Content Reviewers:Lisa Miklush, PhD, RNC, CNS, Antonella Melani, MD, Jodi Berndt, PhD, RN, CCRN-K, PCCN-K, CNE, CHSE, Gabrielle Proper, RN, BScN, MN
Chad Davis is a 22-year-old male who presents to the health department’s sexually transmitted infection clinic with symptoms of painful urination and urethral discharge for the past two days. He states his girlfriend was recently diagnosed with chlamydia, and they are sexually active. He uses condoms sporadically and he’s worried he also has chlamydia.
Gonorrhea and chlamydia are among the most common sexually transmitted infections, or STIs, in the United States in both men and women. Now, gonorrhea is caused by a gram-negative bacterium called Neisseria gonorrhoeae; while chlamydia is caused by a gram-negative bacterium called Chlamydia trachomatis. Both infections are transmitted during sexual contact through sexual fluids, such as vaginal secretions or semen, so they often occur together, primarily affecting genital organs. However, it’s important to note that these infections can also be transmitted via contact with skin or mucous membranes, including eyes, mouth, and anus.
Risk factors associated with gonorrhea and chlamydia can be subdivided into two main groups. Behavioral risk factors include having unprotected sexual contact, as well as new or multiple sexual partners. On the flip side, individual risk factors include young age, between 15 and 24 years old, since they’re more likely to have new or multiple sexual partners, as well as having a history of prior sexually transmitted infections, and HIV positive status.
Most often, gonorrhea and chlamydia cause asymptomatic infection. However, symptomatic clients can present with mucopurulent discharge from the vagina or penis, as well as dysuria or pain and burning during urination, and urinary frequency. In males, gonorrhea and chlamydia can infect the urethral mucosa, causing inflammation known as urethritis. Sometimes the infection can spread to the prostate, resulting in prostatitis. Also, it can cause inflammation of the epididymis, or epididymitis, and cause symptoms such as testicular pain and swelling. In females, there can also be urethritis, but typically, chlamydia affects the lower genital tract, causing vulvovaginitis when the vulva and the vagina are affected, and cervicitis when the cervix is involved. This may present with changes in vaginal discharge, intermenstrual bleedings, and bleeding after sexual activity. Now, an important complication in females is pelvic inflammatory disease, which is when the infection spreads to the uterus, fallopian tubes, and ovaries. Finally, if left untreated gonorrhea and chlamydia can cause infertility in both male and female clients.
Diagnosis of gonorrhea and chlamydia starts with history and physical examination, and can be confirmed with nucleic acid amplification testing or NAAT, which uses a genital swab or urine sample to look for the bacterial DNA.
Treatment of gonorrhea and chlamydia requires the administration of antibiotics. Gonorrhea is usually treated with a third-generation cephalosporin called ceftriaxone; while chlamydia can be treated with macrolides like azithromycin, or tetracyclines like doxycycline. And since these infections often occur together, clients are usually given treatment for both. Finally, gonorrhea and chlamydia can be prevented using condoms during sexual contact.