Chlamydia. T
A sexually transmitted infection that is caused by the bacteria Chlamydia trachomatis. It can be categorised by uncomplicated- not affecting the upper genital tract and complicated- infection has spread to the upper genital tract. It is spread through sex or contact with infected genital fluids eg. semen, vaginal fluid.
-
According to the NICE guidelines in 2018 and 2019, studies found in the UK that the rate of diagnosis was highest in age groups 15-24 years old
Chlamydia is the most common bacterial sexually transmitted infection according to the WHO
There was an estimated 127 million new cases of chlamydia in 2016 recorded by the WHO [1]
According to the Centre of Disease Control, 1 in 20 sexually active young women aged 14-24 years has chlamydia
Studies found that the risk of transmission of infection from one episode of sexual intercourse is approx 10-20% [2]
-
Unprotected vaginal, anal or oral sex
Sharing sex toys that are not cleaned or covered before use
Contact between genitals
Infected bodily fluids like semen or vaginal fluid getting into the eye
Can be passed from pregnant woman to foetus
Prevention can include using condoms and being in a relationship with one partner who has been tested for chlamydia [4,5]
-
Medical Student
Chlamydia trachomatis is a Gram-negative, anaerobic, obligate intracellular bacterium.
It infects eukaryotic cells, specifically squamocolumnar epithelial cells found in:
The endocervix and upper genital tract (women)
The urethra and rectum (both sexes)
Exists in two forms:
Elementary bodies (EBs): metabolically inactive; infectious form that enters host cells
Reticulate bodies (RBs): active, replicative form inside cells
Pathogenesis:
EBs enter host cells and convert into RBs
RBs replicate using host cell nutrients
RBs revert to EBs, which are released when the host cell bursts (lyses)
This cycle causes cell death and tissue damage, promoting spread
Patients
Chlamydia is a common bacterial infection that spreads through sexual contact.
It hides and grows inside the body’s own cells, especially in:
The cervix and fallopian tubes in women
The urethra and rectum in both men and women
The bacteria has two stages:
A “silent” form that enters the body’s cells
An “active” form that multiplies inside the cells
As the bacteria grow, they burst the cells, which can damage tissues and cause symptoms.
If untreated, it can lead to serious complications like infertility or pelvic pain—but it’s easily treated with antibiotics. [3]
-
Younger age (under 25)
Non-white patients hold a higher risk according to 10 of 23 studies in females and one of four studies in males
Having multiple partners increasing the likelihood of pathogen exposure
Failure to use contraceptive devices and barriers eg condoms
Primarily spread through penetrative sex [1,6]
-
Most people don’t notice any symptoms
Symptoms usually appear between 1-3 weeks after unprotected sex and can disappear after a few days
Symptoms in women
At least 70% don’t experience symptoms
Pain when urinating
Vaginal discharge (unusual patterns)
Pain in the stomach/pelvis
Pain during sex
Bleeding post coital (after sex)
Bleeding between period
Can lead to pelvic inflammatory disease- increasing the risk of ectopic pregnancy and infertility
Burning during urination
Symptoms in women
At least 50% don’t experience symptoms
Pain when urinating
White, cloudy discharge from the tip of the penis
Testicular pain
Burning or itching in the tube that carries urine out of the body (urethra)
Can cause welling of the epididymis (tube carrying sperm from the testicles)
Can lead to affected fertility
Other symptoms
Discomfort or discharge from the rectum (back passage)
Can impact the throat but often presents with no symptoms
Redness, pain and discharge in the eyes [4,7]
-
Nucleic acid amplification testing is preferred as it has a higher level of sensitivity (ability to accurately diagnose positive results)
Can be obtained from urine samples or vaginal swabs
Results normally available in 7 to 10 days (UK)
May be required to repeat testing if inital test was done before 2 weeks post exposre due to diagnosis potentially not being made in the early stages
In England, it is recommended under the National Chlamydia Screening Programme:
Under 25 year old men and women are tested once a year
Sexually active without barrier protection (eg condoms)
After intercourse with new partners. [4]
-
Other sexually transmitted infections:
Bacterial vaginosis
Gonorrhoea
Vaginal candidiasis (fungal)
Trichomonas vaginitis
Pelvic inflammatory disease
Urinary tract infection [1]
-
Medical Student
Doxycycline is the treatment of choice for urogenital chlamydia in adolescents and adults. This is used for 7 days.
A single oral dose of Azithromycin is alternatively used as treatment for those who cannot tolerate doxycyclin, such as pregnant women.
Abstinence is necessary until more than 1 week after treatment and partners must be treated too.
In pregnant women- early intervention such as screening as well as treatment is needed to prevent neonatal chlamydial infections such as conjunctivitis.
Patients
The drug of choice to prevent the growth of bacteria such as Chlamydia is Doxycycline.
This is used for chlamydia affecting the genital and urinary organs in the body amongst adolescents and adults. This is used for 7 days.
A single oral dose of Azithromycin is alternatively used as treatment for those who cannot tolerate doxycyclin, such as pregnant women.
Abstinence (no sex) is necessary until more than 1 week after treatment and partners must be treated too.
In pregnant women- early intervention such as screening as well as treatment is needed to prevent neonatal chlamydial infections (pregnant women with chlamydia can pass the infection onto their feotus) such as conjunctivitis. [8]
-
Pelvic inflammatory disease once the chlamydia spreads to the womb, ovaries or fallopian tubes (female genital organs)
Infertility
Increased risk of ectopic pregnancy (egg implanted outside the womb)
Pelvic pain
Can spread infection to feotus in pregnant women
Inflammation of the testicles due to spread of infection to testicles and epididymis
Reactive arthtitis due to chlamydia causing inflamation of the joints [4]
-
Only women get chlamydia
Chlamydia is self resolving
It can only be spread through vaginal intercourse
You can get chlamydia from surfaces eg toilets
Chlamydia also shows symptoms
You can only get chlamydia if you have multiple partners
Chlamydia is difficult to treat
Chlamydia only affects people once [9,10]
-
How do I know if I have chlamydia if I don’t present with symptoms?
When can I have sex again after treatment?
What can I do to protect myself if I have sex with multiple partners?
What tests need to be done to test for chlamydia?
How long does treatment last?
How can I let my partner(s) know I have chlamydia?
Who should I contact if I suspect that the infection has spread?
-
Centers for Disease Control and Prevention
Terrence Higgins Trust
WHO.int
-
[1] https://cks.nice.org.uk/topics/chlamydia-uncomplicated-genital/background-information/prevalence/
[2] https://www.ncbi.nlm.nih.gov/books/NBK350675/
[3] https://u.osu.edu/kelch.49/pathophysiology-of-chlamydia/
[4] https://www.nhs.uk/conditions/chlamydia/
[5] https://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094865/
[7] https://www.healthline.com/health/std/chlamydia#symptoms
[9] https://familymedicineaustin.com/chlamydia-myths-that-need-to-be-debunked/
[10] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/myths-and-facts-about-chlamydia
Source: SOA Amsterdam
Chlamydia trachomatis
Watery penile discharge in males
Source: SOA Amsterdam
Cervix inflammation (cervicitis) caused by chlamydia found during a pap smear (test to check the cervix)
