What are the symptoms of chlamydia in men?

Symptoms of Chlamydia in Men

Men with chlamydia often have no symptoms, but when present, the most common symptoms are urethral discharge and dysuria (painful urination). 1

Common Symptoms of Chlamydia in Men

Chlamydial infections in men primarily affect the urethra, causing:

• Urethral discharge - typically watery or mucoid rather than purulent 1, 2
• Dysuria (painful urination) 3
• Urethral itching or discomfort

However, it's crucial to understand that:

• Most men with chlamydia have mild symptoms or are completely asymptomatic 1
• The number of asymptomatic chlamydial infections in men is larger than the number of asymptomatic gonococcal infections 1
• Approximately 17% of men with chlamydial infection have no subjective symptoms at all 2

Other Possible Manifestations

In addition to urethritis, chlamydia in men can cause:

1. Epididymitis - inflammation of the epididymis, which can lead to testicular pain, swelling, and potentially fertility issues 3, 4

2. Proctitis - in men who engage in receptive anal intercourse, symptoms may include:

   • Rectal discharge
   • Pain during defecation
   • Symptoms of proctocolitis 1

3. Reactive arthritis (formerly known as Reiter's syndrome) - an uncommon but serious complication that includes:

   • Arthritis
   • Conjunctivitis
   • Urethritis 1, 4

4. Conjunctivitis - chlamydial infection can affect the eyes, causing inflammation 1

Clinical Significance and Complications

While chlamydial infections in men rarely result in serious sequelae for the men themselves, they have significant public health importance because:

• Asymptomatic infected men may unknowingly transmit the infection to their sexual partners 1
• Female partners who become infected are at high risk for serious complications including pelvic inflammatory disease, infertility, and ectopic pregnancy 5
• Chlamydial infections account for 30-40% of the 4-6 million physician visits for nongonococcal urethritis annually 1

Diagnostic Considerations

When symptoms are present, urethritis can be documented by:

• Presence of mucopurulent or purulent discharge
• Gram stain showing ≥5 WBCs per oil immersion field
• Positive leukocyte esterase test on first-void urine
• Microscopic examination of first-void urine showing ≥10 WBCs per high power field 1

Important Clinical Pitfalls

1. Do not assume absence of symptoms means absence of infection - screening may be necessary for high-risk individuals even without symptoms

2. Do not confuse chlamydial urethritis with gonococcal urethritis - while symptoms overlap, chlamydial discharge tends to be more watery compared to the purulent discharge typical of gonorrhea 2

3. Do not overlook partner notification and treatment - all sexual partners within the preceding 60 days should be evaluated and treated to prevent reinfection 1

4. Do not forget to consider co-infections - patients with chlamydia should be tested for other STIs including gonorrhea, syphilis, and HIV 1

By understanding the often subtle or absent symptoms of chlamydia in men, healthcare providers can better identify, treat, and prevent the spread of this common sexually transmitted infection.