Chlamydia – The most common STI

Chlamydia is the most common sexually transmitted infection (STI) worldwide and is caused by a bacteria called Chlamydia trachomatis. It affects both men and women and can be transmitted by any form of sexual contact, including vaginal, anal, and oral sex. Since it is a sexually transmitted disease, people in the younger age groups (< 25 years) are more prone to infection.

Chlamydia, gonorrhea, and syphilis are often seen as coinfections, and about one-third of the patients with chlamydia are found to be positive for gonorrhea (see Gonorrhea I Gonorrhoea), and/or syphilis (see SYPHILIS) as well. Condoms when used correctly and regularly during sexual intercourse, can easily help prevent the transmission of chlamydia and other STIs. It can be treated with antibiotics but the treatment does not offer lifelong immunity.

How does Chlamydia spread?

• Chlamydia trachomatis is the bacteria responsible for causing Chlamydia.
• Unprotected sexual intercourse with an infected person, is the primary cause of Chlamydia.
• Any form of sexual contact – vaginal, anal, or oral can transmit the infection.
• Barrier methods like condoms are the best way to prevent infection.
• Newborns can get Chlamydia from their infected mothers during childbirth and can present with eye infections or pneumonia.
• Chlamydia does not spread by casual contact like hugging, kissing, living in the same household, using the same utensils, and sharing the same toilet, etc.

Risk factors for Chlamydia

Since Chlamydia is a sexually transmitted disease, everyone who is sexually active is at risk. However, the following subset of people are at high risk for Chlamydia, and also other STIs in general:

• Age < 25 years: This is the most sexually active group, and probably the most careless in terms of sexual behavior. Hence particularly vulnerable to STIs.
• Polygamous relationship: Having more sexual partners, increases the risk of getting STIs.
• Even if you are strictly monogamous, a relationship with a partner, who has many other sexual partners, still predisposes you to getting chlamydia through your infected partner.
• If you have a new partner
• If you previously had Chlamydia or any other STI
• Unprotected sexual intercourse: Unprotected sexual intercourse, without the use of condoms, exponentially increases the risk of transmission of Chlamydia, and other STIs.
• High-risk population: Some people are at higher risk of contracting STIs than others. For example, sex workers, and gay men practicing anal intercourse.
• Newborns of infected mothers

What are the symptoms of Chlamydia?

Over two-thirds of the infected people have either no symptoms or nonspecific and vague symptoms. When symptoms are present, it takes about 1 to 2 weeks for the symptoms to appear after sexual contact, as the incubation period of the disease is 7 -14 days. The primary areas infected are the genitourinary tract (cervix, urethra, penis) and the anus. Oral symptoms are rare. The presenting symptoms may be different in men and women and also differ based on the areas infected.

SYMPTOMS IN WOMEN

• Abnormal (mucopurulent) discharge from the urethra and/or cervix
• Painful sexual intercourse (dyspareunia)
• Painful urination (dysuria), and increased frequency urination.
• Pain in lower abdomen or pelvis
• Bleeding after sexual intercourse (Postcoital bleeding)
• Bleeding between periods (Intermenstrual bleeding)
• The cervix is found to be inflamed, swollen and friable on examination
• Anal symptoms: Discharge, or bleeding from the anus, along with pain and itching.

SYMPTOMS IN MEN

• Abnormal (mucopurulent) discharge from the penis
• Painful urination (dysuria), and increased frequency of urination.
• Pain and inflammation in one or both testis
• Anal symptoms: Discharge, or bleeding from the anus, along with pain and itching.

Complications of Chlamydia

Chlamydia is easily treatable with antibiotics. However, untreated chlamydia can cause complications by causing permanent damage to the reproductive organs in both men and women. These complications are more pronounced in women.

WOMEN:

Untreated chlamydia infection in women may ascend upwards to the uterus and fallopian tubes, causing serious complications like Pelvic Inflammatory Disease (PID), Infertility, or Ectopic Pregnancy:

• Pelvic Inflammatory Disease (PID):
  • Infection of the uterus (Endometritis), Cervix (Cervicitis), and Fallopian Tubes (Salpingitis), together are called Pelvic Inflammatory Disease.
  • PID leads to symptoms like abnormal cervical discharge, intermenstrual or postcoital bleeding, Chronic abdominal or pelvic pain, and Painful sexual intercourse (dyspareunia).
  • Inflammation and scarring of fallopian tubes (Salpingitis) from PID causes complications like Infertility (Inability to conceive) and Ectopic pregnancy (Pregnancy at sites other than the uterus).
  • PID should be treated aggressively with antibiotic therapy to prevent permanent damage to the reproductive organs. This is important as antibiotics can prevent further damage, but can not undo the damage already caused.

• Perinatal complications: Untreated chlamydia infection in a pregnant women may lead to perinatal complications like Preterm delivery (Delivery before completing 37 weeks of gestation) or a Low birth weight baby (Baby with birth weight < 2500 gm). In addition, the newborn may suffer from complications like neonatal conjunctivitis or pneumonia.

MEN:

• Chlamydia primarily infects the urethra in men, causing the abnormal urethral discharge.
• Untreated, Chlamydia can cause the infection of coiled tubes called epididymis in the testis (Epididymitis). This causes:
  • Pain, inflammation, and swelling in one or both testis.
  • Infertility as the transport of sperms to the urethra, through the epididymis, is blocked.
• Chlamydia may also spread to the prostate, causing Prostatitis in men. This can present with fever, painful urination, painful intercourse, and abdominal or lower back pain.

BOTH MEN AND WOMEN

• It increases the risk of getting HIV and other STIs in both men and women.
• It can spread to multiple joints in the body, causing Reactive Arthritis.

How is Chlamydia diagnosed?

The diagnosis of chlamydia is based on your symptoms, physical examination, and certain laboratory tests ordered by your healthcare provider. In addition, your healthcare provider may also get you tested for gonorrhea and syphilis which frequently occur as co-infections with chlamydia.

• History: Your doctor will take a detailed history of your symptoms, especially your sexual and medical history. This may include:
  • your current symptoms
  • how many sexual partners you have
  • whether you practice protected or unprotected sex (use of condoms)
  • any known intimate sexual contact to a partner with a sexually transmitted disease
  • whether you have been diagnosed with a sexually transmitted infection before
  • any other medical conditions which can lower your immunity eg HIV, Diabetes.
• Physical examination: A pelvic, rectal or throat exam done by your doctor may suggest important findings suggestive of chlamydia.
• Laboratory tests: For laboratory confirmation of the diagnosis, samples are obtained from the affected areas like the cervix, penis, rectum, throat, or urine and sent for the following tests:
  • Nucleic acid amplification test (NAAT): NAAT is an extremely sensitive and specific test for Chlamydia and is the test of choice for the diagnosis of chlamydia.
  • Gram stain: Gram staining of samples from affected areas shows Gram-negative bacteria.
  • Culture: Tissue cultures of the samples confirm the diagnosis and also provide antimicrobial sensitivity of various antibiotics for the infection. However, it is expensive and time consuming.

How is Chlamydia treated?

Chlamydia is easily treatable with antibiotics. The main principles of treatment are:

• The drug of choice is a single dose of oral antibiotic called azithromycin. Alternatively, another oral antibiotic called doxycycline taken for 7 days may be used, in case of coinfections or allergy to azithromycin. The exact dose, frequency, and duration of treatment will be decided by your doctor.
• Treatment should be started as soon as possible after diagnosis, as untreated chlamydia leads to ascending infection with long-term complications.
• Both sexual partners and their other sexual partners must be treated for chlamydia at the same time with the same antibiotic regimen, so as to prevent reinfection and drug resistance.
• The symptoms may start improving soon after starting the treatment, but DO NOT stop the treatment based on symptom relief. Complete your treatment strictly as prescribed by your healthcare provider. This is important because incomplete treatment leads to residual infection and resistance to future treatment.
• After completion of treatment, both partners should get tested to ensure that they are cured completely and no traces of infection is left.
• Both partners should abstain from any kind of sexual activity till the treatment is complete and follow-up tests indicate that the infection has been completely cured.
• Both partners should contact all their sexual partners and advise them to get tested. This is the only way to break the cycle of transmission of STIs in the community.
• It is very important to remember that treatment of chlamydia does not offer lifelong immunity. You can get infected again if you have unprotected sex with an infected partner. So reformation of your sexual habits is the key to prevent contracting chlamydia or any other STI.

What can be done to prevent Chlamydia?

Strategies that can help your chances of contracting chlamydia and any other sexually transmitted infection in general, are as follows:

• A strictly mutual monogamous relationship: Short of total abstinence of sexual activity, a strictly mutual monogamous relationship between two noninfected partners, is the best way to prevent chlamydia. This means that even if you have only one sexual partner, you can still get chlamydia if your partner has other sexual partners. So both partners should have no other sexual partners, except each other.
• Limiting the number of sexual partners: If you have more than one sexual partner, you should try to limit the number of your sexual partners and use barrier contraception.
• Avoid sexual partners who have active chlamydia or any other sexually transmitted infection.
• Use condoms: Regular and correct use of condoms (see Barrier methods of contraception) during any form of sexual activity, significantly reduces the transmission of chlamydia.
• Regular chlamydia screening: Since most people with chlamydia are asymptomatic, people aged< 25 years, the high-risk categories (see above), or people with more sexual partners, or those who practice unprotected sex, should regular screening for chlamydia and other STIs. This can help in the early detection of asymptomatic cases, thereby preventing transmission to others.
• Partner notification: If you have been diagnosed with chlamydia, you should notify your partners to get tested, so that they can also be treated at the same time as you. This prevents reinfection from each other.

When can I resume sex after treatment?

While you are under treatment, do not engage in any sexual activity, based only on the resolution of your symptoms or a feeling of well-being. This is because your symptoms may have improved, but you may still be infective to others and may transmit infection to your partner.

After completing your treatment as prescribed by your doctor, you should wait for at least one week before resuming sexual activity. This gives time for your body to heal and for the inflammatory processes to settle down.

Remember that successful treatment does not mean lifelong immunity. So practice safe sex, use condoms, and have a strictly mutual monogamous relationship.

Carry home message

Chlamydia is one of the most common STIs worldwide and affects both men and women. It is caused by a bacteria called Chlamydia trachomatis and is easily treatable with antibiotics. It can spread by any form of sexual activity like vaginal, anal, or oral sex. Having a strictly mutual monogamous relationship and using condoms are the pillars of prevention. Treatment should be sought as soon as possible after diagnosis because untreated chlamydia can cause permanent damage to the reproductive organs. This damage is irreversible and may cause infertility and other long-term complications in both men and women. Chlamydia frequently occurs as a coinfection with gonorrhea, and syphilis. So Both these diseases should also be tested while testing for chlamydia. Stay healthy, stay safe!

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