Krohn"
                            2 => "S&#46;L&#46; Hillier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "1991"
                        "volumen" => "29"
                        "paginaInicial" => "297"
                        "paginaFinal" => "301"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1706728"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;A&#46; Ison"
                            1 => "P&#46;E&#46; Hay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Infect"
                        "fecha" => "2002"
                        "volumen" => "78"
                        "paginaInicial" => "413"
                        "paginaFinal" => "415"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12473800"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multiplex PCR testing for nine different sexually transmitted infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;D&#46; Kriesel"
                            1 => "A&#46;S&#46; Bhatia"
                            2 => "C&#46; Barrus"
                            3 => "M&#46; Vaughn"
                            4 => "J&#46; Gardner"
                            5 => "R&#46;J&#46; Crisp"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0956462415615775"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J STD AIDS"
                        "fecha" => "2016"
                        "volumen" => "27"
                        "paginaInicial" => "1275"
                        "paginaFinal" => "1282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26538551"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blind evaluation of the microwave-accelerated metal-enhanced fluorescence ultrarapid and sensitive <span class="elsevierStyleItalic">Chlamydia trachomatis</span> test by use of clinical samples"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;H&#46; Melendez"
                            1 => "J&#46;S&#46; Huppert"
                            2 => "M&#46; Jett-Goheen"
                            3 => "E&#46;A&#46; Hesse"
                            4 => "N&#46; Quinn"
                            5 => "C&#46;A&#46; Gaydos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JCM.00980-13"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2013"
                        "volumen" => "51"
                        "paginaInicial" => "2913"
                        "paginaFinal" => "2920"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23804384"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/2529993X/0000003500000007/v1_201707230042/S2529993X17301892/v1_201707230042/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "63566"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Continuing medical education&#58; Methods of rapid diagnosis in clinical microbiology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003500000007/v1_201707230042/S2529993X17301892/v1_201707230042/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301892?idApp=UINPBA00004N"
]

Article information

ISSN: 2529993X
Original language: English

DOI:10.1016/j.eimce.2017.01.035

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	47	9	56
2024 September	66	9	75
2024 August	46	14	60
2024 July	57	9	66
2024 June	41	6	47
2024 May	65	10	75
2024 April	51	13	64
2024 March	90	11	101
2024 February	126	22	148
2024 January	115	14	129
2023 December	102	9	111
2023 November	124	12	136
2023 October	177	31	208
2023 September	100	8	108
2023 August	113	7	120
2023 July	66	6	72
2023 June	103	12	115
2023 May	138	13	151
2023 April	136	15	151
2023 March	124	12	136
2023 February	73	11	84
2023 January	125	28	153
2022 December	106	14	120
2022 November	110	21	131
2022 October	102	30	132
2022 September	85	26	111
2022 August	56	21	77
2022 July	29	16	45
2022 June	33	11	44
2022 May	47	27	74
2022 April	63	32	95
2022 March	55	20	75
2022 February	66	16	82
2022 January	79	24	103
2021 December	72	19	91
2021 November	69	14	83
2021 October	78	39	117
2021 September	67	20	87
2021 August	41	18	59
2021 July	27	15	42
2021 June	45	21	66
2021 May	46	22	68
2021 April	128	44	172
2021 March	80	10	90
2021 February	48	13	61
2021 January	39	13	52
2020 December	39	7	46
2020 November	38	6	44
2020 October	48	9	57
2020 September	30	12	42
2020 August	39	2	41
2020 July	28	2	30
2020 June	32	9	41
2020 May	38	7	45
2020 April	77	6	83
2020 March	28	8	36
2020 February	34	2	36
2020 January	26	8	34
2019 December	30	9	39
2019 November	13	2	15
2019 October	19	3	22
2019 September	22	9	31
2019 August	14	5	19
2019 July	35	24	59
2019 June	71	22	93
2019 May	165	39	204
2019 April	93	11	104
2019 March	27	9	36
2019 February	42	7	49
2019 January	25	6	31
2018 December	37	5	42
2018 November	45	7	52
2018 October	49	12	61
2018 September	69	4	73
2018 August	22	1	23
2018 July	17	2	19
2018 June	15	5	20
2018 May	17	4	21
2018 April	10	3	13
2018 March	13	4	17
2018 February	6	0	6
2018 January	10	1	11
2017 December	19	0	19
2017 November	15	1	16
2017 October	22	2	24

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter