• Camelia Brande

Chlamydia - a silent STI with many consequences

April is STD Awareness Month and we believe it is time to focus on this important topic. According to the WHO (World Health Organization) around 1 million STIs are acquired every day worldwide.

Last week we talked about STIs, STDs and VDs and the differences between them.

Today, we are shedding a light on one of the most common STIs, Chlamydia, a sexually acquired infection that has become a public health concern. How do you know you have an infection with Chlamydia and what should you do next? Read further!


Chlamydia is a sexually transmitted infection with the bacteria Chlamydia trachomatis. It represents a global public health concern as it is estimated to infect over 100 million people each year worldwide. It is frequent in sexually active young adults with the ages between 18 and 26 years old, with an equal distribution amongst women and men. Left untreated it can cause many complications and increase the risks of acquiring HIV.


Chlamydia can be transmitted through:

  • Direct contact between two individuals during sexual intercourse: vaginal, anal, oral

  • Direct contact with an infected cervical canal during birth


Risk factors

  • Young age: below 25 years old (as studies show that young age is correlated with a riskier sexual life)

  • Previous infection with Chlamydia or other STIs

  • Inconsistent condom use

  • New or multiple partners

  • A partner with an existent infection with Chlamydia



The infection with Chlamydia can be classified depending on the infected region: anogenital (anal and genital area), urogenital (urinary and genital area) and pharyngeal (pharynx) chlamydia


Urogenital infections


Symptoms in women

  • Up to 95% of infections do not show any symptoms

  • Vaginal discharge

  • Dysuria (pain during urination)

  • Frequent urination

  • Bleeding after sexual intercourse or between menstruations

  • Urethritis (inflammation of the urethra - the small tube that is connected to the bladder and which the urine passes through)

  • Abdominal or lower abdominal pain

  • Endocervical ulcers (the cervix presents pink spots on the surface as patches of the mucous membrane are shedding)

  • Cervical edema (swelling)

  • Cervical friability (the cervix becomes oversensitive and easily irritable)

  • Cervicitis (cervical inflammation) accompanied by discharge of mucus or bleeding


When undetected and left untreated, the bacteria travels across the cervix and uterus towards the upper genital tract where it can develop complications such as:

  • ectopic pregnancy: nearly 10% of first pregnancies after pelvic inflammatory disease are ectopic

  • Tubal infertility: infertility caused by affected fallopian tubes

  • PID (pelvic inflammatory disease); studies show that up to 30% of women with untreated urogenital Chlamydia infections developed PID

  • Chronic pelvic pain

  • SARA: Sexually Acquired Reactive Arthritis (combination of urethritis, conjunctivitis and arthritis - swelling and sensitivity in joints); below 1% risks of developing

  • Fitz-Hugh-Curtis syndrome: rare condition when Pelvic Inflammatory Disease causes swelling of the tissues around the liver (perihepatitis)


Symptoms of PID (pelvic inflammatory disease)

  • Lower abdominal pain and sensitivity

  • Sensitivity during vaginal examination

  • Dyspareunia (painful intercourse)

  • Abnormal bleeding: between menstruations, after intercourse and menorrhagia (heavy or prolonged menstrual bleeding) as a result of associated cervicitis (inflammation of the cervix), endometritis (inflammation of the endometrium - the inner lining of the uterus) or bacterial vaginosis

  • Fever (more than 38C)


Symptoms in men

  • Up to 100% of infections do not show any symptoms

  • Dysuria (pain during urination)

  • Urethritis (inflammation of the urethra - the small tube that is connected to the bladder and which the urine passes through)

  • Urethral discharge

  • Testicular pain


When undetected and left untreated the bacteria travels across the urethra towards the upper genital tract where it can develop complications such as

  • SARA (sexually acquired reactive arthritis - swelling and sensitivity in joints)

  • Epididymitis (inflammation of the epididymis, a tube located at the back of the testicle that is in charge with carrying sperm)

  • Epididymo-orchitis (inflammation of the epididymis and the testicles)

  • Indirect effect on fertility as the infection with Chlamydia can influence the sperm production, development and movement



Rectal infections

  • Infections with Chlamydia acquired during anal sex

  • Usually it does not present any symptoms

  • Symptoms that can appear: anal discharge, anorectal discomfort and further development into proctocolitis (inflammation of the rectum and colon- components of the intestines)

  • rates of infection in MSM (men who have sex with men) are up to 10%

  • Rates of infection in women are up to 8% and 95% of infected women present an urogenital infection as well



Pharyngeal infections (infection of the pharynx, part of the throat behind the mouth and nasal cavity)

  • Infection with Chlamydia acquired during oral sex

  • Usually it does not present any symptoms, but sometimes a sore throat can happen



Ocular (eye) infections

  • Neonates (newborn babies) and adults can get ocular infections with Chlamydia and if left untreated the infection can develop into a chronic conjunctivitis (inflammation of the conjunctive, the layer that covers the white part of the eyeball)



Neonatal (newborn) infections

  • Infants that are born through an infected cervical canal can develop conjunctivitis and pneumonia (inflammation of the air sacs of the lungs)

  • Chlamydial pneumonitis (inflammation of lung tissue) occurs in 30% of babies exposed to chlamydia, therefore every women should undergo screening for Chlamydia in the first trimester of pregnancy and in the third trimester (for high risk women)

  • The risk or neonatal infections from infected mothers is up to 75%

  • Chlamydial infections are linked to preterm birth and low-birth-weight as well



When should you get tested for Chlamydia? Recommendations available for all sexual orientations and practices


Women

  • When you have one of the risk factors mentioned above

  • You have cervical or vaginal discharge (discharge is normal and healthy process, but when the color, smell or quantity of discharge modifies, it may be a sign of infection)

  • Acute pelvic pain or symptoms of PID

  • Conjunctivitis (inflammation of the conjunctive, the layer that covers the white part of the eyeball)

  • You are diagnosed with other STIs

  • You had sexual contact with a person with an STI or PID

  • Termination of pregnancy

  • Intrauterine interventions (surgery or treatments at a uterine level)

  • Pregnancy

  • Commercial sex work

  • Being in prison


Men

  • When you have one of the risk factors mentioned above

  • Symptoms of urethritis, epididymo-orchitis (when the you are younger than 40 years old), or proctocolitis (inflammation of the rectum and colon)

  • Acute pelvic pain or symptoms of PID (pelvic inflammatory disease)

  • Conjunctivitis

  • You are diagnosed with other STIs

  • You had sexual contact with a person with an STI or PID

  • Commercial sex work

  • Being in prison


How often should you get tested?

  • Sexually active young (< 25 years of age) women and men should undergo annual testing and without regards of age for MSM (men who have sex with men)

  • Women and men that tested positive for Chlamydia should repeat the test in 3-6 months as reinfection is common (within a year reinfection occurs in one in five people)


What should you do if you tested positive for Chlamydia infection?

  • Follow the doctor’s recommendations for treatment

  • Test yourself for other STIs, such as gonorrhea, syphilis and HIV

  • Inform current and previous partners that you were in contact with in the previous 60 days

  • Abstain from sexual intercourse for seven days after the end of the treatment


Screening

  • Screening and diagnosing can be conducted by analyzing samples taken from cervix, vagina, anus, throat, or urine; many times the patients can collect themselves samples by using home test kits that contain a swab for collection and send them to certified clinics

  • Recurring testing is necessary, as early detection and treatment can prevent further complications such as reproductive issues, especially in women

  • Studies show that screening for Chlamydia infections decreased the development of new cases of PID

  • It is a cost effective measure as it prevents developing complications that result in hospitalization and costly services

  • Increasing access to testing, diagnostic methods, treatment and follow-up with Chlamydia positive patients is crucial in order to control its spread


Treatment

Currently, antibiotics are the only treatment available, prescribed by doctors, upon screening. We are expecting more treatment options hopefully in the near future, as the high rates of re-infection create pressure of developing a Chlamydia vaccine. A vaccine against the infection with Chlamydia has been tested in numerous trials in the last 70 years, but unfortunately, without any promising results.

But we are keeping our hopes up, as in the past 10 years around 12 vaccines studies per year have been conducted. In the meantime, let’s stay safe and test ourselves.



Be smart. Be (c)LIT. Fly with us!🌺🐝


Sources:

https://pubmed.ncbi.nlm.nih.gov/26608577/

https://pubmed.ncbi.nlm.nih.gov/28225683/

https://www.frontiersin.org/articles/10.3389/fmicb.2019.00070/full


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