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un estudio observacional descriptivo a partir de los datos recogidos de forma prospectiva mediante una entrevista estructurada&#46; Se incluyeron todos los pacientes que fueron evaluados en la Unidad de ITS &#40;UITS&#41; del servicio de Dermatolog&#237;a del Hospital General Universitario de Valencia entre enero de 2016 y enero de 2019 y que fueron diagnosticados de herpes genital&#46; El diagn&#243;stico se estableci&#243; cl&#237;nicamente y mediante las siguientes pruebas de laboratorio&#58; test de Tzanck&#44; serolog&#237;as para herpes simple y pruebas moleculares&#46; Las muestras para estas &#250;ltimas pruebas se recogieron de las lesiones genitales &#40;ves&#237;culas o &#250;lceras&#41; mediante hisopos est&#233;riles con punta de algod&#243;n&#44; que eran transferidos inmediatamente al medio de transporte v&#237;rico y enviados al servicio de Microbiolog&#237;a para la realizaci&#243;n de una reacci&#243;n en cadena de la polimerasa &#40;PCR&#41; para la detecci&#243;n de ADN viral&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Las variables analizadas fueron&#58; el sexo&#44; la edad&#44; la orientaci&#243;n sexual&#44; la nacionalidad&#44; el motivo de consulta&#44; la localizaci&#243;n de las lesiones&#44; la puerta de entrada a la UITS&#44; las ITS previas&#44; el tabaquismo&#44; la presencia o no de virus de la inmunodeficiencia humana &#40;VIH&#41;&#44; la recurrencia de las lesiones&#44; la realizaci&#243;n de sexo oral con o sin protecci&#243;n y la presencia de lesiones en la pareja o las parejas sexuales&#46; La orientaci&#243;n sexual se defini&#243; como heterosexual &#40;si habitualmente ten&#237;an relaciones sexuales con parejas del sexo opuesto&#41; u homosexual &#40;si en los &#250;ltimos 12 meses hab&#237;an tenido relaciones con una pareja del mismo sexo&#41;&#46; Los motivos de consulta se clasificaron en &#171;&#250;lcera genital&#187; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; o &#171;ves&#237;culo-p&#250;stulas&#187; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; La localizaci&#243;n de la infecci&#243;n por VHS se clasific&#243; en &#171;anal&#47;perianal&#187; o &#171;genital&#187;&#46; &#171;Anal&#47;perianal&#187; comprend&#237;a el ano y la nalga&#44; mientras que &#171;genital&#187; comprend&#237;a el pene&#44; el meato uretral&#44; el escroto&#44; y el pubis para los hombres y la vulva &#40;los labios mayores y los menores&#41; y el pubis para las mujeres&#46; Los pacientes pod&#237;an acceder a nuestra UITS a trav&#233;s de Urgencias Dermatol&#243;gicas&#44; derivados por el m&#233;dico de atenci&#243;n primaria&#44; por el dermat&#243;logo facultativo de &#225;rea o por otro especialista&#46; Se defini&#243; como una enfermedad recurrente la aparici&#243;n de m&#225;s de un brote cl&#237;nicamente evidenciado por un especialista en los &#250;ltimos 6 meses&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis estad&#237;stico descriptivo de todas las variables&#44; empleando la media y la desviaci&#243;n est&#225;ndar &#40;DE&#41; para las variables cuantitativas y los porcentajes para las variables cualitativas&#46; Los contrastes de hip&#243;tesis se realizaron empleando la prueba de la Ji cuadrado de Pearson o la prueba exacta de Fisher seg&#250;n procediera&#46; Los datos estad&#237;sticos se analizaron mediante el programa SPSS versi&#243;n 21&#46;0 y se consider&#243; la significaci&#243;n estad&#237;stica para un valor p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">Desde enero de 2016 hasta enero de 2019 se diagnosticaron 895 ITS&#44; de las cuales 126 fueron un herpes genital &#40;14&#37;&#41;&#46; Las caracter&#237;sticas cl&#237;nico-epidemiol&#243;gicas de los casos diagnosticados se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; De los 126 casos de herpes genital&#44; 68 &#40;54&#37;&#41; fueron en mujeres y 58 &#40;46&#37;&#41; en hombres&#46; De los 19 pacientes homosexuales&#44; 17 &#40;89&#44;5&#37;&#41; eran hombres que ten&#237;an sexo con hombres &#40;HSH&#41;&#44; 8 de ellos positivos para el VIH&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">De los 126 pacientes diagnosticados de herpes genital&#44; en 110 de ellos &#40;87&#44;3&#37;&#41; se confirm&#243; el diagn&#243;stico detectando la presencia de ADN viral mediante PCR&#46; Se diagnosticaron 52 casos de VHS tipo 1 &#40;47&#44;3&#37;&#41; y 58 casos de VHS tipo 2 &#40;52&#44;7&#37;&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se comparan las caracter&#237;sticas cl&#237;nico-epidemiol&#243;gicas entre los pacientes diagnosticados de VHS tipo 1 y VHS tipo 2&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">En el 69&#44;5&#37; de los hombres se detect&#243; el VHS tipo 2&#44; mientras que en el 29&#44;5&#37; de ellos se detect&#243; un VHS tipo 1&#46; La edad media &#40;&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41; al diagn&#243;stico fue de 37 a&#241;os &#40;&#177;<span class="elsevierStyleHsp" style=""></span>11&#41;&#46; La edad media &#40;&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41; de los hombres diagnosticados de VHS tipo 1 fue de 32 a&#241;os &#40;&#177;<span class="elsevierStyleHsp" style=""></span>13&#41;&#44; significativamente menor que la de los hombres diagnosticados de VHS tipo 2&#44; que fue de 39 a&#241;os &#40;&#177;<span class="elsevierStyleHsp" style=""></span>10&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41;&#46; En el 59&#44;3&#37; de las mujeres se detect&#243; el VHS tipo 1&#44; mientras que en el 40&#44;7&#37; de ellas se detect&#243; un VHS tipo 2&#46; La edad media &#40;&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41; de diagn&#243;stico fue de 31 a&#241;os &#40;&#177;<span class="elsevierStyleHsp" style=""></span>13&#41;&#44; con diferencias significativas con respecto a los hombres &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0069&#41;&#46; La edad media &#40;&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41; de las mujeres diagnosticadas de VHS tipo 1 fue de 26 a&#241;os &#40;&#177;<span class="elsevierStyleHsp" style=""></span>11&#41;&#44; significativamente menor que la de las mujeres diagnosticadas de VHS tipo 2&#44; que fue de 34 a&#241;os &#40;&#177;<span class="elsevierStyleHsp" style=""></span>13&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46; En 9 casos el diagn&#243;stico se realiz&#243; en menores de edad &#40;rango 13-17 a&#241;os&#41;&#44; detect&#225;ndose en 7 casos un VHS tipo 1 y en 2 casos un VHS tipo 2&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0045" class="elsevierStylePara elsevierViewall">En los 3 a&#241;os que dur&#243; nuestro estudio se diagnosticaron 126 casos de herpes genital&#44; un 14&#37; de todas las ITS diagnosticadas durante este tiempo&#46; Esta prevalencia es similar a la publicada por Vall Mayans et al&#46; de la UITS del Instituto Catal&#225;n de la Salud entre julio de 2001 hasta junio de 2002&#46; Durante el per&#237;odo de su estudio se diagnosticaron un total de 750 ITS&#44; siendo un 10&#37; herpes genitales<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a>&#46; Sin embargo&#44; es una prevalencia mucho mayor en comparaci&#243;n con la publicada por Moreno-Ribera et al&#46; del Hospital Cl&#237;nic de Barcelona desde 2010 hasta 2013&#44; donde diagnostican 28 casos de herpes genital entre los 835 pacientes atendidos &#40;3&#44;3&#37;&#41;&#46; En este &#250;ltimo estudio&#44; se diagnosticaron 18 casos de VHS tipo 2 &#40;64&#44;3&#37;&#41; y 10 casos de VHS tipo 1 &#40;35&#44;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a>&#44; diferencias ligeramente m&#225;s amplias en comparaci&#243;n con nuestros datos&#46; El porcentaje de &#250;lceras herp&#233;ticas fue similar en HSH y heterosexuales en este &#250;ltimo trabajo<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a>&#44; lo cual difiere con nuestro estudio donde la proporci&#243;n de pacientes homosexuales con herpes genital es &#250;nicamente del 15&#44;1&#37;&#46; Estas diferencias pueden deberse principalmente a un sesgo de selecci&#243;n&#44; dado que la poblaci&#243;n de referencia de la UITS de su centro incluye un &#225;rea de Barcelona que se ha orientado al comercio especializado y a los locales de ocio nocturno para HSH&#44; por lo que cuentan con una elevada poblaci&#243;n homosexual y VIH positivo<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a>&#46; Una mayor prevalencia de VHS tipo 2&#44; el cual tiene m&#225;s riesgo de recidivas&#44; justifica que los pacientes consulten por lesiones cl&#237;nicas diferentes a sus recidivas habituales&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La PCR detect&#243; ADN de VHS en el 87&#44;3&#37; de casos diagnosticados cl&#237;nicamente&#44; un porcentaje similar al de otros estudios&#44; donde se estima una positividad de alrededor del 83&#37;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a>&#46; Probablemente este valor ser&#237;a mayor ya que no se lleg&#243; a solicitar en todos los pacientes&#46; Aproximadamente el 47&#37; y el 53&#37; de los casos con PCR positiva se debieron al virus VHS tipo 1 y al VHS tipo 2&#44; respectivamente&#46; Mathew et al&#46; en Kerala&#44; al sur de la India&#44; analizaron 40 pacientes en un a&#241;o detectando el VHS tipo 1 en el 58&#37; de casos y el VHS tipo 2 en el 42&#37; de los casos de herpes genital<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a>&#46; Comparando con un estudio tambi&#233;n realizado en la India entre 2010 y 2011 donde se detect&#243; VHS tipo 1 en el 32&#44;2&#37; de casos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a>&#44; se observa que existe un aumento de su incidencia&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Este cambio&#44; en la epidemiolog&#237;a del herpes genital tambi&#233;n se ha observado en los pa&#237;ses m&#225;s desarrollados en los &#250;ltimos a&#241;os&#44; con un aumento del VHS tipo 1&#46; Cowan et al&#46; observaron un aumento en las infecciones genitales debidas al VHS tipo 1 en el Reino Unido&#44; particularmente entre los j&#243;venes<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a>&#46; La proporci&#243;n de herpes genital debido a VHS tipo 1 aument&#243; del 31&#44;4 al 42&#44;8&#37; en Canad&#225;&#44; seg&#250;n Gilbert et al&#46; durante su per&#237;odo de estudio &#40;1997-2005&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a>&#46; Estudios en Estados Unidos<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> y Australia<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> tambi&#233;n mostraron una prevalencia creciente de VHS tipo 1 en el herpes genital&#46; Las posibles explicaciones de esta tendencia cambiante incluyen cambios en las pr&#225;cticas sexuales y&#47;o cambios en la patogenicidad viral<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a>&#46; Tambi&#233;n se ha propuesto un retraso en la adquisici&#243;n de VHS tipo 1 en la primera infancia&#44; lo que hace que los adultos j&#243;venes sean m&#225;s susceptibles a la infecci&#243;n<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a>&#46; Ninguno de nuestros pacientes tuvo una coinfecci&#243;n por VHS tipo 1 y tipo 2&#44; como s&#237; se ha observado en estudios similares<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; el VHS tipo 1 se aisl&#243; m&#225;s frecuentemente en las mujeres j&#243;venes&#44; en consonancia con los trabajos anteriores&#44; y afectaba m&#225;s frecuentemente a la zona anal&#47;perianal en comparaci&#243;n con el VHS tipo 2&#46; Tal vez el VHS tipo 2 tenga una patogenicidad con afinidad casi exclusiva por las mucosas&#44; mientras que el VHS tipo 1 pueda afectar por igual tanto a las mucosas &#40;orolabial&#44; mucosa vulvar&#44; glande&#41; como al epitelio ortoquerat&#243;sico &#40;zona perianal&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Aproximadamente&#44; solo el 9&#37; de los pacientes diagnosticados de infecci&#243;n genital por VHS tipo 1 presentan una historia de ITS previa&#44; frente a casi el 50&#37; de los pacientes diagnosticados de VHS tipo 2 genital&#44; incluyendo VIH previo&#46; Mathew et al&#46; indican que alrededor del 79&#37; de los pacientes con infecci&#243;n por VHS tipo 2 tienen m&#250;ltiples parejas sexuales&#44; siendo un factor de riesgo para la adquisici&#243;n de este virus<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a>&#46; La infecci&#243;n por VHS tipo 2 tambi&#233;n se ha relacionado con un riesgo 3 veces mayor de VIH adquirido sexualmente&#46; La alteraci&#243;n de la mucosa causada por &#250;lceras genitales favorece la adquisici&#243;n del VIH al proporcionar una puerta de entrada<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Las recurrencias de las lesiones en los pacientes con VHS tipo 1 y VHS tipo 2 en nuestra serie fue aproximadamente del 13&#37; y del 40&#37;&#44; respectivamente&#46; Esto concuerda con la mayor parte de la literatura reportada donde se informa que el VHS tipo 2 es la causa m&#225;s com&#250;n de herpes genital recurrente<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a>&#46; Sin embargo&#44; nuestros porcentajes son menores que en otras series publicadas&#44; donde se estima que alrededor del 70-90&#37; de las personas con VHS tipo 2 y del 20-50&#37; con VHS tipo 1 genital tendr&#225;n una recurrencia<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a>&#46; Al ser un estudio enmarcado dentro de la pr&#225;ctica cl&#237;nica habitual&#44; tal vez algunos pacientes han podido tener recurrencias que no hayan sido valoradas por nuestra UITS y&#44; por tanto&#44; no han sido reportadas&#46; Esta tendencia m&#225;s baja de reactivaciones para el VHS tipo 1 es de importancia pron&#243;stica para los pacientes&#44; evitando un seguimiento a largo plazo y un alto grado de malestar psicol&#243;gico&#44; por lo que deber&#237;amos implementar el uso de PCR de forma rutinaria ante la sospecha cl&#237;nica de herpes genital&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">M&#225;s de la mitad de los pacientes diagnosticados de herpes genital por VHS tipo 1 reconocieron pr&#225;cticas sexuales receptivas de sexo oral sin protecci&#243;n&#44; frente al 25&#37; de los pacientes diagnosticados de herpes genital por VHS tipo 2&#46; En otros trabajos&#44; todos los pacientes con infecci&#243;n por VHS tipo 1 admiten un contacto orogenital<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a>&#46; Tales diferencias tal vez se encuentren en el modo de preguntar estas pr&#225;cticas&#44; ya que muchas de estas consultas se realizan a trav&#233;s de Urgencias dermatol&#243;gicas en lugar de en una visita en las consultas externas&#44; adem&#225;s de que no siempre son valorados por un dermat&#243;logo dedicado exclusivamente a ITS&#46; El aumento de la pr&#225;ctica del sexo orogenital y el uso pr&#225;cticamente exclusivo del preservativo para pr&#225;cticas vaginales y&#47;o anales podr&#237;an explicar la tendencia al alza del VHS tipo 1 en el herpes genital&#46; Adem&#225;s&#44; m&#225;s del doble de estos pacientes reconocen lesiones de herpes labial en sus parejas sexuales en comparaci&#243;n con aquellos a los que se les detecta un VHS tipo 2&#44; lo que puede ayudar al diagn&#243;stico&#46; Esta transmisi&#243;n orogenital tambi&#233;n explica la aparici&#243;n del herpes genital dentro de relaciones sexualmente estables donde no ha habido otra pareja dado que el desprendimiento subcl&#237;nico de VHS tipo 1 de la cavidad oral estaba bien documentado&#46; Cabe destacar que el riesgo de transmisi&#243;n a una pareja es mayor durante los per&#237;odos de brote&#44; cuando hay lesiones visibles&#44; aunque tambi&#233;n puede transmitirse durante los per&#237;odos asintom&#225;ticos<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Como conclusi&#243;n&#44; cabe destacar el aumento de la prevalencia del VHS tipo 1 como agente causante de herpes genital&#44; especialmente en mujeres j&#243;venes&#46; Esto tiene un valor pron&#243;stico importante dado el menor riesgo de recurrencias&#44; por lo que se deber&#237;a implementar el uso de PCR de forma rutinaria ante la sospecha cl&#237;nica de herpes genital&#46; Este cambio en la epidemiolog&#237;a es secundario principalmente al aumento de las pr&#225;cticas sexuales orales sin protecci&#243;n&#44; por lo que se debe incidir en el potencial riesgo de transmisi&#243;n del VHS tipo 1 de localizaci&#243;n labial a genital&#44; incluso sin lesiones cl&#237;nicas&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0085" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n y objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se ha constatado un cambio en la epidemiolog&#237;a del herpes genital en los &#250;ltimos a&#241;os con un aumento de la incidencia del virus herpes &#40;VHS&#41; tipo 1&#46; El objetivo de nuestro estudio es analizar las caracter&#237;sticas cl&#237;nico-epidemiol&#243;gicas de los pacientes diagnosticados de un herpes genital&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se dise&#241;&#243; un estudio observacional retrospectivo donde se incluyeron todos los pacientes diagnosticados de herpes genital entre enero de 2016 y enero de 2019 en una Unidad de Infecciones de Transmisi&#243;n Sexual &#40;ITS&#41; en Valencia&#44; Espa&#241;a&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se diagnosticaron 895 ITS&#44; de las cuales 126 fueron un herpes genital &#40;14&#37;&#41;&#44; 68 &#40;54&#37;&#41; en mujeres y 58 &#40;46&#37;&#41; en hombres&#46; En 110 de ellos &#40;87&#44;3&#37;&#41; se confirm&#243; el herpes genital por la detecci&#243;n de ADN viral por t&#233;cnicas moleculares&#46; Se diagnosticaron 52 casos de VHS tipo 1 &#40;47&#44;3&#37;&#41; y 58 casos de VHS tipo 2 &#40;52&#44;7&#37;&#41;&#46; En el 69&#44;5&#37; de los hombres se detect&#243; el VHS tipo 2&#44; mientras que en el 59&#44;3&#37; de las mujeres se detect&#243; el VHS tipo 1&#46; La edad media de las mujeres diagnosticadas de VHS tipo 1 fue de 26 a&#241;os&#44; mientras que la de las mujeres diagnosticadas de VHS tipo 2 fue de 34 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46; Las recurrencias de las lesiones en los pacientes con VHS tipo 1 y VHS tipo 2 fue del 13&#37; y del 40&#37;&#44; respectivamente&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusi&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Destacamos un aumento de la prevalencia del VHS tipo 1 en nuestro medio como agente causante de herpes genital&#44; especialmente en mujeres j&#243;venes&#46; Esto tiene un valor pron&#243;stico importante dado el menor riesgo de recurrencias que tiene&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Material y m&#233;todos"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction and objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The epidemiology of genital herpes has changed in recent years with an increase in the incidence of herpes simplex virus type 1 &#40;HSV-1&#41; infection&#46; The aim of this study was to analyze the clinical and epidemiological characteristics of patients diagnosed with genital herpes&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A retrospective observational study was designed&#46; All patients diagnosed with genital herpes between January 2016 and January 2019 in a Sexually Transmitted Infections Unit &#40;ITS&#41; in Valencia&#44; Spain&#44; were included&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We identified 895 STI diagnoses&#46; Of these&#44; 126 &#40;14&#37;&#41; were genital herpes&#59; 68 &#40;54&#37;&#41; of these cases were in women and 58 &#40;46&#37;&#41; in men&#46; Diagnosis was confirmed by molecular detection of HSV DNA in 110 cases &#40;87&#46;3&#37;&#41;&#46; Of these&#44; 52 were cases of HSV-1 infection &#40;47&#46;3&#37;&#41; and 58 were HSV-2 infection &#40;52&#46;7&#37;&#41;&#46; HSV-2 was more common in men &#40;69&#46;5&#37;&#41;&#44; while HSV-1 was more common in women &#40;59&#46;3&#37;&#41;&#46; In the subgroup of women&#44; mean age at diagnosis was 26 years for HSV-1 and 34 years for HSV-2 &#40;<span class="elsevierStyleItalic">P<span class="elsevierStyleHsp" style=""></span></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;015&#41;&#46; Recurrent genital herpes rates were 13&#37; for HSV-1 and 40&#37; for HSV-2&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">There has been an increase in the number of cases of genital herpes caused by HSV-1 in our setting&#44; with young women in particular being affected&#46; This has important prognostic implications because genital herpes caused by HSV-1 is less likely to recur&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;30&#44;1&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#40;69&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ITS previas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;31&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;69&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Presencia de VIH</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;8&#44;7&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115 &#40;91&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diagn&#243;stico de herpes genital</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cl&#237;nica compatible<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Tzanck positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;7&#44;2&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cl&#237;nica compatible<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IgM herpes positiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#44;5&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PCR VHS tipo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;41&#44;3&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PCR VHS tipo 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Recurrencia de las lesiones</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;31&#44;7&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;68&#44;3&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo oral sin protecci&#243;n reconocido &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">69&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;24&#44;6&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Lesiones de herpes labial en la pareja</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;11&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <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-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Datos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;mero de casos &#40;&#37;&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">VHS tipo 1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">VHS tipo 2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hombre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;26&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;55&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;73&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;44&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad media&#44; a&#241;os</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Orientaci&#243;n sexual</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Homosexual&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otra&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;15&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Motivo de consulta</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#218;lceras&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ves&#237;culas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Localizaci&#243;n de las lesiones</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;007&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Genital&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anal&#47;perianal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ITS previas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">49 &#40;90&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Presencia de VIH</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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