Treatment of Chlamydia trachomatis Infection

Essential Guide to Cure Chlamydia

Is Chlamydia easily curable? The Answer is a big Yes! Chlamydia is one of the sexually transmitted diseases with proven treatment methods. In fact, there are two main treatment options available both of which have guaranteed results: Conventional medicine and natural medicine. These treatment options And lots of other previously unknown facts about Chlamydia have been explained at great length in this eBook. The Essential guide to Cure Chlamydia unveils the mystery of Chlamydia and methodically presents all the important bits of information that you should know about Chlamydia. The Banish Chlamydia Book tackles the sensitive subject of Chlamydia from the perspective of a professional and presents you with a goldmine of information and facts in a way that has never been done before.

Essential Guide to Cure Chlamydia Summary


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Chlamydia trachomatis

Chlamydia trachomatis is the major causative agent of non-gonococcal urethri-tis, as well as epididymitis in men, and is the most common sexually transmitted bacterial pathogen worldwide. Genital C. trachomatis infection is a key global issue facing female reproductive health. It can cause cervicitis, pelvic inflammatory disease, infertility, and ectopic pregnancy. Asymptomatic infections are common in both men and women. Currently, routine screening for chlamydia are recommended by the Centers for Disease Control and Prevention on sexually active teenagers and adults of

Uncomplicated Chlamydial Infections

Chlamydial urethritis is characterized by urethral discharge of mucopurulent or purulent material and sometimes by dysuria or urethral pruritis. Asymptomatic infections are common. All patients who have urethritis should be evaluated for the presence of gonococcal and chlamydial infection. Treatment should be initiated as soon as possible after diagnosis. Single-dose regimens have the advantage of improved compliance and permit DOT. The medication should be provided in the clinic or healthcare provider's office. Recommended regimens include azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice a day for 7 days. Again, the 2 g single oral dose of azithromycin has not been recommended, due to its increased expense and frequency of gastrointestinal intolerance. Alternative regimens include erythromycin base 500 mg orally four times a day for 7 days, erythromycin ethylsuccinate 800 mg orally four times a day for 7 days, ofloxacin 300 mg twice a day for 7 days, or...


The members of the order Chlamydiales have been regrouped into two genera and nine species based on differences in phenotype, 16S rRNA, and 23S rRNA.10 The genus Chlamydia comprises three species C. trachomatis, C. suis, and C. muridarum. The other genus, Chlamy-dophila, consists of six species C. pneumoniae, C. psittaci, C. pecorum, C. felis, C. caviae, and C abortus 0'11 Chlamydiae possess a heat-stable, family-specific antigen that is an essential component of the cell membrane lipopoly saccharide10 species and type-specific protein antigens-also exist. Members of the order Chlamydiales are obligate intracellular bacteria that were once regarded as viruses. These organisms require the biochemical resources of the eukaryotic host cell environment to fuel their metabolism for growth and replication because they are unable to produce high-energy compounds such as adenosine triphosphate. Chlamydiae have unique developmental life cycle, with an intracellular growth, or replicative form,...

Direct Detection Of Microorganisms

However, for many infectious agents, detection and identification are only part of the diagnostic requirement. Determination of certain characteristics, such as strain relatedness or resistance to antimicrobial agents, is often an important diagnostic or epidemiologic component that is not possible without the availability of culture. For this reason, most molecular direct detection methods target organisms for which antimicrobial susceptibility testing is not routinely needed (e.g., chlamydia) or for which reliable cultivation methods are not widely available (e.g., ehrlichia). One or two pathogens cause the majority of infections (e.g., Chlamydia trachomatis and Neisseria gonorrhoeae as common agents of genitourinary tract infections)

Recent Sexual History

'Was this person male or female ' This will guide your questioning and assist you in the risk assessment. Please remember that if the client is female and having sex with another woman this doesn't necessarily mean that they are not at risk that other woman may have had male relationships in the past and may have acquired chlamydia, genital warts or HIV. The use of shared sex toys may also be a risk factor.

Symptoms And Signs

After signs of rhinitis and pharyngitis for a few days, the patient may become hoarse and have inspiratory stridor. There may be a mild to moderate fever. Involvement of the lower respiratory tract (bronchitis and bronchopneumonia) is seen in 30 of primary infections with type 3 virus. Severe croup is seen in 2-3 of primary infections with virus types 1 and 2. The parainfluenzaviruses are second only to respiratory syncytial virus as the cause of serious respiratory tract infections in infants and children. Parainfluenzavirus 1 and 2 most often give infections affecting the larynx and the upper trachea which may result in croup, while type 3 has a predilection for the lower respiratory tract giving bronchitis, bronchiolitis and bronchopneu-monia. Type 4 virus is less virulent, being associated with mild upper respiratory tract illness in children and adults. Due to the presence of protective maternal antibodies, serious illness due to...

DNA Microarray Analysis of Host Pathogen Interaction

Understanding the molecular basis of the host response to bacterial infections is critical for understanding disease mechanisms involved, and in preventing disease and tissue damage resulting from the host response. The global transcription effects on host cells by various bacterial pathogens including Listeria monocytogenes, Salmonella typhimurium, Pseudomonas aeruginosa, Bordetellapertussis,Mycobacterium tuberculosis, H. pylori, and Chlamydia trachomatis have been analyzed by using microarray technology (29,30). Rosenberger et al. (31) identified novel macrophage genes whose level of expression are altered in S. typhimurium infection or when treated with lipo-polysaccharide. Similarly, Cohen et al. (32) identified 74 upregulated RNAs and 23 downregulated host RNAs in L. monocytogenes-infected human promyelocytic THP1 cells. Infection of human bronchial epithelial cells by B. pertussis results in an increase in transcriptional levels of 33 genes and decrease in transcriptional levels...

The Prospects for Microbial Genomics Providing Novel Exploitable Antibacterial Targets

Currently, the number of microbial genomes that have been sequenced since the initial H. influenzae genome is approximately fifty-nine, with many additional projects in progress. Limiting the examples to pathogens alone, organisms such as Streptococcus pyogenes, several strains of Streptococcus pneumoniae, Chlamydia trachomatis, and Chlamydia pneumoniae, Borrelia burgdorferi, Treponema pallidum, Mycobacterium tuberculosis and an enterohaemorrhagic strain of Escherichia coli (13-21) are among many additional pathogen genome sequences in the public domain. Two important organisms in which the bulk of microbial physiology has been performed, E. coli K-12 and Bacillus subtilis, are also available. These are key, as many of the putative function annotations of pathogen genomes are based on sequence similarities to gene products in these two organisms. With individual microbial genomes running between roughly 400,000 to over 4 million base pairs, the sheer volume of this information has...

Bacterial Conjunctivitis

Some forms of bacterial infection, such as inclusion conjunctivitis, that have been associated with chlamydial infections are associated with a preauricular node. Common findings of inclusion conjunctivitis include a mucopurulent discharge and follicular conjunctivitis lasting for more than 2 wk. A Giemsa stain of a conjunctival scraping may reveal intracytoplasmic inclusion bodies and will assist in confirming the diagnosis. In addition, such prolonged ocular infections are commonly associated with a conjunctival response that reveals grayish follicles on the upper palpebra. The condition can be chronic, and treatment consists of lid margin scrubs, warm compresses, and antibiotics. In general, a topical, broad-spectrum antibiotic, such as sulfacetamide, erythromycin, or a combination of polymyxin B, bacitracin, and neosporin, is appropriate. Cultures are necessary only if the conjunctivitis is severe it would be best if they were carefully examined by an ophthalmologist. The...

Ramification Amplification

The practical use of RAM has been shown in several studies for detecting target nucleic acids in clinical samples. Zhang et al. (2002) were able to detect Chlamydia trachomatis in cervical specimens collected in PreservCyt cytological solution. Thirty clinical specimens were tested using the RAM assay, and the assay conferred accurate detection of all the positive samples that were confirmed by PCR and LCx. The RAM assay can detect as few as 10 C. trachomatis elementary bodies in less than 2 hrs. similar to the lower limit of detection for Amplicor PCR and LCx. Therefore, the RAM assay can serve as a feasible alternative to PCR and LCx for the detection of sexually transmitted infectious agents owing to its simplicity and isothermal amplification conditions.

Progress in Macrolide and Ketolide Antibacterial

Introduction - The macolide antibiotic erythromycin was first found in the fermentation products of a strain of Streptomyces erythreus by McGuire (1). It has been used for the treatment of various bacterial infections in both out-patient and in-patient settings for more than forty years. Erythromycin derivatives such as clarithromycin and azithromycin are frequently prescribed for the treatment of both upper and lower respiratory tract infections (2,3). In addition to having better activity than their parent erythromycin A against anaerobes, streptococci, Haemophilus influenzae, Legionella spp., Branhamella spp., Chlamydia spp., Mycoplasma spp. and Pasteurella multocida, these derivatives possess improved pharmacokinetic profiles. However, MRSA and penicillin-resistant S. pneumoniae are found to become increasingly resistant to these newer macrolides. The emergence of resistant community-acquired as well as nosocomial pathogens to the clinically used antibacterial agents, including...

Summary and Future Direction

Clinical diagnosis, and their clinical performance has not yet been demonstrated in large clinical trials. It is anticipated that some of these technologies may not meet the clinical diagnostic requirements and will consequently be lost in market competition. For example, Q-beta replicase technology did not reach the clinical laboratory even after an initial favorable clinical trial, and the LCx assay (LCR technology) for Chlamydia was voluntarily withdrawn by Abbott in 2003 due to significant reproducibility problems (Gronowski et al., 2000). Therefore, it is expected that more changes (exciting or disappointing) will happen in the field of probe-based amplification technologies in the next 10 years.

Drug Selection And Dosing

Information does not ensure that the antibacterial agent is the best available drug. In many cases, the science available may support nonlabeled uses for the agent. A pharmacodynamic (PD) approach considers the etiology (pathogen susceptibility) and antibacterial exposure (pharmacokinetics PK ) as most important. Excluding specialized infection sites such as the cerebrospinal space, middle ear space, or urine, serum concentrations may be used as a surrogate for concentrations at the site of infection. For agents that have significant protein binding (particularly agents that are 85 or more bound), the free concentration represents the bioactive concentration and should be used for defining exposure (20). Special considerations are needed for bacteria that survive and multiply within cells, such as Chlamydia spp. and Legionella spp (21). Likewise, PK PD relationships may differ substantially among agents. Free serum concentrations of a beta-lactam agent may predict response to...

Respiratory Tract Infections

Other causative microorganisms of CAP are Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Streptococcus pyogenes, Moraxella catarrhalis, Klebsiella pneumoniae, Legionella spp., viruses, and other Gram-negative rods.54 In patients hospitalized due to CAP, P. aeruginosa has also been recovered.55 H. influenzae and M. catarrhalis were shown to be significantly resistant to first-generation cephalosporins and other -lactams.63 Abdel-Rahman et al. reported ampicillin resistance in 20 and multidrug resistance in 5.4 of all isolates of H. influenzae in Saudi Arabia, where antibiotics are commonly sold over the counter.66 Being aware of the resistance rates observed in H. influenzae, clinicians should choose an antibiotic other than ampicillin, when empirical antibiotic therapy is needed.

Laboratory Diagnosis

Specimens for isolation are usually swabs of the oropharynx techniques for isolation from sputum are unsatisfactory. Swabs should be placed into chlamydial transport media, transported on ice, and stored at 4 C organisms are rapidly inactivated at room temperature or by rapid freezing or thawing. A cell culture procedure similar to that used for C. trachomatis but using the more sensitive HL or Hep-2 cell lines must be substituted for McCoy cells. Multiple blind passages might be necessary to improve recovery rates. C. pneumoniae species-specific monoclonal antibodies can detect the organism in cell culture.

Neisseria gonorrhoeae

In Africa, sexually transmitted infections (STIs) have a major impact on health including adverse consequences that are exacerbated by structurally deficient health-care systems (Buve et al. 2001 Gerbase et al. 1998 Mullick et al. 2005). Before the era of antibiotics, invasive STIs invariably progressed to long-term complications, a situation that remains for sexually transmitted diseases of viral etiology. Introduction of cheap but effective antimicrobials substantially reduced mortality and spread of sexually transmitted diseases like chlamydial infections, syphilis, and gonorrhea. For many bacterial STIs, penicillins and tetracycline were commonly used for treatment in developing countries until they were challenged by the appearance of plasmid-mediated resistance in N. gonorrhoeae strains from geographically diverse areas of Tanzania (West et al. 1995), Zimbabwe (Mason and Gwanzura 1988), Ghana (Addy 1994), Ethiopia (Habte-Gabr et al. 1983) and Nigeria (Obaseiki-Ebor et al. 1985)....

Broadspectrum versus HIVspecific

While the major focus of microbicide development has been HIV since HIV AIDS is a lethal and incurable disease, other sexually transmitted infections (STIs) are also significant causes of morbidity and mortality 22 . In fact, the spread of these diseases are also facilitated by the same factors driving the worldwide spread of HIV - such as lack of woman-controlled prevention methods and a lack of widespread use of condoms. Non-HIV STIs include curable infections such as trichomoniasis, Chlamydia, gonorrhea, syphilis, and chancroid, as well as non-curable infections caused by Herpes virus and human papillomavirus 22 . Since STIs are important co-factors for HIV transmission, candidate microbicides have been developed with overlapping mechanisms of action and potential activity against other sexually transmitted pathogens. Overall, women at risk for HIV

Environmental Factors Influencing LOH

Inflammation associated with chronic infection can be a contributing risk factor for carcinogenesis. Examples include infection of the gastric wall with Helicobacter pylori as a predisposing factor for gastric cancer26 chronic infections of hepatitis virus leading to hepatocellular carcinoma (HCC) and the linkage of lung cancer with chronic Chlamydia pneumoniae and Mycobacterium tuberculosis (M-TB) infections.25,46 Studies indicate that the mechanism of DNA damage in relation to infections is indirect and comes from the host's activated inflammatory cells sent to fight the infection. Cumulative evidence suggests that free radicals, such as NO, produced by activated inflammatory cells can contribute to cancer, as they are known to be able to cause direct damage to DNA.47

Molecular Detection Methods

No amplification of nucleic acid takes place in the probe hybridization method. This method is based on annealing of complementary nucleic acid strands on a stable double-strand. There are two nucleic acid probe assays the GenProbe PACE 2 and PACE 2C assays (GenProbe) and the Hybrid Capture II assay (Digene Corp., Gaithersburg, MD, USA) (Modarress et al., 1999). Both assays have been approved by the Food and Drug Administration (FDA) in the United States for detecting N. gonorrhoeae. In the GenProbe assay, target sequence of ribosomal RNA of N. gonorrhoeae is hybridized by an acridinium ester-labeled complementary DNA probe (Kluytmans et al., 1991). After adsorption of DNA-RNA hybrids to magnetic particles and removal of the unbound probe, the acridinium ester-DNA-RNA hybrid is measured in a luminometer. PACE 2C is a single-tube assay that can screen for presence of both Chlamydia trachomatis and or N. gonorrhoeae (Iwen et al., 1995). If positive result is initially obtained,...

Discussion Challenges To Effective Health Promotion

The Government has set specific targets for sexual health promotion (for example teenage pregnancy and STIs), and has identified 'high-risk' groups, such as teenagers, gay men, young adults and black and ethnic minority groups (DH, 1991). However, one of the results of this is that professionals fail to recognise sexual health promotion needs and opportunities in other population groups, such as older newly single heterosexuals. In addition, some government public health strategies, such as Chlamydia screening, have excluded men, and this has been criticised by Hart et al. (2002), who question the wisdom of such a policy, as men have the same risk of infection from Chlamydia as women.

Traditional Diagnostic Methods

Stably under ambient conditions, EIA is suitable for public health laboratories covering large geographic areas. It is also inexpensive because specimens can be processed in batch using automated equipment (Newhall et al., 1999). Because the test is based on the detection of chlamydial genus-specific lipopolysaccharide (LPS) using monoclonal or polyclonal antibodies linked to a solid-phase support, chlamydial LPS antibodies may also cross-react with the LPS of other Gramnegative bacteria to give false-positive results. Either DFA or blocking assays are needed to confirm positive EIA results and thus improve specificity. On the other hand, EIA lacks sensitivity as screening assay, especially for asymptomatic men, possibly due to its lower detection limit of 10,000 elementary bodies (Lin etal., 1992).

Mycoplasma and Ureaplasma

Based on differing treatment strategies, urethritis has commonly been categorized etiologically as gonococcal or non-gonococcal urethritis (NGU). Both infections are usually acquired via sexual contact, and the latter infection is mainly attributable to the pathogenic role of Chlamydia trachomatis, which accounts for 30-50 of

Community Acquired Pneumonia CAP

There is a wide spectrum of individuals with special risk factors and exposure to a variety of pathogens. S. pneumoniae is the most common bacterial pathogen isolated and other common bacterial pathogens include H. influenzae, M. catarrhalis, and S. aureus. There are also atypical pathogens that include Legionella pneumophila, Chlamydia pneumoniae, and Mycoplasma pneumoniae, which may occur alone or in combination with the more typical bacterial pathogens, listed above. Antibiotic and MDR pathogens of note include S. pneumoniae and more recently community-acquired MRSA (21,49). Unfortunately, no bacterial pathogen can be identified in 30 to 40 of CAP patients, impeding evaluation of clinical eradication and clinical efficacy difficult.

Sexually Transmitted Diseases

SCAT has been extensively studied for the treatment STDs, where ease of administration, tolerability, and cost has had a great influence. The literature is most robust for Neisseria gonorrhoeae and Chlamydia trachomatis infections. A recent review found clinical trial evidence for 30 regimens that were 95 effective in eradicating gonococcal infection (103). Despite a rising incidence of antibiotic resistance among strains of N. gonorrhoeae, highly active and effective single-dose regimens are available for both of these pathogens, which support the effective use of DOT. DOT greatly increases compliance and decreases secondary transmission when compared with longer courses of antibiotic therapy.

Epidemiology Etiologic Agents

The most common etiologic agent of lower respiratory tract infection among adults younger than 30 years of age is Mycoplasma pneumoniae, which is transmitted via dose contact. Contact with secretions seems to be more important than inhalation of aerosols for becoming infected. After contact with respiratory mucosa, Mycoplasma organisms are able to adhere to and colonize respiratory mucosal cells. Both a protein adherence factor and gliding motility may be virulence determinants. Once situated in their preferred site between the cilia of respiratory mucosal cells, Mycoplasma organisms multiply and somehow destroy ciliary function. Cytotoxins produced by Mycoplasma organisms may account for the cell damage they inflict. Chtarny-daphila pneumoniae (originally called Chlamydia TWAR or Chlamydia pneumoniae) is the third most common agent of lower respiratory tract infection in young adults, after mycoplasmas and influenza viruses it also affects older individuals.11...

Specimen Collection and Transport

Purulent material from the surface of the lower conjunctival sac and inner canthus (angle) of the eye is collected on a sterile swab for cultures of conjunctivitis. Both eyes should be cultured separately. Chlamydial cultures are taken with a dry calcium alginate swab and placed in 2-SP transport medium. An additional swab may be rolled across the surface of a slide, fixed with methanol, and sent if direct fluorescent antibody (DFA) chlamydia stains are used for detection.

Otitis Media Middle Ear Infections

Cases, include Moraxella catarrhalis, Staphylococcus aureus, gram-negative enteric bacilli, and anaerobes in one recent study, M. catarrhalis, S. pneumoniae, and H. influenzae were the most common bacterial pathogens.9 Viruses, chiefly respiratory syncytial virus (RSV) and influenza virus, have been recovered from the middle ear fluid of 4 of children with acute or chronic otitis media. Chlamydia trachomatis and Mycoplasma pneumoniae have occasionally been isolated from middle ear aspirates. Otitis media with effusion (fluid) is considered a chronic sequela of acute otitis media. A slowly growing organism, Alloiococcus otitidis is a potential pathogen that is found solely in patients with otitis media with effusion.1,5

Antibacterial activity

Ciprofloxacin and ofloxacin are broad-spectrum antibiotics with activity against Gram-positive and especially Gram-negative organisms. They are also active against some anaerobes and Chlamydia and Mycoplasma species. Since their launch, quinolones have been widely used, and this has led to the emergence of resistance in some bacterial species. This has been seen in the GUM setting, where in some geographical areas in the UK the increasing amount of gonorrhoea resistant to ciprofloxacin has led to its no longer being considered as a first-line empirical treatment in local guidelines for this condition.

Automated Systems Extraction with Amplification

Becton Dickinson (BD, Franklin Lakes, NJ, USA) has an automated sample processor for the BDProbeTec ET system. The BD Viper Sample Processor is designed to automate sample processing with high-volume testing of Neisseria gonorrhoeae and Chlamydia trachomatis ( 500 samples 8-h shift). Gen-Probe (Gen-Probe Incorporated, San Diego, CA, USA) has launched the TIGRIS, which is a fully automated instrument for high-volume testing (1000 samples 12-h shift). The TIGRIS incorporates Gen-Probe's target capture technology for sample processing, Transcription-mediated Amplification (TMA) amplification, and Hybridization Protection Assay (HPA) detection into one instrument. Currently, the TIGRIS is limited to use with Gen-Probe's APTIMA N. gonorrhoeae C. trachomatis assay and Procleix HIV HCV blood screening assay. Gen-Probe also offers the DTS 800 and 1600 systems (manufactured by Tecan, Research Triangle Park, NC, USA), which automate the liquid handling of other various diagnostic kits. Abbott...

Acute Otitis Media Microbiology

Other organisms that less frequently cause AOM include group A beta-hemolytic streptococci (GABHS), Staphylococcus aureus, Turicella otitidis, Alloiococcus otitis Chlamydia spp., and Staphylococcus epidermidis, and various aerobic and faculatative gram-negative bacilli (7) including Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus spp. Gram-negative bacilli and staphylococci are implicated as dominant etiologic agents in otitis media of the neonate. However, even among very young infants, S. pneumoniae and H. influenzae constitute the most common etiologic agents. Viruses were recovered in the middle-ear fluid of 14.3 of children (8).

Spectrum of Disease

C. trachomatis infections have surpassed gonococcal* infections as a cause of sexually transmitted disease in the United States. Similar to gonococci, C. trachomatis is a cause of urethritis, cervicitis, bartholinitis, proctitis, salpingitis, epididymitis, and acute urethral syndrome in women. In the United States, 60 of cases of nongonococcal urethritis are caused by chlamydiae. Both chlamydiae and gonococci are m jor causes of PID, contributing significandy to the rising rate of infertility and ectopic pregnancies in young women. After only one episode of PID, as many as 10 of women may become infertile because of tubal occlusion. The risk increases drama* tically with each additional episode. Many genital chlamydial infections in both sexes are asymptomatic or not easily recognized by clinical criteria asymptomatic carriage in both men and women may persist, often for months. As many as 25 of men and 70 to 80 of women identified as having chlamydial genital tract infections have no...

Pelvic Inflammatory Disease

PID is usually the result of ascending infection from the endocervix, causing endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess and or pelvic peritonitis. Sexually transmitted infections, such as Chlamydia trachomatis and Neisseria gonorrhoeae are identified as causative agents. Mycoplasma genitalium anaerobes and other organisms may also be implicated (Bevan et al., 1995). This takes the form of peri-hepatitis and is generally chlamydial or gonococ-cal in origin. Laparoscopy reveals oedema of the liver capsule and adhesions to the peritoneum. Clinical symptoms and signs lack sensitivity and specificity (the positive predictive value of clinical diagnosis is 65-90 per cent compared with laparoscopic diagnosis) (Bevan et al., 1995). Microbiological tests for gonorrhoea and Chlamydia in the lower genital tract are recommended, as a positive result strongly supports the diagnosis of PID (Bevan et al., 1995 Morcos et al., 1993). An elevated erythrocyte...

Conjunctivitis And Dacryocystitis Conjunctivitis

Conjunctivitis in the newborn infant usually is due to chemical and mechanical irritation caused by the instillation of silver nitrate drops or ointment into the eye in order to prevent gonorrheal ophthalmia. Chemical conjunctivitis differs from infective forms in that it becomes apparent almost immediately after the instillation. The most common causes of infectious conjunctivitis in descending order of frequency are Chlamydia trachomatis, Neisseria gonorrhoeae, Staphylococcus spp., inclusion conjunctivitis caused by groups A and B Streptococcus, Enterococcus spp., Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, E. coli, Moraxella catarrhalis, Neisseria meningitidis, Corynebacterium diphtheriae, herpes simplex virus, echoviruses, and Mycoplasma hominis (18). Clostridia and peptostreptococci were also implicated as probable causes of neonatal conjunctivitis (19). Because anaerobic bacteria have been recovered from children (22) and adults (23,24) suffering...

Acute Urethral Syndrome

Another UTT is acute urethral syndrome. Patients with this syndrome are primarily young, sexually active women, who experience dysuria, frequency, and urgency but yield fewer organisms than 105 colony-forming units of bacteria per milliliter (CFU mL) urine on culture.7,10,17'18 (The classic criterion of greater than 105 CFU mL of urine is highly indicative of infection in most patients with UTIs.) Almost 50 of all women who seek medical attention for complaints of symptoms of acute cystitis fall into this group. Although Chlamydia trachomatis and N. gonorrhoeae urethritis, anaerobic infection, genital herpes, and vaginitis account for some cases of acute urethral syndrome, most of these women are infected with organisms identical to those that cause cystitis but in numbers less than 105 CFU mL urine. One must use a cutoff of 102 CFU mL, rather than 105 CFU mL, for this group of patients but must insist on concomitant pyuria (presence of 8 or more leukocytes per cubic millimeter on...

Urethritis Cervicitis and Vaginitis

Clue Cells

This discussion focuses only on those specimens submitted for culture and or direct examination. Procedures for the collection and transport of specimens for detection of agents by other non-cultural methods (e.g., detection of Chlamydia tracho- A urogenital swab designed expressly for collection of such specimens should be used. These swabs are made of cotton or rayon that has been treated with charcoal to adsorb material toxic to gonococci and wrapped tightly over one end of a thin wire shaft. Cotton- or rayon-tipped swabs on a thin wire may also be used to collect specimens for isolation of mycoplasmas and chlamydiae. Calcium alginate swabs are generally more toxic for HSV, gonococci, chlamydiae, and mycoplasmas than are treated cotton swabs. Because Dacron swabs are least toxic, they are recommended for viral specimens. Dacron-tipped swabs on plastic shafts are also acceptable for chlamydiae and genital mycoplasmas. To obtain a urethral specimen, a swab is...

Topical Microbicides Under Development 51 Preclinical

Chlamydia trachomatis, Chlamydia trachomatis, Chlamydia trachomatis, Neisseria gonorrheae HIV-1, Chlamydia Phase 1 (Vaginal Defense Enhancer) Phase 1 HIV-1, Treponema pallidum, Phase 1 Herpes simplex, Chlamydia trachomatis, Haemophilus ducreyi, Neisseria gonorrheae, Trichomonas vaginalis, BV-associated bacteria, Staphylococcus aureus, human papillomavirus HIV-1 Phase 1 HIV-1, Chlamydia Phase 1 human papillomavirus, Chlamydia trachomatis, HIV-1, Neisseria gonorrheae HIV-1, Chlamydia Phase 1 HIV-1 Herpes simplex, Chlamydia trachomatis Chlamydia trachomatis

Perinatal Infection

Cocci Lesions

The immediate and long-term effects of perinatal infection are a major problem throughout the world. Perinatal infection is relatively common among the over 4 million births per year in the United States but the incidence is dependent upon the organism. One percent of newborn infants excrete cytomegalovirus. Fifteen percent are infected with Chlamydia trachomatis one-third develop conjunctivitis and one-sixth, pneumonia. One to eight per 1,000 live births develop bacterial sepsis. In utero or perinatal infection with herpes simplex virus, Toxoplasma gondii and varicella-zoster virus occurs in about 1 per 1,000 live births and the sequelae may be severe. In-utero acquired infection may result in resorption of the embryo, abortion, stillbirth, malformation, intrauterine growth retardation, prematurity, and the numerous untoward sequelae associated with chronic infection. Infection acquired at or soon after birth may lead to death or persistent postnatal infection. Some infections may be...

Immunofluorescent Assays

Direct Immunofluorescence Digramof

This is a major factor in their use in tests for chlamydial elementary bodies or respiratory syncytial virus (RSV) antigens. Microscopists can see if the specimen was taken from the columnar epithelial cells at the opening of the cervix in the case of the chlamydia DFA, or from the basal cells of the nasal epithelium in the case of RSV. Many individuals, however, consider it problematic that reading slides is completely subjective and that microbiologists must have extensive training to perform testing. Likewise, many individuals view the requirement for a fluorescent scope as an expensive luxury. Finally, fluorescence fades rapidly over time, which makes the archiving of slides difficult. Therefore, antibodies have been conjugated to other markers besides fluorescent dyes. These newer colorimetric labels use enzymes, such as horseradish peroxidase, alkaline phosphatase, and avidin-biotin, to detect the presence of antigen by converting a colorless...

Clinical Manifestations

Syphilis Penis

Example, gonorrhea or chlamydia infection in the male is usually obvious because of a urethral discharge, yet females with either or both of these infections may have either minimal symptoms or no symptoms at all. Also, the primary lesion of syphilis (chancre) can be unremarkable and go unnoticed by the patient. Therefore, the lack of symptoms does not guarantee the absence of disease. Unfortunately, these asymptomatic individuals can then serve as reservoirs for infection and unknowingly spread the pathogen to other individuals. Also, as in the case for asymptomatic infections in the female caused by N. gonorrhoeae or C. trachomatis, untreated infections can lead to serious sequelae such as pelvic inflammatory disease or infertility. Chlamydia trachomatis serotype L1,L2, and L3

Antigen Detection and Nucleic Add Hybridization

Chlamydial antigen can also be detected by enzyme-linked immunosorbent assays (ELISA). Nuro ous U.S. Food and Drug Administration (FDA)-approv Flggi 46-3 Appearance of fluorescein-conjugated, monoclonal antibody-stained elementary bodies in direct smear of urethral cell scraping from a patient with chlamydial urethritis. (Courtesy Syva Co, San Jose, Calif.) Flggi 46-3 Appearance of fluorescein-conjugated, monoclonal antibody-stained elementary bodies in direct smear of urethral cell scraping from a patient with chlamydial urethritis. (Courtesy Syva Co, San Jose, Calif.) kits are commercially available. These assays use poly-el raal or monoclonal antibodies that detect chlamydial rjps. These tests are not species-specific for C. trachomatis and may cross-react with LPS of other bacterial species present in the vagina or urinary tract and thereby produce a false-positive result. Also available are nucleic arid hybridization tests that use a chemiluminescent tyre afDNAprobe (PACE,...

Qbeta Replicase Amplification

Q-beta replicase-based assay has been successfully used to detect various microorganisms such as Chlamydia trachomatis, Mycobacterium tuberculosis, and HIV (Tyagi et al., 1996). Shah et al. described a dual capture method to detect C. trachomatis in urogenital samples (Shah et al., 1994). In this method, the hybrids between chlamydial-specific MDV RNAs and chlamydial rRNA targets were captured onto magnetic beads via a separate capture probe. After washing, these hybrids were released and recaptured to eliminate nonspecific binding of the MDV RNAs to the beads. The chlamydial-specific MDV RNAs were then amplified by Q-beta replicase in the presence of propidium iodide, and detection was carried out in a real-time fashion using a kinetic fluorescence reader. The analytical sensitivity of the assay was 1000 molecules. In their study of 94 urogenital samples, the assay detected 5 of the 6 culture-positive samples and did not detect C. trachomatis target in 85 of the 88 culture-negative...

DNA Microarray Analysis of Bacterial Pathogens

Chlamydia trachomatis is an obligate intracellular pathogen of humans. Isolates are differentiated into biovars based on their in vitro infection properties and type of disease caused. They are grouped into 15 serovars based on antigenic variation of the major outer membrane protein, OmpA. Serovars A to C are the etiological agents of trachoma serovars D to K and L1 to L3 cause cervicitis and urethritis or lymphogranuloma venereum , respectively (14). The genomes ofthree Chlamydia species, C. trachomatis, C. pneumoniae, and C. psittaci have been sequenced (15-17). Comparative analysis of these genomes (1.04-1.3 Mb) showed a high degree of conservation in terms of gene content and gene order with the exception of one polymorphic region named the plasticity zone (PZ), which showed a significant amount of variation among the different The DNA sequences obtained from all the serovars were aligned with the mouse-adapted C. muridarum cytotoxin (TC0438) gene. Analysis of the sequence showed...

Azithromycin And Clarithromycin Update

A simple assay using infected J774 cells for the quantitation of activities of clarithromycin and azithromycin against intracellular Legionella pneumophila has been developed (61). This MTT assay system permits comparative and quantitative evaluation of intracellular activities of macrolides and processing a large number of samples efficiently. A model of continuous Chlamydia pneumoniae infections in vitro closely resembling to the actual events in vivo was developed (62). HEp-2 cells inoculated with CM-1 and TW-183 strains have been persistently infected for a periods of over 1.5 and 2 years, respectively. Using this model, azithromycin was found to reduce but not to completely eliminate the organism. This observation is in agreement with the failure of antibiotic therapy against C. pneumoniae infection in humans. A liquid chromatographic method using a cyanopropyl column with electrochemical detection for the determination of macrolides was reported (63).

Definite Respiratory Tract Pathogens

Chlamydia trachomatis Some respiratory pathogens evade the host immune system by multiplying within host cells. Chlamydia trachomatis, Chlamydophila psittad (Chlamydia psittaci), and all viruses replicate within host cells. They have evolved methods for being taken in by the nonprofessional phagocytic cells of the host to achieve their required environment. Once within these cells, the organism is protected from host humoral immune factors and other phagocytic cells. This protection lasts until the host il becomes suffidentiy damaged that the organism is then recognized as foreign by the host and is attacked. A second group of organisms that cause respiratory tract disease comprises those that are able to be taken up by phagocytic host cells usually macrophages). Once within the phagocytic cell, these respiratory tract pathogens are able to multiply. Legionella, Pneumocystis jtroved (Pneumocystis carinii), and Histoplasma capsulatum are some of these more common intracellular...

Urinary Tract Infections Urethritis Cystitis and Pyelonephritis

An infection can begin when microorganisms, usually bacteria from the digestive tract (such as Escherichia coli, also called E coli), accumulate at the opening of the urethra. An infection that affects only the urethra is called urethritis. From the urethra, bacteria often move up to the bladder, causing a bladder infection (cystitis). Sexually transmitted microorganisms, such as those that cause gonorrhea and chlamydia, also can infect the urinary tract.

Hybrid Capture Technology

The hybrid capture 2 (HC2) technology is the platform for signal-amplified, nucleic acid tests (for review, seeLorincz and Anthony, 2001). HC2 systems areavail-able to detect human papillomavirus (HPV), cytomegalovirus (CMV), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC), and hepatitis B virus (HBV). An assay for herpes simplex virus (HSV) is in development. Rapidly emerging as a standard of practice in cervical cancer screening, the HPV test helps clinical diagnosis of women who are most at risk of having or developing cervical cancer. In addition, one sample collected and rinsed in Cytyc's ThinPrep Pap Test vial Cytyo Corp., Marlborough, MA can be used for both the Pap test and the HPV test. Another liquid-based method, AutoCyte PREP TriPath Imaging, Inc., Burlington, NC, is expected to be used for the same purpose. HPV, chlamydia, and gonorrhea testing can be performed using one sample. Cervical specimens are collected with a broom collection device and rinsed in the...

Collection And Transport Of Specimens

Cotton-, Dacron-, or calcium alginate-tipped swabs are suitable for collecting most upper respiratory tract microorganisms. If the swab remains moist, no further precautions need to be taken for specimens that are cultured within 4 hours of collection. After that period, some kind of transport medium to maintain viability and prevent overgrowth of contaminating organisms should be used. Swabs for detection of group A streptdr cocci (Streptococcus pyogenes) are the only exception. This organism is highly resistant to desiccation and remains viable on a dry swab for as long as 48 to 72 hou Throat swabs of this type can be placed in glassine paper envelopes for mailing or transport to a distant labora* tory. Throat swabs are also adequate for recovery of adenoviruses and herpesviruses, Corynebacterium diphthe-riae, Mycoplasma, Chlamydia, and Candida spp. Recovery ofj C. diphtheriae is enhanced by culturing both the throat and nasopharynx. Nasopharyngeal swabs are better suited for...

Specimens From Sterile Body Sites Fluids

There are two major types of infections in the peritoneal cavity primary and secondary peritonitis. In primary peritonitis, no apparent focus of infection is evident. The organisms likely to be recovered from specimens from patients with primary peritonitis vary with the patient's age. The most common etiologic agents in children are Streptococcus pneumoniae and group A streptococci, Enterobacteriaceae, other gram-negative bacilli, and staphylococci. In adults, Escherichia coli is the most common bacterium, followed by S. pneumoniae and group A streptococci. Polymicrobic peritonitis is unusual in the absence of bowel perforation or rupture. Among sexually active young women. Neisseria gonorrhoeae and Chlamydia trachomatis are common etiologic agents of peritoneal infection, often in the form of a perihepatitis (inflammation of the surface

Routes of Transmission

Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, human immunodeficiency virus (HIV), Treponema pallidum, Ureaplasma urealyticum, Mycoplasma hominis, other mycoplasmas, herpes simplex virus (HSV), and others may be acquired as people engage in sexual activity. In addition, other agents that cause genital tract disease and may be sexually transmitted include adenovirus, coxsackievirus, molluscum contagiosum virus (a member of the poxvirus group), the human papillomaviruses (HFVs) of genital warts (condylomata acuminata types 6, 11, and others) and those associated with cervical carcinoma (predominandy types 16 and 18, but numerous others are also implicated), Calymmatobacterium granulomatis, and ectoparasites such as scabies and lice. Some of these vaginalis, Candida albicans N sseria gonorrhoeae, Chlamydia

Small GTPases and Bacterial Virulence Strategies

Is privy to a rich nutrient and moisture source, free from circulating antibodies and patrolling macrophages and neutrophils. Many bacterial pathogens invade host cells, and nearly all do this by exploiting members of the Rho GTPase family 5 . Most, such as Shigella and Salmonella, do this by injecting effectors that modulate Rac and Cdc42 activity. Examples of pathogens that use Rho family-mediated invasion include Bartonella, Brucella, Chlamydia, Listeria, and Pseudomonas. Indeed, it is felt that nearly all invasive pathogens use such a strategy for invasion, except perhaps for Rickettsia, which seems to use a phospholipase activity to break into a cell.

Insertion Sequence and Transposons

ISs are found on the chromosomes of many different sequenced bacterial and archaeal genomes (71). No IS element was identified in a few sequenced genomes, notably, Aeropyrumpernix K1, Aquifex aeolicus VF5, Bacillus subtillis 168, Buchnera sp. strain APS, Chlamydia muridarum, Chlamydia trachomatis D UW-3 CX, C. trachomatis

Real Time PCR in Infectious Disease Diagnosis

The application of real-time PCR in infectious diseases enables the diagnosis of microbial pathogens both with accuracy and expediency. The clinical significance of using molecular diagnosis of infectious agents can be characterized by the following aspects. (1) Pathogens that show fastidious slow growth or inability to grow in vitro Mycobacterium, Legionella, Bartonella, Leptospira, Borrelia, Bordetella, Mycoplasma, and Tropheryma whippelii may require days or weeks of incubation under specific conditions (2) obligatory intracellular organisms (Chlamydia, Rickettsia, Coxiella, Ehrlichia, DNA and RNA viruses) (3) prior antibiotic use (4) biochemically inert for phenotypic characterization (5) additional waiting time for drug-resistance determination, (6) diagnostic speed from bench to bedside. Qualitative real-time amplification has outpaced conventional culture methods in detection of a long list of specific pathogens that are difficult to cultivate Bartonella henselae, Bordetella...

Acute Salpingitis And Pelvic Inflammatory Disease Pathogenesis and Microbiology

The recovery of N. gonorrhoeae from the upper genital tract is variable. Many species of aerobes and anaerobes that are related to the normal vaginal flora can be isolated. Chlamydiae and mycoplasmae also have been implicated. It is generally suspected that sexually transmitted pathogens paves the way to polymicrobial aerobic-anaerobic PID and that the cervical bacteria travel through the endometrium and salpinges to the TOA junction (30). Presumably, it explains the rarity of pelvic infections during the full-term pregnancy. The isolation of gonococci from the endocervix does not necessarily account for upper genital tract disease. Moreover, the eradication of gonococci may not be an adequate treatment for acute salpingitis. The morbidity and sequelae of both gonococcal and nongonococcal salpingitis may be attributed to repeated ascending infection by the aerobic and anaerobic microorganisms that are secondary invaders. C. trachomatis has also received attention as an etiologic agent...

Direct Visual Examination

All material submitted for culture should always be smeared and examined directly by Gram stain or Other appropriate techniques. In bacterial conjunctivitis, polymorphonuclear leukocytes predominate in viral infection, the host cells are primarily lymphocytes and monocytes. Specimens in which chlamydia is suspected can be stained immediately with monoclonal antibody conjugated to fluorescein for detection of elementary bodies or inclusions. Using histologic stains, basophilic intracytoplasmic inclusion bodies are seen in epithelial cells. Cytologists and anatomic pathologists usually perform these tests. Direct examination of conjunctivitis specimens using histologic methods (Tzanck smear) may reveal multinucleated epithelial cells typical of herpes group viral infections. However, DFA stains available for both HSV and VZV are most reliable for rapid diagnosis of these viral infections. In patients with keratitis, scrapings are examined by Gram, Giemsa, periodic acid-Schiff (PAS), and...

The Present 31 Pharma and the crisis

The Infectious Disease Society of America (IDSA) newsletter, March 12, entitled The Future of Antimicrobial Drug Availability An Impending Crisis (IDSA, 2003), highlights the current issues facing the development of antimicrobial drugs. Infectious diseases are the second leading cause of death and the leading cause of disability-adjusted life years worldwide. Antibacterials are key tools in treating many globally important infectious diseases, including meningitis, pneumonia, diarrhoeal illness, skin and bone infections, tuberculosis, sexually transmitted infections (gonorrhoea, syphilis, and chlamydia),

Mixed Infections Involving Anaerobic BLPB

Pelvic inflammatory disease (PID) is a polymicrobial infection (191-193) involving in most cases numerous isolates, including Neisseria gonorrhoeae, Chlamydia trachomatis, Enterobacteriaceae, and AGNB (B. fragilis, P. bivia, and P. disiens). All of the above organisms (except for C. trachomatis) are capable of producing BL. In a summary of 36 studies published from 1973 to 1985, Eschenbach found BLPB in 1483 (22 ) of 6637 specimens obtained from obstetric and gynecologic infections (191). The predominant BLPB were Enterobacteriaceae, S. aureus, B. fragilis group and pigmented Prevotella and Porphyromonas spp. The increase in the failure rate of penicillin in eradicating these infections is an indirect proof of their importance (192-194).

Choice Of Antimicrobial Agents

Doxycycline is added to most regimens in the treatment of pelvic infections to provide therapy for chlamydia and mycoplasma. Penicillin is still the drug of choice for bacteremia caused by non-beta-lactamase-producing bacteria. However, other agents should be used for the therapy of bacteremia caused by beta-lactamase-producing bacteria.

Target Amplification Systems

Given the patent restrictions on PCR and the expanding interest in nucleic acid-based diagnosis, alternative amplification methods have been sought. Another target amplification system, transcription-mediated amplification or nucleic acid sequence-based amplification, involves several enzymes and a complex series of reactions that all take place simultaneously at the same temperature and in the same buffer (Kwoh et al., 1989 Compton, 1991). The advantages include very rapid kinetics and the lack of requirement for a thermocycler. Isothermal conditions in a single tube with a rapidly degradable product (RNA) help minimize (but may not eliminate) contamination risks. Amplification of RNA not only makes it possible to detect RNA viruses but also increases the sensitivity of detecting bacterial and fungal pathogens by targeting high copy number RNA templates. A TMA-based system manufactured by GenProbe Inc. has been used to detect Mycobacterium tuberculosis in smear-positive sputum...

Neonatal Infections

The incidence of infection in the fetus and newborn infant is high. As many as 2 of fetuses are infected in utero and up to 10 of infants are infected during delivery or in the first few months of life. The predominant microorganisms known to cause these infections are cytomegalovirus, herpes simplex virus, rubella virus, Toxoplasma gondii, Treponema pallidum, Chlamydia, Group B Streptococcus, Enterococcus spp., Escherichia coli, and anaerobic bacteria. All of these agents can colonize or infect the mother and infect the fetus or newborn either intrauterinely or during the passage through the birth canal. Although anaerobic bacteria cause a small number of these infections, the conditions predisposing to anaerobic infections in newborns are similar to those associated with aerobic microorganisms. Furthermore, the true incidence of anaerobic infections may be underestimated because techniques for the recovery and isolation of anaerobic bacteria are rarely used, or are inadequate....


Chlamydia trachomatis Antigen testing for genital Chlamydia infections has been almost entirely replaced by nucleic acid testing, which is substantially more sensitive and specific. Rapid tests have the potential for POC use, but none is yet FDA approved (Mahony et al., 2003).


Bacteria, viruses, chlamydia, rickettsiae, fungi, parasites, and numerous noninfectious agents and metabolic diseases may induce conjunctivitis. Early etiological diagnosis of acute bacterial conjunctivitis is of utmost importance because of the potential of rapid development that may cause irreversible ocular damage. Arriving at a specific diagnosis is important for the selection of appropriate therapy.


RSV-related bronchiolitis has a mortality risk of 1 . Several studies suggest that atopic children develop IgE antibodies directed at the RSV, which converts the infection into an allergic reaction. About 50 of children with bronchiolitis in whom a family history of either allergies or asthma exists develop recurring wheezing. In most instances, postbronchiolitis asthma is mild in nature and largely under control or in remission by the age of 8 yr. Current studies suggest that some patients with asthma may have an underlying bronchitis caused by Mycoplasma or Chlamydia infection. Such patients generally have adult-onset disease, associated with an initial infection and some persistent cough and mucus production. In such patients, a 1- to 2-mo trial of appropriate antibiotics (such as Clarithromycin, 500 mg bid) might be helpful. Information of the possible relationship between a low-grade infection and asthma is suggested by increased antibody titers against Mycoplasma and or...

Bartholins abscess

The ducts of Bartholin's glands open bilaterally at the introitus, and can become blocked and subsequently infected. As part of the examination, the site of the glands is observed for swelling and any reports of pain by the patient are elicited (Anderson et al., 2005). Abscess formation can occur secondary to gonorrhoea or chlamydia however, it is not always associated with a sexually transmitted organism. Bartholin's abscess should be observed for purulent discharge, and an additional swab sample obtained for microscopy culture and sensitivity (MC&S). If the abscess is non-discharging the patient will need to be referred directly to gynaecology for excision and drainage (Mitchell, 2004).


As a bacterial disease, gonorrhea can be treated with antibiotics, either with a single injection or a week-long course of oral medication. If gonorrhea has spread through the bloodstream, the antibiotics are given intravenously, which sometimes requires hospitalization. Many people with gonorrhea also have chlamydia (see page 183) so they should be tested for both. Untreated gonorrhea may spread to other parts of the body, including the prostate and the testicles. Inflammation of either organ may cause infertility. (Like chlamydia, gonorrhea is a major cause of pelvic inflammatory disease in women, who may become infertile as a result.) If fluids infected with the bacterium come into contact with the eyes, the result may be gonorrheal conjunctivitis, an eye infection that, if left untreated, can lead to blindness. A different kind of eye infection may affect infants born to infected mothers.

Female circumcision

In preparation for gonorrhoea and Chlamydia samples, a larger cotton-tipped swab or 'mop' is gently used to sweep away excess mucus from the cervix. Usually one mop is sufficient, but it is useful to have an extra one ready to hand for heavier cervical discharge blood. The gonorrhoea sample is collected first, using the same type of swab as for vaginal samples. The tip of the swab is gently inserted into the cervical os. All aspects of the cervical opening should be fully sampled using a rotational movement and the swab removed. The sample can be applied thinly to a plain slide for Gram stain and microscopy and inoculated into a selective medium for culture and sensitivity tests on Neisseria gonorrhoeae. Again, a gentle sweeping action is used to ensure the agar remains intact. A cotton-tipped cervical swab is supplied with the appropriate Chlamydia testing kit. The tip of the swab is gently inserted into the cervical os and then agitated in a circular motion for at least 10 seconds...

Tropical Ulcers

LGV is caused by one of the serovars (L1, L2 or L3) of Chlamydia trachomatis. The primary skin lesion may well go unnoticed, and is described as a painless papule, pustule or erosion. These organisms are lymphotropic and, in the secondary phase, the main symptoms of LGV are associated with the lymph nodes. The most common sign is tender inguinal and or femoral lym-phadenopathy. Buboes may form and there may be chronic ulceration and fistula formation. Acute haemorrhagic proctitis may also occur. Since 2003 a series of outbreaks of LGV have been reported in European cities (HPA, 2005). These have been among men who have sex with men (MSM), and most cases present with proctitis.


IN, USA), Argene, Inc (North Massapequa, NY, USA), and Prodesse, Inc. (Waukesha, WI, USA). Reagents from these companies are packaged for research use only (RUO), as ASRs, and as U.S. FDA-approved diagnostic kits. Some, such as the ChemFLASH reagents from Chemicon, are universal detection systems, marketed as RUO, which can be adapted for the detection of a wide range of PCR products. Most, however, include specific primers and probes, directed at clinically relevant pathogens. Reagents are available for the detection of Epstein-Barr virus, herpes simplex virus, human immunodeficiency virus, adenovirus, Bartonella species, Bordetella pertussis, calicivirus, Chlamydia pneumoniae, cytomegalovirus, Cryptosporidium, hepatitis B andC, and numerous other bacterial, viral, and parasitic pathogens. Those that are packaged as complete kits include reagents for specimen processing and PCR amplification, as well as for product detection. These commercially available systems have the advantage of...


Worldwide, Streptococcus pneumoniae is by far the most important pathogen for CAP. Other frequently isolated bacteria are Haemophilus influenzae and Staphylococcus aureus.11--3 Incidences of atypical pathogens, such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila, are generally lower than those of the afore-mentioned bacteria, although variations may be large.17, 18, 20, 23 Pseudomonas aeruginosa can be relevant in patients with structural lung damage, such as those with bronchiectasis or COPD.24 Most frequent viral causes of CAP include influenza virus and parainfluenza virus.23, 25 Viral pneumonias due to infection with influenza, respiratory syncytial virus, coronaviruses, parainfluenza virus, and even rhinoviruses can be life threatening in elderly and immunocompromised patients. Influenza pneumonia may be complicated by secondary bacterial infections caused by S. aureus, S. pneumoniae, H. influenzae, or other Gram- negative pathogens.21, 26

Public Health

According to Naidoo and Wills (2000) public health is characterised by several factors - a concern for the health of the whole population (whether a geographical population, a client group such as gay men, or a group of people experiencing a specific health problem, such as Chlamydia) a concern for the prevention of illness and disease and, lastly, a recognition of the many social factors that contribute to health. There are a number of strands to public health

Nonculture Methods

Although acute and convalescent serologic tests for viral agents might be used in the event of epidemic conjunctivitis, they typically are not performed because the infections are self-limited. Enzyme-linked immunosorbent assay (ELISA) tests and DFA staining are now available for detection of Chlamydia trachomatis. It is antiapated that the direct antigen tests should perform well, particularly because so many eyes have been partially treated before culture. An ELISA test of aqueous humor is available for diagnosis of Toxacara infection. Finally, single and multiplex polymerase chain reaction (PCR) assays induding both conventional and real-time formats have been used to diagnose viral and chlamydial keratoconjunctivitis and other ophthalmic infections induding uveitis.


Other less frequently isolated agents are other gramnegative bacilli, such as Acinetobacter and Alcaligenes spp., other Pseudomonas spp., Citrobacter spp., Gardnerella vaginalis, Aerococcus urinae, and beta-hemolytic streptococci. Bacteria such as mycobacteria, Chlamydia trachomatis.

Adverse reactions

Tetracyclines have been around since the 1940s, and are called such because their chemical structure consists of four linear, tetracyclic rings with functional groups attached that differ from one individual agent to the next (Zhanel et al., 2004).They are used in the treatment of many sexually transmitted infections (Chlamydia, for example) but their use in treating general bacterial infections has declined in recent years as a result of widespread use in both humans and animals having led to emerging resistance. There are also newer classes of antibiotics now available that have fewer adverse effects and are better tolerated.

Infection Acquired

Trachoma inclusion conjunctivitis (TRIC or chlamydial conjunctivitis) usually does not become clinically apparent before the 6th day of life. This shows a dense white membrane which developed over a period of a week. TRIC is one of the few infections which cause the formation of conjunctival membranes, shown on the conjunctival surface of the upper eyelid of this eye. Tetracycline and erythromycin have been used for Crede prophylaxis in some nurseries because of the increasing incidence of chlamydial infection.


Echoviruses) Adenoviruses Influenza viruses BACTERIA (RELATIVELY UNCOMMON) Mycoplasma pneumoniae Chlamydia trachomatis Mycobacterium tuberculosis Staphylococcus aureus Streptococcus pneumoniae Enterobacteriaceae and other gram-negative bacilli FUNGI (RELATIVELY UNCOMMON) Coccidioides immitis Aspergillus spp. Candida spp. Cryptococcus neoformans Histoplasma capsulatum PARASITES (RELATIVELY UNCOMMON) Entamoeba histolytica Toxoplasma gondii

Clinical Syndromes

Seen in various virus infections (rubella, rubella vaccination, parvovirus B19, mumps, alphaviruses) and in chlamydial (Reiter's syndrome) and bacterial infections (Haemophilus influenzae, campylobacter, gonococci, streptococci group A) Herpes simplex virus (Chlamydia trachomatis) Enterovirus 70 (Chlamydia trachomatis) (Gonococci and Chlamydia trachomatis) (Mycoplasma pneumoniae, Chlamydia trachomatis, pneumoniae and psittaci, Coxiella burnetii, Legionella pneumophila, pyogenic bacteria) Herpes simplex virus (Gonococci, Chlamydia trachomatis)