Chlamydia Infections: Symptoms, Testing, and Treatment Options

DR.WASSAN NORI MOHAMMED

In order to assess it is necessary to find out -When sexual intercourse last took place -Whether this was oral, vaginal -What contraception was used? -A travel history and knowledge about the origin of partner might indicate risk of tropical infection. -Information about previous pregnancies and menstruation -Mix infection possible so full screen should be performed -To break the chain of infection and prevent re- infection, it is essential to avoids to intercourse until she is that her partners has been screen and received appropriate treatment,fallow up &evalution test of cure

it is commonest bacterial STD,obligate intracellular bacteria that grows in vitro only in tissue culture infect columnar epithelium of endocervix,urethra, endometrium ,fallopain tubes and rectum . This organism can persist for long periods in an asymptomatic carrier state There s no vaccine available and even though chlamydia antibodies are produced, they do not protect against reinfection

1-Asymptomatic in 50% of male 2-Or can cause non- gonococci urethritis in male In female 1-Asymptomatic 80%in female 2-Vaginal discharge and lower abdominal pain 3-Postcoital bleeding 4-Intermenstrual bleeding 5-Mucopurulent cervical discharge with contact bleeding 6-Dysuria with urethral discharge male female

1-ELISA limited sensitivity samples are collected from the endocervix and areas of cervical ectropian (infect columnar epithelium) 2-Nuclic acid amplification technique 90% sensitive should used replace the old ELISA. 3-Aptima Cmbo 2 and BD probetec are the recommended test for Chlamydia infection

1- Avoid intercourse before treatment of both partners is complete 2- Use of condoms should be encouraged to prevent reinfection and other STDs 3- Restarting if any doubt about complete treatment 4- Test of cure should be routine in pregnancy 5- Contact tracing of all partners when possible 6- A follow-up interview which could also include a telephone consultation within 2- 4weeks 7- Test for other STDs 8-Antibiotic treatment

Doxycycline 100mg twice for 7days Azithromycin 1gram orally single dose is recommended during pregnancy Amoxicillin 500mg three times for seven day In pregnancy can cause -PTL -Chorioamnionitis Post partum endometritis -Neonatal conjunctivitis and pneumonia pregnancy can cause:

1-Partner of the patient diagnosed or suspected with infection 2-History of Chlamydia in the last year 3-Patient attending GUM clinics 4-Ptients with two or more partners with in 12monthes 5-Women undergoing termination of pregnancy 6-History of other sexually transmitted infection and HIV

It is the 2nd most common bacterial STI Chronic a symptomatic infection is common. It infect columnar epithelium Clinical 1-Most of infected female are asymptomatic 2-Increase vaginal discharge with lower abdominal pain 3-dysuria with urethral discharge 4-proctitis with rectal bleeding discharge and pain 5-Endometritis 6-Mucopurluent urethral discharge 7-pelvic tenderness with cervical excitation Clinical features: features:

1-Demonstrating typical gram ve intracellular diplococcic (columnar cubical epith) on gram stained smear of end cervical and rectal pharynx swabs if symptomatic infection Culture required co2 7%, blood agar antibiotic to inhibit growth of other bacteria(Thayer-Martin or Transgrow media culture) 2-Nnuclic acidamplificationtest(NAATs) 3-Nuclic acid hybridization tests

1-Screen both parteners and refer them to genitourinary medicineclinic 2-Counselled regarding the long term implicationsof infection leading to chronic pelvic pain and tubal infection and subfertilty 1-Azithromycin 1g single dose 2-Amoxycillin 1g +probencid 2g single dose 3-ciprofloxacin 500mg single dose 4- single dose cefixime 400mg Sex partner should screened fully Treat other associated infection Abstinence during treatment at least 7 days

1-Fitz hugh curytis syndrome:Intra-abd spread of GC can cause per appendicitis, per hepatitis patient presented with right hypochondria pain tenderness, pyrexia . Examination: usually sign of salpingitis, laparoscopy (fine violin string adhesions)seen between the liver capsule and visceral peritoneum ,treatment 3weeks antibiotic per hepatitis cured 2-Ritters syndrom or sexually acquired reactive arthritis, uveitis and rash 3-PID 4-Adult conjunctivitis

Incurable STD HSV1 cused oral lesion (cold sores),30% of genital herps HSV2 cause genital lesion and 90%of recurrent genital herps. The ferquency of reurranceis much heigher in type 2 than type 1 Infection is frequently sub clinical, presentation can occur many years later as newly acquired infection DX Collecting serum from vesicle by syringe Swab the ulcer demonstrating the virus by electron microscopy Tissue culture Serological test differentiated between type 1 and 2C.F.

Presents up to 3 weeks after acquisition wide spread lesion involve vulva, vagina ,cx painful vesicles coalesce in to multiple ulcers, per urethral involvement may cause sever pain ,urine retention . Systemic symptoms fever ,headache ,malaise and lymphadenopathy. Acute cervicitis may be present. The lesion heal without scarring in 14-21 days Very early vulvae affect small area, so antiviral treatment for 5 days very early vulvae affect small area, so antiviral treatment for 5days for all patients presenting with the first attack An infected mother can transmit the virus to her infant during delivery resulting in significant fetal mortality and morbidity

DX 1-culture 2-virus by electron microscope of the swab taken from the lesion. TREATMENT 1-analgesics 2-bathing in salt and water 3-lignocaine gel to sore area, acyclovir 200mg five times for 5 days

After primary herpes, virus colonizes the neuron in the dorsal root ganglia establishing latent infection. Ulcer, vesicles in the same area or area supply by the same dermatome The spectrum of severity varies 1-asymptomatic shedding of virus 2-apparently trivial ulcers resembling small abrasion on the vulva, 3-locolized clusters of vesicles and ulcers over an area 1-2 cm diameter 4-wide spread or chronic ulceration resembling a primary infection can be seen in pregnant female if a women is immune suppressed, large atypical chronic ulcers may develop 5-a herpetic ulcer persisting for more than 1 month in ADIS individual The spectrum of severity varies

Swabbing small ulcer in female if initial swab ve repeated if ulcer recurs TREATMENT of RECURRENT EPISODES 1-attack will resolve ,washing with salt and water to avoid sexual intercourse until healed. TREATMENT of RECURRENT EPISODES 2-frequent recurrences more than 6-8 per year ,long term suppression with acyclovir 400mg twice day, to reduce frequency,but infection can still be transmitted to partner

Neurological symptoms tingling sensation)before onset of vesicles and pain in the thigh and perineum ,so episodic treatment for 5days, keep at home start treatment once prodromal symptoms start may abort a symptomatic attack, use condoms to prevent transmission of infection ,even in a symptomatic use condoms to prevent transmission of infection ,even in a symptomatic COMPLECATION 1-Psychological distress 2-neurological involvement during primary herpes ,aseptic meningitis ,transverse myelitis, autonomic neuropathy 1-2 months resolve. HSV2 cause encephalitis in adult ,herpes keratitis cause corneal scarring& blindness COMPLECATION

More than 70type, strain causing hand warts can spread to genital area ,STD ,asymptomatic infection may be carried for years the virus infection skin of the vulva ,perineum the vagina cx, rectum orogenital contact leads to warts developing in mouth lips multiple slowly increase in size spread to perianal skin can Infect larynx of neonate, majority of genital warts caused by HPV type6-11 have little oncogenic potential, 16-18cause flat warts linked with cx ca smoking risk factors

Provider applied topical therapy include: 10%-20%podophylin 1-2 per week for 6 weeks 5%has the advantage of self application at home twice per day for 3 days Trichloroacetic acid 80%-90%. Warts will recur until the immune response control the growth of virus Topical imiquimod cream 5% (stimulate local cytokine )may be helpful. Female with warts are not at increase risk of cancer, screen done every 3years, recent sexual partner should examine for genital warts and other STI Surgical therapy: Visible warts with physical methods ,crytherapy ,surgicalexcision,electrocautery,lazervaporization Immune suppressed patient immune based therapies with intralesion interferon

is a retrovirus ,single strand of RNA, reverse transcriptase is carried with in the core to enable proviral DNA to be produce in an infected cell .the outer membrane protein gp 120 ,bind to cd4 receptors which are present on Helper lymphocytes macrophages ,dendritic cell and microglial cell. Another viral protein P24 surrounds the RNA and enzymes present with in the core of the virus which enters the cytoplasm of an infected cell the drugs target reverse transcriptase or viral proteases

1-antibodies to gp-120 2-P24 antigen during seroconversion s detectable 3-monitor the disease by measuring the level of CD4 lymphocyte in the peripheral blood. 4-PCR technology we can measure the viral concentration of viral RNA in the plasma high level so rapid disease developmentDX 1-antibodies to gp-120 2-P24 antigen during seroconversion s detectable 3-monitor the disease by measuring the level of CD4 lymphocyte in the peripheral blood. 4-PCR technology we can measure the viral concentration of viral RNA in the plasma high level so rapid disease development

In developing countries HIV spread through vaginal intercourse In developed countries through homosexual or I.V .drug user and heterosexual Genital ulcer Chlamydia ,GC ,BV. All risk factor for transmission and acquisition ,so good control of STD should decrease incidence of HIV infection

the aim of therapy is to reduce the level in the plasma to zero with a combination of antiretroviral agents with each cycle of replication of virus if therapy is effective CD4 lymphocyte count rises progressively and at least partial immune restoration occurs HIV ,infects long lived memory cells, so eradicated and cure is unlikely ever after several years of treatment If succeful the immune system improves after a few months These drug have potential interaction with Other drug ,they increase the rate of break down of synthetic estrogen in oral CCP

1-Hpv infection (genital warts) present despite aggressive surgical treatment ,so any persistent atypical warty lesion of skin or vulva should be biopsied 2- HPV can result in ca cx , VIN, cytological of cx should done annually 3-PIDrequires longer courses of antibiotic 4-post partum endometritis is common 5-HSV eruption of 2nd genital herpes may become wide spread sever and persist for weeks if not diagnosed and treated genital herpes often present as deep painful ulceration 6-Although all HIV infected female are urged to use condoms to prevent them transmitting the infection to others they should also be advised to used a more reliable form of contraception if they do not wish to become pregnant. 7-CMV infection reactivation

is transmitted mainly in blood, but also in other body fluids such as saliva, semen and vaginal fluid. Drug users who share needles are at high risk Clinical features The HBV has an incubation period of 6 weeks to six months Hepatitis B is a virus that infects the liver but many people with hepatitis B viral infection have no symptoms.

HBsAg is not infectious ,HBsAg is detectable in serum in almost all cases of acute and chronic HBV -HBVeAgcan be detected in liver tissue of persons with acute or chronic HBV infect. HBeAg is detected in the serum of persons with high virus titers and indicates high infectivity. -The presence of anti-HBs indicates immunity to HBV.) Antibody to HBeAg (anti-HBe) becomes detectable when HBeAg is lost and is associated with low infectivity. - Serumantibody to HBcAg (IgM anti-HBc) indicates recent infection with HBV

Women who screen positive for hepatitis B should be referred to a hepatologist for ongoing monitoring for the long-term consequences of chronic infection, for example hepatocellular carcinoma. Prevention 1-Transmission that can be prevented through vaccination and immunization active vaccine provides ongoing protection from subsequent exposure in the household. 2- women who screen negative her partner positive barrier method should use to provide protection against acquiring the infection Prevention:

Systemic STD caused by treponemapallidum ,the first manifestation painless ulcer (chancre),commonest site in (cx)pass unnoticed resolve with out treatment after few weeks Primary syphilis diagnosed by demonstrating M.O. by dark field microscopy spiral M.O.(clear serum from the lesion) Serological test (fluorescent treponemal antibody) TPHT (TP haemagglutination assay) TPPA (T.P. particle agglutination) Non specific VDRL, RPR (rapid plasma regain) These test ve in early primary syphilis

1-demonstrating M.O .from mucosal lesion 2-serelogical test +ve after 2ndsyphilis relapse for up to 2years ,infection can be transmitted to asexual partner Early latent syphilis Late tertiary syphilis neurosyphiliswith in 5 years of infection as meningovascular syphilis strock ,tabs dorsalis ,general paresis of the insane ,CVS thoracic aortic aneurism ,aortic regurgitation. Vertical transmission to fetus IUD severely affected neonate ,late childhood (8th nerve deafness interstitial keratitis abnormal teeth VDRL ve with in years

Procainpencillin 1.2 mu daily IM 12day Benzathinpencillin 2.4 million unit IM repeated after 7 days Doxycycillin 100mg twice for 14 days Erythromycin 500mg for 14 days If infection more than 1 year treatment extended to 21 days parental or oral for 28days