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Chlamydia trachomatis infection of the genital tract is initially mild and most sufferers do not know they have the infection.1 However, over a period of time untreated infections may be associated with considerable pathology.
During a recent prospective survey of 500 men presenting in this department we recorded the Gram stained microscopy results from urethral swabs. These were scored by the pathologist who had no knowledge of the patient. They were scored on a scale of 1–5, corresponding to 0, 1–4, 5–9, 10–14, and >15 polymorphonuclear leucocytes (PMNLs). The results were later correlated with the routine chlamydia ELISA testing. The results are given in table 1⇓.
It can be seen that in the chlamydia positive men 34% do not have urethritis, defined as >5 PMNLs per high power microscopy field. Similarly, urethritis was found in 22% of men who were non-chlamydia, non-gonococcal (non-GC). This clearly confirms that chlamydia infection does exist in the absence of urethritis. Furthermore, this 34% did not correspond with asymptomatic infection; 55% were symptomatic and 45% asymptomatic. Likewise in those with urethritis, 57% were symptomatic and 43% asymptomatic. The most common symptom was discharge and the peak duration was 21 days. Of the total chlamydia positive group 16% had neither symptoms nor urethritis.
Is it therefore possible that not all chlamydia infection leads to pathology and morbidity? Perhaps the non-inflammatory serovars are not harmful and do not produce the pathology that others do.2 Evidence does exist which suggests that different serovars do produce different pathology.3,4
Of the 22% of men who had non-chlamydia non-GC non-specific urethritis it seems highly likely that these will be due to Mycoplasma genitalium.5 In future we intend to test for Mycoplasma genitalium and to compare the pathology that these two organisms produce.
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