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Urethro-oculo-articular syndrome or urithritis-conjunctivitis-arthritis syndrome
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Reiter's
syndrome describes
a condition in which there is inflammation (i.e., itis) -- irritation, swelling, damage -- to the urethra (a tube carrying urine from the bladder to the outside); conjunctiva (lining covering the eye); and joints
(i.e., arthritis). Other structures including the skin, nails, mouth, tongue, cervix, prostate, bladder, penis, heart, and nervous system may also be affected.
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- Occur 1- 2 weeks after the exposure
- Burning or stinging upon urination
- Discharge from the penis
- Painful ejaculation
- Urinary frequency
- Red, painful (burning) eye
- Discharge from the eye
- Dry eye
- May involve both eyes.
- Joint pains -- ankle, knees, lower back, etc. The sacroiliac joint (joint between the tail bone and pelvis in the buttocks) is classically affected.
- Heal pain
- Pain over the tendons especially behind the leg (Achilles tendon)
- Skin thickened (or inflammation) around the nails or on the palms and soles
- Sores (painless and small) inside the mouth, on the tongue, or on the head (glans) of the penis
- Fever, chills, heart problems (valve damage, inflammation of sac covering the heart, etc.) or damage to nerves, such as peripheral Neuropathy (numbness, tingling, etc.), can also occur.
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- Follows an infection with Chlamydia trachomatis (sexually transmitted disease) or after Food Poisoning from or exposure to Diarrhea containing such bacteria as Salmonella, Yersinia, Shigella, and Campylobacter (dysenteric form).
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- History of exposure, allergies, medication, habits, foods, travel, family history, illnesses, etc.
- Medical exam will reveal mouth or skin lesions, urethritis, Conjunctivitis, and arthritis (classically sacroiliitis is present).
- Tests:
- X-Ray picture of the joints, back, and heals may be done.
- Blood test will show increase in white blood cells, ESR (indicates inflammation), and antibodies (protective Proteins) to Chlamydia
- Test for HLA-B27
- If a joint is swollen, it may be tapped (using a needle) and the fluid sent for laboratory studies to rule out other causes of arthritis.
- Normally no bacteria are found in the joint fluid.
- Stool and urine samples may be sent for testing to see if bacteria are present (using a culture) help in arriving at diagnosis.
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- Males > females
- Under 40 in sexually active individuals
- Other sexually-transmitted diseases
- HLA-B27 antigen -- individuals with this surface protein may be at higher risk.
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- Symptomatic management
- NSAIDs (Anti-inflammatories) such as Naproxen or Indomethacin for joint pain and other inflammatory conditions
- Antibiotics if bacteria are found
- Corticosteroids are potent anti-inflammatory agents that can be taken orally, used in eye drops, lotions, or injected into the joints.
- Most cases resolve in 3-4 months
- In up to 50%, the course becomes chronic, with relapse of some or all the symptoms.
- More potent anti-inflammatory drugs (e.g., Methotrexate, Azathioprine) are being tested and used in some cases (not recommended in HIV + individuals) as possible therapies-physical therapy may be required after the illness to help injured joints recover.
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Contact your physician and avoid sexual intercourse until you have been tested for Chlamydia.
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