Recognition and Treatment of Chlamydial Infections

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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Chlamydial Developmental Cycle

The biphasic developmental cycle of chlamydiae is unique among microorganisms and involves two highly specialized morphologic forms. The extracellular form or elementary body (EB) contains extensive disulfide cross-links both within and between outer membrane proteins giving it an almost sporelike structure that is stable outside of the cell. The small (350 nm in diameter) infectious EB is inactive metabolically. The developmental cycle is initiated when an EB attaches to a susceptible epithelial cell. The process of EB internalization is very efficient, suggesting that EBs trigger their own internalization by cells that are not considered professional phagocytes. A number of candidate adhesions have been proposed, but their identity and that of associated epithelial cell receptors remain uncertain. Intriguing data indicate chlamydial EBs interact with human endometrial host cell membrane protein disulfide isomerase (PDI) during attachment. Productive entry into and infectivity of EB...

Inflammation on Pap smear

Moderate or severe inflammation should be evaluated with a saline preparation, KOH preparation, and gonorrhea and Chlamydia tests. If the source of infection is found, treatment should be provided, and a repeat Pap smear should be done every 6 to 12 months. If no etiology is found, the Pap smear should be repeated in 6 months.

Candidate Agents In Ms

Several infectious agents currently remain as viable candidate agents because they may be compatible with the unique worldwide distribution of MS, they induce demyelination in humans or animals, agent-specific antibodies are elevated in the serum or CSF of MS patients, or the agent has been identified in MS tissues (1,14). Measles, human coronavirus 226E, EBV, retroviruses, HHV-6, and Chlamydia pneumoniae have attracted interest in recent years in terms of known agents that commonly infect humans. Animal viruses that have attracted the most attention are JHM, a mouse coronavirus Theiler's murine encephalomyelitis virus, a picomavirus of mice and CDV, a morbilliform virus of dogs and carnivores.

Physical Examination

Pathogens E coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, Staphylococcus saprophyticus, enterococcus, group B streptococcus, Chlamydia trachomatis. Differential Diagnosis Acute cystitis, pyelonephritis, vulvovaginitis, gonococcal or chlamydia urethritis, herpes, cervicitis, papillary necrosis, renal calculus, appendicitis, cholecystitis, pelvic inflammatory disease.

Clinical Manifestations

Most studies report that 25 of men and 70 of women infected with C. trachomatis are asymptomatic or minimally symptomatic. The National Longitudinal Study of Adolescent Health Study collected data prospectively from 14,322 U.S adolescents and followed them into adulthood (Miller et al., 2004). Of the participants that tested positive for chlamydial infection, 95 did not report symptoms in the 24 hours preceding specimen collection. Among men with chlamydial infection, the prevalences of urethral discharge and dysuria were only 3.3 and 1.9 , respectively. Among women with chlamydial infection, the prevalences of vaginal discharge and dysuria were 0.3 and 4.2 , respectively. Among the small number of young men reporting urethral discharge (n 17), the prevalence of chlamydial infection was high (38.5 ), whereas the prevalence of chlamydial infection was only 6.0 among the women reporting dysuria (n 232) and 0.9 among those reporting vaginal discharge (n 98) (Miller et al., 2004).

Infections in Females

In women, chlamydial infections may cause pelvic inflammatory disease, tubal infertility, chronic pelvic pain, and ectopic pregnancy. Chlamydial infection may also be linked to cervical cancer (Koskela et al., 2000). Chlamydial and gonococcal infections may increase susceptibility to and transmission of HIV in both men and women (Plummer et al., 1991). Symptoms in females include mild abdominal pain, intermittent bleeding, vaginal discharge, or dysuria-pyuria syndrome. The cervix can appear normal or exhibit edema, erythema, friability, or mucopurulent discharge. In prepubertal girls, vaginitis can occur secondary to infection of transitional cell epithelium by C. trachomatis. In contrast, the squamous epithelium of the adult vagina is not susceptible to chlamydiae, and vaginal discharge generally reflects endocervical infection. The spectrum of PID associated with C. trachomatis infection ranges from acute, severe disease with perihepatitis and ascites (Fitz-Hugh-Curtis syndrome), to...

Nonculture Tests for C trachomatis

The previous gold standard of cell culture is being outperformed by more sensitive molecular techniques confirmatory studies of discrepant test results frequently find true positives that were negative by cell culture. Amplification tests based on the detection of chlamydial DNA or specific chlamydial ribosomal RNA are now available. Both detect C. trachomatis in urine or in self-administered vaginal swab specimens, with sensitivity comparable to that obtained with urogenital swab specimens, and make noninvasive testing for chlamydial infections possible (Gaydos et al., 2004 Johnson et al., 2002).

Diagnostic approaches

Medical and sexual history and tests for common STDs, such as chlamydia, trichomoniasis, and bacterial vaginosis. Conditions that favor the development of EGWs include diabetes, pregnancy, and immunosuppressed states, including HIV AIDS, lymphoproliferative disorders, and cancer chemotherapy.

Etiology and clinical pathogenesis

PID results when pathogenic microorganisms spread from the cervix and vagina to the upper portions of the genital tract to such structures as the salpinx, ovaries, and adjacent structures. Chlamydia has been shown to be responsible for 25-50 of all cases of PID. About 10-20 of female patients who are infected with gonorrhea will progress to PID.

Epidemiology of Bacterial Pneumonia in Children

Many episodes of pediatric pneumonia are caused by respiratory viruses, Mycoplasma pneumoniae, or Chlamydia pneumoniae (McIntosh, 2002). More severe or complicated cases of pneumonia are usually caused by pyogenic bacteria, including streptococci and staphylococci, though many studies indicate that clinical or radiological criteria do not reliably differentiate bacterial versus viral versus atypical pneumonias (McIntosh, 2002 Michelow et al., 2004). Lung puncture studies performed in children in the developing world 30-40 years ago identified Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus as causes of severe bacterial pneumonia in children (McIntosh, 2002). Group A streptococci and Moraxella catarrhalis were also implicated in some series.

Diseases of blood vessels

Infectious agents, including herpesviruses and Chlamydia pneumoniae, have been identified with some frequency in atherosclerotic lesions. Although the primary role of these agents in the pathogenesis of atherosclerosis has not been determined, infectious agents have the potential to participate as promoters of inflammation, which is important in the progression of atherosclerosis (Kol and

Changes in Inflammatory Cytokines

There has been considerable interest that low grade infections may result in chronic activation of the immune system and that this may predispose to a variety of chronic disease states, including insulin resistance and atherosclerosis. Organisms that have attracted attention include those that cause dental and gum disease, Helicobacter pylori, Chlamydia pneumoniae, and viral infections including cytomegalovirus. A genetic component has also been recognized with polymorphisms in the genes or promoters for many of the cytokines accounting for variation in expression between individuals. For example, the common -174G C polymorphism in the gene for interleukin-6 (IL-6) has recently been linked with longevity as the distribution of genotypes in the very elderly and appears to be different from that of the general population (Hurme et al., 2005). The biological processes involved are obviously very complex, and no single genetic abnormality is going to account for the

Analytic Epidemiology

Has been repeatedly drawn toward the possible role of hormonal factors 4, 12, 14 . No convincing data are available. In a study of 66 women with HS, 23 had acne and 23 (34.8 ) were significantly obese (body mass index, BMI, > 30 kg m2). Plasma androgens were compared with controls matched for BMI and hirsuteness and no difference was documented 12 . The prevalence of HS has been found to be higher among patients attending a sexually transmitted disease (STD) clinic than in an unselected general population 6 . In principle, a selection bias may explain such a difference. However, an association with chlamydial infections has been also suggested. A case-control study based on patients in a STD clinic was unable to confirm the association with chlamydial infection 15 but, quite unexpectedly, it found a higher prevalence of genital human papilloma virus (HPV) infection among HS cases as compared with controls. The significance of such a finding is unclear and a chance effect is quite...

Argentina Biosurveillance

Diseases appearing on only one list (not included in the table) Nipah virus (CDC C list) coccidiomycosis and dengue (NATO) Machupo (USAMRIID) acquired immunodeficiency syndrome (AIDS), amebiasis, Campylobacter, carbon monoxide poisoning, Chlamydia trachomatis, congenital rubella syndrome, food poisoning, giardiasis, Haemophilus influenza type B (HIB), hepatitis A, hepatitis B, hepatitis C, Kawasaki syndrome, Legionnaires' disease, leptospirosis, Lyme disease, lymphogranuloma venereum, malaria, measles, meningitis, mumps, neisseria gonorrhea, neisseria meningitis in blood or cerebrospinal fluid, pertussis, poliomyelitis, rabies, Reye syndrome, rheumatic fever, rubella, syphilis, tetanus, toxic shock syndrome, toxoplasmosis, and trichinosis (Reportable List).

Nonneoplastic Conditions

Epididymitis primary cause of epididymal obstruction and usually related to cystitis, prostatitis or urethritis that spreads through the vas deferens or lymphatics. It may cause testicular ischaemia and necrosis. Causes include chlamydia trachomatis, neisseria gonorrhoea, E-coli, pseudomonas, other urinary tract infection organisms and rarely tuberculosis and brucellosis.

Infectious Diseases

Sexually transmitted diseases (STDs) are a particularly serious problem among street youth. In a longitudinal study of homeless adolescents, the annual incidence of Chlamydia trachomatis infection was 12.1 in females and 7.4 in males the annual incidence of herpes simplex virus type 2 was 25.4 in females and 11.7 in males. (Noell, et al., 2001) A study of street youth and sex workers in Quebec City, Canada found that 13 of women less than 20 years old were infected with Chlamydia trachomatis and 1.7 had Neisseria gonorrhoeae (Poulin, et al., 2001). Newer urine-based screening tests make it easier to screen homeless youth for STDs in outreach settings (Van Leeuwen, et al., 2002).

Technique

Tests for gonorrhea and chlamydia should be obtained, and the cervix and vagina should be prepared with a germicide. Paracervical block is established with 20 mL of 1 lidocaine injected deep into the cervix at the 3, 5, 7, and 9 o'clock positions. The cervix should be grasped with a single-toothed tenaculum placed vertically with one branch inside the canal. Uterine depth is measured with a sound. Dilation then should be performed with a tapered dilator.

Communicable Disease

Increased attention has been paid to the occurrence of sexually transmitted infections among immigrant populations, due in large part to controversies surrounding the admission to the U.S. of HIV-infected immigrants and criteria excluding immigrants with sexually transmitted disease from entry into this country (Editorial Desk, 1993). Relatively little information is available about the risk for or rates of sexually transmitted infections among urban immigrants. An analysis of health care utilization patterns at one Houston clinic found that Central American immigrants accounted for 4 of the 30,000 annual clinic visits and a large proportion of care was devoted to the treatment of sexually transmitted diseases (Eichenberger and Shandera, 1999). A study of 274 TB culture-positive individuals with varying immigration statuses in the Fort Worth-Dallas metropolitan area found a higher prevalence of HIV infection among individuals traveling to the U.S. as nonimmigrants, in comparison with...

The Pathogen

Chlamydiae are obligate intracellular parasites that have been classified under the order Chlamydiales with their own family and genus (Chlamydiaceae, Chla-mydia). Molecular sequencing analysis of their ribosomal RNA has shown that chlamydiae are a unique class of bacteria that are closely related to each other and have little relation to other eubacteria (Weisburg et al., 1986). Like other Gramnegative bacteria, chlamydiae have an outer membrane that contains lipopolysac-charide (LPS) and membrane proteins, but their outer membrane contains no detectable peptidoglycan, despite the presence of genes encoding proteins for its synthesis (Griffiths and Gupta, 2002). This recent genomic finding is the basis for the so-called chlamydial peptidoglycan paradox, for it has been known for years that chlamydial development is inhibited by beta-lactam antibiotics. Although chla-mydiae contain DNA, RNA, and ribosomes, during growth and replication they obtain high-energy phosphate compounds from...

Immunopathogenesis

Most individuals with chlamydial infection spontaneously heal without disease sequelae. Individuals with severe forms of chlamydial disease often display immune responses to a common chlamydial heat shock protein 60 (hsp60) antigen. Because the protein shares nearly 50 sequence identity with the human homolog, it is speculated that molecular mimicry may result in autoimmune inflammatory damage that in turn causes chlamydial disease sequelae. Because hsp60 immune responses are genetically determined, susceptibility genes for chlamydial disease may also exist. Although high serum antibody titers generally correlate with complications of chlamydial disease, they may simply reflect increased overall exposure. However, in a study that controlled for level of exposure, serum antibodies to chlamydial heat shock protein 10 (hsp10), but not chlamydial hsp60 or MOMP were present in higher levels in women with tubal factor infertility (TFI), and the degree of the serologic response correlated...

Immunoprotection

There is a strong inverse relationship between age and susceptibility to chla-mydial infection even when corrected for frequency of sexual contact, suggesting effective adaptive immunity eventually develops. Lymphoproliferative responses, but not serum antibody titers increase with age (Arno et al., 1994). Data from humans (Brunham et al., 1996) point to MHC Class II - restricted CD4+ T cells of the Th1 phenotype as being critical to recovery from chlamydial infection as well as having a role in protection from disease (Kimani et al., 1996). In a cohort of female commercial sex workers with HIV, susceptibility to chlamydial PID increased as numbers of CD4+ T cells decreased (Kimani et al., 1996). Debattista et al. (Debattista et al., 2002) reported that PBMCs from women with chlamydial PID or a history of repeated C. trachomatis infection produced less IFN-gamma in response to chlamydial hsp60 than did women with a single episode of C. trachomatis infection, again suggesting an...

Epidemiology

Chlamydia trachomatis is the most common bacterial sexually transmitted infection, with an estimated 92 million cases occurring globally each year, including more than four million in sexually active adolescents and adults in the United States(Geneva WHO, 2001). Many men and most women infected with C. trachomatis are either asymptomatic or minimally symptomatic and presentation for diagnosis is a result of screening or a contact being symptomatic. Regional estimates are hampered by under diagnosis and underreporting of cases. Because symptoms are absent or minimal in most women and many men, a large reservoir of asymptomatic infection is present that can sustain the pathogen within a community. In the U.S., substantial racial ethnic disparities are present in the prevalence of both chlamydial and gonococcal infections. One large study of U.S. female military recruits found a chlamydial prevalence of 9 that was maintained over 4 consecutive years (Gaydos et al., 2003). Young age,...

Laboratory Diagnosis

A positive laboratory test for C. trachomatis can be utilized for patient education and increases both compliance with drug therapy and the likelihood of referral of sexual partners. Although the development of tissue cell culture methods in the 1960s for detecting C. trachomatis was a major advance, the availability of non-culture tests has dramatically increased the availability and decreased the cost of laboratory detection. Definitive diagnosis of chlamydial infection, as would be required in a medicolegal setting (i.e., suspected sexual abuse or rape), requires isolation of C. trachomatis in cell culture or a positive nucleic acid amplification test (NAAT) confirmed by a second NAAT that targets a different sequence (Johnson et al., 2002).

Serology

Antibodies to Chlamydia spp. are best detected with a microimmunofluores-cent (MIF) assay, but these assays are not widely available. Serologic screening is of very little value in uncomplicated genital infections but may be useful for population studies. Patients who have LGV infections demonstrate elevated specific IgG and IgM antibody levels compared to those with other chlamydial infections. The MIF is species-specific and sensitive but is available only at a limited number of clinical laboratories.

Treatment

The recommended regimen for chlamydial infection during pregnancy is erythromycin base (500 mg four times daily) for 7 days erythromycin estolate is contraindicated because of its potential hepatotoxicity. Patients unable to tolerate this regimen should be treated with either a smaller dose of erythromycin base or erythromycin ethylsuccinate for 14 days or amoxicillin for 7 days (2002). Doxycy-cline and ofloxacin are contraindicated in pregnant women. The safety and efficacy of azithromycin use in pregnant and lactating women have not been established although the CDC lists azithromycin as a potential alternative for treatment during pregnancy. Sex partners should be evaluated, tested, and treated if they had sexual contact with the patient during the 60 days preceding onset of symptoms in the patient or diagnosis of chlamydia. The most recent sex partner should be treated even if the time of the last sexual contact was > 60 days before diagnosis of the index case. Patients do not...

Eye Infection

A controlled clinical trial of 51 patients with ocular trachoma infections investigated the effectiveness of berberine over 3 weeks with a 1 -year follow-up (Babbar et al 1982). Subjects who used the 0.2 berberine either by itself or combined with sulfacetamide demonstrated significant symptom improvement and tested negative for Chlamydia trachomatis, with no relapse after 1 year.

Diagnostic Specimens

The discomfort caused by obtaining a urethral swab in males has precluded its widespread use in asymptomatic men. A dipstick test for leukocyte esterase (LE) performed on the first portion of a voided urine is a cost-effective and moderately sensitive screen (47 to 58 ) for detection of chlamydial infection in asymptomatic young males (Blake et al., 2005). When feasible, urine NAAT provides a much more sensitive and equally noninvasive method of detecting Chlamydia.

Ln[i i fzi

To illustrate these procedures we consider a sample of 877 women diagnosed with an initial infection of either gonorrhea or chlamydia. While both of these diseases are treated quite easily it remains a mystery why the reinfection rate remains high for these diseases in some sub-populations. To study risk factors for reinfection, patients were followed until they had a reinfection or until the closing date of the study. During the study period 347 (40 ) of the women experienced a reinfection. The follow-up time on the 877 women ranged from 1 to 1,529 days with a median of 247 days. In this example we have selected three of the factors considered by investigators years of schooling (median 11.4 years with a range of 618 years), condom use (6 always, 58 sometimes and 34 never), and the indicator of whether the patient had oral sex within the 12 months prior to diagnosis (33 ). Years of schooling is treated as a continuous covariate, while condom use is coded as two binary covariates...

Inner City Asthma

Domestic birds Mycoplasma pneumoniae Chlamydia pneumoniae Respiratory Syncytial Virus (RSV) Chlamydia trachomatis Endotoxins Houseplants preschool-aged children) Endotoxins Fungi or molds* Chlamydia pneumoniae Chlamydia trachomatis Mycoplasma pneumoniae Houseplants Pollen

Infections

There is an increasing body of evidence suggesting that prematurity is a consequence of maternal infections including those that are sexually transmitted gonorrhea, Group B streptococcus, Chlamydia trachomatis, trichomonas vaginalis, bacterial vaginosis, and herpes simplex virus. Premature rupture of the membranes (PROM), a precursor of early delivery, is often accompanied by the presence of one of these organisms, which could cause the fetal membranes in utero to weaken and rupture. Thus it is often suggested that PROM is a symptom of an existing infection, which was not treated (Creasy & Iams, 1999 Iams, Talbert, Barrows, & Sachs, 1985). Bacteria in amniotic fluid are found in approximately 10 of women with PROM and PROM occurs in approximately 5 of all pregnancies (Aries, Rodriquez, Rayne, & Kraus, 1993 Romero, Yoon, et al., 1993).

Exposure

Teams must be prepared for and trained in the delivery and resuscitation of newborn infants. At least a two-person team is recommended to care for newborn resuscitation. This is in addition to the team required for maternal care and newborn delivery. Pre- and perinatal conditions that may complicate delivery include maternal hypertension, maternal infection, gestational diabetes, chronic maternal illness, medications, tobacco, alcohol, drug use, premature or prolonged rupture of membranes, prematurity, breech presentation, nuchal cord, shoulder dystocia, multiple gestation, meconium, and postpartum hemorrhage. Additional complications that may complicate resuscitation include respiratory depression, apnea, pneumothorax, asystole, bradycardia, hypothermia, hypovolemia, acidosis, anemia, infection, sepsis, fetal anomalies, and CNS depression. Neonatal resuscitation protocols developed by the American Heart Association should be followed. Providing warmth, suction, vitamin K to prevent...

Infection

Why would the hosts own immune system turn against it in such a fashion The complete answer has not yet been elucidated. However, there is an indication that the answer might in part be due to molecular mimicry, (for review see (Binder et al., 2002 Rose, 2000 Rose and Mackay, 2000)). Since Chlamydial heat shock proteins are potent antigenic stimuli able to induce specific cellmediated and humoral immune responses, several studies have proposed a link between Chlamydia pneumoniae and pathologies associated with atherosclerosis and coronary heart disease (CHD) (Ausiello et al., 2005 Hoshida et al., 2005). In addition, Chlamydial heat shock proteins have been suggested to increase the risk of secondary cardiovascular events in patients with coronary heart disease with diabetes (Guech-Ongey et al., 2006).

Prevention

Because chlamydial infections usually are not associated with overt symptoms, prevention of infection and screening of asymptomatic high risk patients is the most effective means of preventing disease and sequelae. Behavioral interventions (i.e., delaying intercourse, decreasing the number of sex partners, and use of barrier contraception) should be pursued aggressively. A decreased prevalence of C. trachomatis infections has been reported in regions with active chlamydial screening programs. High-risk patients who should be routinely tested for Chlamydia include women with mucopurulent cervicitis, sexually active women less than 20 years old, and older women with more than one sex partner during the last 3 months or inconsistent use of barrier contraception while in a nonmonogamous relationship (Johnson et al., 2002). Because of the frequency of repeated chlamydial infections within the first several months following treatment of an initial infection, (Burstein et al., 1998...

Cell Culture

Use of chlamydial transport media containing antibiotics maximizes recovery and reduces the likelihood of culture overgrowth by other bacteria. Swabs used to obtain a specimen should have plastic or metal shafts, as soluble components from wooden shafts can have a toxic effect on cell cultures. Storage at 4 C or maintenance at -70 C is required if inoculation within 24 hours is not possible. Cycloheximide-treated McCoy or HeLa cell lines are used most frequently to isolate C. trachomatis. Centrifugation techniques appear to enhance absorption of chlamydiae to cells. Intracytoplasmic inclusions can be detected at 48 to 72 hours with species-specific immunofluorescent monoclonal antibodies for C. trachomatis and Giemsa or iodine stains.