History and exam
Key diagnostic factors
common
presence of risk factors
Typical risk factors include age under 25 years, sexual activity with an infected partner, a new sex partner or multiple sex partners, a sex partner with other concurrent sex partners, history of a prior STI, and not using condoms.
asymptomatic
Approximately 85% of women and men are asymptomatic.[15]
Other diagnostic factors
common
cervical discharge
Examination of the cervical os may reveal a cloudy or yellow discharge.
friable cervix
Cervix bleeds easily with friction from a polyester swab.
abnormal vaginal bleeding
Women may experience postcoital or intermenstrual bleeding.
penile discharge
Mucoid or mucopurulent discharge from the urethral opening. Discharge may appear after applying pressure along the penile shaft from proximal to distal.
vaginal discharge
Odourless mucoid discharge may be present.
uncommon
dysuria
Painful urination may be present in either sex but is more common in men.
pelvic pain
Can occur in women if infection ascends to the upper urogenital tract or as a result of early pelvic inflammatory disease (PID).
fever/chills
Can occur in women if infection ascends to the upper urogenital tract, or rarely secondary to a pericapsular hepatic infection.
Can occur in men in severe infections, including orchitis or epididymitis.
Can occur with Lymphogranuloma venerum (LGV) infection.
nausea/vomiting
Can occur in women if the infection ascends to the upper urogenital tract.
Can occur in men in severe infections.
scrotal pain
Mild to severe scrotal pain may occur in ascending infections that cause epididymitis, orchitis or prostatitis.[2]
In severe infections, the scrotal area may be tender to touch and feel warm.
myalgias
Can occur in women if the infection ascends to the upper urogenital tract.
abdominal pain
Can occur in women if the infection ascends to the upper urogenital tract. Rarely, right upper quadrant abdominal pain occurs secondary to a pericapsular hepatic infection.
mucopurulent rectal discharge or tenesmus
Symptoms and signs of rectal infection are rare, but when present may include mucopurulent rectal discharge or tenesmus. In people with rectal LGV infection, there may be other changes in bowel habit (diarrhoea or constipation), in addition to rectal discharge and tenesmus.
joint pain and swelling
Reactive arthritis is an uncommon manifestation of chlamydial infection, typically occurring up to 4 weeks after an infection. Joints most commonly affected are knees, ankles, and feet.
eye irritation
Conjunctivitis can occur in tandem with joint pain and swelling.
rashes
Rashes can accompany joint and eye symptoms, most commonly on the palms and soles.
inflammation
Inflammation can affect eyes, skin and urethra.
Risk factors
strong
age under 25 years, sexually active
new sex partner or multiple sex partners
Risk is particularly high if a person has recently changed their sexual partner, has multiple sex partners, or has a sex partner with other concurrent sex partners.[5]
sexual activity with infected partner
Risk is particularly high if there is a history of sexual activity with a person who has a chlamydia infection.
condoms not used
Risk for STIs is increased if condoms are not used.
history of prior STI
People with prior STIs should be routinely assessed for re-exposure and those with a prior chlamydial infection should be re-tested 3 months after treatment because the risk of re-infection is high.[5]
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