Chlamydia and Other Nongonococcal Infections

In men, symptoms of chlamydial urethritis start 7 to 28 days after the infection is acquired during intercourse. Typically, men feel a mild burning sensation in their urethra during urination and may have a clear or cloudy discharge from the penis. The discharge is usually less thick than the discharge in gonorrhea. There may be only a small amount of discharge and mild symptoms. However, early in the morning, the opening of the penis is often red and stuck together with dried secretions. Occasionally, symptoms are more noticeable with a frequent urge to urinate, painful urination, and a discharge of pus from the urethra.

Many women with chlamydial infection of the cervix have few or no symptoms. But some have frequent urges to urinate, painful urination, and a discharge of yellow pus from the vagina. Sexual intercourse may be painful.

If the rectum is infected, people may have rectal pain or tenderness and a yellow discharge of pus and mucus from the rectum.

Chlamydia can also be spread during oral sex, causing infection of the throat. Chlamydial throat infection usually causes no symptoms.

Without treatment, symptoms lessen within 4 weeks in about two thirds of people. However, chlamydia can have serious long-term consequences for women, even when their symptoms are mild or absent. Thus, detecting and treating the infection are important, even if symptoms are absent.

Complications

In women, complications from chlamydia include

• Scarring of the fallopian tubes

• Infection of the fallopian tubes (salpingitis)

• Infection of the membrane that lines the pelvis and abdominal cavity (peritonitis)

• Infection in the area around the liver

The infection may spread up the reproductive tract and infect the uterus, the tubes that connect the ovaries to the uterus (fallopian tubes), and sometimes the area around the ovaries. In some women, the infection spreads to the lining of the pelvis and abdominal cavity (peritoneum), causing peritonitis. These infections are called pelvic inflammatory disease (PID) and cause severe lower abdominal pain and sometimes fever. Sometimes infection concentrates in the area around the liver, in the upper right part of the abdomen, causing pain, fever, and vomiting—called the Fitz-Hugh-Curtis syndrome.

Potential complications of pelvic inflammatory disease include severe infection throughout the body (sepsis), chronic abdominal pain, and scarring of the fallopian tubes. The scarring can cause infertility and mislocated (ectopic) pregnancies.

In men, complications from chlamydia include

• Infection of the epididymis

• Narrowing (stricture) of the urethra

Chlamydial infections may cause infection of the epididymis (epididymitis). The epididymis is the coiled tube on top of each testis (see figure Pathway From the Penis to the Epididymis). This infection causes painful swelling of the scrotum on one or both sides. The infection may lead to narrowing of the urine passage through the penis (urethra) due to scarring.

Pathway From the Penis to the Epididymis

Occasionally in men, organisms spread up the urethra and travel through the tube that carries sperm from the testis (vas deferens) to infect the epididymis at the top of a testis.

In all people, complications from chlamydia may include

• Infection of the membrane that covers the white of the eye (conjunctivitis)

• Reactive arthritis

Chlamydial genital infections occasionally cause a joint inflammation called reactive arthritis. Reactive arthritis typically affects only one or a few joints at once. The knees and other leg joints are affected most often. The inflammation seems to be an immune reaction to the genital infection rather than spread of the infection to the joints. Symptoms typically begin 1 to 3 weeks after the initial chlamydial infection. Reactive arthritis sometimes is accompanied by other problems, such as changes in the skin of the feet, problems with the eyes, and inflammation of the urethra.

Reactive Arthritis That Affects the Feet

Image

Image courtesy of Susan Lindsley via the Public Health Image Library of the Centers for Disease Control and Prevention.

In newborns, complications from chlamydial infection include

• Conjunctivitis

• Pneumonia

Newborns may be infected with Chlamydia during delivery if their mother has a chlamydial infection of the cervix. In newborns, the infection may result in pneumonia (neonatal pneumonia) or conjunctivitis (neonatal conjunctivitis).

• Usually, testing of a sample of discharge from the cervix, vagina, penis, throat, or rectum or a sample of urine

Doctors suspect chlamydial, ureaplasmal, and mycoplasmal infections based on symptoms, such as a discharge from the penis or cervix, or risk factors, such as age or high-risk sexual activity.

In most cases, doctors diagnose chlamydia by doing tests that detect the bacteria’s unique genetic material (DNA). Usually, a sample of the discharge from the penis or cervix is used. Sometimes women are asked to use a swab to obtain a sample from their vagina. For some types of these tests, a urine sample can be used. If a urine sample can be used, people can avoid the discomfort of having a swab inserted into the penis or having a pelvic examination to obtain a sample.

If doctors suspect infection of the throat or rectum, samples from those sites may be tested.

Gonorrhea, which is often also present, can be diagnosed using the same sample. Blood tests to check for human immunodeficiency virus (HIV) infection and syphilis may also be done.

Because chlamydia is so common and because many infected women have no symptoms, tests to screen for chlamydia are recommended for certain sexually active people.

If screening is recommended, it is done even if a person uses condoms consistently. Tests are done using samples taken from the rectum, the urethra, or, if they engaged in oral sex, the throat.

Women are screened annually if they are sexually active and under age 25 or if they are 25 years or older, sexually active, and have one or more of the following risk factors:

• A previous STI

• Risky sexual activities (such as having a new sex partner or multiple sex partners, using condoms inconsistently when not in a mutually monogamous relationship, or participating in sex work)

• A history of incarceration

• A partner who participates in risky sexual activities or has an STI

Pregnant women are screened during their first prenatal visit and again during their 3rd trimester if they are at high risk.

Men who have sex with women are not routinely screened, but screening is available if a person requests it and is often offered to all patients at adolescent clinics, STI clinics, and correctional facilities.

Men who have sex with men are screened as follows:

• If they are sexually active: At least once a year

• If they are at increased risk (those with HIV infection, multiple sex partners, or a partner who has multiple partners): Every 3 to 6 months

Transgender and gender diverse people are screened if they are sexually active and on the basis of their sexual practices and anatomy. For example, all people with a cervix who are under age 25 are screened annually. If they are 25 years or older, people with a cervix should be screened annually if at increased risk. Rectal swab screening is done on transgender and gender diverse people based on reported sexual behaviors and exposure.

• An antibiotic

• Simultaneous treatment of sex partners

Chlamydial, ureaplasmal, and mycoplasmal infections are treated with one of the following antibiotics:

If gonorrhea is possible, that is treated at the same time, usually with an antibiotic given as an injection. Such treatment is needed because the symptoms of the two infections are similar and it is common to have both infections at the same time.

Symptoms may persist or return for one of the following reasons:

• Other infections that are also present may be causing the symptoms.

• People may have become infected again.

• The chlamydiae may be resistant to antibiotics.

In such cases, tests for chlamydia and gonorrhea are repeated, and sometimes tests for other infections are done.

Infected people and their sex partners should abstain from sexual intercourse until at least 1 week after they have completed treatment.

The following general measures can help prevent chlamydial infections (and other STIs):

• Safer sex practices, including using a condom every time for oral, anal, or genital sex

• Decreased risk of exposure to STIs by reducing the number of sex partners, not having high-risk sex partners (people with many sex partners or who do not practice safer sex), or practicing mutual monogamy or abstinence

• Prompt diagnosis and treatment of the infection (to prevent spread to other people)

• Identification of the sexual contacts of infected people, followed by counseling or treatment of these contacts

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

1. Centers for Disease Control and Prevention: Chlamydia