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Reactive arthritis that is due to chlamydia transmission is infection responds to antibiotic therapy. Other infectious causes of the condition do not.
So it is worth checking the synovial fluid of affected joints for evidence of chlamydia polymerase chain reaction (PCR), according to Dr. Atul Deodhar, professor of medicine at Oregon Health and Science University in Portland.
In a recent randomized trial, 6 months of rifampin plus either azithromycin or doxycycline significantly improved outcomes versus placebo in patients with chlamydia-induced reactive arthritis. Synovial fluid PCRs were positive for chlamydia in all 42 patients (Arthritis Rheum. 2010;62:1298-307).
The study "has changed my practice. I now send synovial fluid for PCR. I have found several patients" positive for chlamydia, "and we are treating them with antibiotics," Dr. Deodhar said; he also sends urine samples for chlamydia testing.
The primary end point in the study – an improvement of 20% or more in at least four of six variables such as swollen joint count – was achieved by 17 of 27 antibiotic patients (63%) but only 3 of 15 placebo patients (20%). Six patients treated with antibiotics but none of the patients in the placebo group went into complete remission during the trial. Patients on antibiotic were also more likely to clear chlamydia from their joints.
It’s a different story when reactive arthritis is triggered by gastrointestinal pathogens such as salmonella, shigella, campylobacter, and yersinia. In those cases, "avoid antibiotics," Dr. Deodhar said.
He and his colleagues found antibiotic therapy just didn’t help in a population study of 575 likely reactive arthritis cases among 6,379 people with culture-confirmed GI infections. His team confirmed reactive arthritis in 54 of the 82 (66%) subjects they were able to exam. Enthesitis was the most frequent finding; arthritis was less common (Ann. Rheum. Dis. 2008;67:1689-96).
Some patients had been given antibiotics for their GI infections, others not. It "didn’t really make any difference to patients developing or not developing reactive arthritis or the severity of it. Antibiotics are not going to prevent people with dysentery from developing reactive arthritis," Dr. Deodhar said.
They also found that the presence or absence of human leukocyte antigen B27 did not predict risk. In sporadic reactive arthritis cases, the presence of the antigen is "not actually that important in deciding if someone has or does not have reactive arthritis," he said.
Onset of reactive arthritis comes a few days to a maximum of several weeks following the inducing infection. Asymmetrical mono- or oligoarthritis of the lower extremity is the most common joint finding. Uveitis, dactylitis, and enthesitis are also possible.
Besides antibiotics for chlamydia-induced disease, sulfasalazine and tumor necrosis factor inhibitors may help with difficult cases.
Nearly two-thirds of sexually active young women don't get regular chlamydia transmission, a CDC study finds.
That means more than 9 million young American women don't know whether they've been infected, study leader Karen Hoover, MD, MPH, said in a teleconference from this week's National STD Prevention Conference in Minneapolis.
And the odds of being infected are pretty high: Chlamydia is the most common STD, as well as the most common reportable infection in the U.S.
"There were 1.3 million reported cases of chlamydia in 2010, but the CDC believes the actual number is more than twice that -- 2.8 million new cases each year in the U.S.," Gail Bolan, MD, director of STD prevention at the CDC, said at the teleconference.
Among women, nearly 5% of 19-year-olds and more than 1% of 15-year-olds are infected. Men are at least as likely to be infected. But it's women who suffer the most severe consequences. That's because chlamydia infection often is silent -- without symptoms -- until the infection becomes more serious.
Left untreated, 10% to 15% of women will get pelvic inflammatory disease (PID). And up to 15% of those women will be left infertile. And some will die from chlamydia-related ectopic pregnancy.
The CDC recommends an annual chlamydia test for any sexually active woman age 25 and younger. Women over age 25 should get annual tests if they have a new sex partner or have multiple sex partners. Routine screening isn't recommended for men.
When diagnosed, chlamydia is easily treated. But treatment isn't permanent, as Kelly Morrison Opdyke, MPH, and colleagues found in another conference presentation.
Opdyke's Cicatelli Associates Inc. team studied 63,774 people who tested positive for chlamydia from 2007 to 2009. They found that 25% of men and 16% of women have a new chlamydia infection when retested within six months.
And those are just the people who get another test. People who show up for screening tests tend to be healthier than those who don't. Yet only 11% of men and 21% of women got that chlamydia retest in the Opdyke study.
Those who test positive for chlamydia are supposed to get a repeat test three months after treatment. Sex partners should be evaluated and treated as well. Women are at increased risk for reinfection if their sex partners have not been treated appropriately.
Unfortunately, you might not be able to rely on your health care provider to offer you that test.
California Department of Health researcher Holly Howard, MPH, and colleagues studied six of their state's large family planning clinics. They found that only 70% of patients were retested for chlamydia or for gonorrhea, the second most common STD.
When the clinics installed pop-up reminders on patients' computer records -- using existing billing software -- the retesting rate went up to 86%.
To remind patients to ask for chlamydia retests, SUNY Buffalo researcher Gale Burstein, MD, MPH, and colleagues used a simple email system. Four to five weeks after testing positive for chlamydia or gonorrhea, students got an automated email reminder. That was followed by a personal email and, if needed, a telephone call.
What happened? Retest rates for chlamydia went from 16% to 89%.
"We must not only increase chlamydia screening rates but ensure re-testing," Bolan said. "And we must encourage and support individuals' efforts to protect themselves. This may mean abstaining from sex, reducing the number of sex partners, or proper condom use."
chlamydia transmission The American Academy of Pediatrics has shifted its stance on infant male circumcision, announcing on Monday that new research, including studies in Africa suggesting that the procedure may protect heterosexual men against H.I.V., indicated that the health benefits outweighed the risks.
But the academy stopped short of recommending routine circumcision for all baby boys, saying the decision remains a family matter. The academy had previously taken a neutral position on circumcision.
The new policy statement, the first update of the academy's circumcision policy in over a decade, appears in the Aug. 27 issue of the journal Pediatrics. The group's guidelines greatly influence pediatric care and decisions about coverage by insurers; in the new statement, the academy also said that circumcision should be covered by insurance.
The long-delayed policy update comes as sentiment against circumcision is gaining strength in the United States and parts of Europe. Circumcision rates in the United States declined to 54.5 percent in 2009 from 62.7 percent in 1999, according to one federal estimate. Critics succeeded last year in placing a circumcision ban on the ballot in San Francisco, but a judge ruled against including the measure.
In Europe, a government ethics committee in Germany last week overruled a court decision that removing a child's foreskin was "grievous bodily harm" and therefore illegal. The country's Professional Association of Pediatricians called the ethics committee ruling "a scandal."
A provincial official in Austria has told state-run hospitals in the region to stop performing circumcisions, and the Danish authorities have commissioned a report to investigate whether medical doctors are present during religious circumcision rituals as required.
Officials with the Centers for Disease Control and Prevention in Atlanta, which for several years have been pondering circumcision recommendations of their own, have yet to weigh in and declined to comment on the academy’s new stance. Medicaid programs in several states have stopped paying for the routine circumcision of infants.
"We're not pushing everybody to circumcise their babies," Dr. Douglas S. Diekema, a member of the academy’s task force on circumcision and an author of the new policy, said in an interview. "This is not really pro-circumcision. It falls in the middle. It’s pro-choice, for lack of a better word. Really, what we’re saying is, 'This ought to be a choice that's available to parents.' ”
But opponents of circumcision say no one — not even a well-meaning parent — has the right to make the decision to remove a healthy body part from another person.
chlamydia transmission While new cases of HIV have continued to decline, other documented instances of sexually transmitted diseases are on a continuous multi-year rise in San Francisco and across California.
Some local clinics are attempting to combat the spike with additional testing methods for syphilis, gonorrhea and chlamydia that involve checks of the throat and rectum — steps not currently endorsed as essential by the U.S. Food and Drug Administration.
In an effort set to launch next month, The City’s Magnet Clinic is using a public grant to sign up and notify high-risk individuals that it’s time for their regular checkups. And to underscore the importance of paying attention to a serious issue, the “pilot” messages will go beyond dry medical terminology.
“Syphilis, like the ’80s, is back — especially with guys who bareback,” one potential text will read. “Get to Magnet every three months if condoms aren’t your thing.”
Steve Gibson, director of Magnet Clinic, said the edgy reminders are designed to garner more trust and increase visits from gay men, which The City’s Department of Public Health has identified as the highest-risk group for STDs along with adolescent minorities.
“They’re tailored toward gay men,” Gibson said of the new messages. “In order for people to read it, it has to be relevant to them.”
Susan Philip, the health department’s director of STD prevention, said Magnet and others are key partners for combating this year’s rise in infections, which are outpacing 2011’s already troubling total. According to the most recent data in June, 1,278 cases of gonorrhea have been reported so far this year, compared with 1,015 in the same time period of 2011. The figures for chlamydia are similar, with 2,412 cases this year compared with 2,288 last year.
Total syphilis cases, which are broken into four categories, rose by 100 — from 392 to 492 — in the first half of 2012 compared with the same time period in 2011. Of those cases, Philip said, data show 60 percent are seen in HIV-positive gay men, many of whom find each other and have unprotected sex. While the HIV transmission is moot, syphilis often occurs as a result, Philip said.
The local figures are underscored by recently released California Department of Health data that show syphilis cases increased 18 percent statewide, with 80 percent of those impacted being gay men. Philip said more education is in order.
“We’re really trying to have a comprehensive approach to make sure HIV and STDs are seen as a comprehensive unit,” Philip said. “We do have concerns, and we want the rates to go down.”
chlamydia transmission is the most common sexually transmitted disease (STD) in Finland and the number of reported cases is growing by the year.
Experts say the roughly 14,000 new annual infections are mainly contracted inside the country’s borders. Fifteen years ago, new infections numbered around 9,000.
Pekka Ruuska from the infectious disease unit at Kainuu Central Hospital says men are more likely to notice signs of infection than women, who may mistake symptoms for menstruation cramps. In some women chlamydia can cause complications leading to infertility.
In Finland, the STD is most prevalent among 15-24 year-old women and 20-29 year-old men.
Women are twice as often diagnosed with the disease than men.