Chlamydial Conjunctivitis

The chlamydia comprise a group of "large viruses" that are sensitive to tetracycline and erythromycin and that cause relatively minor disability to the eyes in northern Europe and the USA when compared with the severe and widespread eye infection seen especially in Africa and the Middle East. Inclusion conjunctivitis ("inclusion blenorrhoea") is the milder form of chlamydial infection and is caused by serotype D to K of Chlamydia trachomatis. The condition is usually, but not always, sexually transmitted. The conjunctivitis typically occurs one week after exposure. It can cause a more severe type of conjunctivitis in the newborn child, which can also involve the cornea. The infection is usually self-limiting but often has a prolonged course, lasting several months. The diagnosis depends on the results of conjunctival culture and examination of scrapings and the association of a follicular conjunctivitis with cervicitis or urethritis.

Chlamydial conjunctivitis responds to treatment with tetracycline. In children and adults, tetracycline ointment should be used at least four times daily. In adults, the treatment can be supplemented with systemic tetracycline, but this drug should not be used systemically in pregnant mothers or children under seven years of age. Azithromycin and other macrolide antibiotics are known to be particularly effective in treating systemic chlamydial infection; azithromycin can be given conveniently as a one-off dose. A referral to genitourinary medicine is advisable on presentation, as a screening measure, because reinfection from partners can trigger a recurrent infection.

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