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transmitidas principalmente por rela&#231;&#227;o sexual&#46; Dentre os agentes causadores das IST&#44; destacam&#8208;se bact&#233;rias&#44; fungos e protozo&#225;rios&#46; As IST podem estar associadas a infertilidade masculina e feminina&#44; c&#226;ncer&#44; doen&#231;a inflamat&#243;ria p&#233;lvica&#44; prostatite&#44; epididimite e outras complica&#231;&#245;es&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2</span></a> &#201; bem conhecida a import&#226;ncia das IST como cofator na transmiss&#227;o do v&#237;rus da imunodefici&#234;ncia humana &#40;HIV&#41;&#46; V&#225;rios estudos evidenciaram a associa&#231;&#227;o entre corrimento uretral&#44; &#250;lceras genitais e condiloma com o aumento do risco de transmiss&#227;o do HIV e modifica&#231;&#227;o da evolu&#231;&#227;o dessas infec&#231;&#245;es&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#8211;7</span></a> Dentre as IST&#44; a uretrite &#233; 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etiologia das uretrites em homens&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#8211;13</span></a> No Brasil&#44; h&#225; poucas investiga&#231;&#245;es sobre a etiologia das uretrites&#46; Estudo multic&#234;ntrico realizado em 1995 em Manaus&#44; Recife&#44; Belo Horizonte&#44; S&#227;o Paulo e Porto Alegre com 473 homens identificou&#44; por meio de exame de Gram e cultura para gonococo&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em 44&#37; das amostras&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 7&#37;&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em associa&#231;&#227;o com <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 11&#37; e <span class="elsevierStyleItalic">T&#46; vaginalis</span> em 2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> Dez anos depois&#44; por meio de novo estudo com 767 homens apresentando IST&#44; residentes em S&#227;o Paulo&#44; Rio de Janeiro&#44; Porto Alegre&#44; Goi&#226;nia&#44; Fortaleza e Manaus&#44; verificou&#8208;se&#44; por meio do exame de Rea&#231;&#227;o de Polimerase em Cadeia &#40;PCR&#41;&#44; em amostras de urina&#44; a presen&#231;a de <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em 18&#44;4&#37; e <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 13&#44;1&#37; das amostras&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Estudo conduzido em Manaus identificou&#44; dentre 800 pacientes do sexo masculino com corrimento uretral&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em 42&#44;7&#37; dos casos&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 10&#44;7&#37;&#44; infec&#231;&#227;o pelos dois pat&#243;genos em 7&#44;3&#37;&#59; em 39&#44;3&#37; dos enfermos&#44; o agente etiol&#243;gico n&#227;o foi identificado&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Face ao reduzido n&#250;mero de investiga&#231;&#245;es relativas &#224;s uretrites no Brasil&#44; decidiu&#8208;se conduzir estudo para identificar os agentes etiol&#243;gicos de 170 pacientes do sexo masculino com corrimento uretral&#46; Os resultados dos principais aspectos relacionados a idade&#44; fatores de risco&#44; agentes etiol&#243;gicos e coinfec&#231;&#245;es s&#227;o apresentados neste trabalho&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudo transversal descritivo e explorat&#243;rio&#44; realizado no per&#237;odo de novembro de 2015 a maio de 2016 em pacientes atendidos na Funda&#231;&#227;o Alfredo da Matta &#40;FUAM&#41;&#44; centro de refer&#234;ncia para diagn&#243;stico e tratamento de IST no estado do Amazonas&#46; Foram inclu&#237;dos pacientes do sexo masculino com corrimento uretral&#44; sem tratamento pr&#233;vio com antibi&#243;tico&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Quanto aos aspectos cl&#237;nicos&#44; seguiu&#8208;se a orienta&#231;&#227;o do Minist&#233;rio da Sa&#250;de&#44; avaliando&#8208;se a presen&#231;a de exsudato uretral&#46; Dados como idade da primeira rela&#231;&#227;o sexual&#44; orienta&#231;&#227;o sexual&#44; n&#250;mero de parceiros nos &#250;ltimos tr&#234;s meses&#44; hist&#243;ria pregressa de IST&#44; uso de medicamentos e frequ&#234;ncia de utiliza&#231;&#227;o de preservativos tamb&#233;m foram inseridos no protocolo configurado para esse projeto&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Ap&#243;s o exame cl&#237;nico&#44; foi realizada pun&#231;&#227;o digital para os seguintes testes r&#225;pidos&#58; HIV&#44; lues&#44; hepatites B e C&#46; Em caso de positividade do teste r&#225;pido para s&#237;filis&#44; colheu&#8208;se sangue para <span class="elsevierStyleItalic">venereal disease research laboratory</span> &#40;VDRL&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> Os testes r&#225;pidos para HIV foram realizados com o kit <span class="elsevierStyleItalic">Tri Line</span> &#40;Bioclin&#41; e o kit <span class="elsevierStyleItalic">Imunoblot</span> r&#225;pido HIV &#40;Biomanguinhos&#41;&#46; Para testagem r&#225;pida de s&#237;filis&#44; empregou&#8208;se o kit <span class="elsevierStyleItalic">Alere s&#237;filis</span> &#40;Alere&#8208;Abbott&#41;&#59; para o VDRL&#44; utilizou&#8208;se reagente da marca Laborclin&#46; Os kits <span class="elsevierStyleItalic">Alere HCV</span> &#40;Alere&#8208;Abbott&#41; e <span class="elsevierStyleItalic">Vikia HBsAg</span> &#40;Biom&#233;rieux&#41; foram utilizados para os testes r&#225;pidos de hepatites B e C&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">No mesmo dia do primeiro atendimento do paciente&#44; foram coletadas duas amostras de exsudato uretral&#46; Esse procedimento foi executado com o kit <span class="elsevierStyleItalic">Digene</span> &#40;hc2 DNA <span class="elsevierStyleItalic">Collection Device</span>&#41;&#46; Uma das amostras foi enviada para o laborat&#243;rio da FUAM para a realiza&#231;&#227;o dos exames de Gram&#44; cultura em meio de Thayer&#8208;Martin e PCR para herpes simples &#40;HSV&#41; tipos 1 e 2&#46; A outra amostra foi enviada para o laborat&#243;rio conveniado&#44; em Manaus&#44; para realiza&#231;&#227;o de PCR para <span class="elsevierStyleItalic">M&#46; genitalium</span>&#44; <span class="elsevierStyleItalic">M&#46; hominis</span>&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span>&#44; <span class="elsevierStyleItalic">U&#46; parvum</span>&#44; <span class="elsevierStyleItalic">T&#46; vaginalis</span>&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis&#46;</span></p><p id="par0050" class="elsevierStylePara elsevierViewall">A amostra de urina foi coletada duas horas ap&#243;s a obten&#231;&#227;o do exsudato uretral&#46; Os pacientes foram orientados para&#44; no momento da coleta da urina&#44; recolher o prep&#250;cio&#44; desprezar o primeiro jato e coletar o jato m&#233;dio&#46; O material foi mantido refrigerado&#44; a 7<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; at&#233; o envio ao laborat&#243;rio conveniado&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Todos os pacientes foram tratados com azitromicina 1<span class="elsevierStyleHsp" style=""></span>g&#44; em dose &#250;nica&#44; e ciprofloxacino 500<span class="elsevierStyleHsp" style=""></span>mg&#44; tamb&#233;m em dose &#250;nica&#46; No per&#237;odo de realiza&#231;&#227;o do estudo&#44; o ciprofloxacino era o tratamento de primeira escolha para o <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> Nos casos de persist&#234;ncia dos sintomas ap&#243;s sete dias&#44; foram utilizados os medicamentos de segunda linha&#44; indicados para o tratamento do corrimento uretral masculino&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa da FUAM &#40;CAAE52491215&#46;2&#46;0000&#46;0002&#41;&#46; Todos os pacientes assinaram termo de consentimento livre e esclarecido&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos 170 pacientes no estudo&#46; A idade m&#233;dia dos enfermos era 27&#44;7 anos e verificou&#8208;se que 96 &#40;57&#44;5&#37;&#41; casos iniciaram a vida sexual entre 15 e 19 anos de idade&#46; Em rela&#231;&#227;o ao n&#250;mero de parceiros nos &#250;ltimos tr&#234;s meses&#44; 60 &#40;35&#44;3&#37;&#41; declararam ter tido apenas um parceiro&#59; 56 &#40;32&#44;9&#37;&#41; tiveram dois a quatro&#59; 36 &#40;21&#44;2&#37;&#41; indiv&#237;duos tiveram mais de cinco&#44; e 18 &#40;10&#44;6&#37;&#41; informaram n&#227;o ter tido parceiro nesse per&#237;odo &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; Sobre a frequ&#234;ncia do uso de preservativo durante as rela&#231;&#245;es sexuais&#44; 167 enfermos responderam a esse item do question&#225;rio&#58; 128 &#40;76&#44;6&#37;&#41; utilizavam&#8208;no eventualmente&#44; e 32 &#40;19&#44;2&#37;&#41; nunca o usaram&#46; Dentre os que referiram orienta&#231;&#227;o sexual&#44; 151 &#40;90&#44;4&#37;&#41; eram heterossexuais&#44; nove &#40;5&#44;4&#37;&#41; declararam&#8208;se HSH e sete &#40;4&#44;2&#37;&#41; eram bissexuais &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Do total de pacientes inclu&#237;dos no estudo&#44; 94 &#40;55&#44;3&#37;&#41; referiam IST pregressa &#8211; 76 &#40;75&#44;2&#37;&#41; com hist&#243;rico de corrimento uretral&#44; 12 &#40;11&#44;9&#37;&#41; informavam ter tido condiloma&#44; oito &#40;7&#44;9&#37;&#41; referiam herpes&#44; tr&#234;s &#40;3&#44;0&#37;&#41; tiveram s&#237;filis e dois &#40;2&#44;0&#37;&#41;&#44; &#250;lcera genital de etiologia desconhecida&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">O exame de Gram foi realizado em 152 pacientes&#59; desses&#44; 94 &#40;61&#44;8&#37;&#41; tiveram resultado positivo para <span class="elsevierStyleItalic">N&#46;</span><span class="elsevierStyleItalic">gonorrhoeae</span>&#46; A cultura para <span class="elsevierStyleItalic">N&#46;</span><span class="elsevierStyleItalic">gonorrhoeae</span> foi realizada em 153 pacientes&#59; foi positiva em 82 &#40;53&#44;6&#37;&#41; casos e negativa em 71 &#40;46&#44;4&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">O teste r&#225;pido para s&#237;filis foi realizado em 158 enfermos&#58; 17 &#40;10&#44;8&#37;&#41; foram reagentes&#46; Fez&#8208;se VDRL de 23 pacientes&#44; dos quais 12 &#40;52&#44;2&#37;&#41; apresentaram resultado reagente&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Dentre os 164 pacientes que realizaram teste r&#225;pido para HIV&#44; oito &#40;4&#44;9&#37;&#41; foram positivos&#46; Um &#40;0&#44;6&#37;&#41; dos 157 pacientes que fizeram sorologia para hepatite C foi positivo&#44; e a sorologia para hepatite B foi negativa em todos os 142 submetidos a esse exame &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A PCR&#44; realizada no exsudato uretral&#44; identificou <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em 102 &#40;60&#44;0&#37;&#41; enfermos&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 50 &#40;29&#44;4&#37;&#41;&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span> em 29 &#40;17&#44;0&#37;&#41;&#44; <span class="elsevierStyleItalic">M&#46; genitalium</span> em 11 &#40;6&#44;5&#37;&#41;&#44; <span class="elsevierStyleItalic">U&#46; parvum</span> em 10 &#40;5&#44;9&#37;&#41; e <span class="elsevierStyleItalic">M&#46; hominis</span> em sete &#40;4&#44;1&#37;&#41;&#46; <span class="elsevierStyleItalic">T&#46; vaginalis</span> n&#227;o foi identificado em nenhuma das amostras testadas&#46; Em 23 &#40;13&#44;5&#37;&#41; indiv&#237;duos&#44; n&#227;o foi identificado nenhum dos pat&#243;genos testados&#46; A PCR para HSV&#8208;2 foi realizada em 111 pacientes&#44; e foi positiva em 24 &#40;21&#44;6&#37;&#41; amostras examinadas&#46; A frequ&#234;ncia dos pat&#243;genos identificados&#44; isoladamente e em associa&#231;&#227;o a outros&#44; est&#225; listada na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Em 21 &#40;12&#44;4&#37;&#41; pacientes foi identificada&#44; pela PCR&#44; nas amostras de exsudato uretral&#44; associa&#231;&#227;o de <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#46; Desse modo&#44; 80 &#40;47&#37;&#41; pacientes apresentavam infec&#231;&#227;o por <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; isoladamente ou em associa&#231;&#227;o&#46; Oito &#40;4&#44;7&#37;&#41; pacientes apresentaram coinfec&#231;&#227;o desses dois micro&#8208;organismos com mais um terceiro pat&#243;geno &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">As outras coinfec&#231;&#245;es mais frequentes foram&#58; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e HSV tipo 2 em 11 &#40;6&#44;5&#37;&#41; pacientes&#59; <span class="elsevierStyleItalic">N&#46; gonorrhoeae e U&#46; urealyticum</span> em nove &#40;5&#44;3&#37;&#41;&#59; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> e HSV tipo 2 em quatro &#40;2&#44;4&#37;&#41; e <span class="elsevierStyleItalic">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</span> em tr&#234;s &#40;1&#44;8&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Dentre o total de pacientes inclu&#237;dos no trabalho&#44; o exame de PCR foi realizado nas amostras de urina de 47 pacientes&#46; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> foi identificado em 25 &#40;53&#44;2&#37;&#41; pacientes&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 11 &#40;23&#44;4&#37;&#41;&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span> em tr&#234;s &#40;6&#44;4&#37;&#41;&#44; <span class="elsevierStyleItalic">M&#46; genitalium</span> em dois &#40;4&#44;3&#37;&#41; e <span class="elsevierStyleItalic">U&#46; parvum</span> em um &#40;2&#44;1&#37;&#41;&#46; Os pat&#243;genos <span class="elsevierStyleItalic">M&#46; hominis</span> e <span class="elsevierStyleItalic">T&#46; vaginalis</span> n&#227;o foram identificados em nenhuma das amostras&#46; Em cinco pacientes &#40;10&#44;6&#37;&#41;&#44; os exames foram negativos&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Com a finalidade de verificar as taxas de concord&#226;ncia entre os testes microbiol&#243;gicos convencionais&#44; exame de Gram e cultura para <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> com a PCR &#40;em exsudato&#41; para o mesmo agente etiol&#243;gico&#44; foram considerados todos os 152 e 153 pacientes que realizaram ambos os m&#233;todos convencionais&#44; respectivamente&#46; Em rela&#231;&#227;o ao exame de Gram e PCR para <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; foi observado coeficiente de Kappa de concord&#226;ncia de 0&#44;83 &#40;concord&#226;ncia quase perfeita e significativa&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Resultado semelhante foi verificado entre cultura e PCR para <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#58; 0&#44;87 &#40;concord&#226;ncia quase perfeita e significativa&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Foi realizada ainda an&#225;lise das taxas de concord&#226;ncia entre os testes diagn&#243;sticos de PCR nas diferentes amostras cl&#237;nicas coletadas&#44; exsudato uretral e urina&#46; Para essa an&#225;lise&#44; foram considerados os 47 pacientes que realizaram ambos os m&#233;todos diagn&#243;sticos&#46; Concord&#226;ncia quase perfeita e significativa foi identificada para <span class="elsevierStyleItalic">M&#46; genitalium</span> &#40;100&#37;&#41; e <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> &#40;87&#44;1&#37;&#41;&#59; forte e significativa para <span class="elsevierStyleItalic">C&#46; trachomatis</span> &#40;68&#44;4&#37;&#41;&#59; moderada e significativa para <span class="elsevierStyleItalic">U&#46; urealyticum</span> &#40;56&#44;1&#37;&#41;&#59; e razo&#225;vel para <span class="elsevierStyleItalic">U&#46; parvum</span> &#40;56&#44;1&#37;&#41; &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Dentre os 170 pacientes inclu&#237;dos no estudo&#44; 100 &#40;58&#44;8&#37;&#41; ficaram curados com o tratamento de primeira linha&#46; Em tr&#234;s &#40;1&#44;8&#37;&#41; enfermos foi empregada medica&#231;&#227;o de segunda linha com resolu&#231;&#227;o cl&#237;nica do quadro&#59; um &#40;0&#44;6&#37;&#41; paciente n&#227;o respondeu &#224;s medica&#231;&#245;es de primeira e segunda linhas&#44; e 66 &#40;38&#44;8&#37;&#41; n&#227;o retornaram sete dias ap&#243;s a administra&#231;&#227;o do tratamento de primeira linha&#44; o que foi considerado como abandono de tratamento&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">N&#227;o foi observada signific&#226;ncia estat&#237;stica nos resultados dos exames laboratoriais para os tr&#234;s principais agentes etiol&#243;gicos das uretrites entre os pacientes com diferentes orienta&#231;&#245;es sexuais&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o ao comportamento das quatro vari&#225;veis referidas como de maior vulnerabilidade para IST &#40;idade&#44; orienta&#231;&#227;o sexual&#44; n&#250;mero de parceiros sexuais e passado ven&#233;reo&#41;&#44; verificou&#8208;se que idade inferior a 30 anos constituiu fator de risco maior para a infec&#231;&#227;o por <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span><span class="elsevierStyleItalic">Odds ratio</span> &#40;OR&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;08&#59; intervalo de confian&#231;a &#40;IC&#41; 95&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;15</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0135" class="elsevierStylePara elsevierViewall">De acordo com a revis&#227;o bibliogr&#225;fica realizada&#44; este &#233; o primeiro estudo brasileiro em que a PCR foi utilizada para a identifica&#231;&#227;o dos principais agentes etiol&#243;gicos de corrimento uretral em homens&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">13&#8211;15</span></a> Dentre os principais fatores de risco para as IST&#44; est&#227;o&#58; idade entre 20 e 35 anos&#44; multiplicidade de parceiros&#44; relacionamento HSH e hist&#243;ria pregressa de IST&#44; especialmente uretrite&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2&#44;5&#44;17</span></a> Os achados da presente investiga&#231;&#227;o corroboram essas observa&#231;&#245;es&#59; a maioria dos pacientes relatava uso eventual de preservativo&#40;76&#44;6&#37;&#41;&#44; hist&#243;ria pregressa de IST&#40;55&#44;3&#37;&#41; e mais de um parceiro sexual nos &#250;ltimos tr&#234;s meses&#40;54&#44;1&#37;&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A coinfec&#231;&#227;o com o HIV foi diagnosticada em oito &#40;4&#44;9&#37;&#41; pacientes estudados&#46; Sabe&#8208;se que a presen&#231;a ou hist&#243;ria pregressa de corrimento uretral aumenta a chance de transmiss&#227;o de HIV nos homens&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;4&#44;7</span></a> Na Cidade do Cabo e em Johanesburgo&#44; &#193;frica do Sul&#44; a incid&#234;ncia de HIV nessa popula&#231;&#227;o foi de 23&#44;8&#37; e 38&#44;6&#37;&#44; respectivamente&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> Na &#205;ndia&#44; 32&#44;2&#37; dos pacientes estavam coinfectados com HIV no momento do diagn&#243;stico do corrimento uretral&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> No Zimb&#225;bue&#44; 28&#44;5&#37; dos homens com corrimento uretral apresentavam HIV&#59; no entanto&#44; dentre os homens com &#250;lcera genital&#44; a coinfec&#231;&#227;o foi maior&#58; 45&#44;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> Nos pa&#237;ses desenvolvidos&#44; tais como It&#225;lia&#44; a coinfec&#231;&#227;o com o HIV em homens com uretrite foi menos frequente&#40;4&#44;1&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Em 152 enfermos&#44; al&#233;m da PCR&#44; fez&#8208;se esfrega&#231;o para a identifica&#231;&#227;o de diplococos Gram&#8208;negativos&#44; verificando&#8208;se positividade em 94 &#40;61&#44;8&#37;&#41;&#59; 153 fizeram cultura&#44; em meio de Thayer&#8208;Martin&#44; com crescimento de <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em 82 &#40;53&#44;4&#37;&#41; casos&#46; &#201; importante enfatizar que&#44; no presente estudo&#44; sem o uso da PCR&#44; a coinfec&#231;&#227;o com outros pat&#243;genos n&#227;o seria diagnosticada em 56 &#40;33&#37;&#41; pacientes&#44; e&#44; em 68 &#40;40&#37;&#41; enfermos&#44; n&#227;o haveria identifica&#231;&#227;o do agente etiol&#243;gico da uretrite&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Os agentes etiol&#243;gicos de corrimento uretral identificados com maior frequ&#234;ncia por meio da PCR&#44; isoladamente ou associados&#44; foram <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis&#46;</span> Esses agentes foram observados nas amostras de 131 &#40;77&#44;05&#37;&#41; pacientes&#58; 46 &#40;27&#44;05&#37;&#41; eram s&#243; portadores de <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e 13 &#40;7&#44;6&#37;&#41; tinham apenas <span class="elsevierStyleItalic">C&#46; trachomatis&#46;</span> Esses resultados s&#227;o similares aos relatados na &#205;ndia&#44; &#193;frica do Sul&#44; Zimb&#225;bue e Israel&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;8&#44;9&#44;20</span></a> Em pa&#237;ses desenvolvidos&#44; como os Estados Unidos&#44; Jap&#227;o&#44; Austr&#225;lia&#44; Est&#244;nia e Inglaterra&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> &#233; mais frequente que <span class="elsevierStyleItalic">N&#46; gonorrhoeae&#46;</span><a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;21&#8211;26</span></a> A associa&#231;&#227;o entre <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span> foi identificada em 12&#44;4&#37; da amostra estudada&#46; Esse achado &#233; superior aos identificados em estudos realizados nos Estados Unidos &#40;5&#44;9&#37;&#41;&#44; Israel &#40;5&#44;9&#37;&#41; e comunidades abor&#237;genes da Austr&#225;lia&#40;4&#44;1&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#44;21&#44;27</span></a> Essa associa&#231;&#227;o foi encontrada com maior frequ&#234;ncia no Zimb&#225;bue &#40;24&#44;5&#37;&#41; e na It&#225;lia &#40;30&#44;1&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;19</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">No presente estudo&#44; al&#233;m das bact&#233;rias <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; foram identificados&#44; em amostras de exsudato uretral&#44; isoladamente ou em associa&#231;&#227;o com outros pat&#243;genos&#58; <span class="elsevierStyleItalic">U&#46; urealitycum</span> &#40;29 pacientes&#59; 17&#37;&#41;&#44; <span class="elsevierStyleItalic">M&#46; genitalium</span> &#40;11 pacientes&#59; 6&#44;5&#37;&#41;&#44; <span class="elsevierStyleItalic">U&#46; parvum</span> &#40;10 pacientes&#59; 5&#44;9&#37;&#41; e <span class="elsevierStyleItalic">M&#46; hominis</span> &#40;sete pacientes&#59; 4&#44;1&#37;&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Dentre os 170 pacientes da presente investiga&#231;&#227;o&#44; foram identificadas outras coinfec&#231;&#245;es&#44; tais como <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e HSV tipo 2 &#40;11 pacientes&#59; 6&#44;5&#37;&#41;&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae e U&#46; urealyticum</span> &#40;nove pacientes&#59; 5&#44;3&#37;&#41;&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> e HSV tipo 2 &#40;quatro pacientes&#59; 2&#44;4&#37;&#41; e <span class="elsevierStyleItalic">C&#46; trachomatis</span> associado a <span class="elsevierStyleItalic">U&#46; urealyticum</span> &#40;tr&#234;s pacientes&#59; 1&#44;8&#37;&#41;&#46; Associa&#231;&#245;es de <span class="elsevierStyleItalic">T&#46; vaginalis com N&#46; gonorrhoeae</span> e C&#46; <span class="elsevierStyleItalic">trachomatis</span>&#59; <span class="elsevierStyleItalic">M&#46; genitalium</span> e <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#59; <span class="elsevierStyleItalic">M&#46;</span><span class="elsevierStyleItalic">genitalium</span> e <span class="elsevierStyleItalic">C&#46;</span><span class="elsevierStyleItalic">trachomatis&#59;</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</span> j&#225; foram demonstradas em casos de corrimento uretral&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">21&#44;27&#8211;29</span></a> Bact&#233;rias dos g&#234;neros <span class="elsevierStyleItalic">Mycoplasma</span> e <span class="elsevierStyleItalic">Ureaplasma</span> t&#234;m sido identificadas como importantes causas de uretrite n&#227;o gonoc&#243;cica &#40;UNG&#41;&#44; particularmente <span class="elsevierStyleItalic">M&#46; genitalium</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;28&#44;30&#8211;34</span></a> Em rela&#231;&#227;o &#224;s demais esp&#233;cies de <span class="elsevierStyleItalic">Mycoplasma</span> e <span class="elsevierStyleItalic">Ureaplasma&#44;</span> ainda persistem d&#250;vidas do papel etiopatog&#234;nico dessas nas uretrites&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">33&#44;35</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Em estudos com grupos de pacientes com uretrite e sadios&#44; identificou&#8208;se <span class="elsevierStyleItalic">U&#46; parvum e M&#46; hominis</span>&#44; em ambos os grupos&#44; em propor&#231;&#245;es semelhantes&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">28&#44;32</span></a> Apesar da ambiguidade do papel etiopatog&#234;nico de <span class="elsevierStyleItalic">U&#46; parvum</span>&#44; estudo realizado com pacientes sintom&#225;ticos e assintom&#225;ticos&#44; com PCR positiva para esse pat&#243;geno na urina&#44; verificou correla&#231;&#227;o positiva entre o n&#250;mero de c&#243;pias de genes 16 S rRNA de <span class="elsevierStyleItalic">U&#46; parvum</span> e contagem de polimorfonucleares na urina&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> No presente estudo&#44; n&#227;o &#233; poss&#237;vel definir se <span class="elsevierStyleItalic">M&#46; hominis</span> e <span class="elsevierStyleItalic">U&#46; parvum</span> s&#227;o&#44; realmente&#44; causadores de uretrites&#46; &#201; importante ressaltar que <span class="elsevierStyleItalic">U&#46; parvum</span><span class="elsevierStyleItalic">e M&#46; hominis</span> fazem parte da microbiota da uretra&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">30&#44;33</span></a> Portanto&#44; outros estudos s&#227;o necess&#225;rios&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Dentre os 111 pacientes com corrimento uretral que realizaram PCR para HSV tipo 2&#44; esse exame foi positivo em 24 &#40;21&#44;6&#37;&#41; enfermos&#44; isoladamente ou em associa&#231;&#227;o com outros pat&#243;genos&#46; Na literatura&#44; h&#225; relatos de que esses pacientes tendem a apresentar inflama&#231;&#227;o do meato urin&#225;rio&#44; dis&#250;ria&#44; ulcera&#231;&#227;o genital e linfadenopatia inguinal&#59; a presen&#231;a de exsudato uretral &#233; menos comum quando comparada a pacientes com uretrite causada por <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">36&#44;37</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">A aus&#234;ncia de identifica&#231;&#227;o de <span class="elsevierStyleItalic">T&#46; vaginalis</span> pela PCR&#44; dentre as amostras dos 170 pacientes investigados&#44; deve ser ressaltada&#46; No Malawi&#44; esse pat&#243;geno foi identificado em 17&#44;3&#37; dos casos estudados&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a> No Jap&#227;o&#44; na Inglaterra e no Brasil&#44; <span class="elsevierStyleItalic">T&#46; vaginalis</span> &#233; raramente identificado nos pacientes com uretrite&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;14&#44;39</span></a> Resultado semelhante &#224; presente pesquisa foi relatado em Israel&#44; por Gottemann et al&#46;&#59; neste estudo&#44; n&#227;o foi identificado nenhum caso de corrimento uretral causado por <span class="elsevierStyleItalic">T&#46; vaginalis&#46;</span><a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> O papel etiopatog&#234;nico desse pat&#243;geno nas uretrites &#233; controverso&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Atualmente&#44; no Brasil&#44; a ceftriaxona e a azitromicina s&#227;o empregadas como tratamento de primeira linha para o corrimento uretral em pacientes do sexo masculino&#46; A ceftriaxona tem a&#231;&#227;o sobre <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; e a azitromicina&#44; sobre <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; pat&#243;genos identificados em 131 &#40;77&#37;&#41; pacientes do presente estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> Deve&#8208;se salientar que a azitromicina tamb&#233;m tem a&#231;&#227;o sobre <span class="elsevierStyleItalic">U&#46; urealitycum</span> e <span class="elsevierStyleItalic">U&#46; parvum</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a> No presente estudo&#44; essas duas bact&#233;rias foram identificadas em 13 &#40;7&#44;6&#37;&#41; enfermos&#46; Portanto&#44; a combina&#231;&#227;o de subst&#226;ncias utilizadas no estudo seria&#44; teoricamente&#44; eficaz em mais de 84&#37; da presente amostra&#46; Face &#224; elevada taxa de pacientes que n&#227;o retornaram ap&#243;s o tratamento &#40;38&#44;8&#37;&#41;&#44; essa constata&#231;&#227;o n&#227;o p&#244;de ser observada&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A escolha do m&#233;todo diagn&#243;stico das uretrites depender&#225; do contexto em que o paciente for atendido&#46; Por&#233;m&#44; quando houver disponibilidade&#44; o exame de PCR &#233; o ideal pelo fato de&#44; no mesmo material&#44; serem investigados os demais agentes que podem estar associados a <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> ou&#44; isoladamente&#44; causar UNG&#46; A cultura&#44; em meio de Thayer&#8208;Martin&#44; tamb&#233;m &#233; importante para a identifica&#231;&#227;o de <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; particularmente nos casos com d&#250;vida diagn&#243;stica&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Dentre os pacientes que realizaram PCR nas amostras de exsudato uretral e urina&#44; a concord&#226;ncia entre os resultados foi quase perfeita e significativa na identifica&#231;&#227;o dos pat&#243;genos <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">M&#46; genitalium</span>&#44; e forte para <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#46; A PCR na urina vem sendo realizada em v&#225;rios centros&#44; e &#233; um exame fact&#237;vel quando n&#227;o h&#225; exsudato uretral evidente&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">30&#44;33&#44;35</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0195" class="elsevierStylePara elsevierViewall">De acordo com os dados obtidos&#44; verificou&#8208;se&#44; nesta investiga&#231;&#227;o&#44; que os exames de biologia molecular&#44; tais como a PCR&#44; s&#227;o importantes para o r&#225;pido e preciso diagn&#243;stico dos agentes etiol&#243;gicos das uretrites gonoc&#243;cicas e n&#227;o gonoc&#243;cicas&#46; Esses procedimentos possibilitam&#44; tamb&#233;m&#44; o diagn&#243;stico de coinfec&#231;&#245;es e tratamento adequado dos pacientes que n&#227;o respondem &#224;s recomenda&#231;&#245;es preconizadas nos fluxogramas para a abordagem sindr&#244;mica dos corrimentos uretrais&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">No presente trabalho&#44; demonstrou&#8208;se a presen&#231;a de <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; isolados ou em associa&#231;&#227;o&#44; em 47&#37; das amostras&#46; Em 77&#37; das amostras&#44; esses agentes foram identificados&#44; isoladamente&#44; em associa&#231;&#227;o entre si e com outros pat&#243;genos&#44; o que justifica a manuten&#231;&#227;o da ceftriaxona e azitromicina como medicamentos de primeira linha no esquema terap&#234;utico do corrimento uretral no Brasil&#46; Face ao aumento dos casos de resist&#234;ncia do <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> ao ciprofloxacino&#44; esse antibi&#243;tico foi substitu&#237;do pelo ceftriaxona em 2018&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">Os achados deste estudo indicam n&#227;o haver necessidade de tratamento para <span class="elsevierStyleItalic">T&#46; vaginalis</span> nos casos de falha terap&#234;utica com a abordagem sindr&#244;mica&#44; pois o mesmo n&#227;o foi isolado em nenhum dos pacientes&#46; Novos estudos s&#227;o necess&#225;rios para a comprova&#231;&#227;o desse achado&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Aspectos &#233;ticos</span><p id="par0210" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa da FUAM &#40;CAAE 52491215&#46;2&#46;0000&#46;0002&#41;&#46; Todos os pacientes assinaram termo de consentimento livre e esclarecido&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Suporte financeiro</span><p id="par0215" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Contribui&#231;&#227;o dos autores</span><p id="par0220" class="elsevierStylePara elsevierViewall">Lucilene Sales de Souza&#58; Concep&#231;&#227;o e o desenho do estudo&#59; levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; reda&#231;&#227;o do artigo&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Jos&#233; Carlos Sardinha&#58; Concep&#231;&#227;o e o desenho do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Sin&#233;sio Talhari&#58; Concep&#231;&#227;o e o desenho do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; reda&#231;&#227;o do artigo&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Marcel Heibel&#58; Levantamento dos dados&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">M&#244;nica Nunes dos Santos&#58; An&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Carolina Talhari&#58; Concep&#231;&#227;o e o desenho do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; reda&#231;&#227;o do artigo&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflito de interesses</span><p id="par0250" class="elsevierStylePara elsevierViewall">O laborat&#243;rio Sabin realizou os exames de PCR para a detec&#231;&#227;o de <span class="elsevierStyleItalic">M&#46; genitalium</span>&#44; <span class="elsevierStyleItalic">Mycoplasma hominis</span>&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span>&#44; <span class="elsevierStyleItalic">Ureaplasma parvum</span>&#44; <span class="elsevierStyleItalic">T&#46; vaginalis</span>&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis&#46;</span></p></span></span>"
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    "fechaRecibido" => "2020-07-08"
    "fechaAceptado" => "2020-07-12"
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            0 => "<span class="elsevierStyleItalic">Chlamydia trachomatis</span>"
            1 => "Infec&#231;&#245;es sexualmente transmiss&#237;veis"
            2 => "<span class="elsevierStyleItalic">Mycoplasma genitalium</span>"
            3 => "<span class="elsevierStyleItalic">Mycoplasma hominis</span>"
            4 => "<span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>"
            5 => "<span class="elsevierStyleItalic">Ureaplasma urealyticum</span>"
            6 => "Uretrite"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">As infec&#231;&#245;es sexualmente transmiss&#237;veis representam problema global de sa&#250;de p&#250;blica&#46; As uretrites est&#227;o entre as doen&#231;as mais comuns desse grupo de enfermidades&#44; e podem ocasionar diversas complica&#231;&#245;es e facilitar a transmiss&#227;o do v&#237;rus HIV&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Investigar os principais agentes etiol&#243;gicos causadores de uretrite em 170 homens atendidos na Funda&#231;&#227;o Alfredo da Matta&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Para a identifica&#231;&#227;o dos agentes&#44; foram colhidos exsudato uretral e urina&#46; Foram realizados exame de Gram e cultura em meio de Thayer&#8208;Martin para <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> e rea&#231;&#227;o de polimerase em cadeia para <span class="elsevierStyleItalic">Neisseria gonorrhoeae&#44; Chlamydia trachomatis&#44; Trichomonas vaginalis&#44; Ureaplasma urealyticum&#44; Ureaplasma parvum&#44; Mycoplasma hominis&#44; Mycoplasma genitalium</span> e herpes simples tipos1e2&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram identificados <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em 102 &#40;60&#44;0&#37;&#41; pacientes<span class="elsevierStyleItalic">&#44;</span><span class="elsevierStyleItalic">C&#46; trachomatis</span> em 50 &#40;29&#44;4&#37;&#41;&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span> em 29 &#40;17&#44;0&#37;&#41;&#44; <span class="elsevierStyleItalic">M&#46; genitalium</span> em 11 &#40;6&#44;5&#37;&#41;&#44; <span class="elsevierStyleItalic">U&#46; parvum</span> em 10&#40;5&#44;9&#37;&#41; e <span class="elsevierStyleItalic">M&#46; hominis</span> em sete&#40;4&#44;1&#37;&#41; pacientes<span class="elsevierStyleItalic">&#46;</span> Herpes simples tipo 2 foi diagnosticado em 24 &#40;21&#44;6&#37;&#41; dos 111 pacientes que realizaram PCR para esse pat&#243;geno&#46; Em 69casos havia coinfec&#231;&#227;o&#59; as mais frequentes foram&#58; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 21&#40;14&#44;7&#37;&#41; enfermos&#59; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 21 &#40;12&#44;4&#37;&#41;&#59; <span class="elsevierStyleItalic">N&#46;</span> gonorrhoeae e herpes simples tipo2 em 11 &#40;6&#44;5&#37;&#41; e <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</span> em nove &#40;5&#44;3&#37;&#41; indiv&#237;duos&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">N&#227;o relevante&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span> e herpes simples tipo2 foram os agentes patog&#234;nicos identificados com maior frequ&#234;ncia no presente estudo&#46; A principal coinfec&#231;&#227;o encontrada foi <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis&#46; T&#46; vaginalis</span> e herpes simples tipo1 n&#227;o foram identificados em nenhum dos paciente<span class="elsevierStyleItalic">s&#46;</span></p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Fundamentos"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivos"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
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          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Limita&#231;&#245;es do estudo"
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          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Conclus&#227;o"
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    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Souza LS&#44; Sardinha JC&#44; Talhari S&#44; Heibel M&#44; Santos MN&#44; Talhari C&#46; Main etiological agents identified in 170 men with urethritis attended at the Funda&#231;&#227;o Alfredo da Matta&#44; Manaus&#44; Amazonas&#44; Brazil&#46; An Bras Dermatol&#46; 2021&#59;96&#58;176&#8211;83&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado na Funda&#231;&#227;o Alfredo da Matta e Universidade do Estado do Amazonas&#44; Manaus&#44; AM&#44; Brasil&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>20 a 29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>30 a 39&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>40 a 49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&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">10&#44;0&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>&#62;<span class="elsevierStyleHsp" style=""></span>49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&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
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                  \t\t\t\t">2&#44;4&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="elsevierStyleItalic">Idade da 1&#170; rela&#231;&#227;o</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>167&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>15&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>15 a 19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">96&nbsp;\t\t\t\t\t\t\n
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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>20 a 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
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N&#227;o informados<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&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="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Parceiros nos &#250;ltimos tr&#234;s meses</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nenhum&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18&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
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                  \t\t\t\t">10&#44;6&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>1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&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
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                  \t\t\t\t">35&#44;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"><span class="elsevierStyleHsp" style=""></span>2 a 4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;9&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>&#8805; 5&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">36&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">21&#44;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="elsevierStyleHsp" style=""></span>Uso de preservativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>167&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Em todas as rela&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&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">4&#44;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="elsevierStyleHsp" style=""></span>&#192;s vezes&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">128&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">76&#44;6&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>N&#227;o usa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&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">19&#44;2&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  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o informados<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>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">Orienta&#231;&#227;o sexual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>167&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HSH ativo&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">0&#44;6&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>HSH passivo&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><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&#44;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="elsevierStyleHsp" style=""></span>HSH ativo&#47;passivo&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">3&#44;6&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>Bissexual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&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">4&#44;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="elsevierStyleHsp" style=""></span>Heterossexual&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">151&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">90&#44;4&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  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o informados<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>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"><span class="elsevierStyleItalic">Passado ven&#233;reo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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>Sim&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">94&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">55&#44;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"><span class="elsevierStyleHsp" style=""></span>N&#227;o&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">76&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">44&#44;7&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  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#42;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Aspectos epidemiol&#243;gicas de pacientes do sexo masculino com uretrite atendidos no ambulat&#243;rio de IST da FUAM</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Exames&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">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" 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">Positivo&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">&#37;&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">Negativo&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">&#37;&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">Exame de Gram&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">152&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">94&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">61&#44;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">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;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">Cultura para gonococo&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
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \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
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                  \t\t\t\t">71&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&#44;4&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">Teste r&#225;pido s&#237;filis&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
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                  \t\t\t\t">158&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
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                  \t\t\t\t  " align="left" valign="\n
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                  \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">141&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">89&#44;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">VDRL&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
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                  \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">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">52&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;8&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">Teste r&#225;pido 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
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                  \t\t\t\t">164&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">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
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                  \t\t\t\t">4&#44;9&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">156&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">95&#44;1&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">Hepatite 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">142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0&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">142&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">100&#44;0&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">Hepatite 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">157&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">0&#44;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">156&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">99&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Resultados de exame de Gram&#44; cultura para <span class="elsevierStyleItalic">N&#46;</span><span class="elsevierStyleItalic">gonorrhoeae</span>&#44; testes para s&#237;filis&#44; HIV&#44; hepatite B&#44; hepatite C e VDRL em pacientes do sexo masculino com corrimento uretral atendidos no ambulat&#243;rio de IST da FUAM</p>"
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                  \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">Agentes etiol&#243;gicos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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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="elsevierStyleItalic">N&#46; gonorrhoeae</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \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
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                  \t\t\t\t">27&#44;1&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">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#44;4&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">C&#46; trachomatis</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&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
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                  \t\t\t\t">7&#44;6&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">N&#46; gonorrhoeae</span> e HSV tipo 2&nbsp;\t\t\t\t\t\t\n
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                  \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><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&#44;5&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">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&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">5&#44;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"><span class="elsevierStyleItalic">U&#46; urealyticum</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&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
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                  \t\t\t\t">4&#44;1&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="elsevierStyleItalic">M&#46; genitalium</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;9&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">U&#46; parvum</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&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&#44;9&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">N&#46; gonorrhoeae&#44; C&#46; trachomatis</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&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&#44;4&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">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</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">3&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&#44;8&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">HSV tipo 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;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">M&#46; genitalium</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</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">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">U&#46; parvum</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</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">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;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">U&#46; urealyticum</span> e <span class="elsevierStyleItalic">M&#46; hominis</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">3&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&#44;8&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">C&#46; trachomatis</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">0&#44;6&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">C&#46; trachomatis</span>&#44; <span class="elsevierStyleItalic">M&#46; hominis</span> e <span class="elsevierStyleItalic">M&#46; urealyticum</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">0&#44;6&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">C&#46; trachomatis</span>&#44; <span class="elsevierStyleItalic">M&#46; genitalium</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">0&#44;6&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">C&#46; trachomatis</span>&#44; <span class="elsevierStyleItalic">M&#46; genitalium</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">0&#44;6&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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">M&#46; hominis</span>&#44; <span class="elsevierStyleItalic">U&#46; parvum</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">0&#44;6&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">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">M&#46; genitalium</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">0&#44;6&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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">U&#46; parvum</span> e <span class="elsevierStyleItalic">M&#46; hominis</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">0&#44;6&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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">0&#44;6&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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">M&#46; genitalium</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">0&#44;6&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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">M&#46; hominis</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">0&#44;6&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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">U&#46; parvum</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">0&#44;6&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">U&#46; urealyticum</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">0&#44;6&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">Nenhum agente&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">13&#44;5&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  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#42;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2579709.png"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Agentes etiol&#243;gicos e coinfec&#231;&#245;es identificados pela PCR nas amostras de exsudato uretral de170 pacientes do sexo masculino com corrimento uretral atendidos no ambulat&#243;rio de IST da FUAM</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:40 [
            0 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sexually transmitted infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "World Health Organization"
                          "etal" => false
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Artigo original
Principais agentes etiológicos identificados em 170 homens com uretrite atendidos na Fundação Alfredo da Matta, Manaus, Amazonas, Brasil
Lucilene Sales de Souzaa, José Carlos Sardinhaa, Sinésio Talharia, Marcel Heibelb, Mônica Nunes dos Santosb,c, Carolina Talharia,b,
Autor para correspondência
carolinatalhari@gmail.com

Autor para correspondência.
a Departamento de Infecções Sexualmente Transmissíveis, Fundação Alfredo da Matta, Manaus, AM, Brasil
b Departamento de Dermatologia, Universidade do Estado do Amazonas, Manaus, AM, Brasil
c Departamento de Dermatologia, Fundação Alfredo da Matta, Manaus, AM, Brasil
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            "entidad" => "Departamento de Dermatologia&#44; Funda&#231;&#227;o Alfredo da Matta&#44; Manaus&#44; AM&#44; Brasil"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspond&#234;ncia&#46;"
          ]
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">As infec&#231;&#245;es sexualmente transmiss&#237;veis &#40;IST&#41; representam problema global de sa&#250;de p&#250;blica&#46; Segundo estimativas da Organiza&#231;&#227;o Mundial da Sa&#250;de &#40;OMS&#41;&#44; mais de um milh&#227;o de pessoas adquirem uma IST diariamente&#46; Em 2016&#44; houve 376 milh&#245;es de novos casos de infec&#231;&#227;o por <span class="elsevierStyleItalic">Chlamydia trachomatis</span>&#44; <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">Treponema pallidum</span> e <span class="elsevierStyleItalic">Trichomonas vaginalis</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As IST s&#227;o afec&#231;&#245;es contagiosas&#44; transmitidas principalmente por rela&#231;&#227;o sexual&#46; Dentre os agentes causadores das IST&#44; destacam&#8208;se bact&#233;rias&#44; fungos e protozo&#225;rios&#46; As IST podem estar associadas a infertilidade masculina e feminina&#44; c&#226;ncer&#44; doen&#231;a inflamat&#243;ria p&#233;lvica&#44; prostatite&#44; epididimite e outras complica&#231;&#245;es&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2</span></a> &#201; bem conhecida a import&#226;ncia das IST como cofator na transmiss&#227;o do v&#237;rus da imunodefici&#234;ncia humana &#40;HIV&#41;&#46; V&#225;rios estudos evidenciaram a associa&#231;&#227;o entre corrimento uretral&#44; &#250;lceras genitais e condiloma com o aumento do risco de transmiss&#227;o do HIV e modifica&#231;&#227;o da evolu&#231;&#227;o dessas infec&#231;&#245;es&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#8211;7</span></a> Dentre as IST&#44; a uretrite &#233; uma das enfermidades mais comuns&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Na &#193;frica do Sul&#44; estima&#8208;se que&#44; em 2017&#44; ocorreram 1&#44;42 milh&#227;o de casos de uretrite masculina causados pelo <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e 1&#44;28 milh&#227;o por <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A uretrite &#233; definida como inflama&#231;&#227;o da uretra&#44; acompanhada ou n&#227;o de exsudato uretral e&#44; ao exame microsc&#243;pico do esfrega&#231;o&#44; presen&#231;a de mais de cinco polimorfonucleares por campo examinado&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> Entre os fatores de risco para as uretrites est&#227;o&#58; idade&#44; entre 20 e 35 anos&#44; multiplicidade de parceiros&#44; Homens que fazem Sexo com Homens &#40;HSH&#41; e indiv&#237;duos com antecedente de IST&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;3&#8211;9</span></a> Os agentes mais comuns das uretrites s&#227;o <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; T<span class="elsevierStyleItalic">&#46; vaginalis</span>&#44; <span class="elsevierStyleItalic">Ureaplasma urealitycum</span> e <span class="elsevierStyleItalic">Mycoplasma genitalium</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;5&#44;6&#44;9&#44;10</span></a><span class="elsevierStyleItalic">M&#46; hominis</span>&#44; <span class="elsevierStyleItalic">U&#46; parvum</span>&#44; herpes&#8208;v&#237;rus tipo 2&#44; <span class="elsevierStyleItalic">Haemophilus influenza</span> e adenov&#237;rus tamb&#233;m t&#234;m sido associados &#224; etiologia das uretrites em homens&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#8211;13</span></a> No Brasil&#44; h&#225; poucas investiga&#231;&#245;es sobre a etiologia das uretrites&#46; Estudo multic&#234;ntrico realizado em 1995 em Manaus&#44; Recife&#44; Belo Horizonte&#44; S&#227;o Paulo e Porto Alegre com 473 homens identificou&#44; por meio de exame de Gram e cultura para gonococo&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em 44&#37; das amostras&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 7&#37;&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em associa&#231;&#227;o com <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 11&#37; e <span class="elsevierStyleItalic">T&#46; vaginalis</span> em 2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> Dez anos depois&#44; por meio de novo estudo com 767 homens apresentando IST&#44; residentes em S&#227;o Paulo&#44; Rio de Janeiro&#44; Porto Alegre&#44; Goi&#226;nia&#44; Fortaleza e Manaus&#44; verificou&#8208;se&#44; por meio do exame de Rea&#231;&#227;o de Polimerase em Cadeia &#40;PCR&#41;&#44; em amostras de urina&#44; a presen&#231;a de <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em 18&#44;4&#37; e <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 13&#44;1&#37; das amostras&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Estudo conduzido em Manaus identificou&#44; dentre 800 pacientes do sexo masculino com corrimento uretral&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em 42&#44;7&#37; dos casos&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 10&#44;7&#37;&#44; infec&#231;&#227;o pelos dois pat&#243;genos em 7&#44;3&#37;&#59; em 39&#44;3&#37; dos enfermos&#44; o agente etiol&#243;gico n&#227;o foi identificado&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Face ao reduzido n&#250;mero de investiga&#231;&#245;es relativas &#224;s uretrites no Brasil&#44; decidiu&#8208;se conduzir estudo para identificar os agentes etiol&#243;gicos de 170 pacientes do sexo masculino com corrimento uretral&#46; Os resultados dos principais aspectos relacionados a idade&#44; fatores de risco&#44; agentes etiol&#243;gicos e coinfec&#231;&#245;es s&#227;o apresentados neste trabalho&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudo transversal descritivo e explorat&#243;rio&#44; realizado no per&#237;odo de novembro de 2015 a maio de 2016 em pacientes atendidos na Funda&#231;&#227;o Alfredo da Matta &#40;FUAM&#41;&#44; centro de refer&#234;ncia para diagn&#243;stico e tratamento de IST no estado do Amazonas&#46; Foram inclu&#237;dos pacientes do sexo masculino com corrimento uretral&#44; sem tratamento pr&#233;vio com antibi&#243;tico&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Quanto aos aspectos cl&#237;nicos&#44; seguiu&#8208;se a orienta&#231;&#227;o do Minist&#233;rio da Sa&#250;de&#44; avaliando&#8208;se a presen&#231;a de exsudato uretral&#46; Dados como idade da primeira rela&#231;&#227;o sexual&#44; orienta&#231;&#227;o sexual&#44; n&#250;mero de parceiros nos &#250;ltimos tr&#234;s meses&#44; hist&#243;ria pregressa de IST&#44; uso de medicamentos e frequ&#234;ncia de utiliza&#231;&#227;o de preservativos tamb&#233;m foram inseridos no protocolo configurado para esse projeto&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Ap&#243;s o exame cl&#237;nico&#44; foi realizada pun&#231;&#227;o digital para os seguintes testes r&#225;pidos&#58; HIV&#44; lues&#44; hepatites B e C&#46; Em caso de positividade do teste r&#225;pido para s&#237;filis&#44; colheu&#8208;se sangue para <span class="elsevierStyleItalic">venereal disease research laboratory</span> &#40;VDRL&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> Os testes r&#225;pidos para HIV foram realizados com o kit <span class="elsevierStyleItalic">Tri Line</span> &#40;Bioclin&#41; e o kit <span class="elsevierStyleItalic">Imunoblot</span> r&#225;pido HIV &#40;Biomanguinhos&#41;&#46; Para testagem r&#225;pida de s&#237;filis&#44; empregou&#8208;se o kit <span class="elsevierStyleItalic">Alere s&#237;filis</span> &#40;Alere&#8208;Abbott&#41;&#59; para o VDRL&#44; utilizou&#8208;se reagente da marca Laborclin&#46; Os kits <span class="elsevierStyleItalic">Alere HCV</span> &#40;Alere&#8208;Abbott&#41; e <span class="elsevierStyleItalic">Vikia HBsAg</span> &#40;Biom&#233;rieux&#41; foram utilizados para os testes r&#225;pidos de hepatites B e C&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">No mesmo dia do primeiro atendimento do paciente&#44; foram coletadas duas amostras de exsudato uretral&#46; Esse procedimento foi executado com o kit <span class="elsevierStyleItalic">Digene</span> &#40;hc2 DNA <span class="elsevierStyleItalic">Collection Device</span>&#41;&#46; Uma das amostras foi enviada para o laborat&#243;rio da FUAM para a realiza&#231;&#227;o dos exames de Gram&#44; cultura em meio de Thayer&#8208;Martin e PCR para herpes simples &#40;HSV&#41; tipos 1 e 2&#46; A outra amostra foi enviada para o laborat&#243;rio conveniado&#44; em Manaus&#44; para realiza&#231;&#227;o de PCR para <span class="elsevierStyleItalic">M&#46; genitalium</span>&#44; <span class="elsevierStyleItalic">M&#46; hominis</span>&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span>&#44; <span class="elsevierStyleItalic">U&#46; parvum</span>&#44; <span class="elsevierStyleItalic">T&#46; vaginalis</span>&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis&#46;</span></p><p id="par0050" class="elsevierStylePara elsevierViewall">A amostra de urina foi coletada duas horas ap&#243;s a obten&#231;&#227;o do exsudato uretral&#46; Os pacientes foram orientados para&#44; no momento da coleta da urina&#44; recolher o prep&#250;cio&#44; desprezar o primeiro jato e coletar o jato m&#233;dio&#46; O material foi mantido refrigerado&#44; a 7<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; at&#233; o envio ao laborat&#243;rio conveniado&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Todos os pacientes foram tratados com azitromicina 1<span class="elsevierStyleHsp" style=""></span>g&#44; em dose &#250;nica&#44; e ciprofloxacino 500<span class="elsevierStyleHsp" style=""></span>mg&#44; tamb&#233;m em dose &#250;nica&#46; No per&#237;odo de realiza&#231;&#227;o do estudo&#44; o ciprofloxacino era o tratamento de primeira escolha para o <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> Nos casos de persist&#234;ncia dos sintomas ap&#243;s sete dias&#44; foram utilizados os medicamentos de segunda linha&#44; indicados para o tratamento do corrimento uretral masculino&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa da FUAM &#40;CAAE52491215&#46;2&#46;0000&#46;0002&#41;&#46; Todos os pacientes assinaram termo de consentimento livre e esclarecido&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos 170 pacientes no estudo&#46; A idade m&#233;dia dos enfermos era 27&#44;7 anos e verificou&#8208;se que 96 &#40;57&#44;5&#37;&#41; casos iniciaram a vida sexual entre 15 e 19 anos de idade&#46; Em rela&#231;&#227;o ao n&#250;mero de parceiros nos &#250;ltimos tr&#234;s meses&#44; 60 &#40;35&#44;3&#37;&#41; declararam ter tido apenas um parceiro&#59; 56 &#40;32&#44;9&#37;&#41; tiveram dois a quatro&#59; 36 &#40;21&#44;2&#37;&#41; indiv&#237;duos tiveram mais de cinco&#44; e 18 &#40;10&#44;6&#37;&#41; informaram n&#227;o ter tido parceiro nesse per&#237;odo &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; Sobre a frequ&#234;ncia do uso de preservativo durante as rela&#231;&#245;es sexuais&#44; 167 enfermos responderam a esse item do question&#225;rio&#58; 128 &#40;76&#44;6&#37;&#41; utilizavam&#8208;no eventualmente&#44; e 32 &#40;19&#44;2&#37;&#41; nunca o usaram&#46; Dentre os que referiram orienta&#231;&#227;o sexual&#44; 151 &#40;90&#44;4&#37;&#41; eram heterossexuais&#44; nove &#40;5&#44;4&#37;&#41; declararam&#8208;se HSH e sete &#40;4&#44;2&#37;&#41; eram bissexuais &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Do total de pacientes inclu&#237;dos no estudo&#44; 94 &#40;55&#44;3&#37;&#41; referiam IST pregressa &#8211; 76 &#40;75&#44;2&#37;&#41; com hist&#243;rico de corrimento uretral&#44; 12 &#40;11&#44;9&#37;&#41; informavam ter tido condiloma&#44; oito &#40;7&#44;9&#37;&#41; referiam herpes&#44; tr&#234;s &#40;3&#44;0&#37;&#41; tiveram s&#237;filis e dois &#40;2&#44;0&#37;&#41;&#44; &#250;lcera genital de etiologia desconhecida&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">O exame de Gram foi realizado em 152 pacientes&#59; desses&#44; 94 &#40;61&#44;8&#37;&#41; tiveram resultado positivo para <span class="elsevierStyleItalic">N&#46;</span><span class="elsevierStyleItalic">gonorrhoeae</span>&#46; A cultura para <span class="elsevierStyleItalic">N&#46;</span><span class="elsevierStyleItalic">gonorrhoeae</span> foi realizada em 153 pacientes&#59; foi positiva em 82 &#40;53&#44;6&#37;&#41; casos e negativa em 71 &#40;46&#44;4&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">O teste r&#225;pido para s&#237;filis foi realizado em 158 enfermos&#58; 17 &#40;10&#44;8&#37;&#41; foram reagentes&#46; Fez&#8208;se VDRL de 23 pacientes&#44; dos quais 12 &#40;52&#44;2&#37;&#41; apresentaram resultado reagente&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Dentre os 164 pacientes que realizaram teste r&#225;pido para HIV&#44; oito &#40;4&#44;9&#37;&#41; foram positivos&#46; Um &#40;0&#44;6&#37;&#41; dos 157 pacientes que fizeram sorologia para hepatite C foi positivo&#44; e a sorologia para hepatite B foi negativa em todos os 142 submetidos a esse exame &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A PCR&#44; realizada no exsudato uretral&#44; identificou <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em 102 &#40;60&#44;0&#37;&#41; enfermos&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 50 &#40;29&#44;4&#37;&#41;&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span> em 29 &#40;17&#44;0&#37;&#41;&#44; <span class="elsevierStyleItalic">M&#46; genitalium</span> em 11 &#40;6&#44;5&#37;&#41;&#44; <span class="elsevierStyleItalic">U&#46; parvum</span> em 10 &#40;5&#44;9&#37;&#41; e <span class="elsevierStyleItalic">M&#46; hominis</span> em sete &#40;4&#44;1&#37;&#41;&#46; <span class="elsevierStyleItalic">T&#46; vaginalis</span> n&#227;o foi identificado em nenhuma das amostras testadas&#46; Em 23 &#40;13&#44;5&#37;&#41; indiv&#237;duos&#44; n&#227;o foi identificado nenhum dos pat&#243;genos testados&#46; A PCR para HSV&#8208;2 foi realizada em 111 pacientes&#44; e foi positiva em 24 &#40;21&#44;6&#37;&#41; amostras examinadas&#46; A frequ&#234;ncia dos pat&#243;genos identificados&#44; isoladamente e em associa&#231;&#227;o a outros&#44; est&#225; listada na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Em 21 &#40;12&#44;4&#37;&#41; pacientes foi identificada&#44; pela PCR&#44; nas amostras de exsudato uretral&#44; associa&#231;&#227;o de <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#46; Desse modo&#44; 80 &#40;47&#37;&#41; pacientes apresentavam infec&#231;&#227;o por <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; isoladamente ou em associa&#231;&#227;o&#46; Oito &#40;4&#44;7&#37;&#41; pacientes apresentaram coinfec&#231;&#227;o desses dois micro&#8208;organismos com mais um terceiro pat&#243;geno &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">As outras coinfec&#231;&#245;es mais frequentes foram&#58; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e HSV tipo 2 em 11 &#40;6&#44;5&#37;&#41; pacientes&#59; <span class="elsevierStyleItalic">N&#46; gonorrhoeae e U&#46; urealyticum</span> em nove &#40;5&#44;3&#37;&#41;&#59; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> e HSV tipo 2 em quatro &#40;2&#44;4&#37;&#41; e <span class="elsevierStyleItalic">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</span> em tr&#234;s &#40;1&#44;8&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Dentre o total de pacientes inclu&#237;dos no trabalho&#44; o exame de PCR foi realizado nas amostras de urina de 47 pacientes&#46; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> foi identificado em 25 &#40;53&#44;2&#37;&#41; pacientes&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 11 &#40;23&#44;4&#37;&#41;&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span> em tr&#234;s &#40;6&#44;4&#37;&#41;&#44; <span class="elsevierStyleItalic">M&#46; genitalium</span> em dois &#40;4&#44;3&#37;&#41; e <span class="elsevierStyleItalic">U&#46; parvum</span> em um &#40;2&#44;1&#37;&#41;&#46; Os pat&#243;genos <span class="elsevierStyleItalic">M&#46; hominis</span> e <span class="elsevierStyleItalic">T&#46; vaginalis</span> n&#227;o foram identificados em nenhuma das amostras&#46; Em cinco pacientes &#40;10&#44;6&#37;&#41;&#44; os exames foram negativos&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Com a finalidade de verificar as taxas de concord&#226;ncia entre os testes microbiol&#243;gicos convencionais&#44; exame de Gram e cultura para <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> com a PCR &#40;em exsudato&#41; para o mesmo agente etiol&#243;gico&#44; foram considerados todos os 152 e 153 pacientes que realizaram ambos os m&#233;todos convencionais&#44; respectivamente&#46; Em rela&#231;&#227;o ao exame de Gram e PCR para <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; foi observado coeficiente de Kappa de concord&#226;ncia de 0&#44;83 &#40;concord&#226;ncia quase perfeita e significativa&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Resultado semelhante foi verificado entre cultura e PCR para <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#58; 0&#44;87 &#40;concord&#226;ncia quase perfeita e significativa&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Foi realizada ainda an&#225;lise das taxas de concord&#226;ncia entre os testes diagn&#243;sticos de PCR nas diferentes amostras cl&#237;nicas coletadas&#44; exsudato uretral e urina&#46; Para essa an&#225;lise&#44; foram considerados os 47 pacientes que realizaram ambos os m&#233;todos diagn&#243;sticos&#46; Concord&#226;ncia quase perfeita e significativa foi identificada para <span class="elsevierStyleItalic">M&#46; genitalium</span> &#40;100&#37;&#41; e <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> &#40;87&#44;1&#37;&#41;&#59; forte e significativa para <span class="elsevierStyleItalic">C&#46; trachomatis</span> &#40;68&#44;4&#37;&#41;&#59; moderada e significativa para <span class="elsevierStyleItalic">U&#46; urealyticum</span> &#40;56&#44;1&#37;&#41;&#59; e razo&#225;vel para <span class="elsevierStyleItalic">U&#46; parvum</span> &#40;56&#44;1&#37;&#41; &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Dentre os 170 pacientes inclu&#237;dos no estudo&#44; 100 &#40;58&#44;8&#37;&#41; ficaram curados com o tratamento de primeira linha&#46; Em tr&#234;s &#40;1&#44;8&#37;&#41; enfermos foi empregada medica&#231;&#227;o de segunda linha com resolu&#231;&#227;o cl&#237;nica do quadro&#59; um &#40;0&#44;6&#37;&#41; paciente n&#227;o respondeu &#224;s medica&#231;&#245;es de primeira e segunda linhas&#44; e 66 &#40;38&#44;8&#37;&#41; n&#227;o retornaram sete dias ap&#243;s a administra&#231;&#227;o do tratamento de primeira linha&#44; o que foi considerado como abandono de tratamento&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">N&#227;o foi observada signific&#226;ncia estat&#237;stica nos resultados dos exames laboratoriais para os tr&#234;s principais agentes etiol&#243;gicos das uretrites entre os pacientes com diferentes orienta&#231;&#245;es sexuais&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o ao comportamento das quatro vari&#225;veis referidas como de maior vulnerabilidade para IST &#40;idade&#44; orienta&#231;&#227;o sexual&#44; n&#250;mero de parceiros sexuais e passado ven&#233;reo&#41;&#44; verificou&#8208;se que idade inferior a 30 anos constituiu fator de risco maior para a infec&#231;&#227;o por <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span><span class="elsevierStyleItalic">Odds ratio</span> &#40;OR&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;08&#59; intervalo de confian&#231;a &#40;IC&#41; 95&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;15</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0135" class="elsevierStylePara elsevierViewall">De acordo com a revis&#227;o bibliogr&#225;fica realizada&#44; este &#233; o primeiro estudo brasileiro em que a PCR foi utilizada para a identifica&#231;&#227;o dos principais agentes etiol&#243;gicos de corrimento uretral em homens&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">13&#8211;15</span></a> Dentre os principais fatores de risco para as IST&#44; est&#227;o&#58; idade entre 20 e 35 anos&#44; multiplicidade de parceiros&#44; relacionamento HSH e hist&#243;ria pregressa de IST&#44; especialmente uretrite&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2&#44;5&#44;17</span></a> Os achados da presente investiga&#231;&#227;o corroboram essas observa&#231;&#245;es&#59; a maioria dos pacientes relatava uso eventual de preservativo&#40;76&#44;6&#37;&#41;&#44; hist&#243;ria pregressa de IST&#40;55&#44;3&#37;&#41; e mais de um parceiro sexual nos &#250;ltimos tr&#234;s meses&#40;54&#44;1&#37;&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A coinfec&#231;&#227;o com o HIV foi diagnosticada em oito &#40;4&#44;9&#37;&#41; pacientes estudados&#46; Sabe&#8208;se que a presen&#231;a ou hist&#243;ria pregressa de corrimento uretral aumenta a chance de transmiss&#227;o de HIV nos homens&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;4&#44;7</span></a> Na Cidade do Cabo e em Johanesburgo&#44; &#193;frica do Sul&#44; a incid&#234;ncia de HIV nessa popula&#231;&#227;o foi de 23&#44;8&#37; e 38&#44;6&#37;&#44; respectivamente&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> Na &#205;ndia&#44; 32&#44;2&#37; dos pacientes estavam coinfectados com HIV no momento do diagn&#243;stico do corrimento uretral&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> No Zimb&#225;bue&#44; 28&#44;5&#37; dos homens com corrimento uretral apresentavam HIV&#59; no entanto&#44; dentre os homens com &#250;lcera genital&#44; a coinfec&#231;&#227;o foi maior&#58; 45&#44;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> Nos pa&#237;ses desenvolvidos&#44; tais como It&#225;lia&#44; a coinfec&#231;&#227;o com o HIV em homens com uretrite foi menos frequente&#40;4&#44;1&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Em 152 enfermos&#44; al&#233;m da PCR&#44; fez&#8208;se esfrega&#231;o para a identifica&#231;&#227;o de diplococos Gram&#8208;negativos&#44; verificando&#8208;se positividade em 94 &#40;61&#44;8&#37;&#41;&#59; 153 fizeram cultura&#44; em meio de Thayer&#8208;Martin&#44; com crescimento de <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em 82 &#40;53&#44;4&#37;&#41; casos&#46; &#201; importante enfatizar que&#44; no presente estudo&#44; sem o uso da PCR&#44; a coinfec&#231;&#227;o com outros pat&#243;genos n&#227;o seria diagnosticada em 56 &#40;33&#37;&#41; pacientes&#44; e&#44; em 68 &#40;40&#37;&#41; enfermos&#44; n&#227;o haveria identifica&#231;&#227;o do agente etiol&#243;gico da uretrite&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Os agentes etiol&#243;gicos de corrimento uretral identificados com maior frequ&#234;ncia por meio da PCR&#44; isoladamente ou associados&#44; foram <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis&#46;</span> Esses agentes foram observados nas amostras de 131 &#40;77&#44;05&#37;&#41; pacientes&#58; 46 &#40;27&#44;05&#37;&#41; eram s&#243; portadores de <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e 13 &#40;7&#44;6&#37;&#41; tinham apenas <span class="elsevierStyleItalic">C&#46; trachomatis&#46;</span> Esses resultados s&#227;o similares aos relatados na &#205;ndia&#44; &#193;frica do Sul&#44; Zimb&#225;bue e Israel&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;8&#44;9&#44;20</span></a> Em pa&#237;ses desenvolvidos&#44; como os Estados Unidos&#44; Jap&#227;o&#44; Austr&#225;lia&#44; Est&#244;nia e Inglaterra&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> &#233; mais frequente que <span class="elsevierStyleItalic">N&#46; gonorrhoeae&#46;</span><a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;21&#8211;26</span></a> A associa&#231;&#227;o entre <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span> foi identificada em 12&#44;4&#37; da amostra estudada&#46; Esse achado &#233; superior aos identificados em estudos realizados nos Estados Unidos &#40;5&#44;9&#37;&#41;&#44; Israel &#40;5&#44;9&#37;&#41; e comunidades abor&#237;genes da Austr&#225;lia&#40;4&#44;1&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#44;21&#44;27</span></a> Essa associa&#231;&#227;o foi encontrada com maior frequ&#234;ncia no Zimb&#225;bue &#40;24&#44;5&#37;&#41; e na It&#225;lia &#40;30&#44;1&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;19</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">No presente estudo&#44; al&#233;m das bact&#233;rias <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; foram identificados&#44; em amostras de exsudato uretral&#44; isoladamente ou em associa&#231;&#227;o com outros pat&#243;genos&#58; <span class="elsevierStyleItalic">U&#46; urealitycum</span> &#40;29 pacientes&#59; 17&#37;&#41;&#44; <span class="elsevierStyleItalic">M&#46; genitalium</span> &#40;11 pacientes&#59; 6&#44;5&#37;&#41;&#44; <span class="elsevierStyleItalic">U&#46; parvum</span> &#40;10 pacientes&#59; 5&#44;9&#37;&#41; e <span class="elsevierStyleItalic">M&#46; hominis</span> &#40;sete pacientes&#59; 4&#44;1&#37;&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Dentre os 170 pacientes da presente investiga&#231;&#227;o&#44; foram identificadas outras coinfec&#231;&#245;es&#44; tais como <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e HSV tipo 2 &#40;11 pacientes&#59; 6&#44;5&#37;&#41;&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae e U&#46; urealyticum</span> &#40;nove pacientes&#59; 5&#44;3&#37;&#41;&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> e HSV tipo 2 &#40;quatro pacientes&#59; 2&#44;4&#37;&#41; e <span class="elsevierStyleItalic">C&#46; trachomatis</span> associado a <span class="elsevierStyleItalic">U&#46; urealyticum</span> &#40;tr&#234;s pacientes&#59; 1&#44;8&#37;&#41;&#46; Associa&#231;&#245;es de <span class="elsevierStyleItalic">T&#46; vaginalis com N&#46; gonorrhoeae</span> e C&#46; <span class="elsevierStyleItalic">trachomatis</span>&#59; <span class="elsevierStyleItalic">M&#46; genitalium</span> e <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#59; <span class="elsevierStyleItalic">M&#46;</span><span class="elsevierStyleItalic">genitalium</span> e <span class="elsevierStyleItalic">C&#46;</span><span class="elsevierStyleItalic">trachomatis&#59;</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</span> j&#225; foram demonstradas em casos de corrimento uretral&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">21&#44;27&#8211;29</span></a> Bact&#233;rias dos g&#234;neros <span class="elsevierStyleItalic">Mycoplasma</span> e <span class="elsevierStyleItalic">Ureaplasma</span> t&#234;m sido identificadas como importantes causas de uretrite n&#227;o gonoc&#243;cica &#40;UNG&#41;&#44; particularmente <span class="elsevierStyleItalic">M&#46; genitalium</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;28&#44;30&#8211;34</span></a> Em rela&#231;&#227;o &#224;s demais esp&#233;cies de <span class="elsevierStyleItalic">Mycoplasma</span> e <span class="elsevierStyleItalic">Ureaplasma&#44;</span> ainda persistem d&#250;vidas do papel etiopatog&#234;nico dessas nas uretrites&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">33&#44;35</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Em estudos com grupos de pacientes com uretrite e sadios&#44; identificou&#8208;se <span class="elsevierStyleItalic">U&#46; parvum e M&#46; hominis</span>&#44; em ambos os grupos&#44; em propor&#231;&#245;es semelhantes&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">28&#44;32</span></a> Apesar da ambiguidade do papel etiopatog&#234;nico de <span class="elsevierStyleItalic">U&#46; parvum</span>&#44; estudo realizado com pacientes sintom&#225;ticos e assintom&#225;ticos&#44; com PCR positiva para esse pat&#243;geno na urina&#44; verificou correla&#231;&#227;o positiva entre o n&#250;mero de c&#243;pias de genes 16 S rRNA de <span class="elsevierStyleItalic">U&#46; parvum</span> e contagem de polimorfonucleares na urina&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> No presente estudo&#44; n&#227;o &#233; poss&#237;vel definir se <span class="elsevierStyleItalic">M&#46; hominis</span> e <span class="elsevierStyleItalic">U&#46; parvum</span> s&#227;o&#44; realmente&#44; causadores de uretrites&#46; &#201; importante ressaltar que <span class="elsevierStyleItalic">U&#46; parvum</span><span class="elsevierStyleItalic">e M&#46; hominis</span> fazem parte da microbiota da uretra&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">30&#44;33</span></a> Portanto&#44; outros estudos s&#227;o necess&#225;rios&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Dentre os 111 pacientes com corrimento uretral que realizaram PCR para HSV tipo 2&#44; esse exame foi positivo em 24 &#40;21&#44;6&#37;&#41; enfermos&#44; isoladamente ou em associa&#231;&#227;o com outros pat&#243;genos&#46; Na literatura&#44; h&#225; relatos de que esses pacientes tendem a apresentar inflama&#231;&#227;o do meato urin&#225;rio&#44; dis&#250;ria&#44; ulcera&#231;&#227;o genital e linfadenopatia inguinal&#59; a presen&#231;a de exsudato uretral &#233; menos comum quando comparada a pacientes com uretrite causada por <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">36&#44;37</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">A aus&#234;ncia de identifica&#231;&#227;o de <span class="elsevierStyleItalic">T&#46; vaginalis</span> pela PCR&#44; dentre as amostras dos 170 pacientes investigados&#44; deve ser ressaltada&#46; No Malawi&#44; esse pat&#243;geno foi identificado em 17&#44;3&#37; dos casos estudados&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a> No Jap&#227;o&#44; na Inglaterra e no Brasil&#44; <span class="elsevierStyleItalic">T&#46; vaginalis</span> &#233; raramente identificado nos pacientes com uretrite&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;14&#44;39</span></a> Resultado semelhante &#224; presente pesquisa foi relatado em Israel&#44; por Gottemann et al&#46;&#59; neste estudo&#44; n&#227;o foi identificado nenhum caso de corrimento uretral causado por <span class="elsevierStyleItalic">T&#46; vaginalis&#46;</span><a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> O papel etiopatog&#234;nico desse pat&#243;geno nas uretrites &#233; controverso&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Atualmente&#44; no Brasil&#44; a ceftriaxona e a azitromicina s&#227;o empregadas como tratamento de primeira linha para o corrimento uretral em pacientes do sexo masculino&#46; A ceftriaxona tem a&#231;&#227;o sobre <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; e a azitromicina&#44; sobre <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; pat&#243;genos identificados em 131 &#40;77&#37;&#41; pacientes do presente estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> Deve&#8208;se salientar que a azitromicina tamb&#233;m tem a&#231;&#227;o sobre <span class="elsevierStyleItalic">U&#46; urealitycum</span> e <span class="elsevierStyleItalic">U&#46; parvum</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a> No presente estudo&#44; essas duas bact&#233;rias foram identificadas em 13 &#40;7&#44;6&#37;&#41; enfermos&#46; Portanto&#44; a combina&#231;&#227;o de subst&#226;ncias utilizadas no estudo seria&#44; teoricamente&#44; eficaz em mais de 84&#37; da presente amostra&#46; Face &#224; elevada taxa de pacientes que n&#227;o retornaram ap&#243;s o tratamento &#40;38&#44;8&#37;&#41;&#44; essa constata&#231;&#227;o n&#227;o p&#244;de ser observada&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A escolha do m&#233;todo diagn&#243;stico das uretrites depender&#225; do contexto em que o paciente for atendido&#46; Por&#233;m&#44; quando houver disponibilidade&#44; o exame de PCR &#233; o ideal pelo fato de&#44; no mesmo material&#44; serem investigados os demais agentes que podem estar associados a <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> ou&#44; isoladamente&#44; causar UNG&#46; A cultura&#44; em meio de Thayer&#8208;Martin&#44; tamb&#233;m &#233; importante para a identifica&#231;&#227;o de <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; particularmente nos casos com d&#250;vida diagn&#243;stica&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Dentre os pacientes que realizaram PCR nas amostras de exsudato uretral e urina&#44; a concord&#226;ncia entre os resultados foi quase perfeita e significativa na identifica&#231;&#227;o dos pat&#243;genos <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">M&#46; genitalium</span>&#44; e forte para <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#46; A PCR na urina vem sendo realizada em v&#225;rios centros&#44; e &#233; um exame fact&#237;vel quando n&#227;o h&#225; exsudato uretral evidente&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">30&#44;33&#44;35</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0195" class="elsevierStylePara elsevierViewall">De acordo com os dados obtidos&#44; verificou&#8208;se&#44; nesta investiga&#231;&#227;o&#44; que os exames de biologia molecular&#44; tais como a PCR&#44; s&#227;o importantes para o r&#225;pido e preciso diagn&#243;stico dos agentes etiol&#243;gicos das uretrites gonoc&#243;cicas e n&#227;o gonoc&#243;cicas&#46; Esses procedimentos possibilitam&#44; tamb&#233;m&#44; o diagn&#243;stico de coinfec&#231;&#245;es e tratamento adequado dos pacientes que n&#227;o respondem &#224;s recomenda&#231;&#245;es preconizadas nos fluxogramas para a abordagem sindr&#244;mica dos corrimentos uretrais&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">No presente trabalho&#44; demonstrou&#8208;se a presen&#231;a de <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; isolados ou em associa&#231;&#227;o&#44; em 47&#37; das amostras&#46; Em 77&#37; das amostras&#44; esses agentes foram identificados&#44; isoladamente&#44; em associa&#231;&#227;o entre si e com outros pat&#243;genos&#44; o que justifica a manuten&#231;&#227;o da ceftriaxona e azitromicina como medicamentos de primeira linha no esquema terap&#234;utico do corrimento uretral no Brasil&#46; Face ao aumento dos casos de resist&#234;ncia do <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> ao ciprofloxacino&#44; esse antibi&#243;tico foi substitu&#237;do pelo ceftriaxona em 2018&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">Os achados deste estudo indicam n&#227;o haver necessidade de tratamento para <span class="elsevierStyleItalic">T&#46; vaginalis</span> nos casos de falha terap&#234;utica com a abordagem sindr&#244;mica&#44; pois o mesmo n&#227;o foi isolado em nenhum dos pacientes&#46; Novos estudos s&#227;o necess&#225;rios para a comprova&#231;&#227;o desse achado&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Aspectos &#233;ticos</span><p id="par0210" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa da FUAM &#40;CAAE 52491215&#46;2&#46;0000&#46;0002&#41;&#46; Todos os pacientes assinaram termo de consentimento livre e esclarecido&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Suporte financeiro</span><p id="par0215" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Contribui&#231;&#227;o dos autores</span><p id="par0220" class="elsevierStylePara elsevierViewall">Lucilene Sales de Souza&#58; Concep&#231;&#227;o e o desenho do estudo&#59; levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; reda&#231;&#227;o do artigo&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Jos&#233; Carlos Sardinha&#58; Concep&#231;&#227;o e o desenho do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Sin&#233;sio Talhari&#58; Concep&#231;&#227;o e o desenho do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; reda&#231;&#227;o do artigo&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Marcel Heibel&#58; 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genitalium</span>&#44; <span class="elsevierStyleItalic">Mycoplasma hominis</span>&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span>&#44; <span class="elsevierStyleItalic">Ureaplasma parvum</span>&#44; <span class="elsevierStyleItalic">T&#46; vaginalis</span>&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis&#46;</span></p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">As infec&#231;&#245;es sexualmente transmiss&#237;veis representam problema global de sa&#250;de p&#250;blica&#46; As uretrites est&#227;o entre as doen&#231;as mais comuns desse grupo de enfermidades&#44; e podem ocasionar diversas complica&#231;&#245;es e facilitar a transmiss&#227;o do v&#237;rus HIV&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Investigar os principais agentes etiol&#243;gicos causadores de uretrite em 170 homens atendidos na Funda&#231;&#227;o Alfredo da Matta&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Para a identifica&#231;&#227;o dos agentes&#44; foram colhidos exsudato uretral e urina&#46; Foram realizados exame de Gram e cultura em meio de Thayer&#8208;Martin para <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> e rea&#231;&#227;o de polimerase em cadeia para <span class="elsevierStyleItalic">Neisseria gonorrhoeae&#44; Chlamydia trachomatis&#44; Trichomonas vaginalis&#44; Ureaplasma urealyticum&#44; Ureaplasma parvum&#44; Mycoplasma hominis&#44; Mycoplasma genitalium</span> e herpes simples tipos1e2&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram identificados <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> em 102 &#40;60&#44;0&#37;&#41; pacientes<span class="elsevierStyleItalic">&#44;</span><span class="elsevierStyleItalic">C&#46; trachomatis</span> em 50 &#40;29&#44;4&#37;&#41;&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span> em 29 &#40;17&#44;0&#37;&#41;&#44; <span class="elsevierStyleItalic">M&#46; genitalium</span> em 11 &#40;6&#44;5&#37;&#41;&#44; <span class="elsevierStyleItalic">U&#46; parvum</span> em 10&#40;5&#44;9&#37;&#41; e <span class="elsevierStyleItalic">M&#46; hominis</span> em sete&#40;4&#44;1&#37;&#41; pacientes<span class="elsevierStyleItalic">&#46;</span> Herpes simples tipo 2 foi diagnosticado em 24 &#40;21&#44;6&#37;&#41; dos 111 pacientes que realizaram PCR para esse pat&#243;geno&#46; Em 69casos havia coinfec&#231;&#227;o&#59; as mais frequentes foram&#58; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 21&#40;14&#44;7&#37;&#41; enfermos&#59; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</span> em 21 &#40;12&#44;4&#37;&#41;&#59; <span class="elsevierStyleItalic">N&#46;</span> gonorrhoeae e herpes simples tipo2 em 11 &#40;6&#44;5&#37;&#41; e <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</span> em nove &#40;5&#44;3&#37;&#41; indiv&#237;duos&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">N&#227;o relevante&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span> e herpes simples tipo2 foram os agentes patog&#234;nicos identificados com maior frequ&#234;ncia no presente estudo&#46; A principal coinfec&#231;&#227;o encontrada foi <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis&#46; T&#46; vaginalis</span> e herpes simples tipo1 n&#227;o foram identificados em nenhum dos paciente<span class="elsevierStyleItalic">s&#46;</span></p></span>"
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                  \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">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;5&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>15 a 19&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">57&#44;5&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>20 a 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">5&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&#44;0&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  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o informados<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&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="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Parceiros nos &#250;ltimos tr&#234;s meses</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nenhum&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">18&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&#44;6&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&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">60&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">35&#44;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"><span class="elsevierStyleHsp" style=""></span>2 a 4&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">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;9&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>&#8805; 5&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">36&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">21&#44;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="elsevierStyleHsp" style=""></span>Uso de preservativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>167&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Em todas as rela&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&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">4&#44;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="elsevierStyleHsp" style=""></span>&#192;s vezes&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">128&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">76&#44;6&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>N&#227;o usa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&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">19&#44;2&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  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o informados<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>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">Orienta&#231;&#227;o sexual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>167&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HSH ativo&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">0&#44;6&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>HSH passivo&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><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&#44;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="elsevierStyleHsp" style=""></span>HSH ativo&#47;passivo&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">3&#44;6&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>Bissexual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&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">4&#44;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="elsevierStyleHsp" style=""></span>Heterossexual&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">151&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">90&#44;4&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  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o informados<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>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"><span class="elsevierStyleItalic">Passado ven&#233;reo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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>Sim&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">94&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">55&#44;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"><span class="elsevierStyleHsp" style=""></span>N&#227;o&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">76&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">44&#44;7&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  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#42;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Aspectos epidemiol&#243;gicas de pacientes do sexo masculino com uretrite atendidos no ambulat&#243;rio de IST da FUAM</p>"
        ]
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Exames&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">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&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">Positivo&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">&#37;&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">Negativo&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">&#37;&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">Exame de Gram&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">152&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">94&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">61&#44;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">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;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">Cultura para gonococo&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">153&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">82&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">53&#44;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">71&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&#44;4&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">Teste r&#225;pido s&#237;filis&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">158&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">17&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&#44;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">141&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">89&#44;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">VDRL&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">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">52&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;8&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">Teste r&#225;pido 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">164&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">4&#44;9&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">156&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">95&#44;1&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">Hepatite 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">142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0&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">142&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">100&#44;0&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">Hepatite 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">157&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">0&#44;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">156&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">99&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Resultados de exame de Gram&#44; cultura para <span class="elsevierStyleItalic">N&#46;</span><span class="elsevierStyleItalic">gonorrhoeae</span>&#44; testes para s&#237;filis&#44; HIV&#44; hepatite B&#44; hepatite C e VDRL em pacientes do sexo masculino com corrimento uretral atendidos no ambulat&#243;rio de IST da FUAM</p>"
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              "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">Agentes etiol&#243;gicos&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">n&#42;&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">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N&#46; gonorrhoeae</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">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">27&#44;1&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">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">C&#46; trachomatis</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">21&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&#44;4&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">C&#46; trachomatis</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">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;6&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">N&#46; gonorrhoeae</span> e HSV tipo 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;5&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">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</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">9&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">5&#44;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"><span class="elsevierStyleItalic">U&#46; urealyticum</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">7&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">4&#44;1&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">M&#46; genitalium</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">5&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&#44;9&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">U&#46; parvum</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">5&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&#44;9&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">N&#46; gonorrhoeae&#44; C&#46; trachomatis</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&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&#44;4&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">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</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">3&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&#44;8&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">HSV tipo 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;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">M&#46; genitalium</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</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">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">U&#46; parvum</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">U&#46; urealyticum</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">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;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">U&#46; urealyticum</span> e <span class="elsevierStyleItalic">M&#46; hominis</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">3&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&#44;8&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">C&#46; trachomatis</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">0&#44;6&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">C&#46; trachomatis</span>&#44; <span class="elsevierStyleItalic">M&#46; hominis</span> e <span class="elsevierStyleItalic">M&#46; urealyticum</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">0&#44;6&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">C&#46; trachomatis</span>&#44; <span class="elsevierStyleItalic">M&#46; genitalium</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">0&#44;6&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">C&#46; trachomatis</span>&#44; <span class="elsevierStyleItalic">M&#46; genitalium</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">0&#44;6&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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">M&#46; hominis</span>&#44; <span class="elsevierStyleItalic">U&#46; parvum</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">0&#44;6&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">N&#46; gonorrhoeae</span> e <span class="elsevierStyleItalic">M&#46; genitalium</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">0&#44;6&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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">U&#46; parvum</span> e <span class="elsevierStyleItalic">M&#46; hominis</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">0&#44;6&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">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">U&#46; urealyticum</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">0&#44;6&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="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">M&#46; genitalium</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6&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="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">M&#46; hominis</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6&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="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">C&#46; trachomatis</span> e <span class="elsevierStyleItalic">U&#46; parvum</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6&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="elsevierStyleItalic">U&#46; urealyticum</span> e HSV 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Nenhum agente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#42;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>170&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Agentes etiol&#243;gicos e coinfec&#231;&#245;es identificados pela PCR nas amostras de exsudato uretral de170 pacientes do sexo masculino com corrimento uretral atendidos no ambulat&#243;rio de IST da FUAM</p>"
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      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
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          "bibliografiaReferencia" => array:40 [
            0 => array:3 [
              "identificador" => "bib0205"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sexually transmitted infections"
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                          "colaboracion" => "World Health Organization"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protocolo Cl&#237;nico e Diretrizes Terap&#234;uticas para Aten&#231;&#227;o Integral &#224;s Pessoas com Infec&#231;&#245;es Sexualmente Transmiss&#237;veis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Brasil&#44; Minist&#233;rio da Sa&#250;de"
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            2 => array:3 [
              "identificador" => "bib0215"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Resolution of concentration of HIV&#8208;1 in semen after treatment of urethritis&#58; implications for prevention of sexual transmission of HIV&#8208;1"
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                          "etal" => true
                          "autores" => array:6 [
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                            2 => "R&#46;A&#46; Royce"
                            3 => "P&#46; Kazembe"
                            4 => "J&#46;R&#46; Dyer"
                            5 => "C&#46;C&#46; Daly"
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                    0 => array:2 [
                      "doi" => "10.1016/s0140-6736(97)02190-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet&#46;"
                        "fecha" => "1997"
                        "volumen" => "349"
                        "paginaInicial" => "1868"
                        "paginaFinal" => "1873"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of genital tract infections on HIV&#8208;1 shedding in the genital tract&#58; a systematic review and meta&#8208;analysis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;F&#46; Johnson"
                            1 => "D&#46;A&#46; Lewis"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/OLQ.0b013e3181812d15"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Dis&#46;"
                        "fecha" => "2008"
                        "volumen" => "35"
                        "paginaInicial" => "946"
                        "paginaFinal" => "959"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18685546"
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                    0 => array:2 [
                      "titulo" => "The etiology of male urethral discharge in Zimbabwe&#58; results from the Zimbabwe STI etiology study"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;A&#46; Rietmeijer"
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                            3 => "O&#46; Mugurungi"
                            4 => "V&#46; Kupara"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiology and STI&#47;HIV coinfections among patients with urethral and vaginal discharge syndromes in South Africa"
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                          "etal" => true
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                            1 => "P&#46; Magooa"
                            2 => "E&#46;E&#46; M&#252;ller"
                            3 => "N&#46; Nel"
                            4 => "F&#46; Radebe"
                            5 => "E&#46; Wasserman"
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                        "volumen" => "37"
                        "paginaInicial" => "566"
                        "paginaFinal" => "570"
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                          0 => array:2 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;R&#46; McKinnon"
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                            2 => "J&#46;A&#46; Juno"
                            3 => "P&#46; Izulla"
                            4 => "J&#46; Munyao"
                            5 => "N&#46; Ireri"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/sextrans-2013-051310"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Infect&#46;"
                        "fecha" => "2014"
                        "volumen" => "90"
                        "paginaInicial" => "237"
                        "paginaFinal" => "242"
                        "link" => array:1 [
                          0 => array:2 [
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            7 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "autores" => array:1 [
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                          "etal" => true
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                            0 => "R&#46;S&#46; Kularatne"
                            1 => "R&#46; Niit"
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                            3 => "T&#46; Kufa-Chakezha"
                            4 => "R&#46;P&#46;H&#46; Peters"
                            5 => "M&#46;M&#46; Taylor"
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                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0205863"
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                  "contribucion" => array:1 [
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                          "etal" => false
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                    0 => array:1 [
                      "Revista" => array:6 [
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                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "The role of Ureaplasma spp&#46; in the development of nongonococcal urethritis and infertility among men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CMR.00137-18"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Rev&#46;"
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                        "paginaInicial" => "e00137"
                        "paginaFinal" => "e218"
                        "link" => array:1 [
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                0 => array:2 [
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                      "titulo" => "Ureaplasma parvum and Mycoplasma genitalium are found to be significantly associated with microscopy&#8208;confirmed urethritis in a routine genitourinary medicine setting"
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                          "etal" => false
                          "autores" => array:4 [
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                            3 => "P&#46;V&#46; Coyle"
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                    0 => array:2 [
                      "doi" => "10.1177/0956462415597620"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J STD AIDS&#46;"
                        "fecha" => "2016"
                        "volumen" => "27"
                        "paginaInicial" => "861"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26378187"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of genital mycoplasma&#44; ureaplasma&#44; gardnerella&#44; and human papillomavirus in Japanese men with urethritis&#44; and risk factors for detection of urethral human papillomavirus infection"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Shigehara"
                            1 => "S&#46; Kawaguchi"
                            2 => "T&#46; Sasagawa"
                            3 => "K&#46; Furubayashi"
                            4 => "M&#46; Shimamura"
                            5 => "Y&#46; Maeda"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10156-010-0203-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Chemother&#46;"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "487"
                        "paginaFinal" => "492"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21213011"
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            12 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical courses of herpes simplex virus&#8208;induced urethritis in men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Ito"
                            1 => "M&#46; Yasuda"
                            2 => "H&#46; Kondo"
                            3 => "Y&#46; Yamada"
                            4 => "K&#46; Nakane"
                            5 => "K&#46; Mizutani"
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                        ]
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                  ]
                  "host" => array:1 [
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