What are the signs and symptoms of gonorrhea and chlamydia?

Signs and Symptoms of Gonorrhea and Chlamydia

Both gonorrhea and chlamydia are frequently asymptomatic, particularly in women, making clinical detection challenging and screening essential to prevent serious complications like pelvic inflammatory disease, infertility, and ectopic pregnancy. 1

Key Clinical Distinction

The most important clinical difference is that gonorrhea is more likely to be symptomatic than chlamydia, especially in men, though both infections often produce no symptoms at all. 1

Chlamydia: Clinical Presentation

In Women

• Most infections are asymptomatic or have nonspecific symptoms that are too mild to prompt treatment 1, 2
• When symptomatic, may present with:
  • Abnormal vaginal discharge 2
  • Dysuria (painful urination) 1
  • Cervicitis (inflammation of the cervix) 2
  • Lower abdominal pain if pelvic inflammatory disease develops 1
• Acute dysuria-pyuria syndrome: dysuria with pyuria but sterile urine cultures, occurring in young women 1, 2

In Men

• Symptoms are often absent or mild, in contrast to gonorrhea 1
• When symptomatic:
  • Urethral discharge (typically less profuse than gonorrhea) 1
  • Dysuria 1
  • Urethritis 1
  • Epididymitis (testicular pain and swelling) 1
• Asymptomatic chlamydial infections in men outnumber asymptomatic gonorrhea cases 1

Extragenital Sites

• Rectal infections are generally asymptomatic but may cause proctitis symptoms including rectal discharge and pain during defecation 1
• Pharyngeal infections are asymptomatic and chlamydia has not been established as a cause of pharyngitis 1
• Conjunctivitis: chronic conjunctivitis in adolescents and adults from autoinoculation or oral-genital contact 1

Gonorrhea: Clinical Presentation

In Women

• Frequently asymptomatic, with many infections not producing recognizable symptoms until complications like PID occur 1
• When symptomatic:
  • Abnormal vaginal discharge 1
  • Dysuria 1
  • Cervicitis 1
  • Lower abdominal pain (if PID develops) 1

In Men

• The majority of urethral infections produce symptoms that cause men to seek treatment 1
• Symptomatic presentation:
  • Urethral discharge (typically more profuse than chlamydia) 1
  • Dysuria 1
  • Urethritis 1
  • Epididymitis 1
• Gonorrhea is more likely than chlamydia to be symptomatic in men compared to women 1

Extragenital Sites

• Rectal infections may be asymptomatic or cause proctitis symptoms (rectal discharge, pain during defecation) or proctocolitis 1
• Pharyngeal infections are typically asymptomatic 1
• Conjunctivitis requires urgent treatment to prevent corneal perforation 2

Neonatal Manifestations

Chlamydia in Newborns

• 15-25% of exposed infants develop chlamydial conjunctivitis despite prophylaxis 1
• 3-16% develop chlamydial pneumonia 1
• Chlamydia is the most common cause of neonatal conjunctivitis 1
• Infection occurs in nearly two-thirds of infants born vaginally to infected mothers 1

Gonorrhea in Newborns

• Gonococcal ophthalmia (conjunctivitis) 1
• Requires urgent treatment to prevent corneal perforation 2

Serious Complications (Often from Asymptomatic Infection)

In Women

• Pelvic inflammatory disease (PID) leading to:
  • Ectopic pregnancy 1
  • Tubal factor infertility 1
  • Chronic pelvic pain 1
• Many women with tubal infertility had unrecognized PID because symptoms were absent or nonspecific 1, 2
• Perihepatitis (Fitz-Hugh-Curtis syndrome) 1
• Postpartum endometritis: 10-28% after abortion, 19-34% after vaginal delivery in untreated pregnant women 1

In Men

• Epididymitis 1
• Urethritis 1

Both Sexes

• Reiter's syndrome (reactive arthritis): arthritis, conjunctivitis, and urethritis, occurring primarily in men, developing 1-4 weeks after infection 1, 3
• Both infections facilitate HIV transmission 1

Critical Clinical Pitfall

The high proportion of asymptomatic cases—approximately 70% of chlamydia and trichomoniasis infections and 53-100% of extragenital gonorrhea and chlamydia—means that absence of symptoms cannot rule out infection. 4 This is why screening based on risk factors rather than symptoms is essential for sexually active women under 25 years and those at increased risk 1.