Management Of Chlamydia Infection For Young Females: A Literature Review

Urinary Tract Infection

Discuss about the Report for Urgent Primary Surgical Care of Urinary Tract Infection.

Urinary Tract Infection or UTI is an infection of the urinary tract and based on its location, it is known as kidney or bladder infection. The kidney infection is also known as pyelonephritis and the bladder infection is also known as cystitis. The symptoms of UTI include urination and pain, increased frequency of urination and rare appearance of blood in the urine (Nicolle, 2012). Management of UTI is done with the help of antibiotics as they are the first line treatment for the disease. The type of drug and the duration of treatment depend on the severity of the disease and the bacterial strain found in the urine. Chlamydia infection is a type of UTI that is sexually transmitted and the responsible bacteria is Chlamydia trachomatis. The severity of the disease may be extended in women to cause ectopic pregnancy and future infertility (Grigoryan, Trautner & Gupta, 2014). Therefore, the management of the disease is essential for its prevention and control to prevent further damage. This assignment will be the management of Chlamydia infection for a 14-year-old Samoan New Zealand girl who presented to the afterhours clinic.

In association with the presentation of the patient in the clinic, a question will be developed following the PICOT framework. The framework consists of the parameters of problem, intervention, comparison, outcome and time (Elias et al., 2015). Considering these parameters, a question will be framed which will be answered for the management of the disease. The clinical question for this assignment has been provided below.

In young females suffering from Chlamydia infection, what is the applied management intervention? Compare the various outcomes from the studies in the provided treatment duration.

Using the structured clinical question, a literature search was carried out using two relevant databases. The used databases for this assignment are Pubmed and Embase as these are the prime search engines for the topics of biomedical and life sciences. These are the search engines that are free to access for searching the references and abstracts. Pubmed is used primarily used to access the database of Medline and it is selected for the reason that it is an intuitive and fast search interface that helps in the automatic mapping of the terms by automatic inclusion of the medical subject headings and synonyms in the search criteria. The rationale for the selection of Embase is that it is used for faster access to the articles that are recently published. This makes the retrieval of the articles more comprehensive and is readily extracted. It is a database containing published literature on the biomedical and pharmacological topics. Therefore, these two databases were used as sources of information. Five relevant articles were selected in accordance with the clinical question following the PICOT framework. The search terms used for the literature search were Chlamydia infection in young females, management of Chlamydia infection, comparison of the outcome efficacy of Chlamydia infection and time required for progression of Chlamydia infection. These search terms were in accordance with the PICOT framework for answering the clinical question. The search terms were used in conjugation with the Boolean operators like AND and OR with the application of parenthesis for their classification. From the database search, thousands of results were obtained and they were segregated using the inclusion criteria. The inclusion period for the literature was for the last six years that ranged from 2010 to 2016. The articles were selected based on their headings, definitions and abstracts. Filters were applied to the databases for the period of search and were sorted based on their relevance. The selected articles were the ones which were most recent from their date of publication compared with the other articles based on similar topics.

Clinical Question

Table 1: Summary of the searched articles

Sl. No.	Author and Year of Publication	Database and Name of the Article	Major Theme	Key Learning
1.	Paavonen (2012)	Database: Pubmed Chlamydia trachomatis infections of the female genital tract: state of the art	This article dealt with the problem section and aimed at studying the prevalence of the Chlamydia infection in young females globally followed by its prevention	The study found out the screening programs for the Chlamydia infections have been over estimated and may lead to cervical carcinogenesis. The study recommended secondary prevention by screening to limit the spread of the diseases and further increase the complications
2.	Geisler (2015)	Database: Pubmed Diagnosis and management of uncomplicated Chlamydia trachomatis infections in adolescents and adults: summary of evidence reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines	This article dealt with the intervention section and aimed at summarizing the recommendations, evidence and key questions for the management and diagnosis of the uncomplicated  cases of Chlamydia infections in adults and adolescents according to the CDC STD guidelines of treatment of 2015	The researchers carried out an extensive literature search from the databases of Pubmed and Medline to find out the effective intervention methods for the disease with antibiotics like azithromycin and doxycycline. Both these medications were found to be effective for the treatment of the infection in young adolescent females
3.	Kong et al. (2014)	Database: Embase Azithromycin versus doxycycline for the treatment of genital chlamydia infection–a meta-analysis of randomized controlled trials	This article dealt with the comparison section and aimed at conducting a meta-analysis for comparing the efficacy of 100mg doxycycline vs. 1g azithromycin for the treatment of genital Chlamydia infection in women for a period of seven days	The study found that there was a small increase in the efficacy of about 3% for doxycycline when compared to azithromycin in the treatment of Chlamydia infection. Since there has been  a significant treatment failure with azithromycin, doxycycline can be effective for the treatment of the infection
4.	Morgan, Donnell & Bell (2010)	Database: Embase Is everyone treated equally? Management of genital Chlamydia trachomatis infection in New Zealand	This article dealt with the outcome section and aimed at  establishing the cases of genital infections of Chlamydia managed by the equitable factors of ethnicity, gender and age in a locality of New Zealand with higher rates of prevalence of the infection	The study found the differences in the management of cases by ethnicity and gender suggesting barriers for timely and appropriate persist of healthcare. It was found in the study that the local settings of healthcare had worked efficiently in the recent times to collect the self-identified ethnicity in their systems of patient management. There was a significant lack of the effective partner notification for the various demographic variables
5.	Herzog et al. (2012)	Database: Embase Timing of progression from Chlamydia trachomatis infection to pelvic inflammatory disease: a mathematical modeling study	This article dealt with the time section and aimed at  investigates the three hypothetical processes for the progression time for the beginning, end and throughout the duration of spread of Chlamydia infection	From the study findings, it can be said that complication of the Chlamydia infection can take place throughout its course that can result in pelvic inflammatory disease and screening has to be done for preventing the complications of the infection

The searched articles and their key findings were analyzed to draw the relevance with the presentation of the patient for effective clinical decision making. The patient was a 14-year-old Samoan girl from New Zealand who presented with the symptoms of Chlamydia infection like stinging and burning pain on urination, increased frequency of urine, lower back pain and lower abdominal pain. Her diagnostic tests were found to be positive for Chlamydia infection that occurred from her sexual partner. According to the study by Paavonen (2012), Chlamydia infection is the results of bacterial infections that are transmitted sexually and is highly prevent globally among the adolescent females. It is evident that about 1 in 20 young women of the age 14 to 24 who are sexually active are known to suffer from the infection. In women, spreading of the infection occurs from the cervix to the upper reproductive tract resulting in various complications like pelvic inflammatory disease (Cai et al., 2012). Since the patient has been sexually active for 1 year with multiple partners and without any contraceptive, therefore, it is quite evident that she has developed the infection from her partner.

The key to the management of Chlamydia infection includes the arrival at the appropriate diagnosis and the assuring that the patient should comply with the treatment. Adolescent females are found to be at a higher risk for treatment non-compliance as they attempt to hide the information from their parents (Foxman, 2014). It has been evident that the patient is afraid to inform her mother about the diagnosis as her family environment is not supportive and she has been a part of domestic abuse. According to the study by Geisler (2015), it was found that doxycycline could be the drug of choice along with azithromycin for the treatment of Chlamydia infection. Antibiotics like sitafloxacin and quinolone were also found to be effective but studies were not carried out effectively for their implications. In office single dose treatments are being increasingly in use for improving confidentiality and compliance. Treatment of the partner is also crucial for prevention of the re-infection (Flores-Mireles et al., 2015). Antibiotic therapy has to be initiated at the earliest and the potential adverse effects, cost and compliance have to be considered and test for possible infection of gonorrhea has to be conducted. The specimens from the infection sites have to be sent to the laboratory for culture and pregnancy tests has to be carried out as they can alter the follow up care of the patient and the antibiotic treatment (Hooton, 2012). It should be advised to the patient to abstain from any sexual intercourse until the testing and treatment is complete. Since the patient is likely to know the partner from whom she has developed the infection, therefore, she has to be advised to avoid sexual intercourse with that partner and get him treated to avoid further complications.

Literature Search

According to the study by Kong et al. (2014), doxycycline was found to be more effective than azithromycin in the treatment of Chlamydia infection due to its high compliance. The efficacy of Azithromycin was found to be 97% when compared to the 100% efficacy of doxycycline. However, non-adherence to the treatment of doxycycline is common in comparison to azithromycin due to the frequency of dosing of multiple and single dose. Morgan, Donnell & Bell (2010) opined that Chlamydia surveillance could be improved by the introduction of comprehensive collection of national data with laboratory reporting of the test results in New Zealand. The local settings of healthcare have worked efficiently in the recent times to collect the data and opportunistic Chlamydia testing has to be discussed with all the people who are under 25 years of age and are sexually active. Herzog et al. (2012) stated that about 10% of the women suffering from Chlamydia infection develop pelvic inflammatory disease if left untreated. Therefore, for the patient, either azithromycin in 1g single dose or doxycycline in 100mg twice daily for seven days can be prescribed for the management of Chlamydia infection. She should be advised with the necessary precautions for the prevention and reoccurrence of the disease.

References

Cai, T., Mazzoli, S., Mondaini, N., Meacci, F., Nesi, G., D’Elia, C., … & Bartoletti, R. (2012). The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat?. Clinical infectious diseases, 55(6), 771-777.

Elias, B. L., Polancich, S., Jones, C., & Convoy, S. (2015). Evolving the PICOT Method for the Digital Age: The PICOT-D. Journal of Nursing Education, 54(10), 594-599.

Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiology, 13(5), 269-284.

Foxman, B. (2014). Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious disease clinics of North America, 28(1), 1-13.

Geisler, W. M. (2015). Diagnosis and management of uncomplicated Chlamydia trachomatis infections in adolescents and adults: summary of evidence reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clinical Infectious Diseases, 61(suppl 8), S774-S784.

Grigoryan, L., Trautner, B. W., & Gupta, K. (2014). Diagnosis and management of urinary tract infections in the outpatient setting: a review.JAMA, 312(16), 1677-1684.

Herzog, S. A., Althaus, C. L., Heijne, J. C., Oakeshott, P., Kerry, S., Hay, P., & Low, N. (2012). Timing of progression from Chlamydia trachomatis infection to pelvic inflammatory disease: a mathematical modelling study.BMC infectious diseases, 12(1), 187.

Hooton, T. M. (2012). Uncomplicated urinary tract infection. New England Journal of Medicine, 366(11), 1028-1037.

Kong, F. Y. S., Tabrizi, S. N., Law, M., Vodstrcil, L. A., Chen, M., Fairley, C. K., … & Hocking, J. S. (2014). Azithromycin versus doxycycline for the treatment of genital chlamydia infection–a meta-analysis of randomised controlled trials. Clinical Infectious Diseases, ciu220.

Morgan, J., Donnell, A., & Bell, A. (2010). Is everyone treated equally? Management of genital Chlamydia trachomatis infection in New Zealand.International journal of STD & AIDS, 21(8), 595-600.

Nicolle, L. E. (2012). Urinary tract infections. Encyclopedia of Intensive Care Medicine, 2359-2364.

Paavonen, J. (2012). Chlamydia trachomatis infections of the female genital tract: state of the art. Annals of medicine, 44(1), 18-28.