Skin Rash: When Should Chlamydia Be Considered?

Chlamydiae are bacteria responsible for certain common sexually transmitted infections (STIs), the most well-known being Chlamydia trachomatis. This bacterium can cause urethritis, cervicitis, conjunctivitis, and in rare cases, systemic complications. A particular form, Lymphogranuloma venereum (LGV), is less common and manifests as ulcerative lesions and lymph node enlargement. Other species such as Chlamydia pneumoniae or Chlamydia psittaci are not sexually transmitted and are therefore less relevant in gynecological or urological practice.

Symptoms and Clinical Features

In women, most infections are asymptomatic, but some may experience vaginal discharge, burning during urination, or pelvic pain. If left untreated, serious complications such as salpingitis, infertility, or preterm birth can occur.

In men, the most frequent signs are urethritis, discharge, and dysuria, while epididymitis is less common.

Skin rash is extremely rare (<5%). When it does appear—usually in the context of disseminated infection or Reiter’s syndrome—the rash is typically maculopapular, located on the palms, soles, and occasionally the trunk or limbs. It may be slightly itchy but is usually painless.

Reiter’s Syndrome

Reiter’s syndrome is a reactive arthritis that can follow a chlamydial infection, mainly in young men. Its classical triad includes:

• Urethritis

• Arthritis (knees, ankles, toes)

• Conjunctivitis or uveitis

Skin manifestations, such as blennorrhagic keratoderma (palms and soles), or more rarely, oral ulcers and nail changes, may occur. The syndrome is rare, occurring in about 1–4% of Chlamydia infections.

Prevalence and Course

Chlamydia infections affect approximately 5–10% of sexually active young adults, with peaks reaching up to 20% in some developing countries. Spontaneous resolution is possible but rare; infections can persist for several months without symptoms. The occurrence of a rash is exceptionally uncommon, and Reiter’s syndrome remains rare.

Transmission

Chlamydiae are primarily sexually transmitted (vaginal, anal, oral) and can also be passed from mother to child during birth, causing neonatal conjunctivitis or pneumonia. They cannot be transmitted through handshakes, clothing, or surfaces.

Diagnosis

The PCR test is the gold standard, detecting current infection at the urethra, cervix, urine, pharynx, or rectum, with high sensitivity and specificity.

Serology only shows past contact with the bacteria and does not indicate active infection or cure. It is often misused and is generally unreliable for diagnosis or treatment monitoring.

Treatment

Treatment is simple, safe, and highly effective using antibiotics, such as single-dose azithromycin or seven days of doxycycline. Traditional or home remedies have no proven effect and may delay effective therapy.

Risks if Untreated

• Women: salpingitis, infertility, preterm birth, neonatal infection

• Men: chronic urethritis, epididymitis

• Newborns: conjunctivitis, pneumonia

Conclusion

A skin rash is almost never a symptom of Chlamydia, and Reiter’s syndrome remains rare. PCR testing is essential, while serology is largely historical and unreliable. Antibiotics provide a simple and effective treatment, whereas traditional remedies are ineffective.

Early detection and treatment help prevent complications in women, men, and newborns.

Take good care of yourself!

Kind regards,

Dr. Sandra Yene Amougui