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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El desarrollo de estas gu&#237;as se justifica por el aumento creciente de las infecciones de transmisi&#243;n sexual &#40;ITS&#41;&#44; particularmente entre adolescentes&#44; hombres que tienen sexo con hombres &#40;HSH&#41; y trabajadores del sexo comercial&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Es importante realizar un diagn&#243;stico diferencial adecuado en cada caso&#44; aplicar las t&#233;cnicas microbiol&#243;gicas oportunas en funci&#243;n de la exposici&#243;n sexual&#44; as&#237; como el tratamiento eficaz para cada una de ellas<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">1</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">S&#237;filis &#47; L&#250;es</span><p id="par0015" class="elsevierStylePara elsevierViewall">Dada su relevancia tanto cl&#237;nica como epidemiol&#243;gica&#44; la etiopatogenia y las manifestaciones cl&#237;nicas de la s&#237;filis se abordar&#225;n en el cap&#237;tulo &#171;Gu&#237;as de manejo de s&#237;filis&#187; &#40;que estar&#225; disponible en pr&#243;ximas publicaciones de esta revista&#41;&#44; incluyendo en este apartado solo su diagn&#243;stico y tratamiento&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Diagn&#243;stico</span><p id="par0020" class="elsevierStylePara elsevierViewall">El m&#233;todo definitivo para el diagn&#243;stico tanto de la s&#237;filis primaria como la cong&#233;nita es la identificaci&#243;n del <span class="elsevierStyleItalic">Treponema pallidum</span> en campo oscuro o por la aplicaci&#243;n de test moleculares &#40;PCR&#41; en una lesi&#243;n exudativa o tejido&#59; sin embargo&#44; estas t&#233;cnicas no tienen una distribuci&#243;n universal y solo se cuenta con ellas en centros espec&#237;ficos&#44; por lo cual el diagn&#243;stico de la s&#237;filis en cualquiera de sus estadios se sigue basando en la realizaci&#243;n de las pruebas serol&#243;gicas trepon&#233;micas y no trepon&#233;micas<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Las pruebas trepon&#233;micas &#40;<span class="elsevierStyleItalic">T&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">pallidum passive particle agglutination</span> &#91;TP-PA&#93; <span class="elsevierStyleItalic">assay</span> o FTA-ABS&#44; etc&#46;&#41; son las m&#225;s espec&#237;ficas y son las primeras en positivizarse&#59; sin embargo&#44; una vez positivas no vuelven a negativizarse &#40;en la mayor&#237;a de los casos&#41;&#44; por lo cual sus fluctuaciones no sirven ni para seguimiento ni para nuevos diagn&#243;sticos<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">3</span></a>&#46; En cuanto a las pruebas no trepon&#233;micas &#40;<span class="elsevierStyleItalic">Venereal Disease Research Laboratory</span> &#91;VDRL&#93; o <span class="elsevierStyleItalic">Rapid Plasma Reagin</span> &#91;RPR&#93; test&#41;&#44; son las m&#225;s sensibles&#44; por lo que pueden tener falsos positivos con m&#225;s frecuencia y pueden tardar unos d&#237;as m&#225;s en positivizarse que las trepon&#233;micas&#59; sin embargo&#44; con el tratamiento adecuado pueden negativizarse&#44; por lo que sus fluctuaciones y nuevas positividades sirven tanto para el seguimiento como el diagn&#243;stico de nuevas infecciones<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Para el diagn&#243;stico correcto se requiere la realizaci&#243;n de ambas pruebas&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Para considerar bien tratada una infecci&#243;n se requiere una disminuci&#243;n en m&#237;nimo 2 diluciones &#40;por ejemplo&#44; 1&#58;16 a 1&#58;4&#44; 1&#58;32 a 1&#58;8&#41; a los 6 meses del tratamiento&#46; Se recomienda que se utilice la misma prueba tanto en el diagn&#243;stico como en el seguimiento y a poder ser en el mismo laboratorio<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">3</span></a> &#40;2&#44;<span class="elsevierStyleHsp" style=""></span>C&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Si ambas pruebas son positivas&#44; se procede a realizar el tratamiento seg&#250;n en el estadio cl&#237;nico que se encuentre el paciente&#59; si la prueba trepon&#233;mica es positiva y la no trepon&#233;mica es negativa&#44; se aconseja realizar otra prueba trepon&#233;mica por un m&#233;todo diferente&#59; si continua siendo positiva y hay antecedente previo de s&#237;filis&#44; no se recomienda ampliar estudio&#59; si no hay antecedente previo y&#47;o la sospecha cl&#237;nica o epidemiol&#243;gica es alta&#44; se recomienda volver a testar a las 2-4 semanas&#44; remarcando la importancia de la abstinencia sexual hasta la resoluci&#243;n del caso<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">2</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Tratamiento</span><p id="par0045" class="elsevierStylePara elsevierViewall">El tratamiento de la s&#237;filis se realiza seg&#250;n el estadificaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; En todos los casos el antibi&#243;tico de elecci&#243;n es la penicilina parenteral&#44; cuya eficacia es avalada por la amplia experiencia cl&#237;nica y por estudios cl&#237;nicos&#46; Existen algunas situaciones en las cuales se admite la administraci&#243;n de otro antibi&#243;tico&#44; siendo m&#225;s estrictos en el seguimiento posterior&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Seguimiento &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41; a los 3&#44; 6&#44; 12 meses</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Manejo de contactos<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">4</span></a></span><p id="par0050" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Contacto de paciente con s&#237;filis temprana &#60;<span class="elsevierStyleHsp" style=""></span>90 d&#237;as del contacto&#58; tratar como s&#237;filis temprana&#44; aunque las pruebas serol&#243;gicas sean negativas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Contacto de paciente con s&#237;filis temprana &#62;<span class="elsevierStyleHsp" style=""></span>90 d&#237;as del contacto&#58; si pruebas negativas&#44; no tratar&#59; si pruebas positivas&#44; tratar seg&#250;n su estadificaci&#243;n&#59; si es un paciente con riesgo de p&#233;rdida de seguimiento&#44; tratar como s&#237;filis temprana&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Contacto de paciente con s&#237;filis tard&#237;a&#58; si pruebas positivas&#44; tratar seg&#250;n su estadificaci&#243;n particular&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></li></ul></p></span></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Herpes genital</span><p id="par0070" class="elsevierStylePara elsevierViewall">La infecci&#243;n por herpes se caracteriza porque&#44; tras la primoinfecci&#243;n&#44; el virus permanece latente y puede reactivarse a lo largo de toda la vida<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">2</span></a>&#46; Tanto el virus del herpes simple tipo<span class="elsevierStyleHsp" style=""></span>1 &#40;VHS1&#41; como el tipo<span class="elsevierStyleHsp" style=""></span>2 &#40;VHS2&#41; pueden afectar la zona genital&#44; siendo el VHS2 el m&#225;s frecuente&#46; Muchos pacientes permanecen sin el diagn&#243;stico debido a la baja sospecha en el caso de herpes pauci o asintom&#225;tico&#44; y son estos pacientes lo que est&#225;n en alto riesgo de ser trasmisores de la infecci&#243;n&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El riesgo de transmisi&#243;n parece ser m&#225;s alto en los pr&#243;dromos y las recurrencias&#44; por lo que debe aconsejarse a los pacientes de abstenerse de tener contacto sexual durante estos periodos&#46; La eficacia del preservativo en la prevenci&#243;n de la transmisi&#243;n no est&#225; comprobada&#59; sin embargo&#44; datos indirectos apoyan su uso tanto en mujeres como en hombres<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">5</span></a> &#40;IIb&#44;<span class="elsevierStyleHsp" style=""></span>B&#41;&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Cl&#237;nica</span><p id="par0080" class="elsevierStylePara elsevierViewall">Cl&#237;nicamente se caracteriza por ves&#237;culas y &#250;lceras dolorosas&#44; recurrentes y auto-resolutivas&#46; Se aconseja hacer el diagn&#243;stico de confirmaci&#243;n con PCR siempre que sea posible&#44; teniendo en cuenta que la mayor&#237;a de los pacientes se presentan en la consulta cuando ya han resuelto el brote<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">6</span></a> &#40;III<span class="elsevierStyleHsp" style=""></span>b&#41;&#46; Las recurrencias y las formas subcl&#237;nicas en zona genital est&#225;n descritas con mayor frecuencia con el VHS2 que con el VHS1<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">7</span></a>&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Diagn&#243;stico</span><p id="par0085" class="elsevierStylePara elsevierViewall">La prueba diagn&#243;stica recomendada es la PCR por su alta sensibilidad<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">5</span></a> &#40;Ib&#44;<span class="elsevierStyleHsp" style=""></span>A&#41;&#59; dada la baja sensibilidad del cultivo&#44; solo se aconseja utilizarlo como t&#233;cnica diagn&#243;stica cuando no se tenga disponibilidad de la PCR o para estudio de resistencias antivirales en casos refractarios&#46; La muestra debe tomarse de la lesi&#243;n activa<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">8</span></a> &#40;Ib&#44;<span class="elsevierStyleHsp" style=""></span>A&#41;&#59; no se recomienda hacer tomas en zonas aleatorias dada su baja sensibilidad&#44; y porque un resultado negativo no descarta la posibilidad de infecci&#243;n latente &#40;Ib&#44;<span class="elsevierStyleHsp" style=""></span>A&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En cuanto a las serolog&#237;as de VHS&#44; solo se recomienda su utilizaci&#243;n en los siguientes escenarios<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">5</span></a>&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#46;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Pacientes con lesiones recurrentes o cl&#237;nica at&#237;pica y que la PCR o el cultivo den repetitivamente negativos o no hayan podido realizarse &#40;III&#44;<span class="elsevierStyleHsp" style=""></span>B&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#46;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Para diferenciar entre un primer episodio o una recidiva con fines del asesoramiento y manejo &#40;III&#44;<span class="elsevierStyleHsp" style=""></span>B&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#46;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Pareja de pacientes con diagn&#243;stico de VHS y que desconozcan si previamente han tenido las lesiones con fines de asesoramiento &#40;Ib&#44;<span class="elsevierStyleHsp" style=""></span>A&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4&#46;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Personas gestantes asintom&#225;ticas con pareja con historia de herpes &#40;IIb&#44;<span class="elsevierStyleHsp" style=""></span>B&#41;&#46;</p></li></ul></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Tratamiento</span><p id="par0115" class="elsevierStylePara elsevierViewall">El objetivo del tratamiento en la primoinfecci&#243;n es mejorar los s&#237;ntomas y prevenir o disminuir la frecuencia de los brotes&#59; y en las recurrencias&#44; adem&#225;s&#44; disminuir la posibilidad de transmisi&#243;n&#46; Hay que tener en cuenta que el tratamiento no tiene la capacidad de erradicar el virus&#46; y no se ha demostrado que afecte la frecuencia ni la gravedad de los brotes sucesivos<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">2</span></a>&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Tratamiento en la primoinfecci&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">Se recomienda tratar a todos los pacientes que se diagnostiquen con una primoinfecci&#243;n herp&#233;tica en los primeros 5<span class="elsevierStyleHsp" style=""></span>d&#237;as de la infecci&#243;n o mientras tenga lesiones activas<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">5</span></a>&#44; por lo sintom&#225;ticas que suelen ser y&#44; adem&#225;s&#44; porque pueden presentar cursos larvados &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">No se recomienda el uso de tratamientos t&#243;picos&#44; ya que son menos efectivos que los orales y pueden generar resistencias<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">9&#44;10</span></a> &#40;IV&#44;<span class="elsevierStyleHsp" style=""></span>C&#41;&#46; La v&#237;a intravenosa se reserva solo para aquellos pacientes que no puedan realizar las tomas orales por trastornos funcionales o por v&#243;mito&#44; y en pacientes inmunosuprimidos&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Tratamiento en las recurrencias</span><p id="par0130" class="elsevierStylePara elsevierViewall">Suelen ser menos frecuentes las recidivas del VHS1 que el VHS2&#44; de ah&#237; la importancia del genotipado a la hora del consejo postinfecci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">El momento ideal para iniciar el tratamiento es en el pr&#243;dromo de la infecci&#243;n o en el primer d&#237;a de la aparici&#243;n de la lesi&#243;n&#46; El tratamiento de las recurrencias reduce la duraci&#243;n del brote en 1-2 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">5</span></a> &#40;Ib&#44;<span class="elsevierStyleHsp" style=""></span>A&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Tratamiento supresor</span><p id="par0140" class="elsevierStylePara elsevierViewall">Se debe consensuar con el paciente y realizarse en los casos en los que se confirme infecci&#243;n por VHS2 o VHS1 y se produzcan brotes frecuentes que impacten en la calidad de vida de este&#46; El tratamiento puede disminuir la posibilidad de recidiva en un 70-80&#37;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">5</span></a>&#46; Adem&#225;s&#44; disminuye la excreci&#243;n asintom&#225;tica del virus<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">2</span></a>&#46; Se han demostrado su seguridad y su eficacia a largo plazo<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">2</span></a>&#46; Se recomienda el uso de terapia supresora en parejas serodiscordantes sintom&#225;ticas o con m&#250;ltiples parejas<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">5</span></a>&#46; No hay datos de efectividad en pacientes con VHS2 asintom&#225;ticos &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Consideraciones especiales</span><p id="par0145" class="elsevierStylePara elsevierViewall">Manejo VHS en pacientes inmunodeprimidos y personas que viven con el VIH &#40;<span class="elsevierStyleItalic">people living with HIV</span> &#91;PWH&#93;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;&#46; Otras situaciones especiales se consideran en la <a class="elsevierStyleCrossRef" href="#tbl0035">tabla 7</a>&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">El factor de riesgo m&#225;s importante para la reactivaci&#243;n del VHS es el grado de inmunosupresi&#243;n&#46; Los esquemas de tratamiento con antivirales sist&#233;micos han demostrado ser igual de eficaces en pacientes inmunosuprimidos&#59; sin embargo&#44; son mucho m&#225;s frecuentes las resistencias a los antivirales en los pacientes PWH&#44; lo que puede llevar a fracasos terap&#233;uticos m&#225;s frecuentes<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">5</span></a>&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Linfogranuloma ven&#233;reo</span><p id="par0155" class="elsevierStylePara elsevierViewall">El linfogranuloma ven&#233;reo &#40;LGV&#41; es una infecci&#243;n de transmisi&#243;n sexual causada por la bacteria C<span class="elsevierStyleItalic">hlamydia trachomatis</span> serotipos L1-L3&#44; siendo el L2 y L2b el m&#225;s com&#250;n en Europa<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Desde 2003 es end&#233;mico en Europa entre hombres que tienen sexo con hombres &#40;HSH&#41;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">13</span></a>&#44; sobre todo en PWH<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">14</span></a> &#40;1&#44;<span class="elsevierStyleHsp" style=""></span>A&#41;&#44; y desde 2015 se trata de una EDO en Espa&#241;a&#46;</p><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Cl&#237;nica</span><p id="par0160" class="elsevierStylePara elsevierViewall">El 25&#37; de las infecciones por LGV en HSH son asintom&#225;ticas<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">15</span></a>&#46; En sintom&#225;ticos&#44; el per&#237;odo de incubaci&#243;n puede variar entre 1-4 semanas&#44; describi&#233;ndose cl&#225;sicamente tres etapas&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Primera etapa&#46;</span> Peque&#241;a p&#225;pula o p&#250;stula indolora que puede ulcerarse&#44; auto-resoluci&#243;n en una semana&#46; Puede haber secreci&#243;n mucopurulenta&#44; sobre todo si hay afectaci&#243;n rectal&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Segunda etapa</span> &#40;&#171;etapa inguinal&#187;&#41;&#46; Linfadenopat&#237;a inguino-femoral dolorosa que aparece 2-6 semanas despu&#233;s de la lesi&#243;n primaria&#44; predominio unilateral &#40;2&#47;3 casos&#41;&#46; Puede complicarse con inflamaci&#243;n&#44; supuraci&#243;n y abscesos&#59; algunos de estos pueden drenar espont&#225;neamente&#46; El signo del surco &#40;patognom&#243;nico&#41; se debe a la inflamaci&#243;n de ganglios inguinales y femorales separados por el ligamento inguinal&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Tercera etapa</span> &#40;&#171;etapa ano-genito-rectal&#187;&#41;&#46; Inicialmente presentan proctocolitis&#44; caracterizada por s&#237;ntomas severos de dolor anorrectal&#44; secreci&#243;n hemopurulenta y rectorragia&#44; junto con tenesmo y estre&#241;imiento&#44; seguidas de abscesos perirrectales&#44; f&#237;stulas o estenosis rectal&#46; Puede simular enfermedades inflamatorias intestinales cr&#243;nicas&#44; como la enfermedad de Crohn&#44; tanto a nivel cl&#237;nico como histopatol&#243;gico&#44; por lo que debe ser considerado en el diagn&#243;stico diferencial&#46; Sin tratamiento&#44; puede complicarse con megacolon&#44; y la linfangitis cr&#243;nica progresiva con elefantiasis&#44; esti&#243;meno &#40;enfermedad ulcerativa cr&#243;nica de la vulva&#41; o s&#237;ndrome de la pelvis congelada&#46; Actualmente&#44; la forma de presentaci&#243;n m&#225;s frecuente del LGV es en forma de proctitis sintom&#225;tica en HSH&#44; siendo infrecuente que se manifieste con &#250;lceras genitales o adenopat&#237;as inflamatorias inguinales</p></li></ul></p><p id="par0180" class="elsevierStylePara elsevierViewall">Menos frecuentemente puede acompa&#241;arse de cl&#237;nica sist&#233;mica&#44; como febr&#237;cula&#44; escalofr&#237;os&#44; malestar&#44; artromialgias&#44; artritis reactiva&#44; neumonitis y perihepatitis&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Diagn&#243;stico</span><p id="par0185" class="elsevierStylePara elsevierViewall">El diagn&#243;stico inicial est&#225; basado en la sospecha cl&#237;nica&#44; pero debe confirmarse mediante la detecci&#243;n de ADN espec&#237;fico de la variedad LGV &#40;L1&#44; L2 y L3&#41;&#44; a trav&#233;s de un procedimiento de dos pasos &#40;1&#44;<span class="elsevierStyleHsp" style=""></span>B&#41;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">16-18</span></a>&#46;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Se utilizan pruebas de amplificaci&#243;n de &#225;cidos nucleicos &#40;NAAT&#41; en muestras cl&#237;nicas sospechosas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Si se detecta ADN&#47;ARN de <span class="elsevierStyleItalic">C&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">trachomatis</span>&#44; se debe detectar ADN espec&#237;fico de genovar de LGV&#46;</p></li></ul></p><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Tratamiento</span><p id="par0200" class="elsevierStylePara elsevierViewall">Se recomienda iniciar precozmente el tratamiento&#44; disminuyendo as&#237; las posibles complicaciones&#44; como el megacolon y la linfangitis cr&#243;nica progresiva &#40;2&#44;<span class="elsevierStyleHsp" style=""></span>C&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0040">tabla 8</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia></span></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Chancroide o chancro blando</span><p id="par0205" class="elsevierStylePara elsevierViewall">El chancroide&#44; o chancro blando&#44; es una infecci&#243;n de transmisi&#243;n sexual causada por la bacteria gramnegativa <span class="elsevierStyleItalic">Haemophylus ducreyi</span><a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">23</span></a>&#46; Es m&#225;s frecuente en pa&#237;ses tropicales&#44; aunque su incidencia ha ido disminuyendo incluso en la mayor&#237;a de los pa&#237;ses donde previamente era end&#233;mica&#44; exceptuando el norte de India y Malawi<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">24&#44;25</span></a>&#46;</p><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Cl&#237;nica</span><p id="par0210" class="elsevierStylePara elsevierViewall">Tras un per&#237;odo de incubaci&#243;n de 3-7 d&#237;as&#44; aparecen peque&#241;as p&#225;pulas eritematosas dolorosas que r&#225;pidamente progresan a p&#250;stulas y &#250;lceras&#46; Estas &#250;ltimas se caracterizan por ser superficiales con bordes irregulares y socavados&#44; con base granulomatosa y exudado purulento&#44; que pueden permanecer durante meses si no se tratan&#46; Hasta en un 50&#37; se acompa&#241;an de adenopat&#237;as inguinales unilaterales dolorosas que pueden confluir hasta formar bubones&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Diagn&#243;stico</span><p id="par0215" class="elsevierStylePara elsevierViewall">El diagn&#243;stico suele ser cl&#237;nico &#40;<a class="elsevierStyleCrossRef" href="#tbl0045">tabla 9</a>&#41;&#44; ya que el aislamiento de la bacteria en cultivo es dif&#237;cil &#40;sensibilidad &#60;<span class="elsevierStyleHsp" style=""></span>80&#37;&#41; &#40;III&#44;<span class="elsevierStyleHsp" style=""></span>B&#41;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">26</span></a>&#46; Las t&#233;cnicas de amplificaci&#243;n de &#225;cido nucleico&#44; como la PCR&#44; son las m&#225;s empleadas&#44; pudiendo realizarse el diagn&#243;stico diferencial entre los diferentes agentes microbiol&#243;gicos&#44; como <span class="elsevierStyleItalic">T&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">pallidum</span> y VHS<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">27&#44;28</span></a> &#40;III&#44;<span class="elsevierStyleHsp" style=""></span>B&#41;&#46; El tratamiento se recoge en la <a class="elsevierStyleCrossRef" href="#tbl0050">tabla 10</a>&#46;</p><elsevierMultimedia ident="tbl0045"></elsevierMultimedia><elsevierMultimedia ident="tbl0050"></elsevierMultimedia></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Seguimiento</span><p id="par0220" class="elsevierStylePara elsevierViewall">Los pacientes deben ser reevaluados a los 3-7 d&#237;as del tratamiento&#46; El tiempo de curaci&#243;n depender&#225; del tama&#241;o de la &#250;lcera y de las adenopat&#237;as&#44; y la evoluci&#243;n es m&#225;s lenta en PWH y no circuncidados<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Se aconseja realizar un estudio de contactos&#44; incluyendo las parejas sexuales de los 10 d&#237;as anteriores al inicio de los s&#237;ntomas&#46;</p></span></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">MPOX</span><p id="par0230" class="elsevierStylePara elsevierViewall">La viruela del mono&#44; o <span class="elsevierStyleItalic">monkeypox</span> &#40;MPOX&#41;&#44; es una enfermedad zoon&#243;tica emergente causada por un ortopoxvirus &#40;virus ADN de doble cadena&#59; g&#233;nero <span class="elsevierStyleItalic">Orthopoxvirus</span>&#44; familia <span class="elsevierStyleItalic">Poxviridae</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Se considera end&#233;mica en &#193;frica central y occidental&#44; donde se identificaron dos variantes&#58; la de &#193;frica central&#47;valle del Congo &#40;mortalidad alrededor del 10&#37;&#41; y la de &#193;frica occidental &#40;mortalidad del 3-4&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">31-33</span></a>&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">En mayo de 2022 se identificaron varios casos de MPOX sin antecedentes de viajes recientes a &#225;reas end&#233;micas o de contacto con casos confirmados&#44; lo que llev&#243; a la OMS&#44; el 23 de julio del mismo a&#241;o&#44; a declarar este &#250;ltimo brote como una emergencia de salud p&#250;blica internacional<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">34</span></a>&#46; Al momento de la redacci&#243;n de este art&#237;culo se hab&#237;an reportado un total de 91&#46;123 casos a nivel mundial&#44; con 157 defunciones<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">35</span></a>&#46; En Europa se han registrado 26&#46;229 casos<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">36</span></a>&#44; siendo Espa&#241;a el pa&#237;s con m&#225;s casos notificados&#44; con un total de 7&#46;611 casos<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">35&#44;36</span></a>&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">En &#225;reas end&#233;micas existen cuatro formas de transmisi&#243;n de MPOX&#58; mordedura o ara&#241;azos con animales infectados &#40;ardillas&#44; roedores&#44; monos&#41;&#44; contacto con sus fluidos&#44; consumo de carne no suficientemente cocinada o humanos infectados&#46; En este &#250;ltimo caso la infecci&#243;n puede adquirirse por v&#237;a a&#233;rea &#40;microgotas&#41;&#44; contacto directo &#40;heridas&#44; costras&#44; fluidos corporales&#41; y contacto indirecto &#40;f&#243;mites&#41;&#44; aunque tambi&#233;n se han descripto la v&#237;a vertical y la nosocomial<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">En el brote actual se considera que el mecanismo de transmisi&#243;n principal es el contacto sexual<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">38</span></a>&#44; siendo las personas m&#225;s afectadas HSH&#44; j&#243;venes &#40;media edad de 34 a&#241;os&#41; y PWH &#40;52&#44;5&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">35&#44;36&#44;38-42</span></a>&#46;</p><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Cl&#237;nica</span><p id="par0255" class="elsevierStylePara elsevierViewall">El per&#237;odo de incubaci&#243;n oscila entre 5-21 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">43</span></a>&#46; El s&#237;ntoma m&#225;s frecuente es la fiebre<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">35&#44;36&#44;38-42</span></a>&#46; Las manifestaciones cl&#237;nicas se relacionan con el mecanismo de transmisi&#243;n<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">44</span></a>&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">-</span><p id="par0260" class="elsevierStylePara elsevierViewall">V&#237;a respiratoria&#47;cl&#225;sica &#40;forma end&#233;mica principalmente&#41;&#58; inicialmente fiebre&#44; cefalea&#44; adenopat&#237;as&#44; mialgias&#59; posteriormente m&#250;ltiples p&#225;pulas y pseudop&#250;stulas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">-</span><p id="par0265" class="elsevierStylePara elsevierViewall">Inoculaci&#243;n subcut&#225;nea&#58; pseudop&#250;stulas bien circunscritas&#44; profundas&#44; a menudo umbilicadas&#44; dolorosas&#44; que tardan semanas en resolverse y que pueden acompa&#241;arse de edema local y linfadenopat&#237;a regional&#46; Tambi&#233;n pueden presentar lesiones periorales&#47;linguales o panadizos&#46;</p></li></ul></p><p id="par0270" class="elsevierStylePara elsevierViewall">Se han registrado complicaciones en el 8&#44;3&#37; de los casos<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">38-42</span></a>&#44; siendo las m&#225;s frecuentes sobreinfecci&#243;n bacteriana&#44; &#250;lceras orales y proctitis&#47;proctocolitis&#47;proctalgia<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">45-51</span></a>&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Diagn&#243;stico</span><p id="par0275" class="elsevierStylePara elsevierViewall">El diagn&#243;stico es cl&#237;nico-epidemiol&#243;gico y se confirma por PCR y&#47;o secuenciaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">52</span></a>&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">En el an&#225;lisis histopatol&#243;gico pueden encontrarse cuerpos de inclusi&#243;n citoplasm&#225;ticos acid&#243;filos &#40;&#171;cuerpos de Guarnieri&#187;&#41;&#44; que corresponden a agregados de part&#237;culas virales&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Dentro del diagn&#243;stico diferencial se deben considerar&#58; varicela&#44; infecci&#243;n por herpes zoster&#44; sarampi&#243;n&#44; zika&#44; dengue&#44; chikingunya&#44; herpes simple&#44; imp&#233;tigo&#44; MARSA&#44; gonorrea diseminada o localizada&#44; s&#237;filis primaria o secundaria&#44; chancroide&#44; linfogranuloma ven&#233;reo&#44; molusco contagioso&#46;</p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Tratamiento</span><p id="par0290" class="elsevierStylePara elsevierViewall">Al d&#237;a de la fecha no existen tratamientos espec&#237;ficos aprobados por la FDA&#47;EMA por los pacientes con MPOX&#44; por lo que el tratamiento sintom&#225;tico es el pilar de la terapia &#40;<a class="elsevierStyleCrossRef" href="#tbl0055">tabla 11</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0055"></elsevierMultimedia></span></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Donovanosis o granuloma inguinal&#47;ven&#233;reo</span><p id="par0295" class="elsevierStylePara elsevierViewall">Infecci&#243;n genital infrecuente causada por la bacteria intracelular aerobia gramnegativa <span class="elsevierStyleItalic">Klebsiella granulomatis</span>&#46; Actualmente los focos principales se encuentran en Pap&#250;a Nueva Guinea&#44; Sud&#225;frica&#44; parte de India y Brasil<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">60&#44;61</span></a>&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Con un periodo de incubaci&#243;n de 50 d&#237;as&#44; se caracteriza por una o varias lesiones papulares firmes que inicialmente aumentan en tama&#241;o y n&#250;mero&#44; y posteriormente progresan a &#250;lceras indoloras de predominio en la regi&#243;n genital&#47;perianal &#40;90&#37;&#41;&#46; Generalmente cursa sin linfadenopat&#237;a&#44; y ocasionalmente se asocia a granulomas subcut&#225;neos &#40;pseudobubones&#41;<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">62</span></a>&#46; Las lesiones son altamente vascularizadas y con tendencia al sangrado&#47;friables &#40;por esta causa el riesgo de coinfecci&#243;n con VIH es alto&#41;<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">63</span></a>&#46;</p><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Cl&#237;nica</span><p id="par0305" class="elsevierStylePara elsevierViewall">Las formas cl&#237;nicas m&#225;s frecuentes son la &#250;lcero-granulomatosa&#44; seguida de la hipertr&#243;fica&#47;verrucosa&#44; necr&#243;tica y escler&#243;tica&#46; La infecci&#243;n extragenital &#40;6&#37;&#41; puede ocurrir a nivel p&#233;lvico&#44; en &#243;rganos intraabdominales&#44; en huesos o en la cavidad oral<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">62</span></a>&#46;</p></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Diagn&#243;stico</span><p id="par0310" class="elsevierStylePara elsevierViewall">El diagn&#243;stico se puede realizar a trav&#233;s de la visualizaci&#243;n de la bacteria en campo oscuro o microscopia directa con tinci&#243;n Giemsa&#47;Leishman&#47;Wright &#40;c&#233;lulas grandes mononucleares con quistes intracitoplasm&#225;ticos llenos de cuerpos de Donovan&#41;&#44; en biopsia de lesiones o por PCR con detecci&#243;n del ADN&#46; Se trata de una bacteria dif&#237;cil de cultivar<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">62</span></a>&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">El estudio de contactos deber&#237;a realizarse desde los 60 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">60</span></a> a 6 meses<a class="elsevierStyleCrossRefs" href="#bib0620"><span class="elsevierStyleSup">61&#44;62</span></a> previos al inicio de los s&#237;ntomas&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">El principal diagn&#243;stico diferencial es el carcinoma escamoso de pene&#44; que puede imitar o complicar la infecci&#243;n&#46; Por esta raz&#243;n&#44; se recomienda biopsiar las lesiones persistentes<span class="elsevierStyleSup">64</span>&#46;</p></span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Tratamiento</span><p id="par0325" class="elsevierStylePara elsevierViewall">Su objetivo es frenar la progresi&#243;n de las lesiones&#59; la curaci&#243;n t&#237;picamente se inicia en los m&#225;rgenes de la &#250;lcera&#44; requiriendo terapia prolongada para permitir granulaci&#243;n y re-epitelizaci&#243;n&#46; La duraci&#243;n en todos los casos ser&#225; de 3 semanas como m&#237;nimo&#44; debiendo mantenerse el tratamiento hasta la resoluci&#243;n de las lesiones<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">62</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0060">tabla 12</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0060"></elsevierMultimedia></span></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conclusiones</span><p id="par0330" class="elsevierStylePara elsevierViewall">En el presente cap&#237;tulo hemos expuesto las principales caracter&#237;sticas epidemiol&#243;gicas&#44; cl&#237;nicas y terap&#233;uticas de las ITS ulcerativas de un modo did&#225;ctico&#44; pr&#225;ctico y sencillo para el r&#225;pido acceso de los m&#233;dicos dedicados a la atenci&#243;n de las ITS&#46; El diagn&#243;stico adecuado de las mismas facilitar&#225; el tratamiento precoz de las mismas&#44; redundando en una disminuci&#243;n de los contagios&#46;</p></span><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Financiaci&#243;n</span><p id="par0335" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En la actualidad&#44; las infecciones de transmisi&#243;n sexual ulcerativas&#44; que incluyen la s&#237;filis&#44; el virus del herpes simple &#40;VHS&#41;&#44; el linfogranuloma ven&#233;reo &#40;LGV&#41;&#44; el chancroide&#44; la donovanosis y&#44; m&#225;s recientemente&#44; el <span class="elsevierStyleItalic">monkeypox</span> &#40;MPOX&#41;&#44; representan un desaf&#237;o creciente para los profesionales sanitarios&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La incidencia de s&#237;filis y LGV ha aumentado en los &#250;ltimos a&#241;os en Espa&#241;a&#46; Adem&#225;s VHS&#44; s&#237;filis y chancroide son infecciones que pueden incrementar el riesgo de la adquisici&#243;n y transmisi&#243;n de VIH&#46; Los grupos poblacionales con mayor vulnerabilidad ante estas infecciones son j&#243;venes&#44; hombres que tienen sexo con hombres &#40;HSH&#41; y trabajadores del sexo comercial&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Es importante realizar un diagn&#243;stico diferencial oportuno&#44; ya que las lesiones ulcerativas genitales&#44; anales&#44; perianales y orales pueden plantear diagn&#243;stico diferencial con otras condiciones infecciosas y no infecciosas&#44; como vulvovaginitis candidi&#225;sica&#44; lesiones traum&#225;ticas&#44; carcinoma&#44; aftas&#44; enfermedad de Beh&#231;et&#44; eritema fijo medicamentoso o psoriasis&#46; Por este motivo&#44; el dermat&#243;logo tiene un papel crucial en el diagn&#243;stico y el tratamiento de las infecciones de transmisi&#243;n sexual&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En el presente cap&#237;tulo se exponen las principales caracter&#237;sticas epidemiol&#243;gicas&#44; cl&#237;nicas y terap&#233;uticas de dichas infecciones&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Currently&#44; ulcerative sexually transmitted infections&#44; including syphilis&#44; herpes simplex virus &#40;HSV&#41;&#44; lymphogranuloma venereum &#40;LGV&#41;&#44; chancroid&#44; donovanosis and&#44; more recently&#44; monkeypox &#40;MPOX&#41;&#44; represent a growing challenge for health care professionals&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The incidence of syphilis and LGV has increased in recent years in Spain&#46; Additionally&#44; HSV&#44; syphilis and chancroid can also increase the risk of HIV acquisition and transmission&#46; The population groups most vulnerable to these infections are young people&#44; men who have sex with men &#40;MSM&#41; and commercial sex workers&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">It is important to make a timely differential diagnosis since genital&#44; anal&#44; perianal&#44; and oral ulcerative lesions may pose differential diagnosis with other infectious and non-infectious conditions such as candidiasis vulvovaginitis&#44; traumatic lesions&#44; carcinoma&#44; aphthous ulcers&#44; Beh&#231;et&#39;s disease&#44; fixed drug eruption&#44; or psoriasis&#46; For this reason&#44; the dermatologist plays a crucial role in the diagnosis and management of sexually transmitted infections&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">This chapter presents the main epidemiological&#44; clinical and therapeutic features associated with these infections&#46;</p></span>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">D d&#237;a o d&#237;as&#59; DU&#58; dosis &#250;nica&#59; IM intramuscular&#59; IV&#58; intravenosa&#59; VO&#58; v&#237;a oral&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Para la formulaci&#243;n de las recomendaciones hemos empleado la metodolog&#237;a GRADE&#46;</p>"
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                  \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>1&#46;<span class="elsevierStyleSup">a</span> l&#237;nea&#58; penicilina benzat&#237;nica 2&#46;400&#46;000 UI IM DU &#40;1&#44; B&#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>2&#46;<span class="elsevierStyleSup">a</span> l&#237;nea&#58; penicilina proca&#237;nica 600&#46;000 UI IM&#47; D 10-14 D cuando no hay disponibilidad de Penicilina Benzat&#237;nica&#41; &#40;1&#44; C&#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>Trastorno coagulaci&#243;n&#58; Ceftriaxona 1 g&#47;D IV 10 D &#40;1&#44; C&#41; o doxiciclina 200 mg D VO 14 D &#40;1&#44; C&#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>Embarazo&#58; penicilina benzat&#237;nica 2&#46;400&#46;000 UI IM DU&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>Alergia penicilina&#58; Doxiciclina 200 mg d&#237;a 14 D VO &#40;1&#44; C&#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">S&#237;filis tard&#237;a &#40;latente tard&#237;a&#44; s&#237;filis terciaria&#44; gomas sifil&#237;ticos&#41;</span>&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>1&#46;<span class="elsevierStyleSup">a</span> l&#237;nea&#58; penicilina benzat&#237;nica 2&#46;400&#46;000 UI IM &#47; semana&#44; 3 semanas &#40;1&#44; C&#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>2&#46;<span class="elsevierStyleSup">a</span> l&#237;nea&#58; penicilina proca&#237;nica 600&#46;000 UI IM&#47; D 17-21 D &#40;cuando no hay disponibilidad de penicilina benzat&#237;nica &#40;1&#44; C&#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>Alergia penicilina&#58; desensibilizaci&#243;n &#40;1&#44; C&#41; o doxiciclina 200 mg D VO 21-28 D &#40;2&#44; D&#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">Neuros&#237;filis&#44; s&#237;filis ocular o s&#237;filis auricular</span>&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>1&#46;<span class="elsevierStyleSup">a</span> l&#237;nea&#58; penicilina benc&#237;lica 18-24 millones UI D &#40;3-4 millones cada 4<span class="elsevierStyleHsp" style=""></span>h&#41; IV 10-14 D&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>2&#46;<span class="elsevierStyleSup">a</span> l&#237;nea&#58; ceftriaxona 1-2 g IV D 10-14 D&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>3&#46;<span class="elsevierStyleSup">a</span> l&#237;nea&#58; penicilina proca&#237;nica 1&#44;2-2&#44;4 millones UI IM D &#43;<span class="elsevierStyleHsp" style=""></span>probenecid 500 mg 4 veces D por 10-14 D&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>Alergia penicilina&#58; desensibilizaci&#243;n &#40;1&#44; C&#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">Embarazo</span>&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>1&#46;<span class="elsevierStyleSup">a</span> l&#237;nea&#58; penicilina benzat&#237;nica 2&#46;400&#46;000 UI IM DU &#40;1&#44; B&#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>2&#46;<span class="elsevierStyleSup">a</span> l&#237;nea&#58; penicilina proca&#237;nica 600&#46;000 UI IM D 10-14 d&#237;as &#40;cuando no hay disponibilidad de penicilina benzat&#237;nica&#41; &#40;1&#44; C&#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>Alergia&#58; desensibilizaci&#243;n &#43;<span class="elsevierStyleHsp" style=""></span>penicilina benzat&#237;nica 2&#46;400&#46;000 UI IM DU &#40;1&#44; C&#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>PWH igual que el resto de la poblaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t">S&#237;filis temprana&#58; VDRL&#47;RPR 3&#44; 6&#44; 12 meses m&#237;nimo disminuci&#243;n 2 diluciones &#40;4 veces&#41;&#46; Si no disminuci&#243;n&#44; valorar la posibilidad de neuros&#237;filis &#40;2&#44; D&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">S&#237;filis tard&#237;a&#58; VDRL&#47;RPR pueden no negativizarse&#46; No se recomienda seguimiento a menos que sea de alto riesgo de reinfecci&#243;n&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">D&#58; d&#237;a o d&#237;as&#59; VO&#58; v&#237;a oral&#59; vd&#58; veces d&#237;a&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento primoinfecci&#243;n VHS &#40;Ib&#44; A&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aciclovir 400 mgVO 3 vd 7-10 D &#40;preferencia en embarazadas&#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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Famciclovir 250 mg VO 3 vd 7-10 D&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Valaciclovir 1<span class="elsevierStyleHsp" style=""></span>g VO 2<span class="elsevierStyleHsp" style=""></span>vd 7-10 D&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>Aciclovir 200 mg VO 5 vd 7-10 D &#40;no recomendado por bajo cumplimiento&#41;&nbsp;\t\t\t\t\t\t\n
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            "detalle" => "Tabla "
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">D&#58; d&#237;a o d&#237;as&#59; DU&#58; dosis &#250;nica&#59; vd&#58; veces d&#237;a&#59; VO&#58; v&#237;a oral&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento recurrencias VHS &#40;Ib&#44; A&#41;</span>&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aciclovir 400 mg VO 3<span class="elsevierStyleHsp" style=""></span>vd 7 D &#40;no recomendable&#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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aciclovir 800 mg VO 2<span class="elsevierStyleHsp" style=""></span>vd 5 D&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>Aciclovir 800 mg VO 3<span class="elsevierStyleHsp" style=""></span>vd 2 D&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>Famciclovir 1<span class="elsevierStyleHsp" style=""></span>g VO 2<span class="elsevierStyleHsp" style=""></span>vd 1 D&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>Famciclovir 500 mg VO DU<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>250 mg 2<span class="elsevierStyleHsp" style=""></span>vd 2 D&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>Famciclovir 125 mg VO 2<span class="elsevierStyleHsp" style=""></span>vd 5 D&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>Valaciclovir 500 mg VO 2<span class="elsevierStyleHsp" style=""></span>vd 3 D&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>Valaciclovir 1<span class="elsevierStyleHsp" style=""></span>g VO 1 vez al d&#237;a 5 D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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">Tratamiento supresor VHS &#40;Ib&#44; A&#41;</span>&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>Aciclovir 400 mg VO 2 vd&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>Valaciclovir 500 mg VO 1 vez al d&#237;a &#40;no aconsejable si &#62;<span class="elsevierStyleHsp" style=""></span>de 10 brotes al a&#241;o&#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>Valaciclovir 1<span class="elsevierStyleHsp" style=""></span>g VO al d&#237;a &#40;preferible si &#62;<span class="elsevierStyleHsp" style=""></span>10 brotes al a&#241;o&#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>Famciclovir 250 VO 2 veces al d&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Tratamiento supresor VHS 2</p>"
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      5 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Tabla 6"
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        "mostrarFloat" => true
        "mostrarDisplay" => false
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          0 => array:3 [
            "identificador" => "at6"
            "detalle" => "Tabla "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">vd&#58; veces d&#237;a&#59; VO&#58; v&#237;a oral&#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=""><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">Tratamiento primoinfecci&#243;n VHS en PWH &#40;2&#41;</span>&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>Aciclovir 400 mg VO 5<span class="elsevierStyleHsp" style=""></span>vd 7-10D &#40;IV&#44; C&#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>Valaciclovir 500-1&#46;000 mg VO 2<span class="elsevierStyleHsp" style=""></span>vd 10 D &#40;IV&#44; C&#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>Famciclovir 250-500 mg VO 3<span class="elsevierStyleHsp" style=""></span>vd 10 D &#40;IV&#44; C&#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>Si enfermedad fulminante&#58; aciclovir 5-10 mg&#47;kg cada 8<span class="elsevierStyleHsp" style=""></span>h 2-7 D o hasta mejor&#237;a cl&#237;nica seguido de antiviral oral hasta ajustar 10 D m&#237;nimo &#40;IV&#44; C&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab3518946.png"
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          "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Consideraciones especiales&#44; tratamiento primoinfecci&#243;n HSV en PWH</p>"
        ]
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        "identificador" => "tbl0035"
        "etiqueta" => "Tabla 7"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at7"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">D&#58; d&#237;a o d&#237;as&#59; IV&#58; intravenoso&#59; vd&#58; veces d&#237;a&#59; VO&#58; v&#237;a oral&#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="\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">Tratamiento supresor en paciente PWH&#40;Ib&#44; A&#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">Tratamiento recidivas paciente PWH &#40;Ib&#44; A&#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">Tratamiento supresor gestantes<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">10</span></a> &#40;iniciar sem 36&#41; &#40;Ib&#44; A&#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">Tratamiento de herpes recidivante en paciente inmunodeprimido &#40;Ib&#44; A&#41;&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">Aciclovir 400-800 mg VO 3<span class="elsevierStyleHsp" style=""></span>vd&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">Aciclovir 400 VO 3<span class="elsevierStyleHsp" style=""></span>vd 5-10D&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">Aciclovir 400 mg VO 3<span class="elsevierStyleHsp" style=""></span>vd &#40;Ib&#44; B&#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">Lesiones accesibles&#58; foscarnet crema o cidofovir 1&#37; gel&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">Famciclovir 500 mg VO 2<span class="elsevierStyleHsp" style=""></span>vd&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">Famciclovir 500 mg VO 2<span class="elsevierStyleHsp" style=""></span>vd 5-10 D&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">Valaciclovir 500 mg VO 2 vd&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">Lesiones no accesibles&#58; foscarnet 40mg&#47;kg IV cada 8<span class="elsevierStyleHsp" style=""></span>h o cidofovir 5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg IV semanal&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">Valaciclovir 500<span class="elsevierStyleHsp" style=""></span>mg 2<span class="elsevierStyleHsp" style=""></span>vd&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">Valaciclovir 1<span class="elsevierStyleHsp" style=""></span>g VO 2<span class="elsevierStyleHsp" style=""></span>vd 5-10 D&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></tr></tbody></table>
                  """
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          "es" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Otras consideraciones especiales</p>"
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        "etiqueta" => "Tabla 8"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at8"
            "detalle" => "Tabla "
            "rol" => "short"
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        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">D&#58; d&#237;a o d&#237;as&#59; VO v&#237;a oral&#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=""><tbody title="tbody"><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">Tratamiento de primera elecci&#243;n</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doxiciclina</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"><span class="elsevierStyleItalic">Sintom&#225;ticos</span>&#58; 100 mg cada 12<span class="elsevierStyleHsp" style=""></span>horas por 21 d&#237;as&#44; VO &#40;1&#44; B&#41;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">19</span></a>&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">Asintom&#225;ticos</span>&#58; 100 mg cada 12 horas por 21 d&#237;as&#44; v&#237;a oral &#40;1&#44; C&#41; o pauta corta<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> 100 mg cada 12 horas por 7 d&#237;as&#44; VO &#40;2&#44; D&#41;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">20</span></a>&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="elsevierStyleItalic">Tratamiento alternativo</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></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">Azitromicina&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">1 g monodosis o 1 g semanal durante 3 semanas&#44; VO &#40;2&#44; D&#41;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">21</span></a>&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">Eritromicina &#40;elecci&#243;n en gestantes&#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">400mg cada 6 horas por 21 d&#237;as&#44; VO &#40;2&#44; D&#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="elsevierStyleItalic">Tratamiento quir&#250;rgico</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">Los bubones fluctuantes deben drenarse mediante aspiraci&#243;n con aguja a trav&#233;s de la piel &#40;2&#44; D&#41;&#46; No se recomienda la incisi&#243;n quir&#250;rgica por el riesgo de complicaciones como formaci&#243;n cr&#243;nica de cavidades &#40;2&#44; D&#41;</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">En algunos casos se precisa tratamiento m&#225;s prolongado si hay complicaciones como f&#237;stulas o bubones<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">22</span></a>&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">En caso de utilizar tratamiento alternativo o pauta corta de doxiciclina&#44; se aconseja realizar TOC a las 4-6 semanas de finalizar el tratamiento &#40;2&#44; D&#41;&#46;</p>"
            ]
          ]
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        "descripcion" => array:1 [
          "es" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Tratamiento del linfogranuloma ven&#233;reo</p>"
        ]
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      8 => array:8 [
        "identificador" => "tbl0045"
        "etiqueta" => "Tabla 9"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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">Si se cumplen todos los siguientes criterios</span><span class="elsevierStyleHsp" style=""></span>1&#41; El paciente tiene una o m&#225;s &#250;lceras genitales dolorosas<span class="elsevierStyleHsp" style=""></span>2&#41; La presentaci&#243;n cl&#237;nica&#44; la aparici&#243;n de &#250;lceras genitales y&#44; si est&#225;n presentes&#44; la linfadenopat&#237;a regional son t&#237;picas del chancroide<span class="elsevierStyleHsp" style=""></span>3&#41; El paciente no tiene evidencia de infecci&#243;n por <span class="elsevierStyleItalic">T&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">pallidum</span> por el examen de campo oscuro del exudado de la &#250;lcera o por una prueba serol&#243;gica para s&#237;filis realizada al menos 7 d&#237;as despu&#233;s del inicio de las &#250;lceras<span class="elsevierStyleHsp" style=""></span>4&#41; Una prueba de PCR VHS1 o 2 o cultivo de VHS realizado en el exudado de la &#250;lcera es negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Azitromicina 1 g v&#237;a oral monodosis &#40;Ib&#44; A&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ceftriaxona 250 mg IM monodosis &#40;Ib&#44; A&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento alternativo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ciprofloxacino 500 mg cada 12<span class="elsevierStyleHsp" style=""></span>horas VO por 3 d&#237;as &#40;Ib&#44; B&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Eritromicina 500 mg cada 6<span class="elsevierStyleHsp" style=""></span>horas VO por 7 d&#237;as &#40;Ib&#44; B&#41;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">EMA&#58; Agencia Europea Medicamento&#59; FDA&#58; <span class="elsevierStyleItalic">Food And Drug Administration</span>&#59; UE&#58; Uni&#243;n Europea&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento sintom&#225;tico</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antiinflamatorios no esteroideos &#40;AINE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Corticoides t&#243;picos o sist&#233;micos en caso de inflamaci&#243;n importante&#47;mucositis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Analg&#233;sicos para atenuar el dolor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un microambiente limpio y h&#250;medo cubriendo las &#250;lceras infecciosas puede mitigar el potencial de transmisi&#243;n y promover la reepitelizaci&#243;n del exantema&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antibioticoterapia si hay sobreinfecci&#243;n bacteriana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Medicamentos antivirales aprobados</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tecovirimat &#40;&#250;nico f&#225;rmaco con indicaci&#243;n para el tratamiento de infecciones por ortopoxvirus&#44; autorizado por la EMA&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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>Brincidofovir no est&#225; autorizado por la UE&#44; pero s&#237; por la FDA para el tratamiento de MPOX&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cidofovir&#58; activo <span class="elsevierStyleItalic">in vitro</span> para la viruela&#59; asociado a nefrotoxicidad&#46; El uso t&#243;pico <span class="elsevierStyleItalic">off-label</span> parece tener efecto&#44; reduciendo el tiempo de resoluci&#243;n de las lesiones y mejorando su resultado cosm&#233;tico<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">53</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Vacunas recomendadas</span>&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vacuna contra la viruela&#58; protecci&#243;n cruzada de hasta 85&#37;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">54</span></a>&#46; El efecto protector disminuye con el tiempo&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
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                  \t\t\t\t">&#40;&#62;<span class="elsevierStyleHsp" style=""></span>20 a&#241;os&#41;&#46; La profilaxis postexposici&#243;n dentro de los 4 d&#237;as iniciales puede prevenir la infecci&#243;n o reducir su gravedad<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">55</span></a>&#46; Vacuna no replicante de tercera generaci&#243;n aprobada&#58; Imvanex&#8482; - Vaccinia Ankara modificada<a class="elsevierStyleCrossRefs" href="#bib0595"><span class="elsevierStyleSup">56&#44;57</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Posolog&#237;a&#58; inyecci&#243;n subcut&#225;nea 0&#44;5<span class="elsevierStyleHsp" style=""></span>ml dos dosis o r&#233;gimen alternativo intrad&#233;rmico de 0&#44;1<span class="elsevierStyleHsp" style=""></span>ml &#40;con 28 d&#237;as de diferencia entre ambas dosis&#41;<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">58</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Medidas de prevenci&#243;n&#47;aislamiento</span><a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">59</span></a><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aislamiento de contacto y respiratorio<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Permanecer en su propia habitaci&#243;n&#44; no compartir art&#237;culos personales&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Evitar contacto con personas inmunodeprimidas&#44; gestantes&#44; ni&#241;os&#44; mascotas o mam&#237;feros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Utilizar mascarilla y cubrir lesiones en caso de tener que abandonar el domicilio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Realizar lavado e higiene de manos de forma frecuente&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Abstinencia sexual<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">BASHH&#58; <span class="elsevierStyleItalic">British Association for Sexual Health and HIV</span>&#59; VO&#58; v&#237;a oral&#46;</p><p id="spar0160" class="elsevierStyleSimplePara elsevierViewall">Duraci&#243;n m&#237;nima de 3 semanas y hasta la curaci&#243;n total de las lesiones&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Azitromicina 1<span class="elsevierStyleHsp" style=""></span>g VO una vez a la semana o 500<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;1<span class="elsevierStyleHsp" style=""></span>B&#44; en gestantes 1<span class="elsevierStyleHsp" style=""></span>D&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamientos alternativos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doxiciclina 100 mg cada&#47;12<span class="elsevierStyleHsp" style=""></span>horas VO &#40;1<span class="elsevierStyleHsp" style=""></span>C&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Eritromicina base 500<span class="elsevierStyleHsp" style=""></span>mg cada&#47;6<span class="elsevierStyleHsp" style=""></span>horas VO &#40;1<span class="elsevierStyleHsp" style=""></span>C&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TMP-SMX 160&#47;800 mg cada&#47;12<span class="elsevierStyleHsp" style=""></span>horas &#40;2<span class="elsevierStyleHsp" style=""></span>B&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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