Tags: Cervicitis

Chlamydia

Chlamydia trachomatis, Chlamydia psittaci, and Chlamydia pneumoniae are among the most prevalent microbial pathogens in humans worldwide. C trachomatis is responsible for a variety of sexually transmitted disease (STD) syndromes in both sexes. In addition, certain serotypes of C trachomatis are responsible for trachoma, the most common infectious cause of blindness in humans. C psittaci is a zoonotic pathogen associated with atypical pneumonia.

Chlamydia Trachomatis Infections

C trachomatis is associated with urethritis, proctitis, conjunctivitis, and arthritis in women and men; epididymitis in men; and mucopurulent cervicitis (MPC), acute salpingitis, bartholinitis, and the Fitz-Hugh and Curtis syndrome in women (Box 1). C trachomatis and Neisseria gonorrhoeae (see site) coinfections are common in women with MPC and men with urethritis. In men, C trachomatis is the most common etiologic agent of the nongonococcal (NGU) and postgonococcal urethritis (PGU) syndromes.

Neisseria Meningitidis

N meningitidis is found only in humans and is a member of the normal oropharyngeal flora in 5-15% of healthy adults and children. In crowded or closed populations such as in boarding schools or military camps, higher carriage rates are observed.

Neisseria Gonorrhoeae & Neisseria Meningitidis

Neisseria gonorrhoeae was first described by Albert Neisser in 1879, in the ocular discharge and exudate from newborn infants with conjunctivitis. Descriptions of a condition resembling the disease gonorrhea can be found in the written record as early as 130 AD, when Galen created a descriptor for the malady by using the Greek words gonos (seed) and rhoea (flow) to characterize what was believed to be the morbid loss of semen.

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In 3995 patients who took azithromycin 1.5 g in divided doses over 5 days or who took 1 g as a single dose for urethritis/cervicitis adverse events occurred in 12%. In patients over 65 years the rate was 9.3%, and in children under 14 years of age it was 5.4%.

Cervicitis, Ectropion & True Erosion

Cervicitis — Chlamydia trachomatis, Trichomonas vaginalis. Ectropion — hormonal changes with oral contraceptive use (especially with progesterone) or during pregnancy. True erosion — injury to atrophic epithelium due to estrogen deficiency in menopause.

Cervicitis

Infectious cervicitis may be caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, ureaplasmas, Herpes simplex or Trichomonas vaginalis. Chronic cervicitis is characterized by inflammation of the cervix without an identified pathogen.

Specific Anti-Infective Agents

Clinicians should be familiar with the general classes of antibiotics, their mechanisms of action, and their major toxicities. The differences between the specific antibiotics in each class can be subtle, often requiring the expertise of an infectious disease specialist to design the optimal anti-infective regimen. The general internist or physician-in-training should not attempt to memorize all the facts outlined here, but rather should read the pages that follow as an overview of anti-infectives. The chemistry, mechanisms of action, major toxicities, spectrum of activity, treatment indications, pharmacokinetics, dosing regimens, and cost are reviewed.

Sexually Transmitted Diseases: Trichomoniasis

The spectrum of sexually transmitted diseases includes the classic venereal diseases – gonorrhea, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale – as well as a variety of other pathogens known to be spread by sexual contact (Table Sexually Transmitted Diseases). Common clinical syndromes associated with sexually transmitted diseases are listed in Table Selected Syndromes Associated with Common Sexually Transmitted Pathogens.

Gonorrhea. Clinical presentation, diagnosis and treatment

All currently recommended regimens are single-dose treatments with various oral or parenteral cephalosporins and fluoroquinolones. Ceftriaxone (125 mg intramuscularly) is the only parenteral agent recommended by the Centers for Disease Control as a first-line agent for treatment of gonorrhea.