Chlamydial urethritis is a term denoting an infection by Chlamydia trachomatis, the second-most common cause of urethritis after Neisseria gonorrhoeae. Up to 50-80% of patients may be asymptomatic, whereas urethral discharge, urinating difficulties, and pruritus are main complaints in symptomatic cases. Gram stain of urethral swabs and urinalysis are two crucial steps for the diagnosis, but several other tests can be employed to solidify clinical suspicion.
C. trachomatis is a causative agent of a number of infections, including lymphogranuloma venereum (LGV), epididymitis, cervicitis, endometritis, salpingitis, and urethritis [1]. Chlamydia is the primary cause of non-gonococcal urethritis, constituting between 12-40% of all the remaining pathogens [1] [2] [3] [4]. Chlamydial urethritis (CU) poses a great risk for both males and females, as it may lead to numerous complications in the absence of proper therapy, such as pelvic inflammatory disease (PID), infertility, and sterility [2] [5]. Unfortunately, up to 50% of men and 70-80% of women have an asymptomatic course, which significantly delays the diagnosis [1] [6]. In symptomatic patients, main complaints are the presence of a urethral discharge, irritation of the urethra, pruritus, and dysuria [1] [7]. The urethral discharge in CU is described as clear-to-white (but it also may be mucopurulent), and most frequently appears before early morning voiding [6] [7]. Dysuria is not typically accompanied by other related signs such as increased frequency or urgency to urinate [6]. In rare cases, CU can be complicated by a form of reactive arthritis accompanied by conjunctivitis and painless mucopurulent lesions on the palms and soles, known as Reiter's syndrome [6].
Because of the common asymptomatic nature of the ailment, CU may be particularly hard to diagnose. For this reason, the physician must obtain a detailed patient history and conduct a proper physical examination. During the interview, the presence of symptoms, their duration, as well as severity should be assessed, whereas a history of sexual activity could identify a recent contact with partners who are already suffering from sexually transmitted infections (STIs). A urethral examination can be crucial for a presumptive diagnosis, as serial palpation of the urethra might result in the release of urethral discharge [8], which should be then collected for microbiological investigation. Swabs of the urethra and the urethral discharge must be obtained and stored very delicately, as Chlamydia rapidly dies in the external environment [5]. Several laboratory procedures are used to confirm the medical entity [5] [6] [8] [9]: