Clinical Manifestations and Sequelae (continued)

Complications in Men

Complications are uncommon in men. If complications do occur, they may include epididymitis and Reiter’s Syndrome.

Epididymitis is the most common local complication of C. trachomatis infection in young males.

Signs and symptoms of epididymitis include:

• Fever
• Unilateral scrotal pain
• Swelling
• Tenderness
• Evidence of urethritis on Gram stain
• Epididymal tenderness or mass on exam

Up to 70% of sexually transmitted cases are due to Chlamydia trachomatis. Some sexually transmitted cases are due to gonorrhea. Some cases have both pathogens.

Bacterial etiology varies by sexual behavior and age. It is important to distinguish sexually transmitted cases in young heterosexuals (usually due to chlamydia or gonorrhea) from cases in men who have sex with men (can also be caused by enteric organisms or gonorrhea) from cases of non-sexually transmitted epididymitis (more often due to E. coli or pseudomonas), which is more common in older men.

Reiter’s syndrome is a post-inflammatory autoimmune disease that can result from chlamydial infection. The characteristics of the syndrome include conjunctivitis, urethritis, oligoarthritis, and skin lesions (keratoderma blenorrhagica and circinate balanitis), which occur 3-6 weeks after genital chlamydial infection.

Reiter’s syndrome affects predominantly males, and it usually resolves within 2-6 months. Chlamydial antigens and DNA are present within the joints. Reiter’s syndrome is not a simple disease, and it does not respond to short courses of antimicrobials. However, symptoms generally respond to non-steroidal anti-inflammatory agents.

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