**5. Clinic considerations**

In Chlamydia, due to the asymptomatic course of the infection, diagnosis can usually be delayed until discovery of a symptomatic partner or a positive screening result. Therefore, the chlamydia screening programs, which have been shown to reduce PID rates [29, 30], can be claimed to be necessary for the timely diagnosis and treatment of this infection.

Despite this mostly asymptomatic course, *C.trachomatis* can cause a broad range of urogenital diseases, including cervicitis, endometritis, salpingitis, pelvic inflammatory disease, urethritis, prostatitis, epididymitis, lymphogranuloma venereum; and extragenital diseases like conjunctivitis, pharyngitis, reactive arthritis, proctitis, and neonatal pneumonia. Asymptomatic men and women act as reservoirs for the infection. In a previous study, the rate of transmission was estimated to be 68% both for women and men [31].

In the symptomatic patients, clinical signs and symptoms depend on the infection site, and local mucosal inflammation with a subsequent discharge can lead to vaginitis, cervicitis, and urethritis in females and urethritis in males.

Symptoms are felt with different severity in different anatomic regions, depending on the bacterial variants that vary according to the specific epitopes encoded by ompA [32, 33]. There is a link between the genotype of *C.trachomatis* and its pathogenicity and the severity of infection [34, 35]. Chen et al. showed in their study that patients infected with genotype D, the most prevalent type in their study, had a lower risk of both coinfection with other pathogens and cervical cancer. Genotype F was found to be the most associated with bacterial coinfections, and serovar G was also the type at risk for coinfection. Genotype E was associated with mucopurulent cervicitis and cervical dysplasia [36]. Extensive studies of *C. trachomatis* serovars have found that variant prevalence show marked geographic distributions and differ by studied region, gender, ethnicity, and sexual orientation [34, 37–40].

The most common signs, symptoms, and history issues can be listed as follows: These can be encountered in both sexes:


These can be seen in females:


Signs of chlamydial infection in women may include the following:


Signs of lymphogranuloma venereum (LGV) may include the following:

