What are the signs and symptoms of chlamydia?

Signs and Symptoms of Chlamydia

Chlamydia infections are often asymptomatic, with over 80% of cases showing no symptoms, making it a "silent" infection that can lead to serious complications if left untreated. 1

Symptoms in Women

• Most women with chlamydial infections are asymptomatic or have minimal symptoms 2
• When symptoms do occur, they may include:
  • Abnormal vaginal discharge 3
  • Dysuria (painful urination) 3
  • Lower abdominal pain 3
  • Intermenstrual bleeding or postcoital bleeding 3
  • Dyspareunia (painful intercourse) 3
• Untreated infections can ascend to the upper genital tract causing:
  • Pelvic inflammatory disease (PID) 1
  • Endometritis 3
  • Salpingitis (fallopian tube infection) 3
  • Perihepatitis (Fitz-Hugh-Curtis syndrome) 3

Symptoms in Men

• Urethritis is the most common manifestation 3
• Symptoms are similar to gonorrhea but often milder or absent 3
• When present, symptoms may include:
  • Urethral discharge 3
  • Dysuria (painful urination) 3
• Epididymitis may develop, causing testicular pain and swelling 1, 4
• Proctitis in men who engage in receptive anal intercourse, with symptoms including:
  • Rectal discharge 3
  • Pain during defecation 3

Rectal and Pharyngeal Infections

• Rectal infections are generally asymptomatic 3
• When symptomatic, rectal infections may cause:
  • Discharge 3
  • Pain during defecation 3
  • Symptoms of proctocolitis 3
• Pharyngeal infections can occur but have not been established as a cause of pharyngitis 3

Ocular Manifestations

• Chlamydia can cause conjunctivitis in adults through exposure to infectious genital secretions or autoinoculation 3, 4
• In neonates, chlamydia is the most common cause of neonatal conjunctivitis 3

Other Manifestations

• Reactive arthritis (formerly known as Reiter's syndrome) can develop 1-4 weeks after genital infection 5
  • More common in men 5
  • Characterized by inflammation of joints, eyes, and urogenital tract 5
• Chlamydia may cause acute dysuria-pyuria syndrome in women with pyuria but sterile urine cultures 3

Important Clinical Considerations

• The asymptomatic nature of chlamydia makes screening essential for early detection 6, 1
• Untreated infections can lead to serious complications:
  • In women: PID (20% of infected women), chronic pelvic pain (4%), infertility (3%), and adverse pregnancy outcomes (2%) 7
  • In men: epididymitis, orchitis, and reactive arthritis 4
• Pregnant women with untreated chlamydia are at risk for postpartum PID and can transmit the infection to infants during delivery 3
• Infants born to infected mothers may develop:
  • Conjunctivitis (15-25% of exposed infants) 3
  • Pneumonia (3-16% of exposed infants) 3

Screening Recommendations

• Due to the high prevalence of asymptomatic infections, screening is recommended for:
  • All sexually active women under 25 years 4
  • All pregnant women 4
  • Women at increased risk of infection 4
  • Sexual partners of infected individuals 6
• Screening is not currently recommended for men in general 4