Some facts and data:

A majority of genitourinary infections such as Chlamydia can be asymptomatic and some have a high prevalence rate.  The center for Disease Control (CDC) ( estimates that there are 19 million new infections every year in the US alone. Some data about common STI is listed below.


  • Chlamydia:Case reports have been increasing steadily over the past 20 years, and in 2010, 1.3 million chlamydia cases were reported. While the increase is due to expanded screening efforts, and not to an actual increase in the number of people with chlamydia, a majority of infections still go undiagnosed. Less than half of sexually active young women are screened annually as recommended by CDC.
  • In a study in Malaysia used to screen for chlamydial antibody among Malaysian infants, children, sexually active adults and prostitutes a high seropositvity rate was reported be 45.5%) (J Clin Pathol. 1990 May; 43(5): 400–402. Prevalence of chlamydial antibody in Malaysians.Y F Ngeow, S P Rachagan, and S Ramachandran.
  • Trichomoniasis, caused by Trichomonas vaginalis, is the one of the most common treatable STDs. In women, infection with T. vaginalis has been suggested to be associated with adverse pregnancy outcomes, including premature rupture of membranes and pre-term labor, pelvic inflammatory disease, and increased risk for HIV infection. The average Prevalence Rates is about approximately 3% prevalence in the general female population. 18%-50% prevalence in females with vaginal complaints and overall 85% of women are asymptomatic.
  • Urethritis:Several organisms can cause infectious urethritis. Asymptomatic infections are common. N. gonorrhoeae and C. trachomatis are clinically important infectious causes of urethritis.  Complications of NGU among men infected with C. trachomatis include epididymitis, prostatitis. The etiology of the majority of cases of nonchlamydial NGU is unknown but organisms such as Ureaplasma urealyticum and Mycoplasma genitalium have been implicated.
  • Cervicitis: Common oorganisms implicated is typically C. trachomatis or N. gonorrhoeae. Cervicitis also can accompany trichomoniasis and genital herpes (especially primary HSV-2 infection). Some data indicate that infection with M. genitalium and BV as well as frequent douching might cause cervicitis. (
  • Pelvic Inflammatory Disease:Pelvic inflammatory disease (PID) refers to infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs. Up to 10-15% of these women may become infertile as a result of PID. A large proportion of the ectopic pregnancies occurring every year are due to the consequences of PID. Symptoms of PID vary from mild to severe. Chlamydia can also cause fallopian tube infection without any symptoms. Because of vague symptoms, PID often goes unrecognized by women and their health care providers.
  • Chronic Urinary symptom: In a clinical study involving analysis of U. urealyticum and M. hominis  in men and women, the authors conclude that the significant improvement noted in all symptom scores after treatment in women with positive cultures for U. urealyticum and M. hominis suggesting  that these pathogens might have been in the etiology of chronic urinary symptoms.  (Baka S, Kouskouni E, Antonopoulou S, Sioutis D, Papakonstantinou M, Hassiakos D, Logothetis E, Liapis A. Urology. 2009 Jul;74(1):62-6.)


Consequences and Outcome of genitourinary infections 

“A majority of STI / Genitourinary infections may be asymptomatic and if left untreated become major cause of diseases such as PID, extra uterine pregnancy, infertility, chronic pelvic pain, cervicitis and urethritis.”

  • Even though symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur “silently” before a woman ever recognizes a problem.
  • Infertility and genitourinary Infections:CDC Recommends Chlamydia Screening of All Sexually Active Women 25 and Under. Chlamydia and gonorrhea are important preventable causes of infertility. Untreated, about 10-15% of women with chlamydia will develop pelvic inflammatory disease (PID). Chlamydia can also cause fallopian tube infection without any symptoms. PID and “silent” infection in the upper genital tract may cause permanent damage to the fallopian tubes, uterus, and surrounding tissues, which can lead to infertility.
  • A pregnant woman with an STD can infect her baby before, during, or after the baby’s birth.
  • Nanobacteria such as Ureaplasma and Mycoplasma have recently been described as novel microorganisms characterized by a small size (0.2 to 0.5 μ) with a 16S rRNA. They have been implicated in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and also been found from vaginal swabs in patients with Vaginitis. (Korean J Urol 2011;52:194-199.

Etiology and Diagnosis: Asymptomatic infections: A challenge

  • Detection of organisms implicated in genitourinary and reproductive infections is frequently difficult as they are difficult to culture by traditional methods. Infections may also be frequently asymptomatic and therefore present diagnostic challenges.

Chlamydia: The Most Common Infection & Impact on Pregnancy

  • Chlamydia is one of the most common genitourinary infections in the world. It is caused by the bacterium, Chlamydia trachomatis, which can damage a woman’s reproductive organs. 
  • Chlamydia is known as a “silent” disease because about three quarters of infected women and about half of infected men have no symptoms.
  • Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.
  • Chlamydia has been linked with premature delivery resulting from the infection stimulating the rupture of uterine membranes.
  • Chlamydia can cause the baby to have a low birth weight at birth.
  •  Babies who are born to infected mothers can get chlamydial infections in their eyes and respiratory tracts.
  • Chlamydia is a leading cause of early infant pneumonia and conjunctivitis (pink eye) in newborns. Conjunctivitis can be very damaging to your newborn’s eyes and can cause scarring and even permanent blindness.
  • 50% of newborns with Chlamydia pneumonia will also develop Chlamydial conjunctivitis.

Clinical Significance of Testing and Diagnosis of Genitourinary infections

  • Testing to determine the specific etiology is recommended because a specific diagnosis will assist in investigations for clinical situations such as 
  1. Investigation for infertility cases.
  2. Chronic urinary symptoms.
  3. Men with symptoms of prostatitis.
  4. Women with suspected reproductive infections.
  5. Screening for infections among sexually active men and women.


  • Testingmay also benefit partner notification and improve compliance with treatment, especially in exposed partners.


Test Offered: “Synapse introduces a MultiPathogen DNA / RNA test for Genitourinary and Reproductive infections. Partner testing is recommended.”

  • Chlamydia trachomatis
  • Neisseria gonorrhea
  • Trichomonas vaginalis
  • Mycoplasma genitalum