Urogenital infection with chlamydia trachomatis A56.0

The proportion of non-specific urethritides is 35-60% (still increasing).

In Germany, it is assumed that there are approximately 300,000 new cases per year. In about 7 out of 10 infected women and 5 out of 10 infected men, the infection is asymptomatic.

Incubation period: 4 days to 1 month. Vitreous to purulent urethral fluoride. Pain in the urethra. In women often no clinical symptoms, otherwise bleeding disorders are a typical leading symptom due to infestation of the cylinder epithelium of the cervix and subsequent ascending infection. In the fallopian tubes, the bacteria may persist for years and lead to tubal occlusion with subsequent sterility, pyo- and hydrosalpinx. Other sequelae include extrauterine pregnancy, arthritis, infection of the newborn during delivery, and perihepatitis.

In males, the urethra is the main port of entry resulting in epididymitis and infertility.

Smear preparation (fluorescently labeled antibodies, staining with iodine or according to Papanicolaou), cultural pathogen detection, antibody detection, nucleic acid amplification test (NAAT), the latter is the method of choice and is mainly performed on first-stream urine and cervical smears. The sensitivity of the cervical smear is somewhat greater due to the higher pathogen density.

In Germany, screening is carried out once a year in young women up to their 25th birthday and in pregnant women (the only way to identify asymptomatic patients!). For this purpose, first stream urine, i.e. the first 10 ml, is collected (tip: have it produced on site in the practice!).

Cooperation with urologist. Physical rest, bed rest. In men, if necessary, testicular benching (raising the testicles). Drink plenty of fluids, preferably mildly disinfecting kidney teas (e.g. mixed teas of bearberry, hawthorn root, birch leaves, etc.).

• Uncomplicated course: Doxycycline (e.g. Doxy Wolff) 2 times/day 100 mg p.o. or tetracycline (e.g. Achromycin) 4 times/day 500 mg p.o. for 10-14 days. In case of dysuria additional administration of an analgesic/spasmolytic like Flavoxat (e.g. Spasuret) 3-4 times/day 200 mg p.o. Alternative: Erythromycin (e.g. Erythrocin) 4 times/day 500 mg for 7?(14) days or Azithromycin (e.g. Zitromax) 1 time/day 1,5 g p.o. or better 2 x 1,5g as single dose. Meanwhile, there is increasing resistance to azithromycin!

• Reminder. Co-treatment of all sexual partners of the last 60 days!

• Complicated course: Antibiotics as above for at least 14 days. If necessary, glucocorticoids in low doses such as prednisolone 20-40 mg/day with rapid dose reduction. Administration of antiphlogistics and/or analgesics/spasmolytics such as flavoxate (e.g. Spasuret) 3-4 times/day 200 mg p.o. S. Guideline of the German STI Society p. 14

Pregnancy

• Erythromycin ethyl succinate 4x880mg as granules or dry juice for 7 days.
• Alternatively (according to DGGG and CDC guidelines): Amoxicilin 3x500mg / 1-10 days
• Azithromycin and Roxithromycin in the second line (2 x 150mg Roxithromycin over 10 days, better tolerated than Erythromycin)
• Contraindicated tetracyclines, gyrase inhibitors, clarythromycin and erythromycin estolate both in embryonic and fetal periods and during lactation.

After therapy:

• Success control by means of urine tests 4 weeks after the end of treatment (tip: have gonococci determined in the same urine sample, co-infections are not uncommon!).

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4. Jensen JS (2004) Mycoplasma genitalium: the aetiological agent of urethritis and other sexually transmitted diseases. J Eur Acad Dermatol Venereol 18: 1-11
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6. Petzolt D et al (1980) Genital Chlamydia infections. Dermatologist 31: 263-267