Treatment of chlamydial infections.

Antibiotic therapy of chlamydial infections means treatment of an intracellular parasite. That is, the antibiotic drug has to pass not only over the cell membrane of the organism but also over the cell membrane of the host cell and over the membrane lining the intracytoplasmatic vacuole, where the chlamydiae reproduce. To what extent antibiotic may induce "latent" chlamydial infections is badly defined. Beta-lactam antibiotics in certain concentrations may induce cell wall-deficient forms of chlamydiae. Still there is non-conformity in performing in vitro susceptibility tests and diversed opinions of how to interpret such tests. For several antibiotics there is a discrepancy between the result of in vitro susceptibility tests and therapeutic trials. There is a need for long term follow-up studies of the effect of antibiotic therapy of genital chlamydial infections. Just less than half of such infections in females are complicated, i.e., cases of endometritis/salpingitis. It is very difficult to differentiate uncomplicated from complicated genital chlamydial infections without invasive tests. Approximately 40% of chlamydial cervicitis cases has a concomitant PID. Thus all genital chlamydial infections in females should be treated as complicated.