Pharmacotherapy of Chlamydial Genital Tract Infections
PST 06106
Basic Pharmacotherapy
Session 16: Pharmacotherapy of Chlamydial Genital Tract Infections
Learning Tasks
By the end of this session students are expected to be able to
:
Define
chlamydial genital tract infections
Explain pathophysiology of chlamydial genital tract infections
Explain the clinical presentation of chlamydial genital tract infections
Outline diagnosis of chlamydial genital tract infections
Describe pharmacological treatment of chlamydial genital tract infections
Describe the monitoring of chlamydial genital tract infections therapy
Activity: Buzzing
What
is Chlamydial Genital Tract Infections?
Definition of Chlamydial Genital Tract Infections
Chlamydial Genital Tract Infections
Chlamydial Genital Tract Infections is a sexually transmissible infection caused by bacterium
Chlamydia
t
rachomatis
Persons infected with the bacterium may not have symptoms of infection but can still transmit the bacterium.
Chlamydia can affect the urethra (the urine passage), cervix (the neck of the womb), rectum and anus, throat, and eyes
.
Pathophysiology of Chlamydial Genital Tract Infections
is an obligate intracellular parasite that shares properties of both viruses and bacteria.
Like viruses,
chlamydiae
require cellular material from host cells for replication; however, unlike viruses,
chlamydiae
maintain their cellular identity throughout development.
Although
lacks a cell-wall peptidoglycan, its major outer membrane is similar to gram-negative bacteria.
At least 18
serovars
(subspecies) of
exist, of which only the lymphogranuloma venereum strains produce potentially invasive infections.
The remaining
serovars
are involved primarily with superficial infection of epithelial cells
.
Pathophysiology of Chlamydial Genital Tract
Infections Cont
..
Chlamydia have the ability to establish long-term associations with host cells.
When an infected host cell is starved for various nutrients such as amino acids (for example, tryptophan), iron, or vitamins, this has a negative consequence for Chlamydiae since the organism is dependent on the host cell for these nutrients.
The starved
Chlamydiae
enter a persistent growth state wherein they stop cell division and become morphologically aberrant by increasing in size.
Persistent organisms remain viable as they are capable of returning to a normal growth state once conditions in the host cell improve and causing chronic
Clinical
Presentation of Chlamydial Genital Tract Infections
In comparison with gonorrhea, chlamydial genital tract infections are more frequently asymptomatic, and when present, symptoms tend to be less noticeable.
Urethral discharge usually is less profuse and more mucoid or watery than the urethral discharge associated with gonorrhea.
Diagnosis of Chlamydia Genital tract infection
A sample of urine can be collected and analyzed in the laboratory to investigate the presence of this infection.
A swab of the discharge can be collected for culture or antigen testing for chlamydia.
Nucleic Acid Amplification Tests
(NAAT), such
as
Polymerase Chain Reaction
(PCR
),
Transcription Mediated Amplification
(
TMA), and the DNA
Strand Displacement Amplification
(SDA) now are the mainstays.
NAAT for chlamydia may be performed on swab specimens sampled from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine
Activity
: Small Group Discussion
What
is the treatment of Chlamydial Genital Tract Infections?
Pharmacological treatment of Chlamydial Genital Tract infection
Monitoring of chlamydial Genital Tract Infections Therapy
Treatment of chlamydial infections with the recommended regimens is highly effective; therefore, post-treatment laboratory testing is not recommended routinely unless symptoms persist or there are other specific concerns (e.g., pregnancy).
Post-treatment tests should not be performed for at least 3 weeks following
completion
of
therapy.
When post-treatment tests are positive, they usually represent noncompliance, failure to treat sexual partners, or laboratory error rather than inadequate therapy or resistance to therapy.
Infants with pneumonitis should receive follow-up testing because erythromycin is only 80% effective, and a second course of therapy can be necessary
Key
Points
Chlamydia
is a sexually transmissible infection caused by bacterium
Chlamydia
t
rachomatis
Persons infected with the bacterium may not have symptoms of infection but can still transmit the bacterium.
Azithromycin is drug of choice for the treatment of chlamydia infection
Evaluation
What
is
Chlamydia
infection?
What is the pathophysiology of
Chlamydial
infection?
What are the signs and symptoms of
Chlamydia
infection?
How is the treatment of
Chlamydia
Infection?
References
Wells
BG,
DiPiro
J,
Schwinghammer
T (2013),
Pharmacotherapy Handbook
(6
th
Ed). New York, NY: McGraw-Hill.
DiPiro
JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):
Pharmacotherapy: A Pathophysiologic Approach
(7
th
ed
): New York, NY: McGraw-Hill.
Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011)
Principles & Practice Study Guide: A Case-Based Care Plan Approach
: New York, NY: McGraw-Hill.
Schwinghammer
TL, Koehler JM (2009)
Pharmacotherapy Casebook: A Patient-Focused Approach
(7
th
ed
): New York, NY: McGraw-Hill.
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