No Symptoms? You Could Still Have Chlamydia – Here’s Why

1. Etiology

Pathogen: Chlamydia trachomatis (obligate intracellular bacterium). 18 known serovars:

• Serovars D-K cause urogenital chlamydia
• Serovars L1-L3 cause lymphogranuloma venereum
• Serovars A-C cause trachoma

2. Transmission Routes

• Sexual (vaginal, anal, oral intercourse)
• Vertical (mother to child during delivery)
• Household contact (very rare, via shared towels)

3. Symptoms

In men:

• Mucous/purulent urethral discharge
• Dysuria (painful urination)
• Scrotal pain (with epididymitis)

In women (70% asymptomatic):

• Mild vaginal discharge
• Intermenstrual bleeding
• Lower abdominal pain
• Dyspareunia (painful intercourse)

Systemic complications:

• Men: epididymitis, prostatitis, infertility
• Women: salpingitis, ectopic pregnancy, infertility
• Reactive arthritis (urethritis+conjunctivitis+arthritis triad)

4. Diagnostic Methods

1. PCR (urethral/cervical swab) – gold standard
2. ELISA (antibody detection)
3. Culture (rarely used, for antibiotic sensitivity)
4. Rapid tests (low reliability)

5. Prevention

• Barrier contraception (condoms)
• Routine screening (every 6-12 months)
• Prenatal screening
• Sexual health education

6. Treatment Protocols

First-line regimens:

1. Azithromycin 1g single dose
2. OR Doxycycline 100mg bid for 7 days

Alternative options:

• Josamycin
• Levofloxacin

Critical notes:

• Treat all sexual partners
• Abstain from sex for 7 days post-treatment
• Follow-up testing at 3-4 weeks

7. Clinical Recognition

Warning signs:

• Abnormal discharge
• Urinary discomfort
• Pelvic pain
• Postcoital/intermenstrual bleeding

8. Post-Exposure Protocol

1. Within 2 hours:
   • Genital disinfection with chlorhexidine
   • Urination
2. Within 3-5 days:
   • PCR testing
3. Prophylaxis:
   • Azithromycin 1g (physician-supervised only)

9. Identifying Potential Cases

Indicators:

• Recurrent genitourinary inflammation
• Unexplained infertility
• Chronic conjunctivitis
• Reactive arthritis

Key fact: 50-70% cases are asymptomatic! Laboratory confirmation required.

10. Complications

• Female infertility (tubal occlusion)
• Male infertility (vas deferens obstruction)
• Ectopic pregnancy
• Chronic pelvic pain syndrome
• Reactive arthritis

Prognosis: Full recovery with early treatment. Chronic cases may cause permanent damage.