Neisseria Gonorrhea & Chlamydia Trachomatis Thesis

Excerpt from Thesis :

The newest is the nucleic acid amplification test. It has 92-96% sensitivity and 94-99% specificity, as compared with culture tests (Norris). The Centers for Disease Control and Prevention recommends the maintenance of a low threshold to physicians when diagnosing pelvic inflammation disease because of the lack or absence of significant negative changes. The Center recommends diagnosing women with PID and who experience uterine and adnexal painfulness or cervical tenderness during the examination. Women who have urogenital disease can submit to the nucleic acid amplification text by endocervical or urine sample. Endocervical samples are, however, preferred, a urine samples have lower sensitivity (Miller).


The Centers for Disease Control and Prevention revised its guidelines and now recommends the use cephalosporins in the treatment of gonorrhea and PID (Armstrong, 2007). This class of drugs has replaced fluoroquinolones, which have been popularly used since 1993. Fluoroquinolones have been the choice drugs because of their effectiveness, availability and convenient single dose. But resistance to the drugs soon became prevalent in gonorrhea cases, necessitating modifications in the therapy. Incidents were initially reported as occurring in Hawaii, followed by cases in California and the Western States. The resistance trend was first noted among men at 30% in 1994 who have sex with men, then in other groups (Armstrong; Norris, 1999). The incidence persisted and necessitated a change into another regimen. CDC currently recommends a single 125-mg intramuscular shot of ceftriaxone as treatment for uncomplicated urogenita and anorectal gonorrhea. The oral dose is 400 mg of cefixime. Cefixime may be used as an alternative regimen in combination with 1 gram of cefuroxime. CDC also recommends a single intramuscular shot of ceftriaxone for pharyngeal gonorrhea (Armstrong). The list of new class of antibiotics taken orally or given by injection consists of ciprofloxacin, ofloxacin, azithromycin, amoxicillin, doxycycline, and ceftriaxone. Patients who are allergic to penicillin should be treated instead with erhythromycin (Norris).

Alternative treatments include herbs and minerals as supplements (Norris, 1999).

Lactobacillus acidophilus or live-culture yogurts may replenish gastrointestinal flora. Zinc, multivitamins, especially Vitamin C, minerals and garlic help improve the body's immune system. Herbs like kelp, calendula, myrrh, and thuja have demonstrated values on the body's systems. Hot baths also help reduce pain and inflammation. Fasting and juices contribute to cleaning up the urinary and gastrointestinal systems. So do acupressure and acupuncture (Norris).


If the diagnosis is made early and the treatment is correct and complete, the disease can be entirely treated (Norris, 1999). Otherwise, 40% of untreated female patients can develop PID, liver infection and sterility. When the disease spreads throughout the body, the gonococcal infection is likely to cause fever, arthritic joints and skin lesions. The best prevention is still abstinence or exclusive sex with one partner. Infection may also be prevented with the use of contraceptive devices, such as condoms (Norris).

Name of Bacteria: Chlamydia Trachomatis

Disease: Chlamydia or Genital Chlamydia

Body System Involved: Uro-genital System


Domain - Bacteria

Class - Chlamydiae

Order - Chlamydiales

Family - Chlamydiacea

Genus - Chlamydia

Species - C. Trachomatis


Chlamydia trachomatis are gram-negative, aerobic, intracellular pathgens (Stephanie, 2008). They are typically coccoid or rod-shaped. They need growing cells to remain alive but can be artificially grown in a suitable medium. They cannot synthesize their own ATP. They were previously believed to be viruses (Stephanie).

The preferred non-culture technique today is the nucleic acid amplification, which have a 85% sensitivity and specificity (Miller, 2006). A Gram stain of mucopurulent discharge from the penis with more than 5 white blood cells per oil-immersion field and no intracellular Gram-negative diplococci can confirm urethritis. The nucleic acid amplification technique can detect and confirm C. trachomatis (Miller). Other tests are cytology, culture, antigen detection, serologic tests, and nucleic acid probes. Because chlamydia are intracellular parasites, swabs of the infected or involved sites, instead of exudates, should be submitted for examination and analysis for accuracy (Mayer, 2007).

Media for Cultivation

Specimens are merged with cultures of susceptible cells (Mayer, 2007). Infected cells are then examined for iodine-staining inclusion bodies, as iodine stains glycogen in these bodies. Their presence confirms C. trachomatis. Other species of the bacterium have no glycogen (Mayer).


These organisms are small obligate intracellular parasites (Mayer, 2007). They have their own DNA, RNA and ribosomes and make their own proteins and nucleic acids. They have an inner and outer membrane like gram-negative bacteria. The are unable to make their own ATP and, are, thus energy parasites (Mayer)..

C. trachomatis attacks and infects non-ciliated columnar epithelial cells (Mayer, 2007). They stimulate the infiltration of polymorphonuclear cells and lymphocytes. This leads to the formation of lymphoid follicle and fibrotic changes. Cell destruction follows. The host creates an inflammatory response. Long-lasting immunity is not stimulated by the infection. Re-infection brings on a repeat inflammatory response and resulting tissue damage (Mayer).


This depends on the site of the infection, the age of the infected person and whether the infection is complicated or uncomplicated (Miller, 2006). The Centers for Disease Control and Prevention recommends a single oral dose of 1 g of azithromycin for uncomplicated chlamydial infection. The equivalent oral dose is 100 mg doxycycline twice a day for seven days. The azithromycin single dose has the advantage in that it can be administered at the doctor's office. If the patient vomits the drug within one or two hours, alternative treatment should be given. If symptoms persist after the completion of the regimen, treatment should be changed to 2 g metronidazole as a single oral dose in addition to 500 mg erhthromycin ethylsccinate, also taken orally, four times a day for seven days. An alternative dosage is 800 mg erythromycin ethylsuccinate orally four times a day for seven days (Miller).

Tetracyclines, erythromycin and sulfonamides are commonly used to treat Chlamydia and other sexually transmitted diseases (Mayer, 2007). But their effectiveness is limited where re-infection is common. Vaccines are not effective against these diseases. Only proper treatment, improved hygiene, prevention of re-infection, safe sexual practices and abstinence will help (Mayer).

Specific Disease Chosen

Genital Chlamydia or Chlamydia is the most frequently reported bacterial STD (NWHRC Health Center, 2005). Statistics say that there are more than 3 million new cases of the disease very year. The American Social Health Association reported that it is most common among teen-agers and young adults. From an invasion of the endocervix, the disease spreads to the reproductive tract. If untreated, it can lead t infertility, ectopic pregnancy and chronic pelvic pain. It has been called the "silent epidemic" in that three out of four infected persons do not develop symptoms. Yet it produces complications and damage. In 1999 alone, the annual costs incurred in treating the infection and its complications went beyond $2 billion Chlamydia is so common among young women that health authorities estimate half of all sexually active women, by age 30, will contract it some time in their lives (NWHRC Health Center).

Chlamydia usually presents symptoms (Miller, 2006). These are dysuria and discharge from the penis in men and pelvic inflammatory disease in women. Most women do not have symptoms. Despite the lack, it can cause ophthalmia neonatorum in newborns and chlamydial pneumonia. Untreated Chlamydia in men can spread to the epididymis. Oral treatment may be a single dose of azithromycin or a weekly dosage of 100 mg twice daily of doxycycline. Amoxicillin or an erythromycine base is recommended for pregnant women. CDC and the U.S. Preventive Services Task Force strongly recommend the examination of women at increased risk and women under 25 (Miller).


Congress allotted a budget to fund a national STD-related infertility prevention program (NWHRC Health Center, 2005). This increased the number of Chlamydia screenings. It also raised the level of awareness on the seriousness of the disease, especially on health professionals. A consequence was that States now require insurance companies to cover the costs of Chlamydia screenings (NWHRC).

When diagnosed, the disease is easily treated and cured (NWHRC Health Center, 2005). But if left untreated, it can develop serious medical problems. In women, it can produce pelvic inflammatory disease involving the upper genital tract. This includes endometritis and trubo-ovarian abscess. Acute pelvic inflammatory disease is also hard to diagnose. It has subtle signs and varying symptoms (NWHRC Health Center).


Armstrong, C. (2007). CDC changes guidelines for gonorrhea. American Family

Physician: the Academy of American Physicians. Retrieved on November 26, 2008 from;col1

Javanbakht, M., et al. (2000). Increases in gonorrhea - eight Western states: 2000-2005. Morbidity and Mortality Weekly Report: Government Printing Office. Retrieved on November 26, 2008 at;col1

Justesen, S (2002). Slowing the spread of gonorrhea. Nursing: Springhouse Corporation. Retrieved on November 26, 2008 at;col1

Mayer, G (2007). "Chlamydia." Bacteriology, Chapter 20. Microbiology and Immunobiology. The Board of Trustees: University of South Carolina School of Medicine. Retrieved on November 29, 2008 at

Miller, K.E. (2006). Diagnosis and treatment of neisseria gonorrhea. American Family Physician: the Academy of Family Physicians. Retrieved on November 26, 2008 from;col1

Diagnosis and treatment of Chlamydia Trachomatis.…

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