A 19 year old sexually active woman presents to your clinic with left lower crampy abdominal pain for the last week. Bimanual exam elicits cervical motion tenderness, although gram stain of vaginal discharge is negative for pathogenic organisms. The pain is worse during and right after menstruation.
Labs: Inclusion bodies in Giemsa stain. Obligate intracellular bacteria. PCR is also a useful tool.
Discussion: It is the lab in this instance that differentiates Neisseria gonorrhoeae from Chlamydia trachomatis. Discharge may be slightly more watery in Chlamydia trachomatis than in Neisseria gonorrhoeae but this should not be used as a determining factor. Chlamydia trachomatis is an important cause of PID. It is the result of an ascending lower genital tract infection of Neisseria gonorrhoeae and Chlamydia trachomatis. An infection of one organism is presumptive for an infection of the other. Signs and symptoms include purulent cervicitis which causes abnormal vaginal discharge. Vaginal discharge is caused only by the cervical discharge. The patient may also be asymptomatic. These signs and symptoms look like gonorrhea. Factors that predispose to the ascent of bacteria include the use of an intrauterine device (IUD) and the hormonal and physical changes associated with menstruation.
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