If left untreated, genitourinary tract infections caused by Chlamydia and Mycoplasma can last for months and may have comorbidities, including pelvic inflammatory disease, vestibulitis, or proctitis. Chlamydia or (and) gonorrhea together may even cause perihepatitis (per***titis), called Fitz-Hugh-Cur-tis syndrome. Therefore, the disease should be treated as soon as it is diagnosed. The second hospital of Sanming City, Department of Traditional Chinese Medicine, Jiang Qiaoyan 1 Chlamydia treatment Chlamydia trachomatis is sensitive to tetracycline and is still the drug of choice for the treatment of Chlamydia infection, erythromycin is the second choice, but can be used in pregnant women and children. In addition, doxycycline, minocycline, ciprofloxacin and cotrimoxazole also have good effect on it. The specific options are as follows. 1.1 Tetracycline hydrochloride is prohibited for pregnant women and children. Minocycline 100mg, twice daily for 10 days. Its antibacterial effect is slightly stronger than that of tetracycline. Doxycycline 100mg twice daily for 7~10 days. Its antibacterial effect is 4~10 times stronger than that of tetracycline. 1・2 Macrolides Azithromycin 1g, single dose in a single dose. This drug has excellent ability to inflammatory tissue, the concentration of the drug at the site of infection is tens to hundreds of times the blood concentration. The half-life of this drug is 40~60h, and the effective concentration can be maintained for 5 days with a single dose. Erythromycin 250~500mg, 4 times daily for 5~7 days. Erythromycin 800mg, 4 times daily for 7 days. This drug can be used when high doses of erythromycin cannot be tolerated. Roxithromycin 300mg once a day for 7 days. josamycin 400mg 4 times a day for 10 days. 1・3 Quinolones are prohibited for hepatic and renal dysfunction, pregnant women and children. Ciprofloxacin 500mg twice a day for 7 days. If comorbidities exist, the dose may be increased or the course of treatment may be extended.2 Treatment of mycoplasma infections Mycoplasma has been shown to be parasitic in healthy populations. Therefore, mycoplasma is considered to be clonal, i.e., it can live with the host without showing signs of infection, when the number of clones is more or less 104/mL. On the other hand, it can become a pathogen causing infection under certain conditions. Therefore, mycoplasma infection is an opportunistic infection caused by a pathogen with low pathogenicity. Mycoplasma infections with clinical symptoms should be treated when mycoplasma is detected in the laboratory or when the titer of serum antibody increases more than 4 times. Mycoplasma is sensitive to antibiotics that act on the nucleoproteome, such as doxycycline, erythromycin, tetracycline, kanamycin and streptomycin, but not to antibiotics that affect cell wall synthesis, such as penicillin. Mycoplasma genitalium (MG), Mycoplasma humanum (MH), and Mycoplasma urealyticum (UU) are the main pathogens of mycoplasma infections in the genital tract of sexually transmitted diseases. Since different types of mycoplasma infections have different sensitivity to some antibiotics, for example, erythromycin is effective against UU but not MH, and lincomycin is ineffective against UU but effective against MH. Therefore, it is better to find out the type before treatment and choose the drug. 2・2 Specific regimen The following regimen can be chosen. Doxycycline 100mg twice a day for 7~14 days. Minocycline 100mg twice a day for 10 days. Erythromycin 500mg 4 times a day for 7 days. If high dose erythromycin is not tolerated, switch to erythromycin 800mg 4 times a day for 7-14 days. Azithromycin 1g, single dose, can maintain the effective concentration for 5 days. Roxithromycin 300mg, once daily for 7 days. Ovofloxacin 200mg twice a day for 7~14 days. 2・3 Drug resistance Mycoplasma resistance to antibiotics has a growing trend and should be noted. It has been reported that 8%-28% of UU doxycycline-resistant strains and 10%-52% of erythromycin-resistant strains; less than 20% of UU and MH are resistant to ofloxacin.3 Treatment of non-gonococcal urethritis In non-gonococcal urethritis (NGU), 40%-50% are caused by Chlamydia trachomatis, 20%-30% are caused by Mycoplasma solani. Mycoplasma, and 10%-20% can be caused by microorganisms such as Trichomonas vaginalis, Pseudomonas albicans, Mycoplasma genitalium, herpes simplex virus, adenovirus and Mycobacterium avium. 3・1 Drug selection Many antibacterial drugs are effective for NGU, including macrolides, tetracycline hydrochloride and fluoroquinolones. However, penicillin is not effective against NGU; cephalosporins are not effective against Chlamydia trachomatis, so they are not used; streptomycin and daikonomycin are effective against mycoplasma and poor against chlamydia. Therefore, unless the pathogenic diagnosis is clear, they are not used; because mycoplasma has low resistance to sulfonamide, they are also rarely used in NGU patients. 3.2 Standard treatment guidelines (CDC, 2002) 3.2.1 Initial NGU cases (including UTI and cervicitis) (1) Preferred regimen: Azithromycin 1g, single dose, given orally 1h before or 2h after meals. Doxycycline 100mg twice daily for 7 days. (2) Alternative regimen: Erythromycin 500mg, 4 times daily for 7 days. Erythromycin 800mg 4 times a day for 7 days. Ofloxacin 300mg twice daily for 7 days. Levofloxacin 500mg once a day for 7 days. 3・2・2 NGU relapse or persistent cases Metronidazole 2g, single oral dose, plus erythromycin 500mg 4 times daily for 7 days, or erythromycin 800mg 4 times daily for 7 days. 3・2・3 Doxycycline and Ofloxacin are contraindicated in NGU during pregnancy. The recommended regimen is: Erythromycin 500mg 4 times daily for 7 days. Amoxicillin 500mg 3 times a day for 7 days. The alternative regimen is: Erythromycin 250mg 4 times a day for 14 days. Erythromycin 400mg 4 times a day for 14 days. Azithromycin 1g, single dose in a single dose. 3・2・4 Chlamydia conjunctivitis in newborns: 0・5 % erythromycin eye ointment or 1 % tetracycline eye ointment, eye drops immediately after birth. Local treatment alone is not enough, and systemic treatment must be given at the same time. Systemic medicine: erythromycin dry syrup powder or erythromycin 50mg/(kg・d), divided into 4 oral doses, for 14 days. 3・2・5 Cure criteria After 1 week of treatment, if the patient’s conscious symptoms disappear, no urethral discharge, no white blood cells in urine precipitation, and no chlamydia in cell smear, it can be judged as cured. When judging the cure, the pathogen culture is usually not done. Molecular biology tests can detect the antigen and DNA of dead bacteria, so they cannot be used to determine cure.