Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The potential sequelae of Chlamydia trachomatis--nonspecific urethritis and post gonococcal urethritis in men and nonspecific genital infection in women--suggest a need for a chlamydial diagnostic service in clinics that treat sexually transmitted diseases. In this prospective study, over 2000 endocervical samples were obtained over an 18-month period from women presenting to a sexually transmitted diseases clinic. The isolation rate for chlamydia averaged 23.6%/month. There was no significant difference in presenting symptoms such as vaginal discharge, dysuria, pruritus, and abdominal pain between patients with chlamydial infection alone, those with gonorrhea alone, and women with no sexually transmitted disease. 178 (31%) of patients with chlamydia were sexual contacts of patients with nonspecific urethritis and 122 (22%) were contacts of men with gonorrhea. In the absence of a chlamydial service laboratory, only contacts of patients with nonspecific urethritis are likely to receive treatment, leaving 2/3 of chlamydia-positive women untreated. In 1976, an estimated 18,300 women were seen in British clinics with undiagnosed, untreated chlamydial infection. Given the magnitude and severity of this problem, a chlamydial diagnostic service should become a mandatory clinic component.
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PMID:The need for a chlamydial culture service. 48 48

The chemistry, mechanism of action, antimicrobial spectrum, pharmacokinetics, clinical efficacy, adverse effects, drug interactions, and dosage and administration of clarithromycin and azithromycin are described. Clarithromycin and azithromycin are new macrolide antibiotics that are similar in structure to erythromycin. Compared with erythromycin, clarithromycin demonstrates increased activity against Staphylococcus aureus, streptococci, Legionella pneumophila, Moraxella catarrhalis, and Chlamydia trachomatis. Clarithromycin also has in vitro activity against Mycobacterium avium complex (MAC) and Toxoplasma gondii. Azithromycin has increased gram-negative activity compared with erythromycin, including activity against Haemophilus influenzae, while maintaining activity against gram-positive organisms. Azithromycin also has activity against sexually transmitted organisms including Chlamydia trachomatis. The pharmacokinetic profiles of clarithromycin and azithromycin are characterized by good oral bioavailability, excellent tissue penetration and persistence, and long elimination half-lives, which allow for once-daily or twice-daily dosing. Initial data show that clarithromycin and azithromycin are effective for the treatment of upper-respiratory-tract and lower-respiratory-tract infections and infections of the skin and skin structures. Azithromycin has been shown to be effective for the treatment of sexually transmitted diseases caused by Chlamydia trachomatis. Clarithromycin and azithromycin have been used to treat MAC and Toxoplasma infections in patients with the acquired immunodeficiency syndrome. The most frequently reported adverse effects for both agents have been nausea, diarrhea, and abdominal pain. Oral formulations of clarithromycin and azithromycin have recently been approved by the FDA. Clarithromycin and azithromycin are new macrolide antibiotics that have potential advantages over erythromycin; however, the role of these agents will be better defined as results of more ongoing trials become available for evaluation.
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PMID:Clarithromycin and azithromycin: new macrolide antibiotics. 151 40

Pelvic inflammatory disease (PID) is a syndrome unrelated to pregnancy or surgery and characterized by lower abdominal pain and tenderness, cervical motion tenderness, and adnexal tenderness. Fever, leukocytosis, and the results of laboratory tests are used to support the diagnosis. Participants in clinical trials should be stratified into two groups: those with and those without tubo-ovarian abscess--i.e., those with complicated and those with uncomplicated PID. Diagnostic studies and treatment should be directed at four major groups of pathogens: Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, and facultative bacteria such as Escherichia coli. Women requiring hospitalization should generally be treated as inpatients for at least 4-7 days; outpatient therapy should then be instituted to complete a 14- to 21-day course. Clinical and laboratory evaluations should be conducted daily during hospitalization and both 2-4 days and 2-4 weeks after the completion of therapy.
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PMID:Evaluation of new anti-infective drugs for the treatment of acute pelvic inflammatory disease. Infectious Diseases Society of America and the Food and Drug Administration. 147 52

The toleration and safety profile of the azalide antibiotic, azithromycin, has been assessed in 3,995 patients aged 2-94 (mean, 36) years, comprising 1,644 females and 2,351 males. Patients with infections of the respiratory tract or skin/skin structure received 1.5 g azithromycin over 5 days; patients with urethritis/cervicitis caused by Chlamydia were treated with 1 g as a single dose. Assessments of side effects and laboratory safety test abnormalities were made pretreatment and approximately 7-14 and 30 days after the start of therapy. Twelve standard antibiotics have been used for comparison. Overall, side effects were recorded in 12.0% of patients, significantly less (p less than 0.05) than with comparative drugs (14.2%). The most common side effects were diarrhea (3.6%), abdominal pain (2.5%), and other gastrointestinal symptoms. Ninety-three percent of side effects were classed as mild or moderate, and only 0.7% of patients withdrew from treatment, significantly less (p less than 0.001) than with comparative agents (2.6%). The frequency of side effects was not affected by patient age. Azithromycin had no marked or consistent effect on laboratory safety parameters. Treatment-related laboratory abnormalities were rare, the most common being transient increases of ALT and AST in 1.7% and 1.5% of patients, respectively. Specific tests revealed no neurologic, audiometric, or ophthalmologic abnormalities, or evidence of phospholipidosis. There were no pharmacokinetic interactions observed with theophylline, warfarin, cimetidine, carbamazepine, or methylprednisolone, but coadministration with food altered the absorption of the drug. Coadministration with antacids decreased the peak serum concentration of azithromycin, but did not affect its overall absorption. Azithromycin was well tolerated in the presence of a wide variety of concurrent illnesses and medications.
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PMID:Clinical toleration and safety of azithromycin. 165 42

Chlamydia trachomatis is a well-known cause of acute and chronic salpingitis, accounting for approximately half of all cases of pelvic inflammatory disease. Typically, patients with acute chlamydial salpingitis present with acute lower abdominal pain, tenderness on bimanual pelvic examination, or vaginal discharge. We describe a case of acute chlamydial salpingitis with marked ascites and an adnexal mass that simulated a malignant neoplasm. Microscopically, a severe lymphofollicular salpingitis and a marked lymphofollicular hyperplasia of the omentum and retroperitoneal lymph nodes were found. Chlamydial inclusions in the fallopian tube epithelium were demonstrated by immunohistochemistry using a mouse monoclonal antibody to a genus-specific outer membrane lipoprotein. Chlamydial infection may cause marked ascites and a palpable adenexal mass and should be considered whenever marked chronic inflammation with a lymphofollicular hyperplasia involves the fallopian tube or other female genital tract sites.
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PMID:Acute chlamydial salpingitis with ascites and adnexal mass simulating a malignant neoplasm. 177 10

23 women with lower abdominal pain and Chlamydia trachomatis in the cervix, urethra, or both sites were studied. Laparoscopy was done with sampling of the endometrium and fallopian tubes for detection of C trachomatis. 11 women had laparoscopic evidence of pelvic inflammatory disease (PID); C trachomatis was detected in the upper genital tract of 8, but not in the upper tract of 5 who had laparoscopy again after treatment. The organism was also found in the upper genital tract of 9 of the 12 women without laparoscopic evidence of PID. Most of the women with abdominal pain or tenderness had tubal or endometrial C trachomatis infection, although only half had laparoscopic evidence of salpingitis. This finding suggests that antibiotic treatment should be given as soon as chlamydial infection is detected in the cervix and that pain does not necessarily point to C trachomatis in the upper genital tract. Laparoscopy may miss important pathogens in the upper genital tract, unless the procedure is complemented with detailed microbiological investigation.
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PMID:Chlamydia trachomatis in the fallopian tubes of women without laparoscopic evidence of salpingitis. 197 3

The prevalence of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in 232 sexual assault victims who presented for examinations between August 1, 1987, and July 31, 1988, was determined. Results are reported for cervical, rectal, and oropharyngeal NG cultures and for cervical and rectal CT smears. Results from a one-week follow-up are also reported. Cervical test results from the initial sexual assault examination were compared with cervical tests on 399 randomly selected female emergency department patients who presented for other gynecological conditions or lower abdominal pain. The victims of sexual assault had ten of 210 positive cervical NG cultures (4.76%), and 13 of 213 positive cervical CT smears (6.1%) at the first visit. These prevalence rates were not significantly different (P = .3058). There were none of 28 positive rectal NG cultures (0%) and one of 22 positive rectal CT smears (4.34%) (P = .451). None of the 43 oral NG cultures was positive. Seventy-three victims returned for follow-up examination. No follow-up cervical, rectal, or oral NG cultures were positive. However, one of 53 follow-up cervical smears for CT was positive, but this was not significantly different than for cervical NG (P = .461). Sexually assaulted patients had ten of 210 (4.76%) cervical NG cultures positive, and nonassaulted patients showed 53 of 393 positives (13.4%) (P less than .001). Assaulted patients had 13 of 213 (6.1%) cervical CT smears positive, and nonassaulted patients showed 33 of 352 (9.3%) positives (P = .11).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis in victims of sexual assault. 199 36

One hundred and eighty-two patients were enrolled in a randomized third-party blinded study to assess the efficacy and safety of azithromycin in the treatment of sexually transmitted diseases. Three regimens of azithromycin, including a single oral dose, were compared with a standard treatment with doxycycline. The patients were followed for four weeks. Efficacy was evaluated in 168 patients (113 azithromycin, 55 doxycycline). Fourteen patients had negative cultures or did not come for all follow-up visits. Of the 168, 138 were infected with Chlamydia trachomatis, 43 with Neisseria gonorrhoeae, and 45 with Ureaplasma urealyticum. Ninety-six per cent of patients with chlamydial infections and 92% of those with gonorrhoea were cured with azithromycin. Two patients infected with N. gonorrhoeae, four with C. trachomatis and six with U. urealyticum had positive cultures on follow-up visits after receiving azithromycin. Of these 11 patients with positive cultures on follow-up visits, seven (five with U. urealyticum and two with C. trachomatis) violated the protocol by having intercourse with infected individuals during the study. Azithromycin was very well tolerated; one patient complained of mild abdominal pain shortly after receiving the drug, seven patients complained of mild nausea and two patients had mild diarrhoea.
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PMID:Azithromycin in the treatment of sexually transmitted disease. 215 28

The relationship between IUD and oral contraceptive (OC) use and tubal infertility of infectious origin was retrospectively studied in 89 French women undergoing operations for tubal infertility between 1978- 87, 178 women who had spontaneously become pregnant regardless of outcome formed the control group, which was matched for age, socioprofessional status, and ethnic origin. Chlamydia trachomatis was responsible for 73% of cases of tubal infertility. 22 of the 89 women had a history of diagnosed salpingitis and 20 had had abdominal pain of unknown origin. 47 had had no symptoms of salpingitis. The average age was 29.68 years for the tubal infertility group and 29.7 for the fertile women. The socioprofessional status of the 2 groups was similar and higher than that of the general French population. 58% in the tubal infertility group and 36% in the fertile group were nulligestes. 60.1% of fertile vs. 47.2% of infertile women had used OCs. More infertile (22.5%) than fertile (14.6%) women had used IUDs, but the difference was not statistically significant. 45% of infertile women who had used IUDs had a history of diagnosed salpingitis, vs. 19% of pill and 18.5% of other contraceptive method users. The rate of chlamydia infection was similar for OC, IUD, and other method users. The rate of use of IUDs was similar for nulliparous fertile and infertile women, but for multiparous women it was significantly higher among infertile women. The finding that the infertile group had used OCs less often than controls suggest that OCs have a protective effect against this type of infertility. The role of the IUD is harder to establish, but a significant relationship was found between infectious tubal infertility and IUD use among multiparas and among women aged 25-34 years. The study also demonstrated that chlamydia infections are not related to contraceptive method used. In the light of this study it appears important to advise OCs rather than IUDs for women who are likely to desire a future pregnancy, even for multiparous women.
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PMID:[Contraception and tubal sterility of infective origin]. 232 37

Two hundred women attending the sexually transmitted disease (STD) clinic at Middle Road Hospital were investigated. Chlamydia trachomatis was isolated from 32% of women who were contacts of men with nongonococcal urethritis, 15% of contacts of gonococcal urethritis, 27% of contacts of unspecified STD, and 13% of women without any history of STD in their sex partners. Overall, Chlamydia trachomatis was isolated from 17% of 200 women, Neisseria gonorrhoeae from 13% of 199 women, Candida albicans from 34% and Trichomonas vaginalis from 6% of 197 women. Three per cent of the patients had positive VDRL results. A history of bilateral lower abdominal pain and the presence of cervicitis were significantly associated with chlamydial infection. Forty one per cent of the 34 chlamydia-positive women were asymptomatic. The results of this study show that C. trachomatis infection is more common than infection with N. gonorrhoeae in women who attend STD clinics. The need for routine screening and treatment on the basis of epidemiological and clinical markers of infection has to be carefully examined.
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PMID:Endocervical chlamydial infection in women attending a sexually transmitted disease clinic in Singapore. 260 75


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