Reviewed by Dr Jeni Worden, GP
What is Chlamydia?
In the western world, Chlamydia trachomatis is a bacterium which causes a sexually-transmitted infection.
A slightly different type of chlamydia can also cause trachoma, which is an eye disease found commonly in the Tropics but this is NOT a sexually transmitted infection.
Chlamydia is a very common disease, which, because of its complications, should be taken very seriously. In women, the commonest site for infection is the cervix, or neck of the womb. It can also affect the urethra, which is the tube which carries urine from the bladder to the outside world.
Other sites for chlamydial infection in both men and women include the tissues around the rectum and also the eyes.
The most worrying effect of a chlamydial infection in women is that of potential fertility problems, due to inflammation of the Fallopian tubes or cervix.
The disease is particularly common among young people.
How do you get Chlamydia?
Chlamydia is primarily transmitted through sexual intercourse.
Mothers with chlamydia can infect their children during delivery. There are usually no symptoms at birth, but some 7-14 days after delivery the infection starts to show itself and may result in pneumonia in the baby when 2-3 weeks old.
If symptoms occur, they will show one to three weeks after the time of infection.
What are the symptoms of Chlamydia?
- Stinging feeling during urination, due to inflammation of the urethra. This can be quite a mild symptom and may only last for a few days so can be easily missed
- Discharge from the penis and possible itchiness around the opening.
- Pain or tenderness in the testicles.
- Stinging feeling during urination.
- Unusual vaginal discharge.
- Pain in the lower abdomen due to inflammation of the Fallopian tubes (see Pelvic Inflammatory Disease).
- Pain during sex, which may be superficial (as the penis goes in) or deep (when penis is deep inside vagina)
- in some cases, bleeding between periods.
- In infants
- Premature birth.
- Pneumonia (rare).
In adults, Chlamydia may also infect the rectum, with an inflammation of the tissues around that area (proctitis). This can cause a clear, sticky discharge of mucus from the rectum and pain on opening the bowels as well as diarrhoea, although this is not a common symptom.
Chlamydia can also cause eye infections (conjunctivitis). This, however, should not be confused with the tropical eye disease mentioned in the introduction. Trachoma (the eye disease that causes blindness) is caused by a slightly different type of Chlamydia to the one which is spread sexually.
How does the doctor diagnose Chlamydia?
One of the most common ways of testing for Chlamydia is for the GP to collect a cell sample from the infected area (cervix or penis) with a cotton swab, which is sent to a laboratory for evaluation and results.
However, because of the importance in diagnosing chlamydial infections and the practical difficulties in doing this in the GP surgery, many GPs will advise that you are seen in a specialist genito-urinary clinic so that a firm diagnosis can be made and treatment started as soon as possible.
It is important to take any antibiotics given and to also get your partner treated. Some clinics advise re-testing some weeks after treatment, to make sure that the chlamydia has been cleared but re-testing may be delayed for up to six months, when any possible re-infection will be picked up, or may be advised with a change of partner.
Chlamydial infection can be confused with gonorrhea because the symptoms of both diseases are similar. Sometimes they occur together; however, the treatment is different so an accurate diagnosis is important. If you think you are at risk of infection, by either having a new partner, or several partners at the same time, and have any of the symptoms mentioned, then you should avoid any further sexual contact and make an appointment as soon as possible with your local genito-urinary clinic (most will see people on the day of booking or at a ‘walk-in’ clinic).
Remember that the symptoms of chlamydial infection can be mild or easy to miss so if there is any suggestion at all of infection, it is always best for you and your partner or partners to get things checked out. Even though you feel healthy, if you are sexually active you may still need to be tested periodically.
How is Chlamydia treated?
Chlamydia is easily treatable with a course of antibiotic medication, usually erythromycin or tetracycline tablets. If a Chlamydia infection is present, the patient’s partner(s) will also need to be treated so that the infection does not recur.
When treated early, there are usually no long-term consequences of Chlamydia although this cannot be guaranteed. Serious complications can result, however, when left untreated.
Long-term complications in men
- Epididymitis – an inflammation of the epididymis, which is the tube which carries the sperm from the testicles. In very rare cases, where both epididymal tubes have been affected, this infection can cause sterility.
- Reiter’s syndrome – an autoimmune condition where sufferers have conjunctivitis or an eye problem known as ‘uveitis’, inflammation of several joints (polyarthritis) and rarely, a rash on the palms of the hands and soles of the feet.
- Fertility problems – past chlamydial infections can affect fertility but without necessarily causing definite sterility.
Long-term complications in women
- Pelvic Inflammatory Disease (PID) – an ascending infection that spreads from the vagina and cervix to the uterus and Fallopian tubes. PID can lead to sterility.
- Perihepatitis – an infection around the liver.
- Reiter’s syndrome – see above.
There are no guarantees that treatment of chlamydia will prevent further problems occurring particularly when it comes to fertility.
The chance of becoming infected with Chlamydia can be reduced by avoiding risky sexual behaviour. Limiting the number of sexual partners and using condoms during sexual intercourse greatly reduces the chance of become infected.
Based on a text by Dr Flemming Andersen and Dr Ulla Sønderberg, specialist