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From: Sent: To: Cc: Subject: Wednesday, September 21, 2011 4:37 PM Jeffrey Epstein; Some helpful info.. U.S. National Library of =edicine - The World's Largest Medical Library About PubMed =ealth chttp://www.ncbi.nlm.nih.gov/pubmedhealth/about/> I • Home <http://www.ncbi.nlm.nih.gov/pubmedhealthk • Help PubMed Health Search Home > Diseases and =onditions > Chlamydia Print A.D.A.M. Medical =ncyclopedia. Last reviewed: June 7, 2010. Causes, incidence, and risk =actors Chlamydia infection is =he most common sexually transmitted disease in the United States. =exually active individuals and individuals with multiple partners are =t highest risk. Symptoms As =any as 1 in 4 men with chlamydia have no symptoms. In men, chlamydia =ay produce symptoms similar to gonorrhea. Symptoms may =nclude: * Burning sensation during urination Discharge from the penis or =ectum Testicular =enderness or pain Rectal discharge or pain Only about 30% of =omen with chlamydia have symptoms. Symptoms that may occur in women =nclude: Burning sensation during urination Painful sexual =ntercourse Rectal pain or discharge Symptoms of PID, salpingitis, liver =nflammation similar to hepatitis Vaginal =ischarge EFTA_R1_00121313 EFTA01791381 See =lso: Chlamydia in =omen In =erious cases, domestic animals such as cats and dogs should be watched =losely. If they start loosing their fur, it could be an indication of a =erious heart infection and they could have an increased likelihood of =n early death if not properly treated. See =lso: Chlamydia in =omestic animals Signs =nd tests The diagnosis of =hlamydia infection involves sampling of the urethral =ischarge in males or cervical secretions in females. If an =ndividual engages in anal sexual contact, samples from the rectum may =lso be needed. The sample is sent for a fluorescent or =onoclonal antibody test, DNA =robe test, or cell culture. Some of these tests may also be performed =n urine samples. Treatment The usual treatment =or chlamydia is antibiotics, including tetracyclines, azithromycin, =r erythromycin chttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000662/> . You can get chlamydia with gonorrhea or =yphilis, so if you have one sexually transmitted disease you must be =creened for other sexually transmitted diseases as well. All sexual =ontacts should be screened for chlamydia. Sexual partners must be treated to prevent passing the infection back =nd forth. There is no significant immunity following =he infection and a person may become repeatedly infected. A follow-up evaluation may be done in 4 =eeks to determine if the infection has been cured. Expectations (prognosis) Early antibiotic treatment is extremely =uccessful and may prevent the development of long-term complications. =ntreated infection, however, may lead to complications. Complications Chlamydia infections in women may lead to =nflammation of the cervix. In men, chlamydia infection can lead to =nflammation of the urethra called urethritis. An untreated chlamydia infection may spread =o the uterus or the fallopian tubes, causing salpingitis or pelvic =nflammatory disease. These conditions can lead to infertility and =ncrease the risk of ectopic pregnancy. If a =omen is infected with chlamydia while pregnant, the infection may cause =nfection in the uterus after delivery (late postpartum endometritis). =n addition, the infant may develop chlamydia-related conjunctivitis =eye infection) and pneumonia. See: chlamydial =neumonia Calling your health care provider Call =our health care provider if you have symptoms of chlamydia. Because many people with chlamydia may not =ave symptoms, sexually active adults should be screened periodically =or the infection. Prevention All =exually active women up through age 25 should be screened yearly for =hlamydia. All women with new sexual partners or multiple partners =hould also be screened. A =utually monogamous sexual relationship with an uninfected partner is =ne way to avoid this infection. The proper use of condoms during =ntercourse usually prevents infection. 2 EFTA_R1_00121314 EFTA01791382 References 1. U.S. =reventive Services Task Force. Screening for chlamydial infection: U.S. =reventive Services Task Force recommendation statement. Ann =ntern Med. 2007;147:128.134. [PubMed] 2. Stamm WE, Batteiger =E. Chlamydiatrachomatis (trachoma, perinatal infections, =ymphogranuloma venereum, and other genital infections). In: Mandell GI., =ennett JE, Dolin R, eds. Principles and =ractice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier =hurchill Livingstone; 2009:chap 180. Review Date: =/7/2010. Reviewed by: Linda J. =orvick, MD, Medical Director, MEDEX Northwest Division of Physician =ssistant Studies, University of Washington, School of Medicine; Susan =torck, MD, FACOG, Chief, Eastside Department of Obstetrics and =ynecology, Group Health Cooperative of Puget Sound, Redmond, =ashington; Clinical Teaching Faculty, Department of Obstetrics and =ynecology, University of Washington School of Medicine. Also reviewed =y David Zieve, MD, MHA, Medical Director, A.D.A.M., =nc. A.D.A.M., =isclaimer Copyright © 2011, A.D.A.M., Inc. What works? Interventions for treating genital chlamydia trachomatis =nfection in pregnancyChlamydia is a sexually transmitted infection which, if a mother has =t during pregnancy and labour, can cause eye or lung infections in the =ewborn baby. The risk of transmission during birth varies, but is about =0% to 50% for eye infections and about 10% to 20% for infection of the =ungs. Mothers may also be at increased risk of infection of the uterus. =he review looked at various antibiotics being used during pregnancy to =educe these problems and to assess any adverse effects. Tetracyclines =aken in pregnancy are known to be associated with teeth and bone =bnormalities in babies, and some women find erythromycin unpleasant to =ake because of feeling sick and vomiting. The review found eleven =rials, involving 1449 women, on erythromycin, amoxycillin, azithromycin =nd clindamycin, and the overall trial quality was good. However, all =he trials assessed 'microbiological cure' (that is they looked for an =radication of the infection) and none assessed whether the eye or lung =roblems for the baby were reduced. Also, none of the trials were large =nough to assess potential adverse outcomes adequately. The review found =moxycillin was an effective alternative to erythromycin but lack of =ong-term assessment of outcomes caused concern about its =outine use in practice. If erythromycin is used, some women may stop =aking it because of adverse effects. Azithromycin and clindamycin are =otential alternatives. More research is needed. See =11 (12)... Figures Drugs of interest 3 EFTA_R1_00121315 EFTA01791383 Azithromycin Azithromycin is used to treat certain infections caused by =acteria, such as bronchitis; pneumonia; sexually transmitted diseases =STD); and infections of the ears, lungs, skin, and throat. Azithromycin =s in a class of medications called macrolide antibiotics. It works by =topping the growth of bacteria. Antibiotics will not work for colds, =lu, or other viral infections. • Erythromycin Erythromycin is an antibiotic used to treat certain infections =aused by bacteria, such as bronchitis; diphtheria; Legionnaires' =isease; pertussis (whooping cough); pneumonia; rheumatic fever; =enereal disease (VD); and ear, intestine, lung, urinary tract, and skin =nfections. It is also used before some surgery or dental work to =revent infection. Antibiotics will not work for colds, flu, or other =iral infections. This medication is sometimes prescribed for other =ses; ask your doctor or pharmacist for more information. ` Doxycycline Doxycycline is used to treat bacterial infections, including =neumonia and other respiratory tract infections; Lyme disease; acne; =nfections of skin, genital, and urinary systems; and anthrax (after =nhalational exposure). It is also used to prevent malaria. Doxycycline =s in a class of medications called tetracycline antibiotics. It works =y preventing the growth and spread of bacteria. Antibiotics will not =ork for colds, flu, or other viral infections. • Levofloxacin Levofloxacin is used to treat certain infections such as =neumonia chronic bronchitis and sinus, urinary tract, kidney, prostate =a male reproductive gland), and skin infections. Levofloxacin is also =sed to prevent anthrax (a serious infection that may be spread on =urpose as part of a bioterror attack) in people who may have been =xposed to anthrax germs in the air. Levofloxacin is in a class of =ntibiotics called fluoroquinolones. It works by killing bacteria that =ause infections. Antibiotics will not work for colds, flu, or other =iral infections. • Clarithromycin Clarithromycin is used to treat certain infections caused by =acteria, such as pneumonia (a lung infection), bronchitis (infection of =he tubes leading to the lungs), and infections of the ears, sinuses, =kin, and throat. It also is used to treat and prevent disseminated =ycobacterium avium complex (MAC) infection (a type of lung infection =hat often affects people with human immunodeficiency virus (HIV)]. It =s used in combination with other medications to eliminate H. pylori, a =acteria that causes ulcers. Clarithromycin is in a class of medications =alled macrolide antibiotics. It works by stopping the growth of =acteria. Antibiotics will not work for colds, flu, or other viral =nfections. See =11... Read More ` Penis <http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002279/> • Epididymitis • Orchitis * Chlamydia infections in women • Pelvic inflammatory disease (PID) <http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000888/> * Infertility <http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001191/> * Ectopic pregnancy • Conjunctivitis <http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001010/> • Psittacosis <http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000088/> Chlamydia Infections MedlinePlus.gov links to free, =eliable, up-to-date health information from the National Institutes of =ealth (NIH) and other trusted health =rganizations. 4 EFTA_R1_00121316 EFTA01791384 Recent activity ClearTurn Off Chlamydia Chlamydia PubMed Health See =ore... NIHUSA.gov PubMed Health Home I About PubMed Health I Copyright I Disclaimer I Contact Us NCBI <http://www.ncbi.nlm.nih.govh National Center for =iotechnology Information, U.S. National Library of =edicine8600 Rockville Pike, Bethesda 20894 USA In partnership =ith: AHRQ: Agency for Healthcare Research and Quality <http://www.ahrq.govi> The Cochrane Collaboration chttp://www.cochrane.org/> IQWIG: German Institute for Quality and Efficiency in =ealth Care <https://www.ic.vig.de/index.2.en.html> OHSU: Oregon Health & Science University <http://www.ohsu.edu/> VA: Veterans Health Administration <http://www.research.va.gov/> ASHP: The American Society of Health-System =harmacists <http://www.ashp.org/> 5 EFTA_R1_00121317 EFTA01791385