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Abstract Urogenital Infection in Women Urogenital Infection in Men Reiter Syndrome Treatment of Urogenital Infection Chlamydial Infection in Children Prevention References.

In men, chlamydial infection of the lower genital tract causes urethritis and, on occasion, epididymitis. trachomatis infection in approximately 15 to 55 percent of men, although the prevalence is lower among older men.2 Symptoms, if present, include a mild to moderate, clear to white urethral discharge.

This is best observed in the morning, before the patient voids.

To observe the discharge, the penis may need to be milked by applying pressure from the base of the penis to the glans. The diagnosis of nongonococcal urethritis can be confirmed by the presence of a mucopurulent discharge from the penis, a Gram stain of the discharge with more than five white blood cells per oil-immersion field, and no intracellular gram-negative diplococci.2 A positive result on a leukocyte esterase test of first-void urine or a microscopic examination of first-void urine showing 10 or more white blood cells per high-powered field also confirms the diagnosis of urethritis.

trachomatis infection in men with suspected urethritis, the nucleic acid amplification technique to detect chlamydial and gonococcal infections is best (see Urogenital Infection in Women).4 Empiric treatment should be considered for patients who are at high risk of being lost to follow-up.

Untreated chlamydial infection can spread to the epididymis.

Patients usually have unilateral testicular pain with scrotal erythema, tenderness, or swelling over the epididymis. Men 35 years or younger who have epididymitis are more likely to have C.

trachomatis as the etiologic agent than are older men.

Abstract Urogenital Infection in Women Urogenital Infection in Men Reiter Syndrome Treatment of Urogenital Infection Chlamydial Infection in Children Prevention References. A rare complication of untreated chlamydial infection is the development of Reiter syndrome, a reactive arthritis that includes the triad of urethritis (sometimes cervicitis in women), conjunctivitis, and painless mucocutaneous lesions.

Reactive arthritis develops in a small percentage of individuals with chlamydial infection.

Women can develop reactive arthritis, but the male-to-female ratio is 5:1. The arthritis begins one to three weeks after the onset of chlamydial infection. The joint involvement is asymmetric, with multiple affected joints and a predilection for the lower extremities. The mucocutaneous lesions are papulosquamous eruptions that tend to occur on the palms of the hands and the soles of the feet. The initial episode usually lasts for three to four months, but in rare cases the synovitis may last about one year. Abstract Urogenital Infection in Women Urogenital Infection in Men Reiter Syndrome Treatment of Urogenital Infection Chlamydial Infection in Children Prevention References.

trachomatis infection depends on the site of the infection, the age of the patient, and whether the infection is complicated or uncomplicated.

For uncomplicated genitourinary chlamydial infection, the CDC recommends 1 g azithromycin (Zithromax) orally in a single dose, or 100 mg doxycycline (Vibramycin) orally twice per day for seven days (Table 1) .2 These regimens have similar cure rates and adverse effect profiles,6 although a benefit of azithromycin is that physicians can administer the dose in the office.

If patients vomit the dose of azithromycin within one to two hours of taking the medication, an alternative treatment should be considered (Table 1) .2.

CDC-Recommended Regimens for Uncomplicated Urogenital Chlamydial Infection in Adults.

Azithromycin (Zithromax) 1 g orally in a single dose.

Doxycycline (Vibramycin) 100 mg orally twice per day.

Erythromycin base 500 mg orally four times per day. Erythromycin ethylsuccinate 800 mg orally four times per day.

note : All regimens except azithromycin are for a total of seven days . CDC-Recommended Regimens for Uncomplicated Urogenital Chlamydial Infection in Adults. Azithromycin (Zithromax) 1 g orally in a single dose. Doxycycline (Vibramycin) 100 mg orally twice per day. Erythromycin base 500 mg orally four times per day. Erythromycin ethylsuccinate 800 mg orally four times per day. note : All regimens except azithromycin are for a total of seven days .

Follow-up of patients with urethritis is necessary only if symptoms persist or recur after completion of the antibiotic course.

If symptoms suggest recurrent or persistent urethritis, the CDC recommends treatment with 2 g metronidazole (Flagyl) orally in a single dose plus 500 mg erythromycin base orally four times per day for seven days, or 800 mg erythromycin ethylsuccinate orally four times per day for seven days.2 [ corrected] This recommendation is to provide treatment for other bacterial causes of urethritis.

Patients should be advised to abstain from sexual intercourse for seven days after treatment initiation. In addition, physicians should obtain exposure information for the preceding 60 days and consider screening for other STDs such as human immunodeficiency virus (HIV).2. The CDC does not recommend repeat testing for chlamydia after completion of the antibiotic course unless the patient has persistent symptoms or is pregnant.2 Because reinfection is a common problem, the CDC recommends that women with chlamydial infection should be rescreened three to four months after antibiotic completion.

Women who present within 12 months after the initial infection and have not been screened should be reassessed for infection regardless of whether the patient believes her sex partner was treated or not.2. Hospitalization is required if a patient is pregnant; has severe illness, nausea and vomiting, or high fever; has tuboovarian abscess; is unable to follow or tolerate the outpatient oral regimen; or has disease that has been unresponsive to oral therapy.

Hospitalization also is indicated if surgical emergencies cannot be excluded.2 The CDC-recommended options for the treatment of PID are listed in Table 2 .2.

Ofloxacin (Floxin) 400 mg orally twice daily for 14 days or levofloxacin (Levaquin) 500 mg orally once daily for 14 days; with or without metronidazole (Flagyl) 500 mg orally twice daily for 14 days.

Ceftriaxone (Rocephin) 250 mg IM in a single dose or cefoxitin (Mefoxin) 2 g IM in a single dose with concurrent probenecid (Benemid) 1 g orally in single dose or other parenteral third-generation cephalosporin; plus doxycycline (Vibramycin) 100 mg orally twice daily for 14 days with or without metronidazole 500 mg orally twice daily for 14 days. Cefotetan (Cefotan) 2 g IV every 12 hours or cefoxitin 2 g IV every six hours; plus doxycycline 100 mg orally or IV every 12 hours.

Clindamycin (Cleocin) 900 mg IV every eight hours; plus gentamicin loading dose IV or IM (2 mg per kg) followed by a maintenance dose (1.5 mg per kg) every eight hours (single daily dosing may be substituted) Ofloxacin 400 mg IV every 12 hours or levofloxacin 500 mg IV once daily; with or without metronidazole 500 mg IV every eight hours. Ampicillin/sulbactam (Unasyn) 3 g IV every six hours; plus doxycycline 100 mg orally or IV every 12 hours.

note : Doxycycline should be given orally whenever possible because it causes sclerosis and obliteration of venous access when given IV . CDC = Centers for Disease Control and Prevention; PID = pelvic inflammatory disease; IM = intramuscular; IV = intravenous . Ofloxacin (Floxin) 400 mg orally twice daily for 14 days or levofloxacin (Levaquin) 500 mg orally once daily for 14 days; with or without metronidazole (Flagyl) 500 mg orally twice daily for 14 days. Ceftriaxone (Rocephin) 250 mg IM in a single dose or cefoxitin (Mefoxin) 2 g IM in a single dose with concurrent probenecid (Benemid) 1 g orally in single dose or other parenteral third-generation cephalosporin; plus doxycycline (Vibramycin) 100 mg orally twice daily for 14 days with or without metronidazole 500 mg orally twice daily for 14 days. Cefotetan (Cefotan) 2 g IV every 12 hours or cefoxitin 2 g IV every six hours; plus doxycycline 100 mg orally or IV every 12 hours. Clindamycin (Cleocin) 900 mg IV every eight hours; plus gentamicin loading dose IV or IM (2 mg per kg) followed by a maintenance dose (1.5 mg per kg) every eight hours (single daily dosing may be substituted) Ofloxacin 400 mg IV every 12 hours or levofloxacin 500 mg IV once daily; with or without metronidazole 500 mg IV every eight hours.

Ampicillin/sulbactam (Unasyn) 3 g IV every six hours; plus doxycycline 100 mg orally or IV every 12 hours. note : Doxycycline should be given orally whenever possible because it causes sclerosis and obliteration of venous access when given IV . CDC = Centers for Disease Control and Prevention; PID = pelvic inflammatory disease; IM = intramuscular; IV = intravenous .

Doxycycline and ofloxacin (Floxin) are contraindicated during pregnancy; therefore, the CDC recommends erythromycin base or amoxicillin for the treatment of chlamydial infection in pregnant women (Table 3) .2 Amoxicillin is more effective and tends to have fewer side effects than erythromycin in the treatment of antenatal chlamydial infection, and thus is better tolerated.7 , 8 Preliminary data suggest that azithromycin is a safe and effective alternative.2.

CDC-Recommended Regimens for Treatment of Chlamydial Infection in Pregnant Women.

Erythromycin base 500 mg orally four times per day for seven days. Amoxicillin 500 mg orally three times per day for seven days. Erythromycin base 250 mg orally four times per day for 14 days. Erythromycin ethylsuccinate 800 mg orally four times per day for seven days.

Erythromycin ethylsuccinate 400 mg four times per day for 14 days. Azithromycin (Zithromax) 1 g orally in a single dose. CDC-Recommended Regimens for Treatment of Chlamydial Infection in Pregnant Women.

Erythromycin base 500 mg orally four times per day for seven days.

Amoxicillin 500 mg orally three times per day for seven days.

Erythromycin base 250 mg orally four times per day for 14 days. Erythromycin ethylsuccinate 800 mg orally four times per day for seven days.

Erythromycin ethylsuccinate 400 mg four times per day for 14 days. Azithromycin (Zithromax) 1 g orally in a single dose.

Testing for cure is indicated in patients who are pregnant and should be performed three weeks after completion of treatment.2 Culture is the preferred technique.2 If risk of reexposure is high, screening should be repeated throughout the pregnancy.

Abstract Urogenital Infection in Women Urogenital Infection in Men Reiter Syndrome Treatment of Urogenital Infection Chlamydial Infection in Children Prevention References. trachomatis during delivery can cause ophthalmia neonatorum (conjunctivitis) in neonates or chlamydial pneumonia at one to three months of age. Ophthalmia neonatorum usually occurs within five to 12 days of birth but can develop at any time up to one month of age.2 It may cause swelling in one or both eyes with mucopurulent drainage. Prophylaxis with silver nitrate or antimicrobial ointment, which reduces the risk of gonococcal infection in neonates, does not reduce the risk of chlamydial infection.

Testing for chlamydial infection in neonates can be by culture or nonculture techniques. The eyelid should be everted and the sample obtained from the inner aspect of the eyelid.

Sampling the exudates is not adequate because this technique increases the risk of a false-negative test.

Ophthalmia neonatorum can be treated with erythromycin base or ethylsuccinate at a dosage of 50 mg per kg per day orally, divided into four doses per day for 14 days.2 The cure rate for both options is only 80 percent, so a second course of therapy may be necessary.