STDs without Lesions

CHLAMYDIAL INFECTIONS Chlamydia trachomatis is an obligate intracellular bacterium that has a growth cycle that alternates between two morphologic forms. Chlamydial infections present with a wide spectrum of clinical manifestations. In men, infection causes urethritis, epididymitis, and proctitis. In women, urethritis, cervicitis, and PID are common. In both sexes, the prevalence of asymptomatic infection is high, ranging from 3 to 5 percent in the general population to 15 to 20 percent among individuals attending STD clinics. Patients with gonorrhea have an even higher incidence of concomitant chlamydial infection. Untreated chlamydial infections are thought to be an important cause of infertility in women. The incubation period is 1 to 3 weeks, and symptoms, if present, can range from mild vaginal burning or irritation to peritonitis.

Diagnosis Although the organism can be cultured, this has a relatively low yield. Indirect methods using direct immunofluorescence, enzyme-linked immunosorbent assay (ELISA)-type assays, and DNA probes are available.

Treatment Treatment is with azithromycin 1 g PO in a single dose or doxycycline 100 mg PO bid for 7 days. T§ble...13Z:1 lists alternative treatment options.

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