Chlamydia - symptoms, signs, diagnosis and treatment
Medically Reviewed by Dr Sravya, MBBS, MS
Introduction
Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) are infectious diseases that spread through sexual activity. When a person has vaginal, anal, or oral sexual intercourse with someone infected with an STI, the former becomes susceptible to the infection. Sexually transmitted infections are caused by bacteria, viruses, or parasites. Bacterial STIs include chlamydia, gonorrhea, and syphilis. Viral STIs include HIV/AIDS, genital herpes, genital warts, and hepatitis B. Parasitic STIs include trichomoniasis, crabs, and scabies.
What is Chlamydia?
One of the common STIs seen in humans is chlamydia. It is caused due to the bacteria Chlamydia trachomatis. As the bacteria is transmitted through vaginal fluid or semen, anyone who is sexually active is at risk of infection. This condition can affect both males and females. Certain groups of individuals are at higher risk, such as –
- Males and females under age 25 who are sexually active.
- Men who have sex with men (MSM)
- People who have multiple sexual partners
According to Newman, et al, chlamydia affects 4.2% of females and 2.7% of males all over the world. Infection rates usually are higher than reported, as symptoms are not seen initially. Deaths are rare but have been reported.
Causes Of Chlamydia
The bacteria travels through vaginal fluid and semen. The ways in which infection can occur are –
- Having unprotected vaginal, anal, or oral sex.
- Using sex toys without sanitising beforehand.
- Genital contact with the genitals of an infected person, not necessarily due to penetration or ejaculation.
- Infected semen or vaginal fluid coming in contact with eyes.
- Affected pregnant women can transmit it to their newborn at birth.
The infection cannot be transferred through kissing, holding hands, hugging, sharing food, coughing, sneezing, or using a toilet after someone.
Signs And Symptoms
The majority of cases are asymptomatic, i.e., people infected with it do not see any signs of the infection. That is why it is often called a silent infection. Almost 50-70% of patients do not experience any chlamydia symptoms. If signs and symptoms are present, they may be seen several weeks after exposure. According to the Centres for Disease Control and Prevention (CDC), signs of chlamydia are seen in 10% of men and 5-30% of women.
Signs and symptoms in women are –
- Foul-smelling discharge from the vagina which is whitish or yellowish
- Pain during urination
- Frequent urge to urinate
- Bleeding between periods
- Painful periods
- Painful sexual intercourse
- Itching or burning sensation around the vagina
- Pain in the lower abdomen
Signs of chlamydia in men are –
- Clear or cloudy discharge from the penis
- Pain and burning during urination
- Pain or itching around the penis
- Pain or swelling in the testicles
If the infection spreads to the rectum, rectal bleeding, discharge, and pain is present in males and females. If the infected fluid comes in contact with the eyes, it may cause chlamydial conjunctivitis (pink eye), showing signs such as redness, pain, and discharge.
Diagnosis Of Chlamydia
The most widely used test for the diagnosis of chlamydia infection is the nucleic acid amplification test (NAAT). In this test, a sample of the vaginal fluid or semen is collected from the patient and examined. In females, the sample is collected using a cotton swab from the cervix. In males, the sample is collected from the urethra. Alternatively, a urine sample may also be collected. Sample collection can be done at home by the patient, or at the doctor’s office.
This sample is then tested in a laboratory for the presence of infection-causing bacteria.
There are some other tests used to diagnose chlamydia, such as Ligase chain reaction (LCR), direct fluorescent antibody test, enzyme immunoassay, and cell culture. However, NAAT is the most preferred test owing to better sensitivity and efficacy, and ease of sample collection and management.
Treatment Of Chlamydia
Chlamydia is a curable infection. A person diagnosed with the infection will be prescribed antibiotics by the doctor. The most common antibiotics for the treatment of chlamydia are azithromycin, doxycycline ofloxacin, levofloxacin, erythromycin, and amoxicillin. Erythromycin and amoxicillin are recommended for pregnant women.
Once treatment of chlamydia is started, the symptoms usually alleviate in a week. However, it is advisable to complete the prescribed dose even if there are no symptoms. In severe cases of infection, intravenous (IV) antibiotics and painkillers may be given.
Things to keep in mind during the treatment of chlamydia –
- Refrain from all sexual activity until the infection is cleared up.
- All sexual partners must be informed and screened irrespective of whether symptoms are experienced or not.
- It is advisable to get tested for other STIs such as HIV, syphilis, gonorrhoea, etc just to be safe.
- Diagnostic tests should be repeated after 3 months to check for reinfection.
Complications Due To Chlamydia
Chlamydia is mostly asymptomatic. Therefore, there is a risk of the infection being left untreated for a long time. Even though there are no symptoms, it can cause long-term complications in males and females.
Complications in females include –
- Pelvic Inflammatory Disease (PID) - It is a serious infection that affects the upper reproductive system, namely the uterus, fallopian tubes, and ovaries. This may lead to infertility, chronic pelvic pain, or ectopic pregnancy (pregnancy occurring outside the uterus).
- Premature birth in pregnant women
- Babies born to women with chlamydia may have conjunctivitis, which may lead to blindness
- Infertility due to permanent scarring of reproductive organs
Complications in males include –
- Epididymitis - It is the infection of the epididymis (the tube that carries sperm from the testes)
- Proctitis - Inflammation of the rectum
- Infertility in some cases
Complications in males and females –
- Nongonococcal urethritis - Infection of the urethra
- Risk of reactive arthritis
- Risk of HIV/AIDS
Prevention Of Chlamydia
The only way to completely avoid getting infected by the infection is to abstain from any form of sexual activity with someone infected. This includes vaginal, oral, and anal sex. However, this can be difficult in practice. If a person wishes to be sexually active, certain safety measures can be put in place to prevent infection. These include –
- Proper usage of a condom during all sexual activity
- Usage of a dam during oral sex
- Avoid sharing sex toys. If shared, they must be cleaned and sanitised thoroughly
- Limiting the number of sexual partners
An important method to reduce the spread of infection is screening for chlamydia. As the condition is mostly asymptomatic, the risk of unknowingly spreading infection is higher. Thus screening is important to limit this spread. Ideally, all sexually active individuals must undergo screening regularly. However, screening is highly recommended in certain high-risk groups such as –
- Males and females under the age of 25
- Pregnant women
- Those with multiple sexual partners
- Those having a new sexual partner
- Males having sex with males