Chlamydia

Chlamydia is caused by *Chlamydia trachomatis*, an obligate intracellular bacterium transmitted primarily through sexual contact. It infects mucosal epithelial cells, where intracellular replication produces localized inflammation. That inflammation may be clinically quiet, which is why a patient can have a positive infection with no pain, discharge, or dysuria. When symptoms occur, they depend partly on the infected site. Cervicitis may produce mucopurulent discharge, cervical friability, postcoital bleeding, intermenstrual bleeding, or dysuria. Urethritis can cause dysuria or urethral discharge. Rectal infection may cause anorectal pain, discharge, bleeding, or tenesmus, although many rectal infections are also asymptomatic. Pharyngeal infection is often silent. Untreated infection can ascend from the cervix into the upper reproductive tract. Pelvic inflammatory disease may then cause lower abdominal or pelvic pain, fever, dyspareunia, abnormal bleeding, cervical motion tenderness, uterine tenderness, or adnexal tenderness. Inflammation and scarring of the fallopian tubes can later impair fertility or increase the risk of ectopic pregnancy. Chlamydia can also be associated with epididymitis, conjunctivitis, and reactive arthritis. A positive chlamydia result does not explain every pelvic complaint. Severe unilateral pain, syncope, shoulder pain,...