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As we have learned more and more about chlamydia, we have come to recognize that gonorrhea and chlamydia are not only often transmitted together but also very, very difficult to differentiate in terms of the syndromes they produce Chlamydia, clamidia. They are the two most common bacterial sexually transmitted diseases in the United States and they are fairly common. Interestingly, it has been a race, with gonorrhea way ahead and that was because the methods for detecting chlamydia were not. 

Then chlamydia started catching up and as our methodology has gotten better and better, chlamydia has become more common than gonorrhea. It probably always was, but we just weren't able to demonstrate it. They produce similar syndromes. They can both produce urethritis, mucopurulent cervicitis, anorectal infections, conjunctivitis, epididymitis, pelvic inflammatory disease, the Fitz-Hugh-Curtis syndrome, or perihepatitis and they both can produce arthritis, although the arthritis with chlamydia is not a true infectious arthritis, it is Reiter's syndrome or host chlamydial infection arthritis, which at one time was also attributed to the gonococcus. This is just like what we spoke about yesterday in terms of gastrointestinal infections. This is a post infectious arthritis and is presumably immunologic and one of the things that can trigger it is chlamydial infection. It is most commonly seen in people with HLAB27 tissue type, but can be seen.

I always think very hard in terms of making up test exam questions and so on about how they differ. What does one do that the other doesn't do? I used to count arthritis as one of them, because truly the Reiter's syndrome is not an infectious arthritis, but that gets blurred because arthritis can follow both. So all I can come up with is that chlamydia causes pneumonia in the newborn and the gonococcus does not. That is the differentiating factor in terms of syndromes produced. Co-infection is very common and serves to further confuse the issue.

Gonorrhea is a disease of the young - 15 to 25 years as defined by the CDC. It is more common in urban blacks of low socioeconomic status. This is somewhat interesting. We see a lot more gonorrhea in people in lower socioeconomic groups and more chlamydia in people of upper socioeconomic groups - college students, for example. Females who develop gonorrhea are usually asymptomatic and males are usually symptomatic. As a matter of fact, the figure is that after contracting the gonococcus, over ninety percent of males will become symptomatic within five days.

Rectal infection is common in women and in male homosexuals. Twenty percent of male homosexuals who practice anal receptive intercourse develop gonorrhea. Rectal infection is usually asymptomatic. Pharyngeal infection is common in women practicing fellatio - the figure if twenty percent - and male homosexuals. Pharyngeal infection is usually asymptomatic. They can produce symptomatic infection, but it serves as a mucosal site from which dissemination can occur and certainly from which spread of infection can occur to another individual.

Females are less effective transmitters of gonorrhea than male. One-third of males will be infected by one exposure, sixty percent by three exposures and in males it is fifty percent of females who will be affected by one exposure and ninety percent of females will be affected by three exposures. So males are far more effective in terms of transmission; it is thirty-three percent with one exposure versus fifty percent and sixty percent with one exposure versus ninety.