Stock Ingo, Henrichfreise Beate
Institut für Medizinische Mikrobiologie, Immunologie und Parasitologie, Abteilung Pharmazeutische Mikrobiologie, Universität Bonn, Meckenheimer Allee 168, 53115 Bonn.
Med Monatsschr Pharm. 2012 Jun;35(6):209-22; quiz 223-4.
The gram-negative obligate intracellular bacterium Chlamydia trachomatis is the pathogen that is most often transmitted through sexual contact. C. trachomatis is responsible for a wide range of different diseases. Strains of serovars D to K primarily cause urogenital infections, which are often asymptomatic, but can also lead to uncomplicated and complicated genital diseases. Pelvic inflammatory diseases attributed to ascending genital infections can result in ectopic pregnancies and infertility in women. After perinatal transmission, infections in the newborn can also occur. Strains of serovars L1, L2 and L3 cause lymphogranuloma venereum, a common sexually transmitted disease in many tropical and subtropical regions. The illness is associated with various skin lesions and systemic symptoms such as fever and headache. Unlike other serovars, strains of serovar A, B and C are transmitted primarily by infectious eye discharge. They cause a chronic eye disease called trachoma that occurs under poor hygienic conditions. Infections with C. trachomatis should be treated with antibacterial drugs reaching high intracellular concentrations. The choice of antibiotics and duration of treatment depend on the indication. In general, intracellular acting agents such as doxycycline, macrolides like azithromycin and erythromycin and certain quinolones (i.e. levofloxacin and ofloxacin) are applied for specific therapy of C. trachomatis infections. During pregnancy, application of macrolides or aminopenicillins has been recommended for most indications. Because of the serious potential consequences of urogenital C. trachomatis infection in women, many industrialized countries offer a C. trachomatis screening. For the elimination of trachoma, which is envisaged by the World Health Organization for the year 2020, the so-called SAFE strategy is used. This strategy includes therapeutic and hygienic measures that may be suitable to eliminate one of the leading causes of blindness worldwide.
革兰氏阴性专性细胞内细菌沙眼衣原体是最常通过性接触传播的病原体。沙眼衣原体可引发多种不同疾病。血清型D至K的菌株主要引起泌尿生殖系统感染，这些感染通常没有症状，但也可能导致单纯性和复杂性生殖器疾病。由上行性生殖器感染引起的盆腔炎可导致女性异位妊娠和不孕。围产期传播后，新生儿也可能发生感染。血清型L1、L2和L3的菌株会引起性病性淋巴肉芽肿，这是许多热带和亚热带地区常见的性传播疾病。该疾病伴有各种皮肤病变和全身症状，如发热和头痛。与其他血清型不同，血清型A、B和C的菌株主要通过感染性眼部分泌物传播。它们会引发一种在卫生条件差的情况下发生的慢性眼病——沙眼。沙眼衣原体感染应使用能达到高细胞内浓度的抗菌药物进行治疗。抗生素的选择和治疗持续时间取决于适应症。一般来说，细胞内作用药物如多西环素、大环内酯类药物如阿奇霉素和红霉素以及某些喹诺酮类药物（即左氧氟沙星和氧氟沙星）用于沙眼衣原体感染的特异性治疗。在怀孕期间，对于大多数适应症，建议使用大环内酯类药物或氨基青霉素。由于女性泌尿生殖系统沙眼衣原体感染可能产生严重后果，许多工业化国家提供沙眼衣原体筛查。为实现世界卫生组织计划在2020年消除沙眼的目标，采用了所谓的SAFE策略。该策略包括治疗和卫生措施，可能适合消除全球主要致盲原因之一。
