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The organism Chlamydia trachomatis (serovars D-K) is one of the major causes of sexually transmitted infections (STIs). 1 Genital infection in adults may result in follicular conjunctivitis with or without a keratitis following exposure to infectious genital secretions during oro-genital sexual contact or by autoinoculation. 2 Such patients may go on to develop middle ear infections. 3, 4 However, the aetiological role of C trachomatis in otitis media (OM) in adults is still controversial.
METHODS
We performed a retrospective case notes review of all patients with chlamydial conjunctivitis attending the diagnostic clinic, Moorfields Eye Hospital, from January 1992 to December 2004 for otological symptoms, in particular hearing loss, earache, and sensation of blocked ear. Two clinicians cared for these patients in the diagnostic clinic at any one time, one of whom (BTG) was the main clinician throughout the study period. The main referral ophthalmologist (NDV) and the clinicians were trained to inquire for otological symptoms that were known to be associated with chlamydial conjunctivitis. Four consecutive patients with otological symptoms selected at random were reviewed by an otologist (JH). If otitis media was confirmed, otological tests including myringotomy were performed. Chlamydia diagnostic tests including culture and in-house plasmid based polymerase chain reaction (PCR) tests were carried out on specimens from the middle ear.
RESULTS
Of 276 consecutive patients with chlamydial conjunctivitis seen from January 1992 to December 2004, 36 (13.0%) had otological symptoms (12.6% of women and 13.9% of men). Of these 36 patients, 21 had noted ear problems on the same side as the affected eye, 12 noted problems with both ears, and three noted difficulties with the contralateral ear. All otological symptoms resolved following chlamydial treatment using either doxycycline 200 mg daily or erythromycin 500 mg four times daily for a week or 3 weeks if upper genital tract complications.
Four consecutive patients with otological symptoms (three women, one man) who were seen by an otologist (JH) were found to have otitis media. C trachomatis was detected from the middle ear aspirate by culture and PCR in two cases and from the nasopharynx of the other two. Screening for other STIs was negative in all cases.
Case 1
A 21 year old woman gave a 2 week history of a red, irritable,...