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Symptoms and Signs of Genital Chlamydial Infection

Men
Over 50% of men with urethral chlamydial infection are asymptomatic. Symptoms of chlamydial infection may include painful urination, urinary frequency, meatal itching or discomfort, and urethral discharge. If the patient has not voided recently, a urethral discharge may be apparent on examination and typically is clear or cloudy, often with mucus strands; accompanying the discharge may be meatal erythema or swelling, or both. However, it is important to recognize that asymptomatic urethral chlamydial infection without discharge occurs commonly. If no spontaneous discharge is noted, the urethra should be stripped ("milked") from the base of the penis to the urethral meatus and examined again. Unlike the LGV chlamydial strains, the non-LGV strains do not cause genital ulcers or significant lymph node swelling.

Women
At least 75% of women with endocervical chlamydial infection are asymptomatic, and even when symptoms are present, they are nonspecific and often overlap with symptoms found in other vaginal or endocervical infections. Symptoms may include new or increased vaginal discharge, intermenstrual bleeding, lower abdominal pain, or pain during intercourse. Up to 50% or more of women with endocervical chlamydial infection have concomitant urethral infection and may present with painful urination or urinary frequency, or both. Many women also have asymptomatic rectal infection. Symptoms and signs of proctitis are rare with such non-LGV chlamydial strains.

Even in the absence of symptoms, older studies using chlamydia culture have demonstrated up to one third of chlamydia-infected women have signs of infection on pelvic examination (Geisler and colleagues, utilizing NAATs, found fewer than 10% of asymptomatic women had signs of infection.) Mucopurulent endocervical discharge, easily induced endocervical bleeding ("friability"), and edematous ectopy are the signs most suggestive of chlamydial infection, yet all are nonspecific and may be seen in other sexually transmitted endocervical infections. Abnormal vaginal discharge (originating from the endocervix) may also be present.

Although cervical ectopy may predispose to chlamydial infection (through increased exposure to susceptible columnar epithelial cells), ectopy without edema or congestion may be present in up to 60–80% of sexually active female adolescents and young adults, especially those using oral contraceptives, and is not indicative of chlamydial infection.

Concomitant chlamydial infection of the Bartholin ducts may occur, manifesting as ductal erythema and swelling, often with purulent ductal exudate.