**10.** *Chlamydia trachomatis* **genital infections and inclusion conjunctivitis**

**Clinic:** *Chlamydia trachomatis* D-K serovars cause sexually transmitted diseases and eye infections (conjunctivitis with inclusion). Inclusion conjunctivitis in adults is follicular conjunctivitis involving the lower eyelid. In the first two weeks, there are purulent-mucoid discharge and signs of hyperemia in the eye. It is accompanied by keratitis, indistinguishable from ocular trachoma. It usually heals spontaneously. However, if left untreated, it may become chronic and deformities may develop [20].

In newborns, 20–60% are infected as they pass through the birth canal. Conjunctivitis with inclusions (15–20%) and respiratory system infections (10–40%) may develop in infected infants. Neonatal inclusion conjunctivitis begins 7–12 days after birth as mucopurulent conjunctivitis. It tends to improve within weeks to months, either spontaneously or with erythromycin or tetracycline therapy, rarely can become chronic [11].

Most chlamydial endocervical infections are asymptomatic or have mild symptoms such as dysuria, mild abdominal pain, bleeding, and vaginal discharge. Mucopurulent discharge is seen in cervicitis. In women, it causes urethritis, cervicitis, endometritis, pelvic inflammatory disease, and its complications. Ectopic pregnancy, spontaneous abortion, tubal infertility, and chronic pelvic pain are the main complications. Pelvic inflammatory disease can progress to a widespread disease that progresses to perihepatitis and ascites [21].

In men, it causes nongonococcal urethritis and epididymitis. It is the most common cause of nongonococcal urethritis, up to 50% in men and women [22]. The incubation period is 7–14 days. It has clinical signs such as dysuria, non-purulent discharge, and frequent urination [23]. Infected adults infect their conjunctiva by autoinoculation and inclusion conjunctivitis resembling acute trachoma may

develop. The most common cause of epididymitis in men over 35 years of age is *Escherichiae coli*, and those under 35 years of age are *C. tachomatis* and *Neisseria gonorrhoeae*. Azoospermia can be seen in the acute phase in the chlamydial epididymitis. It is not known whether it causes infertility or not. It is the most common cause of proctitis and proctocolitis in both men and women, more often in gay men [24]. Patients with proctocolitis have fever, tenesmus, and rectal pain. Asymptomatic rectal carriage can occur in neonates and adults [11, 12]. However, since infections are often asymptomatic, diagnosis cannot be made in most cases [6]. Chlamydial infections trigger reactive arthritis and some of them develop Reiter's Syndrome. Reiter's Syndrome is a disease with urethritis, conjunctivitis, arthritis, mucocutaneous lesions [5, 6]. In addition, chlamydial infections can cause cancerous lesions such as cervical dysplasia [4, 25].
