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].

• Reiter Syndrome

  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. [symptoma.com]

  The treatment had no effect on the complications of urethritis like prostatitis and Reiter's syndrome. [ncbi.nlm.nih.gov]

  Due to a mixed infection, the Reiter's syndrome is also possible due to gonorrhea. fig. Keratoma blennorrhagicum: Reiter's syndrome (e.g. after urethritis) may result in excessive cornification of the palms or soles. Figure from Dr. M. F. [urology-textbook.com]

  Reiter syndrome is much less common in women as compared to men. Reiter Syndrome Reiter syndrome may follow sexually transmitted urethritis; most cases in the United States seem to occur in sexually active young men. [antimicrobe.org]

  Reiter’s syndrome (arthritis) Conjunctivitis Skin lesions Discharge Women Pelvic Inflammatory Disease (PID) which can result in ectopic (tubal) pregnancy. Recurrent PID may lead to infertility. [ashasexualhealth.org]

• Malaise

  Fever and malaise commonly accompany local symptoms. The primary genital ulcer often resolves before or during this stage, but proctitis is likely to persist. [ecdc.europa.eu]

• Hutchinson's Triad

  triad in the congenital form is due to a gram-negative diplococcus produces an ulcer that has ragged edges and soft borders produces symptoms extremely similar to gonorrhea symptoms exhibits antibiotic resistance in PPNG strains is endemic in undeveloped [quizlet.com]

• Urethral Discharge

  In symptomatic patients, main complaints are the presence of a urethral discharge, irritation of the urethra, pruritus, and dysuria. [symptoma.com]

  Men with HSV urethritis were significantly more likely to have meatitis (62% vs 23%, P 0.01), genital ulceration (37% vs 0%, P 0.01), or inguinal lymphadenopathy (30% vs 0%, P 0.01) but less likely to have urethral discharge (32% vs 69%, P 0.01). [ncbi.nlm.nih.gov]

  Signs and tests Taking a sample of secretions from the penis and sending it to a lab for a culture or a test called polymerase chain reaction (PCR) Urethral discharge culture or genital fluid testing for gonorrhea Urine test Treatment Chlamydia can be [coordinatedhealth.com]

  Symptoms Difficlty urinating Painful urination Burning sensation during urination Discharge from the penis Testicular tenderness Redness, swelling of the opening of the urethra at tip of the penis Signs and tests Urethral discharge culture or seminal [medical-dictionary-search-engines.com]

• Dysuria

  Dysuria is not typically accompanied by other related signs such as increased frequency or urgency to urinate. [symptoma.com]

  Compared with chlamydial urethritis, men with HSV urethritis were significantly more likely to report severe dysuria (20% vs 0%, P 0.01) or constitutional symptoms (15% vs 0%, P 0.01). [ncbi.nlm.nih.gov]

  Snapshot A 22-year-old man presents to the clinic with a complaint of a dysuria and itching with urination. He admits that he has been engaging in unprotected sexual intercourse with several females. [medbullets.com]

  Overview Urethral discharge and/or dysuria are typical symptoms of male urethritis. Make a clinical diagnosis of gonorrhoea or non-gonococcal urethritis (NGU) and treat accordingly. [sti.guidelines.org.au]

  Urethral syndrome/dysuria in females- infections of the cervix and vagina (vaginitis- mentioned later) can spread to the urethral opening and into the urethra causing dysuria (external dysuria). [atsu.edu]

• Vaginal Discharge

  Symptoms in women include Abnormal vaginal discharge, which may have a strong smell A burning sensation when urinating Pain during intercourse If the infection spreads, you might get lower abdominal pain, pain during sex, nausea, or fever. [icdlist.com]

  discharge abnormal vaginal bleeding dyspareunia cervicitis fever (in pelvic inflammatory disease) asymptomatic in 80% of patients in males dysuria yellow mucopurulent discharge from the urethra unilateral pain and swelling of the scrotum fever asymptomatic [medbullets.com]

  There may be a slight vaginal discharge and pelvic pain. [britannica.com]

  Chlamydia Symptoms in Women: unusual or abnormal vaginal discharge, sometimes yellowish and smelly painful and frequent urinating bleeding between periods or heavy periods painful sex or bleeding after sex pain in the lower abdominal sometimes with nausea [std-gov.org]

  If you have trichomonas, it definitely can be transmitted to a female partner -- where it causes vaginal discharge (if it causes symptoms at all) but in general is not a serious health threat. Cranberry juice etc won't make any difference. [medhelp.org]

• Epididymal Tenderness

  For urethritis: Check for penile discharge, meatal crusts, no costovertebral angle tenderness, no epididymal tenderness or prostatic tenderness on exam. [clinicaladvisor.com]

  Male Men may have: Epididymal tenderness. Mucoid or mucopurulent discharge. Perineal fullness due to prostatitis. Differential diagnosis Gonorrhoea (although co-infection is relatively common). Other causes of prostatitis / PID / epididymo-orchitis. [patient.info]

• Burning Micturition

  Case Report A 33-year-old man presented to the sexually transmitted disease clinic at All India Institute of Medical Sciences, New Delhi, with a mucopurulent urethral discharge and burning micturition for 20 days. [ijdvl.com]

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]:

• Non-specific tests - The leukocyte esterase (LE) test, designed to detect products secreted by polymorphonuclear (PMN) cells, provides a qualitative result of an ongoing disease within 30 minutes, while enzyme immunoassay (EIA) testing for C. trachomatis may be performed [5] [6]. Although possessing a low sensitivity and specificity rate [5] [6], they are of great use in the initial diagnostic workup. The early-morning urine sample should be evaluated with non-specific tests [8]. Detection of >10 white blood cells in the urine sediment is another indication of a genitourinary disorder [5] [6] [8].
• Specific tests - Gram staining, although now being replaced by novel methods, is a highly useful and rapid procedure that excludes gram-negative diplococci on microscopic examination [4] [7], which then points to other pathogens, primarily C. trachomatis. For a definite diagnosis to be made, cultivation, direct fluorescent antibody test (DFA), cytology, enzyme-linked immunosorbent assay (ELISA), and polymerase chain reaction (PCR) exam need to be done [5] [6] [8].

• Pyuria

  However, approximately 20% of women with these symptoms have sterile pyuria ( 8 leukocytes/mm 3 of urine) caused by chlamydiae. [glowm.com]

  The majority of patients with cystitis will have pyuria ( 10 WBCs per mm3) on microscopy; however, pyuria without symptoms and signs is not sufficient to make the diagnosis. [clinicaladvisor.com]

  Children with urethritis Sexual abuse must be considered if there are symptoms of unexplained pyuria in prepubertal boys or young males who are not sexually active (see Sexual Abuse in Peripubertal and Prepubertal Children chapter). [canada.ca]

  Dysuria (always consider chlamydia as a cause of sterile pyuria). Vague lower abdominal pain. Fever. Intermenstrual or postcoital bleeding. Deep dyspareunia. [patient.info]

  […] presence of urethral discharge, a positive leukocyte esterase test result in first-void urine, or at least 10 white blood cells per high-power field in first-void urine sediment. 16 If no discharge is present, first-void urine should be tested to document pyuria [aafp.org]

• Chlamydia Trachomatis

  Abstract Trospectomycin is an aminocyclitol analog of spectinomycin with significant in vitro activity against Chlamydia trachomatis. [ncbi.nlm.nih.gov]

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3. Wetmore CM, Manhart LE, Lowens MS, et al. Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study. Sex Transm Dis. 2011;38:180–186.
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6. Malhotra M, Sood S, Mukherjee A, Muralidhar S, Bala M. Genital Chlamydia trachomatis: An update. Indian J Med Res. 2013;138(3):303-316.
7. Moi H, Blee K, Horner PJ. Management of non-gonococcal urethritis. BMC Infect Dis. 2015;15:294.
8. Brill JR. Diagnosis and treatment of urethritis in men. Am Fam Physician. 2010;81(7):873-878.
9. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006: diseases characterized by urethritis and cervicitis. https://www.cdc.gov/std/treatment/2010/urethritis-and-cervicitis.htm