Chlamydia and Gonorrhea

Chlamydia (Chlamydia trachomatis) is one of the most prevalent sexually transmitted infections.  This bacterial infection affects 3-4 million people each year.  It is the most common cause of pelvic inflammatory disease (PID), ectopic pregnancy and infertility in women.  Chlamydia is a frequent cause of testicular and prostate infections and is the most common cause of sterility in men.

Gonorrhea (Neisseria gonorrhoeae) is a bacterial infection that often co-exists with Chlamydia.  Approximately 600,000 new gonorrhea infections occur every year.  These bacteria can also cause PID, ectopic pregnancy and sterility in women and testicular and prostate infections in men.
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Chlamydia and gonorrhea are transmitted through vaginal and anal sexual contact.  Both infections cause symptoms for some people while other people have no recognizable symptoms at all.  For women, symptoms include a change in the color or texture of vaginal discharge, irregular bleeding or spotting, vaginal burning, or pain and burning with urination.  Pelvic pain may indicate that the bacteria have progressed into the uterus, fallopian tubes and ovaries.  Because it is more common that women may not have recognizable symptoms, the Centers for Disease Control and Prevention recommend that all sexually active adolescent and young adult women be tested during their annual exam.  Any woman having new or multiple partners should request testing.

Men may have mild burning with urination and may notice a yellow penile discharge.  Symptoms may resolve without treatment even though the infection is still present.  Examination is recommended for symptoms of discharge or pain and burning with urination even if the symptoms have spontaneously resolved.  Gonorrhea symptoms may develop within 2-10 days while Chlamydia symptoms may occur 7-21 days after exposure.

Gonorrhea can also be transmitted by oral and rectal sexual contact.  Symptoms of gonococcal infections of the throat include redness and swelling of the tonsils, sometimes accompanied by exudate (white spots) on the tonsils.  Ano-rectal symptoms include rectal pain and bleeding.

Testing for Chlamydia and gonorrhea involves taking a sample of cells from the urethra or cervix using a small cotton swab.  A urine specimen obtained after not urinating for at least four hours is sometimes used as an alternative method of testing.

Routine screening in the absence of symptoms should be performed approximately 2 weeks after a suspected exposure to ensure accuracy of the testing.  Since Chlamydia and/or gonorrhea may occur simultaneously with other infections, such as hepatitis B, syphilis, and HIV, additional testing may be recommended.  Repeat testing may be done if desired, 3-4 months after medications have been completed, unless symptoms reoccur.

Chlamydia is usually treated with an antibiotic such as azithromycin (Zithromax) or doxycycline.  Gonorrhea is treated with an injection of ceftriaxone or a drug from the category referred to as fluoroquinolones (Cipro, Floxin).

You and your sexual partner(s) must be treated and must complete the prescribed medication.  Any sexual partners in the preceding 60 days should be evaluated, tested, and treated.  The most recent sex partner should be evaluated and treated even if the last sexual contact was more than 60 days before the diagnosis.  You must abstain from all sexual contact for seven days after single-dose therapy or until completion of a seven-day treatment.  You must also abstain from all sexual contact until your current sex partner(s) are treated or you will be re-exposed and will need to be retreated.  If symptoms do not clear or reoccur after treatment is completed, it is important to return to your health care provider for further evaluation.

Consistent condom use can reduce but not totally prevent the transmission of sexually transmitted infections.  It is important to talk with all new sexual partners about their sexual history.  Although gonorrhea and Chlamydia testing can be performed, there are other sexually transmitted infections that may be transmitted even though no symptoms are present.

If your partner has been found to have Chlamydia and/or gonorrhea, recognize that the infection can be present for years without symptoms.  It is important that you seek medical attention to be evaluated and treated. It is important to finish all of the medication even if your Chlamydia test is negative.  Refrain from all sexual contact until you both have been examined and have completed treatment.  The use of condoms is recommended to prevent re-infection.

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2002. MMWR 2002;51 (No, RR-6): pages 32-38