Treatment efficacy and safety of chlamydial infection in gynecologic diseases

Background: Chlamydia trachomatis is known to be the causative microorganism of multiple gynecologic diseases such as pelvic inflammatory disease (PID), tubo-ovarian abscess (T-O abscess), and Fitz-Hugh-Curtis syndrome (FHC syndrome). Due to its ability to destruct the celial lining of the fallopian tube and thereby obstructing the passage of the sperm and the egg, chlamydial infection may also result in female infertility. Therefore adequate care of the chlamydial infection is strongly advocated and the currently used treatment of choice is antibiotic coverage such as azithromycin or doxycycline.Methods: Medical records of the 50 patients who had been admitted to the department of Obstetrics and Gynecology, Ilsan hospital from May 2013 to May 2014, under the diagnosis of pelvic inflammatory disease, tubo-ovarian abscess, and Fitz-Hugh-Curtis syndrome with the confirmatory chlamydia trachomatis PCR positive result were taken into account. Patient’s characteristics, complications of the treatment, follow up results were analyzed.Results: Of the 37 patients given azithromycin 1000mg, 7 vomited completely (18.9%) requiring doxycycline to cover up. None of the patients taking doxycycline developed vomiting requiring second line of treatment. All of the patients were followed up in the outpatient clinic 4 weeks after being discharged from the hospital. 16.7% of the azithromycin taking group and 15.0% of the doxycycline taking group showed positive PCR result which showed no statistical significance.Conclusions: The advised 1000mg azithromycin single dosage to cover chlamydial infection is a convenient way of taking the medication, but as gastro-intestinal discomfort may follow, patients with a tendency to develop the complications should be advised to take doxycycline instead. Further research should focus on the test of cure evaluation method to differentiate reinfection from persisting disease