zithromax and Pregnancy--Ectopic

Topics: Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Cost-Benefit Analysis; Doxycycline; Female; Humans; Mass Screening; Pelvic Inflammatory Disease; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Infectious; Pregnancy, Ectopic; Risk Factors; Self Care; Sexual Behavior; Young Adult

Pelvic inflammatory disease (PID), the infection and inflammation of the female upper genital tract, is a common cause of infertility, chronic pain and ectopic pregnancy. Diagnosis and management are challenging, largely resulting from varying signs and symptoms and a polymicrobial etiology that is not fully delineated. Owing to the potential for serious sequelae, a low threshold for diagnosis and treatment is recommended. As PID has a multimicrobial etiology, including Neisseria gonorrhoeae, Chlamydial trachomatis and anaerobic and mycoplasmal bacteria, treatment of PID should consist of a broad spectrum antibiotic regimen. Recent treatment trials have focused on shorter duration regimens, such as azithromycin, and monotherapies including ofloxacin, but data are sparse. Research comparing sequelae development by differing antimicrobial regimens is extremely limited, but will ultimately shape future treatment guidelines.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia trachomatis; Female; Humans; Infertility, Female; Neisseria gonorrhoeae; Ofloxacin; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Risk Factors; Sexually Transmitted Diseases; Ureaplasma; Women's Health

Chlamydia trachomatis is a gram-negative bacterium that infects the columnar epithelium of the cervix, urethra, and rectum, as well as nongenital sites such as the lungs and eyes. The bacterium is the cause of the most frequently reported sexually transmitted disease in the United States, which is responsible for more than 1 million infections annually. Most persons with this infection are asymptomatic. Untreated infection can result in serious complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy in women, and epididymitis and orchitis in men. Men and women can experience chlamydia-induced reactive arthritis. Treatment of uncomplicated cases should include azithromycin or doxycycline. Screening is recommended in all women younger than 25 years, in all pregnant women, and in women who are at increased risk of infection. Screening is not currently recommended in men. In neonates and infants, the bacterium can cause conjunctivitis and pneumonia. Adults may also experience conjunctivitis caused by chlamydia. Trachoma is a recurrent ocular infection caused by chlamydia and is endemic in the developing world.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Chlamydial Pneumonia; Doxycycline; Epididymitis; Female; Humans; Incidence; Infertility, Female; Lymphogranuloma Venereum; Male; Mass Screening; Orchitis; Pelvic Inflammatory Disease; Practice Guidelines as Topic; Pregnancy; Pregnancy, Ectopic; Prevalence; Risk Factors; Sexually Transmitted Diseases; Trachoma; Treatment Outcome; United States

Mycoplasma genitalium is associated with acute and chronic urethritis in men. Existing data on infection in women are limited and inconsistent but suggest that M. genitalium is associated with urethritis, cervicitis, pelvic inflammatory disease, and possibly female infertility. Data are inconclusive regarding the role of M. genitalium in adverse pregnancy outcomes and ectopic pregnancy. Available data suggest that azithromycin is superior to doxycycline in treating M. genitalium infection. However, azithromycin-resistant infections have been reported in 3 continents, and the proportion of azithromycin-resistant M. genitalium infection is unknown. Moxifloxacin is the only drug that currently seems to uniformly eradicate M. genitalium. Detection of M. genitalium is hampered by the absence of a commercially available diagnostic test. Persons with persistent pelvic inflammatory disease or clinically significant persistent urethritis or cervicitis should be tested for M. genitalium, if possible. Infected persons who have not previously received azithromycin should receive that drug. Persons in whom azithromycin therapy fails should be treated with moxifloxicin.

Topics: Anti-Bacterial Agents; Aza Compounds; Azithromycin; Doxycycline; Drug Resistance, Bacterial; Female; Fluoroquinolones; Humans; Infertility, Female; Male; Moxifloxacin; Mycoplasma genitalium; Mycoplasma Infections; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Quinolines; Treatment Outcome; Urethritis; Uterine Cervicitis

Systemic methotrexate therapy for interstitial pregnancy has an increased failure rate as compared to other ectopic locations. No case of interstitial pregnancy with a retained intrauterine device (IUD) has been reported on before.. An asymptomatic, 21-year-old woman presented with a positive pregnancy test and a retained IUD. Vaginal ultrasound revealed a left interstitial pregnancy. Diagnostic laparoscopy was followed by a single dose of methotrexate (50 mg/m2). Five days later, a marked increase in the human chorionic gonadotropin level was followed by a second course (four doses) of methotrexate, 1 mg/kg, alternating with 0.1 mg/kg of leucovorin. Concomitant Chlamydia was treated with azithromycin, and the IUD was expelled spontaneously.. Medical management of interstitial pregnancy may prevent surgery that limits future fertility, but the evidence suggests that more than one dose of methotrexate may be required.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Intrauterine Devices; Leucovorin; Methotrexate; Pregnancy; Pregnancy, Ectopic; Vaginal Diseases