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Clinical manifestations and diagnosis of Chlamydia trachomatis infections

Jeanne Marrazzo, MD, MPH, FACP, FIDSA
Section Editor
Noreen A Hynes, MD, MPH, DTM&H
Deputy Editor
Allyson Bloom, MD


Chlamydia trachomatis is the most common bacterial cause of sexually transmitted genital infections [1]. The majority of affected persons are asymptomatic, and thus provide an ongoing reservoir for infection. In infants born to mothers through an infected birth canal, conjunctivitis and pneumonia can occur. Moreover, both men and women can experience clinical syndromes due to infection at common epithelial sites, including the rectum and conjunctivae. Other types of C. trachomatis infection, including lymphogranuloma venereum and endemic trachoma, an ocular infection spread by direct contact and seen commonly in the developing world, may occur in both men and women.

The clinical manifestations and diagnosis of C. trachomatis in women and men are discussed below. The epidemiology and treatment of C. trachomatis as well as neonatal C. trachomatis infection, lymphogranuloma venereum, and endemic trachoma are discussed in detail elsewhere. (See "Epidemiology of Chlamydia trachomatis infections" and "Treatment of Chlamydia trachomatis infection" and "Chlamydia trachomatis infections in the newborn" and "Lymphogranuloma venereum" and "Trachoma".)

Screening for chlamydia and other sexually transmitted infections is also discussed elsewhere. (See "Screening for sexually transmitted infections".)


Although the majority of women with C. trachomatis infection are asymptomatic, the pathogen is an important cause of several common clinical syndromes, discussed below.

Genital infection — In women, the cervix is the most commonly infected anatomic site [2], and a proportion of women may also have infection of the urethra. Untreated, cervical infection can ascend to cause pelvic inflammatory disease and its sequelae of infertility and chronic pain. Pregnant women with genital chlamydial infection are also at high risk for complications.

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Literature review current through: Nov 2017. | This topic last updated: Nov 15, 2016.
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  1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2015. Atlanta, GA: US Department of Health and Human Services; October 2016.
  2. Stamm WE. Chlamydia trachomatis infections of the adult. In: Sexually Transmitted Diseases, 4th Ed, Holmes KK, Sparling PF, Mardh PA, et al (Eds), McGraw-Hill, New York 2008. p.575.
  3. Samoff E, Koumans EH, Markowitz LE, et al. Association of Chlamydia trachomatis with persistence of high-risk types of human papillomavirus in a cohort of female adolescents. Am J Epidemiol 2005; 162:668.
  4. Jensen KE, Thomsen LT, Schmiedel S, et al. Chlamydia trachomatis and risk of cervical intraepithelial neoplasia grade 3 or worse in women with persistent human papillomavirus infection: a cohort study. Sex Transm Infect 2014; 90:550.
  5. Detels R, Green AM, Klausner JD, et al. The incidence and correlates of symptomatic and asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in selected populations in five countries. Sex Transm Dis 2011; 38:503.
  6. Marrazzo JM. Mucopurulent cervicitis: no longer ignored, but still misunderstood. Infect Dis Clin North Am 2005; 19:333.
  7. Gaydos CA, Howell MR, Pare B, et al. Chlamydia trachomatis infections in female military recruits. N Engl J Med 1998; 339:739.
  8. Geisler WM. Duration of untreated, uncomplicated Chlamydia trachomatis genital infection and factors associated with chlamydia resolution: a review of human studies. J Infect Dis 2010; 201 Suppl 2:S104.
  9. Geisler WM, Lensing SY, Press CG, Hook EW 3rd. Spontaneous resolution of genital Chlamydia trachomatis infection in women and protection from reinfection. J Infect Dis 2013; 207:1850.
  10. Geisler WM, Wang C, Morrison SG, et al. The natural history of untreated Chlamydia trachomatis infection in the interval between screening and returning for treatment. Sex Transm Dis 2008; 35:119.
  11. Bachmann LH, Richey CM, Waites K, et al. Patterns of Chlamydia trachomatis testing and follow-up at a University Hospital Medical Center. Sex Transm Dis 1999; 26:496.
  12. Hook EW 3rd, Spitters C, Reichart CA, et al. Use of cell culture and a rapid diagnostic assay for Chlamydia trachomatis screening. JAMA 1994; 272:867.
  13. Stamm WE, Guinan ME, Johnson C, et al. Effect of treatment regimens for Neisseria gonorrhoeae on simultaneous infection with Chlamydia trachomatis. N Engl J Med 1984; 310:545.
  14. Morré SA, van den Brule AJ, Rozendaal L, et al. The natural course of asymptomatic Chlamydia trachomatis infections: 45% clearance and no development of clinical PID after one-year follow-up. Int J STD AIDS 2002; 13 Suppl 2:12.
  15. Sweet RL. Pelvic Inflammatory Disease: Current Concepts of Diagnosis and Management. Curr Infect Dis Rep 2012.
  16. Tubal infertility: serologic relationship to past chlamydial and gonococcal infection. World Health Organization Task Force on the Prevention and Management of Infertility. Sex Transm Dis 1995; 22:71.
  17. Svensson L, Weström L, Ripa KT, Mårdh PA. Differences in some clinical and laboratory parameters in acute salpingitis related to culture and serologic findings. Am J Obstet Gynecol 1980; 138:1017.
  18. Rours GI, Duijts L, Moll HA, et al. Chlamydia trachomatis infection during pregnancy associated with preterm delivery: a population-based prospective cohort study. Eur J Epidemiol 2011; 26:493.
  19. Kent CK, Chaw JK, Wong W, et al. Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clin Infect Dis 2005; 41:67.
  20. Cecil JA, Howell MR, Tawes JJ, et al. Features of Chlamydia trachomatis and Neisseria gonorrhoeae infection in male Army recruits. J Infect Dis 2001; 184:1216.
  21. Takahashi S, Takeyama K, Kunishima Y, et al. Analysis of clinical manifestations of male patients with urethritis. J Infect Chemother 2006; 12:283.
  22. Stamm WE, Jones RB, and Batteiger BE. Chlamydia trachomatis (trachoma, perinatal infections, lymphogranuloma venereum, and other genital infections. In: Principles and Practice of Infectious Disease, 6th edition, Mandell GL, Bennett JE, and Dolin R (Eds), Elsevier, 2005. Vol 2, p.2239-2255.
  23. Rietmeijer CA, Mettenbrink CJ. Recalibrating the Gram stain diagnosis of male urethritis in the era of nucleic acid amplification testing. Sex Transm Dis 2012; 39:18.
  24. Bradshaw CS, Tabrizi SN, Read TR, et al. Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure. J Infect Dis 2006; 193:336.
  25. Ward AM, Rogers JH, Estcourt CS. Chlamydia trachomatis infection mimicking testicular malignancy in a young man. Sex Transm Infect 1999; 75:270.
  26. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
  27. Mutlu N, Mutlu B, Culha M, et al. The role of Chlamydia trachomatis in patients with non-bacterial prostatitis. Int J Clin Pract 1998; 52:540.
  28. Ostaszewska I, Zdrodowska-Stefanow B, Badyda J, et al. Chlamydia trachomatis: probable cause of prostatitis. Int J STD AIDS 1998; 9:350.
  29. Gümüş B, Sengil AZ, Solak M, et al. Evaluation of non-invasive clinical samples in chronic chlamydial prostatitis by using in situ hybridization. Scand J Urol Nephrol 1997; 31:449.
  30. Ward H, Alexander S, Carder C, et al. The prevalence of lymphogranuloma venereum infection in men who have sex with men: results of a multicentre case finding study. Sex Transm Infect 2009; 85:173.
  31. Patton ME, Kidd S, Llata E, et al. Extragenital gonorrhea and chlamydia testing and infection among men who have sex with men--STD Surveillance Network, United States, 2010-2012. Clin Infect Dis 2014; 58:1564.
  32. Owen BN, Brock PM, Butler AR, et al. Prevalence and Frequency of Heterosexual Anal Intercourse Among Young People: A Systematic Review and Meta-analysis. AIDS Behav 2015; 19:1338.
  33. Solomon ML, Middleman AB. Abdominal pain, constipation, and tenesmus in an adolescent female: consider Chlamydia proctitis. J Pediatr Adolesc Gynecol 2013; 26:e77.
  34. Martin-Iguacel R, Llibre JM, Nielsen H, et al. Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries. Eur J Clin Microbiol Infect Dis 2010; 29:917.
  35. de Vrieze NH, de Vries HJ. Lymphogranuloma venereum among men who have sex with men. An epidemiological and clinical review. Expert Rev Anti Infect Ther 2014; 12:697.
  36. Ahdoot A, Kotler DP, Suh JS, et al. Lymphogranuloma venereum in human immunodeficiency virus-infected individuals in New York City. J Clin Gastroenterol 2006; 40:385.
  37. Høie S, Knudsen LS, Gerstoft J. Lymphogranuloma venereum proctitis: a differential diagnose to inflammatory bowel disease. Scand J Gastroenterol 2011; 46:503.
  38. Kobayashi S, Kida I. Reactive arthritis: recent advances and clinical manifestations. Intern Med 2005; 44:408.
  39. Rice P, Handsfield HH. Arthritis associated with sexually transmitted diseases. In: Sexually Transmitted Diseases, 4th Ed, Holmes KK, Sparling PF, Mardh PA, et al (Eds), McGraw-Hill, New York 2008.
  40. Rahman MU, Hudson AP, Schumacher HR Jr. Chlamydia and Reiter's syndrome (reactive arthritis). Rheum Dis Clin North Am 1992; 18:67.
  41. Taylor-Robinson D, Gilroy CB, Thomas BJ, Keat AC. Detection of Chlamydia trachomatis DNA in joints of reactive arthritis patients by polymerase chain reaction. Lancet 1992; 340:81.
  42. van Rooijen MS, van der Loeff MF, Morré SA, et al. Spontaneous pharyngeal Chlamydia trachomatis RNA clearance. A cross-sectional study followed by a cohort study of untreated STI clinic patients in Amsterdam, The Netherlands. Sex Transm Infect 2015; 91:157.
  43. Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. MMWR Recomm Rep 2014; 63:1.
  44. Kowalski RP, Karenchak LM, Raju LV, Ismail N. The verification of nucleic acid amplification testing (Gen-Probe Aptima Assay) for chlamydia trachomatis from ocular samples. Ophthalmology 2015; 122:244.
  45. Geisler WM. Diagnosis and management of uncomplicated Chlamydia trachomatis infections in adolescents and adults: summary of evidence reviewed for the 2010 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis 2011; 53 Suppl 3:S92.
  46. Hobbs MM, van der Pol B, Totten P, et al. From the NIH: proceedings of a workshop on the importance of self-obtained vaginal specimens for detection of sexually transmitted infections. Sex Transm Dis 2008; 35:8.
  47. Marrazzo JM, Johnson RE, Green TA, et al. Impact of patient characteristics on performance of nucleic acid amplification tests and DNA probe for detection of Chlamydia trachomatis in women with genital infections. J Clin Microbiol 2005; 43:577.
  48. Cook RL, Hutchison SL, Østergaard L, et al. Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med 2005; 142:914.
  49. Cosentino LA, Campbell T, Jett A, et al. Use of nucleic acid amplification testing for diagnosis of anorectal sexually transmitted infections. J Clin Microbiol 2012; 50:2005.
  50. Moncada J, Schachter J, Liska S, et al. Evaluation of self-collected glans and rectal swabs from men who have sex with men for detection of Chlamydia trachomatis and Neisseria gonorrhoeae by use of nucleic acid amplification tests. J Clin Microbiol 2009; 47:1657.
  51. Gaydos CA, Van Der Pol B, Jett-Goheen M, et al. Performance of the Cepheid CT/NG Xpert Rapid PCR Test for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae. J Clin Microbiol 2013; 51:1666.
  52. Greer L, Wendel GD Jr. Rapid diagnostic methods in sexually transmitted infections. Infect Dis Clin North Am 2008; 22:601.
  53. Nadala EC, Goh BT, Magbanua JP, et al. Performance evaluation of a new rapid urine test for chlamydia in men: prospective cohort study. BMJ 2009; 339:b2655.
  54. Batteiger BE, Tu W, Ofner S, et al. Repeated Chlamydia trachomatis genital infections in adolescent women. J Infect Dis 2010; 201:42.
  55. Klausner JD, Kohn R, Kent C. Etiology of clinical proctitis among men who have sex with men. Clin Infect Dis 2004; 38:300.