Men may have symptomatic or nonsymptomatic urethritis. Conjunctivitis often is chronic and may last for many months. Inferior tarsal conjunctival follicles are obvious, and a tender enlarged preauricular lymph node is common. Keratitis may develop during the second week after onset. Untreated disease has a chronic remittent course, and keratitis and possibly iritis occur more commonly in the late stage of disease.
Diagnosis is based on clinical appearance and laboratory tests.
Basophilic intracytoplasmic epithelial inclusion bodies are seen with Giemsa staining of conjunctival scrapings. Azithromycin can be given as a single dose of 1 g, which can be increased to 2 g if Neisseria gonorrhoeae is suspected. Tetracyclines are avoided in children younger than 7 years and in pregnant or breastfeeding women. The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Antibiotics - Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.