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 . Chlamydia is the primary cause of non-gonococcal urethritis, constituting between 12-40% of all the remaining pathogens    . 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  . Unfortunately, up to 50% of men and 70-80% of women have an asymptomatic course, which significantly delays the diagnosis  . In symptomatic patients, main complaints are the presence of a urethral discharge, irritation of the urethra, pruritus, and dysuria  . 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  . Dysuria is not typically accompanied by other related signs such as increased frequency or urgency to urinate . 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 .
Entire Body System
- Reiter Syndrome
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]
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]
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]
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]
In the previously mentioned large study of Harrison and co-workers, 26 women with antepartum Mycoplasma hominis had a 7.3 times increased risk of postpartum endometritis compared with women without M. hominis, but there was only a weak association between [glowm.com]
- Lower Abdominal Pain
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]
Signs and Symptoms : Symptoms in women include vaginal discharge, irritation of the pubic area, burning during urination, lower abdominal pain, painful intercourse, and vaginal bleeding. [austincc.edu]
Infected women may have an abnormal vaginal discharge, burning sensation when urinating, pain during intercourse, lower abdominal pain. When the infection spreads from the cervix to the fallopian tubes, some women still have no any warning symptoms. [emedexpert.com]
Vague lower abdominal pain. Fever. Intermenstrual or postcoital bleeding. Deep dyspareunia. [patient.info]
Data were collected on a detailed standard questionnaire regarding the reasons for attendance, age, symptoms (vaginal discharge, urethral pain during micturition, intermenstrual, or postcoital bleeding, and lower abdominal pain), contraceptive method, [sti.bmj.com]
- Rectal Pain
[…] men or women), it can cause rectal pain, discharge, and/or bleeding. [icdlist.com]
Drawbacks Rectal Chlamydia infection According to the latest evidence 9, a single dose azithromycin therapy for rectal chlamydia often results in treatment failure. Therefore doxycycline may be more preferable choice for rectal infection. [emedexpert.com]
Anorectal infection is manifested by rectal pain and mucopurulent rectal discharge. Pharyngeal infection is important as a cause of sore throat due to pharyngitis, tonsillitis and gingivitis. [atsu.edu]
A digital rectal examination of the prostate may be considered, especially in older patients or if rectal pain is reported. [aafp.org]
[…] region is usually asymptomatic, but can lead to proctitis or proctocolitis, which can manifest as rectal pain, mucoid or hemorrhagic discharge, fever, and/or tenesmus. [ 34 ] Diagnosis can be supported via anoscopy findings (mucopurulent discharge, pain [std.uw.edu]
He was treated with methotrexate and his arthritis improved. The past chlamydial infection may have been involved in the pathogenesis of reactive arthritis in this patient. [ncbi.nlm.nih.gov]
Both men and women can develop reactive arthritis because of a chlamydia infection. Reactive arthritis is a type of arthritis that happens as a "reaction" to an infection in the body. [icdlist.com]
Reactive arthritis is characterized by NGU, anterior uveitis, and arthritis and is strongly associated with the gene for HLA-B27. Rare but serious complications of DGI include arthritis, meningitis, and endocarditis. [emedicine.medscape.com]
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]
Complications of C trachomatis include Reiter's syndrome (reactive arthritis). Reactive arthritis consists of conjunctivitis, urethritis (or in females’ cervicitis), arthritis and psoriasis-like mucocutaneous lesions. [atsu.edu]
- Skin Rash
There are characteristic papulopustular rashes on the skin of soles and other places, similar to pustular psoriasis or papular syphilides. There is variety of internal organ lesions. Hepatitis is most common. [iliveok.com]
Burgis JT, Nawaz H., 3rd Disseminated gonococcal infection in pregnancy presenting as meningitis and dermatitis. Obstet Gynecol. 2006;108(3 Pt 2):798–801. [PubMed] [Google Scholar] 6. [ncbi.nlm.nih.gov]
- 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]
Manifestations Urethral discharge. Dysuria. Urethral itching or meatal erythema. Often asymptomatic. [canada.ca]
Clinical presentation Symptoms Considerations Urethral discharge Gonorrhoea - usually copious and purulent. More common in MSM and Indigenous populations. Non-gonococcal urethritis - usually less discharge. [sti.guidelines.org.au]
CI 1.49-5.92)] and previous history of urethral discharge [OR=2.4(95%CI 1.11-5.18)]. [scielo.br]
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]
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]
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]
- Vaginal Discharge
[…] from the eyes containing mucus or pus eyelid inflammation blepharospasm conjunctival scarring trichiasis (inward-growing eyelashes) Chlamydia in females dysuria yellow mucopurulent discharge from the urethra vaginal discharge abnormal vaginal bleeding [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]
Men complain of glassy or purulent discharge from the urethra, Dysuria and burning in the urethra. Women complain of vaginal discharge, dysuria or abdominal pain (sign of progression to pelvic inflammatory disease). [urology-textbook.com]
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 cystitis: Check for presence of suprapubic or lower abdominal tenderness, 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 , 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 . Several laboratory procedures are used to confirm the medical entity    :
- 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  . Although possessing a low sensitivity and specificity rate  , they are of great use in the initial diagnostic workup. The early-morning urine sample should be evaluated with non-specific tests . Detection of >10 white blood cells in the urine sediment is another indication of a genitourinary disorder   .
- 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  , 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   .
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
trachomatis Dutch Chlamydia niet-gespecificeerde urethritis, venerische urethritis door Chlamydia trachomatis, Chlamydia trachomatis urethritis, Chlamydia trachomatis urethritis reactie, Chlamydia-urethritis French Urétrite à Chlamydiae, Urétrite à Chlamydia [fpnotebook.com]
2013 ICD-9-CM Diagnosis Code 099.41 Other nongonococcal urethritis, chlamydia trachomatis Short description: Chlmyd trachomatis ureth. [icd9data.com]
Abstract Trospectomycin is an aminocyclitol analog of spectinomycin with significant in vitro activity against Chlamydia trachomatis. [ncbi.nlm.nih.gov]
Pruebas disponibles para Chlamydia trachomatis EliSpot Chlamydia trachomatis EliSpot (2x tubo ACD/CPDA) IFT, ELISA, Immunoblot Anticuerpos Chlamydia trachomatis-IgA y Chlamydia trachomatis-IgG (1x Tubo de suero/SST) PCR Chlamydia trachomatis-PCR (Frotis [arminlabs.com]
Both treatments lasted for 9 days. Follow-up examinations were carried out 2 weeks (14-16 days) and 4 weeks (26-30 days) after the start of treatment. [ncbi.nlm.nih.gov]
Expectations (prognosis) Antibiotic treatment is usually successful. Complications Narrowing (strictures) of the urethra may occur. This may require surgery to correct. [coordinatedhealth.com]
Expectations (prognosis) Antibiotic treatment is usually successful. Complications Strictures (narrowing) of the urethra may occur. This may require surgical intervention to correct. [medical-dictionary-search-engines.com]
In humans, chlamydiae are known to cause trachoma (which is still one of the major blinding diseases in the world) and are also one of the most common etiological agents of sexually transmitted diseases and the sequelae thereof, such as infertility. [books.google.com]
License: Public Domain Definition of Urethritis Urethritis is a term that means inflammation of the urethra which is usually infectious in etiology. [lecturio.com]
Etiology The etiology of most cases of NGU is not known however, Chlamydia trachomatis serovars D-K is a frequent cause (15%--55% of cases). The prevalence differs by age group, with fewer infections associated with this organism among older men. [atsu.edu]
Incubation periods ranging from 2 to 35 days have been described, and many men with nongonococcal urethritis develop urethral symptoms within 4 days, so that the incubation period is not a reliable factor in the etiologic diagnosis. [antimicrobe.org]
Trichomonas vaginalis: an anaerobic, parasitic flagellated protozoan, rare cause of urethritis ( Uncertain etiology: in 20–30%. Signs and Symptoms Urethritis: Incubation period 1–5 weeks. [urology-textbook.com]
The sensitive micro IF test is considered useful in the epidemiologic study of chlamydial infections of genital origin and can provide information about the nature of infecting strains. [jimmunol.org]
Prostitute women and AIDS: epidemiology. AIDS. 1988 Dec; 2 (6):413–419. [ PubMed ] [ Google Scholar ] Pepin J, Plummer FA, Brunham RC, Piot P, Cameron DW, Ronald AR. [ncbi.nlm.nih.gov]
(HIV) and exacerbate retroviral disease.  The identification of this new serovar indicates the need for larger epidemiological and clinical studies in India as characterization of C. trachomatis strains can provide important epidemiological knowledge [ijdvl.com]
American Journal of Epidemiology 1987;125:1048-1057. Raiteri R, Fora R, Sinicco A. No HIV-1 transmission through lesbian sex. Lancet 1994;344:270. Darrow WW, Echenberg DF, Jaffe HW et al. [cdc.gov]
Describe the epidemiology, spectrum, and clinical manifestations of diseases caused by C pneumoniae. Discuss the limitations of serology in the diagnosis of C pneumoniae infections in children. [pedsinreview.aappublications.org]
Insight into the pathophysiology of chla mydial infections has also increased, and new methods for the diagnosis of chlamydial infections have been introduced. [books.google.com]
Review Date: 5/5/2008 Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and David C. [lutheranhealthcare.org]
Urethritis can also complicate the picture of lower urinary tract infections and cystitis, Pathophysiology of Urethritis The different identified organisms for urethritis are known to be transmitted by sexual intercourse. [lecturio.com]
Pathophysiology Urethritis is an inflammatory condition that can be infectious or posttraumatic in nature. [emedicine.medscape.com]
The proper use of condoms during intercourse usually prevents infection. References U.S. Preventive Services Task Force. Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement. [indiatoday.intoday.in]
Part 7 of 7: Prevention How to Prevent Chlamydial Urethritis in Men Men who are sexually active can prevent STIs with safe sex practices. Male and female condoms can greatly reduce the spread of infection. [en.parsiteb.com]
This helps prevent reinfection. Without proper treatment, sexual partners may continue to pass the bacteria back and forth. [healthline.com]
The proper use of condoms during intercourse usually prevents infection. [coordinatedhealth.com]
- Bachmann LH, Manhart LE, Martin DH, et al. Advances in the Understanding and Treatment of Male Urethritis. Clin Infect Dis. 2015;61 Suppl 8: S763-769.
- Tait I, Hart C. Chlamydia trachomatis in non-gonococcal urethritis patients and their heterosexual partners: routine testing by polymerase chain reaction. Sex Transm Infect. 2002;78(4):286-288.
- 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.
- Falk L, Fredlund H, Jensen JS. Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis. Sex Transm Infect. 2004;80:289–293.
- Chernesky MA. The laboratory diagnosis of Chlamydia trachomatis infections. Can J Infect Dis Med Microbiol. 2005;16(1):39-44.
- Malhotra M, Sood S, Mukherjee A, Muralidhar S, Bala M. Genital Chlamydia trachomatis: An update. Indian J Med Res. 2013;138(3):303-316.
- Moi H, Blee K, Horner PJ. Management of non-gonococcal urethritis. BMC Infect Dis. 2015;15:294.
- Brill JR. Diagnosis and treatment of urethritis in men. Am Fam Physician. 2010;81(7):873-878.
- 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