Letter to the Editor
Proctitis in an HIV-infected male who have sex with men
Proctitis en varón con relaciones sexuales con hombres e infectado por el virus de la inmunodeficiencia humana
Joaquín Escobar-Sevillaa, Carmen Hidalgo-Tenoriob, José María Navarro-Maríc, José Gutiérrez-Fernándezc,d,
Corresponding author
a Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, Spain
b Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, Spain
c Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, Spain
d Departamento de Microbiología, Universidad de Granada, Instituto de Investigación Biosanitaria de Granada, Granada, Spain
Read
6
Timeswas read the article
3
Total PDF
3
Total HTML
Share statistics
array:24 [ "pii" => "S2387020616303588" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.06.040" "estado" => "S300" "fechaPublicacion" => "2016-05-20" "aid" => "3459" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2016;146:468-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "formatos" => array:2 [ "HTML" => 1 "PDF" => 1 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775315006430" "issn" => "00257753" "doi" => "10.1016/j.medcli.2015.11.017" "estado" => "S300" "fechaPublicacion" => "2016-05-20" "aid" => "3459" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2016;146:468-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 19 "formatos" => array:2 [ "HTML" => 9 "PDF" => 10 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Proctitis en varón con relaciones sexuales con hombres e infectado por el virus de la inmunodeficiencia humana" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "468" "paginaFinal" => "469" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Proctitis in an HIV-infected male who have sex with men" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Joaquín Escobar-Sevilla, Carmen Hidalgo-Tenorio, José María Navarro-Marí, José Gutiérrez-Fernández" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Joaquín" "apellidos" => "Escobar-Sevilla" ] 1 => array:2 [ "nombre" => "Carmen" "apellidos" => "Hidalgo-Tenorio" ] 2 => array:2 [ "nombre" => "José María" "apellidos" => "Navarro-Marí" ] 3 => array:2 [ "nombre" => "José" "apellidos" => "Gutiérrez-Fernández" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020616303588" "doi" => "10.1016/j.medcle.2016.06.040" "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/S2387020616303588?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315006430?idApp=UINPBA00004N" "url" => "/00257753/0000014600000010/v1_201604290136/S0025775315006430/v1_201604290136/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020616303576" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.06.039" "estado" => "S300" "fechaPublicacion" => "2016-05-20" "aid" => "3458" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2016;146:e55" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Cyanoacrylate-related pulmonary embolism following transhepatic embolization of esophageal varices" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "e55" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Embolia pulmonar por cianoacrilato tras embolización transhepática de varices esofágicas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Gorospe Sarasúa, Frank Eric Farfán-Leal, Rubén Eduardo Pacios-Blanco, Raquel García-Latorre" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" ] 1 => array:2 [ "nombre" => "Frank Eric" "apellidos" => "Farfán-Leal" ] 2 => array:2 [ "nombre" => "Rubén Eduardo" "apellidos" => "Pacios-Blanco" ] 3 => array:2 [ "nombre" => "Raquel" "apellidos" => "García-Latorre" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315006429" "doi" => "10.1016/j.medcli.2015.11.016" "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/S0025775315006429?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616303576?idApp=UINPBA00004N" "url" => "/23870206/0000014600000010/v1_201609110046/S2387020616303576/v1_201609110046/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S238702061630359X" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.06.041" "estado" => "S300" "fechaPublicacion" => "2016-05-20" "aid" => "3462" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2016;146:467-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Chronic bilateral panuveitis as first manifestation of Whipple's disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "467" "paginaFinal" => "468" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Panuveítis crónica bilateral como primera manifestación de la enfermedad de Whipple" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Arriola-Villalobos, Jorge Ruiz-Medrano, David Diaz-Valle, Jose M. Benitez del Castillo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Arriola-Villalobos" ] 1 => array:2 [ "nombre" => "Jorge" "apellidos" => "Ruiz-Medrano" ] 2 => array:2 [ "nombre" => "David" "apellidos" => "Diaz-Valle" ] 3 => array:2 [ "nombre" => "Jose M." "apellidos" => "Benitez del Castillo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315006466" "doi" => "10.1016/j.medcli.2015.11.020" "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/S0025775315006466?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061630359X?idApp=UINPBA00004N" "url" => "/23870206/0000014600000010/v1_201609110046/S238702061630359X/v1_201609110046/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Proctitis in an HIV-infected male who have sex with men" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "468" "paginaFinal" => "469" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Joaquín Escobar-Sevilla, Carmen Hidalgo-Tenorio, José María Navarro-Marí, José Gutiérrez-Fernández" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Joaquín" "apellidos" => "Escobar-Sevilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Carmen" "apellidos" => "Hidalgo-Tenorio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "José María" "apellidos" => "Navarro-Marí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:4 [ "nombre" => "José" "apellidos" => "Gutiérrez-Fernández" "email" => array:1 [ 0 => "josegf@go.ugr.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Microbiología, Universidad de Granada, Instituto de Investigación Biosanitaria de Granada, Granada, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Proctitis en varón con relaciones sexuales con hombres e infectado por el virus de la inmunodeficiencia humana" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Proctitis is a common problem characterized by anal bleeding, purulent discharge, itching, anal pain, ulceration and, sometimes, inguinal lymph nodes and fever. The incidence of infectious proctitis appears to be increasing in relation to unprotected sex in men who have sex with men (MSM). The typically involved pathogens are: <span class="elsevierStyleItalic">Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum</span> and <span class="elsevierStyleItalic">Herpes simplex</span>, although others have been also associated such as <span class="elsevierStyleItalic">Escherichia coli, Shigella, Campylobacter</span> and <span class="elsevierStyleItalic">Clostridium difficile</span>,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> which are clinically indistinguishable. This fact justifies taking adequate samples, even performing a biopsy if the condition does not improve with the prescribed treatment. Proctitis may occur less frequently due to non-infectious problems such as inflammatory bowel disease. There is also a high proportion (60–70%) of these patients who are asymptomatic carriers of these pathogens.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> We report a rare cause of proctitis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This was a 32-year-old patient without a medical history, who underwent an orchiectomy due to testicular torsion in 2012, who occasionally drinks alcohol and smokes 20 cigarettes a day. He went to the sexually transmitted diseases (STDs) unit because, after having had unprotected sex, presented with a lesion classified as chancre. A <span class="elsevierStyleItalic">T. pallidum</span> serology was performed, which proved positive for the current disease and was treated with penicillin G benzathine, 2 doses intramuscularly. At that time, HIV serology was positive, so it was referred to the hospital's infectious diseases consultation. During that appointment, the main symptoms were a feverish feeling, watery diarrhoea and weight loss. The initial HIV patient battery study was completed and treatment was initiated with a single-dose triple therapy (EVG/c<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>TDF<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3TC). HIV viral load was 9,961,378<span class="elsevierStyleHsp" style=""></span>copies/ml, so an appointment was made in a month's time. After a month of therapy, the patient was feeling better overall, but had started to experience proctalgia together with both, anal and urethral purulent secretion, having resumed unprotected sex with other men at that time. A diagnosis of proctitis with a probable infectious aetiology was made. In order to study infectious agents, secretion samples were taken. Empirical therapy was then initiated with single dose ceftriaxone 1<span class="elsevierStyleHsp" style=""></span>g and single dose azithromycin 1.5<span class="elsevierStyleHsp" style=""></span>g, improving the patient's signs and symptoms. Subsequently, results about the growth of <span class="elsevierStyleItalic">Neisseria meningitidis</span> serogroup B were received, identified by mass spectrometry with Biotyper<span class="elsevierStyleSup">®</span> (Bruker Daltonics) and standard biochemistry (Vitek<span class="elsevierStyleSup">®</span> II; bioMérieux, Anglum Road, Hazelwood, MO, USA). Antimicrobial susceptibility profile was performed using the <span class="elsevierStyleItalic">E-test</span> method, being sensitive to tetracycline (MIC: 0.047<span class="elsevierStyleHsp" style=""></span>mg/l), cefotaxime (MIC: 0.125<span class="elsevierStyleHsp" style=""></span>mg/l), ciprofloxacin (MIC: 0.004<span class="elsevierStyleHsp" style=""></span>mg/l) and azithromycin (MIC: 0.75<span class="elsevierStyleHsp" style=""></span>mg/l).</p><p id="par0015" class="elsevierStylePara elsevierViewall">MSM patients with HIV infection experience STDs<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> more often and, of them, gonococcal infections are the most common,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> these being more symptomatic than those caused by other etiologic agents, allowing diagnosis and treatment in most cases. Also the fact of finding infectious proctitis, justifies changes in the patient's rectal mucosa, increasing the risk threshold of HIV acquisition.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleItalic">N. meningitidis</span> descriptions in cases of proctitis is limited in literature, representing only 8.7% of all <span class="elsevierStyleItalic">Neisseria</span> isolates in genitourinary samples,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> being associated with sexual activity.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Isolates in the largest series studied were statistically associated with MSM practices.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Some authors question their pathogenic significance due to the small percentage of symptomatic patients with positive isolations; against this theory, significant histopathological changes have been observed in rectal mucosa of patients with <span class="elsevierStyleItalic">N. meningitidis</span> isolates, regardless of the time course of infection.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Escobar-Sevilla J, Hidalgo-Tenorio C, Navarro-Marí JM, Gutiérrez-Fernández J. Proctitis en varón con relaciones sexuales con hombres e infectado por el virus de la inmunodeficiencia humana. Med Clin (Barc). 2016;146:468–469.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infectious proctitis: when to suspect it is not inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Hoetien" 1 => "D.T. Rubin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-011-1935-0" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2012" "volumen" => "57" "paginaInicial" => "269" "paginaFinal" => "273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21994137" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asymptomatic gonorrhea and chlamydial infections detected by nucleic acid amplification tests among Boston area men who have sex with men" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Mimiaga" 1 => "K.H. Mayer" 2 => "S.L. Reisner" 3 => "A. Gonzalez" 4 => "B. Dumas" 5 => "R. Vanderwarker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/OLQ.0b013e31816471ae" "Revista" => array:6 [ "tituloSerie" => "Sex Transm Dis" "fecha" => "2008" "volumen" => "35" "paginaInicial" => "495" "paginaFinal" => "498" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18354345" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ongoing sezually transtimetted disease adquisition and risk-taking behaviour among US HIV-infected patients in primary-care: implication for prevention interventions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.H. Mayer" 1 => "T. Bush" 2 => "K. Henry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/OLQ.0b013e31823b1922" "Revista" => array:6 [ "tituloSerie" => "Sex Transm Dis" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "1" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22183836" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The emerging theart of untreatable gonococcal infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.A. Bolan" 1 => "P.F. Sparling" 2 => "J.N. Waserheit" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMp1112456" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2012" "volumen" => "366" "paginaInicial" => "485" "paginaFinal" => "487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22316442" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and correlates of rectal Chlamydia and gonorrhea among female clients at sexually transmitted disease clinics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Javanbakht" 1 => "P. Gorbach" 2 => "A. Stirland" 3 => "M. Chien" 4 => "P. Kerndt" 5 => "S. Guerry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/OLQ.0b013e31826ae9a2" "Revista" => array:7 [ "tituloSerie" => "Sex Transm Dis" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "917" "paginaFinal" => "922" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23191945" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204514711829" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isolations of <span class="elsevierStyleItalic">Neisseria meningitidis</span> from anogenital sites in adolescent: clinical implication" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.R. Jaffe" 1 => "J.A. Stavis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Adolesc Health Care" "fecha" => "1983" "volumen" => "4" "paginaInicial" => "171" "paginaFinal" => "173" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6415020" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Neisseria meningitidis</span> in urogenital infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Beck" 1 => "J.L. Fluker" 2 => "D.J. Platt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Vener Dis" "fecha" => "1974" "volumen" => "50" "paginaInicial" => "367" "paginaFinal" => "369" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4214581" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Neisseria meningitidis</span> proctitis in a child after sexual abuse" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.C. Argent" 1 => "D.H. Hanslo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatr Infec Dis J" "fecha" => "1994" "volumen" => "13" "paginaInicial" => "330" "paginaFinal" => "331" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anogenital non-gonococcal <span class="elsevierStyleItalic">neisseriae</span>: prevalence and clinical significance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.G. McKenna" 1 => "R.J. Fallon" 2 => "A. Moyes" 3 => "H. Young" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J STD AIDS" "fecha" => "1993" "volumen" => "4" "paginaInicial" => "8" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8427910" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histology of rectal gonorrhoea in men, with a note on anorectal infection with <span class="elsevierStyleItalic">Neisseria meningitidis</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. McMillan" 1 => "McNeillage" 2 => "H.M. Gilmour" 3 => "F.D. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Pathol" "fecha" => "1983" "volumen" => "36" "paginaInicial" => "511" "paginaFinal" => "514" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6404946" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014600000010/v1_201609110046/S2387020616303588/v1_201609110046/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014600000010/v1_201609110046/S2387020616303588/v1_201609110046/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616303588?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 2 | 2 | 4 |
| 2016 September | 1 | 1 | 2 |
