Case history #1
A 22-year-old woman presents with postcoital bleeding, but denies any other symptoms. She is currently in a monogamous relationship with a male sexual partner. She is concerned that her partner may have had other sexual contacts. She currently uses oral contraception and does not use condoms. Her last sexual contact with her boyfriend was 8 days ago. On examination, her external genitalia are normal. Speculum examination reveals a mucopurulent discharge from the cervical os. The cervix is friable when scraped with a Dacron swab. Manual pelvic examination reveals no cervical motion tenderness. She has no other abnormalities on physical examination.
Case history #2
A 19-year-old man presents with dysuria. He denies any penile discharge. He does not use condoms and had recent unprotected vaginal intercourse with a new female sexual partner about 7 days ago. He denies any prior sexually transmitted infections. On examination, there is no apparent discharge on initial inspection. There is a slight whitish discharge after applying pressure along the penile shaft. No other physical abnormalities are noted.
Although uncommon, women may present with an odorless vaginal discharge. In addition, infection in women can ascend to the upper urogenital tract and cause fever, chills, myalgias, nausea, vomiting, and pelvic or abdominal pain. In rare cases it can cause fever and right upper quadrant abdominal pain secondary to a pericapsular hepatic infection.
Men can also have ascending infection that causes epididymitis or prostatitis, which can lead to unilateral pain in the testicle. Physical findings may include scrotal erythema and tenderness or swelling over the epididymis.
In men who have sex with men and in women who practice receptive anal intercourse, rectal infection is possible; it is usually asymptomatic except when the infection occurs with the lymphogranuloma venereum (LGV) serotypes, which can cause symptoms of proctitis and proctocolitis.
Chlamydia infections can also cause a reactive arthritis in adults. Neonates born to mothers with urogenital chlamydia can develop infections including conjunctivitis (ocular trachoma) and pneumonia.
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