Chlamydial Genitourinary Infections Clinical Presentation

  • Author: Kelley Struble, DO; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 17, 2012
 

History

C trachomatis is a sexually transmitted microorganism responsible for a wide spectrum of diseases that include cervicitis, salpingitis, endometritis, urethritis, epididymitis, conjunctivitis, and neonatal pneumonia. In contrast to gonorrhea infection, most men and women who are infected are asymptomatic, and, therefore, diagnosis is delayed until a positive screening result or upon discovering a symptomatic partner. In July 2007, The US Preventive Services Task Force Screening released a new recommendation statement for chlamydial infections.

Routine chlamydia screening in sexually active young women is recommended to prevent consequences of untreated chlamydial infection (eg, pelvic inflammatory disease, infertility, ectopic pregnancy, chronic pelvic pain). Fewer than half of young, sexually active females in the United States are screened for chlamydia, reports Morbidity and Mortality Weekly Report. Nationally, the annual screening rate increased from 25.3% in 2000 to 43.6% in 2006 and then decreased slightly to 41.6% in 2007.[4]

Chlamydia has been isolated in approximately 40-60% of males presenting with nongonococcal urethritis. Recent epidemiological studies indicate a high prevalence rate of asymptomatic men who act as a reservoir for chlamydial infections. A study by Quinn et al (1996) demonstrated that transmission probability in both men and women is estimated at 68%.[5]

  • Risk factors
    • Nonwhite race
    • Multiple sexual partners
    • Age younger than 19 years
    • Poor socioeconomic conditions
    • Single marital status
    • Nonbarrier contraceptive use
  • Neonatal risk
    • Conjunctivitis
    • Neonatal pneumonia
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Physical

  • Women
    • Easily induced endocervical bleeding
    • Mucopurulent endocervical discharge
    • Intermenstrual bleeding
    • Cervical discharge
    • Dysuria
    • Abdominal pain
  • Men
    • Urethral discharge
    • Urinary frequency and/or urgency
    • Dysuria
    • Scrotal pain/tenderness
    • Perineal fullness (related to prostatitis)
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Contributor Information and Disclosures
Author

Kelley Struble, DO  Fellow, Department of Infectious Diseases, University of Oklahoma College of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Rhett L Jackson, MD  Associate Professor and Vice Chair for Education, Department of Medicine, Director, Internal Medicine Residency Program, University of Oklahoma College of Medicine; Assistant Chief, Medicine Service, Oklahoma City Veterans Affairs Hospital

Rhett L Jackson, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association

Disclosure: Nothing to disclose.

Renuka Heddurshetti, MD  Fellow in Infectious Diseases, Department of Internal Medicine, State University of New York at Brooklyn

Renuka Heddurshetti, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Jeffrey Blitstein, MD  Staff Physician, Department of Internal Medicine, Division of Infectious Disease, VA New York Harbor Health Care System at Brooklyn

Disclosure: Nothing to disclose.

Specialty Editor Board

John M Leedom, MD  Professor Emeritus of Medicine, Keck School of Medicine of the University of Southern California

John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Srivastava P, Jha R, Bas S, Salhan S, Mittal A. In infertile women, cells from Chlamydia trachomatis infected sites release higher levels of interferon-gamma, interleukin-10 and tumor necrosis factor-alpha upon heat-shock-protein stimulation than fertile women. Reprod Biol Endocrinol. May 20 2008;6:20. [Medline].

  2. Centers for Disease Control and Prevention. Department of Health and Human Services. Sexually Transmitted Disease Surveillance, 2007. Available at http://www.cdc.gov/std/pubs/. Accessed December 2008.

  3. World Health Organization. Chlamydia Trachomatis. Initiative for Vaccine Research. Accessed June 2009. Available at http://www.who.int/vaccine_research/diseases/soa_std/en/index.html.

  4. Centers for Disease Control and Prevention. Chlamydia screening among sexually active young female enrollees of health plans--United States, 2000-2007. MMWR Morb Mortal Wkly Rep. Apr 17 2009;58(14):362-5. [Medline]. [Full Text].

  5. Quinn TC, Gaydos C, Shepherd M. Epidemiologic and microbiologic correlates of Chlamydia trachomatis infection in sexual partnerships. JAMA. Dec 4 1996;276(21):1737-42. [Medline].

  6. Peters RPH, Nijsten N, Mutsaers J, Jansen CL, Morré SA, van Leeuwen AP. Screening of Oropharynx and Anorectum Increases Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae Infection in Female STD Clinic Visitors. Sexually Transmitted Diseases. Sept 2011;38(9):783-7.

  7. Mangin D, Murdoch D, Wells JE, Coughlan E, Bagshaw S, Corwin P, et al. Chlamydia trachomatis Testing Sensitivity in Midstream Compared With First-Void Urine Specimens. Ann Fam Med. Jan 2012;10(1):50-3. [Medline].

  8. [Guideline] Centers for Disease Control and Prevention. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6. [Medline]. [Full Text].

  9. Centers for Disease Control and Prevention. Availability of cefixime 400 mg tablets--United States, April 2008. MMWR Morb Mortal Wkly Rep. Apr 25 2008;57(16):435. [Medline].

  10. Bell TA, Sandstrom IK, Eschenbach DA. Treatment of Chlamydia trachomatis in pregnancy with amoxicillin. In: Mardh PA, Holmes KK, Oriel JD, Piot P, Schachter J, eds. Chlamydial Infections. New York, NY: Elsevier Biomedical; 1982:221-4.

  11. Bowie WR. Nongonococcal urethritis. Urol Clin North Am. Feb 1984;11(1):55-64. [Medline].

  12. Centers for Disease Control and Prevention. Diseases characterized by urethritis and cervicitis (see update from April 13, 2007). MMWR Morb Mortal Wkly Rep [serial online]. Aug 4 2006;55(RR-11):35-49. Available at http://www.cdc.gov/std/treatment/2006/urethritis-and-cervicitis.htm#uc4.

  13. [Guideline] Centers for Disease Control and Prevention. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6. [Medline]. [Full Text].

  14. [Guideline] Centers for Disease Control and Prevention, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55(RR-11):1-94. [Medline]. [Full Text].

  15. Cook RL, Hutchison SL, Østergaard L, et al. Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med. Jun 7 2005;142(11):914-25. [Medline].

  16. Donders GG. Management of genital infections in pregnant women. Curr Opin Infect Dis. Feb 2006;19(1):55-61. [Medline].

  17. Donovan B. Sexually transmissible infections other than HIV. Lancet. Feb 14 2004;363(9408):545-56. [Medline].

  18. Dorman SA, Danos LM, Wilson DJ. Detection of chlamydial cervicitis by Papanicolaou stained smears and culture. Am J Clin Pathol. Apr 1983;79(4):421-5. [Medline].

  19. Ehret JM, Judson FN. Susceptibility testing of Chlamydia trachomatis: from eggs to monoclonal antibodies. Antimicrob Agents Chemother. Sep 1988;32(9):1295-9. [Medline].

  20. Hook EW 3rd, Smith K, Mullen C. Diagnosis of genitourinary Chlamydia trachomatis infections by using the ligase chain reaction on patient-obtained vaginal swabs. J Clin Microbiol. Aug 1997;35(8):2133-5. [Medline].

  21. Katz BP, Fortenberry D, Orr DP. Factors affecting chlamydial persistence or recurrence one and three months after treatment. In: Stephens RS, Byrne GI, Christiansen G, et al, eds. Chlamydial Infections, Proceedings of the Ninth International Symposium on Human Chlamydial Infection. San Francisco, Calif: International Chlamydial Symposium; 1998:35-8.

  22. Magat AH, Alger LS, Nagey DA. Double-blind randomized study comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. Obstet Gynecol. May 1993;81(5 ( Pt 1)):745-9. [Medline].

  23. Martin DH, Mroczkowski TF, Dalu ZA. 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. Sep 24 1992;327(13):921-5. [Medline].

  24. Rahman MU, Hudson AP, Schumacher HR Jr. Chlamydia and Reiter's syndrome (reactive arthritis). Rheum Dis Clin North Am. Feb 1992;18(1):67-79. [Medline].

  25. Stamm WE. Chlamydia trachomatis infections: progress and problems. J Infect Dis. Mar 1999;179 Suppl 2:S380-3. [Medline].

  26. Wehbeh HA, Ruggeirio RM, Shahem S. Single-dose azithromycin for Chlamydia in pregnant women. J Reprod Med. Jun 1998;43(6):509-14. [Medline].

 
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