日本性感染症学会誌 Journal of Japanese Society for Sexually Transmitted Infections

Case 1 involved a 25-year-old Japanese male who first presented to the department of orthopedics at Toho University Hospital with pain in his right knee. The patient also was suffering from untreated painful urination. Tests for serum Chlamydia trachomatis IgG and IgA as well as urinary C. trachomatis DNA were positive, and the patient was diagnosed with Chlamydia-associated arthritis (Chl-AA). He was prescribed Azithromycin (AZM, single dose, 2 g) followed by Celecoxib (400 mg) and Ryutanshakanto (a Japanese herbal medicine, 7.5 g), which treated his pain effectively.

Case 2 was a 37-year-old Japanese male, who presented with high fever and joint pain in the left knee and elbow. Tests for serum C. trachomatis IgG, IgA, and IgM as well as urinary C. trachomatis DNA were positive and the patient was diagnosed with Chl-AA. Therapy with AZM (2 g), Rifampicin (RFP, 450 mg), and Celecoxib (400 mg) was started, but these were judged to be ineffective due to pseudogout, and thus the patient was prescribed 30 mg of prednisolone. However, because RFP reduces the efficacy of steroids, AZM and RFP were replaced by 400 mg of Clarithromycin (CAM). Four months later, the pain decreased and the patient was able to walk. Six months later therapy with CAM was stopped, and Ryutanshakanto was prescribed to treat Chl-AA. One year later his joint pain was relieved with Celecoxib (400 mg).