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Making Sense of ... Chlamydia

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chlamydia

What is chlamydia trachomatis?

Chlamydia is a sexually transmitted bacterial disease, caused by Chlamydia trachomatis.

Where is chlamydia usually found?

Chlamydia occurs in sexually active men and women throughout the world.

How common is chlamydia?

Very common. In 2004, nearly one million cases were reported in the USA alone.

Underreporting is common because many people with chlamydia experience no symptoms from their infections and do not seek treatment. Too frequently, patients are treated for symptom with no tests to confirm the cause.

Some estimates put the real rate of infection as three times higher - almost three million in the USA each year. Re-infection is a major problem, as symptom-free sex partners may not be treated.

How is chlamydia transmitted?

Chlamydia is sexually transmitted during vaginal, oral, or anal sex. Chlamydia can also be transmitted during vaginal childbirth.

Any sexually active person can be infected with chlamydia. The more sex partners, the higher the risk of infection. Young women are at particularly high risk of infection, because the cervix is not fully matured.

Chlamydia is transmissable by oral and anal sex, putting at risk men who have sex with men.

What are the symptoms of chlamydia?

Any genital symptom, including discharge, burning sensation during urination, pain during intercourse, unexpalined sores or rash should be a signal to abstain from sexual activity and to seek advice without delay.

As many as three quarters of infected women and half of infected men never experience symptoms from the original infection, so chlamydia may not be diagnosed or treated until complications develop, or a partner reports the disease.

If symptoms do occur, they usually appear within 1 to 3 weeks of exposure. Chlamydia is highly transmissable; it is a safe assumption for any infected person that all recent sex partners either also have the disease, or are at risk - they need to be told.

In women, the disease attacks the cervix and the urethra. this may cause an abnormal vaginal discharge or a burning sensation when urinating.

The infection may then spread from the cervix to the fallopian tubes; some women will still have no signs or symptoms, while others may report lower abdominal pain, low back pain, pain during sexual intercourse, nausea, fever, and bleeding between menstrual periods.

If the infection is allowed to spread into the higher reproductive system, irreversible damage may occur.

Men may report a discharge from the penis and a burning sensation when urinating. Men may also experience itching or burning around the opening of the penis or pain and swelling in the testicles, sometimes both.

How is chlamydia diagnosed?

There are laboratory tests to confirm Chlamydia trachomatis, including urine testing, or culturing specimens from the cervix or urethra.

Is there a treatment for chlamydia?

First line treatment is a 7-day course of twice daily doxycycline 100 mg tablets.

Azithromycin 1g in a single oral dose, has the advantage of being effective when compliance over seven days is in doubt. However, there is increasing evidence of disease resistance to azithromycin.

Erythromycin, ofloxacin and levofloxacin are also effective, amoxicillin or erythromycin are the treatment of choice in pregnancy and for nursing mothers.

Coinfection with Chlamydia trachomatis often occurs among patients who have gonococcal infection; many doctors recommend dual treatment if one or the other infection is known to be present. Good practice, however, suggests that in all cases, swabs and spcimens are taken before treatment is commenced, in order to compile an accurate patient history, and to add to the general knowledge of disease incidence.

Is there a way to prevent infection?

The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact, or maintain along-term mutually monogamous relationship with a partner who has been tested and is known not to be infected with Chlamydia trachomatis.

A latex condom, used consistently and correctly, can reduce the risk of transmission of Chlamydia trachomatis; it offers no guarantee, however, as transmission does not depend on copulation itself - foreplay offers ample opportunity.

Treating an infected patient will prevent transmission to future sex partners - but as many people experience no symptoms when the disease is present, simultaneous treatment of both partners, while abstaining from all sexual activity, is the only way to be sure of avoiding reinfection, which is very common.

Treatment of chlamydia in pregnant women usually prevents transmission of Chlamydia trachomatis to infants during birth. Treatment of sex partners helps to prevent reinfection of the index patient and infection of other partners.

Chlamydia screening is a wise precaution for all sexually active women. An annual screen for women up to the age of 25, and older women with a new sex partner or multiple sex partners. All pregnant women should have a screening test for chlamydia.

Anyone infected with Chlamydia trachomatis should ensure that all recent sex partners are advised to seek investigation and treament. This will reduce the risk that they will develop serious complications from chlamydia and will also reduce everyone's risk of becoming re-infected. The spread of Chlamydia trachomatis can only be ensured if all infected people abstain from all sexual activity until treatment is complete.

While it is not azodium's intention to preach or lecture, Chlamydia trachomatis has reached epic proportions, and will cause increasing misery for many if responsble action is not taken.

What is the mortality rate for chlamydia?

The damage caused by Chlamydia trachomatis can leave a woman at increased risk of ectopic pregnancy (pregnancy outside the uterus), which can be fatal.

Genital infections account for up to 40% of premature births, and so are a major cause of infant mortality.

What are the long term effects of chlamydia?

In women, untreated Chlamydia trachomatis can spread into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID). This probably occurs in about 40% of women with untreated Chlamydia trachomatis. PID can - and frequently does - cause permanent damage to the fallopian tubes, the uterus and surrounding tissues. The damage can lead to chronic pelvic pain, infertility, and ectopic pregnancy.

Women who have been infected with chlamydia much more likely to become infected with HIV, if exposed to it later.

Chlamydia trachomatis can cause proctitis, infection of the lining of the rectum, in people who have anal sex with a partner who has chlamydia.

Chlamydia trachomatis can also be found in the throats of people who have oral sex.

Untreated Chlamydia trachomatis in men may spread to the sperm delivery system. This may cause pain, fever, and even infertility.

Is there a chlamydia vaccine?

Currently, there is no vaccine available - but development and testing are taking place.

However, screening is available in some countries, particularly for pregnant women, who - with their baby - are at increased risk of harm, and research suggests this is welcomed by women1,2

Is there legal protection for those infected?

There is unlikely to be any specific protection in your country; but long term problems due to failures of diagnosis and treatment have been taken to court in more than one country. Failure to abstain from sex while knowingly infected, probably constitutes assault - but would be a difficult case to prove.

Bibliography and Further Information Sources

References

  1. Jade E Bilardi, J. E. et al., (2010) Young pregnant women's views on the acceptability of screening for chlamydia as part of routine antenatal care
    BMC Public Health. 2010; 10: 505.
  2. Pavlin, N. L., et al., (2006) Implementing chlamydia screening: what do women think? A systematic review of the literature
    BMC Public Health. 2006; 6: 221
If this article hasn't answered your question, email me at the address below, and I'll try to get the information you seek. I regret I cannot assist with individual cases or essays and school projects, but if it's something I've missed, I'll be happy to try and help.

Article written by Andrew Heenan BA (Hons), RGN, RMN

First Published: 17 August 2006
Last updated: 19 April 2012
© Andrew Heenan 2006, 2011
 

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