Tags: Trachoma

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 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.

Adenoviruses: Clinical Syndromes

Adenoviruses cause primary infection in children and, less commonly, adults. Reactivation of virus occurs in immunocompromised children and adults. Several distinct clinical syndromes are associated with adenovirus infection (Box 1). Acute pharyngitis is usually nonexudative but is associated with fever.

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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%.

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Torsade de pointes and cardiorespiratory arrest have been reported in a patient with congenital long QT syndrome who took azithromycin. In a prospective study of 47 previously healthy people, there was a modest statistically insignificant prolongation of the QTC interval without clinical consequences after the end of a course of azithromycin 3 g/day for 5 days. Azithromycin can cause ototoxicity. In one study, 8 (17%) of 46 HIV-positive patients had probable (n = 6) or possible (n = 2) ototoxicity with azithromycin.

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.