Chlamydia

What is Chlamydia?

Chlamydia is a sexually transmitted disease caused by a bacterium named Chlamydia trachomatis. In the US, it is the bacterial infection reported most often. Around the world, it’s the most common infection spread through sexual contact. This bacterium can also cause an eye infection known as “trachoma,” which is the main infection-related cause of blindness around the globe.

In women, this bacterium usually infects the cervix. The infection can lead to multiple health problems, including cervicitis (an inflammation of the cervix), urethritis, pelvic inflammatory disease, perihepatitis, or proctitis. Untreated chlamydial infections in women can increase the risk of infertility and ectopic pregnancy, resulting in high medical costs. There are also associated risks during pregnancy. Infants born naturally to mothers with genital Chlamydia trachomatis can develop an eye infection (conjunctivitis) or pneumonia.

In men, the infection can result in urethritis, inflammation in the epididymis (epididymitis), inflammation of the prostate (prostatitis), proctitis, or reactive arthritis. Men and women with this infection might encounter conjunctivitis, a sore throat (pharyngitis), and a condition called lymphogranuloma venereum. This condition, also known as LGV and caused by specific types of Chlamydia trachomatis, can lead to swollen lymph nodes or severe inflammation in the rectum and colon. It is, however, less common.

What Causes Chlamydia?

Chlamydia trachomatis is a type of bacteria known as chlamydophila. These bacteria are particular in their lifestyle – they can’t live outside of other cells and, once inside, they multiply. There are 18 different strains of C. trachomatis, each known as a serovar. We identify these strains based on tests using special antibodies.

Different serovars are associated with different health problems. For example, serovars A, B, Ba, and C cause trachoma, a severe eye disease common in Africa and Asia. This disease causes long-term inflammation of the eye’s outer covering and can eventually lead to blindness.

Serovars D through K can cause infections in the genital tract or in newborn babies. And serovars L1 to L3 are tied to a condition called lymphogranuloma venereum (LGV). This disease, which causes sores in the genital area, is common in tropical countries.

Risk Factors and Frequency for Chlamydia

Urogenital chlamydia infections, which are infections in the reproductive and urinary systems, are the most commonly reported bacterial infections in the United States. Additionally, these infections are considered the most common of sexually transmitted infections worldwide. The rate of these infections is twice as high in women as it is in men in the United States. The age group that sees the most cases in women is 15 to 24 years old, while for men, it’s 20 to 24 years old.

Signs and Symptoms of Chlamydia

The bacterium C. trachomatis can lead to various infections in the urinary and genital systems, including inflammation of the cervix, pelvic area, urethra, testicles, prostate, and a sexually transmitted infection known as lymphogranuloma venereum. It can also cause infections outside the genital region, including conjunctivitis (eye infection), perihepatitis (liver membrane inflammation), a sore throat, reactive arthritis (joint inflammation), and proctitis (rectal inflammation). Often, people carrying this bacterium have no symptoms and unknowingly spread the disease.

The symptoms that do emerge depend on where in the body the infection is located. Here are some common symptoms related to specific C. trachomatis infections:

• Cervicitis (inflammation of the cervix): Most women have no symptoms, or only mild ones such as vaginal discharge, bleeding, abdominal pain, and painful urination. In rare cases, a woman may experience bleeding after intercourse or between menstrual periods.
• Pelvic Inflammatory Disease: This occurs when C. trachomatis moves up into the upper reproductive tract. Symptoms may include abdominal or pelvic pain, nausea, vomiting, fevers, chills, lower back pain, pain during intercourse, or bleeding after intercourse.
• Urethritis (inflammation of the urethra): Most commonly seen in men and characterized by painful urination and discharge from the penis, which is usually white or gray. Women may also have these symptoms but mistake them for a urinary tract infection.
• Perihepatitis (Fitz-Hugh-Curtis syndrome): The bacterium inflames the liver’s outer tissue and nearby peritoneal surfaces, causing right upper abdominal pain.
• Epididymitis (inflammation of the tube carrying sperm): Typically, men with this condition experience pain and swelling in one testicle, possibly accompanied by a fever.
• Proctitis (inflammation of the rectum): This may cause rectal pain, discharge, and bleeding, especially following receptive anal intercourse. Other symptoms may include fever or fatigue.
• Prostatitis (inflammation of the prostate): Symptoms include painful urination, urinary problems, pelvic pain, and pain during ejaculation.
• Reactive Arthritis: A condition that occurs in approximately 1% of men with urethritis from chlamydial infection and includes arthritis, urethritis, and eye inflammation.
• Conjunctivitis: Genital secretions infected with the bacterium can lead to eye infection, characterized by non-purulent conjunctivitis (redness and inflammation of the eye’s outer layer).
• Pneumonia: Infants born to mothers infected with C. trachomatis may develop pneumonia 5-30% of the time.
• Pharyngitis: While not a significant cause, C. trachomatis can be detected in cases of pharyngitis (sore throat).
• Lymphogranuloma Venereum: This sexually transmitted disease often starts with painless genital ulcers and progresses to swollen lymph nodes in the groin area.

Testing for Chlamydia

Among infections caused by C. trachomatis bacterium, only trachoma, an eye infection, can be identified without laboratory tests. For all other chlamydia related infections, lab tests are necessary to confirm the diagnosis.

The most reliable test for diagnosing chlamydia in the urinary tract is called nucleic acid amplification testing (NAAT). For women, the test uses samples from a swab of the vagina. For men, a urine sample is used. The swabs used to take samples from the cervix or urethra should have a wire or plastic handle, and the tip should be made of specific materials such as dacron, rayon or a cytobrush. Using other materials could interfere with the chlamydia bacterium, making the test ineffective.

There are also other ways of testing for chlamydia, such as culture, rapid testing, serology, antigen detection, and genetic probes. However, in cases where testing is unavailable, treatments are prescribed based on the signs and symptoms.

When someone shows symptoms of a chlamydia infection, they should also be tested for other sexually transmitted diseases (STDs). If Pelvic Inflammatory Disease (PID) is suspected, a complete blood count is essential. You might also consider getting tested for HIV, gonorrhea, and syphilis. It’s also important to test the sexual partner for chlamydia. Additionally, a pregnancy test should be done as pregnancy prevents the use of doxycycline, a common treatment for chlamydia.

Cytology, the study of cells, can be useful for patients with conjunctivitis and ocular trachoma. Cultures, another type of test, is usually not done for chlamydia since it’s hard to grow the bacteria in a lab. However, for patients with anal and rectal infections, cultures are the best option since other tests might not give accurate results.

The United States Preventive Services Task Force (USPSTF) advises that all sexually active women get regular screenings for chlamydia. This is because untreated chlamydia is linked with PID, infertility, and chronic pelvic pain. For men, a leucocyte esterase test could be performed on a urine sample when no urinary tract infection is present, to diagnose either gonorrhea or chlamydia.

Treatment Options for Chlamydia

The goal of treating chlamydia, a sexually transmitted infection, is to prevent further complications like Pelvic Inflammatory Disease (PID) and infertility, reduce the risk of spreading the infection, and alleviate symptoms. The usual treatment for uncomplicated urogenital chlamydia infection is azithromycin, which is preferred as it is a single-dose therapy. However, other options such as doxycycline, erythromycin, levofloxacin, and ofloxacin can also be used if needed.

It’s important to note that chlamydia infection often occurs alongside gonorrhea in men. The decision to co-treat for urogenital gonococcal infection should be based on whether the organism is detected in specialized lab tests or in a microscopic examination. The process is slightly different for women, as the microscopic examination is less effective due to the possibility of normal Neisseria species colonization within the vaginal flora. In these cases, co-treatment should be based on an assessment of the individual patient’s risk and the local rate of gonorrhea infections.

Patients should be encouraged to get their partners tested and receive counseling on behaviors that could lead to higher risk of infection. Patients should also avoid sexual activity for at least one week after starting treatment and consider getting tested for HIV.

It’s important to confirm that the treatment worked by testing again three weeks after completion of treatment. Retesting three months after treatment is also recommended.

If symptoms continue after treatment, other infections or a repeat chlamydia infection could be the cause.

Follow-up testing is usually not necessary in most people, but it might be considered in pregnant women to ensure the bacteria is gone.

What else can Chlamydia be?

Chlamydia trachomatis, a type of bacterial infection, can cause a wide variety of health issues. As a result, when diagnosing symptoms that could be caused by this infection, doctors should also consider other health conditions that can cause similar symptoms in different areas of the body.

For instance:

• If a patient experiences a burning sensation while urinating, they might also be suffering from Gonorrhea, Genital herpes, or a Urinary tract infection.
• Abdominal pain could be due to issues unrelated to Chlamydia, such as Appendicitis, Gallbladder inflammation (Cholecystitis), or Constipation.
• When a patient has pelvic pain, other conditions to consider might include Endometriosis, Ovarian cysts, or Adenomyosis (a condition where endometrial tissue grows into the muscular walls of the uterus).
• In the case a patient presents with vaginal discharge, doctors would also consider Bacterial vaginosis, Trichomonas vaginalis, Gonorrhea, Yeast infection (Vaginal candidiasis), foreign objects presence, or other infections such as Mycoplasma genitalium and Ureaplasma.
• If rectal discharge is reported, Inflammatory bowel disease and Gonorrhea could be potential health concerns.
• For Conjunctivitis or ‘pink eye’, a Viral infection, Allergies, or a Gonococcal infection might be the culprits.
• Postcoital or intermenstrual bleeding could also indicate serious conditions like Cervical cancer, polyps in the cervix or the endometrium, Cervical ectropion (where inner lining of the cervix protrudes out and comes in contact with the vagina), Leiomyoma (a type of benign tumor), or Pregnancy.
• Lastly, when Genital ulceration is present, a physician might also check for other sexually transmitted diseases such as Herpes simplex, Syphilis, Chancroid, or Granuloma inguinale.

In conclusion, a range of conditions could mimic symptoms associated with Chlamydia trachomatis, so a thorough evaluation needs to be carried out to arrive at the right diagnosis.

What to expect with Chlamydia

Antibiotics are effective in treating diseases about 95% of the time on the first try. The chances of recovery are excellent if treatment starts promptly and the patient takes all the prescribed antibiotics. Failure and relapse during the first round of treatment are uncommon, but reinfection can occur. This usually happens if a sexual partner is infected and hasn’t been treated, or if the patient gets the disease from a new partner.

Death from these conditions is very rare but can happen if the infection progresses to inflicts the fallopian tubes and creates an abscess, a painful, pus-filled lump that can rupture and cause a condition called peritonitis. Repeated chlamydia infections are particularly risky, as they can cause the fallopian tubes to scar, which can lead to the person being unable to have children.

Possible Complications When Diagnosed with Chlamydia

Pelvic inflammatory disease can make it more likely for a woman to have an ectopic pregnancy, which is when a fertilized egg starts to grow outside the uterus. This disease can also cause inflammation and scarring in the female reproductive system, which can result in fertility problems or ongoing pelvic pain. If a woman gets a chlamydial infection while she is pregnant, it can increase the risk of her water breaking prematurely, also known as prelabour rupture of membranes (PROM) or premature prelabour rupture of membranes (PPROM), and it can lead to a preterm delivery, which is when the baby comes before its due date.

Preventing Chlamydia

Infection with Chlamydia trachomatis often shows no symptoms but can lead to serious problems if not detected and treated. That’s why doctors recommend regular checks for this infection. Pregnant women should be tested for this Chlamydia trachomatis. Women under the age of 25 who are sexually active should have yearly exams. If they are over 25, they should still get tested if they are at a higher risk for catching sexually transmitted infections (STIs). This includes those with multiple sexual partners, new sexual partners, those who don’t always use condoms in a non-monogamous relationship, those who exchange sex for money or drugs, or have another STI. Men who have sex with men are also advised to be checked for this chlamydia strain.

People with HIV should be checked when they first get diagnosed and then once a year after that. If a person is moving into a prison, women 35 and younger, and men 30 and younger should be tested for the infection.

In the United States, Chlamydia trachomatis is categorized as a disease that needs to be reported. Local and state laws may require people with this infection to inform their sexual partners. The partners need to get tested and treated if necessary. Some places may allow doctors to prescribe medication to the partners without seeing them as patients.

Patients need to know how severe a chlamydia infection can be and how crucial testing is. They should understand that testing can often be done simply and painlessly with a urine sample. Once patients are informed about the process, they may be more willing to get tested even if they initially feared it would be an unpleasant experience.