Chlamydia is one of the most frequently reported bacterial sexually transmitted infections in the United States, according to CDC reports. The infection is spread easily between sexual partners because it is rarely accompanied by obvious symptoms. CDC estimates that about 2.86 million infections occur annually.
Many people get infected with chlamydia but fail to seek treatment because they are not aware of the symptoms, or the symptoms fail to appear in the first place. Unfortunately, serious complications can arise in both males and females when chlamydia is left untreated for a long time. Therefore, it is important to know and understand the signs and symptoms of chlamydia so that you can seek treatment whenever you contract this infection. Regular screening and testing are also recommended because chlamydia is often asymptomatic.
Before we get to the signs and symptoms of chlamydia, we need to first understand what it is, what causes it and what risk factors predispose on to the infection. We can then look at the treatment and prevention of chlamydia, after considering the signs and symptoms.
What is Chlamydia
Chlamydia is a sexually transmitted bacterial infection that is passed on from one person to the next through the exchange of bodily fluids such as semen, vaginal fluids, rectal, saliva, and mucus. Fortunately, chlamydia is treatable when diagnosed early, late diagnosis may cause complications that may be difficult and expensive to treat.
What Causes Chlamydia
Chlamydia is caused by a chlamydia Trachomatis bacterium. This bacterium is commonly transported through vaginal, seminal, rectal and oral fluids passed on during acts of sexual intercourse. It is also a possibility that an infected mother can pass on the chlamydia infection to her child during the birthing process. In the child, the bacterium will cause pneumonia or serious eye infections.
To understand the signs and symptoms caused by chlamydia, it is important to first understand the replication process of this bacterium. Chlamydia Trachomatis is a virus like, in that it requires a human host to be able to replicate and survive. It goes through two basic phases; an elementary phase where it is dormant and a reticulate phase where it actively replicates. When this bacterium is passed on from one person to the next, it first goes through the elementary or dormancy phase. This is why it will not cause any symptoms for a long time, as much as it is present in the bodily fluids of the affected host.
You may have a new sexual partner who is infected with chlamydia but is in the dormancy phase. You will feel cheated when you contract the infection from them, thinking that they have been sexually involved with someone else during the time that you have been together. This may not always be the case; considering that they may have just been asymptomatic all along. Understanding this can save you a lot of doubt and potential heartache, in case you are the infected partner.
That said, it is important to test for chlamydia whenever you have a new sexual partner, bearing in mind that chlamydia is highly prevalent and asymptomatic in many cases.
What are the Risk Factors Associated with Chlamydia?
Being sexually active is the first and foremost risk factor, as this is a sexually transmitted infection. Other risk factors include:
- Being sexually active before the age of 25
- Having multiple sexual partners
- Having unprotected sex regularly
- Having a previous sexually transmitted infection
You cannot build immunity against chlamydia; therefore, reinfection is always a possibility, especially when risk factors are not mitigated.
What are the Signs and Symptoms of Chlamydia?
Only 10% of males and 5%-30% of females will show symptoms in the early stages of chlamydia infection. This asymptomatic phase happens one to two weeks after exposure, but may even go on for a few months, given the slow replication cycle of this bacterium.
The signs and symptoms caused by chlamydia will depend on the part of the body that has been infected in both males and females. This could be the vagina, fallopian tubes, urethra, rectum or throat in females. In males affected parts include the penis, urethra, epididymis, rectum or throat. Often the symptoms occur during urination or sexual intercourse.
In females, common symptoms include:
- Pus filled or mucous filled discharge cause by infection in the cervix
- Pain during sex caused by an infection in the vagina
- Bleeding in between periods
- Painful periods
- Fever and chills
- Lower abdominal pain when the infection ascends to the fallopian tubes and uterus
- Pain when urinating
In males, common symptoms include:
- Pain in the urethra which may be accompanied by mucus or watery discharge from the tip of the penis
- Pain and swelling around the testicles
- Painful sex especially during ejaculation
- Fever and chills
- Pain when urinating
Both men and women can be infected in the rectum through receptive anal sex or via spread from other sexual organs. This may cause rectal pain and rectal bleeding. Males and females can also get chlamydial conjunctivitis through transmission of infected genital secretions to the eyes. This will have the symptoms of watery of pus-filled discharge from the eyes, itchiness and pain.
Rare Symptoms Caused by Chlamydia
Symptoms that are less common may include:
- Pharyngitis may also occur in a few instances, when genital fluids are transmitted through oral sex.
- Perihepatitis which is also known as Fitz-Hugh-Curtis-Syndrome occurs when the capsule of the liver is infected and becomes inflamed. It will present as burning pain in the right upper part of the abdomen.
- Reactive arthritis occurs not as a result of the infection itself but as a result of a post inflammatory process where the body forms anti bodies against its own tissues. It may cause joint pain and inflammation of the eyes and urethra. Usually, it occurs 3-6 weeks after exposure to the bacteria and resolves within 3-6 months.
Complications Associated with Chlamydia
Pelvic Inflammatory Disease (PID)
When the bacterium passes through the cervix and uterus and into the fallopian tubes and ovaries it may cause PID. Symptoms of PID include back pain, lower abdominal tenderness and fevers.
Infertility in both males and females
Inflammation may cause scarring of the fallopian tubes and epididymis which may eventually lead to infertility in both males and females.
Scarring of the fallopian tubes due to PID may increase chances for an ectopic pregnancy, as the fertilized egg may get stuck in the scarred fallopian tube tissues.
Chlamydia can be passed on from an infected mother to her child during the birthing process. In this case, the child will develop eye infections (ophthalmia neonatorum) and pneumonia in fewer occasions. Due to this, routine screening should be conducted in women at high risk of having chlamydia infections.
Rectal Scarring and Fissures
In rare circumstances and when receptive anal sex is involved, rectal scarring and fissures may occur. This will present as pain and bleeding during defecation and frequent constipation.
Increased Cervical Cancer Risk
A 2016 review of 22 studies revealed that chlamydia infection coupled with HPV increases a woman’s chances of developing cervical cancer.
A different serotype of chlamydia trachomatis (L1, L2 and L3) can cause a more severe form of infection known as Lymphogranuloma Venereum (LGV). The symptoms closely resemble those of syphilis. LGV begins with a swelling on the genitals one to two weeks after exposure, it then progresses to an open ulcer accompanied by fevers, muscle aches, swollen lymph nodes and chills.
How is Chlamydia Diagnosed
The most common tests for chlamydia are nucleic acid amplification tests (NAATs). These tests require a swab specimen from the urethra in men and cervix/ vagina swabs in females. A urine sample may also be used. Rarely are rectal or oral swabs used, but they may be helpful in cases where unprotected oral and receptive rectal sex is commonly performed as this 2017 study revealed.
Should you test positive for chlamydia, it is important to commence treatment immediately. You will also need to inform all your sexual partners so they too can get tested and put on treatment should the need arise. Otherwise, you stand a high chance of reinfection from the same partners.
In rare circumstances, you may get false negative results where you have the infection, but the test fails to detect it. In this case, should you have symptoms that resemble those of chlamydia but have a negative test you should inform your doctor so that other tests are carried out. Remember that the earlier the treatment is started the better for you.
In even rarer circumstances you may get a false positive result, where the test is positive but you do not have the infection. In this case, there is no need to worry as treatment for chlamydia is tolerated well by most people. There is no significant risk associated with being put on chlamydia treatment.
Should symptoms persist after treatment, it will be necessary to re-test. Remember that reinfection is possible as you cannot develop immunity against chlamydia.
The U.S. Preventive Services Task Force recommends that sexually active women aged below 25 years should be screened for chlamydia yearly.
How is Chlamydia Treated
Chlamydia, when it has no complications, is pretty easy to treat. Your doctor will most likely prescribe oral antibiotics such as azithromycin (Zithromax) erythromycin or doxycycline. A 2017 review of studies showed similar cure rates among all three options, Zithromax, however, was better tolerated by most patients, having fewer side effects. Erythromycin is not recommended in pregnancy as it may exacerbate first trimester morning sickness symptoms such as nausea and vomiting.
Your doctor will also recommend that your sexual partner/s be put on treatment too.
It is important that you adhere to the antibiotic treatment until you complete the recommended schedule. Women with severe symptoms may need admission for intravenous antibiotics and control of other symptoms.
How to Prevent Chlamydia
The easiest way to prevent chlamydia is to avoid any sexual activity when this is a possibility.
In short, you can:
- Abstain from sex before the age of 25
- Have fewer sexual partners
- Use barriers such as condoms
- Go for regular chlamydia screening even in the absence of symptoms
When to See a Doctor
- When you suspect symptoms of chlamydia you should consult your doctor immediately.
- When a sexual partner has tested positive for chlamydia, you too should see your doctor to be tested and started on treatment, should the need arise.
Chlamydia is a fairly common bacterial infection among the sexually active; it is also simple to treat. But like in most diseases, early detection and correct treatment are pivotal. In the unfortunate circumstance that chlamydia is not identified early and treatment instituted, severe complications may arise.
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