Erythromycin stearate in treating chlamydial infection of the cervix.

A total of 157 women attending departments of genitourinary medicine were treated for chlamydial infection of the cervix with erythromycin stearate 500 mg twice a day. Chlamydiae were eradicated from the cervix in 64/80 women treated for seven days and in 51/77 women treated for 14 days. In 12 of those treated for seven days and 15 of those treated for 14 days, reinfection was the probable cause of reisolation after treatment. The possibility of latent infection with Chlamydia trachomatis could not be excluded in five women, but was not more likely to occur with the shorter treatment course. Erythromycin stearate 500 mg twice daily for seven days appears to be an effective regimen for the treatment of uncomplicated chlamydial infection of the cervix.     

Ciprofloxacin treatment of chlamydial infections of urogenital tracts of women.

Ciprofloxacin was evaluated in chlamydial infections of the urogenital tracts of women treated with a dosage regimen of 500 mg orally twice a day for seven days. Of the 40 women evaluated, 30 were infected with Chlamydia trachomatis only, two were infected with Neisseria gonorrhoeae only, and a further eight had combined gonococcal and chlamydial infections. Ten were found to be harbouring Chlamydia trachomatis in the urethra as well as the cervix. Neisseria gonorrhoeae was eradicated from all patients with or without concomitant chlamydial infection. The overall chlamydial reisolation rates were 14% (5/35) four weeks after treatment and 23% (6/26) 11 weeks after treatment. The organism was not reisolated from the urethra of any of the patients after treatment. Ciprofloxacin was effective against Mycoplasma hominis, but almost completely ineffective against Ureaplasma urealyticum.     

Evaluation of ciprofloxacin 500 mg twice daily for one week in treating uncomplicated gonococcal chlamydial, and non-specific urethritis in men.

Ciprofloxacin, a quinolone antibacterial, was evaluated in the treatment of gonococcal, chlamydial, gonococcal and chlamydial, and non-gonococcal non-chlamydial urethritis. The dosage regimen used was 500 mg orally twice a day for seven days. Of the 56 patients evaluated 22 had gonococcal infection only, 13 were infected with Chlamydia trachomatis only, seven had combined infection, and 14 were harbouring neither of these organisms. Neisseria gonorrhoeae was cleared in all the 29 patients with or without chlamydial infection. Of those who denied having sexual intercourse during the follow-up period, post gonococcal urethritis (PGU) developed in 12 (63%) out of 19, C trachomatis was isolated again from 11 (78%) out of 14, and urethritis recurred in five (55%) out of nine patients with non-gonococcal non-chlamydial infection. There was also evidence that the dosage regimen used was only partially effective against Ureaplasma urealyticum.     

Roxithromycin compared with erythromycin against genitourinary chlamydial infections.

The efficacy and safety of roxithromycin 300 mg once a day was compared with that of erythromycin 500 mg twice a day, both for seven days, in a double blind study of 281 patients (188 men, 93 women) with genitourinary chlamydial infections. At the end of the treatment 251 (89%) patients were evaluable, and at follow up two weeks later 227 (81%) were evaluable. The bacteriological cure rate was close to 100% at the end of both treatment regimens. At follow up 55/75 (73%) evaluable men and 38/39 (97%) evaluable women treated with roxithromycin were chlamydia negative compared with 50/71 (70%) evaluable men and 37/42 (88%) evaluable women treated with erythromycin. Of the 47 who were still chlamydia positive, reinfection could not be excluded in half the men and all the women. Side effects were mainly gastrointestinal and were found in about 15% of patients receiving each treatment, but did not necessitate discontinuing treatment in any case. Roxithromycin seems to be as safe and efficacious as erythromycin in treating chlamydial infections in men and women, and it has the advantage that treatment is by a single daily dose.     

Twice daily dosing of erythromycin in the treatment of venereal chlamydial infections

Background. Tetracyclines are recommended as primary choice for the treatment of venereal chlamydial infections. Erythromycin has been used in high doses as an alternative. Erythromycin acistrate (EA) is a 2'-acetyl ester prodrug of erythromycin that can be used in lower doses.
Objective. To show the efficacy of EA 400 mg twice daily in the treatment of venereal chlamydial infections.
Study design. A randomized, double-blind parallel group study. Chlamydia-positive patients were randomized to treatment with either EA or erythromycin stearate (ES) for 10 days. Follow up cultures were performed at 28 days after the start of therapy. The sexual consort was treated with erythromycin stearate.

Subjects.

Subjects. A total of 151 patients participated (47 males, 104 females). Seventy-two patients received EA and 79 ES.

Intervention.

Intervention. EA (0.4 g) and ES (0.5 g) were given twice daily for 10 days.

Results.

Results. The bacteriological cure rate was 98% in the EA group and 97% in the ES group. There were no statistically significant differences between the treatment groups. No patient discontinued the medication in either group, although 30% of the EA group and 27% of the ES group reported adverse effects, mainly transient gastrointestinal symptoms.

Main outcome.

Main outcome. Treatment with erythromycin acistrate or stearate twice daily is a simple and efficient alternative for the treatment of sexually transmitted chlamydial infection in both male and female patients.     

Double-blind comparison of trovafloxacin and doxycycline in the treatment of uncomplicated Chlamydial urethritis and cervicitis. Trovafloxacin Chlamydial Urethritis/Cervicitis Study Group.

BACKGROUND: Chlamydia trachomatis is among the most common sexually transmitted bacteria worldwide. With excellent activity against C. trachomatis and Neisseria gonorrhoeae and prolonged elimination half-life allowing once-daily dosage, the fluoroquinolone trovafloxacin has potential advantages in the treatment of uncomplicated chlamydial infection. GOAL OF THIS STUDY: This study compared the efficacy of trovafloxacin with that of doxycycline for the treatment of uncomplicated chlamydial infection. STUDY DESIGN: In a double-blind, multicenter trial, trovafloxacin 200 mg was administered once daily for 5 days and doxycycline 100 mg was administered twice daily for 7 days to patients with uncomplicated chlamydial urethritis or cervicitis. Follow-up visits were conducted 10, 21, and 35 days after enrollment. RESULTS: Of the 970 patients (403 men, 567 women) observed, 511 were microbiologically evaluable and 360 were clinically evaluable. C. trachomatis eradication rates in the trovafloxacin and doxycycline groups were equivalent in women (95% and 97%, respectively), but not in men (89% and 99%). Similarly, rates of clinical success (cure plus improvement) demonstrated equivalence of trovafloxacin and doxycycline in women (96% and 94%), but not in men (94% and 100%). The most frequent treatment-related adverse events were dizziness, nausea, and headache in patients given trovafloxacin, and nausea, vomiting, and headache in patients given doxycycline. Treatment-related discontinuations were comparable between the drug groups. CONCLUSION: Trovafloxacin given once daily for 5 days was clinically and bacteriologically equivalent to doxycycline given twice daily for 7 days in women with uncomplicated chlamydial cervicitis. This equivalence was not demonstrated in men with uncomplicated chlamydial urethritis.     

Pivampicillin compared with erythromycin for treating women with genital Chlamydia trachomatis infection.

In a randomised single blind study, pivampicillin was compared with erythromycin in women with urogenital Chlamydia trachomatis infections. The pivampicillin dosage was 700 mg twice a day and the erythromycin dosage 500 mg twice a day for seven days. Follow up took place on days 7 and 14 after the start of treatment. All 26 women treated with pivampicillin were culture negative for chlamydiae at the first and second follow up visits. All 23 women who received erythromycin were culture negative at the first follow up visit, but one was culture positive at the second follow up visit. Gastrointestinal side effects were recorded in five patients receiving pivampicillin and in nine receiving erythromycin. Two patients receiving erythromycin were withdrawn from treatment because of gastrointestinal disturbances, compared with none receiving pivampicillin.     

Is a test of cure necessary following treatment for cervical infection with Chlamydia trachomatis?

Tests of cure (TOC) were performed on specimens from 106 women following treatment for chlamydial infection of the cervix. 91 women attended for the first TOC with enzyme immunoassay (EIA) within one week of finishing antibiotics. Three were EIA positive, 88 were EIA negative. These three women were subsequently EIA and culture negative although they received no further antibiotics. Ninety women returned for the second TOC with EIA and culture between seven and 27 days after completing treatment. All the results were negative. Routine TOC is unnecessary following appropriate antichlamydial therapy. If TOC is indicated antigen-detection methods should not be used immediately after finishing antibiotics as misleading positive results may be obtained. EIA or culture at one week or later after treatment is reliable.     

Effect of amoxicillin on simultaneous Chlamydia trachomatis infection in men with gonococcal urethritis: comparison of three dosage regimens

Of 92 men with gonococcal urethritis who were treated orally with amoxicillin, 25 (27.1%) had a simultaneous Chlamydia trachomatis infection. At the first visit 25 patients were treated with a single dose of 1 g of amoxicillin plus 1 g of probenecid (group 1); 24 men were treated with 1 g of amoxicillin twice a day for two days (group 2); and 43 men were treated with 0.75 mg of amoxicillin three times a day for seven days (group 3). At the follow-up visit, one patient in each group still had Neisseria gonorrhoeae-positive cultures. C. trachomatis was not isolated again after treatment from men in group 3, but was isolated from 81.8% in groups 1 and 2 combined (P less than 0.05). One (10%) of the ten men in group 3 who were C. trachomatis-positive before treatment developed postgonococcal urethritis, as compared with seven (63.6%) of 11 in groups 1 and 2 combined (P less than 0.05). Thus a multiple-dose amoxicillin regimen may prove to be a useful alternative to the present-day treatment of chlamydial infections of the urogenital tract.     

Comparison of rosaramicin and erythromycin stearate for treatment of cervical infection with Chlamydia trachomatis

The macrolide antibiotic rosaramicin inhibits in vitro growth of Chlamydia trachomatis. Rosaramicin (1 g daily given to 18 patients for seven days) and erythromycin stearate (2 g daily given to 19 patients for seven days) were compared in the treatment of chlamydial cervicitis. Cultures of cervical specimens obtained nine to 11 days and 24-32 days after commencement of therapy were negative for all rosaramicin-treated patients seen at follow-up. The first follow-up culture of one erythromycin recipient was positive. The extent of cervicitis decreased in all patients after treatment, but the only patients to achieve a completely normal cervical appearance were those with minimal-to-moderate lesions before treatment. Gastrointestinal side effects, including nausea, vomiting, and abdominal pain, occurred in ten of 19 patients given erythromycin and in 13 of 18 given rosaramicin. Minimally elevated levels of alanine aminotransferase in serum occurred in four (22.2%) of 18 rosaramicin recipients. It is concluded that rosaramicin and erythromycin stearate both eradicate C. trachomatis cervical infection but frequently cause adverse gastrointestinal effects.     

Does detection of chlamydial antibodies by microimmunofluorescence help in managing chlamydial lower genital tract infection in women?

A total of 113 women thought to have chlamydial infection of the lower genital tract were studied prospectively to evaluate the effect of antibiotic treatment on antibodies to chlamydiae detected by microimmunofluorescence. Of them, 81 were randomly selected for treatment with a two week course of either triple tetracycline or erythromycin stearate, and 32 who had microimmunofluorescent antibodies to, but did not yield cultures for, chlamydiae were used as controls and left untreated. Results for the treated patients showed that 22 (27%) had at least a fourfold fall in the microimmunofluorescent titre, but there was a similar rise in titre in 14 (17%), and the titre remained unaltered in 45 (56%) patients. In the control group 10 (31%) patients had at least a fourfold fall in titre, but there was a similar rise in titre in seven (22%), and it remained unaltered in 15 (47%) patients. The differences between these percentages in treated and untreated patients were not significant.     

Treatment of chancroid with erythromycin. A clinical and microbiological appraisal.

One hundred and thirty seven patients presenting with genital ulcerations from which Haemophilus ducreyi was isolated were treated with erythromycin stearate 500 mg every six hours for seven days. Of these, 91 (66%) had associated inguinal lymphadenopathy. Only two of the 100 patients who returned after one week showed no clinical improvement. Despite decrease in size H ducreyi was reisolated from the ulcers of three patients, two of whom had not complied with treatment. The patients were treated for a further week either with erythromycin or with a placebo preparation and on day 14 no discernible difference in clinical response was evident. H ducreyi was not reisolated from any lesion. In contrast, the natural course of development of associated lymphadenopathy was not modified by treatment. H ducreyi was not, however, isolated from any gland after the start of treatment. Side effects attributable to erythromycin were minimal and treatment had to be discontinued in only two patients. This study clearly indicates that treatment with erythromycin for one week results in rapid healing of lesions and the elimination of H ducreyi from both ulcers and associated lymph glands.     

Treatment of chancroid with erythromycin. A clinical and microbiological appraisal

One hundred and thirty seven patients presenting with genital ulcerations from which Haemophilus ducreyi was isolated were treated with erythromycin stearate 500 mg every six hours for seven days. Of these, 91 (66%) had associated inguinal lymphadenopathy. Only two of the 100 patients who returned after one week showed no clinical improvement. Despite decrease in size H ducreyi was reisolated from the ulcers of three patients, two of whom had not complied with treatment. The patients were treated for a further week either with erythromycin or with a placebo preparation and on day 14 no discernible difference in clinical response was evident. H ducreyi was not reisolated from any lesion. In contrast, the natural course of development of associated lymphadenopathy was not modified by treatment. H ducreyi was not, however, isolated from any gland after the start of treatment. Side effects attributable to erythromycin were minimal and treatment had to be discontinued in only two patients. This study clearly indicates that treatment with erythromycin for one week results in rapid healing of lesions and the elimination of H ducreyi from both ulcers and associated lymph glands.     

2016 European guideline on Mycoplasma genitalium infections

Mycoplasma genitalium infection contributes to 10–35% of non‐chlamydial non‐gonococcal urethritis in men. In women, M. genitalium is associated with cervicitis and pelvic inflammatory disease (PID). Transmission of M. genitalium occurs through direct mucosal contact. Asymptomatic infections are frequent. In women, symptoms include vaginal discharge, dysuria or symptoms of PID – abdominal pain and dyspareunia. In men, urethritis, dysuria and discharge predominates. Besides symptoms, indication for laboratory test is a high‐risk sexual behaviour. Diagnosis is achievable only through nucleic acid amplification testing (NAAT). If available, NAAT diagnosis should be followed with an assay for macrolide resistance. Therapy for M. genitalium is indicated if M. genitalium is detected or on an epidemiological basis. Doxycycline has a low cure rate of 30–40%, but does not increase resistance. Azithromycin has a cure rate of 85–95% in macrolide susceptible infections. An extended course appears to have a higher cure rate. An increasing prevalence of macrolide resistance, most likely due to widespread use of azithromycin 1 g single dose without test of cure, is drastically decreasing the cure rate. Moxifloxacin can be used as second‐line therapy, but resistance is increasing. Uncomplicated M. genitalium infection should be treated with azithromycin 500 mg on day one, then 250 mg on days 2–5 (oral), or josamycin 500 mg three times daily for 10 days (oral). Second line treatment and treatment for uncomplicated macrolide resistant M. genitalium infection is moxifloxacin 400 mg od for 7–10 days (oral). For third line treatment of persistent M. genitalium infection after azithromycin and moxifloxacin doxycycline 100 mg two times daily for 14 days can be tried and may cure 30%. Pristinamycin 1 g four times daily for 10 days (oral) has a cure rate of app. 90%. Complicated M. genitalium infection (PID, epididymitis) is treated with moxifloxacin 400 mg od for 14 days.     

Prevalence of Chlamydia trachomatis cervical infection in a college gynecology clinic: relationship to other infections and clinical features

A total of 479 sexually active college women presenting for routine gynecologic care were screened for gonorrheal and chlamydial infection of the cervix. Most of these women were asymptomatic; those with symptoms had minor complaints related to the lower genital tract. A direct fluorescent antibody test (DFA) showed the prevalence of chlamydial infection to be 8.1%, while culture for Neisseria gonorrhoeae indicated that the prevalence of gonorrhea was 1.5%. DFA-positive women had some minor alterations in the appearance of their cervix, but only 10% had overt mucopurulent cervicitis. The presence of purulent cervical discharge was four times more common in DFA-positive women, but only one-fourth of positive women had this finding. The use of an endocervical gram stain showing ten or more white cells per oil immersion field (x970) did not appear to be clinically useful in diagnosing suspected chlamydial infection because there was no significant difference in the number of white cells seen in specimens from DFA-positive (16 polymorphonuclear leukocytes) and DFA-negative women (ten polymorphonuclear leukocytes). Thus, use of the gram stain as an initial screening mechanism would not markedly reduce the number of women to be tested for Chlamydia trachomatis; half of all women met the gram-stain criterion, and nearly a quarter of the DFA-positive women would be overlooked.     

Bacampicillin to treat non-gonococcal urethritis in men: pilot study.

Of 84 men with non-gonococcal urethritis (NGU), 24 yielded Chlamydia trachomatis by either cell culture or MicroTrak immunofluorescence test. All 84 were treated with bacampicillin 800 mg twice a day for seven days. Five (one chlamydia positive) defaulted from follow up 10 to 14 days after the start of treatment. Of the 23 chlamydia positive patients who attended follow up, 22 became chlamydia negative; 14 of the 23 patients also became asymptomatic and had normal urethral smears. Of the 56 chlamydia negative patients who attended follow up, 21 were cleared of their urethritis. Two patients reported side effects; one drowsiness and one mild diffuse alopecia. Bacampicillin may therefore be a safe and effective alternative to tetracycline or erythromycin in treating chlamydial urethritis in men.     

A prospective randomized trial of ofloxacin vs. doxycycline in the treatment of uncomplicated male urethritis

One hundred fourteen men with uncomplicated urethritis were randomized to receive 1 week of therapy with either doxycycline (100 mg twice daily) or ofloxacin (300 mg twice daily). Of the 109 men completing the post-treatment visit, 56 received ofloxacin and 52 (93%) were clinically cured. Forty four (83%) of the 53 men treated with doxycycline were cured. All 30 patients with gonorrhea (including three with penicillinase-producing Neisseria gonorrhoeae [PPNG] isolates) who were treated with ofloxacin became culture-negative, as compared with 32 of 34 patients receiving doxycycline. In contrast, three of 18 patients with Chlamydia trachomatis were microbiologic failures after ofloxacin therapy, while all ten treated with doxycycline were cured. Adverse effects of both treatment regimens were generally mild, and compliance was excellent except for one patient receiving doxycycline. These results show that ofloxacin, in a dosage of 300 mg taken orally twice daily for seven days, is an effective treatment for uncomplicated urethritis in men but may not reliably cure chlamydial infections.     

Screening women in jails for chlamydial and gonococcal infection using urine tests: feasibility, acceptability, prevalence, and treatment rates

BACKGROUND: Women entering jails are at high risk for sexually transmitted diseases; however, screening for chlamydial and gonococcal infection is not routinely performed in most jails. New urine tests have made it easier to screen for these infections in nonclinical settings. GOAL: The feasibility and acceptability of urine-based screening for women entering jails and the prevalence of and treatment rates for chlamydial and gonococcal infections were determined. STUDY DESIGN: Women entering jails in Chicago, Illinois; Birmingham, Alabama; and Baltimore, Maryland, who signed consent forms were tested for chlamydial and gonococcal infection by means of the urine ligase chain reaction assay. Those testing positive were treated in jail; health department staff members attempted to contact those already released. RESULTS: Most women who were approached agreed to be tested (range, 87-98%, depending on city), and most of these women provided a specimen (range, 92-100%). Among 5364 women aged 16 to 75 years who were tested, the prevalence of chlamydial and gonococcal infections was high, especially among those <25 years of age (range, 15.3-21.5% for chlamydial infection and 8.2-9.2% for gonorrhea, depending on city). The majority of women testing positive were treated in jail or outside of jail (61-85%). CONCLUSIONS: Screening women in jails for chlamydial and gonococcal infection with urine tests is feasible, is acceptable to most women, and leads to detection and treatment of many infections. Routine screening should reduce medical complications in this population and should prevent transmission in the community, given that many women are soon released.     

Pelvic inflammatory disease associated with Chlamydia trachomatis infection after therapeutic abortion. A prospective study.

Chlamydia trachomatis was cultured from the cervix of 70 of 557 (12.6%) patients admitted for therapeutic abortion. Postoperatively, 22 (3.9%) developed acute pelvic inflammatory disease (PID); of these women, 14 (63.6%) had harboured C trachomatis in the cervix before the abortion. Thus of 70 patients with chlamydial infection, 14 (20%) developed PID postoperatively. Of the chlamydia-positive patients, six of the 15 (40%) aged less than 20 years and eight of the 53 (15%) patients aged 20-30 years developed PID. Twelve of the 70 women with chlamydial infections showed a significant increase in serum chlamydial IgG antibody titres over a four week period; four of these women developed PID. Neisseria gonorrhoeae was recovered from only four patients, one of whom developed PID after the abortion. Treatment with a single dose of intravenous doxycycline (200 mg) was given before and during surgery to about half of the patients. In our study, this regimen had no protective effect against the development of PID associated with C trachomatis.     

Pelvic inflammatory disease associated with Chlamydia trachomatis infection after therapeutic abortion. A prospective study

Chlamydia trachomatis was cultured from the cervix of 70 of 557 (12.6%) patients admitted for therapeutic abortion. Postoperatively, 22 (3.9%) developed acute pelvic inflammatory disease (PID); of these women, 14 (63.6%) had harboured C trachomatis in the cervix before the abortion. Thus of 70 patients with chlamydial infection, 14 (20%) developed PID postoperatively. Of the chlamydia-positive patients, six of the 15 (40%) aged less than 20 years and eight of the 53 (15%) patients aged 20-30 years developed PID. Twelve of the 70 women with chlamydial infections showed a significant increase in serum chlamydial IgG antibody titres over a four week period; four of these women developed PID. Neisseria gonorrhoeae was recovered from only four patients, one of whom developed PID after the abortion. Treatment with a single dose of intravenous doxycycline (200 mg) was given before and during surgery to about half of the patients. In our study, this regimen had no protective effect against the development of PID associated with C trachomatis.