Chlamydial Infection - a comprehensive view
Several types of nonculture tests for detection of C. trachomatis in clinical specimens have been available in the past. These include EIAs, specifically Chlamydiazyme (Abbott Diagnostics, Chicago, IL) and MicroTrak EIA (Genetic Systems, Seattle, WA) and direct fluorescent antibody (DFA) tests, including Syva MicroTrak (Genetic Systems, Seattle, WA) and Pathfinder (Sanofi-Pasteur, Chaska, MN) and a deoxyribonucleic acid (DNA) hybridization assay, GenProbe Pace II (GenProbe, San Diego, CA), were introduced in the 1980s (20). Unlike the DFA, EIAs were semiautomated and suitable for processing large numbers of specimens. EIAs use either a polyclonal or a monoclonal antibody directed against the Chlamydia genus-specific lipopolysaccharide antigen. These tests will detect other chlamydia species, specifically C. pneumoniae, if used for respiratory specimens. The direct nucleic acid probe was until recently the most commonly used nonculture test for detection of C. trachomatis in many...
Chlamydia is the most common bacterial STD in the United States. The microorganism Chlamydia trachomatis infects more than 3 million men and women each year. Chlamydia also is one of the most devastating STDs, because it often causes no symptoms and can lead to pelvic inflammatory disease (PID) in women. PID is responsible for up to 15 percent of cases of female infertility. Among men, chlamydia is one of the leading causes of urethritis (inflammation of the urethra). If you experience pain during urination, burning or itching around the urethra, a discharge from the penis, or swelling in the testicles, you may have chlamydia. About 50 percent of infected men have none of these symptoms and do not get treatment, which puts their sexual partners at considerable risk. Women are even less likely to have symptoms, but they are more likely to experience long-term consequences. In addition to developing PID, a woman with chlamydia can pass the infection to her baby during childbirth,...
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.
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.
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
A new sexual partner increases the risk of acquiring sexually transmitted diseases, such as trichomonas, chlamydia, or Neisseria gonorrheae. Trichomoniasis often occurs during or immediately after the menstrual period candida vulvovaginitis often occurs during the premenstrual period.
A diagnosis of cervicitis, typically due to Neisseria gonorrhoeae or Chlamydia trachomatis, must always be considered in women with purulent vaginal discharge. The presence of high-risk behavior or any sexually transmitted disease requires screening for HIV, hepatitis B, and other STDs.
Bacterial vaginosis (BV) is characterized by changes in the microbiological flora of the vagina, where there is a transition from Lactobacillus sp to Gram-negative and anaerobic bacteria. The most characteristic organisms are Gardnerella vaginalis, Chlamydia, Myocoplasma, and anaerobes such as Bacteroides andMobiluncus (42,43). There are no studies correlating the clinical diagnosis of BV and placental pathology. BV is associated with second trimester fetal loss and premature delivery (44,45). Pla-cental changes often include severe chorioamnionitis, which is frequently necrotizing and polymicrobial (43).
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).
Testing for sexually transmitted diseases (eg, HIV, syphilis, hepatitis B surface antigen, chlamydia, gonorrhea) should be repeated in the third trimester in any woman at high risk for acquiring these infections all women under age 25 years should be retested for Chlamydia trachomatis late in pregnancy. E. Pap smear, urine pregnancy test, urinalysis and urine culture. Cervical culture for gonorrhea and chlamydia.
Testing for sexually transmitted diseases (eg, HIV, syphilis, hepatitis B surface antigen, chlamydia, gonorrhea) should be repeated in the third trimester in any woman at high risk for acquiring these infections all women under age 25 years should be retested for Chlamydia trachomatis late in pregnancy.
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.
Epidemiological evidence strongly suggests that the infant acquires chlamydial infection from the mother during vaginal delivery. Ascending infection through intact membranes during pregnancy can occur, but is very rare. Depending on the population examined, cervical infection with C. trachomatis has been reported in 2-30 of pregnant women attending prenatal clinics (4-8). In most studies, chlamydial infection was far more prevalent than gonococcal infection. The prevalence of chlamydial infection is associated more weakly with socioeconomic status, urban or rural residence, and race or ethnicity than are gonorrhea and syphilis. The prevalence of C. trachomatis infection is consistently higher than 5 among sexually active adolescent and young adult women attending outpatient clinics, regardless of the region of the country, location of the clinic (urban or rural), and the race or ethnicity of the population. Among sexually active adolescents, prevalences commonly exceed 10 and may...
The majority of women, including pregnant women, with chlamydial infection are asymptomatic. Results from a National Institutes of Health-sponsored multicenter study of 8000 pregnant women (Vaginal Infection and Prematurity Study Group) found that cervical polymorphonuclear (PMN) leukocytes were poor predictors of the existence of chlamydial infection (8). The predictive values of cervical mucopus and cervical PMNs were lower than those reported in nonpregnant women. Cervical friability was also an insensitive indicator. Infection with C. trachomatis in pregnancy has been inconsistently linked to preterm delivery, low birth weight, and premature rupture of the membranes. A major problem with several of these studies has been the confounding presence of other infections, especially the genital mycoplasmas (Mycoplasma hominis and Ureaplasma urealyticum) and the organisms involved with bacterial vaginosis, which also may have adverse effects on the pregnancy and fetus (5,10). Results...
An infant born to a woman with active cervical infection with C. trachomatis is at risk of acquiring the infection during passage through the infected birth canal. Approximately 50-75 of infants born to infected women become infected at one or more anatomic sites, including the conjunctiva, nasopharynx, rectum, and vagina (Table 1). Overall, the nasopharynx is the most frequently infected site in the infant. Approximately 30-50 of infants born to Chlamydia-positive mothers will develop conjunctivitis (11-14). Studies in the 1980s identified C. trachomatis in 14-46 of infants younger than 1 month of age presenting with conjunctivitis. Chlamydia ophthalmia appears to occur much less frequently now secondary to systematic screening and treatment of pregnant women. The incubation period is 5-14 days after delivery. C. trachomatis is usually not detectable in the eye or nasopharynx immediately after birth unless there has been prolonged rupture of membranes. At least 50 of infants with...
Chronic endometritis in the nonobstetric population is due to infections (eg, chlamydia, tuberculosis, and other organisms related to cervicitis and PID), intrauterine foreign bodies (eg, intrauterine device, submucous leiomyoma), or radiation therapy. In the obstetric population, chronic endometritis is associated with retained products of conception after a recent pregnancy.
Superficial ophthalmic infections due to Staphylococcus aureus, Streptococcus, Streptococcus pneumoniae, Escherichia coli, Neisseria, and Bacteroides. Prophylaxis of Neisseria gonorrhoeae in newborns. With oral therapy for treatment of Chlamydia trachomatis. Topical Acne vulgaris, prophylaxis or treatment of infection
An infection can begin when microorganisms, usually bacteria from the digestive tract (such as Escherichia coli, also called E coli), accumulate at the opening of the urethra. An infection that affects only the urethra is called urethritis. From the urethra, bacteria often move up to the bladder, causing a bladder infection (cystitis). Sexually transmitted microorganisms, such as those that cause gonorrhea and chlamydia, also can infect the urinary tract.
DLE of the oral mucosa is not an infrequent finding. It begins as one or a few round, well-demarcated erythematous plaques with patchy and streaky white hyperkeratosis, most often of the buccal mucosa, the (lower) lips, and the hard palate, that often turn into erosions and even ulcers. Lesions tend to be symptomless. Involvement of the conjunctival mucosa occurs much less often and may lead to ectropium and scarring (differential diagnoses cicatricial pemphigoid, chlamydial conjunctivitis, and basal cell carcinoma).
Uses Should not be used for trivial infections. Systemic. Serious respiratory tract infections (e.g., empyema, lung abscess, pneumonia) caused by staphylococci, streptococci, and pneumococci. Serious skin and soft tissue infections, septicemia, intraabdominal infections, pelvic inflammatory disease, female genital tract infections. May be the drug of choice for Bacteroides fragilis. In combination with aminoglycosides for mixed aerobic and anaerobic bacterial infections. Staphylococci-induced acute hematogenous osteomyelitis. Adjunct to surgery for chronic bone joint infections. Bacterial endocarditis prophylaxis. Non-FDA Approved Uses Alternative to sulfona-mides in combination with pyri-methamine in the acute treatment of CNS toxoplasmosis in AIDS clients. In combination with primaquine to treat Pneumocystis carinii pneumonia. Chlamydial infections in women. Bacterial vaginosis due to Gardnerella vaginalis. Topical Use. Used topically for inflammatory acne vulgar-is. Vaginally to...
Tests for gonorrhea and chlamydia should be obtained, and the cervix and vagina should be prepared with a germicide. Paracervical block is established with 20 mL of 1 lidocaine injected deep into the cervix at the 3, 5, 7, and 9 o'clock positions. The cervix should be grasped with a single-toothed tenaculum placed vertically with one branch inside the canal. Uterine depth is measured with a sound. Dilation then should be performed with a tapered dilator.
Health care providers should maintain a low threshold for the diagnosis of PID, and sexually active young women with lower abdominal, adnexal, and cervical motion tenderness should receive empiric treatment. The specificity of these clinical criteria can be enhanced by the presence of fever, abnormal cervical vaginal discharge, elevated ESR and or serum C-reactive protein, and the demonstration of cervical gonorrhea or chlamydia infection.
Mophilus influenzae, and Bacte-roides infections. Also prophylaxis of ocular infections due to Neisseria gonorrhoeae and Chlamydia trachomatis. Topical solution Acne vulgaris. Topical ointment Prophylaxis of infection in minor skin abrasions treatment of superficial infections of the skin. Acne vulgaris. Contraindications Use of topical preparations in the eye or near the nose, mouth, or any mucous membrane. Ophthalmic use in dendritic keratitis, vaccinia, varicella, myobac-terial infections of the eye, fungal diseases of the eye. Use with steroid combinations following uncomplicated removal of a corneal foreign body. Chlamydial infections. Infants 50 mg kg day in four divided doses for 14 (conjunctivitis) to 21 (pneumonia) days adults 500 mg q.i.d. for 7 days or 250 mg q.i.d. for 14 days for urogenital infections. Prophylaxis of neonatal gonococcal or chlamydial conjunctivitis.
Test for syphilis, rubella antibody titer, urinalysis, culture, Pap smear, cervical cultures for gonorrhea and Chlamydia, and hepatitis B surface antigen (HbsAg). 2. During labor, the CBC, urinalysis and RPR are repeated. The HBSAG is repeated for high-risk patients. A clot of blood is placed on hold.
Chlamydiae are obligate intracellular pathogens that have established a unique niche within the host cell. Until recently, the order Chlamydiales contained one family, Chlamydiaceae, which contained one genus, Chlamydia, with four recognized species Chlamydia trachomatis, Chlamydia psittaci, Chlamydia pneumoniae, and Chlamydia pecorum. The species most important in human disease are C. trachomatis and C. pneumoniae. C. trachomatis infection is the most prevalent sexually transmitted pathogen and infectious disease in the United States today (1). The Centers for Disease Control and Prevention estimates that the number of new C. trachomatis infections exceeds 4 million annually (1,2). C. pneumoniae is now recognized as an important respiratory pathogen, and C. psittaci is primarily a zoonosis. Taxonomic analysis using the 16S and 23S ribosomal ribonucleic acid (RNA) genes have suggested that the order Chlamydiales contains at least four distinct groups at the family level, and that...
Laboratories, Lenexa, KS) or can be prepared locally (62). 2 SP (10 v v heat-inactivated fetal calf serum with 0.2M sucrose in 0.02M phosphate buffer, pH 7.2), which is also used for transport of specimens for chlamydial cultures, is also acceptable. Other media available commercially for transport and storage of specimens include Stuart's medium, A3B, and arginine broth. From a practical standpoint, transport media can be kept frozen in small volumes in a freezer located in a clinical unit so that it can be rapidly thawed and used to inoculate specimens at bedside.
Action Kinetics Well absorbed. Peak serum levels 4-5 hr. 50 excreted in the urine. Uses Community acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, or Streptococcus pneumoniae. Acute bacterial exacerbations of chronic bronchitis caused by C. pneumoniae, Enterobacter cloacae, H. influenzae, H. parainfluenzae, Klebsiella pneumoniae, M. catarrhalis, Staphylococ-cus aureus, or S. pneumoniae. Contraindications Hypersensitiv-ity, photosensitivity, disopyramide, amiodarone, and class Ia and III antiarrhythmics, terfenadine, bepri-dil patients with prolonged Qtc intervals, hypokalemia, significant bradycardia
Chlamydia is treated with erythromycin if the patient is pregnant. If compliance is an issue (alcoholic, drug abusing, homeless, or unreliable patient), you can give azithromycin, 1 gm orally all at once, and watch the patient take it. 2. Any patient with gonorrhea is generally treated lor presumed chlamydial coinfection (give ceftriaxone and doxycycline).
Prostatitis is an extremely common condition, which is classified into several subgroups. Acute bacterial prostatitis is the result of an acute pathogenic infection and can lead to chronic bacterial prostatitis. Chronic nonbacterial prostatitis, or chronic pelvic pain syndrome (CPPS), is a multifactorial condition that may be linked to other conditions such as bladder neck obstruction, urethral stricture, detrusor sphincter, dyssynergia, or dysfunctional voiding. Nonculturable organisms and sexually transmitted infections (e.g., Chlamydia trachomonas) are also possible causes.