THE OFFICIAL PATIENT’S SOURCEBOOK
on
HLAMYDIA
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
ii
ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Chlamydia: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83291-9 1. Chlamydia-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of chlamydia.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to chlamydia. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to chlamydia, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Bacterial STDs
·
The Official Patient's Sourcebook on Bacterial Vaginosis
·
The Official Patient's Sourcebook on Genital Herpes
·
The Official Patient's Sourcebook on Genital HPV Infection
·
The Official Patient's Sourcebook on Gonorrhea
·
The Official Patient's Sourcebook on Pelvic Inflammatory Disease
·
The Official Patient's Sourcebook on STDs and Pregnancy
·
The Official Patient's Sourcebook on Syphilis
·
The Official Patient's Sourcebook on Tuberculosis
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION...................................................................................... 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 4 PART I: THE ESSENTIALS ............................................................................................................. 7
CHAPTER 1. THE ESSENTIALS ON CHLAMYDIA: GUIDELINES .............. 9 Overview ....................................................................................................................................... 9 What Is Chlamydia? .................................................................................................................... 10 How Do People Get Chlamydia? ................................................................................................. 11 How Common Is Chlamydia? ..................................................................................................... 11 What Are the Symptoms of Chlamydia? ..................................................................................... 11 How Soon after Exposure Do Symptoms Appear?...................................................................... 12 How Is Chlamydia Diagnosed? ................................................................................................... 12 Who Is at Risk for Chlamydia?.................................................................................................... 12 What Is the Treatment for Chlamydia? ....................................................................................... 12 What Complications Can Result from Untreated Chlamydia? ................................................... 12 How Can Chlamydia Be Prevented? ........................................................................................... 13 For More Information.................................................................................................................. 14 More Guideline Sources .............................................................................................................. 15 Vocabulary Builder...................................................................................................................... 21
CHAPTER 2. SEEKING GUIDANCE ....................................................... 25 Overview ..................................................................................................................................... 25 Associations and Chlamydia........................................................................................................ 25 Finding More Associations ......................................................................................................... 27 Finding Doctors........................................................................................................................... 28 Selecting Your Doctor ................................................................................................................. 30 Working with Your Doctor ......................................................................................................... 30 Broader Health-Related Resources .............................................................................................. 32
CHAPTER 3. CLINICAL TRIALS AND CHLAMYDIA .............................. 33 Overview ..................................................................................................................................... 33 Recent Trials on Chlamydia ........................................................................................................ 36 Benefits and Risks........................................................................................................................ 37 Keeping Current on Clinical Trials ............................................................................................. 40 General References....................................................................................................................... 41 Vocabulary Builder...................................................................................................................... 42 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 45
CHAPTER 4. STUDIES ON CHLAMYDIA................................................ 47 Overview ..................................................................................................................................... 47 The Combined Health Information Database .............................................................................. 47 Federally-Funded Research on Chlamydia .................................................................................. 50 E-Journals: PubMed Central ....................................................................................................... 61 The National Library of Medicine: PubMed................................................................................ 70 Vocabulary Builder...................................................................................................................... 71
CHAPTER 5. PATENTS ON CHLAMYDIA .............................................. 79 Overview ..................................................................................................................................... 79
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Patents on Chlamydia.................................................................................................................. 80 Patent Applications on Chlamydia.............................................................................................. 86 Keeping Current .......................................................................................................................... 89 Vocabulary Builder...................................................................................................................... 90
CHAPTER 6. BOOKS ON CHLAMYDIA .................................................. 93 Overview ..................................................................................................................................... 93 Book Summaries: Federal Agencies ............................................................................................. 93 Book Summaries: Online Booksellers ........................................................................................ 100 The National Library of Medicine Book Index........................................................................... 102 Chapters on Chlamydia ............................................................................................................. 105 General Home References .......................................................................................................... 108 Vocabulary Builder.................................................................................................................... 109
CHAPTER 7. MULTIMEDIA ON CHLAMYDIA ..................................... 113 Overview ................................................................................................................................... 113 Video Recordings....................................................................................................................... 113 Audio Recordings ...................................................................................................................... 119 Bibliography: Multimedia on Chlamydia .................................................................................. 120 Vocabulary Builder.................................................................................................................... 121
CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES ................... 123 Overview ................................................................................................................................... 123 NIH Guidelines ......................................................................................................................... 123 NIH Databases .......................................................................................................................... 124 Other Commercial Databases .................................................................................................... 135 The Genome Project and Chlamydia ......................................................................................... 136 Specialized References ............................................................................................................... 140 Vocabulary Builder.................................................................................................................... 141
CHAPTER 9. DISSERTATIONS ON CHLAMYDIA ................................. 143 Overview ................................................................................................................................... 143 Dissertations on Chlamydia ...................................................................................................... 143 Keeping Current ........................................................................................................................ 144 Vocabulary Builder.................................................................................................................... 145 PART III. APPENDICES .............................................................................................................. 147
APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 149 Overview ................................................................................................................................... 149 Your Medications: The Basics ................................................................................................... 150 Learning More about Your Medications ................................................................................... 151 Commercial Databases............................................................................................................... 153 Contraindications and Interactions (Hidden Dangers)............................................................. 155 A Final Warning ....................................................................................................................... 155 General References..................................................................................................................... 156 Vocabulary Builder.................................................................................................................... 157
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 159 Overview ................................................................................................................................... 159 What Is CAM? .......................................................................................................................... 159 What Are the Domains of Alternative Medicine? ..................................................................... 160 Can Alternatives Affect My Treatment?................................................................................... 163 Finding CAM References on Chlamydia................................................................................... 164 Additional Web Resources......................................................................................................... 171 General References..................................................................................................................... 174 Vocabulary Builder.................................................................................................................... 175
Contents
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APPENDIX C. RESEARCHING NUTRITION ......................................... 177 Overview ................................................................................................................................... 177 Food and Nutrition: General Principles .................................................................................... 178 Finding Studies on Chlamydia .................................................................................................. 182 Federal Resources on Nutrition................................................................................................. 185 Additional Web Resources......................................................................................................... 185 Vocabulary Builder.................................................................................................................... 186
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 189
Overview ................................................................................................................................... 189 Preparation ................................................................................................................................ 189 Finding a Local Medical Library ............................................................................................... 190 Medical Libraries Open to the Public ........................................................................................ 190
APPENDIX E. MORE ON CHLAMYDIA ............................................... 197 Overview ................................................................................................................................... 197 What Is the Magnitude of the Problem?.................................................................................... 198 How Are Adolescents and Young Women Affected? ................................................................ 198 What Does Chlamydia Cost?..................................................................................................... 199 What Is Being Done to Address the Problem? .......................................................................... 199 What Still Needs to Be Done? ................................................................................................... 200
APPENDIX F. MORE ON SEXUALLY TRANSMITTED DISEASES .......... 201 Overview ................................................................................................................................... 201 What Can You Do to Prevent STDs? ....................................................................................... 205 Research..................................................................................................................................... 206 Vocabulary Builder.................................................................................................................... 207
APPENDIX G. STDS AND PREGNANCY ............................................. 209 Overview ................................................................................................................................... 209 How Can STDs Affect a Woman during Pregnancy? .............................................................. 209 How Can a Pregnant Woman’s Baby Become Infected? ........................................................... 210 How Can STDs Affect the Fetus or Newborn? ......................................................................... 210 How Common Are STDs Among Pregnant Women in the U.S.? ............................................ 210 Should Pregnant Women Be Tested for STDs? ........................................................................ 211 Can STDs Be Treated during Pregnancy?................................................................................ 211 How Can Pregnant Women Protect Themselves against Infection?......................................... 211 Where Can I Get More Information? ........................................................................................ 212 Vocabulary Builder.................................................................................................................... 212 ONLINE GLOSSARIES ............................................................................................................... 213 Online Dictionary Directories................................................................................................... 217 CHLAMYDIA GLOSSARY ......................................................................................................... 219 General Dictionaries and Glossaries ......................................................................................... 238 INDEX.............................................................................................................................................. 240
Introduction
1
INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Chlamydia
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Chlamydia has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to chlamydia, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on chlamydia. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on chlamydia should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching chlamydia (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to chlamydia. It also gives you sources of information that can help you find a doctor in your local area specializing in treating chlamydia. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with chlamydia. Part II moves on to advanced research dedicated to chlamydia. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on chlamydia. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with chlamydia or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with chlamydia. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with chlamydia.
Scope While this sourcebook covers chlamydia, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that chlamydia is often considered a synonym or a condition closely related to the following: ·
Cervical Inflammation
·
Chlamydia Trachomatis
·
Ectocervicitis
4
Chlamydia
·
Endocervicitis
·
Inflammation - Cervix
·
Mucopurulent Cervicitis
In addition to synonyms and related conditions, physicians may refer to chlamydia using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for chlamydia:4 ·
079.8 chlamydia infection
·
098.15 acute gonococcal cervicitis
·
381.51 acute salpingitis
·
597.80 urethritis
·
604.0 epididymitis
·
616.0 cervicitis
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to chlamydia. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful.
4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with chlamydia will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with chlamydia is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of chlamydia, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
7
PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on chlamydia. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of chlamydia to you or even given you a pamphlet or brochure describing chlamydia. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
CHAPTER 1. GUIDELINES
THE
ESSENTIALS
ON
9
CHLAMYDIA:
Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on chlamydia. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on chlamydia can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on chlamydia. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with chlamydia and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
·
Centers for Disease Control and Prevention: various fact sheets on infectious diseases at http://www.cdc.gov/health/diseases.htm
Among the above, the National Institute of Allergy and Infectious Diseases (NIAID) is particularly noteworthy. The mission of the NIAID is to provide support for scientists conducting research aimed at developing better ways to diagnose, treat, and prevent the many infectious, immunologic and allergic diseases that afflict people worldwide.6 The NIAID is composed of four extramural divisions: the Division of AIDS; the Division of Allergy, Immunology and Transplantation; the Division of Microbiology and Infectious Diseases; and the Division of Extramural Activities. In addition, NIAID scientists conduct intramural research in laboratories located in Bethesda, Rockville and Frederick, Maryland, and in Hamilton, Montana. The following patient guideline was recently published by the NIAID on chlamydia.
What Is Chlamydia?7 Chlamydia is a common sexually transmitted disease (STD) caused by Chlamydia trachomatis, a bacterium, which can damage a woman’s reproductive organs. Because symptoms of chlamydia are mild or absent, 6 This paragraph has been adapted from the NIAID: http://www.niaid.nih.gov/facts/overview.htm. “Adapted” signifies that a passage has been reproduced exactly or slightly edited for this book. 7 Adapted from the Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/nchstp/dstd/Fact_Sheets/FactsChlamydiaInfo.htm.
Guidelines 11
serious complications that cause irreversible damage, including infertility, can occur “silently” before a woman ever recognizes a problem.
How Do People Get Chlamydia? Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her newborn during vaginal childbirth.
How Common Is Chlamydia? Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States. More than 650,000 cases were reported in 1999, and three of every four reported cases occurred in persons under age 25. Under-reporting is substantial because most people with chlamydia are not aware of their infections and do not seek testing. An estimated 3 million Americans are infected with chlamydia each year. Chlamydia is so common in young women that, by age 30, 50% of sexually active women have evidence that they have had chlamydia at some time during their lives.
What Are the Symptoms of Chlamydia? Chlamydia is known as a “silent” disease because three quarters of infected women and half of infected men have no symptoms. The infection is frequently not diagnosed or treated until complications develop. In women, the bacteria initially attack the cervix (opening to the uterus) and the urethra (urine canal). The few women with symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. When the infection spreads from the cervix to the fallopian tubes, some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, and bleeding between menstrual periods. Whenever the infection spreads past the cervix into the upper reproductive system, permanent and irreversible damage can occur. Men with signs or symptoms might have a discharge from the penis and a burning sensation when urinating. Men might also have burning and itching around the opening of the penis or pain and swelling in the testicles, or both.
12 Chlamydia
How Soon after Exposure Do Symptoms Appear? If symptoms do occur, they usually appear within 1 to 3 weeks of exposure.
How Is Chlamydia Diagnosed? There are two kinds of laboratory tests to diagnose chlamydia. One involves collecting a specimen from an infected site (cervix or penis) to detect the bacterium directly. Another test that is becoming widely available can accurately detect chlamydia bacteria in a urine sample. A Pap test is not a test for chlamydia; it is a test for abnormal cervical cells.
Who Is at Risk for Chlamydia? Sexually active men and women can be exposed to chlamydia bacteria during sexual contact with an infected person. The more sex partners a person has, the greater the risk of chlamydia infection. Babies are at risk of acquiring a chlamydial infection from their infected mother. Sexually active teenagers and young women are especially susceptible to chlamydia bacteria because of the characteristics of the cells that form the lining of the cervical canal.
What Is the Treatment for Chlamydia? Chlamydia can be easily treated and cured with antibiotics. A single dose of azithromycin or a week of doxycycline (twice daily) are the most commonly used treatments. All sex partners must also be treated.
What Complications Can Result from Untreated Chlamydia? If untreated, chlamydia infection can progress to serious reproductive and other health problems with both short-term and long-term consequences. Like the disease itself, the damage that chlamydia causes is often “silent.”
Guidelines 13
Untreated chlamydia in men typically causes urethral infection. Infection sometimes spreads to the epididymis (a tube that carries sperm from the testis), causing pain, fever, and, potentially, infertility. In women, the chlamydia bacteria often infect the cells of the cervix. If not treated, the infection can spread into the uterus or fallopian tubes (egg canals) and cause an infection called pelvic inflammatory disease (PID). This happens in up to 40% of women with untreated chlamydia. PID can cause permanent damage to the fallopian tubes, uterus, and tissues surrounding the ovaries. This damage can lead to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy (pregnancy outside the uterus). In pregnant women, there is some evidence that chlamydia infections can lead to premature delivery. Babies who are born when their mothers are infected can get chlamydial infections in their eyes and respiratory tracts. Chlamydia is a leading cause of early infant pneumonia and conjunctivitis (pinkeye) in newborns. Compared to women who do not have chlamydia, women infected with chlamydia may also have higher risk of acquiring HIV infection from an infected partner. Chlamydia can cause proctitis (an infection of the lining of the rectum) in persons having receptive anal intercourse. The bacterium also can be found in the throats of women and men having oral sex with an infected male partner.
How Can Chlamydia Be Prevented? Safe sexual behavior and seeking proper health care can help keep people from becoming infected or re-infected with chlamydia and from experiencing chlamydia complications. ·
Use condoms correctly every time you have sex. Persons who engage in sexual behaviors that can place them at risk for STDs should use latex or polyurethane condoms every time they have sex. A condom put on the penis before starting sex and worn until the penis is withdrawn can help protect both the male and the female partner from chlamydia. When a male condom cannot be used appropriately, sex partners should consider using a female condom Common methods of birth control, like the oral contraceptive pill or the contraceptive shot or implant, do not give women protection from STDs. Women who use these methods should also use condoms every time they have sex to prevent STDs.
14 Chlamydia
Condoms do not provide complete protection from all STDs. Sores and lesions of other STDs on infected men and women may be present in areas not covered by the condom, resulting in transmission of infection to a new person. ·
Limit the number of sex partners, and do not go back and forth between partners. Practice sexual abstinence, or limit sexual contact to one uninfected partner.
·
Get a screening test. If you are young, sexually active, and do not use condoms correctly every time you have sex, you should be screened for chlamydia at least once a year. It has been shown that screening and treatment of women with chlamydia infection of the cervix reduces the likelihood of PID. All pregnant women should have a screening test for chlamydia.
If you think you are infected, avoid sexual contact, and see a health care provider immediately. Any genital signs or symptoms such as discharge or burning during urination or an unusual sore or rash should be a signal to stop having sex and to consult a health care provider immediately. If you are told you are infected, notify all your sex partners immediately. If you are told you have chlamydia or any other STD and receive drug treatment, you should notify all of your recent sex partners so that they can see a health care provider and be treated. A sex partner needs treatment even if (s)he has no symptoms. This will reduce the risk that your partners will develop serious complications from chlamydia and reduce your risk of becoming re-infected. Do not have sex until both you and your sex partner complete your chlamydia drug treatment.
For More Information For more information, contact: American Social Health Association P. O. Box 13827 Research Triangle Park, NC 27709-3827 1-800-783-9877 www.ashastd.org
Guidelines 15
CDC NPIN P.O. Box 6003 Rockville, MD 20849-6003 1-800-458-5231 1-888-282-7681 Fax 1-800-243-7012 TTY www.cdcnpin.org/
[email protected] DSTD Web address www.cdc.gov/std/ CDC National STD Hotline (800) 227-8922 or (800) 342-2437 En Espanol (800) 344-7432 TTY for the Deaf and Hard of Hearing (800) 243-7889 National HPV and Cervical Cancer Hotline (919) 361 - 4848 Resource Center www.ashastd.org/hpvccrc/ National Herpes Hotline (919) 361-8488
More Guideline Sources The guideline above on chlamydia is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to chlamydia. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with chlamydia. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this
16 Chlamydia
Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on chlamydia and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
What is It Going to Cost You? Chlamydia Contact: Health Edco, Division of WRS Group, Inc., PO Box 21207, Waco, TX, 76702-1207, (254) 776-6461. Summary: This brochure, written for adolescents, discusses the sexually transmitted disease (STD), chlamydia. The following topics are discussed: (1) diagnosis; (2) symptoms; (3) transmission (e.g., unprotected oral, vaginal, or anal sex with an infected person); (4) treatment with antibiotics; (5) prevention measures such as practicing sexual abstinence, monogamy, and safer sex with condoms and maintaining a healthy diet and lifestyle; and (6) the financial costs of chlamydia. The long-term effects for women with untreated chlamydia are pelvic inflammatory disease (PID), which can cause scarring in the fallopian tubes or tubal pregnancies, and if passed perinatally, blindness; can cause eye infections, or pneumonia in infants. In men, untreated chlamydia may
Guidelines 17
lead to the development of epididymitis, an inflammation of the testicles that can cause sterility. ·
Chlamydia Contact: Medical Institute for Sexual Health, PO Box 162306, Austin, TX, 78716-2306, (512) 328-6268, http://www.medinstitute.org. Summary: This brochure, for adolescents and young adults, discusses the sexually transmitted disease (STD), chlamydia; the most common STD in humans. The brochure discusses the epidemiology of chlamydia in the United States (US). Chlamydia is primarily transmitted through unprotected sexual activity and can be passed from a pregnant mother to her infant. Typical symptoms include vaginal or urethral discharge, pelvic pain in women, burning urination, swelling and tenderness of the scrotum in men, and sometimes genital ulcers; however, chlamydia is often an asymptomatic infection. This STD can be diagnosed with a visual examination or urine testing. The various available treatments for chlamydia are presented. Some of the possible long-term effects of chlamydia if left untreated include pelvic inflammatory disease, infertility, or ectopic pregnancy. Individuals can prevent genital herpes by practicing sexual abstinence until marriage, since condoms only provide partial protection.
·
What Everyone Should Know About STDs And Pregnancy Source: South Deerfield, MA: Channing L. Bete Company, Inc. 1992. 8 p. Contact: Available from Channing L. Bete Company, Inc. 200 State Road, South Deerfield, MA 01373. (800) 628-7733. Price: $1 each for 1-24 copies, $0.78 each for 25-99 copies. Order Number 38141. Summary: This brochure, written in simple, easy-to-understand language, presents an overview of sexually-transmitted diseases (STDs) and their effects on pregnancy. Diseases discussed include syphilis, gonorrhea, chlamydia, herpes, AIDS, hepatitis B, and genital warts. Topics covered include the importance of prevention; the effects of STDs on babies before, during and after birth; the symptoms of STDs; the role of the health care provider; and guidelines for staying healthy during pregnancy. The concepts presented are illustrated with simple cartoon figures and charts.
·
Facts About STDs Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Allergy and
18 Chlamydia
Infectious Diseases, 31 Center Dr MSC 2520, Bethesda, MD, 20892-2520, (301) 496-5717, http://www.niaid.nih.gov. Summary: This information package provides basic facts about sexually transmitted diseases (STDs), ways in which they are spread, their common symptoms, and how they can be treated. The package contains an introduction to STDs and a series of fact sheets on the following: chlamydia, genital herpes, gonorrhea, hepatitis, HIV/AIDS, human papillomavirus and genital warts, pelvic inflammatory disease, syphilis, and vaginal infections. Most fact sheets present information on diagnosis, complications, prevention, and research. Also included is a sheet on other important STDs such as chancroid, granuloma inguinale, group B streptococcal infections, molluscum contagiosum, and human T-cell lymphotropic virus. ·
Situation Sex and STDs Contact: Health Impact, PO Box 9443, Seattle, WA, 98109-9443, (206) 2843865, http://www.healthimpact.org/. Summary: This videotape is designed to serve as a trigger tape to stimulate discussion among older, sexually active adolescents about sexually transmitted diseases (STDs) and HIV. The accompanying facilitator's guide provides information on conducting the intervention, leading the discussion, and offering suggestions and factual information to the discussion group. The dramatic scenario on the tape is a realistic portrayal of a budding heterosexual relationship and the difficulties the individuals encounter by engaging in unprotected, unplanned sexual intercourse. It examines the role of alcohol consumption in risk-taking behavior. Heather and Justin are seen as college freshman who meet, attend a party, and have unplanned intercourse. Justin later discovers he has chlamydia and must now tell Heather. The tape illustrates the vulnerability of young adults, and intends to provide the motivation to change behavior. The National Guideline Clearinghouse™
The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “chlamydia” or synonyms. The following was recently posted:
Guidelines 19
·
2002 national guideline for the management of Chlamydia trachomatis genital tract infection. Source: Association for Genitourinary Medicine/Medical Society for the Study of Venereal Diseases.; 1999 August (revised 2002); Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2255&sSearch_string=chlamydia
·
Management of genital Chlamydia trachomatis infection. A national clinical guideline. Source: Scottish Intercollegiate Guidelines Network.; 2000 March; 26 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1530&sSearch_string=chlamydia
·
Screening for chlamydial infection: recommendations and rationale. Source: United States Preventive Services Task Force.; 2001; 5 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1886&sSearch_string=chlamydia
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Chlamydial Infection Summary: This booklet describes the symptoms of chlamydial infection in both men and women, diagnosis, treatment, and prevention. Source: National Institute of Allergy and Infectious Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=67
20 Chlamydia
·
Chlamydia's Quick Cure Summary: This online article provides an overview of Chlaymidia, a sexually transmitted disease that often presents with no syptoms. Source: Office of Consumer Affairs, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=4760
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to chlamydia. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. NORD (The National Organization of Rare Disorders, Inc.) NORD provides an invaluable service to the public by publishing, for a nominal fee, short yet comprehensive guidelines on over 1,000 diseases. NORD primarily focuses on rare diseases that might not be covered by the previously listed sources. NORD’s Web address is www.rarediseases.org. To see if a recent fact sheet has been published on chlamydia, simply go to the following hyperlink: http://www.rarediseases.org/cgibin/nord/alphalist. A complete guide on chlamydia can be purchased from NORD for a nominal fee.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
Guidelines 21
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Blindness: The inability to see or the loss or absence of perception of visual stimuli. This condition may be the result of eye diseases; optic nerve diseases; optic chiasm diseases; or brain diseases affecting the visual pathways or occipital lobe. [NIH] Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Chancroid: Acute, localized autoinoculable infectious disease usually acquired through sexual contact. Caused by haemophilus ducreyi, it occurs endemically almost worldwide, especially in tropical and subtropical countries and more commonly in seaports and urban areas than in rural areas. [NIH] Chlamydia: A genus of the family chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine.
22 Chlamydia
Chlamydia species are gram-negative and produce glycogen. The type species is chlamydia trachomatis. [NIH] Chronic: Persisting over a long period of time. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [EU] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Fatal: Causing death, deadly; mortal; lethal. [EU] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Hepatitis: Inflammation of the liver. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae,
Guidelines 23
archaea, and viruses. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Papillomavirus: A genus of papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH]
Penis: The male organ of copulation and of urinary excretion, comprising a root, body, and extremity, or glans penis. The root is attached to the descending portions of the pubic bone by the crura, the latter being the extremities of the corpora cavernosa, and beneath them the corpus spongiosum, through which the urethra passes. The glans is covered with mucous membrane and ensheathed by the prepuce, or foreskin. The penis is homologous with the clitoris in the female. [EU] Proctitis: Inflammation of the rectum. [EU] Sterility: 1. the inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. the state of being aseptic, or free from microorganisms. [EU] Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Uterus: The hollow muscular organ in female mammals in which the fertilized ovum normally becomes embedded and in which the developing embryo and fetus is nourished. In the nongravid human, it is a pear-shaped structure; about 3 inches in length, consisting of a body, fundus, isthmus, and cervix. Its cavity opens into the vagina below, and into the uterine tube on either side at the cornu. It is supported by direct attachment to the vagina and by indirect attachment to various other nearby pelvic structures. Called also metra. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]
Seeking Guidance 25
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with chlamydia. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with chlamydia. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Chlamydia As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
26 Chlamydia
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Social Health Association Address: American Social Health Association P.O. Box 13827, Research Triangle Park, NC 27709 Telephone: (919) 361-8400 Fax: (919) 361-8425 Email:
[email protected] Web Site: http://www.ashastd.or Background: The American Social Health Association (ASHA) is a notfor-profit voluntary organization dedicated to stopping sexually transmitted diseases (STDs) and their harmful consequences to individuals, families, and communities. Established in 1914, ASHA provides direct patient support through the Herpes Resource Center/National Herpes Hotline and the HPV Support Group, which coordinate a network of over 100 local support groups and publish quarterly journals. ASHA also operates the National AIDS Hotline and the National STD Hotline, both under contract with the Centers for Disease Control and Prevention (CDC), as well as the FIRST STEP Hotline and Health Check Hotline, components of North Carolina's effort to improve the health and development of children in the state. In addition, ASHA advocates for increased funding for STD programs and public policies on STD control, working through its office in Washington D.C.; provides leadership for the National Coalition to Fight Sexually Transmitted Diseases; and operates the Women's Health Matters program. The organization also administers the ASHA Research Fund, the only privately funded training program for STD research. ASHA's materials include an annual report, quarterly catalog, and pamphlets. ASHA also maintains a web site at http://sunsite.unc.edu/ASHA/. Relevant area(s) of interest: Chlamydia, Gonorrhea
Seeking Guidance 27
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about chlamydia. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “chlamydia” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “chlamydia”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “chlamydia” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with chlamydia. You should check back periodically with this database since it is updated every 3 months.
28 Chlamydia
The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “chlamydia” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with chlamydia must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 29
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at http://www.abms.org/newsearch.asp.11 You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 11
30 Chlamydia
Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about chlamydia?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for chlamydia?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
12 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 13 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 31
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
32 Chlamydia
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
Clinical Trials 33
CHAPTER 3. CLINICAL TRIALS AND CHLAMYDIA Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning chlamydia.
What Is a Clinical Trial?15 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for chlamydia is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
15
34 Chlamydia
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
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Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on chlamydia.
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Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for chlamydia compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment.
How Is a Clinical Trial Conducted? Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on chlamydia carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on chlamydia. In other clinical trials, where a new surgery or device (not a medicine) is being
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tested, patients in the control group may receive a “sham treatment.” This treatment, like a placebo, has no effect on chlamydia and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how chlamydia develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for chlamydia. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history.
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If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Chlamydia The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to chlamydia.16 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
Pediatrics:Chlamydia, Sickle Cell Anemia and Stroke Risk - Ancillary to STOP II Condition(s): Blood Disease; Anemia, Sickle Cell; Chlamydia infections; Cerebrovascular accident Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To establish a link among Chlamydia infection, sickle cell anemia, and stroke risk. Study Type: Epidemiology, Analysis of Clinical Trials Contact(s): Styles, Lori A. Oakland, California, United States . Study chairs or principal investigators: Styles, Lori A., Study Chair; Children's Hospital, Oakland Oakland, California, United States
16
These are listed at www.ClinicalTrials.gov.
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00037388;jsessionid=A94449 76D48757B89954896383098270 ·
Clinical Trial of Eye Prophylaxis in the Newborn Condition(s): Chlamydia Infections; Ophthalmia Neonatorum Study Status: This study is completed. Sponsor(s): National Eye Institute (NEI) Purpose - Excerpt: To compare the effectiveness of silver nitrate drops, erythromycin ointment, or no medication in preventing neonatal conjunctivitis caused by Chlamydia trachomatis and other eye infections. To compare side effects of the two prophylactic agents. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000120;jsessionid=A94449 76D48757B89954896383098270
Benefits and Risks17 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for chlamydia. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
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If the treatment is effective, then it may improve health or prevent diseases or disorders.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 17
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with chlamydia. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient. What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.
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What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
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Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care.
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What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for chlamydia? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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Will taking part in the study affect my daily life? Do I have time to participate?
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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with
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most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “chlamydia” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/
General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
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·
The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]
Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to
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50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Herpesviridae: A family of enveloped, linear, double-stranded DNA viruses infecting a wide variety of animals. There are three subfamilies based on biological characteristics: alphaherpesvirinae, betaherpesvirinae, and gammaherpesvirinae. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Prophylaxis: The prevention of disease; preventive treatment. [EU] Thromboembolism: Obstruction of a blood vessel with thrombotic material carried by the blood stream from the site of origin to plug another vessel. [EU]
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on chlamydia. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on chlamydia. In Part II, as in Part I, our objective is not to interpret the latest advances on chlamydia or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with chlamydia is suggested.
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CHAPTER 4. STUDIES ON CHLAMYDIA Overview Every year, academic studies are published on chlamydia or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on chlamydia. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on chlamydia and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and chlamydia, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “chlamydia” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Urethritis and Cervicitis Source: Australian Family Physician. 28(4): 333-338. April 1999. Contact: Available from Royal Australian College of General Practitioners. 1 Palmerston Cr, South Melbourne VIC 3205. 0392141414. Fax 0392141400. E-mail:
[email protected]. Summary: With sexually transmitted diseases (STDs) no longer on the decline, it is prudent to assume that all cases of nonspecific urethritis and cervicitis are caused by sexually transmitted infection. Specific infections of the urethra and cervix due to chlamydia and other non gonococcal organisms are common and, because they are often not apparent clinically, are underdiagnosed. This article provides a realistic approach to the management of urethritis and cervicitis by encouraging the performance of investigations and the instigation of treatment at the first consultation. The author stresses that a knowledge of the patient's sexual history combined with a working knowledge of the new DNA based technologies should provide for the early assessment of and intervention with patients who are at risk of at least one STD infection. In women, urethritis and cervicitis are commonly asymptomatic but may present with dysuria (painful urination), discharge, postcoital (after sexual intercourse) bleeding, and intermenstrual bleeding. In men, symptoms are more common and may include dysuria, discharge, and urinary urgency. As up to 10 percent of cases with gonorrhea may be missed if microscopy alone forms the basis of diagnosis, a urethral swab should ideally be cultured for N. gonorrhoeae. Antimicrobial regimens (drug therapy) should cover the potential coexisting infection with chlamydia and other as yet undiagnosed non gonococcal infections. All patients at risk of one STD infection should be considered at risk of other STDs. 1 figure. 3 tables. 6 references.
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Screening asymptomatic adolescent males for chlamydia Source: Journal of Adolescent Health Care. 11(2): 141-144. March 1990.
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Summary: This article reports the results of a study on the prevalence of chlamydia urethral infection in high-risk asymptomatic adolescent males. Screening techniques for chlamydia are discussed, including enzyme immunoassay and detection of pyuria by cytometer and microscopic examination. [Funded by the Maternal and Child Health Bureau]. ·
Effect of Cigarette Smoking, Chlamydia Trachomatis Infection, and Vaginal Douching on Ectopic Pregnancy Source: Obstetrics and Gynecology. 79(1):85-90, January 1992. Summary: Health professionals conducted a case-control study of the relation between ectopic pregnancy and three exposures of interest: Cigarette smoking, previous chlamydial infection, and vaginal douching. Cases were women with surgically confirmed tubal pregnancy and controls were women with an intrauterine pregnancy. Case and control women were between the ages of 18 and 40, received gynecologic and obstetric care at the Brigham and Women's Hospital in Boston, and had a period of gestation less than or equal to 14 weeks. Participants were black, white, or Hispanic. The health professionals recruited 69 women to be cases and selected 101 unmatched controls. The women gave informed written consent, and a trained research interviewer conducted a standardized questionnaire asking information regarding (1) previous sexually transmitted infections, (2) douching history, (3) cigarette smoking, (4) contraceptive history, and (5) sociodemographic characteristics. Serologic testing gave evidence of chlamydial infection; cigarette smoking was categorized as currently smoking, not currently smoking, or formerly smoking; and douching variables included frequency of douching or no prior douching. Logistic regression models assessed and controlled for confounders. Results indicated that cases were more likely than controls to be nulliparous, nonwhite, unmarried, and having a high school education or less. Fifty-one percent of cases and 20 percent of controls reported smoking during the month of conception. Approximately 35 percent of cases and 20 percent of controls had previous chlamydial infection. Twenty-eight percent of cases and 19 percent of controls douched once or more per month. The health professionals concluded that current cigarette smoking may be associated independently with ectopic pregnancy and that smoking cessation before the month of conception may reduce this risk. For these women, previous chlamydial infection and vaginal douching did not appear to increase significantly the risk of ectopic pregnancy. 1 table, 26 references.
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Federally-Funded Research on Chlamydia The U.S. Government supports a variety of research studies relating to chlamydia and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.18 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to chlamydia and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore chlamydia and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for chlamydia: ·
Project Title: Chlamydia Genetics and Ocular Disease Principal Investigator & Institution: Kane, Colleen D.; Henry M. Jackson Fdn for the Adv Mil/Med the Advancement of Military Med Bethesda, Md 20814 Timing: Fiscal Year 2001; Project Start 1-DEC-2000 Summary: Chlamydia trachomatis is the etiologic agent of trachoma, the world s leading cause of preventable infectious blindness. Trachoma is believed to be an immunopathologic disease which results from repeated exposure to chlamydial antigens. The chlamydial 60 kDa heat shock protein (GroEL) is the primary candidate for this immunopathologic antigen, although it remains controversial whether immune responses to Chlamydia-specific or highly conserved regions of GroEL lead to pathology. Moreover, it is unclear whether other chlamydial antigens contribute to immunopathology. This project will use a novel genetic approach to test the hypothesis that GroEL is responsible for the pathology of trachoma by identifying GroEl epitopes which elicit
18 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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hypersensitivity in an animal model of ocular infection. This analysis will be extended to the study of recombinant chlamydiae expressing defined GroEL epitopes in the context of the whole organism. The long-term goals of this project include defining pathologic or protective GroEL epitopes to be excluded/included in a recombinant trachoma vaccine strain of Chlamydia. Perhaps more importantly, a reproducible system of gene replacement in Chlamydia will be developed and can be applied to the study of other chlamydial genes, providing unique insights into their function. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Chlamydial Evasion of IFN Mediated Immunity Principal Investigator & Institution: Carlin, Joseph M.; Microbiology; Miami University Oxford Oxford, Oh 45056 Timing: Fiscal Year 2001; Project Start 1-JUN-2001; Project End 0-APR2005 Summary: (Adapted from the Applicant's Abstract): This proposal is in response to the program announcement 'Research on molecular immunology of STDs (ROMIS).' Interferon (IFN)-y induces an effective antichlamydial mechanism in vitro by inducing indoleamine 2,3dioxygenase (IDO) which depletes tryptophan that is essential for chlamydial growth. Although proinflammatory cytokines produced during infection enhance the amount of IDO induced by IFN, the presence of chronic disease suggests that Chlamydia is evading this response. The goals of this research project are to identify and characterize mechanisms by which Chlamydia evades the effect of IFN. Chlamydia may be affecting IDO regulation directly by interfering with transcriptional activation of the IDO gene by IFNS, or by blocking the effect of proinflammatory cytokines. Chlamydia also may be regulating IDO indirectly by stimulating production of interieukin-10 (IL-10) leading to inhibition of IDO transcription. Specific aim 1: Molecular mechanisms of IDO potentiation. IDO regulatory mechanisms will be evaluated using HeLa cells transfected with a green fluorescent protein reporter vector containing the IDO promoter. Identification of IDO promoter regions and DNA-binding proteins will be by DNase I footprinting, EMSA, and super-shift assays. Site-directed mutagenesis will be used to confirm promoter site function. Specific aim 2: Direct mechanisms of evasion. The effect of Chlamydia on IDO promoter activity and cytokine receptor expression will be assessed using twocolor flow cytometric analysis of infected HeLa cells. Specific aim 3: Indirect mechanisms of evasion. The role of IL-10 in inhibition of IDO will be assessed by quantifying IL-10 production by Chlamydia-exposed
52 Chlamydia
cells using ELISA, assessing the effect of IL-10 on proinflammatory cytokine production by Chlamydia-exposed cells and by measuring the effect of IL-10 on IDO regulation using the fluorescent IDO promoter reporter. Thus, the aims are to dissect the process of IDO potentiation at the transcriptional level, and to assess the means by which Chlamydia interferes with this process. Accomplishment of the aims will help resolve the long- term objectives of this research project: to determine how Chlamydia evades an otherwise effective immunological response, and to understand regulation of this response in order to overcome Chlamydia's evasive mechanisms. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Cytotoxic T-Cell Mediated Immunity to Chlamydia Principal Investigator & Institution: Starnbach, Michael N.; Assistant Professor; Microbiol & Molecular Genetics; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2001; Project Start 1-JUL-1996; Project End 1-MAY2006 Summary: (provided by the applicant): The obligate intracellular pathogen Chlamydia trachomatis is the most common cause of sexually transmitted disease in the developed world, causing both overt disease and infertility, and is also the leading cause of preventable blindness worldwide. Infection with C. trachomatis results in a specific immune response against the organism, and CD8+ cytotoxic T-lymphocytes (CTL) specific for C. trachomatis can be cultured from infected mice. Adoptive transfer of cultured CD8+ T-cells into infected mice reduces the number of organisms found in the spleens of these animals. The experiments in this proposal are designed to determine which Chlamydia gene products are recognized by these Chlamydia specific murine CD8+ T-cells. Three independent approaches will be used to identify these antigens. Once the C. trachomatis gene products responsible for priming the CD8+ T-cell response are identified, they will be introduced into vaccinia virus and tested for their ability to stimulate protective T-cells in a vaccine strategy. Because these antigens stimulate CD8+ T-cells, it suggests that they have access to the cytosol of host cells during the C. trachomatis developmental cycle. Experiments to characterize the developmental regulation and subcellular localization of these proteins will be carried out as a first step in understanding the role these proteins may play in C. trachomatis pathogenesis. Additional experiments will focus on the mechanism by which CD8+ T-cells protect against Chlamydia infection. Interferon-g (IFN-g) appears to be the primary effector mechanism used by these T-cells to protect against C. trachomatis infection. IFN-g release
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by CD8+ T-cells could protect mice against C. trachomatis infection by stimulating the antimicrobial activity of macrophages or by directly inhibiting the replication of C. trachomatis. Experiments to clarify the mechanism by which IFN-g produced by T-cells mediates protection will use radiation bone marrow chimeras in which either the hematopoietic cells (including macrophages) or the resident cells are unable to respond to IFN-g as a result of a disruption in the IFN-g receptor gene. A better understanding of the immune response to C. trachomatis and the development of a vaccine would have a pronounced effect on worldwide morbidity resulting from theseinfections. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Diversity of CTL Epitopes and Chlamydia Principal Investigator & Institution: Lampe, Mary F.; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2000 Summary: Chlamydia is the most prevalent cause of bacterial sexually transmitted disease in the developed world, Causing both overt disease and infertility, and is also the leading cause of preventable blindness worldwide. Natural immunity against Chlamydia and the vaccine strategies that have been attempted to date provide protection against only limited serovars. The goal of these studies is to ascertain whether a vaccine strategy which primes a cytotoxic T-lymphocyte (CTL) response can provide protection against a wide range of Chlamydia serovars. We have cultured Chlamydia reactive CTL from infected mice and have shown that they are specific for and lyse Chlamydia infected cells in vitro. Upon adoptive transfer of these CTL into Chlamydia infected mice, a reduction in bacterial load can be measured in the spleen. The initial experiments in this proposal will determine whether CTL specific for Chlamydia can be primed in mice of different MHC haplotypes. Other experiments characterize the diversity of antigens recognized by Chlamydia specific CTL and whether the diversity of antigens recognized by CTL primed by genital infection differ from those primed intraperitoneally. Thirdly, we propose to determine which of these antigens can prime CTL which are both protective and cross-reactive between Chlamydia serovars. This project will contribute to the overall program by characterizing at the cellular and molecular level antigens which are important in a protective CTL response. The project will complement project 3 which proposes in part to examine the CTL response elicited by Chlamydia infection in humans. This project is dependent on the resources provided by the laboratory (D) and statistical (B) cores. By providing novel information about the protective CTL
54 Chlamydia
response engendered during Chlamydia STD, this project will contribute to the overall objective of developing a vaccine to prevent and control these infections. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Indentification of Translocated Chlamydia Proteins. Principal Investigator & Institution: Loomis, Wendy P.; Microbiol & Molecular Genetics; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2000; Project Start 9-MAR-2001 Summary: There is a growing body of evidence suggesting that some Chlamydia proteins are able to gain access to the host cell cytosol to promote survival of these obligate intracellular organisms. I propose to identify Chlamydia proteins that are translocated from the vacuole where Chlamydia reside into the host cell cytosol or the vacuolar membrane. This will be done by generating a C. trachomatis library where individual Chlamydia proteins are fused to known peptide epitopes recognized by CD8+ T cells. Translocation of these fusion proteins can then be monitored by recognition of the epitope tags by epitope-specific CD8+ T cells. Proteins identified using this method will be further characterized to define the role of each protein in directing an immune response against Chlamydia and in establishing this organism's intracellular niche. The experimental system proposed here is a unique approach for identifying potential virulence determinants in this elusive pathogen. Identification of Chlamydia proteins that are translocated into the host cell cytosol will yield insight into C. trachomatis pathogenesis and cell biology. In addition, translocated proteins that are targets of the immune system can be considered as components of experimental Chlamydia vaccines. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
·
Project Title: Infection
Lymphoepithelial
Interaction
During
Chlamydial
Principal Investigator & Institution: Eko, Francis O.; Professor; Microbiology and Immunology; Morehouse School of Medicine 720 Westview Dr Sw Atlanta, Ga 30310 Timing: Fiscal Year 2000; Project Start 1-SEP-1996; Project End 1-AUG2001 Summary: (Adapted from the applicant's abstract): Chlamydial genital infection is the most common bacterial sexually-transmitted disease in the U.S. and complications in women can result in infertility. The infection initiates at the epithelial surface of the genital mucosae, and
Studies 55
associated fallopian tube or endometrial abnormalities manifest in epithelial tissues as well. Specific lymphocyte-epithelial interactions in the genital mucosa tissues lead to the acquisition of immunity or the onset of immunopathology. No studies have been reported that examined lymphoepithelial interactions associated with the elicitation of anti- chlamydial immune responses or how such interactions culminate in the intracellular inhibition of Chlamydia. By using a murine model of chlamydial genital infection and specifically-designed in vitro culture systems, this grant proposal is designed to investigate the cellular and molecular interactions, involving chlamydial-infected epithelial cells, chlamydial-specific T lymphocytes and their cytokines, that are required for controlling intraepithelial growth of Chlamydia in mice. Studies proposed would employ chlamydial-specific T cell clones, an in vitro model of the mucosal epithelium for studying epithelial-lymphocyte interactions, specific monoclonal antibodies directed at T cell-derived cytokines and adhesion molecules, inhibitors of anti-microbial processes induced by cytokines, and other molecular biologic and immunologic techniques to (a) identify protective chlamydial-specific T cells, (b) define the anti-microbial biochemical processes induced by T cell- derived cytokines (including tryptophan deprivation and nitric oxide production) that lead to intracellular inhibition of Chlamydia, and (c) analyze the epithelial-T cell interactions, involving cytokines, MHC and adhesion molecules, that contribute to intracellular inhibition of Chlamydia and promote local anti-chlamydial immunity. These studies will contribute to a better understanding of the cellular and molecular mechanisms of chlamydial immunity, which may be useful when designing a rational vaccine against Chlamydia. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Molecular Genetic Analysis of Chlamydia Pathogenicity Principal Investigator & Institution: Maurelli, Anthony T.; Professor; Henry M. Jackson Fdn for the Adv Mil/Med the Advancement of Military Med Bethesda, Md 20814 Timing: Fiscal Year 2000; Project Start 1-DEC-1998; Project End 0-NOV2003 Summary: (Adapted from the Applicant's Abstract): Bacteria of the genus Chlamydia are significant pathogens of animals and man. The diseases caused by Chlamydia spp. in man include pneumonitis, endocarditis, polyarthritis, blindness, and a wide range of sexually transmitted diseases including cervicitis, salpingitis, pelvic inflammatory disease, and infertility in females; and non-gonococcal urethritis and acute epididymitis in males. Despite many years of effort, the Chlamydia
56 Chlamydia
remain intractable to genetic analysis due to their obligate intracellular lifestyle and complex developmental cycle. No one has been able to introduce foreign DNA into this organism and achieve stable inheritance of the expression of the foreign genes. Few attempts at isolation of Chlamydia mutants have been reported. Even cloning of Chlamydia genes by complementation has been problematic due to the absence of, or poor expression of cloned Chlamydia genes in Escherichia coli. Our long term goal is to apply the power of genetics to study the pathogenic mechanisms of Chlamydia. The goal of this proposal is to develop genetic tools for the analysis of Chlamydia biology and pathogenesis and to use these tools to address specific problems of Chlamydia pathogenesis. The Specific aims are to: 1) design an efficient, reproducible method for introduction, expression, and stable maintenance of foreign DNA in Chlamydia; 2) design genetic tools for mutagenesis and selection of mutant phenotypes of Chlamydia ; 3) clone Chlamydia genes by functional complementation; and, 4) develop a system for gene replacement in Chlamydia. Each of these aims will include development of a genetic tool, demonstration of the tools effectiveness, and application of the tool to a fundamental question of Chlamydia biology. Success in achieving these goals will have a significant impact on Chlamydia research by making new tools for genetic analysis of Chlamydia available. Rapid advances in our understanding of Chlamydia pathogenesis and biology as well as the ability to construct Chlamydia mutants for vaccine development will be made possible by these new techniques. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Pathogenic Mechanisms in Chlamydial Reactive Arthritis Principal Investigator & Institution: Whittum-Hudson, Judith A.; Professor; Internal Medicine; Wayne State University Detroit, Mi 48202 Timing: Fiscal Year 2001; Project Start 8-SEP-2001; Project End 1-AUG2006 Summary: (provided by applicant): Reactive arthritis (ReA) is a chronic disease characterized by periods of flare alternating with periods of less active inflammation. One criterion of disease classification is a history of prior sexually transmitted or GI infection. Recent data from our collaborative group have shown that a significant number of ReA patients have metabolically active chlamydia in their synovial tissues. To facilitate study of ReA, we developed a murine model of genital chlamydial infection using a human strain of Chlamydia trachomatis to study the inflammatory/immunopathologic mechanisms of joint inflammation. Mice develop ascending genital infection within three
Studies 57
weeks. Synovial tissue from knees of these animals exhibits histologic signs of synovitis including increased synovial lining cells, dilated vessels, and foci of mononuclear inflammatory cells, and is PCR positive for chlamydial genes. This model will extend our previous data from a murine ocular chlamydial infection model that demonstrated both dissemination of chlamydia to synovial tissue and development of synovitis.The model will allow us to test mechanisms in chlamydiaassociated spondyloarthropathy (ReA) relating to the initiation of synovial inflammation and to determine the roles of local and distant host responses in development of persistent chlamydial infection. Specific molecular, microbiologic and immunologic questions to be asked with the murine model are guided by questions raised by the group's clinical findings from ReA patients: (1) what are the roles of proinflammatory and immunologic cytokines produced in synovial tissue during the inflammatory processes? (2) what host cells are infected and where does chlamydial persistence begin? (3) what is the metabolic state of chlamydia in those cells? (4) are persistently infected host cells (presumed mononuclear cells/macrophages) the stimulus for inflammation, or do responses by uninfected host cells to the latter provide the inflammatory stimulus? (5) do the locally produced cytokines determine the establishment of inapparent/persistent chlamydial infection in synovial tissue? The proposed studies in a noninvasive murine model of reactive arthritis will extend our clinical and laboratory findings from patients with chlamydia-associated reactive arthritis, and under controlled experimental conditions, enable us to determine the host cells vs chlamydial components which predispose to development and chronicity of joint inflammation. In the long term, these studies will lead to improved therapies for patients with reactive arthritis and/or indicate requirements to prevent this spondyloarthropathy. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Pathogenesis
Reiters
Syndrome--Mechanism
of
Chlamydia
Principal Investigator & Institution: Hudson, Alan P.; Associate Professor; Immunology and Microbiology; Wayne State University Detroit, Mi 48202 Timing: Fiscal Year 2000; Project Start 0-SEP-1993; Project End 1-MAR2003 Summary: (Adapted from the applicant's abstract): Reactive arthritis/Reiter's syndrome (ReA/RS) is known to be related to infection with Chlamydia trachomatis, since the disease has often been observed to follow episodes of urethritis. Studies from the investigator's laboratory
58 Chlamydia
have demonstrated that a far larger proportion of ReA/RS cases than expected are attributable to this organism. They have further shown that chlamydia are present in synovial tissues in ReA/RS patients, even in those with long disease duration, and that the organism is metabolically active at that site. Our data show that the primary synovial host cell for persistent chlamydial infection is the monocyte/macrophage. Other studies have demonstrated that chlamydial gene expression is aberrant during synovial infection, with transcription of the major outer membrane protein gene (omp1) severely attenuated and that of the strongly antigenic heat shock protein gene (hsp60) at high level. This latter chlamydial protein is probably the cause of the synovial inflammation characteristic of ReA/RS. The ability of chlamydia to persist in synovial tissue and cause disease results from a balanced hostparasite interaction, and it is the purpose of the present application to delineate the molecular dynamics of that interaction. In the studies proposed here, the investigators employ reverse transcriptionpolymerase chain reaction (RT-PCR) and other assays to define bacterial gene products relating to cell division, energy metabolism and other critical functions, in both synovial biopsy samples from ReA/RS patients and an in vitro tissue culture model system they have developed. Similarly, they use RT-PCR and other standard molecular and cell biological methods to assess production of cytokines and other proinflammatory molecules by synovial tissue in persistent infection, again using materials from both ReA/RS patients and the in vitro model system. In these and other studies, they address biochemical, molecular genetic, and clinical questions regarding the dynamics of persistent synovial infection with C. trachomatis. Results of these studies will provide a significant new understanding of the roles played by both chlamydia and host in the maintenance of inflammatory joint disease. In future research, they will employ results from the present studies to assess therapies designed to reduce bacterial load in the synovium and inflammation in that tissue, using both the in vitro cell culture system and an animal model of reactive arthritis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Translating Chlamydia Screening Guidelines Into Practice Principal Investigator & Institution: Thompson, Robert S.; Group Health Cooperative of Puget Sound 200 15Th Ave E Seattle, Wa 98112 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 0-JUN2003
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Summary: Sexually transmitted Chlamydia trachomatis infections in women, often asymptomatic, have serious consequences if left untreated. However, studies from Group Health Cooperative (GHC) have shown the impact can be decreased (i.e., a 56 percent decrease in PID) if at-risk women receive screening and treatment. Over the last two years, GHC has developed an evidence-based chlamydia screening guideline to initiate translation of the evidence into practice. Objective: To evaluate the effectiveness of several multifaceted strategies for guideline implementation. Site: Thirty staff model outpatient clinics at GHC. Methods: This is a randomized trial of guideline implementation strategies carried out at the provider and patient levels. Using a 2x2 factorial design, we will compare standard guideline implementation to three other strategies: one with only provider-specific components, one with only patient-specific components and one with both provider- and patient-specific components. Provider- specific strategies (with randomization occurring at the clinic level) include the use of opinion leaders, measurement and feedback, and prompts placed in Pap test kits. The patient- specific strategy (with randomization of individual enrollees) consists of a prompt placed in the chart of 14-20 year-old females as a paper-based test to establish the case for a future computerized automated prompt system. Outcomes: Outcomes will be measured at baseline and post-implementation. The primary outcome is the rate of appropriate chlamydia screening among 14- 25 year-old females. Other primary outcomes are 1) the rate of chlamydia screening as defined by a new HEDIS measure; 2) changes in provider knowledge, attitudes/beliefs, self-efficacy, practices, and perceived barriers and supports; 3) the cost per woman appropriately screened and the marginal cost-effectiveness of each intervention arm. Secondary outcomes include changes in the rates of positive chlamydia tests, PID and ectopic pregnancy. Major study benefits: To our knowledge this will be the first study to evaluate conceptually-based guideline implementation strategies in a defined HMO clinical population. In order to further enhance generalizability, we will test selected implementation strategies in a network-model managed care setting. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Macrophaage Lipid Receptors in Atherosclerosis Principal Investigator & Institution: Freeman, Mason W.; Chief, Lipid Metabolism Unit; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2000; Project Start 0-SEP-1989; Project End 0-APR2005
60 Chlamydia
Summary: Macrophages are activated to produce inflammatory cytokines in response to a variety of external stimuli. Some of the most potent of these stimuli are lipids derived from the cell ways of infectious organisms. These lipids activate cell surface receptors than then engage downstream signaling pathways responsible for the induction of cytokine expression gene expression. One of the best characterized of the receptor signaling pathways involves lipopolysaccharide binding protein (LBP) and CD14, a 55 kDa glycosyl phosphatidylinositol (GPI)-linked protein that is also present in a soluble form (sCD14) in serum. CD14 binds lipopolysaccharides, presented to it by LBP, that are derived from the outermost layer of Gram-negative bacteria and activates a signaling cascade via a newly described family of protein called Toll receptors (TLRs). This results in the production of tumor necrosis-alpha (TNFalpha) interleukin-6 (IL-6), and interleukin-1(IL-1), major cytokine effectors of the inflammatory response. This CD14 initiated response has been shown to be important in the pathogenesis of septic shock following Gram-negative septicemia. Another Gram negative bacteria. Chlamydia pneumoniae, has recently been implicated in the progression of an another important medical disease, atherosclerosis. Chlamydia is an obligate intracellular parasite that resides within macrophages and recent data has suggested that the lipopolysaccharides from Chlamydia may play a role in accelerating atherosclerotic plaque development by enhancing the formation of the macrophage foam cell, the histologic hallmark of the early atheroma. In the previous grant award period, we generated animals lacking the CD14 receptor and LBP. Macrophages taken from these animals will be used to explore the role of Chlamydia and its lipopolysaccharide coat in infecting and activating macrophages. As mouse models of atherosclerosis can be used to study the progression of lesions in animals infected with Chlamydial organisms, the CD14 and LBP deficient mice will also be used to perform studies of the relevance of these pathways to atherogenesis in vivo. Comparisons will be made of the Chlamydial activating signaling pathways in macrophages to those pathways engaged by enteric Gram negative pathogens in order to analyze the roles of CD14, LBP, and TLRs in these differing infection. These studies should provide new insights into the biology of Chlamydia- induced atherosclerotic lesion progression as well as more detailed understanding of macrophage activation by infectious agents and their pro-inflammatory cell wall lipids. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Pathogenesis of Tubal Factor Infertility Principal Investigator & Institution: Ault, Kevin A.; Obstetrics and Gynecology; University of Iowa Iowa City, Ia 52242
Studies 61
Timing: Fiscal Year 2000; Project Start 1-AUG-1999; Project End 1-JUL2002 Summary: Tubal factor infertility is a common gynecological problem, responsible for 15-30 percent of all infertility. Most cases of tubal factor infertility are caused by Chlamydia trachomatis. Chlamydia is the most common sexually transmitted disease in the United States. Upper genital tract infections with Chlamydia are often asymptomatic or subclinical but can result in fallopian tube damage. These obligate intracellular microorganisms elude host defenses causing a persistent indolent infection. While multiple epidemiological studies have shown a link between Chlamydia and infertility, the underlying immunology and pathogenesis is poorly understood. Recent research has shown that an antibody response to the chlamydial 60-kilodalton heat shock protein (hsp 60) is associated with tubal factor infertility. Another 10-kilodalton heat shock protein (hsp 10) has been recently described. Our initial studies would indicate that infertile women also have antibodies to this chlamydial antigen. The central hypothesis of this research plan is that an altered immune response to chlamydial heat shock proteins is responsible for tubal factor infertility. The specific aims for this project are 1) to determine lymphocyte responses to hsp 10 and hsp 60 in women with tubal factor infertility and 2) to study expression of hsp 10 and hsp 60 in an in vitro model of fallopian tube infection. This research plan is part of a NICHD Mentored Clinical Scientist Development Award. The candidate for this award, Dr. Kevin Ault, is a clinically trained gynecologist. His interest in infectious diseases is the result of caring for women with tubal factor infertility. Other common gynecological diseases, such as ectopic pregnancy and pelvic inflammatory disease, have also been linked to infection with Chlamydia. By training gynecologists to apply fundamental techniques in immunology and microbiology to the problem of Chlamydia and infertility, we can have a better understanding of this common problem in women's health. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central19 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
19
62 Chlamydia
Information (NCBI) at the U.S. National Library of Medicine (NLM).20 Access to this growing archive of e-journals is free and unrestricted.21 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “chlamydia” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for chlamydia in the PubMed Central database: ·
A Developmentally Regulated Chlamydial Gene with Apparent Homology to Eukaryotic Histone H1 by E Perara, D Ganem, and JN Engel; 1992 March 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=48609
·
A Heat-Labile Protein of Chlamydia trachomatis Binds to HeLa Cells and Inhibits the Adherence of Chlamydiae by TD Joseph and SK Bose; 1991 May 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51592
·
A Recombinant Chlamydia trachomatis Major Outer Membrane Protein Binds to Heparan Sulfate Receptors on Epithelial Cells by H Su, L Raymond, DD Rockey, E Fischer, T Hackstadt, and HD Caldwell; 1996 October 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38298
·
Ability of the Digene Hybrid Capture II Test To Identify Chlamydia trachomatis and Neisseria gonorrhoeae in Cervical Specimens by Julius Schachter, Edward W. Hook, III, William M. McCormack, Thomas C. Quinn, Max Chernesky, Sylvia Chong, Jennifer I. Girdner, Paula B. Dixon, Lynette DeMeo, Eva Williams, Allison Cullen, and Attila Lorincz; 1999 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85720&ren dertype=external
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 21 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 20
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·
An Important Proportion of Genital Samples Submitted for Chlamydia trachomatis Detection by PCR Contain Small Amounts of Cellular DNA as Measured by [beta]-Globin Gene Amplification by Francois Coutlee, Manon de Ladurantaye, Carole Tremblay, Jean Vincelette, Louise Labrecque, and Michel Roger; 2000 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86955&ren dertype=external
·
Analysis of Genetic Heterogeneity in Chlamydia trachomatis Clinical Isolates of Serovars D, E, and F by Amplified Fragment Length Polymorphism by Servaas A. Morre, Jacobus M. Ossewaarde, Paul H. M. Savelkoul, Jeroen Stoof, Chris J. L. M. Meijer, and Adriaan J. C. van den Brule; 2000 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87408&ren dertype=external
·
CD8 + T cells recognize an inclusion membrane-associated protein from the vacuolar pathogen Chlamydia trachomatis by Steven P. Fling, R. Alec Sutherland, Lisa N. Steele, Bruce Hess, Sarah E. F. D'Orazio, JeanFrancois Maisonneuve, Mary F. Lampe, Peter Probst, and Michael N. Starnbach; 2001 January 30 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=14725
·
Characterization of Chlamydia trachomatis omp1 Genotypes among Sexually Transmitted Disease Patients in Sweden by Margaretha Jurstrand, Lars Falk, Hans Fredlund, Margret Lindberg, Per Olcen, Soren Andersson, Kenneth Persson, Jan Albert, and Anders Backman; 2001 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88464&ren dertype=external
·
Chlamydia trachomatis cytotoxicity associated with complete and partial cytotoxin genes by Robert J. Belland, Marci A. Scidmore, Deborah D. Crane, Daniel M. Hogan, William Whitmire, Grant McClarty, and Harlan D. Caldwell; 2001 November 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=61153
·
Chlamydia trachomatis Developmentally Regulated Protein is Homologous to Eukaryotic Histone H1 by T Hackstadt, W Baehr, and Y Ying; 1991 May 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51568
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·
Chlamydia trachomatis Serology: Diagnostic Value of Outer Membrane Protein 2 Compared with That of Other Antigens by S. Bas, P. Muzzin, and T. L. Vischer; 2001 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88490&ren dertype=external
·
Chlamydial Serology: Comparative Diagnostic Value of Immunoblotting, Microimmunofluorescence Test, and Immunoassays Using Different Recombinant Proteins as Antigens by S. Bas, P. Muzzin, B. Ninet, J. E. Bornand, C. Scieux, and T. L. Vischer; 2001 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87941&ren dertype=external
·
Comparison between the LCx Probe System and the COBAS AMPLICOR System for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae Infections in Patients Attending a Clinic for Treatment of Sexually Transmitted Diseases in Amsterdam, The Netherlands by G. J. J. van Doornum, L. M. Schouls, A. Pijl, I. Cairo, M. Buimer, and S. Bruisten; 2001 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87837&ren dertype=external
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Comparison of a Ligase Chain Reaction-Based Assay and Cell Culture for Detection of Pharyngeal Carriage of Chlamydia trachomatis by Andrew J. Winter, Gerry Gilleran, Kirstine Eastick, and Jonathan D. C. Ross; 2000 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87419&ren dertype=external
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Comparison of a Polymer Conjugate-Enhanced Enzyme Immunoassay to Ligase Chain Reaction for Diagnosis of Chlamydia trachomatis in Endocervical Swabs by Max Chernesky, Dan Jang, Debby Copes, Jay Patel, Astrid Petrich, Kathleen Biers, Arlene Sproston, and Julius Kapala; 2001 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88131&ren dertype=external
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Comparison of the PACE 2 Assay, Two Amplification Assays, and Clearview EIA for Detection of Chlamydia trachomatis in Female Endocervical and Urine Specimens by Tsai-Ling Lauderdale, Lenore Landers, Ian Thorneycroft, and Kimberle Chapin; 1999 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85123&ren dertype=external
·
Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by Enzyme Immunoassay, Culture, and Three Nucleic Acid Amplification
Studies 65
Tests by E. Van Dyck, M. Ieven, S. Pattyn, L. Van Damme, and M. Laga; 2001 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88020&ren dertype=external ·
Detection of Chlamydia trachomatis Endocervical Infections by Ligase Chain Reaction versus ACCESS Chlamydia Antigen Assay by K. B. Waites, K. R. Smith, M. A. Crum, R. D. Hockett, A. H. Wells, and E. W. Hook, III; 1999 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85464&ren dertype=external
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Determination of Chlamydia trachomatis Prevalence in an Asymptomatic Screening Population: Performances of the LCx and COBAS Amplicor Tests with Urine Specimens by Servaas A. Morre, Irene G. M. Van Valkengoed, Robert M. Moes, A. Joan P. Boeke, Chris J. L. M. Meijer, and Adriaan J. C. Van den Brule; 1999 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85500&ren dertype=external
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Effect of Endocervical Specimen Adequacy on Ligase Chain Reaction Detection of Chlamydia trachomatis by Mike J. Loeffelholz, Sandra J. Jirsa, Rebecca K. Teske, and Juliet N. Woods; 2001 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88452&ren dertype=external
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Efficacy of home sampling for screening of Chlamydia trachomatis: randomised study by Lars Ostergaard, Berit Andersen, Frede Olesen, and Jens K Moller; 1998 July 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28598
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Evaluation of a Modified Sanitary Napkin as a Sample Self-Collection Device for the Detection of Genital Chlamydial Infection in Women by Michel Alary, Celine Poulin, Celine Bouchard, Michel Fortier, Gilles Murray, Suzanne Gingras, Michel Aube, and Carol Morin; 2001 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88177&ren dertype=external
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Evaluation of a Rapid Assay for Detection of Chlamydia trachomatis Infections in Outpatient Clinics in South Kalimantan, Indonesia by Susana Widjaja, Surekha Cohen, William E. Brady, Kevin O'reilly, Susanto, Ajar Wibowo, Cahyono, Robert R. Graham, and Kevin R. Porter; 1999 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85921&ren dertype=external
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Evaluation of an Automated Liquid-Handling System (Tecan Genesis RSP 100) in the Abbott LCx Assay for Chlamydia trachomatis by Kevan L. Hanson and Charles P. Cartwright; 2001 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88062&ren dertype=external
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Evaluation of COBAS AMPLICOR (Roche): Accuracy in Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by Coamplification of Endocervical Specimens by Charles H. Livengood, III and Jane W. Wrenn; 2001 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88262&ren dertype=external
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Evaluation of Laboratory Testing Methods for Chlamydia trachomatis Infection in the Era of Nucleic Acid Amplification by Tamara J. Battle, Matthew R. Golden, Kathleen L. Suchland, Jon M. Counts, James P. Hughes, Walter E. Stamm, and King K. Holmes; 2001 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88261&ren dertype=external
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Evaluation of Nucleic Acid Amplification Tests as Reference Tests for Chlamydia trachomatis Infections in Asymptomatic Men by Robert E. Johnson, Timothy A. Green, Julius Schachter, Robert B. Jones, Edward W. Hook, III, Carolyn M. Black, David H. Martin, Michael E. St. Louis, and Walter E. Stamm; 2000 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87609&ren dertype=external
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Evaluation of the Digene Hybrid Capture II CT-ID Test for Detection of Chlamydia trachomatis in Endocervical Specimens by Jennifer L. Girdner, Allison P. Cullen, Teresa G. Salama, Ling He, Attila Lorincz, and Thomas C. Quinn; 1999 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84836&ren dertype=external
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Evaluation of the NucliSens Basic Kit for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in Genital Tract Specimens Using Nucleic Acid Sequence-Based Amplification of 16S rRNA by J. B. Mahony, X. Song, S. Chong, M. Faught, T. Salonga, and J. Kapala; 2001 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87950&ren dertype=external
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Head-to-Head Evaluation of Five Chlamydia Tests Relative to a Quality-Assured Culture Standard by Wilbert J. Newhall, Robert E. Johnson, Susan DeLisle, David Fine, Alula Hadgu, Bessie Matsuda, Donna Osmond, Joyce Campbell, and Walter E. Stamm; 1999 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84517&ren dertype=external
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High-Resolution Genotyping of Chlamydia trachomatis from Recurrent Urogenital Infections by Lisbeth Norum Pedersen, Holger Olaf Kjaer, Jens Kjolseth Moller, Torben Falck Orntoft, and Lars Ostergaard; 2000 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87186&ren dertype=external
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Impact of Reference Standard Sensitivity on Accuracy of Rapid Antigen Detection Assays and a Leukocyte Esterase Dipstick for Diagnosis of Chlamydia trachomatis Infection in First-Void Urine Specimens from Men by M. Chernesky, D. Jang, J. Krepel, J. Sellors, and J. Mahony; 1999 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85376&ren dertype=external
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Isolation in Endothelial Cell Cultures of Chlamydia trachomatis LGV (Serovar L2) from a Lymph Node of a Patient with Suspected Cat Scratch Disease by M. Maurin and D. Raoult; 2000 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86728&ren dertype=external
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Lipid Metabolism in Chlamydia trachomatis-Infected Cells: Directed Trafficking of Golgi-Derived Sphingolipids to the Chlamydial Inclusion by T Hackstadt, MA Scidmore, and DD Rockey; 1995 May 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41810
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Mailed, Home-Obtained Urine Specimens: a Reliable Screening Approach for Detecting Asymptomatic Chlamydia trachomatis Infections by Servaas A. Morre, Irene G. M. van Valkengoed, Afke de Jong, A. Joan P. Boeke, Jacques T. M. van Eijk, Chris J. L. M. Meijer, and Adriaan J. C. van den Brule; 1999 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88635&ren dertype=external
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Molecular Epidemiology of Genital Chlamydia trachomatis Infection in High-Risk Women in Senegal, West Africa by Katharine SturmRamirez, Hunter Brumblay, Khady Diop, Aissatou Gueye-Ndiaye, JeanLouis Sankale, Ibou Thior, Ibrahima N'Doye, Chung-Cheng Hsieh, Souleymane Mboup, and Phyllis J. Kanki; 2000 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86040&ren dertype=external
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Morphologic and Antigenic Characterization of Interferon [gamma]Mediated Persistent Chlamydia trachomatis Infection in vitro by WL Beatty, GI Byrne, and RP Morrison; 1993 May 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=46433
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Multicenter Evaluation of the AMPLICOR and Automated COBAS AMPLICOR CT/NG Tests for Detection of Chlamydia trachomatis by Barbara Van Der Pol, Thomas C. Quinn, Charlotte A. Gaydos, Kimberly Crotchfelt, Julius Schachter, Jeanne Moncada, D. Jungkind, David H. Martin, Buffy Turner, Cynthia Peyton, and Robert B. Jones; 2000 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86350&ren dertype=external
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Multicenter Evaluation of the BDProbeTec ET System for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in Urine Specimens, Female Endocervical Swabs, and Male Urethral Swabs by Barbara Van Der Pol, Dennis V. Ferrero, Linda Buck-Barrington, Edward Hook, III, Connie Lenderman, Thomas Quinn, Charlotte A. Gaydos, Judith Lovchik, Julius Schachter, Jeanne Moncada, Geraldine Hall, Marion J. Tuohy, and Robert B. Jones; 2001 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87865&ren dertype=external
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Multicenter Evaluation of the Fully Automated COBAS AMPLICOR PCR Test for Detection of Chlamydia trachomatis in Urogenital Specimens by Jean Vincelette, Jurjen Schirm, Marc Bogard, Anne-Marie Bourgault, Dirk S. Luijt, Anne Bianchi, Pieter C. van Voorst Vader, Ann Butcher, and Maurice Rosenstraus; 1999 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84172&ren dertype=external
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PCR Assessment of Chlamydia trachomatis Infection of Semen Specimens Processed for Artificial Insemination by Yvonne Pannekoek, Steven M. Westenberg, Jan de Vries, Sjoerd Repping, Lodewijk Spanjaard, Paul P. Eijk, Arie van der Ende, and Jacob Dankert; 2000 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87472&ren dertype=external
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Pooling Cervical Swabs and Testing by Ligase Chain Reaction Are Accurate and Cost-Saving Strategies for Diagnosis of Chlamydia trachomatis by J. Kapala, D. Copes, A. Sproston, J. Patel, D. Jang, A. Petrich, J. Mahony, K. Biers, and M. Chernesky; 2000 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86948&ren dertype=external
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Pooling Cervical Swabs for Detection of Chlamydia trachomatis by PCR: Sensitivity, Dilution, Inhibition, and Cost-Saving Aspects by Servaas A. Morre, Rogier van Dijk, Chris J. L. M. Meijer, Adriaan J. C. van den Brule, Susanne Kruger Kjaer, and Christian Munk; 2001 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88155&ren dertype=external
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Pooling of Urine Specimens for Detection of Asymptomatic Chlamydia trachomatis Infections by PCR in a Low-Prevalence Population: CostSaving Strategy for Epidemiological Studies and Screening Programs by Servaas A. Morre, Chris J. L. M. Meijer, Christian Munk, Susanne Kruger-Kjaer, Jeanette F. Winther, Hans O. Jorgensens, and Adriaan J. C. van den Brule; 2000 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86525&ren dertype=external
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Qualitative analysis of psychosocial impact of diagnosis of Chlamydia trachomatis: implications for screening by Barbara Duncan, Graham Hart, Anne Scoular, and Alison Bigrigg; 2001 January 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26583
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Relative Accuracy of Nucleic Acid Amplification Tests and Culture in Detecting Chlamydia in Asymptomatic Men by Hong Cheng, Maurizio Macaluso, Sten H. Vermund, and Edward W. Hook, III; 2001 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88466&ren dertype=external
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Reproducibility Problems with the Abbott Laboratories LCx Assay for Chlamydia trachomatis and Neisseria gonorrhoeae by Ann M. Gronowski, Susan Copper, David Baorto, and Patrick R. Murray; 2000 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86828&ren dertype=external
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Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis by Matthias Egger, Nicola Low, George Davey Smith, Bo Lindblom, and Bjorn Herrmann; 1998 June 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28575
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Urogenital Chlamydia trachomatis Serovars in Men and Women with a Symptomatic or Asymptomatic Infection: an Association with Clinical Manifestations? by S. A. Morre, L. Rozendaal, I. G. M. van Valkengoed, A. J. P. Boeke, P. C. van Voorst Vader, J. Schirm, S. de Blok, J. A. R. van den Hoek, G. J. J. van Doornum, C. J. L. M. Meijer, and A. J. C. van den Brule; 2000 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86784&ren dertype=external
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Use of a Reverse Dot Blot Procedure To Identify the Presence of Multiple Serovars in Chlamydia trachomatis Urogenital Infection by Diane R. Stothard; 2001 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88204&ren dertype=external
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.22 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with chlamydia, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “chlamydia” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “chlamydia” (hyperlinks lead to article summaries): ·
Chlamydia DNA extraction for use in PCR: stability and sensitivity in detection. Author(s): Daugharty H, Skelton SK, Messmer T. Source: Journal of Clinical Laboratory Analysis. 1998; 12(1): 47-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9484669&dopt=Abstract
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Evaluation the enzyme immunosorbent assay IDEIA test detecting Chlamydia trachomatis in cervix. Author(s): Nunthapisud P, Nuruthisard S. Source: Southeast Asian J Trop Med Public Health. 1991 December; 22(4): 655-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1820656&dopt=Abstract
Vocabulary Builder Aberrant: Wandering or deviating from the usual or normal course. [EU] Alkaline: Having the reactions of an alkali. [EU] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigen: Any substance which is capable, under appropriate conditions, of
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inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chimera: An individual that contains cell populations derived from different zygotes. [NIH] Coagulation: 1. the process of clot formation. 2. in colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. in surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Criterion: A standard by which something may be judged. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Douching: A jet or current of water, sometimes a dissolved medicating or cleansing agent, applied to a body part, organ or cavity for medicinal or
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hygienic purposes. [EU] Dysuria: Painful or difficult urination. [EU] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocytosis: Cellular uptake of extracellular materials within membranelimited vacuoles or microvesicles. Endosomes play a central role in endocytosis. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU]
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Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Haplotypes: The genetic constitution of individuals with respect to one member of a pair of allelic genes, or sets of genes that are closely linked and tend to be inherited together such as those of the major histocompatibility complex. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Labile: 1. gliding; moving from point to point over the surface; unstable; fluctuating. 2. chemically unstable. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU]
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Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH]
Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neisseria: A genus of gram-negative, aerobic, coccoid bacteria whose organisms are part of the normal flora of the oropharynx, nasopharynx, and genitourinary tract. Some species are primary pathogens for humans. [NIH] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nulliparous: Having never given birth to a viable infant. [EU] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Ocular: 1. of, pertaining to, or affecting the eye. 2. eyepiece. [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH]
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Pathogen: Any disease-producing microorganism. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Plasminogen: The inactive precursor of plasmin (=enzyme that catalyses the hydrolysis of peptide bonds at the carbonyl end of lysine or arginine residues). [EU] Polyarthritis: An inflammation of several joints together. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Salpingitis: 1. inflammation of the uterine tube. 2. inflammation of the auditory tube. [EU] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and
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mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Superinfection: A new infection complicating the course of antimicrobial therapy of an existing infectious process, and resulting from invasion by bacteria or fungi resistant to the drug(s) in use. It may occur at the site of the original infection or at a remote site. [EU] Synovitis: Inflammation of a synovial membrane. It is usually painful, particularly on motion, and is characterized by a fluctuating swelling due to effusion within a synovial sac. Synovitis is qualified as fibrinous, gonorrhoeal, hyperplastic, lipomatous, metritic, puerperal, rheumatic, scarlatinal, syphilitic, tuberculous, urethral, etc. [EU] Titre: The quantity of a substance required to produce a reaction with a given volume of another substance, or the amount of one substance required to correspond with a given amount of another substance. [EU] Translating: Conversion from one language to another language. [NIH] Trichomonas: A genus of parasitic flagellate protozoans distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. [NIH] Trypsin: A serine endopeptidase that is formed from trypsinogen in the pancreas. It is converted into its active form by enteropeptidase in the small intestine. It catalyzes hydrolysis of the carboxyl group of either arginine or lysine. EC 3.4.21.4. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Ureaplasma: A genus of gram-negative, nonmotile bacteria which are common parasitic inhabitants of the urogenital tracts of man, cattle, dogs, and monkeys. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in
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the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vaccinia: The cutaneous and sometimes systemic reactions associated with vaccination with smallpox vaccine. [EU] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH]
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CHAPTER 5. PATENTS ON CHLAMYDIA Overview You can learn about innovations relating to chlamydia by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.23 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with chlamydia within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with chlamydia. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
23Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Chlamydia By performing a patent search focusing on chlamydia, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on chlamydia: ·
Assay for Chlamydia trachomatis by amplification and detection of Chlamydia trachomatis cryptic plasmid Inventor(s): Foxall; Paul A. (San Mateo, CA), Berger; Dolores M. (Baltimore, MD) Assignee(s): Becton, Dickinson and Company (Franklin Lakes, NJ) Patent Number: 6,218,125 Date filed: January 12, 2000 Abstract: A region of the Chlamydia trachomatis cryptic plasmid has been identified which is useful for performing amplification assays to determine specifically whether C. trachomatis is present in the sample being tested. Oligonucleotides useful for performing thermal Strand Displacement Assay (tSDA) reactions on this gene are disclosed. The disclosed oligonucleotides can be used in an assay which is specific for all strains of C. trachomatis and which does not show crossreactivity with the genomes of other microorganisms or with human DNA. Excerpt(s): The present invention relates to methods for determining the presence or absence of Chlamydia trachomatis in patients. The method involves using nucleic acid primers to amplify specifically the Chlamydia trachomatis cryptic plasmid, preferably using one of the techniques of Strand Displacement Amplification (SDA), thermophilic Strand Displacement Amplification (tSDA) or fluorescent real time thermal Strand Displacement Amplification. ... Chlamydia trachomatis is the causative agent of trachoma (which is the greatest single cause of blindness), inclusion conjunctivitis, infant pneumonitis, urethritis and lymphogranuloma venereum. Diagnosis and detection of this organism is often on the basis of the pathologic or clinical findings and may be confirmed by isolation and staining techniques. ... The present invention provides oligonucleotides useful as amplification primers and assay
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probes for specific detection and identification of Chlamydia trachomatis. The specific probes amplify the C. trachomatis cryptic plasmid with little or no detectable amplification of either human DNA or DNA of other microorganisms. Two regions of the C. trachomatis cryptic plasmid were selected to develop nucleic acid primers which would specifically amplify this plasmid without showing crossreactivity with human DNA or other microorganism DNA. Web site: http://www.delphion.com/details?pn=US06218125__ ·
Phenylalanyl tRNA synthetase alpha sub-unit from Chlamydia trachomatis Inventor(s): Brown; James R (Berwyn, PA), Lawlor; Elizabeth J (Malvern, PA), Reichard; Raymond W (Quakertown, PA) Assignee(s): SmithKline Beecham Corporation (Philadelphia, PA) Patent Number: 6,214,595 Date filed: August 13, 1999 Abstract: The invention provides phenylalanyl tRNA synthetase (pheS) pheS polypeptides and DNA (RNA) encoding phenylalanyl tRNA synthetase (pheS) pheS polypeptides and methods for producing such polypeptides from Chlamydia trachomatis by recombinant techniques. Also provided are methods for utilizing pheS polypeptides to screen for antibacterial compounds. Excerpt(s): Chlamydiaceae is a family of obligate intracellular parasites. All members share a common developmental cycle. Chlamydia infect a wide range of vertebrate host, particularly humans. ... Chlamydia trachomitis is one of the two recognized species of Chlamydia. Human infections caused by C. trachomitis. are widespread. This species is one of the most common cause of sexually transmitted disease in the world. It is also one of the main causes of infertility in humans. ... The frequency of Chlamydia trachomatis infections has risen dramatically in the past 20 years. This has been attributed to the emergence of multiply antibiotic resistant strains and an increasing population of people with weakened immune systems. It is no longer uncommon to isolate Chlamydia trachomatis stains which are resistant to some or all of the standard antibiotics. This has created a demand for both new anti-microbial agents and diagnostic tests for this organism. Web site: http://www.delphion.com/details?pn=US06214595__
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·
PNA probes for detection of Neisseria gonorrhoeae and Chlamydia trachomatis Inventor(s): Hyldig-Nielsen; Jens J.o slashed.rgen (Vanl.o slashed.se, DK), Godskesen; Michael Anders (Vedb.ae butted.k, DK) Assignee(s): DAKO A/S (Glostrup, DK) Patent Number: 6,169,169 Date filed: May 18, 1995 Abstract: Specific peptide nucleic acid (PNA) probes for detecting a sexual transmitted disease caused by Neisseria gonorrhoeae or Chlamydia trachomatis comprising N-(2-aminoethyl)glycine units in amide linkage with the glycine nitrogen connected to naturally occurring nucleobases or non-naturally occurring nucleobases by a methylene carbonyl linker and said probes capable of hybridizing to 16S or 23S rRNA or rDNA of Neisseria gonorrhoeae or Chlamydia trachomatis are described. PNA is a very stable molecule with very high affinity for nucleic acid allowing a PNA probe to be shorter than conventional nucleic acid probes. Excerpt(s): The present invention relates to specific peptide nucleic acid (PNA) probes and methods for detecting a sexual transmitted disease caused by Neisseria gonorrhoeae or Chlamydia trachomatis. More particularly, the invention relates to peptide nucleic acid (PNA) probes capable of hybridizing to 16S or 23S rRNA or DNA from the area coding for said rRNA of Neisseria gonorrhoeae or Chlamydia trachomatis in test samples which may contain Neisseria gonorrhoeae and/or Chlamydia trachomatis. ... Another very wide spread sexual transmitted disease is caused by Chlamydia trachomatis. Among the more serious complications of C. trachomatis infections are ecotropic pregnancy and tubal infertility. ... Attempts have also been made to use nucleic acid probes for diagnosis of infections caused by Neisseria gonorrhoeae or Chlamydia trachomatis. Web site: http://www.delphion.com/details?pn=US06169169__
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Recombinant Chlamydia trachomatis pgp3 fusion protein Inventor(s): Ratti; Givlio (Siena, IT), Comanducci; Maurizio (Siena, IT), Tecce; Mario F. (Siena, IT), Giuliani; Marzia M. (Siena, IT) Assignee(s): Chiron S.p.A. (Siena, IT) Patent Number: 6,110,705 Date filed: May 18, 1995
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Abstract: A plasmid isolated from Chlamydia trachomatis is described, which comprises 8 genes encoding proteins useful in the formation of vaccines or diagnostic test for determining the bacterium or specific antibodies generated during C. trachomatis infections. In particular, the recombinant fusion protein MS2-pgp3D is described, which comprises polypeptide sequences encoded by pCT and is immunogenic in the course of infections in man. A method for preparing the recombinant fusion protein MS2-pgp3D in E. coli is also described. Excerpt(s): This invention refers to the pCTD plasmid isolated from Chlamydia trachomatis serotype D, cloned and sequenced and to the genes present in said plasmid, to the proteins expressed by said genes, to the expression vectors containing said genes and to the microrganisms transformed by said vectors. The invention further refers to the process for the preparation of genes and of said vectors and to the use of said proteins as antigens for the preparation of polyclonal and monoclonal antibodies apt to recognize Chlamydia trachomatis and hence useful for the preparation of vaccines capable of imparting a protective immunity against infections caused by Chlamydia trachomatis and pathologic conditions deriving from said infections and for the development of diagnostic methods for the search of specific antibodies produced following C. trachomatis infections. ... Chlamydias are gram-negative bacteria, obligate intracellular parasites of eukariotic cells. Chlamydias show an extracellular infective and metabolically practically inert form, called elemental body (EB), and intracellular replicative forms called reticular bodies (RB). ... Chlamydia trachomatis (C. trachomatis or CT), a bacterial species pathogenic to man, is the etiological agent of venereal lymphogranuloma (VLG), of various inflammatory patologies of the genital male and female apparatus and of trachoma, a chronic disease which affects 500 million people and can lead to blindness. Web site: http://www.delphion.com/details?pn=US06110705__ ·
Detection of cervical chlamydia trachomatis infection Inventor(s): Lee; Helen H (Lake Forest, IL) Assignee(s): Abbott Laboratories (Abbott Park, IL) Patent Number: 6,010,857 Date filed: April 15, 1998 Abstract: The present invention provides methods for detecting Chlamydia trachomatis infections using a female urine sample.
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Excerpt(s): The invention relates to detecting Chlamydia trachomatis. In particular, the invention relates to detecting Chlamydia trachomatis infections of cervical origin using a female urine sample. ... Chlamydia trachomatis (C. trachomatis) has been reported as the most common sexually transmitted disease in industrial societies and causes genital infections in both men and women. In the event C. trachomatis infections are undetected and untreated, the infection may escalate to sexually acquired reactive arthritis in men, and tubal factor infertility in women. Accordingly, it is important that such infections are quickly diagnosed and treated. ... Inability to detect cervical C. trachomatis infections using a female urine sample is well documented. Thus, there remains a need for a rapid, specific and reproducible technique that is able to detect a cervical chlamydia infection using a female urine sample. Web site: http://www.delphion.com/details?pn=US06010857__ ·
Antigenic peptides of Chlamydia trachomatis Inventor(s): DeMars; Robert I. (Madison, WI), Ortiz; Linette (Pardeeville, WI) Assignee(s): Wisconsin Alumni Research Foundation (Madison, WI) Patent Number: 6,001,372 Date filed: August 25, 1995 Abstract: Disclosed herein are short antigenic peptides of MOMP protein from Chlamydia trachomatis. They can be used to stimulate antigenic responses and to diagnose the presence of the bacteria. Excerpt(s): The present invention relates to antigenic peptide fragments of the major outer membrane protein ("MOMP") from Chlamydia trachomatis. These peptides appear to be especially well suited for use in detecting the presence of blood lymphocytes that specifically recognize these bacteria (as an indicator of prior infection) and for provoking immune responses to MOMP. ... Chlamydia trachomatis ("CT") is an intracellular bacteria that is the leading cause of preventable infectious blindness (ocular trachoma) in the developing world and of sexually transmitted disease ("STD") in the United States and certain other parts of the developed world. The estimated annual incidence of CT-caused STD is in the millions. While most CT caused disease can be treated with antibiotics, untreated or inadequately treated infections result in hundreds of thousands of cases of pelvic inflammatory disease each year in the United States, alone. Adverse outcomes of pregnancy, ectopic pregnancy and tubal infertility are among the consequences. Moreover, apparent clearance of infection by a given serovar (serologically distinct
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strain of CT) can be followed by the infection becoming latent and prolonged or by re-infection. This is important because much CT-caused pathology results from tissue-damaging inflammatory responses of the immune system that are triggered by repeated or prolonged exposures to the whole organism. Therefore, there is a need for: (i) means to detect signs of prior or of persistent covert infection in individuals who have pelvic inflammatory disease or its sequelae listed above; and (ii) means to prevent primary and repeat infections. ... As such, a need exists for short antigenic MOMP fragments that are present in most or all Chlamydia trachomatis serovars and also are recognized by most human MHC types. Web site: http://www.delphion.com/details?pn=US06001372__ ·
Feline vaccines containing Chlamydia psittaci and method for making the same Inventor(s): Atherton; Rebecca A. (Shawnee, KS), Schmeer; Norbert (Haan, DE), Hallstrom; Jean A. (Merriam, KS), Lane; Jennifer K. (Shawnee, KS), Hennessy; Kristina J. (Parkville, MO) Assignee(s): Bayer Corporation (Pittsburgh, PA), Baker Aktiengesellschaft (Leverkusen, DE) Patent Number: 5,972,350 Date filed: May 6, 1996 Abstract: The present invention relates to feline vaccines comprising inactivated a non reactive Chlamydia psittaci for prevention and treatment of chlamydia diseases in cats. Excerpt(s): Feline chlamydiosis is a common conjunctival and respiratory disease of cats known as feline pneumonitis (FPn). This highly contagious disease is characterized by sneezing and coughing and is accompanied by mucopurulent ocular and nasal discharges. All age groups of cats are susceptible and, although mortality is not great, infected kittens and older cats may become severely debilitated. Because of its extreme infectivity, feline chlamydiosis constitutes a major problem in pet hospitals, clinics and catteries. There is some thought that persistent genital tract infection by Chlamydia psittaci is a cause of reproductive failure in catteries. ... Vaccination studies with modified-live compositions of Chlamydia psittaci have produced conflicting results. Cello (Am. J. Vet. Med. Assoc. 158:932-938, 1971) indicated that such vaccines demonstrated no significant protection of cats. Shewen, et al. (Can. J. Comp. Vet. Res. 44:244-251, 1980) indicated partial protection while McKercher (Am. J. Vet. Res. 13:557-561, 1952) and others indicated
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almost complete protection by such vaccines. However, because the vaccinated cats are receiving live Chlamydia psittaci. some vaccine organisms can shed to other cats and reversion has been proposed to occur. ... Studies with inactivated chlamydia vaccines have produced mixed results and unacceptable local and systemic reactions in vaccinated cats. Comparative challenge studies conducted with four inactivated vaccine preparations and a commercial modified-live vaccine demonstrated that the inactivated preparations conferred virtually no protection against chlamydia infection in cats (Shewen et al, Can. J. Comp. Med. 44:244-30 251, 1980). An inactivated Chlamydia psittaci vaccine has been described by Chu et al. (U.S. Pat. No. 5,242,686). However, this vaccine is not purified and causes unacceptable local reactions when administered to cats (COMPENDIUM). Web site: http://www.delphion.com/details?pn=US05972350__
Patent Applications on Chlamydia As of December 2000, U.S. patent applications are open to public viewing.24 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to chlamydia: ·
Chlamydia oligosaccharides Inventor(s): Kuo, Cho-chou ; (Seattle, WA), Swanson, Albertina F. ; (Tucson, AZ), Hakomori, Sen-Itiroh ; (Seattle, WA), Takahashi, Noriko ; (Nagoya, JP) Correspondence: Dean H. Nakamura; Roylance Abrams Berdo & Goodman; 1300 19th Street, N.W.; Washington; DC; 20036; US Patent Application Number: 20020049172 Date filed: September 13, 2001 Abstract: Oligosaccharides specific for Chlamydia mediate attachment of the organism to host cells. Excerpt(s): Chlamydia trachomatis is one of the most common causes of blindness and sexually transmitted diseases in humans. C. trachomatis is an obligate intracellular bacterium which is biphasic. The intracellular form is the metabolically active reticulate body and the extracellular form
24
This has been a common practice outside the United States prior to December 2000.
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is the infectious elementary body (EB) (Moulder et al. (1984) in Bergey's Manual of Systemic Bacteriology (Krieg, ed.) 1:729-735, Williams & Wilkins, Baltimore). ... A prominently exposed component on the surface of the chlamydial EB involved in the initial interaction between C. trachomatis and the host cell is the major outer membrane protein (MOMP; Mr 40,000) (Caldwell & Judd (1982) Infect. Immun. 38:960-968). The MOMP is the principal structural protein of the EB and individual MOMP proteins are cross-linked by disulfide bonds to provide rigidity to the cell wall (Newhall & Jones (1983) J. Bacteriol. 154:998-1001). The serologic specificity of the organism resides in the MOMP and antibodies raised to MOMP can neutralize infectivity of chlamydia (Caldwell & Perry (1982) Infect. Immun. 38:745-754; Lucero & Kuo (1985) Infect. Immun. 50:595-597). ... MOMP and two other chlamydial proteins (Mr 32,000 and 18,000) were identified as glycoproteins when the organisms were probed with various plant lectins (Swanson & Kuo (1990) Infect. Immun. 58:502-507). Further characterization showed the three proteins to be glycosylated by way of N-linkage, a structure means rarely found in bacteria (Wieland (1988) Biochimie, 70:1493-1504). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Cytotoxic T lymphocyte epitopes of the major outer membrane protein of chlamydia trachomatis Inventor(s): DeMars, Robert I. ; (Madison, WI), Kim, Seon-Kyeong ; (Sunnyvale, CA) Correspondence: Carl R. Schwartz, Esq.; Quarles and Brady LLP; Suite 2040; 411 E. Wisconsin Avenue; Milwaukee; WI; 53202-4497; US Patent Application Number: 20010041788 Date filed: December 28, 2000 Abstract: Disclosed herein are 9 amino acid-long peptides from the major outer membrane protein (MOMP) of Chlamydia trachomatis serovar E. These peptides activate CD8+ cytotoxic T-lymphocytes in human infections that are potentially important for resolution of infection and protection against disease. Thus, the peptides, as well as DNA coding for them, are intended for use in vaccination of humans. Also, they are useful in connection with diagnostic tests. Excerpt(s): The present invention relates to nine amino acid-long peptides of the major outer membrane protein ("MOMP") from Chlamydia trachomatis ("Ct"). These peptides activate human cytotoxic Tlymphocytes ("CTLs"). ... A great deal of effort has been put into developing a vaccine against diseases caused by Ct infections. While
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whole inactivated organisms are often used as a vaccine to immunize humans, such a vaccine is not desirable in the case of Ct because certain proteins expressed by Ct, such as chlamydial heat shock proteins, induce pathological immune responses rather than protective immune responses and, thus, contribute to disease. As a result, much vaccine-related activity in chlamydial research is centered on developing a "subunit vaccine" that consists only of Ct protein antigens or specific parts of the proteins that elicit protective immune responses in vaccinees. The fact that B-cell responses (neutralizing antibody) to Ct MOMP protect mice from Ctcaused disease has led to a prevailing theory that MOMP, when used to vaccinate humans, might also induce protective B- and T-cell responses. ... In yet another form, the invention discloses vaccine candidates containing such peptides or nucleotide sequences. The vaccines are designed to induce cytotoxic T lymphocyte ("CTL") responses in humans so as to increase the capacity of humans to resist adverse diseases resulting from Chlamydia trachomatis ("Ct") infection. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Methods for in Vitro Susceptibility Testing of Chlamydia Inventor(s): Stratton, Charles W; (Nashville, TN), Mitchell, William M ; (Nashville, TN) Correspondence: Karen F. Elbing; Clark and Elbing; 176 Federal Street; Boston; MA; 02110; US Patent Application Number: 20010002421 Date filed: February 18, 1998 Abstract: Methods for determining the susceptibility of intracellular pathogens, particularly Chlamydia, to single or combination of test agents are described. The methods can be used for in vitro or in vivo evaluation of agents that can be used as therapeutic agents in the treatment/eradication of pathogen infection in general or to target a specific infected organ. Assays which utilize nucleic amplification techniques (e.g., PCR) to determine effectiveness of the agent(s) evaluated are also described. Excerpt(s): It has long been recognized that the appropriate use of susceptibility testing allows the most effective use of antimicrobial agents for the therapy of infectious diseases (1,2). Susceptibility testing for microorganisms such as the chlamydiae that cannot be cultured without the use of animal or tissue cultures is well recognized as being quite difficult (3,4). Early work used embryonated egg yolk sacs and animal models, but these techniques were slow and cumbersome (5). In vitro
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susceptibility testing of chlamydiae is currently done using tissue culture cell lines (3-10). In these cell culture procedures, cycloheximide or a similar agent is routinely used to impair host cell metabolism and thus provide intracellular conditions in the host cell that enhance chlamydial growth. The use of cycloheximide has been found to increase the size and visibility of the chlamydial inclusion bodies. After a period of incubation, visual detection of inclusion bodies or immunochemical detection of chlamydial antigen is the endpoint (3,4). The minimal inhibitory concentration (MIC) is generally defined as the lowest concentration of antimicrobial agent at which no inclusion is seen after incubation. The minimal chlamydiacidal concentration (MCC) is defined as the lowest concentration of antimicrobial agent at which no inclusion is seen after several passages. ... The murine model has been used extensively for the in vivo evaluation of chlamydial infection (11-18). Therefore, it is not surprising that in addition to in vitro cell culture methods, the murine model of chlamydial infection is also used for in vivo susceptibility testing (17). ... Susceptibility testing of chlamydiae, including the most recent species C. pneumoniae, has been relatively extensive considering the difficulties encountered in testing an intracellular microorganism (3,5,10,19-21), and the results are considered to be consistent (5). However, in vitro susceptibility testing methods for chlamydiae are not standardized in terms of the testing conditions (3,4). Standardization of testing conditions for susceptibility testing is a well recognized requirement in general (1,2) and likewise should be required for chlamydiae (3). Moreover, results from in vitro susceptibility testing methods using current tissue culture conditions may not reflect the results seen with in vivo conditions (1-3). For example, Wyrick et al. (22) has shown that susceptibility testing results were different with polarized human endothelial cells as opposed to nonpolarized cells. Other conditions of testing have been found to markedly influence the results of chlamydial susceptibility testing (17). The timing of the addition of the antimicrobial agents to the cell culture is particularly important: the addition of agents before infection of the cell culture may lower the MICs and MCCs by 8-fold (23). Accordingly, the antimicrobial agents are usually added 30 to 60 minutes after the cells are infected (3,4). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with chlamydia, you can access the U.S. Patent Office archive via the Internet at
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no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “chlamydia” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on chlamydia. You can also use this procedure to view pending patent applications concerning chlamydia. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Bronchitis: Inflammation of one or more bronchi. [EU] Chlamydiaceae: A family of gram-negative, coccoid microorganisms, in the order chlamydiales, pathogenic for vertebrates. Genera include chlamydia and chlamydophila. [NIH] Chlamydophila: A genus of the family chlamyidaceae comprising gramnegative non chlamydia trachomatis-like species infecting vertebrates. Chlamydophila do not produce detectable quantities of glycogen. The type species is chlamydophila psittaci. [NIH] Cycloheximide: Antibiotic substance isolated from streptomycin-producing strains of Streptomyces griseus. It acts by inhibiting elongation during protein synthesis. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Fibroblasts: Connective tissue cells which secrete an extracellular matrix
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rich in collagen and other macromolecules. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Lectins: Protein or glycoprotein substances, usually of plant origin, that bind to sugar moieties in cell walls or membranes and thereby change the physiology of the membrane to cause agglutination, mitosis, or other biochemical changes in the cell. [NIH] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Metabolite: process. [EU]
Any substance produced by metabolism or by a metabolic
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Mucopurulent: Containing both mucus and pus. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Sinusitis: Inflammation of a sinus. The condition may be purulent or nonpurulent, acute or chronic. Depending on the site of involvement it is known as ethmoid, frontal, maxillary, or sphenoid sinusitis. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
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CHAPTER 6. BOOKS ON CHLAMYDIA Overview This chapter provides bibliographic book references relating to chlamydia. You have many options to locate books on chlamydia. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on chlamydia include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “chlamydia” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on chlamydia:
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·
Texas Resource Guide for HIV/STD Education for Health Education Professionals Contact: Texas Department of Health, Bureau of HIV and STD Prevention, 1100 W 49th St, Austin, TX, 78756-9987, (512) 490-2500, http://www.tdh.state.tx.us/hivstd/. Summary: This directory, for health education professionals, provides a comprehensive listing of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and sexually transmitted disease (STD) resources in Texas. It discusses what individuals can do to become involved in HIV/STD prevention; legal mandates related to health education; STDs; HIV transmission; riskfactors; information on diseases including chlamydia, hepatitis, syphilis, and vaginitis; model education programs and other training opportunities; school-aged HIV/STD education resources; legal resources; special resources (e.g., on sexual abstinence, self-esteem, and sexual education); statistics; HIV/STD resources including treatment resources and training centers; and other resources on abuse, condoms, hemophilia, pharmacies, sex workers, and special populations. It provides helpful telephone numbers for HIV/STD resources in Texas.
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Abstinence: Making Responsible Decisions Contact: Macmillan/McGraw-Hill, Glencoe Division, 936 Eastwind Drive, Westerville, OH, 43081. Summary: This study guide covers teen sexuality and promotes sexual abstinence in the prevention of unplanned pregnancies and sexually transmitted diseases (STDs). It discusses making good decisions; various aspects of dating and relationship building; the physical, emotional, and social consequences of having sex as an adolescent; and the transmission, symptoms, possible long-term effects, and treatment of STDs including chlamydia, gonorrhea, syphilis, genital herpes, vaginitis, the human papillomavirus (HPV), parasitic infections, and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS).
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Sexually Transmissible Diseases Source: Guidelines for Women's Health Care; 1996. Contact: American College of Obstetricians and Gynecologists, PO Box 96920, Washington, DC, 20090-6920, (202) 638-5577, http://www.acog.com.
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Summary: This book chapter reviews the assessment, evaluation, diagnosis, and treatment of sexually transmitted diseases (STDs). The chapter provides an overview and history of the more common STDs followed by guidelines for the treatment of gonorrhea, pelvic inflammatory disease, chlamydia, syphilis, trichomoniasis, herpes simplex virus, human papillomavirus, bacterial vaginosis, candidal vaginitis, hepatitis B, and HIV. ·
Adolescent Health: State of the Nation, Monograph Number 2: Pregnancy, Sexually Transmitted Diseases, and Related Risk Behaviors Among U.S. Adolescents Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and, Health Promotion, Division of Adolescent and School Health, 3005 Chambelle Tucker Rd, Atlanta, GA, 30341-3724, (770) 448-3252. Summary: This monograph reports on the consequences of early, unprotected sexual intercourse among adolescents. It is designed to provide state and local education and health agencies with information about priority health outcomes among adolescents aged 10-24 years. The monograph shows changes over time in the rates of pregnancy, abortion, live births, gonorrhea, and chlamydia. In addition, the national and state profiles include data about live birth rates and trends by age group; live birth rates by race/ethnicity; pregnancy rates (both abortion and live births) by age group; gonorrhea rates and trends by age group and sex; chlamydia cases, rates, and trends by sex; cumulative AIDS case counts by age group and sex; and related risk behaviors for high school students by sex.
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STD Counseling and Treatment Guide Contact: American Social Health Association, PO Box 13827, Research Triangle Park, NC, 27709, (919) 361-8400. Summary: This handbook contains guidelines and patient management protocol for health care providers who treat patients with sexually transmitted diseases (STD). The handbook serves as a tool for physicians who want to improve the STD counseling component of their clinical practice. Part one includes suggestions for communicating more effectively with patients about the behaviors, issues, and emotions that affect STD infection rates and successful treatment. In part two, CDC treatment guidelines for each major STD are presented in an accessible format. Part three provides in-depth information on chlamydia. The
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appendices contain telephone referrals and a sample of the sexual health history form. ·
Guidelines for Perinatal Care Source: Guidelines for Perinatal Care; 3rd edition, 1992. Contact: American College of Obstetricians and Gynecologists, PO Box 96920, Washington, DC, 20090-6920, (202) 638-5577, http://www.acog.com. American Academy of Pediatrics, Department of Maternal Child and Adolescent Health, Committee on Pediatric AIDS, 141 NW Point Blvd, Elk Grove Village, IL, 60007-1098, (847) 434-4000, http://www.aap.org. Summary: This book chapter focuses on the clinical management of viral and bacterial perinatal infections. These include cytomegalovirus, herpes simplex, the human immunodeficiency virus (HIV), human papillomavirus, human parvovirus, rubella, varicella-zoster, group B streptococcal, listeriosis, syphilis, lyme disease, and chlamydia infection. For each of these infections, guidelines are provided on treatment and counseling during pregnancy, obstetric management, management of exposed newborns, nursery management, and early diagnosis. The section on HIV focuses on diagnostic criteria for adults, children, and infants; prevention; and management after delivery.
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Sexually Transmitted Diseases: Problems in Primary Care Contact: Practice Management Information Corporation, 4727 Wilshire Blvd Ste 300, Los Angeles, CA, 90010, (800) 633-7467. Summary: This monograph provides basic and practical information on sexually transmitted diseases (STDs). It is designed for physicians, particularly those practicing family and emergency medicine. The monograph describes how various STDs are spread and exactly what is meant by safe sexual practices. It covers the many types of venereal disease (VD) currently prevalent, as well as non-VD infections that can be spread by sexual contact. Each chapter deals with one type of disease, or groups of closely related diseases or infections. Methods of recognizing, treating, and preventing each disease are covered. The effectiveness and outcome statistics for treatments are discussed, with effectiveness based on current sensitivities of the infecting organism. The type of the organism and its life cycle are described. Chapters on the "classic" STDs include: gonorrhea, syphilis, lymphogranuloma venereum, and chancroid. Other chapters discuss: HIV infection, herpes simplex, cytomegalovirus (CMV), human papilloma virus (HPV), hepatitis, and
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chlamydia. The monograph also contains information concerning related topics such as management of rape victims and contraception. ·
Reasonable Reasons to Wait: Family Life and Character Formation; Student Handbook Contact: An Educated Choice, Inc., Teen Choice, 6201 Leesburg Pike Ste 404, Falls Church, VA, 22044, (703) 532-9455. Summary: This guide is the student handbook of an eight unit sexual abstinence and human sexuality curriculum for high school students. The curriculum covers human development, peer pressure, premarital sex, chemical use and abuse, and the freedom associated with sexual selfcontrol and regaining that self-control. The first unit contains exercises and information that support the decision to remain abstinence until marriage. Unit Two reviews the impact that peer pressure and the need for acceptance often has on the adolescent's sexual behavior. The third unit covers the purpose and responsibilities of dating and the benefits of establishing long lasting relationships. Unit four discusses the facts about common sexually transmitted diseases, including HIV, chlamydia, syphilis, genital herpes, and gonorrhea. Unit five emphasizes the importance of building a solid foundation to marriage relationship. The sixth unit covers the elements and purpose of marriage. Unit seven presents the prerequisites for parenting, and the eighth unit contains the basics of human development.
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Social Diseases Source: The Serious Sides of Sex. Contact: Nevbet Company, 2843 Brownsboro Rd, Louisville, KY, 40206, (502) 897-1664. Summary: This book chapter discusses a dozen Sexually transmitted diseases (STD's), including Acquired immunodeficiency syndrome (AIDS), chancroid, chlamydia, gonorrhea, nonspecific urethritis, syphilis, vaginitis, genital herpes, genital warts, Hepatitis B, pubic lice, and scabies. Symptoms, treatment, diagnosis, and consequences for sexual partners are covered for each. The chapter also looks at public health, education, and ethical, legal, medical and psychological issues involved in STD transmission.
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Sexually Transmitted Diseases Source: Healthy People 2000: National Health Promotion and Disease Prevention Objectives.
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Contact: US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. Summary: This book chapter, located in the second volume of the Healthy People 2000 report, looks at Sexually transmitted diseases (STD's) and their extreme effects on adolescents, women, and children. The chapter looks at targets by the year 2000 for resources and treatments for STD's, including Human immunodeficiency virus (HIV) infection. It lists goals for treatment of gonorrhea, chlamydia, syphilis, congenital syphilis, genital herpes and genital warts, pelvic inflammatory disease, hepatitis B, and repeat gonorrhea infection. It also looks at adolescent postponement of sexual intercourse, condom use, clinic services for Acquired immunodeficiency syndrome (AIDS) and other STD's, STD education in schools, management of STD cases, clinician counseling to prevent STD's, and partner notification of exposure. ·
Sexually - Transmitted Diseases Contact: Daniel Memorial Institute, Incorporated, 3725 Belfort Rd, Jacksonville, FL, 32216, (904) 448-7612. Summary: This teaching guide enables trainers to teach foster parents about sexually transmitted diseases (STDs) as they may affect the children that they will care for. The first section starts off by looking at long-term effects and general symptoms of STDs. It then provides specific symptoms, long-term effects, and treatment for a number of common STDs, including: chlamydia, genital herpes, genital warts, vaginitis, gonorrhea, syphilis, AIDS, crab lice, Hepatitis, and gastrointestinal STDs. The second section teaches caregivers how to recognize those members of the foster-care population who are at risk for STDs; that group includes infants, abused children, and sexually active youth. The third section gives guidance on dealing with STD-infected children. This section presents detailed information on AIDS, including symptoms; routes of transmission; prevention, such as condom use; and talking with children about AIDS. Myths of casual contact transmission are dispelled.
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New Pathways to Health: Lessons for Teaching About AIDS and Other STDs (Sexually Transmitted Diseases) - Senior High School Contact: Los Angeles Unified School District, Office of Health Education Programs, 1320 W Third St Rm 34, Los Angeles, CA, 90012, (213) 6256411. Summary: This AIDS and other sexually transmitted diseases (STD's) instructional guide for teachers of senior high schools provides a framework for AIDS and STD instruction. It is structured to provide
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students with the facts and critical-thinking skills that will enable them to make informed decisions that will reduce their chances of contracting an STD. It is comprised of 8 lesson plans which constitute teaching objectives, materials, procedures, content, and activities. The lesson plans include information on STD's, the body's defenses against disease, chlamydia, gonorrhea, syphilis, AIDS, genital herpes, reducing the risks of STD's, STD's and the law, and communicating about AIDS and other STD's. Worksheets, factsheets, and a resource list are included. ·
VD! STD! or What? Some Facts About Sexually Transmitted Diseases. Translated title Contact: Hawaii Department of Health, AIDS/STD Project, AIDS Prevention Project, PO Box 3378, Honolulu, HI, 96816, (808) 735-5303. Summary: This monograph gives young people basic information about Sexually transmitted diseases (STD's) so they can protect themselves against them. Descriptions of the symptoms of gonorrhea, syphilis, chlamydia, vaginitis, genital herpes, venereal warts, and Human immunodeficiency virus (HIV) are given. The reader is counseled to know one's sex partner, to use condoms, and to seek treatment if symptoms appear. The location of a local clinic is given.
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AIDS and Infections of Homosexual Men Contact: Butterworth Heinemann Publishers, 225 Wild Wood Ave, Woburn, MA, 01801, (800) 366-2665. Summary: This monograph details clinical information on infections related to Acquired immunodeficiency syndrome (AIDS) that occur in homosexual men. The first section examines nondiarrheal Sexually transmitted disease (STD's), such as syphilis and proctitis due to Chlamydia trachomatis, and also examines the relationship of Human immunodeficiency virus (HIV) infection to infections with pathogenic neisseria. In the second section, authors turn to diarrheal STD's, including gay bowel syndrome, bacterial diarrhea, parasitic infectious diseases, cryptosporidiosis, isosporiasis, and microsporidiosis. The third section studies other STD's, beginning with Hepatitis B transmission as a model for AIDS. It also studies herpes simplex virus infection, cytomegalovirus infection in both healthy and immune deficient homosexual men, and laboratory diagnosis of STD's and opportunistic infections. The fourth section looks at infectious and neoplastic complications. It opens with a chapter on HIV as the etiologic agent of AIDS, then gives a revision of the Centers for Disease Control and Prevention (CDC) surveillance case definition for AIDS. The section also includes chapters on surveillance and epidemiology in the U.S between 1981 and 1985; clinical
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manifestations of Kaposi's Sarcoma and its treatment; neurology in AIDS; AIDS in prostitutes, children, and prisoners; AIDS in Europe; and opportunistic infections and their treatment. The fifth section turns to immunologic evaluation methods and controls, such as analysis of mechanisms of immune suppression. It also deals with immunologic responses, epidemiologic observations of immunologic abnormalities, immunogenetic findings in patients with Kaposi's Sarcoma, the significance of endogenous interferon and interferon-induced enzymes in patients with AIDS, and approaches to AIDS therapy. The sixth and final section provides a diagnostic perspective.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to chlamydia (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Chlamydia by Per-Anders Mardh, et al (1989); ISBN: 0306429659; http://www.amazon.com/exec/obidos/ASIN/0306429659/icongroupin terna
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Chlamydia and Chlamydia Induced Diseases by Johannes Storz; ISBN: 0398018707; http://www.amazon.com/exec/obidos/ASIN/0398018707/icongroupin terna
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Chlamydia Research: Proceedings of the European Society (1988); ISBN: 9122012206; http://www.amazon.com/exec/obidos/ASIN/9122012206/icongroupin terna
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Chlamydia: Intracellular Biology, Pathogenesis, and Immunity by Richard S. Stephens (Editor); ISBN: 1555811558; http://www.amazon.com/exec/obidos/ASIN/1555811558/icongroupin terna
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Chlamydial Infections by Peter Reeve (Editor); ISBN: 0387165525; http://www.amazon.com/exec/obidos/ASIN/0387165525/icongroupin terna
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Chlamydial Infections by P. A. Mardh; ISBN: 0444804315; http://www.amazon.com/exec/obidos/ASIN/0444804315/icongroupin terna
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Chlamydial Infections (1987); ISBN: 3540165525; http://www.amazon.com/exec/obidos/ASIN/3540165525/icongroupin terna
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Chlamydial Infections: Proceedings of Seventh International Symposium on Human Chlamydial Infections by William R. Bowie (1990); ISBN: 0521390826; http://www.amazon.com/exec/obidos/ASIN/0521390826/icongroupin terna
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Chlamydial Infections: Proceedings of the Sixth International Symposium on Human Chlamydial Infections, Sanderstead, Surrey, 1521 June 1986 by David Oriel; ISBN: 052132453X; http://www.amazon.com/exec/obidos/ASIN/052132453X/icongroupi nterna
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Chronic Infection, Chlamydia and Coronary Heart Disease (Developments in Cardiovascular Medicine, 218) by Sandeep Gupta, Camm. A. John (1999); ISBN: 0792357973; http://www.amazon.com/exec/obidos/ASIN/0792357973/icongroupin terna
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Diagnostic Procedures for Viral, Rickettsial and Chlamydial Infections by Nathalie J. Schmidt (Editor), Richard W. Emmons (Editor); ISBN: 0875531555; http://www.amazon.com/exec/obidos/ASIN/0875531555/icongroupin terna
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Genital Infection by Chlamydia Trachomatis (Current Topics in Infection, Vol 2) by J. D. Oriel (Editor), et al (1982); ISBN: 0444007008; http://www.amazon.com/exec/obidos/ASIN/0444007008/icongroupin terna
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Guide to the collection and transport of virological specimens (including chlamydial and rickettsial specimens) by C. R. Madeley; ISBN: 9241540559; http://www.amazon.com/exec/obidos/ASIN/9241540559/icongroupin terna
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Infecciones por Chlamydia Trachomatis by Dr. Gabriel GonzálezAlmaráz; ISBN: 9709123602; http://www.amazon.com/exec/obidos/ASIN/9709123602/icongroupin terna
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Laboratory Diagnosis of Chlamydia Trachomatis Infections: 19a (Cumitech Ser.) by Ann Warford, et al (1984); ISBN: 9990058164; http://www.amazon.com/exec/obidos/ASIN/9990058164/icongroupin terna
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Microbiology of Chlamydia by Almen L. Barron (Editor) (1988); ISBN: 0849368774; http://www.amazon.com/exec/obidos/ASIN/0849368774/icongroupin terna
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Rickettsial and Chlamydial Diseases of Domestic Animals by Zerai Woldehiwet (Editor), Miodrag Ristic (Editor); ISBN: 0080408311; http://www.amazon.com/exec/obidos/ASIN/0080408311/icongroupin terna
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Sexually Transmitted Chlamydial Infections: New Approaches to Treatment (International Congress and Symposium Series, No 111) by D. Taylor-Robinson (Editor); ISBN: 090595842X; http://www.amazon.com/exec/obidos/ASIN/090595842X/icongroupi nterna
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Sexually Transmitted Diseases Sourcebook: Basic Information About Herpes, Chlamydia, Gonorrhea, Hepatitis, Nongonoccocal Urethritis, Pelvic inflammat by Linda M. Ross (Editor), Peter Dresser (Editor); ISBN: 0780802179; http://www.amazon.com/exec/obidos/ASIN/0780802179/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “chlamydia” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:25 In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and
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Association of oral contraceptives, trichomonas vaginalis infection and pelvic inflammatory disease [microform]. Author: R.E. Aubert; Year: 1990; Ann Arbor, Michigan, University Microfilms International, 1990 Barrier contraceptives and sexually transmitted diseases. Author: M.J. Rosenberg, J.H. Chen; Year: 1990; 1990
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Chlamydia: intracellular biology, pathogenesis, and immunity. Author: edited by Richard S. Stephens; Year: 1999; Washington, D.C.: ASM Press, c1999; ISBN: 1555811558 (hardcover) http://www.amazon.com/exec/obidos/ASIN/1555811558/icongroupin terna
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Chlamydial infections: proceedings of the Seventh International Symposium on Human Chlamydial Infections, Harrison Hot Springs, British Columbia, Canada, 24-19 June 1990. Author: edited by William R. Bowie ... [et al.]; Year: 1990; Cambridge; New York: Cambridge University Press, 1990; ISBN: 0521390826 http://www.amazon.com/exec/obidos/ASIN/0521390826/icongroupin terna
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Chlamydial infections amongst Egyptian intrauterine device users. Author: M.F. Shaltout ... [et al.]; Year: 1984; [1984]
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Chronic infection, Chlamydia, and coronary heart disease. Author: by Sandeep Gupta and A. John Camm; Year: 1999; Dordrecht; Boston: Kluwer Academic Publishers, c1999; ISBN: 0792357973 (hb: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0792357973/icongroupin terna
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Diagnostic procedures for viral, rickettsial, and chlamydial infections. Author: Gupta, Sandeep, MD; Year: 1995; Washington, DC: American Public Health Association, c1995; ISBN: 0875532209 http://www.amazon.com/exec/obidos/ASIN/0875532209/icongroupin terna
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Epidemiology of chlamydia and gonorrhoea. Author: prepared by Gavin Hart; Year: 1991; Rundle Mall: South Australian Health Commission, Public and Environmental Health Division, [1991?]; ISBN: 0724340475
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Genital ulcers and oral contraceptives facilitate male-female transmission of HIV. Author: F.A. Plummer ... [et al.]; Year: 1987; 1987
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Infertility and sexually transmitted disease: major problems in maternal and child health and family planning. Author: L.A. Mtimavalye, M.A. Belsey; Year: 1987; 1987
PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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Laboratory diagnosis of Chlamydia trachomatis infections. Author: Ann Warford, Max Chernesky, and Ellena M. Peterson; coordinating editor, Curt A. Gleaves; Year: 1999; Washington, DC: American Society for Microbiology Press, 1999
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Management of genital Chlamydia trachomatic infection: a national clinical guideline. Author: Scottish Intercollegiate Guidelines Network; Year: 2000; Edinburgh, Scotland: SIGN, 2000
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New treatments for Chlamydia trachomatis genital infection. Author: J.T. Weber, R.E. Johnson; Year: 1993; 1993
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Partners in Health. Sexuality: contraceptive and reproductive health issues. Author: B.C. Sloane, M. Taylor, M.E. Leonard; Year: 1986; Columbus, Ohio, Charles E. Merrill Publishing, 1986
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Pathophysiology and epidemiology of sexually transmitted diseases in relation to pelvic inflammatory disease and infertility. Author: W. Cates, Jr., R.T. Rolfs, Jr., S.O. Aral; Year: 1988; 1988
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Proceedings of the European Society for Chlamydia Research: Bologna, Italy, May 30th-June 1st 1988. Author: Hart, Gavin; Year: 1988; [Bologna]: University of Bologna; Stockholm, Sweden: Almqvist & Wiksell International, [1988?]; ISBN: 9122012206 http://www.amazon.com/exec/obidos/ASIN/9122012206/icongroupin terna
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Report on the study to evaluate the prevention of Trichomoniasis and Chlamydia reinfection by compliant use of WPC-333 (Reality) female condom. Author: G. Shangold ... [et al.]; Year: 1991; [1991]
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Rickettsial and chlamydial diseases of domestic animals. Author: edited by Zerai Woldehiwet and Miodrag Ristic; Year: 1993; Oxford; New York: Pergamon Press, 1993; ISBN: 0080408311 http://www.amazon.com/exec/obidos/ASIN/0080408311/icongroupin terna
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Risky sex. The onslaught of sexually transmitted diseases. Author: S.J. Genuis; Year: 1991; Edmonton, Canada, KEG Publishing, 1991
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Sexually transmitted diseases and fertility: a case study of Mahalapye Subdistrict, Botswana. Author: M. Edlinger; Year: 1988; Groningen, Netherlands, Groningen State University, Geographical Institute, 1988 Survey of research on sexually transmitted diseases. Author: S.L. Deyette; Year: 1987; Atlanta, Georgia, Centers for Disease Control, Center for Prevention Services, Division of Sexually Transmitted Diseases, 1987
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Treatment of endometriosis and other disorders and infections. Author: edited by Y. Boutaleb and A. Gzouli; Year: 1991; Carnforth, Lancs, UK; Park Ridge, N.J., USA: Parthenon Pub. Group, c1991; ISBN: 185070287X
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http://www.amazon.com/exec/obidos/ASIN/185070287X/icongroupi nterna ·
Vaginal infections in relationship to contraceptive usage [microform]. Author: S.A. Bushey; Year: 1989; Ann Arbor, Michigan, University Microfilms International, 1989
Chapters on Chlamydia Frequently, chlamydia will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with chlamydia, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and chlamydia using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “chlamydia” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on chlamydia: ·
Cultures: Pinpointing the Cause of Infection Source: in Shaw, M., et al., eds. Everything You Need to Know About Medical Tests. Springhouse, PA: Springhouse Corporation. 1996. p. 617636. Contact: Available from Springhouse Publishing. Attention: Trade and Textbook Department, 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477-0908. (800) 331-3170 or (215) 646-4670 or (215) 646-4671. Fax (215) 646-8716. Price: $24.95 (as of 1995). ISBN: 0874348234. Summary: This section on cultures is from a consumer reference guide to over 400 diagnostic tests. For each test, the book covers the reasons for performing the test; what patients should know before the test; what to expect during and after the test; risk factors associated with the test; the normal results; and what abnormal results mean. Tests in this section include general cultures, including urine culture, stool culture, throat culture, nasopharyngeal culture, sputum culture, blood culture, wound culture, stomach culture, and intestinal culture; and genital cultures, including culture for gonorrhea, for herpes, and for chlamydia.
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Health Behaviors Source: in Georgia Women's Health Survey: 1995: Preliminary Report. Serbanescu, F.; Rochat, R. Atlanta, GA, Division of Public Health, Georgia Department of Human Resources, pp. 71-90, October 1996. Contact: Office of Perinatal Epidemiology, Epidemiology and Prevention Branch, Division of Public Health, Georgia Department of Human Resources, Atlanta, GA. Summary: Health Behaviors, a chapter in Georgia Women's Health Survey: 1995: Preliminary Report, presents survey findings on the health behaviors of Georgia women, including (1) cigarette smoking, (2) alcohol intake, (3) cervical cancer screening, (4) prevalence of sexually transmitted diseases (STD's), (5) self-assessed physical and mental health, and (6) perceived levels of current stress. The findings indicated that 65 percent of the women had never smoked and 24 percent were current smokers. Of the ever smokers, 31 percent have stopped smoking. Current smoking was more prevalent among white than black women, among previously married than currently married women, and among nonchurch attenders than those who attend church weekly. Forty-five percent of the women reported not using alcohol and 48 percent averaged less than one drink daily during the past year. Four percent averaged one drink daily and 2 percent averaged two or more drinks per day during the past year. Overall, 15 percent were binge or chronic drinkers. Binge or chronic drinking was more common among whites than blacks, among those with no children than those with one or two children, and among those who never attend church compared with those who attend church monthly or weekly. Binge or chronic drinking was also more common among those with no insurance or private insurance than among those with Medicaid. Eighty-nine percent of all women had ever had a Papanicolaou (Pap) smear test. Over 96 percent of women age 18 to 44 years had ever had a Pap smear test and 99 percent of women with living children had had a Pap smear. Sixty-four percent of the women had had a Pap smear in the past year, 16 percent in the past 1 to 2 years, 5 percent 2 to 3 years ago, and 5 percent more than 3 years ago. Nine percent of the women overall had ever been clinically diagnosed with one of four STD's: (1) Genital warts, (2) chlamydia, (3) gonorrhea, and (4) genital herpes. The prevalence of having had any one STD increased from 3.5 percent with one lifetime partner to 26 percent for those with nine or more partners. The STD prevalence was higher in Atlanta than elsewhere, for those with low incomes, and for those who were previously married. Overall, 38 percent of the women reported their physical health as excellent, 49 percent as good, and 13 percent as fair or poor. Compared with the state average, fair or poor health was reported
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more frequently by Medicaid recipients, those with no health insurance, those who had not completed high school, and blacks. Sixty percent of all women reported their mental health as excellent, 40 percent as good, and 7 percent as fair or poor. Compared with the state average, fair or poor mental health was reported more frequently by Medicaid recipients, women with high school or less education, and by previously married women. Only 17 percent of all women reported not feeling stressed during the preceding week. Twenty percent reported feeling very stressed, 17 percent stressed, and 46 percent somewhat stressed. Compared with the state average, feeling very stressed during the past week was more prevalent among women who never attended church, previously married women, and Medicaid recipients. ·
Reiter's Syndrome Source: in Bork, K., et al. Diseases of the Oral Mucosa and the Lips. Philadelphia, PA: W.B. Saunders Company. 1993. p. 57-58. Contact: Available from W.B. Saunders Company. Book Orders Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32821-9854. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. Website: www.wbsaunders.com. Price: $95.00 plus shipping and handling. ISBN: 0721640397. Summary: This chapter on Reiter's syndrome is from a textbook of diseases of the oral mucosa and the lips. Reiter's syndrome usually involves young males, and follows genitourinary or gastrointestinal tract infection. The typical clinical triad is arthritis, urethritis, and conjunctivitis. The typical triggering agents are genitourinary chlamydia or enteric salmonella or Yersinia infections. The chapter covers the clinical features, diagnosis, and therapy of Reiter's syndrome. The oral mucosa in Reiter's may be involved in a manner similar to psoriasis. The transient lesions are those of geographic tongue and migratory stomatitis. In addition, more permanent plaques are likely to be seen. 2 figures. 4 references.
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Urethritis Source: in Landau, L.; Kogan, B.A. 20 Common Problems in Urology. New York, NY: McGraw-Hill, Inc. 2001. p. 77-94. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070634130. Summary: Urethral discharge (the presenting symptom of urethritis, or inflammation of the urethra, the tube that goes from the bladder to the
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outside of the body) is largely caused by sexually transmitted diseases (STDs). The two most common pathogens causing urethral discharge are gonorrhea and chlamydia. This chapter on urethritis is from a text on common problems in urology (written for the primary care provider). The author develops the differential diagnoses of a segment of STDs: urethritis and urethral discharge. STDs that manifest primarily as genital ulcerations or as cutaneous (skin) lesions are covered in another chapter. The author first reviews the steps for treating any STD, then discusses discharge in males and females; definition of urethritis and urethral discharge; key elements to the patient history; the physical examination and laboratory tests; diagnosis by DNA probes and nucleic acid amplification techniques; classification of male urethritis; gonococcal urethritis; Chlamydia trachomatis; management recommendations for Chlamydia and other nongonococcal urethritis; Ureaplasma urealyticum; Mycoplasma genitalium; Trichomonas vaginalis; treatment of recurrent or persistent symptoms of urethritis; other manifestations and complications of urethritis; and controversies, pitfalls to avoid, and emerging trends. A series of patient evaluation and care algorithms is also provided. The author recommends that physicians consider multiple pathogens (disease causing organisms) in each patient with urethritis. Second, it is vital to include the patient's sexual partner in care and educational strategies. And third, physicians are cautioned to maintain adequate followup after treatment in these patients, to ensure eradication of pathogens (and to prevent reinfection or recurrence of symptoms). 3 figures. 4 tables. 35 references.
General Home References In addition to references for chlamydia, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Encyclopedia of Infectious Diseases (Encyclopedia of Infectious Diseases, 1998) by Carol Turkington, Bonnie Ashby; Library Binding - 384 pages (September 1998), Facts on File, Inc.; ISBN: 0816035121; http://www.amazon.com/exec/obidos/ASIN/0816035121/icongroupinterna · Epidemic! The World of Infectious Disease by Rob Desalle (Editor), American Museum of Natural History; Paperback - 246 pages, 1st edition (September 1999), New Press; ISBN: 1565845463; http://www.amazon.com/exec/obidos/ASIN/1565845463/icongroupinterna
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· The Hidden Epidemic: Confronting Sexually Transmitted Diseases by Institute of Medicine, et al; Hardcover - 432 pages (April 1997), National Academy Press; ISBN: 0309054958; http://www.amazon.com/exec/obidos/ASIN/0309054958/icongroupinterna · Outbreak Alert: Responding to the Increasing Threat of Infectious Diseases by Jason Eberhart-Phillips, M.D.; Paperback - 292 pages (July 2000), New Harbinger Publications; ISBN: 1572242019; http://www.amazon.com/exec/obidos/ASIN/1572242019/icongroupinterna · Sexually Transmitted Diseases: A Physician Tells You What You Need to Know (Johns Hopkins Press Health Book) by Lisa Marr; Paperback - 263 pages (January 1999), Johns Hopkins University Press; ISBN: 0801860431; http://www.amazon.com/exec/obidos/ASIN/0801860431/icongroupinterna · Sexually Transmitted Diseases: Vaccines, Prevention and Control by Lawrence R. Stanberry (Editor), David I. Bernstein (Editor); Hardcover 468 pages, 1st edition (February 15, 2000), Academic Press; ISBN: 0126633304; http://www.amazon.com/exec/obidos/ASIN/0126633304/icongroupinterna · Sexually Transmitted Diseases Sourcebook: Basic Information... by Linda M. Ross (Editor), Peter Dresser (Editor); Library Binding - 600 pages (June 1997), Omnigraphics, Inc.; ISBN: 0780802179; http://www.amazon.com/exec/obidos/ASIN/0780802179/icongroupinterna
Vocabulary Builder Abortion: 1. the premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. premature stoppage of a natural or a pathological process. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Contraception: The prevention of conception or impregnation. [EU] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, cryptosporidium. It occurs in both animals and humans. [NIH] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU]
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Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity; called also adenomyosis externa and endometriosis externa. [EU] Isosporiasis: Infection with parasitic protozoa of the genus isospora, producing intestinal disease. It is caused by ingestion of oocysts and can produce tissue cysts. [NIH] Microsporidiosis: Infections with protozoa of the phylum microspora. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Parvovirus: A genus of the family parvoviridae, subfamily parvovirinae, infecting a variety of vertebrates including humans. Parvoviruses are responsible for a number of important diseases but also can be nonpathogenic in certain hosts. The type species is mice minute virus. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Rubella: An acute, usually benign, infectious disease caused by a togavirus and most often affecting children and nonimmune young adults, in which the virus enters the respiratory tract via droplet nuclei and spreads to the lymphatic system. It is characterized by a slight cold, sore throat, and fever, followed by enlargement of the postauricular, suboccipital, and cervical lymph nodes, and the appearances of a fine pink rash that begins on the head and spreads to become generalized. Called also German measles, roetln, röteln, and three-day measles, and rubeola in French and Spanish. [EU] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH]
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Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Scabies: A contagious dermatitis of humans and various wild and domestic animals caused by the itch mite, Sarcoptes scabiei, transmitted by close contact, and characterized by a papular eruption over tiny, raised sinuous burrows (cuniculi) produced by digging into the upper layer of the epidermis by the egg-laying female mite, which is accompanied by intense pruritus and sometimes associated with eczema from scratching and secondary bacterial infection. Called also the itch and seven-year itch. [EU] Sputum: Matter ejected from the lungs, bronchi, and trachea, through the mouth. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]
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CHAPTER 7. MULTIMEDIA ON CHLAMYDIA Overview Information on chlamydia can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on chlamydia. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on chlamydia is the Combined Health Information Database. You will need to limit your search to “video recording” and “chlamydia” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “chlamydia” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on chlamydia:
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Update: Sexually Transmitted Diseases Contact: Sunburst Technology, 101 Castleton St, Pleasantville, NY, 105079971, (800) 431-1934, http://www.sunburst.com. Summary: This video and accompanying teacher's guide provides information about sexually transmitted diseases (STDs) and teenagers. The objective is to explain what these diseases are, how they are spread, how to prevent them, and what to do when an infection is suspected. In addition to explaining the health risks associated with these diseases, the video provides information on the emotional turmoil these diseases often bring. The video revolves around true-to-life stories of a number of teenagers who find themselves facing the diagnosis of an STD. The video covers HIV, chlamydia, human papilloma virus, and genital herpes. In addition, the video alerts the viewers to the symptoms of other STDs, including chancroid, hepatitis B, syphilis, and gonorrhea.
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Assumptions Contact: Lifejackets Productions, 2828 Clark Rd Ste 11, Sarasota, FL, 34231, (800) 366-2150, http://www.lifejackets.com. Summary: This videorecording is one segment of a nine-part series of scenes adapted from STAR Theatre's live interactive high school production "On the Edge." STAR Theatre is a component of the Mt. Sinai Medical Center's Adolescent AIDS Prevention and Treatment Program in New York City. The theater's material is created by the company, which consists of young people ages 15-24. Audience participation, an integral part of the show, encourages young people to express themselves about sex, drugs, and HIV/AIDS, while a trained peer actor educator and a professional health educator facilitate the discussion. This segment focuses on relationships, communication, and sexually transmitted disease (STD) transmission, detection, and treatment. Kira confronts Joel about his having transmitted chlamydia to her. The couple do not communicate well, and had misinterpreted each other's vague signals. Kira had assumed that because they were having sex it meant they were monogamous. Joel assumed that when Kira did not return his calls for a period of time she wanted to cool off. He saw someone else and contracted the STD he passed on to Kira.
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Infertility: A Focus on Strategies for the Prevention and Treatment of Chlamydia Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Public Health Practice Program Office, Division of Media and Training Services, 1600
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Clifton Rd M/S G21, Atlanta, GA, 30333, (404) 639-3707, http://www.cdc.gov/phtn. Summary: This video, for health professionals, provides current information about the bacterial sexually transmitted disease (STD), chlamydia, its transmission; possible long-term effects on women, men, and infants; symptoms; diagnostic tests; and medical treatment. It explains how chlamydia can make infected individuals more susceptible to other STDs and identifies the high-risk populations. The video discusses ways to educate patients about chlamydia. ·
The Myth of Safe Sex Contact: Focus on the Family, P O Box 3550, (714) 620-8500. Summary: This videorecording questions whether "safer sex" is really safe. It features James C. Dobson, Ph.D., founder of the organization Focus on the Family, and Dr. Joe McIlhaney, an obstetrician/gynecologist and author, urging an audience of young people to practice abstinence as protection against sexually transmitted diseases (STD's). Dr. McIlhaney emphasizes the medical dangers of Chlamydia, human papillomavirus (HPV), and AIDS, and draws on many statistics and examples from among his patients to indicate the destructive nature of these illnesses. The speakers argue that condoms do not guarantee protection from STD's, due to improper and inadequate usage and manufacturing defects. They cite a 20 percent contraceptive failure rate for condoms, stating that this would logically indicate an even higher failure rate for STD's. They conclude that medical implications and morality dictate postponement of intercourse until after marriage, and advocate adoption of "secondary virginity" for those who have previously engaged in premarital sex.
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Love in the Dark Ages Contact: Media Guild, 11722 Sorrento Valley Rd, San Diego, CA, 92121, (619) 755-9191. Summary: This videorecording is a CBS Schoolbreak Special that dramatizes the desirability of sexual abstinence for teenagers. Portraying the story of a young couple whose romance is jeopardized by a sexually transmitted disease (STD), the film focuses on the importance of communication and sexual responsibility in relationships. Jenny, an aspiring artist, feels betrayed when she discovers Mart, a star swimmer, gave her chlamydia during their first evening of intimacy. Her doctor tells her the disease could have caused infertility if left untreated and emphasizes that being on the pill is not protection against STDs. Jenny's mother and Mart's father, both single parents, demonstrate support and
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understanding and help the teens understand the meaning of commitment. The couple reconcile, but in the face of the emotional and philosophical complications surrounding their problem, decide that abstinence is the best choice for them at this point in their lives. The video is accompanied by a guide containing curriculum concepts for the junior high, high school, and adult levels, along with suggested discussion questions and follow-up activities. ·
The Teenage Years: STDs and Sexual Responsibility Contact: AIMS Media, 9710 DeSoto Ave, Chatsworth, CA, 91311-4409, (800) 367-2467. Summary: This videorecording is designed to educate adolescents at the junior high and high school levels about sexual behavior and Sexually transmitted diseases (STD's), including Acquired immunodeficiency syndrome (AIDS). Hosted by television personality Scott Baio, three health educators discuss all STD's including syphilis, gonorrhea, AIDS, herpes, and chlamydia. How STD's are transmitted and how they can be prevented are addressed. The individual's responsibility to self and others is emphasized. Symptoms of STD's are mentioned as are different methods of birth control. The videorecording also explores the issues of sex versus intimacy, the role of alcohol in sexual behavior, and selfesteem.
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STDs and Safer Sex: Your Risk and Responsibility Contact: Family Care Communications Incorporated, 9226 Amsden Way, Eden Prairie, MN, 55347, (612) 944-5350. Summary: This video, aimed at 18- to 24-year-olds, describes sexually transmitted diseases (STD's) and discusses safer sexual practices. It provides the viewer with facts, statistics, symptoms, and warning signs of HIV, chlamydia, pelvic inflammatory disease (PID), HPV, syphilis, and gonorrhea. It illustrates condom do's and don'ts, talks about the use of vaginal spermicides, and urges viewers to be screened for HIV infection. The numbers of several hotlines, including those for Spanish speaking viewers and the hearing impaired, are listed at the end of the video.
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The Facts: Bacterial STD's Contact: Guidance Associates, Box 300, Mt. Kisco, NY, 10549, (914) 6664100. Summary: This is the second of a series of four videorecordings discussing Sexually transmitted diseases (STD's), including Acquired immunodeficiency syndrome (AIDS), which is caused by the Human
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immunodeficiency virus (HIV). Two angels, Clarence, a middle-aged Caucasian male, and Claire, a young Black female, appear throughout the series, commenting upon the action. In this videorecording track, the angels visit the library of Clarence's old high school, where six students are preparing a video about bacterial STD's. Each student in turn inserts a videorecording into the video cassette recorder (VCR) and discusses one bacterial STD, describing symptoms of infection for men and women, medications which are used to treat the disease, and methods of preventing the infection. Bacterial STD's which are discussed are gonorrhea, chlamydia, Gardnerella vaginitis, and syphilis. Each report recommends the use of condoms to reduce the risk of infection. ·
Bodyguard: The Immune System; A Documentary Series Contact: McNabb and Connoly, 60 Briarwood Ave, Port Credit, (416) 2780566. Altschul Group Corporation, 1560 Sherman Ave Ste 100, Evanston, IL, 60201, (847) 328-6700. Summary: This videorecording hosted by Megan Follows focuses on the human immune system and what happens when disease strikes and how to take care of yourself. Computer generated graphics and animated diagrams help to explain what the immune system is and what it does. The video discusses transplants, auto-immune diseases, allergies, cancer, Acquired immunodeficiency syndrome (AIDS), and Sexually transmitted diseases (STD's) including chlamydia, herpes, gonorrhea, and syphilis. It is also states that condom use along with spermicidal foam is the best protection against AIDS and STD's. A rap song about condoms and saying "no" is presented.
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STD Blues Summary: This videorecording, targeted at junior high school students, presents the personal stories of three teenage couples, each taking a different route in their sexual choices. The consequences they face are divergent. The videorecording debunks the myth of teenage invulnerability. The principal characters struggle with choosing sexual abstinence versus having sexual intercourse, the use of condoms, the panic of discovering symptoms, and the fear of seeking proper medical care. Sexually transmitted diseases (STD's) such as herpes, gonorrhea, chlamydia, and Acquired immunodeficiency syndrome (AIDS) are discussed. (Based on producer's abstract.).
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Sexually Transmitted Diseases: What You Should Know Contact: Pleasantville Media, PO Box 415, Pleasantville, NY, 10570, (914) 769-1734.
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Summary: This video cassette presents information for teenagers on sexually transmitted diseases (STD) education and prevention. Although AIDS is the primary concern, it looks also at syphilis, gonorrhea, chlamydia, herpes, trichomoniasis, and genital warts. It provides information and dispels myths about how AIDS and other STD's are transmitted. It encourages sexual abstinence and models assertive behavior for teenagers who wish to say "no" to sexual activity. ·
Pap Test: A Cure for the Crisis Source: Northfield, IL, College of American Pathologists, 1 videorecording, 1988. Contact: College of American Pathologists, 325 Waukegan Road, Northfield, IL 60093. (800) 323-4040. (708) 446-8800. Summary: Pap Test: A Cure for the Crisis is a 30-minute videotape advising women on how to protect themselves from inadequately obtained or incorrectly interpreted Papanicolaou (Pap) smear tests. Introduced by Elizabeth Dole of the American Red Cross (ARC), the program on faulty Pap test results was produced in cooperation with public television station WTVI-TV in Charlotte, North Carolina. Medical experts, including Federal officials, discuss irresponsible doctors and shoddy Pap test mills as exposed in a Pulitzer Prize winning series of Wall Street Journal articles. About 50 percent of Pap test errors arise because the woman's physician obtains an inadequate cell sample, collecting cells from the ectocervix but not the endocervical canal. The other 50 percent of Pap test errors result from cytotechnologists' rapid review of smears, pressed on by a profit-minded laboratory. A technologist reading 150 to 200 slides a day will miss fatally malignant cells. Many laboratories do not report herpes virus, chlamydia, gonorrhea, human papilloma virus, and cytomegalovirus infection, at the request of physicians who prefer not to discuss sexually transmitted diseases (STD) with patients. Dr. Paul Weisner of the Centers for Disease Control (CDC) in Atlanta, Georgia, discusses the need for uniform language and standards of reporting on Pap tests so that clinical implications and needed followup are unmistakable; these criteria may be required by upcoming regulations or legislation. The video urges women to serve as their own health advocates against erroneous Pap test results. It advises women (1) to have an annual Pap test; (2) to schedule the test between menstrual periods if premenopausal; (3) to avoid intercourse or douching 24 hours before a test; (4) to ask the doctor if the Pap test laboratory is licensed, inspected, and accredited, and has a quality assurance program; (5) to inquire about the laboratory's work load and whether it is a mail order operation or one with which the
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doctor communicates regularly; (6) to ask the doctor whether the smears will include endocervical and ectocervical cells; (7) to ask to read the previous Pap test report; and (8) to read the report carefully, noting whether it said the test sample was adequate, if a further test was needed, and if any other disease was found. The College of American Pathologists offers a too free number, 1-800-LAB-5678, so that women may request a brochure giving more information on Pap tests.
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” By making these selections and typing “chlamydia” (or synonyms) into the “For these words:” box, you will only receive results on sound recordings (again, most diseases do not have results, so do not expect to find many). The following is a typical result when searching for sound recordings on chlamydia: ·
Children at Risk Because of AIDS Contact: King's College, Center for Education about Death and Bereavement, 266 Epworth Ave, London, (519) 432-7946. Summary: This sound recording contains an address by Dr. Robert Fulton in which he discusses a study of 1000 first year students at the University of Minnesota. The study is comprised of statistics on the knowledge about sexual behavior, sexual activity, incidences of Sexually transmitted diseases (STD's) and their relationship to divorce. It presents information that STD's are a major health factor on college campuses, and that the use of barrier protection is inversely related to the number of partners each sexually active individual has. It highlights the fact that young women are at greater risk for HIV because of the high incidence of chlamydia. It emphasizes the lack of impact education efforts are having on young adults who are sexually active, and recommends that current education efforts be reexamined.
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Bibliography: Multimedia on Chlamydia The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in chlamydia (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on chlamydia. For more information, follow the hyperlink indicated: · ·
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1990 STD national statistics. Source: Centers for Disease Control; Year: 1991; Format: Slide; [Atlanta, Ga.]: The Centers, [1991] C. trachomatis and pelvic inflammatory disease. Source: [presented by] Ortho Pharmaceutical Corporation; developed and produced by Health Learning Systems Inc; Year: 1987; Format: Videorecording; [Lyndhurst, N.J.]: Health Learning Systems, c1987 Chlamydia : the hidden disease. Source: a presentation of Films for the Humanities & Sciences; Year: 1996; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1996 Chlamydia : the new scourge of reproductive health. Source: by H. Robert Harrison; Year: 1986; Format: Videorecording; Atlanta, Ga.: Emory University, c1986 Chlamydia, pathogenicity & identification. Source: author, Julius Schachter; produced by the American Society for Microbiology, Committee on Educational Materials; Year: 1983; Format: Slide; Washington, D.C.: The Society, c1983 Chlamydia. Source: produced and filmed by Health Education Video, Inc; Year: 1990; Format: Videorecording; Bloomington, MN: Health Education Video, [1990] Chlamydial infections. Source: presented by the Department of Gynecology/Obstetrics, Emory University, School of Medicine; Year: 1982; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1982 Clinical spectrum of human infection with Chlamydia trachomatis. Source: author, Julius Schachter; produced by the American Society for Microbiology, Committee on Educational Materials; Year: 1982; Format: Slide; Washington, D.C.: The Society, c1982 Common gynecologic infections. Source: American Academy of Family Physicians; produced by Gardiner-Caldwell SynerMed; Year: 1990; Format: Videorecording; [Kansas City, Mo.]: The Academy, c1990
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Intimate epidemic. Source: a Films for the Humanities presentation; Year: 1989; Format: Videorecording; [Princeton, N.J.]: Films for the Humanities, c1989 Perinatal infection. Source: NAACOG, the organization for obstetric, gynecologic & neonatal nurses; a production of ECI; Year: 1992; Format: Videorecording; Pittsburgh, PA: Executive Communications, c1992 Sexually transmitted diseases. Source: a Films for the Humanities and Sciences presentation; Year: 1987; Format: Videorecording; [Princeton, N.J.]: Films for the Humanities, c1987 Sexually transmitted diseases. Source: [presented by] AIMS Media; [presented by] Milner-Fenwick; Year: 1989; Format: Videorecording; [Timonium, Md.]: Milner-Fenwick, c1989 Sexually-transmitted diseases. Source: a presentation of Films for the Humanities & Sciences; produced by Coscient Inc. for Radio-Québec, with the participation of Téléfilm Canada; Year: 1995; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1995 Update on chlamydia infections. Source: [presented by] the Emory Medical Television Network, Emory University School of Medicine of the Robert W. Woodruff Health Sciences Center; Year: 1993; Format: Videorecording; Atlanta, GA: The University, c1993 Venereal diseases. Source: [produced by] Hahnemann Medical College & Hospital and World Video Corp; Year: 1980; Format: Videorecording; [S.l.]: Medcare Associates, c1980
Vocabulary Builder Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Spermicide: An agent that is destructive to spermatozoa. [EU]
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CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/health/diseases.htm
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.26 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:27 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 27 See http://www.nlm.nih.gov/databases/databases.html. 26
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat chlamydia, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and chlamydia using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “chlamydia” (or synonyms) into the “For
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these words:” box above, you will only receive results on fact sheets dealing with chlamydia. The following is a sample result: ·
Sexually Transmitted Diseases in America : How Many Cases and at What Cost Contact: Henry J Kaiser Family Foundation, 2400 Sand Hill Rd, Menlo Park, CA, 94025, (650) 854-9400, http://www.kff.org. Summary: This report examines the epidemiology and financial impact on health care systems and individuals of sexually transmitted diseases (STDs) in the United States (US). The report categorizes STDs as either bacterial and viral infections/diseases and explains who is affected by STDs. It examines the efforts in the US to prevent the transmission of STDs and the need for parents, children, sex partners, teachers, students, patients, and health care providers to communicate and discuss STD prevention and transmission risks. The report discusses the epidemiology of STDs in the US and data collection methods. It analyzes the accuracy of this surveillance evidence and breaks down the data by infection/disease such as chlamydia, gonorrhea, syphilis, herpes, human papillomavirus (HPV), hepatitis B, trichomonasis, bacterial vaginosis, and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). The report includes information concerning the direct medical costs incurred in the US as a result of health care for STDs and supplies the readers with the estimated costs of STD care per year by state.
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What You Need to Know About Sexually Transmitted Diseases, HIV Disease, and AIDS Contact: GlaxoSmithKline, 5 Moore Dr, Research Triangle Park, NC, 27709, (888) 825-5249, http://corp.gsk.com/. Summary: This information packet contains booklets and fact sheets regarding sexually transmitted diseases (STDs) as well as hard copies of on-line fact sheets available on the world wide web. The materials explains the risk factors, health consequences, symptoms, diagnosis and treatment of a wide range of STDs. This is followed by an alphabetical listing of common STD, beginning with chlamydia and concluding with trichomoniasis. This listing provides brief explanations on how the disease is transmitted, who is at risk, what the symptoms look like, how to get tested, current treatment, and the consequences of leaving the disease untreated. This listing is followed by comprehensive fact sheets on chancroid, genital herpes (women), genital herpes (men), gonorrhea, pediculosis (lice/crabs), and an STD risk assessment instrument.
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Testing Positive: Sexually Transmitted Disease and the Public Health Response Contact: Alan Guttmacher Institute, New York Office, 120 Wall St, New York, NY, 10005, (800) 765-7514, http://www.agi-usa.org. Summary: This report examines the dimensions of the problem of STD's in the United States, and discusses the Federal program charged with combating their spread. The report recommends that Congress and the Centers for Disease Control and Prevention (CDC) reexamine and redirect national STD program strategies, priorities, and funding to make the programs more effective. It also urges policymakers and leaders to acknowledge sexual behaviors and encourage protective behaviors. A chart describing certain STD's is included. These STD's include chlamydia, trichomoniasis, gonorrhea, syphilis, chancroid, human papillomavirus, genital herpes, hepatitis B, and HIV.
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Choosing the Best; Student Manual Contact: Project Reality, 1701 East Lake Ave Ste 371, Glenview, IL, 60025, (847) 729-3298. Summary: This is the student manual component of a middle- and senior high school-based AIDS and sexually transmitted disease (STD) prevention program that focusses on abstinence as the only method to prevent the sexual transmission of these diseases. The manual is divided into seven sessions; some are complemented by video and slide presentations. In the first session students identify the risks of becoming sexually active. The second session focuses on the transmission and symptoms of chlamydia, herpes, syphilis, gonorrhea, genital warts and human papilloma virus, HIV, and AIDS. Session 3 concentrates on HIV/AIDS. This curriculum takes the position that there is no such thing as safe sex, and the only way to prevent HIV infection is through abstinence and monogamy in a marriage relationship. This session also examines condom failure, safer sex messages, and the improper use of condoms. The fourth session looks at peer pressure to become sexually active. Session five helps the student plan for an abstinent lifestyle. Sessions 6 and seven focus on setting limits before dating and learning assertiveness and resistance skills.
·
Screening for Infectious Diseases Among Substance Abusers Contact: US Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 5600 Fisher Lane, Rockwall 2, Rockville, MD, 20852, (301) 443-7730.
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Summary: The screening, prevention, and control of infectious diseases has become a critically important function for alcohol and other drug abuse (AOD) treatment programs, both to protect staff and patients. These protocols provide screening, counseling, and treatment guidelines to AOD treatment providers in all settings who screen and test patients for infectious disease, provide risk-reduction education, and provide treatment to patients with early and asymptomatic HIV as well as preventive therapy for patients with TB. The focus is on the infectious diseases that occur frequently among treatment populations, such as HIV, AIDS, tuberculosis, syphilis, and hepatitis B and C. Included also are discussions of other infectious diseases common to treatment populations, such as chlamydia, gonorrhea, herpes simplex, chancroid, and hepatitis A and D. Information is provided about transmission, symptoms, and indications for screening. The protocols are intended to guide and instruct a broad spectrum of treatment for health care providers. Some of the guidelines provide information for specific disciplines, and other parts provide legal and ethical guidelines. The first portion addresses issues that affect and support the entire infectious disease screening and treatment process. The remaining chapters provide protocols for specific infectious diseases. ·
Chlamydia : Questions and Answers Contact: Planned Parenthood of Federation of America Incorporated, PO Box 4457, New York, NY, 10163-4457, (800) 669-0156, http://www.plannedparenthood.org. Summary: This brochure presents general information about chlamydia using a question and answer format. The brochure presents the general symptoms of chlamydia and methods of transmission including unprotected vaginal or anal sex. Chlamydia is the most common sexually transmitted disease (STD) in the United States (US), and can lead to the development of pelvic inflammatory disease (PID), a condition that can block fallopian tubes in women. The symptoms of PID in women include longer and/or heavier periods, more cramping during periods, abnormal mucus discharge, lower abdomen pain, tiredness, weakness, fever, vomiting, and/or pain during vaginal intercourse or a pelvic exam. Chlamydia also can cause sterility or Reiter's syndrome in men. Chlamydia can be passed to infants from their mothers during pregnancy or childbirth leading to neonatal conjunctivitis, chlamydia pneumonia, miscarriage, or stillbirth. It can be diagnosed through a cervical exam; lab tests of cells from the penis, cervix, urethra, or anus; or tests of urine samples. Chlamydia can be treated easily using antibiotics such as doxycycline, azithromycin, ofloxacin, erythromycin, or erythromycin
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ethylsuccinate. Persons with chlamydia should adhere to their medical regimen, undergo follow-up visits with their physicians, and get their partner(s) treated at the same time. Persons who have a number of different sex partners, who don't use condoms, or who have a history of other STDs are most likely to get chlamydia. Persons with chlamydia can avoid spreading their infection to others by informing their sex partners about their condition, avoiding sex until treatment is complete, getting their partners tested and treated at the same time, and using female or male condoms during each sexual activity. Persons can prevent getting chlamydia by practicing safer sex or abstaining from intercourse altogether. Birth control pills may increase women's chances for contracting this STD, therefore, they should also use a male or female condoms. Concerned individuals can get tested for chlamydia at Planned Parenthood centers, their doctors' offices, health departments, and clinics. ·
Sexually Transmitted Diseases : Chlamydia : Get the Facts : Protect Yourself Contact: Journeyworks Publishing, PO Box 8466, Santa Cruz, CA, 950618466, (831) 423-1400, http://www.promotehealth.com. Summary: This brochure provides general information about the sexually transmitted disease (STD), chlamydia. The brochure discusses the epidemiology of chlamydia in the United States, especially among adolescents and young adults, and describes the symptoms. It states that chlamydia is transmitted through unprotected sex and can be prevented through safer sex or sexual abstinence. It explains that chlamydia responds to treatment, but can be extremely dangerous if left undiagnosed. The brochure recommends that the reader get tested for chlamydia and all one's sexual partners also get tested.
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Gynecologic Problems: Pelvic Inflammatory Disease (PID) Contact: American College of Obstetricians and Gynecologists, PO Box 96920, Washington, DC, 20090-6920, (202) 638-5577, http://www.acog.com. Summary: This pamphlet addresses the causes, symptoms, diagnosis, and treatment of pelvic inflammatory disease (PID). Most cases of PID develop as a result of sexually transmitted diseases (STDs) such as gonorrhea and chlamydia. PID is normally treated with a combination of two or more antibiotics, such as ampicillin and tetracycline, to combat the wide variety of organisms associated with PID. The pamphlet recommends prevention strategies that include barrier contraception, spermicides, and limiting the number of sexual partners.
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Chlamydia Is Not A Flower, It's the Nation's Most Prevalent Sexually Transmitted Disease Contact: Abbott Laboratories, Public Affairs Department, 100 Abbott Pk Rd, D383-AP6D 2nd Fl, Chicago, IL, 60064-3500, (708) 937-6100. Summary: This brochure informs the reader that chlamydia is the most widespread sexually transmitted disease (STD) in the United States. It describes the different consequences of chlamydial infection in men, women, and newborns. The brochure discusses possible symptoms and preventive measures. Greater public awareness and widespread medical testing are suggestions for controlling the spread of chlamydia.
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Particularly Important Directions About Pelvic Inflammatory Disease Contact: Texas Department of Health Warehouse, Attn: Literature and Forms, 1100 W 49th St, Austin, TX, 78756, (512) 458-7761. Summary: This brochure for women discusses pelvic inflammatory disease (PID). PID is an infection that is often asymptomatic, but some women may experience symptoms such as lower stomach cramps and/or pain, fever, chills, nausea, vaginal discharge, burning during urination, and/or painful sexual intercourse. PID is an infection that is often caused by a lack of treatment for sexually transmitted diseases (STDs) such as gonorrhea and chlamydia. PID can cause complications if left untreated, such as scarring of the fallopian tubes, sterility, tubal pregnancy, miscarriage, pelvic abscesses, abnormal menstrual periods, and continual pelvic pain. The brochure recommends that women with PID avoid having sex until they and their partners have taken all of their medications and have stopped exhibiting symptoms. It advises women about medications used in treatment, their side effects, and specific dosing requirements. The brochure also contains information for those women who use intrauterine device (IUDs) for birth control and recommends condom use to help prevent PID.
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What Everyone Should Know About Chlamydia Contact: Channing L. Bete Company Incorporated, 200 State Rd, South Deerfield, MA, 01373-0200, (800) 477-4776, http://www.channingbete.com. Summary: This brochure provides information about the sexually transmitted disease (STD), chlamydia. Chlamydia is caused by bacteria that is found in blood, vaginal secretions, or semen. Individuals with chlamydia are often asymptomatic, and untreated chlamydia can lead to serious health complications in both men and women. Chlamydia can be transmitted through unprotected sex or from a mother to her infant
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during birth. Teens and young adults are at special risk for this STD because their reproductive systems are still developing. The brochure lists the symptoms of chlamydia that may be experienced by women and men. Symptoms generally appear one to three weeks after infection, if they appear at all. In women, untreated chlamydia can spread to the lining of the uterus or the fallopian tubes causing scarring, which can result in infertility or ectopic pregnancy. Women also may develop pelvic inflammatory disease (PID). Men with untreated chlamydia may experience acute epididymitis or Reiter's syndrome. Men and women with untreated chlamydia may suffer from conjunctivitis or proctitis. For each of the aforementioned complications of untreated chlamydia, symptoms and a description of the condition are provided. Anyone experiencing symptoms of chlamydia should get tested immediately. Screening tests for women and men are quick and accurate. In general, doctors prescribe antibiotics to treat chlamydia. The brochure provides tips on how to make treatment successful. Practicing sexual abstinence, monogamy, or safer sex with condoms can help to prevent chlamydia. Directions for the proper use of condoms are supplied. ·
National Assembly on School-Based Health Care 1998 Conference : Handouts for Session 00A2 : HIV/STDs Testing in SBHCs : SchoolLinked Chlamydia and Gonorrhea Prevention : Creating Effective Contact: Los Angeles County Department of Health Services, Public Health Programs - Disease Control Programs, Sexually Transmitted Disease Program, 2615 S Grand Ave Rm 500, Los Angeles, CA, 90007, (213) 744-3070, http://www.lapublichealth.org/std. Summary: This teaching aid provides statistical information about the sexual behavior of adolescents, including the incidence rates of gonorrhea and chlamydia, and the effectiveness of school-based urine testing for preventing these diseases. The teaching aid provides general information about chlamydia, and statistics about the number of sexually active teens, their average number of partners, and condom use. It describes a high school-based chlamydia and gonorrhea screening project. It shows statistics concerning the number of chlamydia cases found by this screening process in Los Angeles, and compares this data to that of non-school-based testing. It compares the cost of the screening process versus the number of cases missed. The teaching aid discusses the possible disadvantages of urine testing and challenges regarding the implementation of the screening process. Recommendations about how these obstacles can be overcome are given.
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·
Sexually Transmitted Diseases : Autumn 1998 Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of AIDS, 6700-B Rockledge Dr, Bethesda, MD, 20892-7620, (301) 496-0545, http://www.niaid.nih.gov. Summary: This information package discusses the general facts concerning a number of sexually transmitted diseases (STDs). It explains the long-term dangers of untreated STDs, and provides prevention information. Chlamydia, genital herpes, gonorrhea, human papillomavirus (HPV), pelvic inflammatory disease (PID), syphilis, vaginitis, and other STDs are discussed in this information package. For each of these STDs, the information package identifies the symptoms and describes the diagnostic process, as well as, the medical treatments available. It examines the current research being conducted related to the specific STD.
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Carriers Contact: I.E. Clark, Incorporated, PO Box 246, Schulenburg, TX, 78956, (409) 743-3232. Summary: This play consists of a cast of characters, all teenagers, who have various sexually transmitted diseases (STD's), including genital warts, herpes, gonorrhea, chlamydia, and HIV. The play seeks, as its introduction says, to frighten teens with information about STD's and HIV so that they will risk rejection by their peers and avoid unsafe sex. The characters present facts about STD's and HIV, including information about transmission, symptoms, and treatment. Drug use is presented as leading to a lowering of inhibitions and a tendency to engage in unsafe sex. Condom use is discussed, but it is stressed that the only completely safe sex is no sex. The characters in this play present information about STD's and HIV, and leave it up to the viewer to make his or her own decision.
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Treatment and Research Agenda for Women With HIV Infection Contact: AIDS Coalition To Unleash Power, 332 Bleeker St Ste G5, New York, NY, 10014, (212) 966-4873, http://www.actupny.org/. Summary: This report presents an agenda calling for changes in the way women with Acquired immunodeficiency syndrome (AIDS) are treated. It says that in the United States, the epidemiology of Human immunodeficiency virus (HIV) infection is shifting toward women, Hispanics, and Blacks, but that the government response to women's needs has been lacking. The report says the Centers for Disease Control
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and Prevention (CDC) definition of AIDS does not include opportunistic infections common to women, such as Pelvic Inflammatory Disease (PID), cervical candidiasis, chlamydia, and Human Papilloma virus. Its treatment agenda addresses a description of clinical manifestations of HIV infection in women, covering PID, bacterial pneumonias, and menstrual irregularities; recommendations for standards of care, looking at alternative therapies, drug detoxification, and prison issues; a critique of research carried out by the AIDS Clinical Trials Group (ACTG) and the Food and Drug Administration (FDA), with a look at the effects of azidothymidine (AZT) on women; HIV transmission; an examination of CDC policy, including background, current data, problems with current research, and policy recommendations; and personal accounts of women living with HIV infection. The NLM Gateway28 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.29 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.30 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “chlamydia” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 30 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 28 29
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Results Summary Category Items Found Journal Articles 344196 Books / Periodicals / Audio Visual See Details Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 347681
HSTAT31 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.32 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.33 Simply search by “chlamydia” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists34 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 33 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 34 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 31 32
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recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.35 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.36 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
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Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
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Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 36 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 35
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vocabularies; see the following http://www.lexical.com/Metaphrase.html.
Web
site:
The Genome Project and Chlamydia With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to chlamydia. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).37 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “chlamydia” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for chlamydia: ·
Indoleamine 2,3-dioxygenase Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?147435
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
37
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·
Major Histocompatibility Complex Class Ii Transactivator Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?600005
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Regulatory Factor X, 5; Rfx5 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?601863
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Upstream Stimulatory Factor 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?191523
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
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Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich’s ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
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Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic
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kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
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Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
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Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
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To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “chlamydia” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database38 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database39 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis.
Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 39 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 38
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To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “chlamydia” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in chlamydia (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · 2002 Pocket Book of Infectious Disease Therapy by John G. Bartlett; Paperback - 348 pages, 11th edition (November 15, 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781734320; http://www.amazon.com/exec/obidos/ASIN/0781734320/icongroupinterna · Current Diagnosis & Treatment in Infectious Diseases by Walter R. Wilson (Editor), et al; Paperback - 985 pages, 1st edition (June 22, 2001), McGraw-Hill Professional Publishing; ISBN: 0838514944; http://www.amazon.com/exec/obidos/ASIN/0838514944/icongroupinterna · Diagnosis in Color: Sexually Transmitted Diseases by Anthony Wisdom, David A. Hawkins; Paperback, 2nd edition (July 1997), Mosby-Year Book; ISBN: 0723424969; http://www.amazon.com/exec/obidos/ASIN/0723424969/icongroupinterna · Hunter’s Tropical Medicine and Emerging Infectious Diseases by George W. Hunter (Editor), et al; Hardcover - 1192 pages, 8th edition (January 15, 2000), W B Saunders Co; ISBN: 0721662234; http://www.amazon.com/exec/obidos/ASIN/0721662234/icongroupinterna · Ibn Al-Jazzar on Sexual Diseases and Their Treatment (The Sir Henry Wellcome Series) by Ibn Al-Jazzar, Gerrit Bos; Hardcover - 430 pages (May 15, 1997), Kegan Paul International; ISBN: 0710305699; http://www.amazon.com/exec/obidos/ASIN/0710305699/icongroupinterna · Infectious Disease by Barbara Bannister, et al; Paperback - 506 pages, 2nd edition (August 15, 2000), Blackwell Science Inc.; ISBN: 0632053194; http://www.amazon.com/exec/obidos/ASIN/0632053194/icongroupinterna
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· Infectious Disease Epidemiology: Theory and Practice by Kenrad E. Nelson, et al; Hardcover - 600 pages (May 2000), Aspen Publishers, Inc.; ISBN: 083421766X; http://www.amazon.com/exec/obidos/ASIN/083421766X/icongroupinterna · Mandell, Douglas, and Bennett’s Principles & Practice of Infectious Diseases (2 Vol. Set) by Gerald L. Mandell (Editor), et al; Hardcover - 3263 pages, 5th edition (June 15, 2000), Churchill Livingstone; ISBN: 044307593X; http://www.amazon.com/exec/obidos/ASIN/044307593X/icongroupinterna
· Molecular Epidemiology of Infectious Diseases by R. C. Andrew Thompson; Hardcover - 326 pages, 1st edition (October 15, 2000), Edward Arnold; ISBN: 0340759097; http://www.amazon.com/exec/obidos/ASIN/0340759097/icongroupinterna · Sexually Transmitted Diseases by King K. Holmes, M.D., PhD (Editor), et al; Hardcover - 1344 pages, 3rd edition (December 18, 1998), McGraw-Hill Professional Publishing; ISBN: 007029688X; http://www.amazon.com/exec/obidos/ASIN/007029688X/icongroupinterna
· Sexually Transmitted Diseases: A Practical Guide by Niaid Staff (Editor), Robert J. Banis; Paperback - 150 pages (November 1997), Banis & Associates; ISBN: 1888725060; http://www.amazon.com/exec/obidos/ASIN/1888725060/icongroupinterna · Sexually Transmitted Diseases: Epidemiology, Pathology, Diagnosis, and Treatment by Kenneth A. Borchardt (Editor), et al; Hardcover - 349 pages (January 15, 1997), CRC Press; ISBN: 0849394767; http://www.amazon.com/exec/obidos/ASIN/0849394767/icongroupinterna
Vocabulary Builder Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broad-spectrum antibiotic. [NIH] Anus: The distal or terminal orifice of the alimentary canal. [EU] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis,
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and formerly blastodendriosis. [EU] Detoxification: Treatment designed to free an addict from his drug habit. [EU]
Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] Hysterectomy: The operation of excising the uterus, performed either through the abdominal wall (abdominal h.) or through the vagina (vaginal h.) [EU] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Ofloxacin: An orally administered broad-spectrum quinolone antibacterial drug active against most gram-negative and gram-positive bacteria. [NIH] Pediculosis: Infestation with lice of the family Pediculidae, especially infestation with Pediculus humanus. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH]
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CHAPTER 9. DISSERTATIONS ON CHLAMYDIA Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to chlamydia. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Chlamydia ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to chlamydia. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with chlamydia: ·
Caracterisation Des Determinants Antigeniques De Chlamydia Trachomatis Serotypes A, C, H, I Et J (french Text) by Francoeur, Karen; Msc from Universite Laval (canada), 2001, 74 pages http://wwwlib.umi.com/dissertations/fullcit/MQ57813
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·
Carbon and Energy Metabolism in Chlamydia Trachomatis by Iliffe-lee, Emma Rose; Phd from The University of Manitoba (canada), 2001, 258 pages http://wwwlib.umi.com/dissertations/fullcit/NQ62641
·
Characterization of Ihf and Set-domain Proteins of Chlamydia Trachomatis L2 by Zhong, Jianmin; Phd from The University of Tennessee Center for the Health Sciences, 2001, 207 pages http://wwwlib.umi.com/dissertations/fullcit/3006118
·
Hiv/aids and Five Other Leading Sexually Transmitted Diseases: Knowledge and Behavior Levels of University Freshmen (immune Deficiency, Gonorrhea, Syphilis, Herpes, Genital Warts, Chlamydia) by Roper, Robyn Lynn, Edd from Auburn University, 1994, 117 pages http://wwwlib.umi.com/dissertations/fullcit/9503405
·
Investigation of Herpes Simplex Virus-2 and Chlamydia Trachomatis Infections As Human Papillomavirus Cofactors in the Etiology of Invasive Cervical Cancer in Brazil and the Philippines by Smith, Jennifer Susan; Phd from The Johns Hopkins University, 2001, 118 pages http://wwwlib.umi.com/dissertations/fullcit/9993190
·
Microbicides for Blocking Vaginal Transmission of Chlamydia: Efficacy and Mechanisms of Action by Achilles, Sharon Lynelle; Phd from The Johns Hopkins University, 2001, 133 pages http://wwwlib.umi.com/dissertations/fullcit/9993067
·
Suppression of Mhc Class Ii but Not Icam-1 Molecules by Chlamydial Infection by Liu, Li; Msc from The University of Manitoba (canada), 2001, 118 pages http://wwwlib.umi.com/dissertations/fullcit/MQ62783
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to chlamydia is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
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Vocabulary Builder Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. The chief signs of arterial aneurysm are the formation of a pulsating tumour, and often a bruit (aneurysmal bruit) heard over the swelling. Sometimes there are symptoms from pressure on contiguous parts. [EU]
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with chlamydia and related conditions.
Researching Your Medications 149
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with chlamydia. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for chlamydia. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of chlamydia. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
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Your Medications: The Basics40 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of chlamydia. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with chlamydia take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for chlamydia. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
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How and when to take the medicine, how much to take, and for how long.
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What food, drinks, other medicines, or activities you should avoid while taking the medicine.
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What side effects the medicine may have, and what to do if they occur.
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If you can get a refill, and how often.
40
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
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·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for chlamydia). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
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Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
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Diet pills
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Vitamins
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Cold medicine
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Aspirin or other pain, headache, or fever medicine
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Cough medicine
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Allergy relief medicine
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Antacids
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Sleeping pills
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Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for chlamydia. One such source
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is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.41 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of chlamydia. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to chlamydia: Azithromycin ·
Systemic - U.S. Brands: Zithromax http://www.nlm.nih.gov/medlineplus/druginfo/azithromycinsys temic202642.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
41
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Penicillins ·
Systemic - U.S. Brands: Amoxil; Bactocill; Beepen-VK; BetapenVK; Bicillin L-A; Cloxapen; Crysticillin 300 A.S.; Dycill; Dynapen; Geocillin; Geopen; Ledercillin VK; Mezlin; Nafcil; Nallpen; Omnipen; Omnipen-N; Pathocil; Pen Vee K; Pentids; Permapen; Pfizerpen; Pfizerpen-AS; Pi http://www.nlm.nih.gov/medlineplus/druginfo/penicillinssyste mic202446.html Spermicides ·
Vaginal - U.S. Brands: Advantage 24; Because; Conceptrol Contraceptive Inserts; Conceptrol Gel; Delfen; Emko; Emko Pre-Fil; Encare; Gynol II Extra Strength Contraceptive Jelly; Gynol II Original Formula Contraceptive Jelly; Koromex Cream; Koromex Crystal Clear Gel; Koromex Fo http://www.nlm.nih.gov/medlineplus/druginfo/spermicidesvagi nal202531.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office. Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with chlamydia (including those with contraindications):42 ·
Amoxicillin http://www.reutershealth.com/atoz/html/Amoxicillin.htm
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Doxycycline http://www.reutershealth.com/atoz/html/Doxycycline.htm
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Erythromycin http://www.reutershealth.com/atoz/html/Erythromycin.htm
42
Adapted from A to Z Drug Facts by Facts and Comparisons.
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·
Minocycline http://www.reutershealth.com/atoz/html/Minocycline.htm
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Oral Contraceptives Combination Products http://www.reutershealth.com/atoz/html/Oral_Contraceptives_Combi nation_Products.htm
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Progesterone http://www.reutershealth.com/atoz/html/Progesterone.htm
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Tetracycline HCl http://www.reutershealth.com/atoz/html/Tetracycline_HCl.htm
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm. Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
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Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with chlamydia--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat chlamydia or potentially create deleterious side effects in patients with chlamydia. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with chlamydia. Exercise caution--some of these drugs may have fraudulent claims, and
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others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with chlamydia. The FDA warns patients to watch out for43: ·
Secret formulas (real scientists share what they know)
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Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
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Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Interactions in Infectious Diseases (Infectious Disease) by Stephen C. Piscitelli (Editor), et al; Hardcover - 372 pages (September 2000), Humana Press; ISBN: 0896037509; http://www.amazon.com/exec/obidos/ASIN/0896037509/icongroupinterna · Management of Antimicrobials in Infectious Diseases: Impact of Antibiotic Resistance by Arch G., Ph.D. Mainous (Editor), et al; Hardcover - 350 pages, 1st edition (January 15, 2001), Humana Press; ISBN: 0896038211; http://www.amazon.com/exec/obidos/ASIN/0896038211/icongroupinterna · Manual of Antibiotics and Infectious Diseases: Treatment and Prevention by John E. Conte; Paperback - 755 pages, 9th edition (December 15, 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781723167; http://www.amazon.com/exec/obidos/ASIN/0781723167/icongroupinterna
43
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH]
Researching Alternative Medicine 159
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to chlamydia. Finally, at the conclusion of this chapter, we will provide a list of readings on chlamydia from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?44 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 44
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?45 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
45
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.46
46
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Chlamydia Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for chlamydia. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “chlamydia” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Treatment With Jimei'an of Nongonococcal Urethritis Caused by Chlamydia and Ureaplasma Urealyticum Source: Journal of Traditional Chinese Medicine. 19(3): 173-174. 1999.
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Summary: This journal article reports the therapeutic effects of Jimei'an capsules on nongonococcal urethritis (NGU) caused by chlamydia and ureaplasma urealyticum. The sample consisted of outpatients from the Dispensary of Skin Diseases in Shantou City, China, in November and December of 1995. Patients with NGU caused by chlamydia or ureaplasma urealyticum were treated with Jimei'an capsule (n=38) or minocycline (n=160). Jimei'an capsule is a multi-herb formula, with each capsule containing 0.3 g of crude drugs. It was given t.i.d., two capsules each time, for 7 days per therapeutic course. Minocycline was given b.i.d., 100 mg each time, for 10 days per therapeutic course. With both treatments, patients completed up to 3 courses. Outcomes were classified as cured, effective, or ineffective according to predefined criteria. In the Jimei'an group, 26 cases (68.4 percent) were cured, 10 (26.3 percent) effective, and 2 (5.3) ineffective. In the minocycline group, 103 cases were cured (64.4 percent), 28 (17.5 percent) effective) and 29 (18.1 percent) ineffective. Jimei'an capsule had a significantly lower ineffective rate than minocycline. The authors conclude that Jimei'an capsule appears to be an effective treatment for NGU caused by chlamydia and ureaplasma urealyticum, with only mild side effects. The article has 2 tables. ·
Male Sexual Vitality: How You Can Benefit from Diet, Vitamins, Minerals, Herbs, Exercise, and Other Natural Methods Source: Rocklin, CA: Prima Publishing. 1994. 150 p. Contact: Available from Prima Publishing. PO Box 1260BK, Rocklin, CA 95677. 916-786-0426. Price: $10.95. ISBN: 1559584289. Summary: This book presents a natural approach to the prevention and treatment of male sexual dysfunctions. Chapter 1 provides an overview of the anatomy and physiology of the male sexual system. Chapter 2 describes the causes of erectile dysfunction, medical treatments for this problem, and a natural approach using exercise and plant-based medicines. Chapter 3 examines male infertility, including its causes, diagnosis, medical treatment, the role of scrotal temperature, and natural treatment with plant-based medicines, glandular therapy, antioxidants, and nutrients. Chapter 4, on prostate health, discusses the diagnosis of prostate disorders, reduction of prostate cancer risk, medical treatment of benign prostatic hyperplasia and prostatitis, and the natural approach to prostate health. Chapter 5 discusses chlamydia infection, and presents a natural approach to treating male genitourinary tract infections. Chapter 6 explains how to eat to maintain or improve virility. It includes recipes and guidelines for menu planning. Chapter 7 discusses the use of nutritional supplements. Chapter 8 discusses the use of ginseng for
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conditions involving the male reproductive system. The book includes a resource list, references, and an index.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to chlamydia and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “chlamydia” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to chlamydia: ·
Accurate detection of male subclinical genital tract infection via cervical culture and DNA hybridization assay of the female partner. Author(s): Trum JW, Pannekoek Y, Spanjaard L, Bleker OP, Van Der Veen F. Source: International Journal of Andrology. 2000 February; 23(1): 43-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10632761&dopt=Abstract
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Adolescent behavior and sexually transmitted diseases: the dilemma of human papillomavirus. Author(s): Cothran MM, White JP. Source: Health Care for Women International. 2002 April-May; 23(3): 30619. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12003506&dopt=Abstract
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Ansamycins. Chemistry, biosynthesis and biological activity. Author(s): Wehrli W. Source: Top Curr Chem. 1977; 72: 21-49. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=74108&dopt=Abstract
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Application of a long-term enhanced xanthine oxidase-induced luminescence in solid-phase immunoassays. Author(s): Baret A, Fert V, Aumaille J.
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Source: Analytical Biochemistry. 1990 May 15; 187(1): 20-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2115311&dopt=Abstract ·
Application of intensified (+) Qi Gong energy, (-) electrical field, (S) magnetic field, electrical pulses (1-2 pulses/sec), strong Shiatsu massage or acupuncture on the accurate organ representation areas of the hands to improve circulation and enhance drug uptake in pathological organs: clinical applications with special emphasis on the "Chlamydia-(Lyme)-uric acid syndrome" and "Chlamydia-(cytomegalovirus)-uric acid syndrome". Author(s): Omura Y, Beckman SL. Source: Acupunct Electrother Res. 1995 January-March; 20(1): 21-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7572329&dopt=Abstract
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Chlamydia DNA extraction for use in PCR: stability and sensitivity in detection. Author(s): Daugharty H, Skelton SK, Messmer T. Source: Journal of Clinical Laboratory Analysis. 1998; 12(1): 47-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9484669&dopt=Abstract
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Chlamydia trachomatis genitourinary infections: laboratory diagnosis and therapeutic aspects. Evaluation of in vitro and in vivo effectiveness of azithromycin. Author(s): Chiarini F, Mansi A, Tomao P, Gentile V, De Marco F, Brunori S, Wongher L, Di Silverio F. Source: Journal of Chemotherapy (Florence, Italy). 1994 August; 6(4): 23842. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7830100&dopt=Abstract
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Chlamydia trachomatis in 'abacterial' prostatitis: microbiological, cytological and serological studies. Author(s): Weidner W, Arens M, Krauss H, Schiefer HG, Ebner H. Source: Urologia Internationalis. 1983; 38(3): 146-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6346628&dopt=Abstract
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Clinical trial with praneem polyherbal cream in patients with abnormal vaginal discharge due to microbial infections. Author(s): Mittal A, Kapur S, Garg S, Upadhyay SN, Suri S, Das SK, Gupta S, Talwar GP.
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Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1995 May; 35(2): 190-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7677686&dopt=Abstract ·
Community efforts in the reduction of corneal blindness in developing countries. Author(s): Foster A, Gilbert C. Source: Refract Corneal Surg. 1991 November-December; 7(6): 445-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1782160&dopt=Abstract
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Control mechanisms governing the infectivity of Chlamydia trachomatis for HeLa cells: mechanisms of endocytosis. Author(s): Ward ME, Murray A. Source: J Gen Microbiol. 1984 July; 130 ( Pt 7): 1765-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6470672&dopt=Abstract
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Douching and sexually transmitted diseases in pregnant women in Surabaya, Indonesia. Author(s): Joesoef MR, Sumampouw H, Linnan M, Schmid S, Idajadi A, St Louis ME. Source: American Journal of Obstetrics and Gynecology. 1996 January; 174(1 Pt 1): 115-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8571993&dopt=Abstract
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Effect of alkali on the structure of cell envelopes of Chlamydia psittaci elementary bodies. Author(s): Narita T, Wyrick PB, Manire GP. Source: Journal of Bacteriology. 1976 January; 125(1): 300-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1375&dopt=Abstract
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ELISPOT assay for Chlamydia-specific, antibody-producing cells correlated with conventional complement fixation and microimmunofluorescence. Author(s): Daugharty H, Messmer TO, Fields BS.
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Source: Journal of Clinical Laboratory Analysis. 1997; 11(1): 45-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9021524&dopt=Abstract ·
Evaluation the enzyme immunosorbent assay IDEIA test detecting Chlamydia trachomatis in cervix. Author(s): Nunthapisud P, Nuruthisard S. Source: Southeast Asian J Trop Med Public Health. 1991 December; 22(4): 655-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1820656&dopt=Abstract
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Fusion of inclusions following superinfection of HeLa cells by two serovars of Chlamydia trachomatis. Author(s): Ridderhof JC, Barnes RC. Source: Infection and Immunity. 1989 October; 57(10): 3189-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2550371&dopt=Abstract
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In vitro growth of Chlamydia trachomatis in conjunctival and corneal epithelium. Author(s): Patton DL, Chan KY, Kuo CC, Cosgrove YT, Langley L. Source: Investigative Ophthalmology & Visual Science. 1988 July; 29(7): 1087-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2843480&dopt=Abstract
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Inhibitory effect on the formation of chlamydial inclusions in McCoy cells by seminal fluid and some of its components. Author(s): Mardh PA, Colleen S, Sylwan J. Source: Invest Urol. 1980 May; 17(6): 510-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6246025&dopt=Abstract
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Morphological and cytochemical study of Chlamydia with EDTA regressive technique and Gautier staining in ultrathin frozen sections of infected cell cultures: a comparison with embedded material. Author(s): Popov V, Eb F, Lefebvre JF, Orfila J, Viron A. Source: Ann Microbiol (Paris). 1978 October; 129 B(3): 313-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=106752&dopt=Abstract
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Protein-carbohydrate-lipid complex isolated from the cell envelopes of Chlamydia psittaci in alkaline buffer and ethylenediaminetetraacetate. Author(s): Narita T, Manire GP. Source: Journal of Bacteriology. 1976 January; 125(1): 308-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1376&dopt=Abstract
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Role of mercury (Hg) in resistant infections & effective treatment of Chlamydia trachomatis and Herpes family viral infections (and potential treatment for cancer) by removing localized Hg deposits with Chinese parsley and delivering effective antibiotics using various drug uptake enhancement methods. Author(s): Omura Y, Beckman SL. Source: Acupunct Electrother Res. 1995 August-December; 20(3-4): 195229. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8686573&dopt=Abstract
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Significance of Chlamydia trachomatis in "abacterial" prostatitis. Author(s): Krauss H, Schiefer HG, Weidner W, Arens M, Ebner H. Source: Zentralbl Bakteriol Mikrobiol Hyg [a]. 1983 July; 254(4): 545-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6372332&dopt=Abstract
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The role of Chlamydia trachomatis in patients with non-bacterial prostatitis. Author(s): Mutlu N, Mutlu B, Culha M, Hamsioglu Z, Demirtas M, Gokalp A. Source: Int J Clin Pract. 1998 November-December; 52(8): 540-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10622051&dopt=Abstract
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The role of chlamydiae in epididymitis. Author(s): Melekos MD, Asbach HW. Source: International Urology and Nephrology. 1988; 20(3): 293-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3136090&dopt=Abstract
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The role of lipopolysaccharide in the exposure of protective antigenic sites on the major outer membrane protein of Chlamydia trachomatis. Author(s): Vretou E, Psarrou E, Spiliopoulou D.
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Source: J Gen Microbiol. 1992 June; 138 ( Pt 6): 1221-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1382112&dopt=Abstract ·
Treatment with jimei'an of nongonococcal urethritis caused by Chlamydia and Ureaplasma urealyticum. Author(s): Chen X. Source: J Tradit Chin Med. 1999 September; 19(3): 173-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10921144&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to chlamydia; please note that any particular subject below may indicate either a therapeutic use, or a
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contraindication (potential danger), and does not reflect an official recommendation: ·
Herbs and Supplements Ananas comosus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Brom elaincs.html Bromelain Alternative names: Ananas comosus, Bromelainum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Brom elaincs.html Bromelainum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Brom elaincs.html Goldenseal Alternative names: Hydrastis canadensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Goldenseal.htm
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Related Conditions Proctitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Prostate Infection Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Prostatitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Rectal Inflammation Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Reiter's Syndrome Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Reiters Syndromecc.html Sexually Transmitted Diseases Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Sexuall yTransmittedDiseasescc.html STDs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Sexuall yTransmittedDiseasescc.html Urethral Inflammation Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Urethri tiscc.html Urethritis Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Urethri tiscc.html
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·
Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna
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Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna
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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna
· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·
Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna
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·
Natural Alternatives to Antibiotics by John McKenna; Paperback - 176 pages (November 1998), Avery Penguin Putnam; ISBN: 0895298392; http://www.amazon.com/exec/obidos/ASIN/0895298392/icongroupinterna
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New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna
· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Luminescence:
The property of giving off light without emitting a
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corresponding degree of heat. It includes the luminescence of inorganic matter or the bioluminescence of human matter, invertebrates and other living organisms. For the luminescence of bacteria, luminescence, bacterial is available. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH]
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with chlamydia. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with chlamydia may be given different recommendations. Some recommendations may be directly related to chlamydia, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of chlamydia. We will then show you how to find studies dedicated specifically to nutrition and chlamydia.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:47 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
47
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
Researching Nutrition 181
·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?48
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”49 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.50 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 49 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 50 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 48
182 Chlamydia
the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Chlamydia The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.51 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
51
Researching Nutrition 183
periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “chlamydia” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “chlamydia” (or a synonym): ·
A role for tryptophan in immune control of chlamydial abortion in sheep. Author(s): Moredun Research Institute, IRC, Pentlands Science Park, Bush Loan, EH26 0PZ, Scotland, Penicuik, UK. Source: Brown, J Howie, S E Entrican, G Vet-Immunol-Immunopathol. 2001 September 28; 82(1-2): 107-19 0165-2427
·
Acquisition and synthesis of folates by obligate intracellular bacteria of the genus Chlamydia. Author(s): Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada. Source: Fan, H Brunham, R C McClarty, G J-Clin-Invest. 1992 November; 90(5): 1803-11 0021-9738
·
An oligomer of the major outer membrane protein of Chlamydia psittaci is recognized by monoclonal antibodies which protect mice from abortion. Source: Sa, C. de Souriau, A. Bernard, F. Salinas, J. Rodolakis, A. Infectimmun. Washington, D.C., American Society for Microbiology. December 1995. volume 63 (12) page 4912-4916. 0019-9567
·
Animal models of chlamydia and atherosclerosis. Author(s): Division of Cardiology, University of Utah, LDS Hospital, Salt Lake City, UT 84143, USA. Source: Muhlestein, J B Am-Heart-J. 1999 November; 138(5 Pt 2): S514-5 0002-8703
·
Chlamydia-induced bilaterial ectropion of the inferior eyelids in pigeons. Source: Bougiouklis, P. Papaioannou, N. Georgopoulou, I. Iordanidis, P. Vlemmas, I. Lekkas, S. Siarkou, V. Avian-dis. Kennett Square, Pa.: American Association of Avian Pathologists Inc. Apr/June 2000. volume 44 (2) page 372-378. 0005-2086
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·
Cytotoxic-T-lymphocyte-mediated cytolysis of L cells persistently infected with Chlamydia spp. Source: Rasmussen, S.J. Timms, P. Beatty, P.R. Stephens, R.S. Infectimmun. Washington, D.C., American Society for Microbiology. June 1996. volume 64 (6) page 1944-1949. 0019-9567
·
Detection and antigenicity of chlamydial proteins that blind eukaryotic cell membrane proteins. Source: Baghian, A. Schnorr, K.L. Am-J-Vet-Res. Schaumburg, Ill. : American Veterinary Medical Association. June 1992. volume 53 (6) page 980-986. 0002-9645
·
Deviation of immune response to Chlamydia psittaci outer membrane protein in lipopolysaccharide-hyporesponsive mice. Source: Westbay, T.D. Dascher, C.C. Hsia, R.C. Zauderer, M. Bavoil, P.M. Infect-immun. Washington, D.C., American Society for Microbiology. April 1995. volume 63 (4) page 1391-1393. 0019-9567
·
Does addition of anti-inflammatory agents to antimicrobial therapy reduce infertility after murine chlamydial salpingitis? Author(s): San Francisco General Hospital Department of Obstetrics, Gynecology and Reproductive Sciences, CA 94110. Source: Landers, D V Sung, M L Bottles, K Schachter, J Sex-Transm-Dis. 1993 May-June; 20(3): 121-5 0148-5717
·
Effects of ascorbic acid on Chlamydia trachomatis infection and on erythromycin treatment in primary cultures of human amniotic cells. Author(s): Department of Obstetrics and Gynecology, University of Washington, Seattle 98195. Source: Wang, S K Patton, D L Kuo, C C J-Clin-Microbiol. 1992 October; 30(10): 2551-4 0095-1137
·
Evolutionary relationships among members of the genus Chlamydia based on 16S ribosomal DNA analysis. Source: Patterson, B. Andersson, A. Leitner, T. Olsvik, O. Uhlen, M. Storey, C. Black, C.M. J-bacteriol. Washington, D.C. : American Society for Microbiology. July 1997. volume 179 (13) page 4195-4205. 0021-9193
Researching Nutrition 185
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
·
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
·
The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
·
Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
·
Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
·
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
·
Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
·
Open Directory Project: http://dmoz.org/Health/Nutrition/
186 Chlamydia
·
Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a
Researching Nutrition 187
pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 189
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.52
52
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
190 Chlamydia
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):53 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
·
California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
·
California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
·
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
53
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 191
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
·
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
192 Chlamydia
·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
·
Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
·
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
·
Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
·
Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 193
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 195
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
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South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
More on Chlamydia 197
APPENDIX E. MORE ON CHLAMYDIA Overview54 Chlamydia is a sexually transmitted disease (STD) that is caused by the bacterium Chlamydia trachomatis. Because approximately 75% of women and 50% of men have no symptoms, most people infected with chlamydia are not aware of their infections and therefore may not seek health care. When diagnosed, chlamydia can be easily treated and cured. Untreated, chlamydia can cause severe, costly reproductive and other health problems which include both short- and long-term consequences, including pelvic inflammatory disease (PID), which is the critical link to infertility, and potentially fatal tubal pregnancy. Up to 40% of women with untreated chlamydia will develop PID. Undiagnosed PID caused by chlamydia is common. Of those with PID, 20% will become infertile; 18% will experience debilitating, chronic pelvic pain; and 9% will have a life-threatening tubal pregnancy. Tubal pregnancy is the leading cause of first-trimester, pregnancy-related deaths in American women. Chlamydia may also result in adverse outcomes of pregnancy, including neonatal conjunctivitis and pneumonia. In addition, recent research has shown that women infected with chlamydia have a 3 - 5 fold increased risk of acquiring HIV, if exposed.
Adapted from The Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/nchstp/dstd/Fact_Sheets/chlamydia_facts.htm.
54
198 Chlamydia
Chlamydia is also common among young men, who are seldom offered screening. Untreated chlamydia in men typically causes urethral infection, but may also result in complications such as swollen and tender testicles.
What Is the Magnitude of the Problem? Chlamydia is the most frequently reported infectious disease in the United States. Though 526,653 cases were reported in 1997, an estimated 3 million cases occur annually. Severe under reporting is largely a result of substantial numbers of asymptomatic persons whose infections are not identified because screening is not available. Highlights of reported data are as follows: ·
From 1984 through 1997, reported rates of chlamydia increased from 3.2 to 207.0 cases per 100,000 population. This trend primarily reflects increased screening, recognition of asymptomatic infection (mainly in women), and improved reporting capacity rather than a true increase in disease incidence.
·
In 1997, the reported rate of chlamydia for women (335.8) substantially exceeded the rate for men (70.4), due mainly to increased detection of asymptomatic infection in women through screening. Low rates of reported chlamydia among men suggest that many of the partners of women with chlamydia are not screened or treated.
·
As in previous years, 1997 rates of chlamydia were highest in the West and the Midwest, where substantial resources have been committed for organized screening programs.
How Are Adolescents and Young Women Affected? ·
As many as 1 in 10 adolescent girls tested for chlamydia is infected.
·
Based on reports to CDC provided by states that collect age-specific data, teenage girls have the highest rates of chlamydial infection. In these states, 15- to 19-year-old girls represent 46% of infections and 20- to 24year-old women represent another 33%. These high percentages are consistent with high rates of other STDs among teenagers.
·
Among women entering the Job Corps in 1997, chlamydia rates ranged from 4 - 14% by state (20,000 entrants are screened annually). Chlamydial infection is widespread geographically and highly prevalent among these economically disadvantaged young women between 16 and 24 years old.
More on Chlamydia 199
What Does Chlamydia Cost? The annual cost of chlamydia and its consequences in the United States is more than $2 billion. The CDC estimates screening and treatment programs can be conducted at an annual cost of $175 million. Every dollar spent on screening and treatment saves $12 in complications that result from untreated chlamydia.
What Is Being Done to Address the Problem? In 1993, Congress appropriated funds to begin a national STD-related infertility prevention program. Through a cooperative effort between CDC and the Office of Population Affairs, the program involves strong collaboration among family planning, STD and primary health care programs, and public health laboratories. Significant progress has been made where screening programs have been fully implemented. ·
A 65% decline in infection was demonstrated in family planning clinics in Federal Region X (Alaska, Idaho, Oregon, and Washington) in the first 8 years of screening, from 1988 to 1995. These declines have occurred across all age groups since testing began in 1988, although adolescents continue to have the highest rates of disease.
·
A 31% decline in infection was indicated for females under age 20 during the first 2-1/2 years of initial large-scale screening in Region III (Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia), from 7.8% in 1994 to 5.4% during January-June 1996.
·
A 16% decline in infection was indicated for females under age 20 during the first 2-1/2 years of initial large-scale screening in Region VIII (Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming), from 5.5% in 1994 to 4.6% during January-June 1996.
·
Strong evidence is now available that chlamydia screening and treatment not only reduces the prevalence of lower genital tract infection, but also decreases the incidence of costly complications, such as PID. A randomized trial of chlamydia screening and treatment in a health maintenance organization demonstrated a 56% reduction in the incidence of PID in the screened group in the 12 months following the trial.
Due to resource constraints, the program continues only as demonstration projects in most parts of the country. CDC estimates that nearly 75% of women at risk reside in 30 states that are only just beginning to screen for chlamydia. For example, in California, Florida, Georgia, Illinois, New York,
200 Chlamydia
and Texas, more than 200,000 women in each state who attend publicly funded family planning and STD clinics currently do not have access to screening and treatment. Since these programs have focused on prevention efforts in women, many men with chlamydia are not diagnosed and treated, thus continuing the cycle of infection. CDC has developed recommendations for the prevention and management of chlamydia for all providers of health care. These recommendations call for screening of all sexually active females under 20 years of age at least annually, and annual screening of women ages 20 and older with one or more risk factors for chlamydia (i.e., new or multiple sex partners and lack of barrier contraception). All women with infection of the cervix and all pregnant women should be tested.
What Still Needs to Be Done? Programs to provide testing for infection through screening and subsequent treatment are needed nationwide. A successful program must include comprehensive screening and treatment not only for women but also for men. Recent research advances have made available extremely accurate urine tests which make testing of males more feasible and less uncomfortable than older tests. In addition, single-dose antibiotic therapy promises to substantially enhance the likelihood of successful treatment -- especially in adolescents -- as compared to commonly used 7-day oral medication.
More on Sexually Transmitted Diseases 201
APPENDIX DISEASES
F.
MORE
ON
SEXUALLY
TRANSMITTED
Overview55 Sexually transmitted diseases (STDs), once called venereal diseases, are among the most common infectious diseases in the United States today. More than 20 STDs have now been identified, and they affect more than 13 million men and women in this country each year. The annual comprehensive cost of STDs in the United States is estimated to be well in excess of $10 billion. Understanding the basic facts about STDs – the ways in which they are spread, their common symptoms, and how they can be treated– is the first step toward prevention. The National Institute of Allergy and Infectious Diseases (NIAID), a part of the National Institutes of Health, has prepared a series of fact sheets about STDs to provide this important information. Research investigators supported by NIAID are looking for better methods of diagnosis and more effective treatments, as well as for vaccines and topical microbicides to prevent STDs. It is important to understand at least five key points about all STDs in this country today: ·
STDs affect men and women of all backgrounds and economic levels. They are most prevalent among teenagers and young adults. Nearly twothirds of all STDs occur in people younger than 25 years of age.
·
The incidence of STDs is rising, in part because in the last few decades, young people have become sexually active earlier yet are marrying later. In addition, divorce is more common. The net result is that sexually
Adapted from The National Institute of Allergy and Infectious Diseases (NIAID): http://www.niaid.nih.gov/factsheets/stdinfo.htm. 55
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active people today are more likely to have multiple sex partners during their lives and are potentially at risk for developing STDs. ·
Most of the time, STDs cause no symptoms, particularly in women. When and if symptoms develop, they may be confused with those of other diseases not transmitted through sexual contact. Even when an STD causes no symptoms, however, a person who is infected may be able to pass the disease on to a sex partner. That is why many doctors recommend periodic testing or screening for people who have more than one sex partner.
·
Health problems caused by STDs tend to be more severe and more frequent for women than for men, in part because the frequency of asymptomatic infection means that many women do not seek care until serious problems have developed.
·
-
Some STDs can spread into the uterus (womb) and fallopian tubes to cause pelvic inflammatory disease (PID), which in turn is a major cause of both infertility and ectopic (tubal) pregnancy. The latter can be fatal.
-
STDs in women also may be associated with cervical cancer. One STD, human papillomavirus infection (HPV), causes genital warts and cervical and other genital cancers.
-
STDs can be passed from a mother to her baby before, during, or immediately after birth; some of these infections of the newborn can be cured easily, but others may cause a baby to be permanently disabled or even die.
When diagnosed and treated early, many STDs can be treated effectively. Some infections have become resistant to the drugs used to treat them and now require newer types of antibiotics. Experts believe that having STDs other than AIDS increases one’s risk for becoming infected with the AIDS virus.
HIV Infection and AIDS AIDS (acquired immunodeficiency syndrome) was first reported in the United States in 1981. It is caused by the human immunodeficiency virus (HIV), a virus that destroys the body’s ability to fight off infection. An estimated 900,000 people in the United States are currently infected with HIV. People who have AIDS are very susceptible to many life-threatening diseases, called opportunistic infections, and to certain forms of cancer. Transmission of the virus primarily occurs during sexual activity and by sharing needles used to inject intravenous drugs. If you have any questions
More on Sexually Transmitted Diseases 203
about HIV infection or AIDS, you can call the AIDS Hotline confidential tollfree number: 1-800-342-AIDS.
Chlamydial Infection This infection is now the most common of all bacterial STDs, with an estimated 4 to 8 million new cases occurring each year. In both men and women, chlamydial infection may cause an abnormal genital discharge and burning with urination. In women, untreated chlamydial infection may lead to pelvic inflammatory disease, one of the most common causes of ectopic pregnancy and infertility in women. Many people with chlamydial infection, however, have few or no symptoms of infection. Once diagnosed with chlamydial infection, a person can be treated with an antibiotic.
Genital Herpes Genital herpes affects an estimated 60 million Americans. Approximately 500,000 new cases of this incurable viral infection develop annually. Herpes infections are caused by herpes simplex virus (HSV). The major symptoms of herpes infection are painful blisters or open sores in the genital area. These may be preceded by a tingling or burning sensation in the legs, buttocks, or genital region. The herpes sores usually disappear within two to three weeks, but the virus remains in the body for life and the lesions may recur from time to time. Severe or frequently recurrent genital herpes is treated with one of several antiviral drugs that are available by prescription. These drugs help control the symptoms but do not eliminate the herpes virus from the body. Suppressive antiviral therapy can be used to prevent occurrences and perhaps transmission. Women who acquire genital herpes during pregnancy can transmit the virus to their babies. Untreated HSV infection in newborns can result in mental retardation and death.
Genital Warts Genital warts (also called venereal warts or condylomata acuminata) are caused by human papillomavirus, a virus related to the virus that causes common skin warts. Genital warts usually first appear as small, hard painless bumps in the vaginal area, on the penis, or around the anus. If untreated, they may grow and develop a fleshy, cauliflower-like appearance. Genital warts infect an estimated 1 million Americans each year. In addition to genital warts, certain high-risk types of HPV cause cervical cancer and
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other genital cancers. Genital warts are treated with a topical drug (applied to the skin), by freezing, or if they recur, with injections of a type of interferon. If the warts are very large, they can be removed by surgery. Gonorrhea Approximately 400,000 cases of gonorrhea are reported to the U.S. Centers for Disease Control and Prevention (CDC) each year in this country. The most common symptoms of gonorrhea are a discharge from the vagina or penis and painful or difficult urination. The most common and serious complications occur in women and, as with chlamydial infection, these complications include PID, ectopic pregnancy, and infertility. Historically, penicillin has been used to treat gonorrhea, but in the last decade, four types of antibiotic resistance have emerged. New antibiotics or combinations of drugs must be used to treat these resistant strains.
Syphilis The incidence of syphilis has increased and decreased dramatically in recent years, with more than 11,000 cases reported in 1996. The first symptoms of syphilis may go undetected because they are very mild and disappear spontaneously. The initial symptom is a chancre; it is usually a painless open sore that usually appears on the penis or around or in the vagina. It can also occur near the mouth, anus, or on the hands. If untreated, syphilis may go on to more advanced stages, including a transient rash and, eventually, serious involvement of the heart and central nervous system. The full course of the disease can take years. Penicillin remains the most effective drug to treat people with syphilis. Other diseases that may be sexually transmitted include trichomoniasis, bacterial vaginosis, cytomegalovirus infections, scabies, and pubic lice. STDs in pregnant women are associated with a number of adverse outcomes, including spontaneous abortion and infection in the newborn. Low birth weight and prematurity appear to be associated with STDs, including chlamydial infection and trichomoniasis. Congenital or perinatal infection (infection that occurs around the time of birth) occurs in 30 to 70 percent of infants born to infected mothers, and complications may include pneumonia, eye infections, and permanent neurologic damage.
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What Can You Do to Prevent STDs? The best way to prevent STDs is to avoid sexual contact with others. If you decide to be sexually active, there are things that you can do to reduce your risk of developing an STD. ·
Have a mutually monogamous sexual relationship with an uninfected partner.
·
Correctly and consistently use a male condom.
·
Use clean needles if injecting intravenous drugs.
·
Prevent and control other STDs to decrease susceptibility to HIV infection and to reduce your infectiousness if you are HIV-infected.
·
Delay having sexual relations as long as possible. The younger people are when having sex for the first time, the more susceptible they become to developing an STD. The risk of acquiring an STD also increases with the number of partners over a lifetime.
Anyone who is sexually active should: ·
Have regular checkups for STDs even in the absence of symptoms, and especially if having sex with a new partner. These tests can be done during a routine visit to the doctor’s office.
·
Learn the common symptoms of STDs. Seek medical help immediately if any suspicious symptoms develop, even if they are mild.
·
Avoid having sex during menstruation. HIV-infected women are probably more infectious, and HIV-uninfected women are probably more susceptible to becoming infected during that time.
·
Avoid anal intercourse, but if practiced, use a male condom.
·
Avoid douching because it removes some of the normal protective bacteria in the vagina and increases the risk of getting some STDs.
Anyone diagnosed as having an STD should: ·
Be treated to reduce the risk of transmitting an STD to an infant.
·
Discuss with a doctor the possible risk of transmission in breast milk and whether commercial formula should be substituted.
·
Notify all recent sex partners and urge them to get a checkup.
·
Follow the doctor’s orders and complete the full course of medication prescribed. A follow-up test to ensure that the infection has been cured is often an important step in treatment.
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·
Avoid all sexual activity while being treated for an STD.
Sometimes people are too embarrassed or frightened to ask for help or information. Most STDs are readily treated, and the earlier a person seeks treatment and warns sex partners about the disease, the less likely the disease will do irreparable physical damage, be spread to others or, in the case of a woman, be passed on to a newborn baby. Private doctors, local health departments, and STD and family planning clinics have information about STDs. In addition, the American Social Health Association (ASHA) provides free information and keeps lists of clinics and private doctors who provide treatment for people with STDs. ASHA has a national toll-free telephone number, 1-800-227-8922. The phone number for the Herpes Hotline, also run by ASHA, is 919-361-8488. Callers can get information from the ASHA hotline without leaving their names.
Research STDs cause physical and emotional suffering to millions and are costly to individuals and to society as a whole. NIAID conducts and supports many research projects designed to improve methods of prevention, and to find better ways to diagnose and treat these diseases. NIAID also supports several large university-based STD research centers. Within the past few years, NIAID-supported research has resulted in new tests to diagnose some STDs faster and more accurately. New drug treatments for STDs are under investigation by NIAID researchers. This is especially important because some STDs are becoming resistant to the standard drugs. In addition, vaccines are being developed or tested for effectiveness in preventing several STDs, including AIDS, chlamydial infection, genital herpes, and gonorrhea. It is up to each individual to learn more about STDs and then make choices about how to minimize the risk of acquiring these diseases and spreading them to others. Knowledge of STDs, as well as honesty and openness with sex partners and with one’s doctor, can be very important in reducing the incidence and complications of sexually transmitted diseases.
More on Sexually Transmitted Diseases 207
Sexually Transmitted Diseases and the Organisms Responsible Disease Organism(s) Acquired Immunodeficiency Syndrome (AIDS) Human immunodeficiency virus Bacterial vaginosis Bacteroides Gardnerella vaginalis Mobiluncus spp. Mycoplasma hominis Ureaplasma urealyticum Chancroid Haemophilus ducreyi Chlamydial infections Chlamydia trachomatis Cytomegalovirus infections Cytomegalovirus Genital herpes Herpes simplex virus Genital (venereal) warts Human papillomavirus Gonorrhea Neisseria gonorrhoeae Granuloma inguinale (donovanosis) Calymmatobacterium granulomatis Leukemia-Lymphoma/Myelopathy HTLV-I and II Lymphogranuloma venereum Chlamydia trachomatis Molluscum contagiosum Molluscum contagiosum virus Pubic lice Phthirus pubis Scabies Sarcoptes scabiei Syphilis Treponema pallidum Trichomoniasis Trichomonas vaginalis Vaginal yeast infections Candida albicans
Vocabulary Builder Antiviral: Destroying viruses or suppressing their replication. [EU] Bacteroides: A genus of gram-negative, anaerobic, rod-shaped bacteria. Its organisms are normal inhabitants of the oral, respiratory, intestinal, and urogenital cavities of humans, animals, and insects. Some species may be pathogenic. [NIH] Blister: Visible accumulations of fluid within or beneath the epidermis. [NIH] Calymmatobacterium: A genus of bacteria causing granuloma inguinale and other granulomatous lesions. [NIH] Chancre: The primary sore of syphilis, a painless indurated, eroded papule, occurring at the site of entry of the infection. [NIH] Haemophilus: A genus of pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gramnegative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU]
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Menstruation: The cyclic, physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus; it is under hormonal control and normally recurs, usually at approximately four-week intervals, in the absence of pregnancy during the reproductive period (puberty through menopause) of the female of the human and a few species of primates. It is the culmination of the menstrual cycle. [EU] Mobiluncus: A genus of gram-negative, anaerobic, rod-shaped bacteria. Its organisms are found in the human vagina, particularly in association with Gardnerella vaginalis in cases of bacterial vaginosis. [NIH] Neurologic: Pertaining to neurology or to the nervous system. [EU] Phthirus: Lice of the genus Phthirus, family Pediculidae. Phthirus pubis, the crab louse, is usually acquired by sexual contact or contact with infected objects. It is found most frequently in the pubic hair, but also on eyebrows, eyelashes, or on the axillary hairs. [NIH] Suppressive: Tending to suppress: effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Treponema: A genus of microorganisms of the order spirochaetales, many of which are pathogenic and parasitic for man. [NIH]
STDs and Pregnancy 209
APPENDIX G. STDS AND PREGNANCY Overview56 Women who are pregnant can become infected with the same sexually transmitted diseases (STDs) as women who are not pregnant. Pregnancy does not provide women or their babies any protection against STDs. In fact, the consequences of an STD can be significantly more serious--even life threatening--for a woman and her baby if the woman becomes infected with an STD while she is pregnant. As the list of diseases known to be sexually transmitted continues to grow, it is increasingly important that women be aware of the harmful effects of these diseases and know how to protect themselves and their children against infection.
How Can STDs Affect a Woman during Pregnancy? STDs can have many of the same consequences for pregnant women as for women who are not pregnant. STDs can cause cervical and other cancers, chronic hepatitis, cirrhosis, and other complications. Many STDs are silent-or present without symptoms--in women. Among the additional consequences pregnant women may suffer from STDs are early onset of labor, premature rupture of the membranes surrounding the baby in the uterus, and uterine infection after delivery.
Adapted from The National Institute of Allergy and Infectious Diseases (NIAID): http://www.niaid.nih.gov/factsheets/stdinfo.htm. 56
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How Can a Pregnant Woman’s Baby Become Infected? STDs can be transmitted from a pregnant woman to the fetus, newborn, or infant before, during, or after birth. Some STDs (like syphilis) cross the placenta and infect the fetus during its development. Other STDs (like gonorrhea, chlamydia, hepatitis B, and genital herpes) are transmitted from the mother to the infant as the infant passes through the birth canal. HIV infection can cross the placenta during pregnancy, infect the newborn during the birth process, and, unlike other STDs, infect an infant as a result of breast-feeding.
How Can STDs Affect the Fetus or Newborn? Harmful effects on the baby may include stillbirth, low birth weight, conjunctivitis (eye infection), pneumonia, neonatal sepsis (infection in the blood stream), neurologic damage (such as brain damage or motor disorder), congenital abnormalities (including blindness, deafness, or other organ damage), acute hepatitis, meningitis, chronic liver disease, and cirrhosis. Some of these consequences may be apparent at birth; others may not be detected until months or even years later.
How Common Are STDs Among Pregnant Women in the U.S.? Some STDs, such as genital herpes and bacterial vaginosis, are quite common among pregnant women in this country. Other STDs, notably HIV and syphilis, are much less common in pregnant women. The table below shows the estimated number of pregnant women in the U.S., per year with specific STDs. STDs
Estimated Number of Pregnant Women
Bacterial vaginosis Herpes simplex Chlamydia Trichomoniasis Gonorrhea Hepatitis B HIV Syphilis
800,000 800,000 200,000 80,000 40,000 40,000 8,000 8,000
(Source: Goldenberg et al., 1997)
STDs and Pregnancy 211
Should Pregnant Women Be Tested for STDs? STDs affect women of every socioeconomic and educational level, age, race, ethnicity, and religion. The CDC STD Treatment Guidelines (1997) recommend that pregnant women be screened for the following STDs: ·
Chlamydia
·
Gonorrhea
·
Hepatitis B
·
HIV
·
Syphilis
Pregnant women should request these tests specifically because some doctors do not routinely perform them. New and increasingly accurate tests continue to become available. Even if a woman has been tested in the past, she should be tested again when she becomes pregnant.
Can STDs Be Treated during Pregnancy? Bacterial STDs (like chlamydia, gonorrhea, and syphilis) can be treated and cured with antibiotics during pregnancy. There is no cure for viral STDs such as genital herpes and HIV, but antiviral medication for herpes and HIV may reduce symptoms in the pregnant woman. In addition, the risk of passing HIV infection from mother to baby is dramatically reduced by treatment. For women who have active genital herpes lesions at the time of delivery, a cesarean section may be performed to protect the newborn against infection.
How Can Pregnant Women Protect Themselves against Infection? Although a woman may be monogamous during her pregnancy, she can remain at risk of STDs if her partner is not monogamous. For this reason, she may want to consider consistent and correct use of latex condoms for every act of intercourse. Protection is critical throughout a woman’s pregnancy, including the last trimester when active infection can present a great threat to the health of a woman and her baby.
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Where Can I Get More Information? STD Hotline: 1-800-227-8922 HIV Hotline: 1-800-342-AIDS
Vocabulary Builder Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Membranes: Thin layers of tissue which cover parts of the body, separate adjacent cavities, or connect adjacent structures. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH]
Online Glossaries 213
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to chlamydia and keep them on file. The NIH, in particular, suggests that patients with chlamydia visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Chlamydia Chlamydia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001345.htm Chlamydia infections in women Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000660.htm Chlamydial urethritis - male Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000659.htm PID Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000888.htm
·
Signs & Symptoms for Chlamydia Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Abdominal tenderness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Blindness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003040.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Painful intercourse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm
Online Glossaries 215
Sexual intercourse, painful Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm Testicular tenderness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003160.htm Urinary frequency/urgency, increased Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm Urinary hesitancy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003143.htm Urination, painful Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003145.htm Vaginal discharge Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003158.htm ·
Diagnostics and Tests for Chlamydia Complement Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003456.htm Culture from cervix Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003754.htm Urethral discharge culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003750.htm
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·
Background Topics for Chlamydia Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Antibody Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002223.htm Asymptomatic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002217.htm Breathing problems Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000007.htm Cervix Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002317.htm Condoms Web site: http://www.nlm.nih.gov/medlineplus/ency/article/004001.htm High-risk sexual behavior Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001949.htm Immunity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000821.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Penis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002279.htm
Online Glossaries 217
Respiratory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002290.htm Testes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002334.htm Testicles Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002334.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 219
CHLAMYDIA GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Abortion: 1. the premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. premature stoppage of a natural or a pathological process. [EU] Agalactia: Absence or failure of the secretion of milk; called also agalactosis. [EU]
Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broad-spectrum antibiotic. [NIH] Anal: Pertaining to the anus. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. The chief signs of arterial aneurysm are the formation of a pulsating tumour, and often a bruit (aneurysmal bruit) heard over the swelling. Sometimes there are symptoms from pressure on contiguous parts. [EU]
Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as
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simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Asymptomatic: Showing or causing no symptoms. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH]
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Bacteroides: A genus of gram-negative, anaerobic, rod-shaped bacteria. Its organisms are normal inhabitants of the oral, respiratory, intestinal, and urogenital cavities of humans, animals, and insects. Some species may be pathogenic. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Blindness: The inability to see or the loss or absence of perception of visual stimuli. This condition may be the result of eye diseases; optic nerve diseases; optic chiasm diseases; or brain diseases affecting the visual pathways or occipital lobe. [NIH] Blister: Visible accumulations of fluid within or beneath the epidermis. [NIH] Bronchitis: Inflammation of one or more bronchi. [EU] Calymmatobacterium: A genus of bacteria causing granuloma inguinale and other granulomatous lesions. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]
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Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Chancre: The primary sore of syphilis, a painless indurated, eroded papule, occurring at the site of entry of the infection. [NIH] Chancroid: Acute, localized autoinoculable infectious disease usually acquired through sexual contact. Caused by haemophilus ducreyi, it occurs endemically almost worldwide, especially in tropical and subtropical countries and more commonly in seaports and urban areas than in rural areas. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chimera: An individual that contains cell populations derived from different zygotes. [NIH] Chlamydia: A genus of the family chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is chlamydia trachomatis. [NIH] Chlamydiaceae: A family of gram-negative, coccoid microorganisms, in the order chlamydiales, pathogenic for vertebrates. Genera include chlamydia and chlamydophila. [NIH] Chlamydophila: A genus of the family chlamyidaceae comprising gramnegative non chlamydia trachomatis-like species infecting vertebrates. Chlamydophila do not produce detectable quantities of glycogen. The type species is chlamydophila psittaci. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Coagulation: 1. the process of clot formation. 2. in colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. in surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU]
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Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [EU] Contraception: The prevention of conception or impregnation. [EU] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Crabs: Chiefly marine, largely carnivorous crustaceans including the genera Cancer, Uca, and Callinectes. It includes crabs as food. [NIH] Criterion: A standard by which something may be judged. [EU] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, cryptosporidium. It occurs in both animals and humans. [NIH] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Cycloheximide: Antibiotic substance isolated from streptomycin-producing strains of Streptomyces griseus. It acts by inhibiting elongation during protein synthesis. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermatology: A medical specialty concerned with the skin, its structure,
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functions, diseases, and treatment. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU]
Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Douching: A jet or current of water, sometimes a dissolved medicating or cleansing agent, applied to a body part, organ or cavity for medicinal or hygienic purposes. [EU] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Dysuria: Painful or difficult urination. [EU] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocytosis: Cellular uptake of extracellular materials within membranelimited vacuoles or microvesicles. Endosomes play a central role in endocytosis. [NIH] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity; called also adenomyosis externa and endometriosis externa. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemiological: Relating to, or involving epidemiology. [EU]
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Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory
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neurotransmitter. [NIH] Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Haemophilus: A genus of pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gramnegative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Haplotypes: The genetic constitution of individuals with respect to one member of a pair of allelic genes, or sets of genes that are closely linked and tend to be inherited together such as those of the major histocompatibility complex. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH] Hepatitis: Inflammation of the liver. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpesviridae: A family of enveloped, linear, double-stranded DNA viruses infecting a wide variety of animals. There are three subfamilies based on biological characteristics: alphaherpesvirinae, betaherpesvirinae, and gammaherpesvirinae. [NIH] Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the
Glossary 227
feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hysterectomy: The operation of excising the uterus, performed either through the abdominal wall (abdominal h.) or through the vagina (vaginal h.) [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH]
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Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Intravenous: Within a vein or veins. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Isosporiasis: Infection with parasitic protozoa of the genus isospora, producing intestinal disease. It is caused by ingestion of oocysts and can produce tissue cysts. [NIH] Labile: 1. gliding; moving from point to point over the surface; unstable; fluctuating. 2. chemically unstable. [EU] Lectins: Protein or glycoprotein substances, usually of plant origin, that bind to sugar moieties in cell walls or membranes and thereby change the physiology of the membrane to cause agglutination, mitosis, or other biochemical changes in the cell. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Luminescence: The property of giving off light without emitting a corresponding degree of heat. It includes the luminescence of inorganic matter or the bioluminescence of human matter, invertebrates and other living organisms. For the luminescence of bacteria, luminescence, bacterial is available. [NIH]
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Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menstruation: The cyclic, physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus; it is under hormonal control and normally recurs, usually at approximately four-week intervals, in the absence of pregnancy during the reproductive period (puberty through menopause) of the female of the human and a few species of primates. It is the culmination of the menstrual cycle. [EU] Metabolite: process. [EU]
Any substance produced by metabolism or by a metabolic
Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microsporidiosis: Infections with protozoa of the phylum microspora. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Mobiluncus: A genus of gram-negative, anaerobic, rod-shaped bacteria. Its organisms are found in the human vagina, particularly in association with Gardnerella vaginalis in cases of bacterial vaginosis. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monocytes:
Large, phagocytic mononuclear leukocytes produced in the
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vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH]
Nasal: Pertaining to the nose. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neisseria: A genus of gram-negative, aerobic, coccoid bacteria whose organisms are part of the normal flora of the oropharynx, nasopharynx, and genitourinary tract. Some species are primary pathogens for humans. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Pertaining to neurology or to the nervous system. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH]
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Nulliparous: Having never given birth to a viable infant. [EU] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Ocular: 1. of, pertaining to, or affecting the eye. 2. eyepiece. [EU] Ofloxacin: An orally administered broad-spectrum quinolone antibacterial drug active against most gram-negative and gram-positive bacteria. [NIH] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU] Papillomavirus: A genus of papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH]
Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Parvovirus: A genus of the family parvoviridae, subfamily parvovirinae, infecting a variety of vertebrates including humans. Parvoviruses are responsible for a number of important diseases but also can be nonpathogenic in certain hosts. The type species is mice minute virus. [NIH] Pathogen: Any disease-producing microorganism. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pediculosis: Infestation with lice of the family Pediculidae, especially infestation with Pediculus humanus. [EU]
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Penis: The male organ of copulation and of urinary excretion, comprising a root, body, and extremity, or glans penis. The root is attached to the descending portions of the pubic bone by the crura, the latter being the extremities of the corpora cavernosa, and beneath them the corpus spongiosum, through which the urethra passes. The glans is covered with mucous membrane and ensheathed by the prepuce, or foreskin. The penis is homologous with the clitoris in the female. [EU] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Pharyngitis: Inflammation of the pharynx. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phthirus: Lice of the genus Phthirus, family Pediculidae. Phthirus pubis, the crab louse, is usually acquired by sexual contact or contact with infected objects. It is found most frequently in the pubic hair, but also on eyebrows, eyelashes, or on the axillary hairs. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plasminogen: The inactive precursor of plasmin (=enzyme that catalyses the hydrolysis of peptide bonds at the carbonyl end of lysine or arginine residues). [EU] Polyarthritis: An inflammation of several joints together. [EU] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Proctitis: Inflammation of the rectum. [EU] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when
Glossary 233
administered on days 5-25 of the menstrual cycle. [NIH] Prophylaxis: The prevention of disease; preventive treatment. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Pulmonary: Pertaining to the lungs. [EU] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Respiratory: Pertaining to respiration. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU]
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Rubella: An acute, usually benign, infectious disease caused by a togavirus and most often affecting children and nonimmune young adults, in which the virus enters the respiratory tract via droplet nuclei and spreads to the lymphatic system. It is characterized by a slight cold, sore throat, and fever, followed by enlargement of the postauricular, suboccipital, and cervical lymph nodes, and the appearances of a fine pink rash that begins on the head and spreads to become generalized. Called also German measles, roetln, röteln, and three-day measles, and rubeola in French and Spanish. [EU] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Salpingitis: 1. inflammation of the uterine tube. 2. inflammation of the auditory tube. [EU] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Scabies: A contagious dermatitis of humans and various wild and domestic animals caused by the itch mite, Sarcoptes scabiei, transmitted by close contact, and characterized by a papular eruption over tiny, raised sinuous burrows (cuniculi) produced by digging into the upper layer of the epidermis by the egg-laying female mite, which is accompanied by intense pruritus and sometimes associated with eczema from scratching and secondary bacterial infection. Called also the itch and seven-year itch. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Serology: The study of serum, especially of antigen-antibody reactions in
Glossary 235
vitro. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sinusitis: Inflammation of a sinus. The condition may be purulent or nonpurulent, acute or chronic. Depending on the site of involvement it is known as ethmoid, frontal, maxillary, or sphenoid sinusitis. [EU] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spermicide: An agent that is destructive to spermatozoa. [EU] Sputum: Matter ejected from the lungs, bronchi, and trachea, through the mouth. [EU] Sterility: 1. the inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. the state of being aseptic, or free from microorganisms. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Superinfection: A new infection complicating the course of antimicrobial therapy of an existing infectious process, and resulting from invasion by bacteria or fungi resistant to the drug(s) in use. It may occur at the site of the
236 Chlamydia
original infection or at a remote site. [EU] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Synovial: Of pertaining to, or secreting synovia. [EU] Synovitis: Inflammation of a synovial membrane. It is usually painful, particularly on motion, and is characterized by a fluctuating swelling due to effusion within a synovial sac. Synovitis is qualified as fibrinous, gonorrhoeal, hyperplastic, lipomatous, metritic, puerperal, rheumatic, scarlatinal, syphilitic, tuberculous, urethral, etc. [EU] Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thromboembolism: Obstruction of a blood vessel with thrombotic material carried by the blood stream from the site of origin to plug another vessel. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Titre: The quantity of a substance required to produce a reaction with a given volume of another substance, or the amount of one substance required to correspond with a given amount of another substance. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Translating: Conversion from one language to another language. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Treponema: A genus of microorganisms of the order spirochaetales, many of which are pathogenic and parasitic for man. [NIH] Trichomonas: A genus of parasitic flagellate protozoans distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. [NIH] Trypsin: A serine endopeptidase that is formed from trypsinogen in the pancreas. It is converted into its active form by enteropeptidase in the small
Glossary 237
intestine. It catalyzes hydrolysis of the carboxyl group of either arginine or lysine. EC 3.4.21.4. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Ureaplasma: A genus of gram-negative, nonmotile bacteria which are common parasitic inhabitants of the urogenital tracts of man, cattle, dogs, and monkeys. [NIH] Urethritis: Inflammation of the urethra. [EU] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU]
Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterus: The hollow muscular organ in female mammals in which the fertilized ovum normally becomes embedded and in which the developing embryo and fetus is nourished. In the nongravid human, it is a pear-shaped structure; about 3 inches in length, consisting of a body, fundus, isthmus, and cervix. Its cavity opens into the vagina below, and into the uterine tube on either side at the cornu. It is supported by direct attachment to the vagina and by indirect attachment to various other nearby pelvic structures. Called also metra. [EU] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vaccinia: The cutaneous and sometimes systemic reactions associated with vaccination with smallpox vaccine. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Vaginitis: Inflammation of the vagina characterized by pain and a purulent
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discharge. [NIH] Varicella: Chicken pox. [EU] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]
Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
·
Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
Glossary 239
·
Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
·
Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
240 Chlamydia
INDEX A Abdomen ...............23, 111, 128, 230, 235 Abdominal................11, 92, 142, 227, 232 Aberrant.................................................58 Abortion .................95, 109, 183, 204, 219 Adverse .................................88, 197, 204 Algorithms............................................108 Alkaline ................................................170 Ampicillin .............................................129 Anal ...........................11, 13, 16, 128, 205 Anemia ..........................................36, 138 Aneurysm ....................................145, 219 Antibacterial.............81, 92, 142, 231, 235 Antibiotic .......21, 42, 75, 81, 92, 141, 142, 157, 200, 203, 204, 219, 220, 225, 229, 235, 236 Antibody .......61, 72, 74, 76, 88, 168, 220, 223, 227, 234 Antigen .....50, 61, 71, 73, 74, 76, 89, 220, 225, 227, 234 Antimicrobial 22, 53, 77, 88, 184, 224, 235 Antiviral ........................................203, 211 Anus ............................128, 203, 204, 219 Arteries ..........................................42, 223 Asymptomatic .......17, 48, 49, 59, 61, 128, 130, 198, 202 Azithromycin ..........................12, 128, 167 B Benign .................................110, 165, 234 Biochemical .......................55, 58, 91, 228 Biopsy....................................................58 Biosynthesis ........................................166 Biphasic .................................................86 Blindness ....16, 50, 52, 53, 55, 80, 83, 84, 86, 168, 210 C Candidiasis ..........................................133 Capsules......................................165, 181 Carbohydrate.........91, 170, 180, 225, 226 Cervical.....12, 83, 84, 106, 110, 128, 133, 166, 202, 203, 209, 234 Chancre ...............................................204 Chancroid ..18, 96, 97, 114, 126, 127, 128 Cholesterol ..................178, 180, 186, 228 Chronic .13, 51, 56, 83, 92, 106, 110, 197, 209, 210, 212, 222, 233, 235 Cirrhosis ......................................209, 210 Coagulation ...................................74, 226 Conception ......22, 23, 49, 109, 219, 223, 235
Condoms....... 13, 14, 16, 17, 94, 99, 115, 117, 127, 129, 131, 211 Conjunctivitis.... 13, 37, 80, 107, 128, 131, 197, 210 Contraception ....................... 97, 129, 200 Contraceptive.......... 13, 49, 104, 105, 115 Coronary ............................................. 103 Crabs .......................................... 126, 223 Criterion ................................................ 56 Cryptosporidiosis .................... 21, 99, 220 Cutaneous............. 78, 108, 141, 221, 237 Cycloheximide ...................................... 89 Cytokines ...................... 51, 55, 57, 58, 60 Cytomegalovirus ..... 96, 99, 118, 167, 204 Cytoplasm ................................... 186, 230 Cytotoxic ................................... 52, 53, 87 D Degenerative ...................................... 179 Detoxification ...................................... 133 Douching............................... 49, 118, 205 Doxycycline................................... 12, 128 Dysuria.................................................. 48 E Ectopic ..... 13, 17, 49, 59, 61, 70, 84, 131, 202, 203, 204 Endocarditis .......................... 55, 141, 221 Endocytosis........................... 73, 168, 224 Endogenous........................................ 100 Endometriosis ..................... 104, 110, 224 Enzyme ....... 49, 71, 73, 76, 169, 224, 232 Epidemiological..................................... 61 Epithelium ....................... 23, 55, 169, 231 Epitopes .................................... 50, 54, 87 Erythromycin ......................... 37, 128, 184 Extracellular ........ 73, 83, 86, 90, 224, 225 Extraction ...................................... 71, 167 F Fatal ...................................... 13, 197, 202 G Gastrointestinal ............... 73, 98, 107, 225 Genitourinary ..... 75, 107, 165, 167, 230, 237 Genotype ...................................... 76, 232 Gestation............................... 49, 212, 232 Ginseng............................................... 165 Glucose......................................... 91, 225 Glycine .................................................. 82 Glycoproteins .......................... 87, 91, 226 Granuloma ............................................ 18
Index 241
H Hepatitis..17, 18, 94, 95, 96, 98, 114, 126, 127, 128, 209, 210 Herpes ..17, 18, 22, 94, 95, 96, 97, 98, 99, 105, 106, 114, 116, 117, 118, 126, 127, 128, 132, 203, 206, 207, 210, 211, 226 Homologous ..................................23, 232 Hybridization........................................166 Hyperplasia..........................................165 Hypersensitivity .....................................51 I Immunity ......53, 55, 83, 91, 92, 103, 227, 237 Immunization ...................74, 76, 227, 235 Immunoassay ........................................49 Immunogenic .........................................83 Incubation ..............................................89 Induction ................................................60 Infertility ..... 11, 13, 17, 52, 53, 54, 55, 61, 78, 81, 82, 84, 104, 115, 131, 165, 184, 197, 199, 202, 203, 204, 237 Inflammation ....... 17, 56, 58, 76, 91, 107, 212, 222, 228, 232, 234 Intravenous..................................202, 205 Isosporiasis............................................99 L Lectins ...................................................87 Lesion ........................22, 60, 75, 226, 228 Lipid .....................................170, 186, 228 Lipoprotein...................................186, 228 Localization............................................52 Luminescence .....................166, 176, 228 Lymphoma...................................207, 229 M Manifest .........................................55, 108 Membrane ..23, 54, 58, 63, 73, 75, 77, 84, 87, 91, 110, 170, 183, 184, 224, 228, 230, 232, 236 Meningitis ............................210, 212, 229 Menstruation........................................205 Metabolite ............................................181 Microbiological.....................................167 Microbiology ..............61, 75, 90, 220, 229 Microorganism .....21, 76, 81, 89, 220, 231 Microscopy ............................................48 Microsporidiosis.....................................99 Minocycline..........................................165 Molecular .......51, 53, 55, 57, 58, 76, 124, 135, 136, 233 Mucopurulent.........................................85 Mucus ............................................92, 128 Mutagenesis ....................................51, 56 N Nasal .......................................85, 91, 228 Nausea ..........................................11, 130 Necrosis.................................................60
Neisseria ............................................... 99 Neonatal................ 37, 121, 128, 197, 210 Neoplastic ............................. 99, 207, 229 Neural ................................................. 179 Neurologic................................... 204, 210 Neurology............................ 100, 208, 230 Niacin .................................................. 179 Nitrogen ................................................ 82 Nulliparous ............................................ 49 O Ocular ................................. 51, 57, 84, 85 Ofloxacin ............................................. 128 Oligosaccharides .................................. 86 Oral .... 11, 13, 16, 23, 103, 107, 111, 141, 157, 200, 207, 219, 221, 231, 235 Outpatients.......................................... 165 Overdose ............................................ 179 P Papillomavirus ... 18, 94, 95, 96, 115, 126, 127, 132, 166, 202, 203, 207 Parasitic ... 77, 94, 99, 110, 208, 228, 236, 237 Parvovirus ............................................. 96 Pathogen............... 52, 54, 63, 88, 91, 227 Pediculosis.......................................... 126 Penis .... 11, 12, 13, 22, 23, 128, 203, 204, 223, 232 Phenotype..................................... 76, 232 Placenta .............................. 157, 210, 232 Pneumonia...... 13, 16, 128, 197, 204, 210 Polyarthritis ........................................... 55 Polypeptide ............................. 83, 91, 227 Potassium ........................................... 180 Prevalence ............................ 49, 106, 199 Proctitis ................................... 13, 99, 131 Prostate............................................... 165 Prostatitis ............................ 165, 167, 170 Proteins..... 43, 51, 52, 54, 61, 72, 83, 87, 88, 91, 92, 178, 180, 184, 220, 223, 225, 227, 230 Psoriasis ............................. 107, 110, 233 R Receptor ..................... 51, 53, 60, 72, 220 Recurrence ......................................... 108 Reinfection .................................. 104, 108 Respiratory....... 13, 77, 85, 91, 110, 141, 207, 221, 228, 234, 235 Riboflavin ............................................ 178 Rigidity .................................................. 87 Rubella.................................................. 96 S Salmonella .......................................... 107 Salpingitis.................................. 4, 55, 184 Scabies ......................................... 97, 204 Secretion..................... 142, 219, 230, 234 Selenium ............................................. 180
242 Chlamydia
Septic.....................................................60 Septicemia.............................................60 Serum ......60, 76, 92, 157, 219, 232, 234, 235 Sinusitis .........................................92, 235 Sneezing................................................85 Species ..... 21, 22, 73, 75, 77, 78, 81, 83, 89, 90, 110, 142, 207, 208, 221, 222, 224, 225, 226, 229, 230, 231, 235, 237, Spectrum ....111, 120, 128, 141, 142, 157, 219, 231, 238 Sputum ................................................105 Sterility.....................17, 22, 128, 130, 227 Stomach ........................73, 105, 130, 225 Stomatitis .............................................107 Subclinical .....................................61, 166 Superinfection......................................169 Synovial .............................56, 58, 77, 236 Synovitis ................................................57 Syphilis .......17, 18, 94, 95, 96, 97, 98, 99, 114, 116, 117, 118, 126, 127, 128, 132, 204, 207, 210, 211, 222 Systemic ..78, 86, 111, 141, 221, 235, 237 T Testis .......................................13, 23, 237 Tetracycline .............22, 75, 129, 224, 229 Thermal .................................................80 Thyroxine.............................................180 Topical .........................201, 204, 208, 236 Trichomonas........................................103 Tryptophan ..............................51, 55, 183
Tuberculosis........................................ 128 U Ulcer.................................................... 237 Ureaplasma......................................... 165 Urethritis... 4, 48, 55, 57, 80, 97, 107, 165, 171, 214 Urogenital ...... 22, 77, 207, 221, 225, 226, 237 Urology................................................ 108 Uterus .... 11, 13, 109, 131, 142, 157, 202, 208, 209, 219, 227, 229, 232 V Vaccination ............................. 78, 87, 237 Vaccine .... 51, 52, 53, 55, 56, 78, 86, 87, 92, 237 Vaccinia ................................................ 52 Vaginal . 11, 16, 17, 18, 49, 116, 128, 130, 142, 167, 203, 227 Vaginitis ...... 94, 95, 97, 98, 99, 117, 132, 141, 221 Varicella ................................................ 96 Venereal..... 23, 83, 96, 99, 201, 203, 207, 236 Viral.. 23, 91, 96, 103, 126, 170, 203, 211, 228, 238 Virulence ............................................... 54 Viruses ...... 23, 43, 75, 78, 207, 220, 226, 229, 237, 238 W Warts.... 17, 18, 97, 98, 99, 106, 118, 127, 132, 202, 203, 207
Index 243
244 Chlamydia
Index 245
246 Chlamydia
