클라미디아감염증 편집하기 (부분)

==치료==

*확진된 클라미디아감염증의 치료는 적절한 항균제, 성 파트너 공지, 완치판정까지의 금욕 유도 그리고 교육으로 이루어진다. 

  증상 또는 무증상 클라미디아 감염 환자에게는 환자 자신과 성 파트너의 치료기간 동안과 치료 후 1주일 정도까지 금욕하도록 반드시 권한다.

===치료의 시작===

*증상이 있는 환자는 검사결과가 나올 때까지 기다리는 것보다 첫 내원 시 바로 치료를 시작하는 것이 좋다. 골반염질환 연구에서 치료의 지연이 불임의 위험을 더 높였다는 증거가 있다.<ref name="Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility.">Hillis SD, Joesoef R, Marchbanks PA, et al. Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility. Am J Obstet Gynecol 1993;168:1503-1509. </ref>성 파트너도 검사결과를 기다리지 않고 치료를 바로 시작해야 한다.<ref name="National guideline for the management of Chlamydia trachomatis genital tract infection.">Horner PJ, Caul EO. National guideline for the management of Chlamydia trachomatis genital tract infection. Sex Trans Inf 1999;75(Suppl 1):S4-8. </ref><ref name="National Guideline for the Management of Chlamydia trachomatis.">Clinical Effectiveness Group (Association of Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases). National Guideline for the Management of Chlamydia trachomatis. Genital Tract Infection. 2001</ref>(근거수준 2)

 C   클라미디아 감염의 증상이나 징후를 보이는 환자와 그들의 성 파트너는 검사결과를 기다리지 않고 바로 치료를 시작하는 것이 권장된다.

===생식기클라미디아감염===

*메타분석에 따르면 doxycycline 100mg 1일 2회 경구 7일 요법과 azithromycin 1g 경구 단회 요법은 동일한 효과를 보였고, 부작용의 발현에도 차이가 없었다.<ref name="Doxycycline and azithromycin for prevention of chlamydial persistence or recurrence one month after treatment in women.">Hillis SD, Coles FB, Litchfield B, et al. Doxycycline and azithromycin for prevention of chlamydial persistence or recurrence one month after treatment in women. A use-effectiveness study in public health settings. Sex Transm Dis 1998;25:5-11. </ref><ref name="Single dose of azithromycin for the treatment of genital chlamydial infections in adolescents.">Hammerschlag MR, Golden NH, Oh MK, et al. Single dose of azithromycin for the treatment of genital chlamydial infections in adolescents. J Pediatr 1993;122:961-965. </ref><ref name="The role of azalide antibiotics in the treatment of Chlamydia.">Johnson RB. The role of azalide antibiotics in the treatment of Chlamydia. Am J Obstet Gynecol 1991;164(6 Pt 2):1794-1796. </ref><ref name="Cost-effectiveness analysis of azithromycin for Chlamydia trachomatis infection in women: a Canadian perspective.">Marra F, Marra C, Patrick DM. Cost-effectiveness analysis of azithromycin for Chlamydia trachomatis infection in women: a Canadian perspective. Can J Infect Dis 1997;8:202208. </ref><ref name="A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis.">Martin DH, Mroczkowski TF, Dalu ZA, et al. A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. The Azithromycin for Chlamydial Infections Study Group. N Engl J Med 1992;327:921-925. </ref><ref name="A double blind study of single dose azithromycin and doxycycline in the treatment of chlamydial urethritis in males.">Nilsen A, Halsos A, Johansen A, et al. A double blind study of single dose azithromycin and doxycycline in the treatment of chlamydial urethritis in males. Genitourin Med 1992;68:325-327. </ref><ref name="Cost-effectiveness analysis of fi ve different antibiotic regimens for the treatment of uncomplicated Chlamydia trachomatis cervicitis.">Nuovo J, Melnikow J, Paliescheskey M, King J, Mowers R. Cost-effectiveness analysis of fi ve different antibiotic regimens for the treatment of uncomplicated Chlamydia trachomatis cervicitis. J Am Board Fam Pract 1995;8:7-16. </ref><ref name="Effi cacy of single-dose azithromycin versus doxycycline in the treatment of cervical infections caused by Chlamydia trachomatis.">Ossewaarde JM, Plantema FHF, Rieffe M, Nawrocki RP, De Vries A, van Loon AM. Effi cacy of single-dose azithromycin versus doxycycline in the treatment of cervical infections caused by Chlamydia trachomatis. Eur J Clin Microbiol Infect Dis 1992;11:693-697. </ref><ref name="Chlamydial cervicitis and urethritis: single dose treatment compared with doxycycline for seven days in community based practises.">Thorpe EM Jr, Stamm WE, Hook EW 3rd, et al. Chlamydial cervicitis and urethritis: single dose treatment compared with doxycycline for seven days in community based practises. Genitourin Med 1996;72:93-97. </ref><ref name="Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials.">Lau CY, Qureshi AK. Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transm Dis 2002;29:497-502. </ref>(근거수준 1)

 A   생식기 클라미디아 감염의 권장 항생제 요법
    ⋅Azithromycin 1g 경구 단회 요법 
 A  또는
    ⋅Doxycycline 100mg 1일 2회 경구 7일 요법
 B   환자의 낮은 복약 순응도가 예상되는 경우에는 azithromycin 1g 경구 단회 요법이 권장된다.

===임신부의 단순생식기클라미디아감염===

*Amoxicillin, erythromycin과 azithromycin을 비교한 임상연구에서 비슷한 미생물학적, 임상적 치유율(>90%)을 보였지만 erythromycin에서 더 많은 위장관 장애를 보였다. <ref name="Double-blind randomized study comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy">Magat AH, Alger LS, Nagey DA, Hatch V, Lovchik JC. Double-blind randomized study comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. Obstet Gynecol 1993;81(5 Pt 1):745-749. </ref><ref name="A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy.">Kacmar J, Cheh E, Montagno A, Peipert JF. A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy. Infect Dis Obstet Gynecol 2001;9:197-202. </ref><ref name="Single-dose azithromycin for Chlamydia in pregnant women.">Wehbeh HA, Ruggeirio RM, Shahem S, Lopez G, Ali Y. Single-dose azithromycin for Chlamydia in pregnant women. J Reprod Med 1998;43: 509-514. </ref><ref name="Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin.">Adair CD, Gunter M, Stovall TG, McElroy G, Veille JC, Ernest JM. Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin. Obstet Gynecol 1998;91:165-168. </ref><ref name="Randomised comparison of amoxycillin and erythromycin in treatment of genital chlamydial infection in pregnancy.">Alary M, Joly JR, Moutquin JM, et al. Randomised comparison of amoxycillin and erythromycin in treatment of genital chlamydial infection in pregnancy. Lancet 1994;344:1461-1465. </ref><ref name="Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy.">Bush MR, Rosa C. Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy. Obstet Gynecol 1994;84:61-63. </ref><ref name="Treatment of genital Chlamydia trachomatis infection in pregnancy.">Genc MR. Treatment of genital Chlamydia trachomatis infection in pregnancy. Best Pract Res Clin Obstet Gynaecol 2002;16:913-922. </ref><ref name="A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of Chlamydia trachomatis in pregnancy.">Jacobson GF, Autry AM, Kirby RS, Liverman EM, Motley RU. A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of Chlamydia trachomatis in pregnancy. Am J Obstet Gynecol 2001;184: 13521354. </ref><ref name="A randomized, prospective trial comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy.">Silverman NS, Sullivan M, Hochman M, Womack M, Jungkind DL. A randomized, prospective trial comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. Am J Obstet Gynecol 1994;170:829-831. </ref>(근거수준 1)

*임신부에서의 azithromycin에 대한 안전성은 아직 미확립 상태이지만, 많은 전문가들은 안전한 것으로 생각한다.<ref name="A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy.">Kacmar J, Cheh E, Montagno A, Peipert JF. A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy. Infect Dis Obstet Gynecol 2001;9:197-202. </ref><ref name="Single-dose azithromycin for Chlamydia in pregnant women.">Wehbeh HA, Ruggeirio RM, Shahem S, Lopez G, Ali Y. Single-dose azithromycin for Chlamydia in pregnant women. J Reprod Med 1998;43: 509-514. </ref><ref name="Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin.">Adair CD, Gunter M, Stovall TG, McElroy G, Veille JC, Ernest JM. Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin. Obstet Gynecol 1998;91:165-168. </ref><ref name="Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy.">Bush MR, Rosa C. Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy. Obstet Gynecol 1994;84:61-63. </ref><ref name="Treatment of genital Chlamydia trachomatis infection in pregnancy.">Genc MR. Treatment of genital Chlamydia trachomatis infection in pregnancy. Best Pract Res Clin Obstet Gynaecol 2002;16:913-922. </ref><ref name="A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of Chlamydia trachomatis in pregnancy.">Jacobson GF, Autry AM, Kirby RS, Liverman EM, Motley RU. A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of Chlamydia trachomatis in pregnancy. Am J Obstet Gynecol 2001;184: 13521354. </ref>

*Doxycycline과 quinolone제재는 임신부와 수유중인 산모에게는 금기이다. 

*Erythromycin estolate은 간독성 때문에 금기이다. 단지 erythromycin base 또는 erythromycin ethylsuccinate만 사용 가능하다.

 A   임신부 단순 생식기 클라미디아 감염의 권장 항균제 요법
     ⋅ Azithromycin 1g 경구 단회 요법 
     또는
     ⋅ Amoxicillin 500mg 1일 3회 경구 7일 요법
     또는
     ⋅ Erythromycin 500mg 1일 4회 경구 7일 요법
 B   복약순응도, 부작용, 효과 등을 고려할 때, 생식기 클라미디아 감염 임신부에서는 azithromycin 1g 경구 단회 요법이 권장되나 
     안전성 미확립 상태이므로 치료에 따른 이득과 위험을 고려하여 선택을 결정한다.

====클라미디아 난관염====

*클라미디아 난관염에 관한 단독적인 연구결과는 없다. 적절한 클라미디아 치료에도 불구하고 증상이나 징후를 계속 호소할 때, 클라미디아 난관염을 의심해 보아야 하는 점을 보면 단순 생식기 클라미디아 감염증 치료만으로 부족함을 시사한다.

*British Association for Sexual Health and HIV (BASHH)의 지침에 따르면 다음과 같은 항생제 치료를 권장하고 있다.<ref name="United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease.">Ross JDC. British Association for Sexual Health and HIV (BASHH). United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease. London: BASHH; 2005. </ref>(근거수준 4)

 D   클라미디아 난관염에서는 doxycycline 100mg 1일 2회 경구 14일 + metronidazole 500mg 1일 2회 경구 14일 요법이 권장된다.

===클라미디아 부고환-고환염===

*클라미디아 부고환-고환염에 관한 단독적인 연구결과는 없다. 적절한 클라미디아 치료에도 불구하고 고환-부고환염 증상이나 징후를 계속 호소할 때, BASHH의 지침에 따르면 다음과 같은 항균제 치료를 권장하고 있다.<ref name="2001 National Guideline for the Management of epididymo-orchitis.">British Association for Sexual Health and HIV (BASHH). 2001 National Guideline for the Management of epididymo-orchitis. London: BASHH; 2001. </ref>(근거수준 4)

 D   클라미디아 부고환-고환염에서는 doxycycline 100mg 1일 2회 경구 14일 요법이 권장된다.

===클라미디아 직장감염===

*클라미디아 직장감염은 요도 또는 자궁경부내막 감염과 동일하게 치료한다.

 D   클라미디아 직장감염에서는 azithromycin 1g 경구 단회 요법 또는 doxycycline 100mg 1일 2회 경구 7일 요법이 권장된다. 

*클라미디아 혈청형 L1-3에 의한 감염인 성병림프육아종 (lymphogranuloma venereum, LGV)이 의심될 경우 보다 장기간의 doxycycline 치료가 필요하다.<ref name="Lymphogranuloma venereum: an emerging cause of proctitis in men who have sex with men.">Richardson D, Goldmeier D. Lymphogranuloma venereum: an emerging cause of proctitis in men who have sex with men. Int J STD AIDS 2007;18:11-14. </ref>(근거수준 4)

 D   성병림프육아종 (lymphogranuloma venereum, LGV)에서는 doxycycline 100mg 1일 2회 경구 21일 요법이 권장된다. 

  클라미디아 직장감염이 의심되는 환자는 반드시 전문가에게 의뢰한다.