Chlamydia is caused by an organism called Chlamydia trachomatis. It can be simply and effectively treated. However, if not diagnosed soon after infection, complications may occur, particularly in women.
Most people with chlamydia do not have any symptoms and are unaware that they have the infection. Infection in these people may only be detected at an STD check-up, for example after having sex with a new partner.
Symptoms that may occur are:
In males chlamydia may cause urethritis which often produces a discharge from the penis or pain on urination. If untreated, it can lead to inflammation of tissues near the testes which can cause infertility.
In females the consequences of chlamydia can be more severe. Most often infection starts in the cervix, and a vaginal discharge, burning on passing urine, lower abdominal pain and pain on sexual intercourse may occur. If chlamydia is untreated, the infection may spread through the uterus to the fallopian tubes, producing salpingitis which can cause infertility or ectopic pregnancy. More generalised infection of the whole reproductive system (pelvic inflammatory disease or PID) can occur.
Chlamydia is sexually transmitted, usually through vaginal intercourse but possibly also through oral and anal sex. Chlamydia can be passed from a mother to her child during birth, causing eye infection (conjunctivitis) or pneumonia.
Chlamydia can only be diagnosed from special swab tests, from the cervix in women, and the urethra in men. (Women who do not have a cervix can be tested by having a urethral chlamydia test.)
Chlamydia cannot be diagnosed from a blood test.
Chlamydia is usually treated with doxycycline (Doryx, Vibramycin, Doxylin).
Doxycycline should never be taken by young children or women who are pregnant or breast feeding.
The main side effects of doxycycline are irritation of the stomach and increased sensitivity of the skin to sunlight.
Doxycycline decreases the effectiveness of the oral contraceptive pill which means sex during treatment can lead to an increased risk of unwanted pregnancy.
If you are unable to take doxycycline, effective alternatives are available
Do not have sex until all results of your tests are back and you have finished taking all the tablets. There may be a risk of transmitting infection to sexual partners.
For men, any symptoms of discharge, stinging or irritation will settle down much more quickly if you rest the urethra by not having sex (vaginal, oral or anal) and not squeezing or milking the penis to look for a discharge.
Your sexual partner(s) should be promptly tested for chlamydia, even if they have no symptoms.
A repeat test must be performed after treatment
is completed to make sure that the infection
has been cured. Do not have sex until you
know the result of this test.
Unlike most other bacteria, Chlamydia trachomatis is an intracellular organism (it grows within cells). Chlamydia usually infects the cervix and fallopian tubes of women and the urethra of men.
Chlamydial infections are believed to be the most common of all notifiable STDs. It is generally thought that in a population of 15 million, there are up to 300,000 cases of chlamydia each year. Thus there are many undiagnosed cases of chlamydia in the community. It has been estimated that the true prevalence of chlamydia in the sexually active population may be in the order of 5% to 10%. See Statistics Section for recent data.
Chlamydia often produces no symptoms. Approximately 60% of women and 40% of men have no symptoms. Infection of the cervix and fallopian tubes occurs commonly, and chlamydia can also cause urethral infection. Symptoms can include dysuria (pain on urination), cystitis (bladder infection), a thin vaginal discharge and/or lower abdominal pain. Mucopurulent cervicitis (inflammation of the cervix with pus) is very common. Eye infections in infants born of infected mothers can also occur.
In men, chlamydia may produce chlamydial urethritis (inflammation of the urethra) similar to that of gonorrhoea. Symptoms may include dysuria and a mucopurulent discharge.
The most severe complication of chlamydia, as with gonorrhoea, is the risk of pelvic inflammatory disease (PID) in women, as a result of infection ascending into the upper genital tract. Chlamydia has been held responsible for 200,000 cases of infertility in women in the USA each year.
Chlamydia can also ascend the genital tract in men, causing epididymitis, although this upward spread of infection is much less common for men than for women.
The risk of infection from person-to-person is similar to that of gonorrhoea. It can also be passed to the eye by a hand moistened with infected secretions. Chlamydia can be transmitted during anal intercourse causing proctitis (inflammation of the rectum) (Crowe & Norsigian, 1984).
Recently developed tests have made more effective intervention against chlamydia possible. The main methods of testing are the fluorescent antibody (FA) examination of a direct smear, the enzyme immunoassay test (EIA) and polymerase chain reaction on either a genital swab or a urine specimen.
Because chlamydia is an intracellular organism (it exists inside cells, not in the pus), the correct swab technique is very important in order to obtain a positive test result. Any discharge should be removed as this may interfere with the immunoassay. In women a swab is placed just into the cervical canal and rotated gently in order to collect cervical cells. The swab is then placed into the appropriate container.
In men a urethral swab may be required. Some men find this a painful and unpleasant procedure, particularly if there is urethral inflammation. Gentle persuasion as to the necessity of the test may be required. A special urethral swab is inserted 2 cm to 3 cm into the urethra and gently rotated, so that some urethral cells adhere to the swab.
In both men and women, the swab for chlamydia should be the last if a series of swabs are being performed for STD diagnosis. Women can be tested for chlamydia even if they are menstruating (unlike a Pap smear which cannot be performed during menstruation).
Chlamydial infections are treated most effectively with the drug doxycycline, taken orally for 10 days. More complicated infections, such as PID, require longer treatment.
Diagnosis is made on the basis of a positive chlamydia test which is performed on a urethral swab from a male and on an endocervical swab from a female. For women without a cervix (post-hysterectomy) a urethral specimen is taken. In either sex, pharyngeal or rectal swabs may be taken if there is a history of exposure at these sites.
| Urine PCR or urine LCR are alternative tests. These tests are recommended for the screening of asymptomatic men. Tests on urine are not as sensitive as those performed on swabs from the urethra or cervix but may be used in screening programs for convenience. |
Serology is of no value in the diagnosis of genital tract chlamydial infection
.
First line
azithromycin 1 g orally as a single dose
Patients allergic to or intolerant of macrolides
doxycycline 200 mg orally daily for 10 days
Pregnant women
azithromycin 1 g orally as a single dose
(ADEC Category B1)
or
amoxycillin 500 mg orally 3 times daily for 10 days
The latter regimen is less likely to result in side effects. There is evidence in the literature to support its efficacy, but there has not yet been a large amount of clinical experience. Therefore, test of cure 3-4 weeks after treatment is completed and post-delivery is essential.
Epidemiologic treatment is given to sexual partners, regardless of age or gender, of persons with proven chlamydia.
In all cases, appropriate investigations for chlamydia should be performed before treatment is provided.
For most patients, the diagnosis will only be known at the second visit. Males may have been counselled for NSU or gonorrhoea.
Explain the nature of the infection: it is sexually transmitted, and very common. Infection is asymptomatic in 50% of men and up to 90% of women. Reinfection may occur during or after treatment, hence a follow-up visit is essential. The patient should not have sex until one week after medication has been completed.
Chlamydial infection is a curable sexually transmitted disease (STD), which is caused by a bacterium called Chlamydia trachomatis. You can get genital chlamydial infection during oral, vaginal, or anal sexual contact with an infected partner. It can cause serious problems in men and women as well as in newborn babies of infected mothers.
Chlamydial infection is one of the most widespread bacterial STDs in the United States. The U.S. Centers for Disease Control and Prevention (CDC) estimates that more than 4 million people are infected each year. Health economists estimate that chlamydial infections and the other problems they cause cost Americans more than $2 billion a year.
see also:Pelvic inflammatory disease (PID)
Chlamydial Infection(Chinese Version)
Chlamydia
Chlamydia (pronounced Clam-id-ee-a) is a sexually transmitted infection. Officially, it is a bacterium, but it is more like a virus in being very small and unable to multiply outside living cells. Chlamydia is not life-threatening, but it can do serious damage to a woman¡¯s Fallopian tubes. If this happens, the woman could become infertile (unable to become pregnant). The results of chlamydia infection cost the UK NHS about ¡ê50 million a year.
Is chlamydia common?
Many people have never heard of the chlamydia bacterium but, in the UK and USA, it is the commonest sexually transmitted infection. In 2001, 71,055 cases were seen at sexual health clinics in England, Scotland and Northern Ireland; 50% of the men and 70% of the women with chlamydia were in the 16-24-year age group.
The true figure must be even higher than the clinic figures suggest, because chlamydia is often a ¡®silent¡¯ infection ¨C not causing any symptoms ¨C especially in women. There must be hundreds of thousands of people with the infection who are unaware they have it, and therefore don¡¯t go to a clinic. When doctors in Portsmouth, UK, tested urine samples from all sexually active women under the age of 25 (who were visiting their family docotor for any reason), they found about 1 in 10 had chlamydia.
How you get chlamydia
Chlamydia is passed on during sex, but using a condom gives good protection if you use it properly. Because most people with chlamydia do not know that they have it, they can pass it on to someone else unknowingly. It is not caught from toilet seats or swimming pools.
How do you know if you have chlamydia?
About 50% of men with chlamydia have no symptoms, and do not know that they have the infection. In the other 50%, chlamydia irritates the urethra (the tube inside the penis), causing a discharge and making it painful to pass urine. Occasionally (in about 2%), chlamydia spreads to the testicle, where it causes pain and inflammation; some doctors think that if this happens, the man¡¯s fertility could be affected.
In women, chlamydia infection is usually completely silent, so they are unaware that they have it ¨C 80% of women with chlamydia have no symptoms at all. Some women notice a slightly increased discharge, or slight bleeding between periods or after sex. If it has reached the Fallopian tubes (see below), it can cause pain in the lower part of the abdomen (tummy).
Some men (and a few women) develop ¡®Reiter¡¯s syndrome¡¯. It is a reaction to the chlamydia bacterium, and consists of painful joints (usually knees or ankles) and sore eyes (conjunctivitis). It normally clears up within 6 months, but may keep recurring over several years, even if you never get chlamydia again. Whether or not you develop Reiter¡¯s syndrome depends more on your genes than on the severity of your chlamydial infection.
Tests for chlamydia
The best way of knowing if you have chlamydia is to be tested. This can be done at a sexual health clinic (genitourinary medicine clinic), or possibly by your family doctor. There are two types of test.
In women, the cervix is wiped with a cotton wool bud, which is then sent to the laboratory for testing. To do this test, the doctor or nurse will insert a speculum into the vagina, like having a smear test. In men, the cotton wool bud is inserted into the end of the urethra (pee hole) to obtain the sample.
A urine sample can be tested. However, this test is not available everywhere, and in women it is not as reliable as taking a sample from the cervix.
In Sweden, they have had a screening programme for chlamydia for more than 20 years. This is about to start in the UK, but only in ten areas. All women between the ages of 16 and 24 years attending family planning clinics and sexual health (genitourinary medicine) clinics in these areas will be offered a test. Why only women, when it is just as common in men? The reason is that chlamydia is more serious in women, because it can lead to infertility.
When to have a chlamydia test
There are several situations in which it would be sensible to have a chlamydia test:
if you have symptoms, such as discharge or lower abdominal pain (women), pain on passing urine (men) or pain in the testicles (men)
if your partner has symptoms
if you had sex with a new partner without a condom in the past year
if your partner has had a chlamydia infection and you are not sure if he/she was properly treated
if you had treatment for a chlamydia infection, but your partner did not have treatment
if you and your partner had treatment for a chlamydia infection, but had sex before the treatment was completed
if you have another sexually transmitted infection (such as genital warts)
if you are about to have a termination of pregnancy (abortion).
What happens if chlamydia infection is not treated?
If you have a chlamydia infection, it may or may not give you symptoms. If you have symptoms, such as a discharge, the symptom may disappear in a few days. This does not mean that your body has cured the infection. You are probably still carrying the chlamydia bacterium and can pass it on to other people. Also, if you are a woman, it can start to travel towards your Fallopian tubes. So go for a test, even if the symptoms have gone.
Pelvic inflammatory disease. In most women who have it, chlamydia travels no further than the cervix (neck of the womb at the top if the vagina). But in about 1 in 10, it travels further upwards through the uterus (womb) into the Fallopian tubes. In the Fallopian tubes it can cause inflammation known as ¡®pelvic inflammatory disease¡¯ or PID. Other types of bacteria may then move in making the inflammation worse. PID may be painful, but can occur without any pain at all. If the infection is treated at this stage, the tube may recover completely, or some scarring and other damage may remain.
In Sweden, where young women are screened for chlamydia, the number of women with PID has halved in the last 20 years.
Infertility. The Fallopian tube is where the sperm meets the egg, and where fertilization occurs. So if a woman¡¯s tubes have been damaged by PID in the past, the egg and sperm will not be able to travel along it easily, and she may not be able to conceive. If she does conceive, there is a possibility that the fertilized egg could get stuck in the tube, and the baby would start to develop in the tube instead of in the uterus. This is called ¡®ectopic pregnancy¡¯ and is a bad situation, because the developing baby almost always dies in early pregnancy, and there will be dangerous internal bleeding.
However, while it is true that chlamydia can cause infertility, this happens in only a small number of women who have it. The risk is not precisely known, but a Swedish study in the early 1990s gave the following figures.
If 100 women get a chlamydia infection, 20 will develop PID.
Of these 20, 2 will have difficulty conceiving and 1 will have an ectopic pregnancy.
The more times a woman has PID, the greater the damage to the tubes and the greater the chance of later problems. So if those 20 women had another attack of PID, 4 would become infertile and 2 would have ectopic pregnancies.
If those same 20 women had three or more attacks of PID, 8 or 9 would become infertile and 4 would have ectopic pregnancies.
Treatment for chlamydia and talking to your partner
The good news is that chlamydia is easily treated, usually with doxycycline antibiotic. This treatment is over 95% effective if you take the full course (usually twice a day for 7 days) exactly as instructed by your doctor. Other antibiotics (azithromycin, ofloxacin) are sometimes used instead; if you are pregnant or breast-feeding your doctor will probably give you erythromycin.
It is essential that your partner is treated as well. If your partner is not treated at the same time as you, you can catch it again from him/her. This is a bad thing for women, because the more times a woman has a chlamydia infection, the greater her risk of later infertility. So do not have sex (even with a condom) until both of you have completed your treatment.
You may feel anxious about telling your partner about the infection. Sometimes partners do not believe they could have it themselves, because they probably have no symptoms. So explain that most people with chlamydia do not know that they have it. If you think that telling your partner would be problematic, talk to a health advisor at your local sexual health clinic (genitourinary medicine clinic).