Chlamydia trachomatis is the most common sexually transmitted disease (STD) in the world. Most patients infected with this bacteria are asymptomatic, but when symptoms occur, the clinical manifestations are very similar to those of gonorrhea, being impossible to distinguish both infections solely by their symptoms.
Chlamydial infections in women can lead to serious consequences, including pelvic inflammatory disease (PID), infertility and ectopic pregnancy.
Since chlamydia is an infection transmitted through sexual intercourse, the most effective way to prevent it – besides sexual abstinence – is through safe sex, with the use of condom.
In this article we will address the following points about chlamydia:
- What is Chlamydia trachomatis.
- Signs and symptoms.
- Possible Complications.
- Lymphogranuloma venereum.
What is Clamydia?
Chlamydia is a sexually transmitted disease caused by bacteria called Chlamydia trachomatis. Not all people infected with chlamydia have symptoms, so the infection can go unnoticed for many years. Patients with asymptomatic chlamydia may become frequent and undetectable sources of transmission, which is why chlamydia is the most common STD in the world.
Almost 3 million Americans are infected with chlamidia every year. It is estimated that 5% of adults and 10% of sexually active adolescents are infected with Chlamydia trachomatis.
Chlamydia infection is more common in teenagers, people who have had multiple partners in the past few years or people who do not usually use condoms during sex.
Chlamydia trachomatis can be transmitted in two ways: you can get chlamydia by having vaginal, anal, or oral sex with someone infected, or from mother to child, during the baby’s passage through the vaginal canal at the time of birth.
As in gonorrhea, adults and adolescents transmission is exclusively through sexual intercourse. No chlamydia is found in public restrooms or swimming pools. Kissing is also not a form of chlamydia transmission.
Transmission through towels or underwear has not yet been proven, but it is theoretically possible if there is contact with fresh contaminated secretions. For example, if a woman with vaginal discharge contaminates a towel and another person immediately uses it to dry the genital area, transmission may occur. This, however, is a very hypothetical situation. What we see in the real world is the sexual pathway as the only relevant form of transmission of this STD among adults.
Contamination of the eyes by chlamydia can occur if the hands are contaminated with vaginal secretions, and the individual scratches the eyes.
As already mentioned, the majority of patients infected with chlamydia do not show signs of the disease. Only 10% of the women develop symptoms; in men, the number is slightly higher, around 30%. However, it is worth pointing out that even without symptoms, the infected patient is able to transmit the disease.
When the patient develops symptoms, they usually appear one to three weeks after the contamination.
In women, the main symptoms of Chlamydia trachomatis infection are:
- Vaginal discharge.
- Vaginal itching.
- Vaginal bleeding
- Abdominal pain.
- Dyspareunia (painful sexual intercourse).
- Dysuria (painful urination).
In men, the most common symptoms of chlamydia include:
- Dysuria (painful urination).
- Purulent urethral discharge.
- Scrotal swelling.
- Testicle pain.
- Proctitis (inflammation of the anus).
Chlamydial pharyngitis is an uncommon condition, but may occur if the route of transmission is oral sex
The complications of Chlamydia trachomatis infection are more frequent in asymptomatic patients. When a person has symptoms, he seeks medical treatment and ends up being cured. On the other hand, if the patient does not know that he has clamidia, the infection can go on unnoticed for months, even years, and complications may arise.
The main complication of chlamydia in women is pelvic inflammatory disease (PID), a severe infection of the female reproductive organs, namely the uterus, Fallopian tubes, and ovaries. About 10 to 15% of women with untreated cases of Chlamydia trachomatis develop PID.
Infertility is also a common complication of untreated chlamydia, and occurs due to injury of the fallopian tubes and the uterus due to prolonged infection.
Women co-infected with Chlamydia trachomatis (especially serotype G) and HPV present a six-fold increase in the risk for cervical cancer.
In pregnant women, chlamydial infections can lead to premature delivery. Babies born to infected mothers can become infected and develop early complications. Chlamydia is one of the main causes of pneumonia and conjunctivitis in newborns.
In men, the most common complication is prostatitis, an infection of the prostate. Epididymitis, i.e. the infection of the epididymis – is a tube that connects a testicle to a vas deferens -, can also occur.
There are some serotypes of chlamydia, called L1, L2 and L3, that can cause a disease called lymphogranuloma venereum (LGV), a different STD, with different manifestations.
In lymphogranuloma venereum, the initial infection is characterized by a small nodule that ruptures and forms a genital ulcer. These lesions spontaneously heal within a few days. However, two to six weeks later, the infection spreads to the regional lymph nodes, that is, to the lymph nodes of the groin. The patient then develops one or more enlarged lymph nodes, called buboes. These buboes can rupture, draining large amounts of pus.
The best diagnostic test for chlamydial infection is nucleic acid amplification testing (NAAT) of vaginal swabs or first-catch urine. Rectal chlamydial infection in persons who engage in receptive anal intercourse can be diagnosed by testing a rectal swab specimen. The results are generally available within 48 hours.
The treatment is simple and chlamydia can be easily cured with antibiotics. A single 1000 mg dose of azithromycin is the best option. The patient should abstain from sexual activity for at least 7 days. All partners should be tested and, if necessary, treated for chlamydia, even if they do not present symptoms.
Another effective antibiotic regimen is Doxycycline 100 mg twice daily for seven days. This is the best choice for patients with lymphogranuloma venereum or anal chlamydia infection.
Doxycycline is contraindicated during pregnancy; the preferred agent is azithromycin.
It is possible to have chlamydia more than once. Previous chlamydial infection does not confer immunity.