What are the clinical manifestations of Chlamydia trachomatis infection in men and women?

Chlamydia Symptoms

Most chlamydia infections are asymptomatic, but when symptoms occur, women typically experience vaginal discharge and dysuria, while men present with urethral discharge and dysuria from urethritis. 1

Critical Clinical Context

The most important clinical reality is that chlamydia causes symptoms in only a minority of infected individuals 2, with over 80% of cases being asymptomatic 3. This asymptomatic nature is precisely what makes chlamydia so dangerous—untreated infections persist for months and lead to serious complications including infertility, ectopic pregnancy, and chronic pelvic pain 2.

Symptoms in Women

Lower Genital Tract

• Vaginal discharge (abnormal discharge from cervical infection) 2, 1
• Dysuria (painful urination) 2, 1
• Intermenstrual bleeding or postcoital bleeding 1
• Dyspareunia (painful intercourse) 1

Upper Genital Tract Complications

• Lower abdominal pain (from ascending infection to endometrium and fallopian tubes) 2, 1
• Menstrual abnormalities 2
• Endometritis (uterine lining infection) 1
• Salpingitis (fallopian tube infection leading to pelvic inflammatory disease) 1
• Perihepatitis (Fitz-Hugh-Curtis syndrome—inflammation around the liver) 1

A critical pitfall: Many women with tubal infection have symptoms too mild or nonspecific to prompt them to seek treatment, yet these "silent" infections cause the same devastating sequelae—approximately 17% will become infertile, 17% will develop chronic pelvic pain, and 10% who conceive will have ectopic pregnancies 2.

Symptoms in Men

Urogenital Manifestations

• Urethral discharge (most common manifestation) 1
• Dysuria (painful urination) 1
• Urethritis (inflammation of the urethra) 1

In contrast to women, chlamydial infection in men is usually symptomatic 4, though untreated infection can spread to cause epididymitis 3, 5.

Rectal Infections

• Generally asymptomatic but can cause rectal discharge 1
• Pain during defecation 1
• Symptoms of proctocolitis (in more severe cases) 1

These symptoms occur particularly in individuals who engage in receptive anal intercourse 1.

Pharyngeal Infections

• Typically asymptomatic 1
• Have not been established as a cause of pharyngitis 1

Ocular Manifestations

In Adults

• Conjunctivitis from exposure to infectious genital secretions or autoinoculation 1

In Newborns

• Chlamydia is the most common cause of neonatal conjunctivitis (15-25% of exposed infants) 1
• Neonatal pneumonia (3-16% of exposed infants, occurring at 1-3 months of age with staccato cough, usually without wheezing or fever) 1, 4

Reactive Arthritis

• Develops 1-4 weeks after genital infection 1, 6
• Characterized by inflammation of joints, eyes, and urogenital tract 1
• More common in men and primarily affects young adults 6

Clinical pearl: Consider chlamydia screening in young adults presenting with new-onset inflammatory arthritis, especially with urogenital symptoms 6.

Special Syndrome in Women

• Acute dysuria-pyuria syndrome: Women presenting with dysuria and pyuria but sterile urine cultures may have chlamydial urethritis 1

High-Risk Populations

Adolescents and young adults are at highest risk, with prevalence exceeding 10% among sexually active adolescent females 2. Among sexually active females aged 14-24 years, chlamydia prevalence is 4.7% overall and 13.5% among non-Hispanic Black females 7.

Pregnancy-Related Complications

Pregnant women with untreated chlamydia face:

• Postpartum endometritis (19-34% of infected women who deliver vaginally) 2
• Post-abortion endometritis (10-28% of infected women undergoing induced abortion) 2
• Vertical transmission to infants during delivery 1