Over 50% of women with chlamydia infection are asymptomatic. The most common site of infection is the urogenital tract and, when symptomatic, usually manifests as cervicitis with mucoid vaginal discharge, bleeding, and dyspareunia. Ascending infection can present with right upper quadrant pain and/or pleuritic pain consistent with perihepatitis (Fitz-Hugh Curtis syndrome). Upper genital tract infection, otherwise known as pelvic inflammatory disease (PID), can present with vaginal discharge, dysuria, lower abdominal pain, and systemic symptoms such as fever. Chlamydia-induced PID carries a higher rate of infertility for women of child bearing age than gonorrhea. In pregnant women, undiagnosed infection can cause life threatening ectopic pregnancy, premature rupture of membranes, as well as neonatal conjunctivitis and/or pneumonia.
As with their female counterparts, asymptomatic chlamydial infection is common among males, causing health care providers to frequently rely on screening tests in order to detect infection. Urogenital infection in men affecting the lower genital tract can present as a non-gonococcal urethritis or epididymitis. Symptoms include dysuria and urethral mucopurulent discharge. Identification of infection in men is of importance as they can serve as a reservoir for infection in women.
Gonorrhea infections in females most commonly involve the cervix. Females are asymptomatic approximately half of the time. Typical symptoms include a mucopurulent discharge, and the exam may demonstrate friable cervical mucosa. Other symptoms may include abdominal pain, dyspareunia, dysuria, pruritus, PID, or perihepatitis. The main impetus for the early diagnosis and treatment of gonorrhea is to prevent the development of PID. Among women, gonococcal infections might not produce recognizable symptoms until complications such as PID have occurred. PID occurs in up to 40% of women with cervical infection, and can result in tubal scarring that can lead to ectopic pregnancy or infertility.
In men, gonorrhea is asymptomatic only 10% of the time.4
The majority of urethral infections caused by N. gonorrhoeae
among men produce symptoms that cause them to seek curative treatment soon enough to prevent serious sequelae, but treatment might not be soon enough to prevent transmission to others.1
Gonorrhea usually causes urethritis including dysuria and a purulent penile discharge. Furthermore, gonorrhea usually does not cause other invasive disease in men, although it may progress to cause local abscesses, prostatitis, or epididymitis.