Overview Snapshot A 28-year-old heterosexual man recently started having sexual unprotected intercourse with his new girlfriend. He now presents with a painful itching sensation with urination and discomfort in the urethra. He says that sometimes in the morning it appears that the walls of the meatus are stuck together with evidence of dried secretions. On exam, there is no purulent discharge. The meatus does appear red. He said that his girlfriend does not have any symptoms. Introduction Chlamydia is most common STD IN men causes nongonococcal urethritis (NGU), which may progress to epididymitis, prostatitis, proctitis In women, cervicitis may progress to salpingitis, PID Children born to colonized mothers may develop neonatal conjunctivitis (7-12) days following delivery some may develop chlamydial pneumonitis 2-12 weeks after birth Presentation Symptoms often asymptomatic in women in men dysuria and discomfort in the urethra and a clear to mucopurulent discharge symptoms and discharge are more marked early in the morning when the walls of the meatus are often stuck together with dried secretions dysuria cervicitis PID lymphogranuloma venereum infertility Evaluation Chlamydia antigen test In men, Gram-stained slides of the urethral discharge may show PMNs and epithelial cells, but not pathogenic organisms USPSTF recommends screening for chlamydial infection in all sexually active non-pregnant young women aged 24 and younger older non-pregnant women who are at increased risk history of STI new/multiple sexual partners inconsistent condom use practice of exchanging sex for money or drugs Treatment For uncomplicated infections tetracycline (500mg Q6) doxycycline (100mg bid x 7 days) azithromycin (I gram once) ofloxacin (300mg x bid) Prognosis, Prevention, and Complications In men (especially those less than 35) epididymitis, reactive arthritis Reiter's syndrome In women, complications include reactive arthritis Fitz-Hugh-Curtis syndrome (infection of perihepatic peritoneum) Chlamydial salpingitis commonly leads to chronic pelvic pain ectopic pregnancy infertility