Gonorrhea and Chlamydia

As we have learned more and more about chlamydia, we have come to recognize that gonorrhea and chlamydia are not only often transmitted together but also very, very difficult to differentiate in terms of the syndromes they produce. They are the two most common bacterial sexually transmitted diseases in the United States and they are fairly common. Interestingly, it has been a race, with gonorrhea way ahead and that was because the methods for detecting chlamydia were not nearly as good.

Then chlamydia started catching up and as our methodology has gotten better and better, chlamydia has become more common than gonorrhea. It probably always was, but we just weren’t able to demonstrate it. They produce similar syndromes. They can both produce urethritis, mucopurulent cervicitis, anorectal infections, conjunctivitis, epididymitis, pelvic inflammatory disease, the Fitz-Hugh-Curtis syndrome, or perihepatitis and they both can produce arthritis, although the arthritis with chlamydia is not a true infectious arthritis, it is Reiter’s syndrome or host chlamydial infection arthritis, which at one time was also attributed to the gonococcus. This is just like what we spoke about yesterday in terms of gastrointestinal infections. This is a post infectious arthritis and is presumably immunologic and one of the things that can trigger it is chlamydial infection. It is most commonly seen in people with HLAB27 tissue type, but can be seen with other tissue types also.

I always think very hard in terms of making up test exam questions and so on about how they differ. What does one do that the other doesn’t do? I used to count arthritis as one of them, because truly the Reiter’s syndrome is not an infectious arthritis, but that gets blurred because arthritis can follow both. So all I can come up with is that chlamydia causes pneumonia in the newborn and the gonococcus does not. That is the differentiating factor in terms of syndromes produced. Co-infection is very common and serves to further confuse the issue.

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