Chlamydia

Chlamydia is a common and curable bacterial sexually transmitted disease (STD). It occurs frequently among sexually active adolescents and young adults. Chlamydia is known as a “silent disease” because symptoms are often absent in most infected women and half of infected men. It can cause irreversible damage, even when symptoms are not present or noticeable, which includes infertility in women and sterility in men. For this reason and the fact that infected mothers can infect their newborns during birth, it is recommended that all sexually active women under the age of 25 get tested annually for Chlamydia.

The bacteria Chlamydia trachomatis causes Chlamydia, and targets the cells of the mucous membranes (the moist layer of tissue lining the respiratory, digestive, urinary, and reproductive tracts). In women it can infect the cervix, vagina, endometrium (mucous membrane that lines the uterus), and the fallopian tubes (tubes in which an egg moves from the ovaries to the uterus). In men the epididymis (tubes that carry sperm from the testis) can be infected. In both men and women the bacteria can infect the rectum, anus, and lining of the eyelid, and less commonly the throat and lungs. Infants infected during childbirth can have infections in their eyes and lungs.

Reporting

Chlamydia is the most common bacterial sexually transmitted disease (STD) in the United States. According to the Center for Disease and Control (CDC), 1,030,911 Chlamydia infections were reported in 2006. (source) However, it is grossly under reported, because many people who are infected do not have symptoms and are not aware they have Chlamydia. It is estimated that nearly 2 million more infections actually occur each year.
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Transmission

Transmission of Chlamydia occurs when the mucous membranes (the moist layer of tissue lining the respiratory, digestive, urinary, and reproductive tracts) come into contact with infected secretions, vaginal fluid, or semen. This most commonly happens during vaginal or anal sex.

Oral sex is not a common cause of transmission, because the Chlamydia bacterium prefers to target the genital area rather than the throat, meaning it is less likely, but still possible, for it to be transmitted through mouth to penis contact. Vulva (the outer female genital area) to mouth and anus to mouth contact has an even lower chance of causing transmission, although both should not be considered risk-free.

Full penetration of the penis or tongue during sexual activity is not required for Chlamydia to be transmitted. As long as the cervix, vagina, penis, anus, or mouth come in contact with infected secretions, vaginal fluid, or semen it is possible to occur.

Women can get Chlamydia in their anus or rectum even if they have not had anal sex. If their vaginal area is infected with the bacteria it can be spread to their anal area, for example, by wiping with toilet paper.

Teenage girls and young women are at a higher risk for Chlamydia transmission from vaginal sex, because their cervix is not fully matured. However, that doesn’t mean anal and oral sex is risk-free for them. Men who have sex with other men are also at risk from anal and oral sex. Women who engage in oral sex or vulva to vulva contact are also at risk.

If an eye comes in contact with infected secretions, vaginal fluid, or semen, an eye infection can occur. The contact can be the result of discharge during sexual activity into the eye or a hand moist with infected fluids touching the eye. However, Chlamydia can not be transmitted through shaking hands, toilet seats, or door knobs.

An infected woman who is pregnant can transmit Chlamydia to her baby during birth when the baby passes through her infected birth canal. Infection in newborns can cause eye infections, pneumonia, or even death. Chlamydia infections in children can be a sign of possible sexual abuse.

Being treated and cured of Chlamydia does not make a person immune to re-infection. A person who has been cured can be re-infected if he or she is exposed to it again.
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Symptoms

Chlamydia is known as a “silent” disease because most of infected women and half of infected men do not experience any symptoms. When symptoms do occur, they usually happen within one to two weeks after exposure.

When women are exposed vaginally, the Chlamydia bacteria will initially infect the cervix and the urethra (urine canal). If symptoms occur at this stage, they can be experienced as an abnormal vaginal discharge (mucus or pus) that may have an odor, a need to pass urine more often and/or a burning sensation when urinating, or itching and burning in or around the vagina. When the bacteria spreads from the cervix to fallopian tubes (tubes in which an egg moves from the ovaries to the uterus) and infects them, some women still have no symptoms. Those who do have symptoms may also experience painful menstrual periods, pain during vaginal sex, bleeding between menstrual periods, lower abdominal and/or lower back pain, fever, or nausea.

Men who have symptoms may experience a penile discharge that can be a thick yellow-white, watery or cloudy fluid, a burning sensation when urinating, or itching and burning around the opening of the penis. If the infection spreads to the epididymis (tubes that carry sperm from the testis), pain and swelling around the testicles or pain and swelling of the testicles could occur.

Both men and women who have received anal sex may develop a rectal infection of Chlamydia. A rectal infection can cause proctitis (inflamed rectum), experienced as rectal pain, discharge, and/or bleeding. Men and women who perform oral sex on an infected partner may experience soreness and redness in the mouth or throat. Another possible symptom both men and woman may have is conjunctivitis (pink eye), experienced as inflammation of the lining of the eye, if an eye has become infected.

Symptoms in infected infants may include conjunctivitis or pneumonia.
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Testing / Diagnosis

Laboratory tests are used to diagnose Chlamydia. Testing is done on a specimen taken with a swab from the infected area (usually penis or cervix) or a urine sample. It may be helpful to speak to a health care provider to find out what testing options are available.

It is recommended that all women under the age of 25 get tested at least once a year. Older women should also be tested annually if they have a new sexual partner, multiple sexual partners, sexual partners who have other sexual partners, or do not use protection when sexually active. Pregnant women should be tested to avoid the complications that Chlamydia can cause in pregnancy. Women who are experiencing abnormal vaginal discharge and adnominal pain or have an infected cervix should get tested. Men who are experiencing penile discharge, frequent need to urinate, inflammation of the prostate gland, or inflammation involving the anus or rectum should also get tested.

Chlamydia will show up on tests a few days after exposure and often before symptoms occur. Since the symptoms of Chlamydia are similar to the symptoms of gonorrhea, testing is generally done simultaneously for both.
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Treatment

Chlamydia can be treated and cured with the antibiotics azithromycin or doxycyline. Women who have a severe infection may require more aggressive treatment that includes hospitalization, intravenous antibiotics, and pain medication.

It is recommended that all sexual partners also be tested and treated if infected. Women should particularly make sure sexual partner(s) are appropriately treated, because women who have multiple Chlamydia infections increase their risk of serious reproductive health complications.

The infection should clear up in a week or two with treatment. Testing to make sure the infection is cured is recommended, particularly if sexual partner(s) have not been tested or treated. Sex should be avoided with those who refuse to get tested and treated and while undergoing treatment.
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Complications

In women, Chlamydia infections left untreated can spread through the uterus to the fallopian tubes (tubes in which an egg moves from the ovaries to the uterus) and cause salpingitis (inflammation of the fallopian tubes), a painful condition that can result in infertility and ectopic pregnancy (pregnancy outside the uterus that can be potentially fatal). If the infection spreads to the whole reproductive system, pelvic inflammatory disease (PID) can occur. PID can permanently damage the fallopian tubes, uterus, and surrounding tissue. This damage can lead to chronic pelvic pain, and also infertility or ectopic pregnancy.

Untreated Chlamydia in women can also cause premature births, and the infection can be passed on to the newborn during birth. Other complications include cystitis (inflammation of the urinary bladder) and mucopurulent cervicitis, a condition characterized by a yellow discharge from the cervix.

Complications are uncommon for men, but not unheard of. Untreated Chlamydia can cause epididymitis (inflammation of the epididymis, a tube that carries sperm from the testis), causing pain, fever, and sterility. It can also cause prostatitis (inflammation of the prostate gland) and scarring of the urethra (urine canal).

In both men and women untreated Chlamydia infections can lead to Reiter’s Syndrome (RS). RS symptoms include arthritis, skin lesions, inflammation of the eyes, and urinary tract problems.

Leaving Chlamydia infections untreated in infants can lead to blindness and pneumonia, which can cause death.
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Prevention

Abstaining from sexual contact is the surest way to avoid the transmission of Chlamydia. A mutual monogamous relationship with a trusted partner known to be tested and uninfected is another way.

Correctly using latex condoms during vaginal or anal sex can reduce the risk of transmission. Correctly using a condom can also reduce the risk of transmission during oral sex (mouth to penis). For other forms of oral sex (mouth to vulva, the outer female genital area, or oral to anal, also known as rimming) using a dental dam, plastic wrap, or a latex condom cut up and opened flat are risk reducers.

It is recommended to use latex condoms or any of the above methods at the very beginning of sexual contact, because transmission of Chlamydia can occur even if the penis or tongue do not fully penetrate the vagina, rectum, or mouth. To best keep the risk of transmission low, the protection used should be kept on till there is no longer any skin contact.
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