Chlamydia trachomatis infections in adolescents

The guidelines of the Centers for Disease Control should be applied with appreciation of their limitations. The serious sequelae of chlamydial infections in young patients warrant vigorous antichlamydial therapy and specific microbiologic diagnosis. Until public health authorities implement control programs, the efforts of individual practitioners will probably be the mainstay of the flight against C. trachomatis.     

婴幼儿沙眼衣原体肺炎的临床特征及基因型分布

目的 了解湖南郴州地区3个月以内的婴幼儿沙眼衣原体(Chlamydozoa trachomatis,CT)肺炎临床特征、基因型分布及致病力差异,为临床的诊治提供理论依据.方法 采集719例肺炎患儿支气管肺泡灌洗(bronchoalveolar lavage fluid,BALF)标本,用实时荧光定量PCR法检测CT,再...     

沙眼衣原体、支原体感染的不孕症抗生素治疗后临床观察

目的 :探讨沙眼衣原体 (CT)、支原体感染不孕症夫妇系统抗生素治疗后的临床效果。方法 :对CT ,溶脲脲原体 (Uu)和人型支原体 (Mh)感染的原发不孕和继发不孕症 112例进行系统的夫妻双方抗生素治疗及临床随访。结果 :抗生素治疗后CT、Uu和Mh感染转阴率为 77.7% (87/ 112 ) ,不育丈夫的精液常规明显好转 (P <0 .0 1) ,87例治疗后感染转阴的不孕症患者 1年内有 39例妊娠 ,妊娠率为 4 4 .8% (39/ 87) ,妊娠成功率为 84 .6 % (33/ 39)。 4例患者再次感染CT、Uu和Mh而妊娠失败 ,2例发生宫外孕 ,妊娠失败率为 15 .4 % (6 / 39)。结论 :CT、Uu和Mh感染的不育不孕症抗生素系统治疗是有效的 ,对妊娠妇女有必要进行妊娠早期的CT、Uu和Mh感染监测和再次感染治疗。     

Diagnosis and follow-up of Chlamydia trachomatis infections in the ED

The purpose of this study was to determine the impact on patient care and the cost effectiveness of testing for chlamydial infection in the emergency department. All patients tested for chlamydial infection in three emergency departments between October 1, 1993 and January 31, 1994 were retrospectively reviewed for charges and adequacy of therapy. In one hospital, the effectiveness of a call-back system to enhance proper therapy of inadequately treated patients was evaluated. Of 2,416 test results, 249 were positive, and 197 of these charts were available for review. All 16 male patients were treated appropriately at the initial visit; 105 of 181 female patients were inadequately treated at the initial visit. The charge to identify each patient inadequately treated was $981.22 ($103,000 for 105). Of the 28 inadequately treated patients receiving a follow-up call, 20 sought treatment. The high cost of testing patients cannot be justified without an adequate surveillance system to enhance proper follow-up treatment.     

Approaches to the management of uncomplicated genital Chlamydia trachomatis infections

Genital chlamydial infection remains a highly prevalent sexually transmitted infection in the USA. A multifaceted approach to the management of chlamydial infection is essential to ensure cure and prevention of reinfection. This article will review current approaches to the management of uncomplicated genital chlamydial infection, discussing: the pathogen; antimicrobials that are and are not recommended for therapy by the US Centers for Disease Control and Prevention; partner treatment; follow-up; antimicrobial resistance; and potential future therapies.     

Incidence of Chlamydia trachomatis infections in pregnant patients in Vienna

Pregnant women were examined for chlamydia trachomatis-infection on a routine basis during a multicentric study in Vienna. Samples were taken from the cervix and fornix between the 30th and 34th week pregnancy. FTIC-conjugated monoclonal antibodies and immunofluorescence techniques were used to verify chlamydia trachomatis. Out of 1238 pregnant women, 101 (8.16%) were positive for chlamydia trachomatis. Since chlamydia infections can result in severe local or generalized complications and also spread to the newborn baby, screening investigations should be regularly performed during pregnancy and, if indicated, adequate treatment undertaken.     

Approaches to the management of uncomplicated genital Chlamydia trachomatis infections

Genital chlamydial infection remains a highly prevalent sexually transmitted infection in the USA. A multifaceted approach to the management of chlamydial infection is essential to ensure cure and prevention of reinfection. This article will review current approaches to the management of uncomplicated genital chlamydial infection, discussing: the pathogen; antimicrobials that are and are not recommended for therapy by the US Centers for Disease Control and Prevention; partner treatment; follow-up; antimicrobial resistance; and potential future therapies.     

Chlamydia trachomatis in patients with genital contact infections in Austria--studies of 3,367 patients

In order to evaluate the epidemiological importance of Chlamydia trachomatis (C. trachomatis) as a genital microorganism, data were obtained from 3,367 patients with sexually transmitted diseases in Vienna and analyzed by computer-assisted methods. C. trachomatis was cultured in 26.1% of 2,594 patients investigated for the first time. The microorganism was found more often in male patients (31.3%) than in female patients (21%). 32.2% of positive Chlamydia cultures were obtained from patients with non-gonococcal urethritis (NGU) and 64% from postgonococcal urethritis (PGU) patients. A high coincidence with Neisseria gonorrhoeae (N. gonorrhoeae) was detected in males (31.2%) and females (43.5%). Data on Mycoplasma hominis (M. hominis), and Ureaplasma urealyticum (U. urealyticum) show that, in contrast to the low incidence of M. hominis and U. urealyticum in males, the organisms were found predominantly in females.     

PCR detection and differentiation of Chlamydia pneumoniae, Chlamydia psittaci and Chlamydia trachomatis.

A PCR-based system was developed for the detection and differentiation of Chlamydia trachomatis, Chlamydia psittaci and Chlamydia pneumoniae. A conserved 145 bp fragment of the chlamydial omp1 gene was amplified from all three species. The three species were then differentiated from each other by digestion of this PCR product with restriction enzymes Eco RI and either Hind III or Pst I. The system was shown to work for two strains of C. pneumoniae, 11 strains of C. psittaci and 10 serovars of C. trachomatis, and had a sensitivity of less than 10 chlamydial elementary bodies. This method was also applicable to the detection of C. trachomatis in conjunctival and nasopharyngeal swabs.     

Sexually transmitted diseases in women. Chlamydia trachomatis and herpes simplex infections

C trachomatis infection is the most commonly reported STD in the United States, and the majority of women infected are asymptomatic. Screening is recommended for those at high risk, including women who are between 15 and 21 years of age, live in urban areas, are single, or have new or multiple sexual partners. The "gold standard" for diagnosis is chlamydial culture; however, techniques that use DNA and RNA amplification are nearly 100% sensitive and specific and may prove cost-effective. Doxycycline is a recommended first-line therapy, but certain other antibiotics may also be effective. Herpes simplex virus affects more than one third of the world's population. It is diagnosed by observation of shallow, tender ulcerations around the genitalia and by viral isolation using tissue culture. Initial treatment is with antiviral drugs, which may also be necessary episodically or as a suppressive regimen for recurrences. Patient education about prevention of these and other STDs, as well as the impact of such disease on sexual partners, is critical. Physicians should therefore become comfortable questioning and counseling patients about sexual issues and risks for STDs.     

Comparison of spiramycin and doxycycline for treatment of Chlamydia trachomatis genital infections.

We performed a single blind controlled multicenter study in which we compared the efficacy and safety of 100 mg of doxycycline versus those of 1 g (3 x 10(6) IU) of spiramycin given orally twice daily for 14 days in the treatment of culture-positive Chlamydia trachomatis genitourinary tract infections. A total of 367 patients were enrolled in the study, and 364 patients were evaluable for safety and 265 patients were evaluable for efficacy. The cure rate between treatment groups was not statistically significant, being 98% (125 of 128 patients) in the spiramycin group and 100% (133 of 133 patients) in the doxycycline group. Female patients who received spiramycin were more likely to report dysethesias that resolved after the completion of therapy. The results of the study show that spiramycin is an effective drug for the treatment of C. trachomatis infection and warrants further assessment over a shorter treatment period (7 days) and during pregnancy.     

Cervicovaginal coinfections with human papillomavirus and Chlamydia trachomatis

Human papillomavirus (HPV) and Chlamydia trachomatis (CT) are the two most common sexually transmitted pathogens, and infection with either reportedly was associated with cervical intraepithelial neoplasia (CIN) in women. In view of their similar mode of transmission, CT infection was examined as a possible HPV cofactor in the etiology of CIN disease. In total, 129 women were included in the study, of whom 80 were negative (mean age 34.17 +/- 6.9) and 49 were positive (mean age 33.16 +/- 6.8) for HPV DNA (assessed by PCR). CT DNA was determined in endocervical and first-catch urine specimens by PCR. Whereas HPV-positive and HPV-negative women were similar with respect to age (p = 0.419) and pregnancy outcomes (p = 0.628), the number of smokers (p = 0.001), women with multiple male sex partners (p = 0.002) or with abnormal cytology (p < 0.001) was higher in the HPV-positive group. There was an increase in CT infection rate in HPV-positive (29/49) as compared to HPV-negative (10/80) women (p < 0.01). Within HPV-positive patients, there was no significant difference between CT-positive and CT-negative patients with regards to the risk factors studied. Collectively, this suggests that CT infection is a cofactor of HPV in CIN disease development, possibly by modulating the host's immunity and/or precipitation of chronic inflammation.     

泌尿生殖系感染患者尿液中沙眼衣原体、淋球菌、解脲脲原体感染分析

目的检测泌尿生殖系统感染患者尿液中沙眼衣原体(CT)、淋球菌(NG)、解脲脲原体(UU)感染状况,并进一步了解CT、NG、UU病原体在深圳市的感染情况,为临床诊治提供实验室依据。方法采集疑似泌尿系统感染的609例患者(其中男305例,女304例)尿液,并选取其中108例患者同时采集尿液、分泌物,采用实时荧光聚合酶链反应(PCR)检测CT、NG、UU。结果 CT、NG、UU在分泌物及尿液中的检测结果比较差异无统计学意义(P0.05)。单纯感染UU阳性率最高,为42.04%(256/609);CT+NG+UU感染患者感染率为0.33%(2/609);CT+UU感染是双重感染中最高,为2.63%(16/609)。男性患者CT、NG、UU感染率分别为:29.18%(89/305)、14.10%(43/305)、52.45%(160/305);女性患者CT、NG、UU感染率分别是:3.29%(10/304)、2.63%(8/304)、31.58%(96/304)。20岁者CT、NG、UU阳性检出率为64.00%,20~29岁者为63.16%,29~39岁者为63.34%,39岁者为75.00%。结论采用尿液和分泌物检测CT、NG、UU的检出率基本一致;CT、NG、UU的感染率后者明显高于前二者,混合感染以CT+UU感染率最高;男性患者CT、NG、UU感染率均高于女性。     

Dose-ranging study of fleroxacin for treatment of uncomplicated Chlamydia trachomatis genital infections.

Men and women with suspected or proven genital infections caused by Chlamydia trachomatis were enrolled in a double-blind study to evaluate the efficacy and tolerability of fleroxacin. Patients received either 400, 600, or 800 mg once daily for 7 days and were monitored approximately 2, 4, and 7 weeks after initiation of therapy. In men monitored for at least 6 weeks or until failure of the therapy, fleroxacin failed to eradicate C. trachomatis in three of eight on the 400-mg regimen, in one of four on the 600-mg regimen, and in four of seven on the 800-mg regimen. All five women monitored for at least 6 weeks became culture negative. There was no association between in vitro susceptibility of C. trachomatis to fleroxacin and outcome, with MICs being 4 to 8 migrograms/ml for almost all isolates tested. Among those with positive cultures for Ureaplasma urealyticum initially, the first follow-up cultures remained positive in 8 (29%) of 28 men and 8 (50%) of 16 women. Independent of culture results, men with nongonococcal urethritis receiving 800 mg of fleroxacin were significantly more likely to show a clinical response than men receiving 400 or 600 mg (93 versus 54%). Adverse events were frequent, often severe, and dose related. Insomnia and photosensitivity reactions were the most important. The adverse reactions and unacceptably high rates of microbiologic failure resulted in premature termination of the study.     

Chlamydia trachomatis infections of the female genital tract: state of the art

Chlamydia trachomatis (CT) is the most common bacterial cause of sexually transmitted infections. CT infections are strongly associated with risk-taking behavior. Recommendations for testing have been implemented in many countries. The effectiveness of the screening programs has been questioned since chlamydia rates have increased. However, the complication rates including pelvic inflammatory disease, tubal factor infertility, and tubal pregnancy have been decreasing, which is good news. The complication rates associated with CT infection have clearly been over-estimated. Genetic predisposition and host immune response play important roles in the pathogenesis of long-term complications. CT plays a co-factor role in the development of cervical neoplasia caused by high-risk human papillomavirus (HPV) types. The evidence linking CT and other adverse pregnancy outcomes is weak. The current nucleic acid amplification tests perform well. A new genetic variant of CT was discovered in Sweden but has only rarely been detected elsewhere. Single-dose azithromycin remains effective against CT. Secondary prevention by screening is still the most important intervention to limit the adverse effects of CT on reproductive health.