Chlamydia Infection and Seminal Vesicles
Chlamydia trachomatis can remain asymptomatic and affect the seminal vesicles, as demonstrated by research showing that 75% of patients with epididymitis had enlarged seminal vesicles on the affected side. 1
Asymptomatic Chlamydial Infections
- Chlamydial infections are frequently asymptomatic, with approximately 70% of infected individuals showing no symptoms, even when complications like salpingitis occur. 2
- In men, chlamydia is a common cause of urethritis and epididymitis, but can remain undetected due to minimal or absent symptoms. 3
- Asymptomatic infections in men can lead to unknowing transmission to sexual partners before seeking treatment. 3
Chlamydia and Male Reproductive Organs
- Research has demonstrated that chlamydial infection can affect the seminal vesicles, particularly in cases of epididymitis, with 75% of patients showing significantly enlarged seminal vesicles on the affected side. 1
- In a study of patients with epididymitis, 92% of enlarged seminal vesicles returned to normal size within 12 weeks after treatment, indicating that the infection can be effectively cleared from these structures. 1
- Persistently enlarged seminal vesicles were associated with unresolved epididymitis, and further testing revealed continued Chlamydia infection in some patients over 35 years of age. 1
- There are differing opinions about chlamydial involvement of the prostate gland and seminal vesicles, with some research suggesting that identification of C. trachomatis in accessory gland secretions is not sufficiently reproducible. 2
Diagnosis and Detection
- DNA amplification tests on first voided urine or urethral swabs are the most sensitive routine tests for detecting chlamydial infection in men. 2
- Chlamydial antibodies in serum or seminal fluid are not reliable indicators of current infection but may indicate previous exposure. 2
- For suspected chlamydial infections, culture, direct fluorescent antibody tests, enzyme immunoassays, or nucleic acid amplification tests are recommended. 4
Treatment and Management
- For uncomplicated chlamydial infections, recommended treatment includes:
- Azithromycin 1g orally in a single dose, OR
- Doxycycline 100mg orally twice daily for 7 days 3
- For persistent infections, particularly those involving the seminal vesicles, a longer course of 10-14 days of doxycycline 200mg daily or a macrolide antibiotic is recommended. 2
- Treatment of sexual partners is essential to prevent reinfection and further transmission. 3, 2
Complications and Sequelae
- Untreated chlamydial infections in men can lead to epididymitis and orchitis. 5
- Both men and women can experience chlamydia-induced reactive arthritis. 5
- The impact of chlamydial infection on male fertility remains less clear than its well-established effects on female fertility. 6, 2
- Persistent infection can lead to chronic inflammation and potential scarring of reproductive organs. 1
Prevention and Screening
- While screening is recommended for all women younger than 25 years, pregnant women, and women at increased risk, screening is not currently recommended for asymptomatic men. 5
- Partner notification and treatment are crucial components of chlamydia control to prevent reinfection and ongoing transmission. 7
- Early identification and treatment of infected individuals is essential to prevent complications and transmission. 7
Clinical Implications
- Given the evidence that chlamydia can affect seminal vesicles and remain asymptomatic, clinicians should consider chlamydial infection in the differential diagnosis for men with unexplained urogenital symptoms or abnormal findings on imaging studies. 1
- For patients with persistent symptoms after standard treatment, further evaluation for possible involvement of the seminal vesicles may be warranted. 1
- Follow-up imaging may be useful to confirm resolution of seminal vesicle involvement after treatment. 1