Initial treatment: antibiotics and anti-inflammatory agents
The patient was hospitalized and started on intravenous ampicillin/sulbactam and oral azithromycin to cover for disseminated gonococ-cemia and chlamydia. Nonsteroidal anti-inflam-matory medications were given for pain control. The patient rapidly responded to therapy as evidenced by decreased arthralgias, normalization of temperatures and white blood cell count, and decreased abdominal pain. The patient was discharged after the third day in the hospital with instructions to take doxycycline twice daily (finishing a 14-day course).
Chlamydia trachomatis and Reiter’s syndrome
An estimated 3 to 4 million cases of C trachomatis occur each year in the US, making it one of the most prevalent sexually transmitted diseases.1 This disease may be underreported, largely as a result of substantial numbers of asymptomatic persons whose infections are not identified because screening is not available.1 In addition, many females with mucopurulent cervicitis are asymptomatic. In some series, C trachomatis has been identified as the causative agent in up to 50% of women with pelvic inflammatory disease.
Reiter’s syndrome is a multisystem disease commonly triggered by a genitourinary or bacterial enteric infection.2 The incidence of Reiter’s syndrome is estimated to be 3.5 per 100,000 in the US population.3 Up to 85% of patients with Reiter’s syndrome possess the HLA-B27 antigen. 4 However, the true incidence of Reiter’s syndrome is debated because of the protean nature of its symptoms, as well as a lack of consensus in defining the syndrome.
The numbers of cases of Reiter’s syndrome caused from C trachomatis genitourinary infections are equally difficult to document. In some reports, silent cystitis and cervicitis without urethritis may be the only evidence of urogenital involvement.5
A positive DNA probe test for C trachomatis was helpful to guide therapy. As the availability of immunohistochemistry and polymerase chain reaction testing becomes more widely available, the number of cases of Reiter’s syndrome without a documented infectious cause will likely diminish.8
Drug brand names
- Ampicillin/sulbactam • Unasyn
- Azithromycin • Zithromax
- Doxycycline • Doryx, Monodox, Periostat, Vibramycin
Corresponding author
Joseph M. Mazziotta, MD, Associate Director, Tallahassee Memorial Family Practice Residency Program, 1301 Hodges Drive, Tallahassee, FL 32308. E-mail: j@mail.tmh.org