Chlamydia

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What is Chlamydia
Symptoms of Chlamydia
Causes of Chlamydia
Testing for Chlamydia
Treating Chlamydia
Complications of Chlamydia
Preventing Chlamydia

What is Chlamydia
Chlamydia is a sexually transmitted infection (STI) caused by the bacterium chlamydia trachomatis. In the UK, the number of new diagnoses has been steadily increasing each year since the mid-1990s, and it has now become the most commonly diagnosed STI.
Chlamydia is called the ‘silent’ disease because most people who get it do not experience any noticeable symptoms. Around 50% of men and 70-80% of women who get the chlamydia infection will have no symptoms and many cases of chlamydia remain undiagnosed.

How common is it?
Between 2007 and 2008, the number of confirmed cases of chlamydia rose from 121,791 to 123,018. Young people under 25 are most likely to be infected, 65% (80,258) of all new chlamydia diagnoses made in 2008 were in people between the ages of 16 and 24.

Outlook
The chlamydia infection can be easily diagnosed through a simple swab or urine test, once diagnosed it can be treated with antibiotics. Undiagnosed chlamydia can lead to more serious long term health problems and infertility.
Under 25s can get a free, confidential chlamydia test through the National Chlamydia Screening Programme. People over 25 can visit their GP or a local GUM (genitourinary medicine) or sexual health clinic to arrange a test.

Symptoms of chlamydia 
Chlamydia often goes unnoticed due to the lack of noticeable symptoms. Because of this, many cases of chlamydia remain undiagnosed.
Women
In women, genital chlamydia does not always cause symptoms. Signs and symptoms can appear 1-3 weeks after coming in contact with chlamydia, many months later or not until the infection has spread to other parts of your body.

Some women may notice:

• Cystitis (pain when passing urine),
• a change in their vaginal discharge,
• lower abdominal pain,
• pain and/or bleeding during sexual intercourse,
• bleeding after sex, or
• bleeding between periods or heavier periods.

If left untreated the chlamydial infection can spread to the womb, and cause Pelvic Inflammatory Disease (PID). PID is a major cause of infertility, ectopic pregnancy and miscarriage.

Men
Symptoms of genital chlamydia are more common in men than in women. Signs and symptoms can appear 1-3 weeks after coming in contact with chlamydia, many months later or not until the infection has spread to other parts of your body.

Some men may notice:

• a white, cloudy or watery discharge from the tip of the penis,
• pain when passing urine, or
• pain in the tesiticles.

Some men experience mild symptoms that disappear after two or three days. However, after the discomfort disappears, you may still have the chlamydia infection. This means that you can pass it on to a sexual partner and you are at risk of complications such as inflamed and swollen testicles, reactive arthritis and infertility.

Men and women
Very rarely the chlamydia infection may affect areas other than the genitals in both men and women, such as the rectum, eyes or throat.
If the infection is in the rectum it can cause some discomfort and discharge. In the eyes it can cause pain, swelling, irritation and discharge (conjunctivitis). Infection in the throat is very rare and does not usually cause any symptoms.

Causes of chlamydia 
As chlamydia is a sexually transmitted infection (STI), it is transmitted (passed on) from one person to another during intimate sexual contact. You can catch chlamydia through having:

• unprotected vaginal sex,
• unprotected anal sex,
• unprotected oral sex,
• genital contact with an infected partner, or
• sharing sex toys if they are not washed or covered with a condom each time they are used.

If infected semen or vaginal fluid comes into contact with the eye, it can cause conjunctivitis.
It is not clear whether chlamydia infection can be spread by transferring infected semen or vaginal fluid on the fingers or by rubbing female genitals (vulvas) together.
As it is common for someone with the chlamydia infection not to have symptoms, it is possible for him or her to infect a partner without knowing.
Chlamydia can be passed from a mother to her baby during childbirth. Although no obvious symptoms are immediately apparent, the infection will often develop after birth, and can result in complications such as inflammation and discharge in the baby’s eyes (conjunctivitis) and pneumonia.

Testing for Chlamydia
The only way to be certain that you have chlamydia is to be tested. If you suspect you could have chlamydia, it is important not to put off having a test done.
Early diagnosis and treatment of chlamydia will reduce the risk of any complications developing. Complications that arise from long-term chlamydial infection are much more difficult to treat.
The accuracy of chlamydia testing depends on what kind of test is used. Recommended tests are over 90% accurate in picking up the infection, shop bought tests may be less reliable.
There are different ways to test for chlamydia:

Women
Women can be tested for chlamydia by taking a swab from the cervix (neck of the womb) or using a urine sample.
In recent years tests have been developed that allow women to carry them out at home, by using a urine sample, or by taking a swab themselves from the lower vagina. The sample is put into a container and sent to a laboratory to be tested.
Routine cervical screening tests do not detect chlamydia. Ask your doctor or nurse if you also wish to be tested for chlamydia.

Men
In the past, the chlamydia test for men involved putting a swab into the opening of the urethra at the tip of the penis to collect a sample of cells. A urine test is now commonly used. This method is slightly less reliable than using a swab, but it is a much easier and less uncomfortable.
for non-genital chlamydia
If you have had anal or oral sex, a swab of calls may be collected from your rectum or throat, but this is not done routinely.
If you have symptoms of conjunctivitis, such as discharge from the eyes, a swab may be taken to collect cells from your eye.

When to get tested
Statistics from the National Chlamydia Screening Programme (NCSP) in England show that you are more at risk of becoming infected with chlamydia if you are under 25, have a new sexual partner, or have had more than one sexual partner in the past year and have not used condoms.

It is recommended that you consider getting tested for chlamydia if:

• you or your partner think you have symptoms,
• you have had unprotected sex with a new partner,
• you or your partner have unprotected sex with other people,
• you have an STI,
• a sexual partner tells you that they have an STI,
• during a vaginal examination your nurse or doctor tells you that the cells of your cervix are inflamed or there is discharge, or
• you are pregnant or planning a pregnancy.

Where to get tested
There are a number of different places you can go to for a chlamydia test, you can chose the place most comfortable and convenient for you:

• a genitourinary medicine (GUM) or sexual health clinic,
• your GP surgery,
• a contraceptive and young people’s clinic, or
• pharmacists where you can buy a chlamydia test to do at home - some tests may be more reliable than others so it is best to ask your pharmacist for advice.

The National Chlamydia Screening Programme (NCSP) offers free tests to men and women under 25 who have been sexually active. The programme runs across the UK and can help you access local chlamydia screening services. The screening takes place in a variety of community settings, including GP surgeries, military bases, contraceptive clinics, sexual health and GUM clinics, pharmacies, gynaecology departments and youth centres. To find out more, visit the NCSP website or call the sexual health helpline on 0800 567 123.
You can find details of your nearest sexual health or GUM clinic in the phone book, or by using the local health service search. You can attend these clinics at any age, even if you are less than 16 years of age (the age of consent for sex), and all results are treated confidentially.

Treating chlamydia 
The common treatment for chlamydia is a course of antibiotics.  If taken correctly it is more than 95% effective. The course of antibiotics can be either a single dose, or a longer course of up to two weeks. 
If there is a high chance that you have been infected with chlamydia, treatment may be started before you receive your test results. You will always be given treatment if your partner is found to have chlamydia.

The two most commonly prescribed antibiotics to treat chlamydia are:

• Azithromycin (single dose)
• Doxycycline (usually two capsules a day for a week)

Other less commonly prescribed antibiotics include Ofloxacin, Amoxicillin and Erythromycin.

It is important that you finish all the capsules prescribed to you. If you do not, the treatment may not be effective at getting rid of the infection.
You can discuss with your GP  which antibiotic is the most suitable for you. If you are pregnant, for example, some antibiotics may not be suitable, but alternatives are available. Azithromycin, Amoxicillin and Erythromycin are all suitable for pregnant women..
Antibiotics used to treat chlamydia may interact with the combined contraceptive pill and the contraceptive patch. If you use these methods of contraception, you can discuss with your GP or nurse which additional contraception is suitable for this time.

Side effects
The side effects of antibiotics are usually mild, the most common side effects include:

• stomach pain,
• diarrhoea, and
• feeling sick.

Occasionally, Doxycycline can cause a skin rash if you are exposed to too much sunlight (photosensitivity).

Sexual partners
Chlamydia is easily passed on through intimate sexual contact. If you are diagnosed with the infection, anyone you have recently had sex with in the last six months may also have it. It is important that your current partner and any other recent sexual partners are tested and treated.
Your local genitourinary medicine (GUM) or sexual health clinic may be able to help by notifying any of your previous partners on your behalf. A contact slip can be sent to them explaining that they may have been exposed to a sexually transmitted infection (STI) and suggesting that they go for a check up. The slip sometimes notes what the infection is but will not have your name on it, so your confidentiality is protected.

If you or your current partner is diagnosed with chlamydia, you should not have sex until you have both finished your course of treatment.

Complications of chlamydia 
If chlamydia is not treated it can spread to other parts of the body and cause long-term problems.

Women
In women, if chlamydia is not treated it can spread to other reproductive organs causing pelvic inflammatory disease (PID) and inflammation of the cervix (cervicitis), fallopian tubes (salpingitis) and Bartholin’s glands (Bartholinitis).
Infection with chlamydia during pregnancy may also be linked to early miscarriage or premature birth of the baby.

Pelvic Inflammatory Disease (PID)
Chlamydial infection is one of the main causes of pelvic inflammatory disease (PID) in women. PID is an infection of the uterus, ovaries and fallopian tubes that can cause infertility, persistent pelvic pain and an increased risk of ectopic pregnancy. The condition can be treated using antibiotics, and early treatment will reduce the risk of infertility. You should avoid having sexual intercourse while receiving treatment for PID.

Cervicitis
Cervicitis is an inflammation of the neck of the womb, the cervix. It often causes no symptoms but you may experience some discomfort, have a vaginal discharge containing pus or irregular bleeding. Some people also experience pain during intercourse and urinary symptoms, such as the need to urinate more often, and a burning pain when they urinate. When left untreated cervicitis causes the cervix to become enlarged and cervical cysts to develop, which may become infected. Chronic (long term) cervicitis can cause backache, deep pelvic pain, and a persistent vaginal discharge.

Salpingitis
Infection with chlamydia can cause a blockage of the fallopian tubes. This may prevent eggs from passing along, or entering the tubes. Even a partial blockage of the fallopian tubes will increase the risk of ectopic pregnancy occurring. This is when a fertilised egg is implanted outside of the womb, usually in a fallopian tube..Microsurgery can sometimes be used to effectively treat a blockage.

Bartholinitis
The glands that produce the lubricating mucus to make sexual intercourse easier are known as the Bartholin’s glands. They are situated on either side of the vaginal opening. Infection with chlamydia can cause the glands to become blocked and infected and lead to a Bartholin’s cyst. A cyst is usually painless but if it becomes infected it can lead to a pus-filled Bartholin's abscess. An abscess is usually red, very tender and painful to touch, and can cause a fever. An infected abscess  will need to be treated with antibiotics.

Men

Urethritis
Urethritis in men is inflammation of the urethra (the urine tube) that runs along the underside of the penis. Symptoms include a white or cloudy discharge from the tip of the penis, a burning or painful sensation when you urinate, the urge to urinate often and irritation and soreness around the tip of the penis. If left untreated a urethral stricture can occur, this can seriously interfere with the flow of urine and lead to back pressure which can damage the kidneys. Urethritis can be treated with antibiotics.

Epididymitis
Epididymitis is the inflammation of the epididymis, a long tube that connects the testes (where sperm are produced) to the vas deferens (a pair of ducts where sperm collect ready for ejaculation through the urethra).  An infected epididymis can become inflamed, causing swelling and tenderness in the affected area of the scrotum. Infection can lead to an accumulation of fluid in the area or even an abscess.  If left untreated epididymitis can lead to you becoming infertile.

Reactive arthritis
Reactive arthritis develops as a reaction to an infection, such as chlamydia. Symptoms include inflammation of the joints (arthritis), the urethra (urethritis) and the eyes (conjunctivitis). Although chlamydia can sometimes cause inflammation of the joints in women, reactive arthritis is more likely to occur in men. There is no cure for arthritis and although symptoms usually get better in three to 12 months, they can recur after this. Symptoms can be controlled by non-steroidal anti-inflammatory drugs (NSAIDs), such as ibruprofen.

Preventing Chlamydia

Chlamydia can be successfully prevented by:

• using condoms (male or female) every time you have vaginal or anal sex,
• using a condom to cover the penis or latex or plastic square (dam) to cover the female genitals if you have oral sex, and
• not sharing sex toys.  If you do share them wash them or cover them with a new condom before anyone else uses them.

These measures can also protect you from other sexually transmitted infections (STIs), such as genital herpes and gonorrhoea.
If you are worried you may be at risk of having an STI or have any of the symptoms mentioned in the symptoms section, you should visit your local sexual health or GUM clinic to have them checked out. Find your local sexual health service here.
For information on all sexual health services, the fpa run a helpline called sexual health direct, on 0845 122 8690.