Treatment of Chlamydia trachomatis Infection

Essential Guide to Cure Chlamydia

Is Chlamydia easily curable? The Answer is a big Yes! Chlamydia is one of the sexually transmitted diseases with proven treatment methods. In fact, there are two main treatment options available both of which have guaranteed results: Conventional medicine and natural medicine. These treatment options And lots of other previously unknown facts about Chlamydia have been explained at great length in this eBook. The Essential guide to Cure Chlamydia unveils the mystery of Chlamydia and methodically presents all the important bits of information that you should know about Chlamydia. The Banish Chlamydia Book tackles the sensitive subject of Chlamydia from the perspective of a professional and presents you with a goldmine of information and facts in a way that has never been done before.

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Genitourinary Chlamydial Infection

Chlamydia trachomatis infection of the genitourinary tract is the most common bacterial STD in both the United States ( 4 million new cases per year) and worldwide ( 50 million new cases per year). Many infected individuals of either sex are asymptomatic but symptomatic urethritis is common in men, whereas women may present with a mucopurulent cervicitis and acute salpin-gitis. The most serious complication of infection in men is epididymitis. Without treatment, more than 40 of infected women may develop pelvic inflammatory disease, which may lead to tubal infertility or increased risk of ectopic pregnancy. Pregnant women may transmit their infection to their babies as they pass through the infected endocervix at the time of delivery. The baby may develop a mild, neonatal conjunctivitis and or afebrile pneumonia. Infection stimulates host inflammatory and immune responses, but the immunity is of short duration and reinfection occurs frequently.

Mycoplasma and Chlamydia

Data on the incidence of total pneumonia and pneumonia due to Mycoplasma pneumoniae and Chlamydia pneumoniae was presented. Pneumonia occurs most often in the youngest and oldest persons in the population. In a 12-year study in a Seattle HMO, the annual incidence of pneumonia averaged 1 in 80. Simitar rates have been reported from other studies, including a nationwide survey of practitioners in the United States. Similar data also have been reported from Europe. These data suggesting that, on average, everyone has one episode of pneumonia during his lifetime is undoubtedly an underestimation due to the failure of diagnosis in milder cases. In clinical and microbiologically controlled studies, it has been shown that clinical findings do not correlate well with the organism specific diagnosis of pneumonia. Although this session was primarily concerned with atypical pneumonia, it was pointed out that the classification of pneumonias by the typical and atypical criteria is difficult,...

Comparison of the In Vitro Sensitivity of Chlamydia pneumoniae to Macrolides and a New Benzoxazinorifamycin KRM1648

Chlamydia pneumoniae (TWAR) is a frequent cause of community-acquired pneumonia in adults, accounting for approximately 10 of cases (1). Current recommendations for the treatment of C. pneumoniae are based primarily on in vitro sensitivity studies and analogies to the treatment of other chlamydial infections. It has been suggested that prolonged antibiotic therapy may be necessary to cure TWAR infections because symptoms recur frequently after short or conventional courses of appropriate antibiotics, and persistent infection has been documented by culture after treatment. The

Chlamydia screening programme

Chlamydia is the commonest identified pathogen causing PID in the UK. Initial infection with chlamydia is usually asymptomatic but, if identified, can be treated simply and cheaply with antibiotics such as doxycycline or azithromycin thus preventing the development of PID. Screening young women for chlamydia is both feasible and cost-effective 23 , and a national screening programme is now being rolled out across the UK targeting men and women under the age of 25 (further information is available at www.dh.gov.uk PolicyAndGuidance

Hi Mycoplasma Chlamydia

A Comparison of the In Vitro Sensitivity of Chlamydia pneumoniae to M aero Ii des and a New Benzoxazinorifamycin, KRM-1648 Susceptibilities to Azithromycin of Isolates of Chlamydia pneumoniae from Patients with Community-Acquired Pneumonia Microbiologic Efficacy of Azithromycin for the Treatment of Community-Acquired Pneumonia Due to Chlamydia pneumoniae in Children Azithromycin in the Treatment of Chlamydia trachomatis Single-Dose Azithromycin in the Treatment of Genital Chlamydial Infections Uncomplicated Lower Genital Tract Chlamydial Infection 354

Single Dose Azithromycin in the Treatment of Genital Chlamydial Infections

Chlamydial infection is the most frequently encountered sexually transmitted disease and causes serious sequelae. Azithromycin is an azalide antibiotic with a very low minimal inhibitory concentration (MIC) for Chlamydia trachomatis and achieves high intracellular concentration which may be beneficial in eradicating this obligate intracellular pathogen. Azithromycin has high tissue bioavailability and a tissue half-life of 2-4 days. These characteristics enable single-dose administration of azithromycin in the treatment of uncomplicated genital chlamydial infections (1-3). The objective of the study was to state the therapeutic efficacy and tolerance of azithromycin in the treatment of female genital chlamydial infections.

Chlamydia trachomatis Infection

Single-dose therapy is an ideal in venerology. This is especially true in the treatment of infections caused by Chlamydia trachomatis because they are the most widespread sexually transmitted diseases the symptoms of infection in men are often mild and infection in women is very often asymptomatic. Moreover, chlamydial infections may be implicated as a casue of infertility in both sexes, pregnancy complications, and or newborn diseases. Asymptomatic patients, especially female sex partners of men with chlamydial urethritis, or patients with mild symptoms tend to take prescribed antibiotics incompletely. Poor compliance results in therapeutic failures and complications and contributes to the spread of infection. Thus, availability of effective single-dose therapy of chlamydial infections with azithromycin is important. complicated chlamydial urethritis cervicitis were included in the study. Chlamydial infection was diagnosed by direct immunofluorescent test (DIF), Microtrac (Syva) or...

Phylum Chlamydiae

Formerly grouped with the Rickettsia (see above), these non-motile obligate parasites of birds and mammals are now assigned a separate phylum comprising only five genera, of which Chlamydia is the most important. Like the Rickettsia, members of the Chlamydiae have extremely small cells, and very limited metabolic capacities, and depend on the host cell for energy generation. Unlike that group, however, they are not dependent on an arthropod vector for transmission from host to host. Chlamydia trachomatis is the causative agent of trachoma, a major cause of blindness in humans. Different strains of this same species are responsible for one of the most common forms of sexually transmitted disease. C. psittaci causes the avian disease psittacosis, and C. pneumoniae causes chlamydial pneumonia in humans as well as being linked to some cases of coronary artery disease. Representative genus Chlamydia

Description Of The Genus Taxonomy

C. pneumoniae belongs to the genus Chlamydia, which also contains the species Chlamydia trachomatis, Chlamydia psittaci, and Chlamydia pecorum. Due to the detection of new Chlamydia-like organisms and genetic analysis, in 1999 a new taxonomy was proposed which divides the common chlamydiae into the two families, Chlamydophila (including C. pneumoniae) and Chlamydia, and adds two more families containing the newly detected chlamydia-like organisms (Table 1). 1 This proposal, however, is still controversial, leading to the concomitant usage of old and new taxonomies in current publications.1-1,2-1

Macromolecular Composition

Chlamydiae have a bilayered cell membrane similar to other Gram-negative bacteria. The cell membrane contains species-specific antigens such as the major outer membrane protein (MOMP), as well as common antigens such as lipopolysaccharide (LPS). 4 Major outer membrane protein is the most prominent membrane protein making up about 60 of the surface proteins. Variable domains of this protein allow the division of C. trachomatis but not C. pneumoniae, into different serovars. In the genome of C. pneumoniae open reading frames of 21 putative polymorphic membrane proteins (Pmp) have been found. 5 For some, presence on the surface of chlamydiae and immunogenicity could be All chlamydiae share the same LPS structure 7 with a comparably low number of acylic groups, which is probably responsible for the low endotoxic activity. Lipopolysaccharide is used as a group complementation fixation antigen and recombinant ELISA-antigen for chlamydial serodiagnosis. Heat shock proteins, such as the...

Pathogenetic Mechanisms

The various chlamydial infections show an analogous pattern of pathology. 25 Initially, polymorphonuclear leukocytes infiltrate the locus of infection followed by lymphocytes, macrophages, and plasma cells. A strong Th1 response seems to be of major importance for the clearance of infection. Recurrence of infection frequently occurs. This may be explained by the survival of chlamydiae inside the protected cell, possibly in the aforementioned so-called persistent state. Another possibly important factor is the ability of chlamydiae to suppress apoptosis. 26

Genomics And Molecular Typing

The Chlamydia genome is composed of a chromosome of approximately 1.04 million base pairs and a plasmid of 7493 base pairs. 19 The trachoma and LGV biovars have high gene sequence homology and usually only single The major outer membrane protein (MOMP) gene exhibits extensive sequence variation within the serovars. The differences are mainly clustered in four regions (VD1 through 4), which form the basis of serovar differentiation, using sequencing methods and antibody typing. 20,21 The finding that the tryptophan synthase gene becomes inactivated in the ocular infection could prove to be useful in differentiating ocular chlamydial isolates from those normally causing genital tract disease. 22 The finding of polymorphism in the pmpH gene has enabled us to differentiate the trachoma from the LGV biovars. 23

Epidemiology and aetiology

The observed increase in incidence of ectopic pregnancy could also be attributed to an increase in risk factors such as sexually transmitted infections. A recent meta-analysis showed that the odds of having an ectopic pregnancy are significantly higher in women with history of pelvic infection, multiple partners and early age of intercourse. Odds were particularly high in women with history of chlamydia infection 7 . Another study from Sweden also supports an association between ectopic pregnancy and preceding infection by chlamydia. These data showed that a surge in the incidence of ectopic pregnancy was preceded by a similarpeak in the incidence of acute salpingitis 15 years earlier 8 . It has also been found that the reduction in the rate of chlamydia infection due to screening and treatment leads to concomitant decline in the incidence of ectopic pregnancy 4 . However, the findings from epidemiological studies may have been confounded by other factors and they should be...

Discharge And Home Healthcare Guidelines

Follow-up of all sexual partners and to refrain from intercourse during antibiotic therapy to prevent reinfection. While experts recommend that all women less than 25 years of age be screened annually for chlamydia, this recommendation for routine screening does not include men.

Primary Nursing Diagnosis

Treatment of gonorrhea is primarily pharmacologic, with antibiotic regimens. The Centers for Disease Control and Prevention (CDC) recommends that treatment for gonorrhea include concomitant therapy for chlamydia, because it is found in 20 to 40 of all patients with gonorrhea. Both partners should be treated at the same time and instructed to avoid sexual activity until negative cultures are obtained. If the male partner is symptomatic, the female should be treated even before culture results are obtained to prevent infertility. If a woman has an intrauter-ine device (IUD) in place, it may be removed. Effective regimen recommended by the CDC treats chlamydia also, because both STIs often present simultaneously

Patients And Methods

Thirty women with genital chlamydial infection were treated with a 1-g single oral dose of azithromycin. The same treatment was prescribed for the patient's sexual partners. The presence of C. trachomatis was detected by cervical culture which was performed before and 2 weeks after the administration of azithromycin. Cure was defined as an absence, and failure as a presence of C. trachomatis in the cervical culture performed 2 weeks after the administration of azithromycin. Tolerance of azithromycin was assessed by questionnaires that identified the incidence of drug-related side effects.

Urinary Tract Infection

Any patient with prostatitis and or epididymoorchi-tis should be evaluated with a full sexual health history to rule out gonococcal and chlamydial urinary tract infections, as these may require slightly different treatment as well as formal contact tracing to limit the community impact of these potentially sexually transmitted infections.

Simultaneous Detection Of Several Mollicute Species

A variety of assays for simultaneous detection of mollicutes and other pathogens have been described, e.g., a multiplex real-time PCR assay to detect M. pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila in respiratory samples. 17 In addition, a multiplex RT-PCR for the detection of M. pneumoniae and eight additional respiratory pathogens has been constructed.1-18-1 Simultaneous detection of M. hominis together with the bacterial vaginosis-associated pathogens Lactobacillus spp. and Gardnerella vaginalis by real-time PCR has been described. 19

Neonatal Immunization

Induce immunity in neonates in the presence or absence of maternal antibodies makes this approach to vaccination extremely attractive, especially for diseases such as herpes simplex virus-2, human immunodeficiency virus (HIV), hepatitis B, group B strep, and chlamydia which often infect children during birth or shortly thereafter.

Multiplex Nasba And

Greijer et al. 5 designed a multiplex real-time NASBA using molecular beacon probes labeled with three different fluorophores to quantify human cytomegalovirus (CMV) IE1 mRNA by competitive coamplification of wild-type and calibrator RNA. A simultaneous detection of late pp67mRNA in whole-blood samples of CMV-infected lung transplant patients was also obtained. Despite the somewhat lower sensitivity of the real-time NASBA compared with the conventional NASBA, the simultaneous quantification of IE1 and detection of pp67 RNA was reproducible and accurate. Loens et al. 6 also developed a multiplex real-time NASBA for the simultaneous detection of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila RNA in respiratory specimens by using three fluorophores. They also found a slightly lower sensitivity of the multiplex real-time assay compared to the conventional ECL detection on spiked respiratory samples. Gaydos et al. 10 evaluated the performance of the APTIMA Combo 2...

Clinically Relevant Pilot Applications

The practical RCA potential to identify nucleic acid targets, antibodies, and antigens in clinical samples has recently been demonstrated in several feasibility studies. Specifically, the RCA-based protocol for an automated scoring of single nucleotide polymorphisms (SNPs) in a set of human genomic DNA samples with the nanogram sensitivity was developed. 15,20 Highly sensitive multiplex detection of hotspot somatic mutations present at very low abundance was also reported. 21 The RCA capability for pathogen diagnosis was convincingly proved by comparative study of RCA vs. PCR and ligase chain reaction (LCR) in detection of Chlamydia trachomatis in cervical specimens. 22 The workability of immuno-RCA for identification of allergen-specific immunoglobulins in samples from patients was shown in a microarray format. 23 In addition, RCA has been

Urinary frequency and urgency

Cystitis Symptoms Women

Those women who have an abnormal vaginal discharge, history of sexually transmitted diseases or obvious vul-val excoriation should have vaginal, cervical and urethral swabs sent for culture. Chlamydia may be a causative organism which requires a special culture medium for its detection. If there is a history of haematuria, loin or groin pain, and a urinary tract infection cannot be and nocturia in the absence of infection or other obvious pathology 2 . The urethral pain syndrome can occur at any age. There are believed to be two basic causative factors - a bacterial and a urethral element. The bacterial element is thought to be due to migration of Escherichia coli across the perineum and up the urethra for which Smith 258 has recommended perineal hygiene, especially after sexual intercourse. In the case of an acute attack many authorities suggest a high fluid intake combined with bicarbonate of soda to alter the pH of the urine and short courses of antibiotics such as co-trimoxazole,...

Further investigations of female infertility

Male Groin Hernia Examination

Miscarriage, termination of pregnancy, ectopic pregnancy Chronic illnesses (diabetes, hypertension, renal disease) Known endocrine disorders, e.g. hypothyroidism, PCOS Previous STD's, e.g. Chlamydia Known endometriosis Galactorrhoea Cervical smear history Current medication including folate As a test of tubal obstruction, HSG has a sensitivity of 0.65 (95 CI 0.50-0.78) and a specificity of 0.83 (95 CI of 0.77-0.88) (Swart et al. 1995). This suggests that it is a reliable indicator of tubal patency but poor at identifying cases of tubal occlusion. A meta-analysis of 23 studies has found that the discriminative capacity of chlamydial antibody testing using enzyme-linked immunofluorescent assay is comparable to HSG in the diagnosis of tubal pathology (Mol et al. 1997). The use of ultrasound along with injection of a sonoreflective contrast medium through the cervix (HyCosy) has been described, but is yet to become part of standard care in most centres. Preliminary SCREENING FOR CHLAMYDIA...

Could Clarithromycin Prevent Asthma

Asthma is the most disabling of all chronic diseases in childhood, and one of the commonest. About 30 of individuals who are subsequently diagnosed, in middle childhood or later, as having asthma began with symptoms of recurrent wheezing, cough, and bronchospasm in the first year of life, A longitudinal study of infants who wheezed in the first year has revealed that only a portion, about 25 , who have had more severe symptoms and abnormal pulmonary function develop asthma in later life (1). Most severe childhood asthmatics become asthmatic adults. Prior studies have concentrated on family history and demographic factors such as low birth weight and prematurity, social risk, and lower maternal age. Infection with respiratory syncytial virus (RSV) and chlamydia pneumoniae also have been implicated in some studies of asthma, possibly through hostmediated IgE responses (2-4). It is not supposed that infection with U. urealyticum is the only source for chronic asthma. Other agents,...

Legionella and Spirochetes

Depending on the season and location, about 2-10 of community-acquired pneumonias (CAPs) are caused by Legionella spp. Most cases of Legionnaires' disease are caused by Legionella pneumophila, although infections by other species are well documented, Legionella spp. belong to the group of supposedly atypical organisms, together with Chlamydia pneumoniae, Coxiella burnetii, and Mycoplasma pneumoniae. The formerly sharp distinction between typical pneumonia (usually caused by S. pneumoniae and said to be characterized by an abrupt onset, high fever, chest pain, tachycardia, and consolidation, together with the production of purulent sputum) and atypical pneumonia, caused by a different set of microorganisms and causing a different clinical picture (vide infra) is probably of historical interest. Recognition of substantial clinical overlap, better diagnostic tools, the adoption of broad-spectrum regimens for empiric cov

Counselling and preassessment for abortion

Prophylactic antibiotics at the time of abortion are advocated by some and a meta-analysis by Sawaya et al. 9 showed a reduction in risk for subsequent infective morbidity of around 50 . However, that approach still leaves the women at-risk from reinfection from an unrecognized and untreated partner. A third, and possibly ideal strategy, with a 'belt and braces' approach would provide a prophylactic regimen effective against bacterial vaginosis and Chlamydia along with a full vaginal STI screen 10 . Prophylaxis and a 'screen and treat' policy have been compared in a randomized trial which concluded that universal prophylaxis is at least as effective as a policy of screen and treat in reducing the short-term infective complications of abortion and could be provided at lower direct cost 11 . The RCOG Guideline Development Group in the UK 8 recommended that all abortion services should adopt a strategy to reduce post-abortion infective problems and the...

Gender Ethnicracial And Life Span Considerations

Although the occurrence of chlamydial infection is related more to sexual practices than to age, many women with chlamydial infection are young, under 24 years of age, and single. Indigent women with no prenatal care are a high-risk group. The rate of infection is also highest in African American women, and it is highest in the southern states. With more teens engaging in sexual activity, more adolescents of both genders are contracting infections. Depending on the population, 5 to 35 of pregnant women are infected with C. trachomatis.

NOC Knowledge Disease Process

Teach about treatment antibiotics, analgesics, topical agents as ordered (specify) emphasize need to take full course of ordered antibiotic and follow-up exam for syphilis, gonorrhea, pelvic inflammation, chlamydial infection (application of topical chemical agent and removing the drug by washing off in 4-6 hours to remove warts) (topical application of topical antiviral to treat herpes) (specify).

Histology and pathology

Necrosis factor and gamma interferon soon lead to collateral damage to the surrounding tissue and invasion of the submucosa. The tissue damage associated with chlamydia is mediated primarily by the immune response to the infection occurring as a result of a delayed type hyper-sensitivity reaction to one of the chlamydial heat shock proteins. This is characterized by a low-grade lymphocytic response compared with the acute neutrophil response of gonococcal salpingitis. Recurrent infection with chlamydia causes further immune stimulation possibly mediated by a cross reaction between chlamydial and human heat shock proteins 60 15 . This exaggerated immune response following re-exposure to chlamydia may explain the exponential increase in the risk of tubal damage which occurs with repeated infection.

Tubal factor infertility

The principal cause of tubal disease is pelvic inflammatory disease (PID) which may occur spontaneously or as a complication of miscarriage, puerperium, intrauterine instrumentation and pelvic surgery. A single episode of PID carries up to 10 risk of future tubal factor infertility. The risk is aggravated by further infections due to Chlamydia trachomatis or Neisseria gonorrhoeae. Chlamydia is now the most common sexually transmitted disease (STD) in Europe and responsible for at least 50 of identifiable cases of PID. Due to its silent nature, most affected women give no prior history of chlamydia infection, although three quarters of them have anti-chlamydial antibodies in their serum. Factors associated with chlamydia infection contribute to an increased risk of tubal disease. These include multiple sexual partners, young age at first intercourse, poor socio-economic status, heavy alcohol consumption and cigarette smoking. Opinion on previous

Epidemiology and Diagnosis

Urinalysis should be performed on the urine obtained immediately after catheterization (if the patient is completely unable to void) and if anything abnormal is seen, the urine should be sent for formal microscopy and culture, and if sexually transmitted infection is suspected, particularly in younger sexually active patients, urine should also be sent for gonorrhea and chlamydia PCR testing (see also Sect. 11.2.5.2).

Sexually Transmitted Diseases Introduction

Sexually transmitted diseases (STD) are a diverse group of viral, bacterial, protozoal, and ectoparasitic infections that have a common route of transmission through sexual intercourse. Infectious organisms associated with STDs include Chlamydia trachomatis Neisseria gonorrhoeae bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis syphilis herpes simplex papillomavirus (genital warts) genital herpes and HIV. Infection by each of the above organisms has its own pattern of clinical patterns medications treatments prognosis transmission dynamics host response to infection and patterns of sexual contact.

Further investigations of male infertility

The significance of asymptomatic infection of the male genital tract as demonstrated by white blood cells in the ejaculate is unclear. Semen culture is indicated in men with microscopic evidence of infection. Male partners of women with chlamydia infection should be screened.

Biology Of The Organisms

Chlamydiae are obligate intracellular bacteria of limited metabolic capability, characterized by a dimorphic growth cycle. The infectious form is called the elementary body (EB) and is a condensed sporelike spheroid. The EB is metabolically inactive, consisting of a tightly compacted chromosome or nucleoid, and an outer membrane of covalently linked lipopolysaccharides. When it encounters host cells, the EB is taken in by receptor-mediated endocytosis. It has been suggested that a trimolecular mechanism is used to bridge a host receptor with a chlamydial receptor by glycosaminoglycan. 1 The man-nose receptor has also been suggested to have a role in the EB's entry into the cell. 2 The engulfed EB is enclosed in an endosome which does not fuse with a lysosome. Several hours after entering the cell, the EB converts to a metabolically active form called the reticulate body (RB) that undergoes binary fission, forming microscopically visible inclusions containing hundreds of organisms...

Who gets pelvic inflammatory disease

DQA 0501 and DQB 0402 have lower rates of infertility following a diagnosis of PID. It is also possible that certain strains of bacteria are more likely to cause PID than others but the evidence for this is limited, for example, serogroup A Neisseria gonorrhoeae, serovar F Chlamydia trachomatis. Many women with PID also have bacterial vaginosis with an overgrowth of the normal commensual bacteria in the vagina and loss of vaginal lactobacilli. These same vaginal commensual bacteria are often isolated from the upper genital tract raising the possibility that bacterial vaginosis may lead to PID. Longitudinal studies do not support a direct causal association, although women who catch gonorrhoea or chlamydia infection are at higher risk of PID if they also have pre-existing bacterial vagi-nosis suggesting some synergy between the different infections 3 .

Azithromycin in Control of Trachoma

UCSF Chlamydia Research Laboratory, San Francisco General Hospital San Francisco, California Trachoma control is currently based on use of topical tetracycline for infected children and corrective lid surgery for adults with trichiasis. The causative organism, Chlamydia trachomatis, is sensitive to a number of antibiotics, but for many years, tetracyclines were considered the drugs of choice. Recent introduction of azithromycin has dramatically changed our perspectives on treating chlamydial infection. Azithromycin has been shown to be effective in a single-dose therapy for genital chlamydial infection (C. trachomatis is a very common genital tract pathogen) (1). Thus, there is a potential for single-dose therapy of trachoma rather than the long-term treatment currently required with antibiotics such as tetracycline or erythromycin.

Pharmacokinetics

Third, the accumulation of antibiotic within the cells extends the microbiologic spectrum of activity to cover a variety of intracellular pathogens including Mycobacterium avium, legionella, chlamydia, and rickettsia. Activity against these organisms is achieved because of a combination of the high intravacuolar levels as well as the prolonged retention in that space, maximizing exposure of the bacterium to the drug. This prolonged exposure distinguishes the azalides from other macrolides and quinolones which reach elevated peaks but diffuse more rapidly from the cell (6). Table 2 displays the murine pharmacokinetic properties of three azalide analogs and the preferential accumulation of drug within tissues (7).

Clinical Studies

The azalides have distinguished themselves with improved acid stability, enhanced gram-negative activity, and a pharmacokinetic profile allowing for prolonged exposure with less frequent dosing. The prototype compound in this class is azithromycin and its early clinical development was focused on the treatment of respiratory tract disease, building on the enhanced activity against Haemophilus influenzae, Moraxella catarrhal is, Chlamydia pneumoniae, and legionella, while shortening the course of therapy from 10-14 days, typical with erythromycin, to 5 and even 3 days. Its activity against sexually transmitted pathogens, both intracellular, such as Chlamydia trachomatis, and gram-negative, such as Neisseria gonorrhoeae and Hemophilus ducreyi, was developed with single-dose strategies, so important in this area where lack of compliance remains a significant public health issue. Single-dose therapies for treatment of chlamydia, gonorrhea, and chancroid have been studied and published, as...

Therapy

The recommendations for antibiotic treatment of C. pneumoniae infections are based on in vitro studies, animal experiments, case reports, and experiences with the treatment of other chlamydial infections. Therapeutic regimens for C. pneumoniae include doxycycline, erythromycin, or clarithromycin for 2-3 weeks or a 5-day course of azithromycin. For recurrent infection a second course with a different antibiotic is recommended. There are singular publications of development of resistance in C. trachomatis, but resistance in C. pneumoniae has never

Trachoma

Trachoma remains the most common cause of preventable blindness in the world. It is found in communities with poor hygiene or sanitation facilities and inadequate access to potable water. The infection is endemic in many tropical and subtropical areas, especially countries in northern and southern Africa, the Middle East, and on the Indian subcontinent. It is transmitted by direct contact or by flies, which act as mechanical vectors. Trachoma presents as conjunctivitis of both the palpebral and bulbar conjunctivae, followed by the formation of lymphoid follicles the sequelae, entropion, and trichiasis arise as a result of conjunctival scarring, causing corneal damage. Repeated infection and associated bacterial superinfection can result in visual impairment and blindness. The conjunctival epithelium of infected children is the most important reservoir of infection in the affected communities. High chlamydial loads occur in very young children and have been directly correlated with...

Diagnostic Tests

A definitive diagnosis of chlamydial genital infection can be established solely on the basis of laboratory testing. In the past, the standard laboratory test for C. trachomatis genital infections was isolation of the causative organisms in cell culture. By definition, this test is 100 specific but it lacks sensitivity when compared to the newer NAATs. Several commercial tests are currently available (Table 1), and new tests are being developed every year. 8-11 The Roche Amplicor and Cobas Amplicor CT NG tests use polymerase chain reaction 12 the Becton-Dickinson B-D-

Gonorrhea

Many countries today report a high prevalence of 3-lactamase-producing strains of the gonococcus. This has led to use of fluoroquinolones or broad-spectrum cephalosporins as first-line drugs for treatment. However, the increasing appearance of isolates of Neisseria gonorrhoeae resistant to the quinolone drugs, especially ciprofloxacin and ofloxacin, has led to a search for treatment alternatives. In this context, a clinical trial by Gruber et al. (Rijeka, Croatia) compared azithromycin to ciprofloxacin for therapy of gonococcal infection. Frequency of cure and of adverse effects were similar for both drugs. Because the study was conducted in wartime in a busy port city with transient naval and merchant marine personnel, follow-up to ascertain treatment effectiveness was quite difficult. Nonetheless, in this setting, the ability to use a single 1 g dose of azithromycin for treatment of both gonorrhea and chlamydial infection was felt to be highly advantageous.

In Children

Chlamydia pneumoniae is emerging as an important cause of pneumonia in adults and children. Initial serologic studies suggested that this organism is an infrequent cause of pneumonia in young children. However, a recent multicenter treatment study from the United States isolated C, pneumoniae from 14 of children, 3-12 years of age, with radiographically documented pneumonia (1). Data on treatment of these infections are limited most studies have relied on serologic diagnosis thus, microbiologic efficacy could not be assessed. The purpose of the present study was to compare azithromycin suspension to erythromycin suspension and amoxicillin-clavulanate for the treatment of pneumonia in children.

Virulence Factors

Clinical diagnosis of chancroid is unreliable because of similarities of the clinical presentation of different etio-logic agents of GUD, the presence of mixed infections, and atypical ulceration due to long-standing disease. 8 Next to H. ducreyi, causative pathogens of GUD are herpes simplex virus type 2 (HSV-2) and type 1 (HSV-1) and the bacteria T. pallidum (TP), which cause syphilis, and Chlamydia trachomatis, which cause lymphogranuloma venereum. In about 20-40 of GUD cases none of these pathogens are found despite use of the most sensitive assays. 9,10 Coinfection of H. ducreyi and HSV occurs commonly in the tropics. 6

Pcrldr And GapLCR

A major problem of the LCR reaction is joining of blunt end duplexes to each other and to themselves, all of which can serve as templates for further amplification, although no real target DNA is present in the original sample 7 and this poses significant limitations on the sensitivity of LCR. 6 To overcome this problem, several modifications have been developed, including a combined PCR LDR method and Gap-LCR (G-LCR). In PCR LDR, the amplification step for LDR is PCR utilizing outside primers and employing only one pair of adjacent probes to detect the proper sequence in the PCR produced. This procedure does not produce double-stranded oligonucleo-tides to blunt end ligate. 4 A recent study showed that PCR LDR was more accurate than FISH in the quantification of HER2 neu gene copy numbers. 19 Gap-LCR is a version of LCR where the probes are not adjacent but are separated by one to three bases on both the sense and antisense strand. A nonstrand displacing thermostable DNA polymerase,...

Microbiology

Pelvic inflammatory disease is a polymicrobial infection. Gonorrhoea and chlamydia are the most frequently recognized pathogens but a wide variety of other bacteria and viruses can also be isolated from the fallopian tubes of women with PID (Table 42.1). CHLAMYDIA TRACHOMATIS Chlamydia trachomatis is an unusual bacterium as it requires a host cell to grow (obligate intracellular organism), behaving in some ways more like a virus. To detect the organism therefore, the optimal specimen needs to contain cells and should be collected by gently rubbing against the endocervix with a swab. The use of sensitive nucleic acid amplification tests (NAAT) also allows the use of other more accessible samples to detect chlamydia, for example, vulval swabs (which the patient can take herself after appropriate instruction) or first pass urine. Light microscopy is not useful since C. trachomatis is too small to be seen. Chlamydia, like gonorrhoea, initially infects the cervix and sometimes also the...

Treatment

Broad spectrum antibiotic cover to include gonorrhoea, chlamydia and anaerobes is required. The optimal choice of antibiotics may be affected by knowledge of local bacterial resistance patterns, severity of disease, cost and patient convenience. Parenteral therapy should be continued until 24 h after clinical improvement and then switched to oral. PID is usually secondary to a sexually acquired infection so, unless the male partners are identified and either screened for infection or treated empirically, the woman with PID is at high risk of a recurrence. Current male partners should be offered screening for gonorrhoea and chlamydia, and attempts made to contact other partners within the past 6 months, although the exact time period will be influenced by the sexual history. If screening for sexually acquired infections is not possible then antibiotic therapy effective against gonorrhoea and chlamy-dia should be given empirically to the male partners (Fig. 42.3 see British Association...

Prognosis

There is clear, population based, epidemiological evidence of the relationship between a finding of Chlamydia trachomatis specific IgG antibodies and subsequent tubal subfertility 18 . Mild endometritis following surgical termination of pregnancy is relatively common ( 1-2 ) and needs to be treated aggressively to ensure future fertility. If pre-treatment screening for sexually transmitted infection has been employed, it is very unusual to find a positive result on repeat swabs. It is, however, prudent to treat with a broad spectrum of antibiotics effective against both Chlamydia and anaerobes, for example, ofloxacin plus metronidazole, or moxifloxacin. An IUCD only increases the risk of developing PID in the first few weeks after insertion and except for subacute infections with actinomyces, there appears to be no evidence of increased risk with the continuing use of an IUCD. Routine screening for chlamydia, gonorrhoea and bacterial vaginosis before insertion will therefore reduce...

Investigations

Excluding the possibility of ongoing pelvic infection such as Chlamydia by taking endocervical swabs is often useful to allay anxiety. Ultrasound examination may be useful in identifying uterine or adnexal pathology and has been shown to be an effective means of providing reassurance 18 . The presence of dilated veins may indicate pelvic congestion 19 but a recent study using power Doppler suggested that the primary value of sonography was to identify the characteristic multicystic ovarian morphology seen in this condition 20 . Transuterine venography is of limited value in routine clinical practice but is technically simpler than selective catheterization of the ovarian vein. MRI provides the opportunity to identify adenomyosis but is not routinely indicated.

Proteoglycans

Step of the disease, but the most recent version of this hypothesis emphasizes endothelial dysfunction rather than endothelial denudation. Several causes suspected to be responsible for endothelial dysfunction including elevated and modified low density lipoproteins (LDL), free radicals caused by cigarette smoking, elevated plasma homocysteine concentrations, hypertension, infections by microorganisms such as herpes virus or Chlamydia pneumoniae and other factors 2 . The chronicity of the inflammation results in emigration of numerous inflammatory cells from the blood within the lesion. Activation of these cells leads to release of several proteases, cytokines, chemokines and growth factors, which induce further damage and eventually lead to focal necrosis. The repeated cycles of emigration and proliferation of smooth muscle cells (SMCs) and accumulation of fibrous tissue and inflammatory cells lead to further enlargement and formation of advanced complicated lesion 3 . In this case...

Application

The practical uses of RAM assay to detect target nucleic acids in clinical samples have been demonstrated in several studies (Fig. 2). Zhang et al. have applied the RAM assay to detect Chlamydia trachomatis, a leading cause of sexually transmitted disease (STD) in the United States, in cervical specimens collected in PreservCyt cytological solution. 10 They demonstrated the RAM assay can detect as few as 10 C. trachomatis elementary bodies in less than 2 hr, comparable with those of Amplicor PCR and ligase chain reaction (LCR), and they further tested 30 clinical specimens and detected all positive samples confirmed by PCR and LCR. The RAM assay can be an alternative to PCR and LCR to detect sexually transmitted agents because of its simplicity and isothermal amplification nature. Furthermore, it is possible to screen simultaneously cervical intraepithelial lesions and to detect STD agents in a single collection vial. Zhang et al. have also successfully applied the RAM assay for...

Female

Hysterosalpingography (HSG) has been used for many decades but had a reputation for being painful. With newer techniques and in particular the advent of suction caps and small balloon catheters, the need for unnecessary trauma is obviated. It allows assessment of both the uterine cavity and the fallopian tubes and it is an extremely useful screening test that can be performed with a high degree of accuracy without the need for a general anaesthetic. It is recommended that chlamydial screening should be performed beforehand, preferably as part of the initial work up of the female partner, and antibiotic cover for the procedure should be used.

Yoshikiyo Toyonaga

Acute lower respiratory tract infection in children aged 1 year or older is generally caused by Mycoplasma pneumoniae. Chlamydia pneumoniae, Haemophilus influenzae, pneumococci, or Moraxella catarrhalis. Clarithromycin (CAM) is approved for use against infectious diseases caused by these organisms.

Infections

The majority of sticky eyes are not infected but are due to a blocked nasolacrimal duct. In the absence of conjunc-tival redness or swelling investigation for infection and treatment with topical antibiotics is not required. Simple measures such as cleaning with boiled water and lacrimal duct massage suffice with symptoms usually resolving in 3-6 months. Neonatal conjunctivitis can be caused by such organisms as Staphylococcus aureus, Chlamydia trachomatis, Haemophlus influenzae, Streptococcus pneumoniae and Neisseria gonorrhoeae. Gonococcal ophthalmia usually presents within 24 h of delivery with profuse purulent conjunctival discharge and immediate diagnosis and treatment (systemic and topical) is required to prevent damage to the cornea. Chlamydial ophthalmia which is now among the commonest causes of neonatal conjunctivitis presents between 5 and 12 days postnatal age some babies infected as neonates will develop chlamydial pneumonia later in infancy. Corneal scarring is rare 14...

Epididymitis

The patient's age suggests the most likely etiology of epididymitis. Within each age group, the cause appears to be the same as the most common cause of genitourinary infection in that group. In heterosexual men younger than 35, urethritis caused by Neisseria gonorrhoeae or Chlamydia trachomatis is more common than bacteriuria. Thus, in this patient population, epididy-mitis is most commonly caused by these same organ

Iodine and lodophors

Iodine and iodophors have a wide range of activity against gram-positive and gram-negative bacteria, tubercle bacillus, fungi, and viruses. Their activity is based on the oxidizing potential of iodine. Some new studies have shown that povidone-iodine is effective against MRSA, Chlamydia, Herpes simplex, adenoviruses, and enteroviruses 62 .

In Vitro Activity

The in vitro activity of erythromycin encompasses most streptococci, including Streptococcus pneumoniae, Streptococcus pyogenes, and the viridans streptococci, but excludes the enterococci. Staphylococcus aureus is also susceptible with the exception of methicillin-resistant strains (MRSA) which are often multiresistant. Other sensitive gram-positive pathogens include corynebacterium and Listeria monocytogenes. Susceptible gram-negative pathogens include Neisseria gonorrhoeae, Moraxella catarrhalis, Legionella pneumophila, and Bordetella pertussis. Activity against Haemophilus influenzae is equivocal. Gram-positive anaerobic bacteria are often sensitive. The Enterobacteriaceae are not considered susceptible. Other susceptible pathogens include Mycoplasma pneumoniae, Chlamydia trachomatis, Chlamydia pneumoniae, Treponema pallidum, Borrelia burgdorferi, and Mycobacterium spp. Erythromycin is an alternative agent for the treatment of gonococcal infections and also provides useful...