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16 No difference has been seen in outcomes with the various imidazoles or with treatment durations of 1 to 14 days.

Intravaginal nystatin also decreases symptoms of VVC, with a NNT of 3 after 1 week compared with placebo (SOR: B ). Data showing that imidazoles are more effective than nystatin are not strong (SOR: B ).

A Clinical Evidence review 16 identified 1 trial comparing intravaginal miconazole, clotrimazole, econazole, and nystatin; symptomatic relapse was lower with intravaginal imidazoles than with nystatin.

Another trial comparing clotrimazole and nystatin showed no difference in the proportion of women with persistent symptoms after 4 weeks.

An open label study 17 comparing econazole, miconazole, and nystatin showed that the imidazoles had more antifungal activity, but there was no difference in clinical outcome assessment. Diagnosis and Treatment of Chlamydia trachomatis Infection. MILLER, M.D., University of Tennessee College of Medicine, Chattanooga, Tennessee. Abstract Urogenital Infection in Women Urogenital Infection in Men Reiter Syndrome Treatment of Urogenital Infection Chlamydial Infection in Children Prevention References.

Abstract Urogenital Infection in Women Urogenital Infection in Men Reiter Syndrome Treatment of Urogenital Infection Chlamydial Infection in Children Prevention References. Chlamydia trachomatis infection most commonly affects the urogenital tract. In men, the infection usually is symptomatic, with dysuria and a discharge from the penis.

Untreated chlamydial infection in men can spread to the epididymis.

Most women with chlamydial infection have minimal or no symptoms, but some develop pelvic inflammatory disease.

Chlamydial infection in newborns can cause ophthalmia neonatorum.

Chlamydial pneumonia can occur at one to three months of age, manifesting as a protracted onset of staccato cough, usually without wheezing or fever. Treatment options for uncomplicated urogenital infections include a single 1-g dose of azithromycin orally, or doxycycline at a dosage of 100 mg orally twice per day for seven days.

The recommended treatment during pregnancy is erythromycin base or amoxicillin.

The Centers for Disease Control and Prevention and the U.S.

Preventive Services Task Force recommend screening for chlamydial infection in women at increased risk of infection and in all women younger than 25 years.

The incidence of chlamydial infection in women increased dramatically between 1987 and 2003, from 79 to 467 per 100,000.1 In part, this may be attributed to increased screening and improved reporting, but the burden of the disease still is significant.

The most common site of Chlamydia trachomatis infection is the urogenital tract, and severity ranges from asymptomatic to life-threatening. Azithromycin (Zithromax) or doxycycline (Vibramycin) is recommended for the treatment of uncomplicated genitourinary chlamydial infection. Amoxicillin is recommended for the treatment of chlamydial infection in women who are pregnant. Patients who are pregnant should be tested for cure three weeks after treatment for chlamydial infection.

Women with chlamydial infection should be rescreened for infection three to four months after completion of antibiotic therapy.

All women who are 25 years or younger or at increased

risk

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.

For information about the SORT evidence rating system, see page 1313 orhttps://www.aafp.org/afpsort.xml .

Azithromycin (Zithromax) or doxycycline (Vibramycin) is recommended for the treatment of uncomplicated genitourinary chlamydial infection. Amoxicillin is recommended for the treatment of chlamydial infection in women who are pregnant. Patients who are pregnant should be tested for cure three weeks after treatment for chlamydial infection. Women with chlamydial infection should be rescreened for infection three to four months after completion of antibiotic therapy. All women who are 25 years or younger or at increased risk of sexually transmitted diseases should be screened for chlamydial infection annually. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 1313 orhttps://www.aafp.org/afpsort.xml .

Abstract Urogenital Infection in Women Urogenital Infection in Men Reiter Syndrome Treatment of Urogenital Infection Chlamydial Infection in Children Prevention References. In women, chlamydial infection of the lower genital tract occurs in the endocervix.

It can cause an odorless, mucoid vaginal discharge, typically with no external pruritus, although many women have minimal or no symptoms.2 An ascending infection can result in pelvic inflammatory disease (PID).

Physical findings of urogenital chlamydial infection in women include cervicitis with a yellow or cloudy mucoid discharge from the os.