In Part I of The ABCs of Sexually Transmitted Diseases series we learned about trichomoniasis – one of the three most common infectious causes of vaginal complaints among reproductive-aged women, the other two being bacterial vaginosis and candida vulvovaginitis. Today, we will explore Chlamydia trachomatis infections, a very commonly reported STD most prevalent in young people ≤ 24 years. Twice as many infections are reported in women compared to men and what is concerning is that most infected persons are asymptomatic.
So what is Chlamydia?
Chlamydia trachomatis is a bacteria that can be sexually transmitted causing infection in the lining of the cervix, rectum, urethra, and non-genital sites such as the eyes, throat, and lungs. Ejaculation does not need to happen for chlamydia to be transmitted between partners. Often, chlamydia can occur as a co-infection with other STDs, especially gonorrhea.
When should you suspect chlamydia?
Most persons remain asymptomatic or develop symptoms several weeks after exposure. Common symptoms in women include:
- Abnormal vaginal discharge (yellow, mucopurulent)
- Vaginal bleeding between periods and often after intercourse
- Urinary symptoms (pain with urination, urinary frequency, etc.)
- Abdominal &/or pelvic pain
- Cervical motion tenderness or adnexal tenderness on a pelvic exam
- Rectal pain and bleeding
How will you know for sure that you are infected?
Diagnosis requires specimen collection e.g., using a vaginal swab with a nucleic acid amplification test (NAAT).
Did you know that the CDC recommends that all sexually active females <25 years of age be screened annually for chlamydial and gonococcal infection? Additionally, all pregnant women <25 years old should be screened for Chlamydia and gonorrhea during the initial prenatal visit.
What other complications are there following infection?
In women and adolescent girls, chlamydial infections can lead to serious consequences including pelvic inflammatory disease (PID), tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. Pregnant infected but untreated women are at high risk of perinatal transmission to their baby during childbirth. Once the infant is exposed they may develop severe neonatal conjunctivitis or pneumonia. Adults may contract conjunctivitis as well as trachoma. These can cause scarring of the eyes resulting in blindness. Another complication of Chlamydia trachomatis is lymphogranuloma venereum which may present as a very painful inguinal or femoral node.
What are your treatment options?
Chlamydial infections are treated with antibiotics. The preferred treatment is azithromycin (Zithromax; 1g single dose) or doxycycline (100mg twice daily for 7 days). If there is a co-infection with gonorrhea, dual therapy will be needed. Azithromycin is safe to use in pregnancy; replacement options are erythromycin and amoxicillin. Your physician will administer a test of cure a few weeks following completion of treatment. Your sexual partners should be notified and treated as soon as possible. Sexual abstinence is recommended during treatment to prevent re-infection.
How can you protect yourself from getting chlamydia?
Untreated STDs can have critical consequences, especially for adolescent girls and women. This may seem a bit selfish – although relationships are meant to be built on trust, when it comes to your health please focus on yourself! Have an open and honest conversation with your partner regarding your sexual medical history.
The only way to avoid chlamydia is sexual abstinence. If you choose to become sexually active you can lower your risk by practicing safe vaginal, anal, and oral sex. Use condoms, have a monogamous relationship, and get tested if you change partners.
If you become infected with chlamydia, remember that it is curable and both you and your partner(s) should get treated! Remember that treated persons may get re-infected if they have sexual contact with an infected individual.
For more information on Chlamydia and other STDs, click HERE.
References
Centers for Disease Control and Prevention. (2021, January 19). Detailed STD Facts – Chlamydia. Centers for Disease Control and Prevention. https://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm.
Mishori, R., McClaskey, E. L., & WinklerPrins, V. (2012, December 15). Chlamydia Trachomatis Infections: Screening, Diagnosis, and Management. American Family Physician. https://www.aafp.org/afp/2012/1215/p1127.html.
