Single dose of azithromycin for the treatment of genital chlamydial infections in adolescents.

We compared a single 1 gm dose of azithromycin with the standard 7-day course of doxycycline for the treatment of uncomplicated chlamydial genital infection in sexually active adolescents. Seventy-three adolescents (65 female) with a cervical or urethral culture positive for Chlamydia trachomatis were enrolled in the study; 46 received azithromycin and 27 received doxycycline. Follow-up evaluations were done 1, 2, and 4 weeks after treatment with azithromycin or initiation of treatment with doxycycline. There were four treatment failures (8.7%) among the patients who received azithromycin and four in the doxycycline-treated group (14.8%); all were female. Six of these girls (three treated with azithromycin and three with doxycycline) gave histories of unprotected intercourse with an untreated partner and were probably reinfected. Almost half the patients were clinically symptom free. The clinical response rate for the remaining patients with symptoms was 97.4% at 4 weeks. Nineteen percent of the azithromycin-treated patients and 33.3% of those treated with doxycycline had mild to moderate drug-related side effects, which were predominantly gastrointestinal. We conclude that treatment with a single oral dose of azithromycin appears to be as safe and efficacious as a 7-day course of doxycycline for the treatment of uncomplicated genital chlamydial infection in adolescents.

Pelvic inflammatory disease in adolescents.

Clinical, laboratory, and sonographic data were collected prospectively from 100 female adolescents hospitalized with acute pelvic inflammatory disease (PID). The endocervical isolation rates for Chlamydia trachomatis and Neisseria gonorrhoeae were 44.7% and 36.4%, respectively. In comparison with adolescents with chlamydia-associated PID, those with gonococcus-associated PID had a shorter duration of pain before admission (p less than 0.05), higher mean maximum temperatures (p less than 0.01), and higher leukocyte counts (p less than 0.01). Pelvic ultrasound studies showed adnexal enlargement or tubo-ovarian abscess (TOA) in 85.2% of the patients. Of the 88 adolescents in whom adequate sonograms were obtained, 17 (19.3%) had TOA. In 12 of the 17 adolescents, the abscesses were identified sonographically before being diagnosed clinically. With clinical criteria alone, only the leukocyte count and prior history of PID differed significantly between those with TOA and those with uncomplicated PID. These findings support a more liberal use of pelvic ultrasound studies in teenagers with PID. Our high detection rate of C. trachomatis and the difficulty in predicting the cause of the infection in an individual patient support treating all adolescents with PID with agents effective against both C. trachomatis and N. gonorrhoeae.