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Chlamydial Infections
Article Last Updated: Feb 1, 2008
AUTHOR AND EDITOR INFORMATION
Section 1 of 11  
Author: Robert W Tolan Jr, MD, Chief of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan, Jr, is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Coauthor(s):
Marc Grella, MD, Clinical Instructor, Department of Pediatrics, Massachusetts General Hospital
Editors: Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine; Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine; Russell W Steele, MD, Professor and Vice Chairman, Department of Pediatrics, Head, Division of Infectious Diseases, Louisiana State University Health Sciences Center
Author and Editor Disclosure
Synonyms and related keywords:
cervicitis, chlamydia, Chlamydia trachomatis, C trachomatis, chlamydial infection, conjunctivitis, epididymitis, pelvic inflammatory disease, PID, pneumonitis, sexually transmitted disease, STD, sexually transmitted infection, STI, upper genital tract disease, urethritis, salpingitis, tuboovarian abscess, pneumonia, Fitz-Hugh-Curtis syndrome, trachoma, pharyngitis, bronchitis, ectopic pregnancy, dysuria, dyspareunia, proctitis, urinary tract infection, UTI
Background
Chlamydia infection can cause disease in many organ systems. The most frequent disease is caused by Chlamydia trachomatis and is a sexually transmitted infection (STI) that affects the cervix, urethra, salpinges, uterus, nasopharynx, and epididymis. C trachomatis infection causes other diseases, including conjunctivitis, pneumonia, Fitz-Hugh-Curtis syndrome (inflammation of the liver capsule), and trachoma, the world's leading cause of acquired blindness, which is spread from eye-to-hand-to-eye and caused by serotypes A, B, and C. Chlamydophila pneumoniae infection is spread via respiratory droplets and causes pharyngitis, bronchitis, and pneumonia. Chlamydophila psittaci infection is spread by bird droppings and aerosols and causes psittacosis. These infections are not discussed in this article.
Pathophysiology
C trachomatis is an obligate intracellular bacterium that infects the urethra and cervix. The bacterium is usually spread through sexual activity and can be vertically spread, causing conjunctivitis and pneumonia in newborns (see Afebrile Pneumonia Syndrome). If untreated, genital disease can progress to epididymitis in males and upper genital tract disease in females. Chlamydia infects columnar epithelial cells, which places the adolescent female at particular risk of infection because of the presence of the squamocolumnar junction on the ectocervix present until early adulthood. An infected male has a 25% chance per sexual encounter of transmitting the infection to an uninfected female. The transmission rate from infected mother to newborn is 50%, causing conjunctivitis (most cases) or pneumonia (10-20%). The incubation period is 1-5 weeks compared with 0-2 weeks for Neisseria gonorrhoeae infection, which is the most significant STI in the differential diagnosis of conjunctivitis in newborns.
Frequency
United States
More than 3 million episodes of chlamydia are reported each year, making it the most prevalent STI. Sexually active female populations average carriage rates of about 20%. Many patients are asymptomatic. The incidence rate is 2-3 times that of N gonorrhoeae.
Mortality/Morbidity
- Deaths are rare and are caused by progression to salpingitis and tuboovarian abscess with rupture and peritonitis.
- The most significant morbidity occurs when repeated episodes of chlamydia lead to obstruction and scarring of the fallopian tubes, resulting in partial or total sterility.
- Chlamydia is an indirect cause of mortality from ectopic pregnancies.1 Mortality due to ectopic pregnancy is probably more common than is death due to tuboovarian abscess.
Race
- Incidence of chlamydia is more frequent in blacks, Hispanics, and Native Americans in the United States.
- Variability in socioeconomic groups may explain racial differences because of the lack of ability to obtain adequate health care.
Sex
The male-to-female ratio is 1:1.
Age
Chlamydia is most prevalent in persons aged 15-24 years.
History
- Females
- Dysuria
- Vaginal discharge
- Abnormal vaginal bleeding (postcoital or unrelated to menses)
- Dyspareunia
- History of sexual activity without condoms or condom failure
- Proctitis, rectal discharge, or both in cases of receptive anal intercourse
- Slow onset and progression of lower abdominal pain
- Males
- Dysuria
- Urethral discharge
- History of sexual activity without condoms or condom failure
- Proctitis, rectal discharge, or both in cases of receptive anal intercourse
- Newborns
- Symptoms of pneumonia begin in children aged 1-3 months, and symptoms of conjunctivitis develop in children aged 1-2 weeks.
- Cough and fever can occur in pneumonia (although the classic description is afebrile).
- Eye discharge, eye swelling, or both develop in conjunctivitis.
- The mother is diagnosed with or suspected of having a chlamydial infection during pregnancy.
Physical
- Females
- Cervical discharge, urethral discharge (usually thin, mucoid), or both
- Cervical friability (easy bleeding on manipulation)
- Cervical motion tenderness
- Adnexal fullness/tenderness, associated with progression to pelvic inflammatory disease (PID)
- Lower abdomen tender to palpation
- Males
- Urethral discharge (elicited by having examiner or patient milk the urethra)
- Dysuria
- Newborns
- Fever, cough, wheezing, and crackles in pneumonia
- Conjunctival erythema, mucoid discharge, and/or periorbital swelling in conjunctivitis
Causes
Risk factors include the following:
- Age 15-24 years
- Multiple sex partners
- Unprotected intercourse (without condoms)
- History of current or past STI
- Homelessness
- Exchange of sex for drugs or money
Afebrile Pneumonia Syndrome
Candidiasis
Gonorrhea
Herpes Simplex Virus Infection
Trichomoniasis
Urinary Tract Infection
Other Problems to be Considered
Bacterial vaginosis
Fitz-Hugh-Curtis syndrome
Infertility
Pregnancy
Pregnancy, ectopic
Salpingitis
Tuboovarian abscess
Lab Studies
- Pregnancy test: A pregnancy test is mandatory for females. Obtaining a pregnancy test helps with early diagnosis and guidance of treatment.
- Culture
- Cultures are difficult to obtain and expensive to perform; however, in certain clinical situations, such as suspected sexual abuse, cultures are mandatory.
- Cultures are also preferred for rectal specimens because nonculture test results are difficult to interpret in the presence of stool organisms.
- Nonculture tests that detect antigens, DNA, or RNA of Chlamydia species using molecular techniques
- Because C trachomatis grows only within columnar cells, obtaining a specimen that contains cells directly from the urethra or cervix, not on pooled vaginal secretions, is important.
- In obtaining cells along with discharge, attempt to apply pressure to the inside of the cervix or urethra, similar to the method for obtaining cells for Papanicolaou smears.
- In males, insert collection swabs 1-2 cm into the urethra after the urethra is milked to bring down secretions.
- Always follow the directions of the manufacturer of the kit used for collection and follow transport instructions. Newer DNA probe kits currently are available that allow detection of C trachomatis and N gonorrhoeae from voided urine specimens, obviating the need for direct sampling in uncomplicated cases.
- Direct immunofluorescent antibody (DFA, MicroTrak), enzyme immunoassay (EIA, Chlamydiazyme), and DNA probes (PACE Gen-Probe) all are approximately 80% sensitive and 95% specific.
- The APTIMA Combo 2 Assay for ribosomal RNA (rRNA) can be used on ThinPrep liquid-based Papanicolaou test specimens.2
- Polymerase chain reaction (PCR) and ligase chain reaction (LCR) have sensitivity and specificity approaching 100% but remain expensive to perform on a routine basis.
- Screening test for asymptomatic males only
- Obtain urine for leukocyte esterase. This tests for WBCs, which are virtually diagnostic of chlamydia or gonorrhea in the absence of urinary tract infection (UTI) symptoms.
- If the leukocyte esterase test result is positive, proceed with the usual diagnostic tests.
- Infants with suspected pneumonitis
- Perform a nasopharyngeal (NP) swab for chlamydia culture. Currently available rapid tests are not approved for use on NP-derived specimens.
- In severe or complicated cases, bronchoalveolar lavage fluid can be sent for chlamydia culture as well. A CBC count that demonstrates peripheral eosinophilia in the appropriate clinical situation offers additional supportive evidence for C trachomatis pneumonia.
- Infants with suspected chlamydia conjunctivitis
- Perform an antigen/DNA detection test, chlamydia culture, or both by scraping of palpebral conjunctiva.
- If the mother has had documented chlamydial infection during pregnancy that was untreated, presumptively treat the infant, even without confirmation of infection.
Imaging Studies
- Obtain a chest radiograph for infants with suspected pneumonia. Chlamydial pneumonia may appear as a lobar or interstitial pneumonia in infants.
- Imaging studies are usually not required for patients with uncomplicated genital chlamydial infections. However, ultrasonography and CT scanning are useful diagnostic adjuncts in cases of complicated (upper tract) infection (see Media files 1-2).
Medical Care
- The key to management is correct diagnosis and assurance of compliance with treatment.
- Because of the personal nature and time-intensive diagnosis of STIs, many physicians err by presuming that symptoms of an STI are caused by a UTI; therefore, patients often present with a history of multiple UTIs when, in fact, they may have had one or more STIs.
- Adolescents are at high risk for noncompliance with treatment, especially if a patient is attempting to keep information away from parents. Single-dose, in-office treatment is increasingly being used to improve compliance and confidentiality.
- Partner treatment is crucial to avoid reinfection.
Lower genital infections caused by chlamydia can be treated with single-dose, directly observed treatment. This practice is encouraged when possible to reduce noncompliance due to cost, confidentiality issues, motivational issues, and maturity issues. Upper genital tract disease must be vigorously sought out because potential complications are serious, especially in adolescents. With the advent of newer, more sensitive DNA and antigen detection kits that use urine specimens instead of a pelvic examination, the potential to presume a chlamydial infection in uncomplicated lower tract disease is concerning. Inadequately treated PID can lead to sepsis, infertility, and chronic pelvic pain. Many practitioners strongly advise admission for inpatient therapy and monitoring of response whenever PID is suspected because of a tendency of adolescents to minimize or ignore symptoms and eschew follow-up. Inpatient regimens for PID require significant clinical improvement and confidence in completion of medical therapy prior to discharge. Upper genital infections are often treated with a 10-day course that includes treatment of gonorrhea. Some practitioners prefer to complete the entire course of treatment on an inpatient basis, usually 10-14 days. Chlamydial conjunctivitis and pneumonia are usually treated for a total of 14 days.
In April 2007, the Centers for Disease Control and Prevention (CDC) updated treatment guidelines for gonococcal infection and associated conditions. Fluoroquinolone antibiotics are no longer recommended to treat gonorrhea in the United States. The recommendation was based on analysis of new data from the CDC's Gonococcal Isolate Surveillance Project (GISP). The data from GISP showed the proportion of gonorrhea cases in heterosexual men that were fluoroquinolone resistant (QRNG) reached 6.7%, an 11-fold increase from 0.6% in 2001. The data were published in the April 2007 issue of the Morbidity and Mortality Weekly Report.3 This limits treatment of gonorrhea to drugs in the cephalosporin class (eg, ceftriaxone 125 mg IM once as a single dose). Fluoroquinolones may be an alternative treatment option for disseminated gonococcal infection if antimicrobial susceptibility can be documented.
For more information, see the CDC's Antibiotic-Resistant Gonorrhea Web site; CDC Updated Gonococcal treatment recommendations (April 2007); or Medscape Medical News on CDC Issues - New Treatment Recommendations for Gonorrhea.
Drug Category: Antibiotic agents
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
| Drug Name | Azithromycin (Zithromax) |
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| Description | DOC for genital chlamydia infections because it is a single-dose regimen, has high tolerability, and has few contraindications. A macrolide antibiotic with activity against various different bacterial organisms. Binds to the 50S ribosomal subunit of the bacteria. This binding inhibits bacterial protein synthesis. |
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| Adult Dose | 1 g PO once |
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| Pediatric Dose | <45 kg: 20 mg/kg PO once; not to exceed 1 g/dose
>45 kg: Administer as in adults |
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| Contraindications | Documented hypersensitivity |
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| Interactions | Aluminum- and magnesium-containing antacids decrease peak serum levels of azithromycin; do not administer antacids with azithromycin; food decreases the peak serum levels of azithromycin cap and susp but has minimal effect on the tab formulation; administer cap and susp 1 h ac or 2 h pc |
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| Pregnancy | B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
|
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| Precautions | Impaired liver function; common adverse drug reactions include GI symptoms such as diarrhea, abdominal pain, nausea, and vomiting |
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| Drug Name | Doxycycline (Bio-Tab, Vibramycin, Doryx) |
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| Description | Second DOC for genital chlamydia infections. Efficacy is good; however, because of the need for extended therapy, compliance is often poor. A tetracycline derivative. Has a limited spectrum of bacterial activity but is effective in treating chlamydial infections. Binds to the 30S and maybe the 50S ribosomal subunits of the bacteria. This binding inhibits bacterial protein synthesis. |
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| Adult Dose | 100 mg PO bid for 7 d |
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| Pediatric Dose | <8 years: Not recommended (causes dental staining)
>8 years: 100 mg PO bid for 7 d |
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| Contraindications | Documented hypersensitivity; severe hepatic dysfunction |
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| Interactions | Zinc, kaolin, pectin, iron, bismuth subsalicylate, and aluminum-, calcium-, and magnesium-containing antacids may decrease doxycycline bioavailability (administer 1 h before or 2-3 h after any of these products); half-life is decreased by barbiturates, rifampin, phenytoin, and carbamazepine; enhances the effect of warfarin; milk or dairy products, calcium, and iron may decrease absorption; administer 1 h before or 2-3 h after milk, dairy products, or iron |
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| Pregnancy | D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
|
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| Precautions | May cause photosensitivity reaction; avoid prolonged exposure to sunlight or tanning equipment; associated with retardation of skeletal development in infants; common adverse drug reactions include GI symptoms such as nausea and diarrhea |
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| Drug Name | Erythromycin (E.E.S., Eryc, E-Mycin) |
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| Description | DOC in pregnancy and in infants. A macrolide antibiotic with a large spectrum of activity. Binds to the 50S ribosomal subunit of the bacteria, which inhibits bacterial protein synthesis. |
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| Adult Dose | Base: 500 mg PO qid for 7 d
Erythromycin ethylsuccinate (EES): 800 mg PO qid for 7 d |
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| Pediatric Dose | Newborns with chlamydia conjunctivitis or pneumonia: erythromycin (base) 50 mg/kg/d PO divided qid for 14 d |
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| Contraindications | Hypersensitivity to macrolides; hepatic impairment; concomitant administration of terfenadine, cisapride, or astemizole |
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| Interactions | Decreases clearance of terfenadine (recalled from US market), cisapride, and astemizole (recalled from US market), which may result in serious cardiac arrhythmias; decreases clearance of cyclosporin, midazolam, phenytoin, triazolam, and theophylline; may increase toxicity of warfarin and ergotamine |
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| Pregnancy | B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
|
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| Precautions | Common adverse drug reactions include GI symptoms such as abdominal pain, diarrhea, nausea, and vomiting; administration in neonates has been associated with an increased incidence of hypertrophic pyloric stenosis; careful monitoring is prudent in the case of vomiting, which might otherwise be ascribed to macrolide-induced GI distress |
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| Drug Name | Amoxicillin (Trimox, Amoxil) |
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| Description | Because of lower efficacy, this is indicated only when the patient is both pregnant and erythromycin-allergic. Amoxicillin is a penicillin antibiotic with activity against gram-positive and some gram-negative bacteria. Binds to PBPs, inhibiting bacterial cell wall growth. |
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| Adult Dose | 500 mg PO tid for 7-10 d |
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| Pediatric Dose | 30-40 mg/kg/d PO divided tid for 7-10 d |
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| Contraindications | Documented hypersensitivity |
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| Interactions | Decreases PO contraceptive efficacy; probenecid increases serum concentration of amoxicillin |
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| Pregnancy | B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
|
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| Precautions | Use with caution in patients who are allergic to cephalosporin antibiotics |
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| Drug Name | Sulfisoxazole (Gantrisin) |
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| Description | Less effective than most other regimens. Less convenient dosing makes this a poor choice for most adolescents. |
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| Adult Dose | 500 mg PO qid for 10 d |
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| Pediatric Dose | 120-150 mg/kg/d PO divided qid |
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| Contraindications | Documented hypersensitivity; third trimester of pregnancy; newborns; nursing mothers |
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| Interactions | May enhance anticoagulation of warfarin and hemorrhage could occur; thiopental anesthetic effects may be enhanced; risk of nephrotoxicity may increase when concurrently administered with cyclosporine; may increase serum hydantoin levels; may enhance methotrexate-induced bone marrow suppression; may increase sulfonylurea concentrations and cause hypoglycemia in patients with diabetes Coadministration with diuretics may increase incidence of thrombocytopenia with purpura; the sulfonamide-free drug concentration may be increased when concurrently administered with indomethacin; concomitant use with methenamine mandelate may form a precipitate in acidic urine; probenecid and salicylates may displace sulfonamides from plasma albumin resulting in increased free-drug concentrations potentiating its toxicity |
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| Pregnancy | C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
|
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| Precautions | Do not use in pregnancy in last trimester (particularly near term) because of risk of kernicterus; testing for cure after 3-4 wk is advised because of low efficacy |
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Further Outpatient Care
- Follow-up at 3-4 weeks to repeat examination and testing (test of cure) is necessary because recurrent or persistent cases can lead to infertility. Retesting before 3-4 weeks may lead to a false-positive result of nonculture tests due to shedding of dead organisms.
- Perform partner testing and treatment to prevent reinfection.
Deterrence/Prevention
- Abstinence from sexual activity
- Condom use with each sexual encounter
Complications
- Chronic pelvic pain
- PID: This is a serious disease that often requires hospitalization for inpatient care, including intravenous antibiotics, testing to rule out tuboovarian abscess, and intensive counseling on the complications of recurrent infections.
- Salpingitis
- Tuboovarian abscess
- Sterility or ectopic (most commonly tubal) pregnancy in future (especially if recurrent)
- Reactive arthritis (Reiter syndrome), urethritis, conjunctivitis, and arthritis most commonly caused by chlamydia in sexually active populations
- Fitz-Hugh-Curtis syndrome (perihepatitis, a rare complication of PID)
- Presents 5 times more frequently due to chlamydia than to gonorrhea
- Frequently presents without typical examination findings of PID (ie, a normal pelvic examination)
Prognosis
- The prognosis is excellent if diagnosed and treated early.
- Risk of infertility is increased with repeated episodes.
- Reinfection is common unless all sexual partners are treated.
Patient Education
Medical/Legal Pitfalls
- Undiagnosed chlamydia can progress to PID, which may lead to relative or absolute infertility. This may be tragic if it occurs early in life before childbearing.
- Diagnostically evaluate all cases of suspected sexual abuse using chlamydial culture, not nonculture techniques.
Special Concerns
- Many clinicians err on the side of caution and hospitalize patients if PID is a concern (see Medication) or if compliance with therapy is problematic. Consider PID an absolute indication for admission because of the potential for infertility and the poor compliance of many adolescents with prolonged treatment regimens.
- Pregnancy is a contraindication for the use of doxycycline and ofloxacin; therefore, obtaining a pregnancy test before beginning treatment with these drugs is critical.
| Media file 1:
CT scan of an adolescent with chlamydial Fitz-Hugh-Curtis syndrome demonstrating a perihepatic fluid collection anterior to the liver. |
 |  View Full Size Image | |
Media type: CT
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| Media file 2:
CT scan of an adolescent with chlamydial Fitz-Hugh-Curtis syndrome demonstrating free peritoneal fluid. |
 | View Full Size Image | |
Media type: CT
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- Bakken IJ. Chlamydia trachomatis and ectopic pregnancy: recent epidemiological findings. Curr Opin Infect Dis. Feb 2008;21(1):77-82. [Medline].
- Chernesky M, Freund GG, Hook E 3rd, Leone P, D'Ascoli P, Martens M. Detection of Chlamydia trachomatis and Neisseria gonorrhoeae infections in North American women by testing SurePath liquid-based Pap specimens in APTIMA assays. J Clin Microbiol. Aug 2007;45(8):2434-8. [Medline].
- CDC. Update to CDC's Sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR [serial online]. Apr 13 2007;56(14):332-336. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm?s_cid=mm5614a3_e.
- 2004 Canadian sexually transmitted infections surveillance report. Can Commun Dis Rep. May 2007;33 Suppl 1:1-69. [Medline].
- American Academy of Pediatrics. 2006 Red Book: Report of the committee on infectious diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:249-57.
- Azenabor AA, Kennedy P, Balistreri S. Chlamydia trachomatis infection of human trophoblast alters estrogen and progesterone biosynthesis: an insight into role of infection in pregnancy sequelae. Int J Med Sci. 2007;4(4):223-31. [Medline].
- Baud D, Regan L, Greub G. Emerging role of Chlamydia and Chlamydia-like organisms in adverse pregnancy outcomes. Curr Opin Infect Dis. Feb 2008;21(1):70-76. [Medline].
- Behrman RE. Nelson's textbook of pediatrics. Philadelphia, Pa: WB Saunders; 1992:536-7.
- Biro FM. Adolescents, sexual activity, and sexually transmitted infections. J Pediatr Adolesc Gynecol. Aug 2007;20(4):219-20. [Medline].
- Blake DR, Kearney MH, Oakes JM, et al. Improving participation in Chlamydia screening programs: perspectives of high-risk youth. Arch Pediatr Adolesc Med. Jun 2003;157(6):523-9. [Medline].
- Blake DR, Lemay CA, Indurkhya A. Correlates of readiness to receive Chlamydia screening among 2 populations of youths. Arch Pediatr Adolesc Med. Nov 2007;161(11):1088-94. [Medline].
- CDC. Sexually transmitted diseases treatment guidelines, 2006. Centers for Disease Control and Prevention. MMWR Recomm Rep [serial online]. Aug 4 2006;55(RR-11):1-94. [Medline]. Available at http://www.cdc.gov/std/treatment/2006/rr5511.pdf.
- Darville T. Chlamydia trachomatis infections in neonates and young children. Semin Pediatr Infect Dis. Oct 2005;16(4):235-44. [Medline].
- Freeto JP, Jay MS. "What's really going on down there?" A practical approach to the adolescent who has gynecologic complaints. Pediatr Clin North Am. Jun 2006;53(3):529-45, viii. [Medline].
- Gambhir M, Basanez MG, Turner F, Kumaresan J, Grassly NC. Trachoma: transmission, infection, and control. Lancet Infect Dis. Jun 2007;7(6):420-7. [Medline].
- Gaydos CA. Nucleic acid amplification tests for gonorrhea and chlamydia: practice and applications. Infect Dis Clin North Am. Jun 2005;19(2):367-86, ix. [Medline].
- Geisler WM. Management of uncomplicated Chlamydia trachomatis infections in adolescents and adults: evidence reviewed for the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. Apr 1 2007;44 Suppl 3:S77-83. [Medline].
- Glasier A, Gulmezoglu AM, Schmid GP, et al. Sexual and reproductive health: a matter of life and death. Lancet. Nov 4 2006;368(9547):1595-607. [Medline].
- Haggerty CL, Ness RB. Newest approaches to treatment of pelvic inflammatory disease: a review of recent randomized clinical trials. Clin Infect Dis. Apr 1 2007;44(7):953-60. [Medline].
- Hammerschlag MR. Chlamydia trachomatis and Chlamydia pneumoniae infections in children and adolescents. Pediatr Rev. Feb 2004;25(2):43-51. [Medline].
- Heath PT. Epidemiology and bacteriology of bacterial pneumonias. Paediatr Respir Rev. Mar 2000;1(1):4-7. [Medline].
- Hughes G, Simms I, Leong G. Data from UK genitourinary medicine clinics, 2006: a mixed picture. Sex Transm Infect. Oct 2007;83(6):433-5. [Medline].
- Hwang L, Shafer MA. Chlamydia trachomatis infection in adolescents. Adv Pediatr. 2004;51:379-407. [Medline].
- Jalal H, Stephen H, Bibby DF, Sonnex C, Carne CA. Molecular epidemiology of genital human papillomavirus and Chlamydia trachomatis among patients attending a genitourinary medicine clinic - will vaccines protect?. Int J STD AIDS. Sep 2007;18(9):617-21. [Medline].
- Joesoef MR, Kahn RH, Weinstock HS. Sexually transmitted diseases in incarcerated adolescents. Curr Opin Infect Dis. Feb 2006;19(1):44-8. [Medline].
- Kelly P, Koh J. Sexually transmitted infections in alleged sexual abuse of children and adolescents. J Paediatr Child Health. Jul-Aug 2006;42(7-8):434-40. [Medline].
- Kohlberger P, Bancher-Todesca D. Bacterial colonization in suspected sexually abused children. J Pediatr Adolesc Gynecol. Oct 2007;20(5):289-92. [Medline].
- Kropp RY, Latham-Carmanico C, Steben M, Wong T, Duarte-Franco E. What's new in management of sexually transmitted infections? Canadian Guidelines on Sexually Transmitted Infections, 2006 Edition. Can Fam Physician. Oct 2007;53(10):1739-41. [Medline].
- Kucinskiene V, Sutaite I, Valiukeviciene S, et al. Prevalence and risk factors of genital Chlamydia trachomatis infection. Medicina (Kaunas). 2006;42(11):885-94. [Medline].
- Kumar S, Hammerschlag MR. Acute respiratory infection due to Chlamydia pneumoniae: current status of diagnostic methods. Clin Infect Dis. Feb 15 2007;44(4):568-76. [Medline].
- Lee S, Alemayehu W, Melese M, et al. Chlamydia on children and flies after mass antibiotic treatment for trachoma. Am J Trop Med Hyg. Jan 2007;76(1):129-31. [Medline].
- Lee SR, Chung JM, Kim YG. Rapid one step detection of pathogenic bacteria in urine with sexually transmitted disease (STD) and prostatitis patient by multiplex PCR assay (mPCR). J Microbiol. Oct 2007;45(5):453-9. [Medline].
- Majeroni BA, Ukkadam S. Screening and treatment for sexually transmitted infections in pregnancy. Am Fam Physician. Jul 15 2007;76(2):265-70. [Medline].
- Malik AI, Huppert JS. Interval to treatment of sexually transmitted infections in adolescent females. J Pediatr Adolesc Gynecol. Oct 2007;20(5):275-9. [Medline].
- Manhart LE, Golden MR, Marrazzo JM. Expanding the spectrum of pathogens in urethritis: implications for presumptive therapy?. Clin Infect Dis. Oct 1 2007;45(7):872-4. [Medline].
- Marrazzo JM, Martin DH. Management of women with cervicitis. Clin Infect Dis. Apr 1 2007;44 Suppl 3:S102-10. [Medline].
- McCormack WM. Pelvic inflammatory disease. N Engl J Med. Jan 13 1994;330(2):115-9. [Medline].
- Mecaskey JW, Knirsch CA, Kumaresan JA, Cook JA. The possibility of eliminating blinding trachoma. Lancet Infect Dis. Nov 2003;3(11):728-34. [Medline].
- Miller CA, Tebb KP, Williams JK, Neuhaus JM, Shafer MA. Chlamydial screening in urgent care visits: adolescent-reported acceptability associated with adolescent perception of clinician communication. Arch Pediatr Adolesc Med. Aug 2007;161(8):777-82. [Medline].
- Miller KE. Diagnosis and treatment of Chlamydia trachomatis infection. Am Fam Physician. Apr 15 2006;73(8):1411-6. [Medline].
- Miller WC, Zenilman JM. Epidemiology of chlamydial infection, gonorrhea, and trichomoniasis in the United States--2005. Infect Dis Clin North Am. Jun 2005;19(2):281-96. [Medline].
- Mollen CJ, Pletcher JR, Bellah RD, Lavelle JM. Prevalence of tubo-ovarian abscess in adolescents diagnosed with pelvic inflammatory disease in a pediatric emergency department. Pediatr Emerg Care. Sep 2006;22(9):621-5. [Medline].
- Olshen E, Shrier LA. Diagnostic tests for chlamydial and gonorrheal infections. Semin Pediatr Infect Dis. Jul 2005;16(3):192-8. [Medline].
- Peeling RW, Mabey D, Herring A, Hook EW 3rd. Why do we need quality-assured diagnostic tests for sexually transmitted infections?. Nat Rev Microbiol. Dec 2006;4(12):909-21. [Medline].
- Richardus JH, Gotz HM. Risk selection and targeted interventions in community-based control of chlamydia. Curr Opin Infect Dis. Feb 2007;20(1):60-5. [Medline].
- Risser WL, Bortot AT, Benjamins LJ, et al. The epidemiology of sexually transmitted infections in adolescents. Semin Pediatr Infect Dis. Jul 2005;16(3):160-7. [Medline].
- Skinner SR, Parsons A, Kang M, Williams H, Fairley C. Sexually transmitted infections. Initiatives for prevention. Int J Adolesc Med Health. Jul-Sep 2007;19(3):285-94. [Medline].
- Summaries for patients. Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age. Ann Intern Med. Jul 17 2007;147(2):I22. [Medline].
- Summaries for patients. Screening for chlamydial infection: recommendations from the U.S. Preventive Services Task Force. Ann Intern Med. Jul 17 2007;147(2):I44. [Medline].
- Walker CK, Wiesenfeld HC. Antibiotic therapy for acute pelvic inflammatory disease: the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. Apr 1 2007;44 Suppl 3:S111-22. [Medline].
- Waugh M. Sexually transmitted infections-microbial infections, 2007 update. Skinmed. Sep-Oct 2007;6(5):242-4. [Medline].
- Wright HR, Taylor HR. Clinical examination and laboratory tests for estimation of trachoma prevalence in a remote setting: what are they really telling us?. Lancet Infect Dis. May 2005;5(5):313-20. [Medline].
- Zar HJ. Neonatal chlamydial infections: prevention and treatment. Paediatr Drugs. 2005;7(2):103-10. [Medline].
Chlamydial Infections excerpt Article Last Updated: Feb 1, 2008
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