Table 18.1 Nomenclature of bone tumors

Chlamydia genital infections

BASIC INFORMATION
DEFINITION
Genital infection with Chlamydia trachomatis may result in urethritis, epididymitis, cervicitis, and acute salpingitis, but often it is asymptomatic in women. In men, urethritis, mucopurulent discharge, dysuria, urethralpruritis.
EPIDEMIOLOGY & DEMOGRAPHICS
• Chlamydia trachomatis is the most common cause of sexually transmitted disease in the USA. More than 4 million infections occur annually, although the exact number is unknown because reporting is not required in all states. Occurrence is common worldwide, and recognition has been increasing steadily over the last two decades in the USA, Canada, Australia, and Europe.
• Most women with endocervical or urethral infections are asymptomatic.
• Up to 44% of cases of gonococcal infection may have concomitant chlamydial infection.
• Infertility or ectopic pregnancy can result as a complication from symptomatic or asymptomatic chronic infections of the endometrium and fallopian tubes.
• Conjunctival and pneumonic infection of the newborn may result from infection in pregnancy.
• In men 18% to 58% of cases are of C. Trachomatis. Complications of nongonococcal urethritis in men infected with C. trachomatis include epididymites and Reiter’s syndrome.

PHYSICAL FINDINGS & CLINICAL PRESENTATION
Clinical manifestations may be similar to those of gonorrhea: mucopurulent endocervical discharge, with edema, erythema, and easily induced endocervical bleeding caused by inflammation of endocervical columnar epithelium. Less frequent manifestations may include bartholinitis, urethral syndrome with dysuria and pyuria, perihepatitis (Fitz-Hugh-Curtis syndrome).
ETIOLOGY
• Chlamydia trachomatis, serotypes D through K
• Obligate, intracellular bacteria
• Trichomonal vaginalis
• Mycoplasma genitalium
• HSV
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
Gonorrhea, nongonococcal urethritis (nonchlamydial etiologies)
WORKUP
Diagnosis based on laboratory demonstration of evidence of infection in intraurethral or endocervical swab by various tests. The intracellular organism is less readily recovered from the discharge.
LABORATORY TESTS
• Cell culture is the reference method for diagnosis (single culture sensitivity 77% to 91%), but it is labor intensive and takes 48 to 96 hours; it is not suited for large screening programs
• Nonculture methods:
Direct fluorescent antibody (DFA) tests
Enzyme immunoassy (EIA)
DNA probes
Polymerase chain reaction (PCR)
• With the exception of PCR, the other tests are probably less specific than cell culture and may yield false-positive results.
• Because this is an intracellular organism, purulent discharge is not an appropriate specimen. An adequate sample of infected cells must be obtained.
• 10 WBCs per high power field
TREATMENT
Nongonococcal urethritis, urethritis, cervicitis, conjunctivitis (except for LGV):
• Azithromycin 1 g PO × 1 or
• Doxycycline 100 mg PO bid for 7 days
• Alternatives
1. Erythromycin base 500 mg PO qid for 7 days or
2. Erythromycin ethylsuccinate 800 mg PO qid for 7 days or
3. Ofloxacin 300 mg PO bid for 7 days

4. Levofloxacin 500 mg PO qd for7 days
Infection in pregnancy:
• Erythromycin base 500 mg PO qid for 7 days or
• Amoxicillin 500 mg PO tid for 7 days
Alternatives:
1. Erythromycin base 250 mg PO qid for 7 days or
2. Erythromycin ethylsuccinate 800 mg PO qid for 7 days or
3. Erythromycin ethylsuccinate 400 mg PO qid for 14 days or
4. Azithromycin 1 g PO (single dose)
NOTE: Doxycycline and ofloxacin are contraindicated in pregnancy. Safety and efficacy of azithromycin are not established in pregnancy and lactation, although preliminary data indicate that it may be safe and effective. Erythromycin estolate is contraindi-cated in pregnancy because of drug-related hepatotoxicity.
FOLLOW UP:
Reculture after therapy completion and refer partners for evaluation and treatment.
RECURRENT AND PERSISTENTURETHRITIS:
Retreat noncompliant patients with the above regimens. If patient was intially complacent, recommended regimens: metronidazole 2 g PO in single dose plus erythomycin base 500 mg PO qid for 7 days or erythromycin ethylsuccinate 800 mg PO qid for 7 days.