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with serovariants D-K being associated with infection in the genital tract&#44; pharynx&#44; and rectum&#44; while&#44; serovariant L is associated with lymphogranuloma venereum &#40;LGV&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Absence of treatment can lead to pelvic inflammatory diseases&#44; ectopic pregnancy and infertility in women and epididymitis in men&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Also&#44; infections by <span class="elsevierStyleItalic">C&#46; trachomatis</span> increases the risk of HIV acquisition&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Infection in pregnant women can be transmitted to their children during delivery&#44; with subsequent risk of ophthalmia neonatorum and pneumonia&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The gold standard for <span class="elsevierStyleItalic">C&#46; trachomatis</span> diagnosis is nucleic acid amplification test that can be performed on urine&#44; urethral&#44; vaginal&#44; and rectal samples&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Reducing the incidence of anal and genital chlamydial infections is difficult since infections are frequently asymptomatic&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Additionally&#44; there is no <span class="elsevierStyleItalic">C&#46; trachomatis</span> vaccine&#44; so screening of patients&#44; particularly in the presence of other STIs&#44; and partner treatment must be done to prevent <span class="elsevierStyleItalic">C&#46; trachomatis</span> propagation&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Antimicrobial resistance of <span class="elsevierStyleItalic">Chlamydia trachomatis</span> is infrequent&#44; with even lower rates for doxycycline&#44; when compared to azithromycin&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> As such&#44; azithromycin or doxycycline are recommended as first-line therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objectives</span><p id="par0030" class="elsevierStylePara elsevierViewall">The goals of this study were&#58; <ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0035" class="elsevierStylePara elsevierViewall">To determine the number of <span class="elsevierStyleItalic">C&#46; trachomatis</span> infections per year&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0040" class="elsevierStylePara elsevierViewall">To characterize the demographic traits of the infected population&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0045" class="elsevierStylePara elsevierViewall">To identify the proportion of asymptomatic vs symptomatic patients&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0050" class="elsevierStylePara elsevierViewall">Evaluate the presence of other previous&#44; concomitant&#44; and posterior sexual transmitted infections&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Materials and methods</span><p id="par0055" class="elsevierStylePara elsevierViewall">We conducted a retrospective study of all patients with laboratorial confirmed <span class="elsevierStyleItalic">C&#46; trachomatis</span> infections&#44; diagnosed between January 1st&#44; 2009 and December 31st&#44; 2019&#44; in the Microbiology Laboratory of Hospital de Santa Maria&#44; Lisbon&#44; Portugal&#46; We analysed the following parameters&#58; year of diagnosis&#44; which department ordered the test&#44; patient&#8217;s age&#44; gender&#44; nationality&#44; sexual orientation&#44; number of sexual partners in the previous 6 months&#44; if the patient had symptoms related to <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection&#44; previous&#44; concomitant&#44; and subsequent sexually transmitted infections&#44; treatment prescribed for <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection&#44; if the patient presented to a follow-up consultation&#44; and if patients were pregnant at time of diagnosis&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Being symptomatic was defined as presenting with manifestations characteristically associated with <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection&#44; which include&#44; cervicitis&#44; pelvic inflammatory disease&#44; urethritis&#44; epididymitis&#44; prostatitis or proctitis&#46; If patients presented with other concomitant diagnosis &#40;with exception of <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>&#41; that could justify the presence of the clinical manifestations&#44; they were considered asymptomatic to <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Statistical analysis was performed with SPSS &#40;IBM Statistics&#44; version 23&#46;0&#41;&#46; Categorical variables are presented as frequencies and percentages&#44; and continuous variables as means and standard deviations&#46; Comparisons between groups were based on chi square tests&#46; All reported p values are two-tailed&#44; with a p value &#60;0&#46;05 indicating statistical significance&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">From 2009 to 2019&#44; a total of 6404 samples for <span class="elsevierStyleItalic">C&#46; trachomatis</span> were collected &#40;562 urethral swabs&#44; 857 vaginal swabs and 4985 urine samples&#41; with 34 tests being inconclusive&#44; which were excluded&#46; We found 602 confirmed cases of <span class="elsevierStyleItalic">C&#46; trachomatis</span> &#40;9&#46;4&#37; of total samples&#41;&#44; corresponding to 550 patients&#46; The principal method for diagnosis was urine samples &#40;8&#44;7&#37; of total urine samples collected were positive&#41; with 434 patients being diagnosed by this method&#44; corresponding to 78&#44;9&#37; of total patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Over these 11 years&#44; the number of cases of anal and urogenital infection by <span class="elsevierStyleItalic">C&#46; trachomatis</span> increased from a minimum of 16 cases&#44; in 2011&#44; to a maximum of 111 cases per year&#44; in 2018 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; 42 patients had more than one positive test and&#44; of these&#44; 35 had two positive tests in different occasions&#44; six patients had three positive tests on different occasions and one patient had five positive tests on different occasions&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Most patients were males &#40;n&#8239;&#61;&#8239;371&#59; 67&#44;5&#37;&#41;&#46; Median age was 26&#46;1 years &#40;standard deviation 7&#46;98&#41;&#44; ranging between 13 and 68 years &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; More than half cases &#40;51&#46;3&#37;&#41; occurred below the age of 25 years&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The majority of diagnoses were made by the dermatovenereology department &#40;330 patients &#8211; 60&#37;&#41;&#44; either in consultation &#40;93 patients &#8211; 16&#46;9&#37;&#41; or in the dermatovenereology emergency &#40;237 patients &#8211; 43&#46;1&#37;&#41;&#46; The remaining cases were diagnosed by the gynaecology department &#40;109 patients- 19&#46;8&#37;&#41;&#44; general emergency department &#40;37 patients &#8211; 6&#46;7&#37;&#41;&#44; paediatrics department &#40;24 patients &#8211; 4&#46;4&#37;&#41;&#44; infectious diseases department &#40;20 patients &#8211; 3&#46;6&#37;&#41; and by other departments&#44; such as urology and rheumatology &#40;30 patients &#8211; 5&#46;5&#37;&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Concerning nationality&#44; 396 patients &#40;72&#37;&#41; were Portuguese&#44; with the rest being foreign patients &#40;154 patients -28&#37;&#41;&#44; mostly from Brazil and Portuguese speaking African countries&#44; like Angola&#44; Mozambique&#44; and Cape Verde&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">As for the number of sexual partners&#44; in the 6 months previous to the diagnoses&#58; five patients &#40;0&#46;9&#37;&#41; had no sexual partners&#44; 242 patients &#40;44&#37;&#41; had one sexual partner&#44; 85 patients &#40;15&#46;5&#37;&#41; had two sexual partners&#44; 53 patients &#40;9&#46;6&#37;&#41; had three sexual partners&#44; 18 patients &#40;3&#46;3&#37;&#41; had four sexual partners and 23 patients &#40;4&#46;2&#37;&#41; had 5 or more sexual partners&#46; Data regarding number of sexual partners was not available in 124 patients &#40;22&#46;5&#37;&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding sexual orientation&#44; 372 patients were heterosexual &#40;67&#46;6&#37;&#41; and 50 patients were homosexual or bisexual &#40;9&#46;1&#37;&#41;&#46; Data regarding sexual orientation was not available in 128 cases &#40;23&#46;3&#37;&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Of the 371 male patients&#44; 276 &#40;74&#46;3&#37;&#41; were considered symptomatic to <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection&#44; most presenting with symptoms of urethritis&#44; while 7 patients presented with proctitis&#46; Of the 179 female patients&#44; only 39 patients &#40;21&#46;7&#37;&#41; were considered symptomatic to <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection&#44; with 140 patients &#40;78&#46;3&#37;&#41; being asymptomatic&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In 87 patients &#40;15&#46;8&#37;&#41; there was previous history of STI&#44; with 71 patients reporting having had another STI and 16 patients admitting having had more than one previous STI &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> and <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Concomitant STI &#40;diagnosed in simultaneous with <span class="elsevierStyleItalic">Chlamydia Trachomatis</span>&#41; were frequent&#46; 198 patients &#40;36&#37;&#41; had a concomitant STI&#44; of which 15 patients had two or more STIs &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> and <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">As for posterior STIs &#40;diagnosed after <span class="elsevierStyleItalic">Chlamydia Trachomatis</span> was identified&#41; this occurred in 43 patients &#40;7&#46;8&#37;&#41;&#44; with 39 patients developing one more STI and 4 patients acquiring more than one STI &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> and <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Considering therapeutic options&#44; azithromycin was used in monotherapy in 471 patients &#40;85&#46;6&#37;&#41;&#46; 32 patients had doxycycline as first option &#40;5&#46;9&#37;&#41; and 10 patients &#40;1&#46;8&#37;&#41; were treated with penicillin&#46; 37 patients &#40;6&#46;7&#37;&#41; had no therapy to <span class="elsevierStyleItalic">Chlamydia Trachomatis</span> infection administered&#44; because they did not attend the follow-up visit&#46; 12 patients &#40;2&#46;2&#37;&#41; had both azithromycin and doxycycline&#44; because of persistence of symptoms&#46; One patient had levofloxacin&#44; after having persistent symptoms despite azithromycin and doxycycline treatment&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Regarding detection of <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; during pregnancy&#44; there were nine women &#40;1&#46;6&#37;&#41; found positive and they were treated with azithromycin&#46; Of these&#44; three of them terminated pregnancy&#44; for different reasons&#46; None of the six children had complications associated with <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">A significant proportion of patients&#44; corresponding to 196 patients &#40;35&#46;6&#37;&#41; did not show for a re-evaluation consultation after the diagnoses was made&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">In this study we evaluated all confirmed cases of anal and urogenital <span class="elsevierStyleItalic">C&#46; trachomatis&#44;</span> over 11 years at a Tertiary Care Portuguese Hospital&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Overall&#44; we found a rise in the number of confirmed cases of infection&#44; along the years&#44; that related to an also higher number of screening tests &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; This increased number of screening tests may reflect a rising incidence of anal and urogenital chlamydial infection&#44; similar to trends reported in other countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;12</span></a> However&#44; this increment is not proportional&#44; and this may be due to the fact that in earlier years&#44; mainly symptomatic patients were tested and so the likelihood of a positive test was higher&#44; when compared to most recent years where screening of asymptomatic leads to a higher detection of cases&#44; but with also many negative tests&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">There were 42 patients with more than one positive <span class="elsevierStyleItalic">C&#46; trachomatis</span> test at different times&#46; Since in many instances&#44; no tests of cure were collected we cannot ascertain if these cases represent a failure of initial treatment or a chlamydial reinfection&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The age at diagnosis ranged from 13 years to 68 years &#40;mean age&#44; 26&#46;1&#41;&#46; The highest prevalence of chlamydia occurred predominantly in younger age groups &#40;&#60; 25 years&#41;&#46; Our findings agree with European reports stating that&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection cases peak among 20-24-year-old&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Infection with <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> was the most prevalent previous &#40;46 patients &#8211; 8&#46;3&#37;&#41;&#44; concomitant &#40;96 patients -17&#46;4&#37;&#41;&#44; and posterior STI &#40;11 patients &#8211; 2&#37;&#41;&#46; This reflects an important association&#44; specifically as concomitant infections&#44; and the need for simultaneous treatment of both infections&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Taking into account only female patients&#44; most infections were asymptomatic &#40;78&#46;3&#37;&#41; &#40;p&#8239;&#60;&#8239;0&#46;05&#41;&#46; This is in accordance with other reports&#44; affirming that&#44; in the female population&#44; most of <span class="elsevierStyleItalic">C&#46; trachomatis</span> infections are asymptomatic&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a> As for male patients&#44; 74&#46;3&#37; were considered symptomatic &#40;p&#8239;&#60;&#8239;0&#46;05&#41;&#44; confirming that men are predominantly symptomatic to <span class="elsevierStyleItalic">C&#46; trachomatis</span> infections&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> One factor possibly affecting the number of symptomatic patients is that many patients were evaluated in an emergency setting&#44; what may overestimate the rate of symptomatic patients&#46; Additionally&#44; in 96 cases&#44; concomitant infection with <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> was present&#44; and so this may be a confounding factor&#44; because these symptoms cannot be attributed exclusively to chlamydial infection&#46; These data support that screening is essential&#44; especially in the female population&#44; given that most infections are asymptomatic&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The most prescribed treatment was azithromycin&#46; Both the CDC and IUSTI recommend azithromycin 1&#8239;g orally in a single dose or doxycycline 100&#8239;mg bd for 7 days&#44; as a first-line treatment for urogenital <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection&#44; while the British Association for Sexual Health and HIV&#44; no longer recommends azithromycin as a first option&#44; because of the emergence of sexually transmitted pathogens&#44; such as&#44; Mycoplasma genitalium than can present as a coinfection&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;22</span></a> We did not perform tests of cure for the majority of patients&#44; however&#44; tests of cure are recommended for rectal infections and in pregnant patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;21</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Penicillin was initially administered to 10 patients &#40;1&#46;8&#37;&#41;&#44; mainly because of suspicion of syphilis&#44; with 7 patients having confirmed concomitant syphilis&#46; 37 patients &#40;6&#46;7&#37;&#41; had no therapy to <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection administered&#44; because they did not show for a revaluation consultation&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Concerning the nine cases of detection of <span class="elsevierStyleItalic">C&#46; trachomatis</span> during pregnancy&#44; there were no consequences to the children&#44; and six of them were born full-term and with a normal weight&#44; while the other three pregnancies were terminated&#44; by mother&#8217;s choice&#46; However&#44; infections during pregnancy have been associated with premature rupture of membranes&#44; preterm birth and low birthweight&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a> Therefore&#44; screening for <span class="elsevierStyleItalic">C&#46; trachomatis&#44;</span> during pregnancy should be recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Our elevated rate of loss of follow-up is important &#40;35&#46;6&#37; of total patients&#41;&#44; because it does not allow for partners treatment and in the cases where the diagnoses was not considered &#40;either because the patient was asymptomatic or presented with clinical manifestations suggestive of other STI&#41; no treatment for <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection was prescribed&#46; Aside from this fact&#44; a follow-up visit is another chance to remind patients of protective measures against STIs&#44; possibly reducing future STIs&#46; Although we have not found any statistical significance between presenting to a follow-up consultation and developing posterior STIs &#40;30&#47;354 patients vs 15&#47;196 patients&#41; we cannot exclude that patients who abandoned follow-up at our hospital&#44; were not diagnosed with other STIs at a different hospital&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Our study has several limitations&#58; it is a retrospective study and there is missing data regarding the sexual orientation and number of sexual partners in the last 6 months in many patients&#46; Also&#44; some patients may not disclaim all the STIs had previously&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Another limitation is that the amount of STIs acquired after <span class="elsevierStyleItalic">C&#46; trachomatis</span> diagnoses may be underestimated&#44; because of loss of follow-up&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0200" class="elsevierStylePara elsevierViewall">Confirmed cases of <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection have risen along the years in our hospital&#44; with people younger than 25 years representing more than half the number of infected patients&#46; This data emphasizes the need for screening&#44; especially among adolescents and young adults&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Data from this study supports that&#44; in women&#44; most <span class="elsevierStyleItalic">C&#46; trachomatis</span> infections are asymptomatic&#44; while men usually present with genitourinary complaints&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Our findings support a strong association with other STIs and the necessity for screening in order to stop dissemination of this infection in the community&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">The high percentage of diagnoses made by dermatovenereologists support the pivotal role of dermatovenereology in diagnosing <span class="elsevierStyleItalic">C&#46; trachomatis</span> infections&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Financing</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors did not receive any financial support for the research&#44; authorship and&#47;or publication of this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Declaration of conflicts of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declared that they had no potential conflicts of interest with respect to the research&#44; authorship and&#47;or publication of this article&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Chlamydia trachomatis</span> infections remain a burden worldwide&#46; The goals of this study were to determine the number of <span class="elsevierStyleItalic">C&#46; trachomatis</span> infections per year&#44; characterize the demographic traits of the infected population and identify the associated sexually transmitted infections &#40;STI&#41;&#44; over the last 11 years&#44; in Lisbon main Hospital Centre&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Laboratorial confirmed <span class="elsevierStyleItalic">C&#46; trachomatis</span> infections diagnosed between January 1st&#44; 2009 and December 31st&#44; 2019 were evaluated&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 6404 samples were collected&#44; with 602 being positive for <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; corresponding to 550 patients&#46; 60&#37; of diagnoses were made by dermatovenereologists and most cases occurred in males &#40;n&#8239;&#61;&#8239;371&#59; 67&#46;5&#37;&#41;&#44; with a median age of 26&#46;1 years &#40;standard deviation 7&#46;98&#41;&#44; ranging from 13 to 68 years&#46; More than half the cases &#40;51&#46;3&#37;&#41; occurred below the age of 25 years&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In 87 patients &#40;15&#46;8&#37;&#41; there was previous history of STI&#44; in 198 patients &#40;36&#37;&#41; a concomitant STI was present and 43 patients &#40;7&#46;8&#37;&#41; developed a posterior STI&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Concerning follow-up&#44; 196 patients &#40;corresponding to 35&#46;6&#37; of total patients&#41; did not show for a re-evaluation after the diagnosis was made&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Confirmed cases of <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection have risen along the years&#44; affecting mainly people younger than 25 years&#46; <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection is especially associated with <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> infection&#44; but other STI are also very prevalent&#46; Considering the potential complications of <span class="elsevierStyleItalic">C&#46; trachomatis</span> infection&#44; screening and treatment are necessary&#46; The high percentage of diagnoses made by dermatovenereologists support the pivotal role of dermatovenereology in diagnosing <span class="elsevierStyleItalic">C&#46; trachomatis</span> infections&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Las infecciones por <span class="elsevierStyleItalic">Chlamydia trachomatis</span> siguen siendo un problema de salud mundial&#46; Los objetivos de este estudio fueron determinar el n&#250;mero de infecciones por <span class="elsevierStyleItalic">C&#46; trachomatis</span> por a&#241;o&#44; caracterizar los rasgos demogr&#225;ficos de la poblaci&#243;n infectada e identificar las infecciones de transmisi&#243;n sexual &#40;ITS&#41; asociadas&#46; Con dicha finalidad se recogieron los casos diagnosticados en los &#250;ltimos 11 a&#241;os en el principal centro hospitalario de Lisboa&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron todas las infecciones causadas por <span class="elsevierStyleItalic">C&#46; trachomatis</span> y confirmadas laboratorialmente entre el 1 de enero de 2009 y el 31 de diciembre de 2019&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se recogieron un total de 6&#46;404 muestras&#44; de las cuales 602 fueron positivas para <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; y correspond&#237;an a un total de 550 pacientes&#46; El 60&#37; de los casos fueron diagnosticados por dermat&#243;logos &#8211; venere&#243;logos&#46; La mayor&#237;a de los casos se observaron en pacientes de sexo masculino &#40;n&#8239;&#61;&#8239;371&#59; 67&#46;5&#37;&#41;&#44; con una mediana de edad de 26&#46;1 a&#241;os &#40;desviaci&#243;n est&#225;ndar de 7&#46;98&#41; y con un rango de edad que oscilaba entre los 13 y los 68 a&#241;os&#46; M&#225;s de la mitad de los casos &#40;51&#46;3&#37;&#41; se diagnosticaron en pacientes menores de 25 a&#241;os&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">En 87 pacientes &#40;15&#46;8&#37;&#41; se hallaron antecedentes de otra ITS&#46; En 198 pacientes &#40;36&#37;&#41; se diagnosticaron adem&#225;s otras ITS concomitantes y 43 pacientes &#40;7&#46;8&#37;&#41; presentaron una ITS posteriormente&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">En cuanto al seguimiento&#44; 196 pacientes &#40;correspondientes al 35&#46;6&#37; del total de pacientes&#41; no acudieron a una reevaluaci&#243;n tras el diagn&#243;stico&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">El n&#250;mero de casos confirmados de <span class="elsevierStyleItalic">C&#46; trachomatis</span> han demostrado un incremento con el transcurso de los a&#241;os&#44; afectando principalmente a pacientes menores de los 25 a&#241;os&#46; La infecci&#243;n por <span class="elsevierStyleItalic">C&#46; trachomatis</span> se asociar&#225; especialmente a la infecci&#243;n por <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>&#44; sin embargo&#44; las infecciones concomitantes por otras ITS ser&#225;n tambi&#233;n muy prevalentes&#46; Teniendo en cuenta las posibles complicaciones de la infecci&#243;n por <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; tanto las pruebas de cribado&#44; como el tratamiento oportuno de esta entidad ser&#225;n necesarios&#46; El hecho de que un elevado porcentaje de diagn&#243;sticos se hayan realizado por dermat&#243;logos - venere&#243;logos confirma el rol fundamental que tendr&#225;n estos especialistas en el diagn&#243;stico de esta infecci&#243;n&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiales y m&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Silva L&#44; Queir&#243;s C&#44; Borges-Costa J&#44; Barreto R&#44; Filipe P&#44; Melo-Cristino J&#44; Infecciones por <span class="elsevierStyleItalic">Chlamydia trachomatis</span> en un hospital portugu&#233;s de atenci&#243;n terciaria&#58; estudio retrospectivo de 11 a&#241;os&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;528&#8211;533&#46;</p>"
      ]
    ]
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      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "detalles" => array:1 [
          0 => array:3 [
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          ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of screening tests and confirmed cases over 11 years&#46; The number of positive cases includes persistent positive <span class="elsevierStyleItalic">Chlamydia trachomatis</span> infections and reinfections&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 849
            "Ancho" => 1500
            "Tamanyo" => 57315
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Age distribution at time of diagnosis&#46; The age at diagnosis ranged from 13 years to 68 years &#40;standard deviation 7&#46;98&#41;&#44; median age was 26&#46;1 years&#46; The highest prevalence of <span class="elsevierStyleItalic">Chlamydia trachomatis</span> infections occurred predominantly in younger age groups &#40;&#60;25 years&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 832
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        "detalles" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Associated STIs&#44; before&#44; concomitant&#44; and posterior to <span class="elsevierStyleItalic">Chlamydia trachomatis</span> diagnosis&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">&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">Previous STIs&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">Concomitant STIs&nbsp;\t\t\t\t\t\t\n
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                  \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">Posterior STIs&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">Hepatitis B&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">16&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&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">-&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">Hepatitis C&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&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">-&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">-&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">Syphilis&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">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&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">10&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">Gonorrhea&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">46&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">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&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">Genital herpes&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">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&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">3&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">HPV&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">6&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">50&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">2&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">Molluscum contagiosum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&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">2&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">HIV&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">24&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">6&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">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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