Chlamydia

Chlamydia is one of the most common STIs in the UK. Most people who have chlamydia don’t notice any symptoms and won’t know they have the infection. Otherwise, symptoms may include pain when you urinate, unusual discharge and, in women, bleeding between periods or after sex. Diagnosing chlamydia is easily done with a urine test or a swab of the affected area. Chlamydia is easily treated with antibiotics, but can lead to serious long-term health problems if it’s left untreated. Chlamydia is passed on from one person to another through unprotected sex (sex without a condom). In 2010, there were 186,753 people who tested positive for chlamydia in England. Most of these – more than 150,000 – were people aged 24 or younger.

Symptoms of chlamydia

Most people who have chlamydia don’t notice any symptoms, and so don’t know they have it. Research suggests that 50% of men and 70-80% of women don’t get symptoms at all with chlamydia infection. Symptoms of chlamydia could be pain when you urinate, unusual discharge vagina or rectum or bleeding between periods or after sex. If you do get signs and symptoms, these usually appear between one and three weeks after having unprotected sex with an infected person. For some people, the symptoms occur many months later, or not until the infection has spread.

Symptoms in women

• pain when urinating (peeing)
• a change in vaginal discharge
• pain in the lower abdomen
• pain and/or bleeding during sex
• bleeding after sex
• bleeding between periods
• heavier periods than usual

If chlamydia is left untreated in women, it can spread to the womb and cause pelvic inflammatory disease (PID). PID is a major cause of infertility, miscarriage and ectopic pregnancy (when a fertilised egg implants itself outside the womb, usually in one of the fallopian tubes).

Chlamydia in the rectum, throat or eyes

Chlamydia can infect the rectum, eyes or throat if you have unprotected anal or oral sex. If infected semen or vaginal fluid comes into contact with the eyes you can also develop conjunctivitis. Infection in the rectum can cause discomfort, pain, bleeding or discharge. In the eyes chlamydia can cause irritation, pain, swelling and discharge the same as conjunctivitis. Infection in the throat is less common and usually causes no symptoms.

Chlamydia Transmission

• Condoms and lubricant – If you use lubricant when you have sex with a condom, make sure that it’s water-based (it will say on the label). Oil-based lubricant, such as lotion, baby oil, moisturiser or lipstick, can damage latex condoms.
• Chlamydia is a sexually transmitted infection (STI), which means that you get it through having unprotected sex (sex without a condom) with someone who has chlamydia. You can get chlamydia through: unprotected vaginal sex, unprotected anal sex, unprotected oral sex, your genitals coming into contact with your partner’s genitals or sharing sex toys when they are not washed or covered with a new condom between each person who uses them
• Sexual fluid from the penis or vagina can pass chlamydia from one person to another even if the penis does not enter the vagina, anus or mouth. This means you can get chlamydia from genital contact with someone who has the infection even if there is no penetration, orgasm or ejaculation.
• Chlamydia and giving birth – During childbirth, a woman with chlamydia can pass the infection on to her baby. If chlamydia develops in the baby there might not be any obvious symptoms at first. Chlamydia in a newborn baby can cause inflammation (swelling) and discharge in the baby’s eyes (known as conjunctivitis) and pneumonia.

Diagnosis of Chlamydia

The only way to find out if you have chlamydia is to get tested. You can get tested whether or not you have symptoms. The test for chlamydia is simple. Most people can have the test carried out on a urine sample. Some people have a swab test (a small cotton bud). The swab is used to gently wipe the area where you might have chlamydia, to collect some cells. The cells are then tested for infection. People who have had anal or oral sex might have a swab taken from their rectum or throat. This isn’t done on everyone. If you have symptoms in your eye, such as discharge or inflammation, a swab test might be taken to collect cells from your eyelid.

Chlamydia tests on women can be done with a urine sample or swab test. If a woman has a swab test, it can be taken from the cervix, or inside the lower vagina. Occasionally the doctor or nurse may advise you to have a swab test from the urethra (where urine comes out). Usually you can do a lower vaginal swab yourself, although sometimes a nurse or doctor may do it.

It is recommended that you get tested for chlamydia if:

• you or your partner think you have any symptoms
• you’ve had unprotected sex with a new partner
• unprotected sex with a new partner
• you’ve had a split condom
• you or your partner have unprotected sex with other people
• you think you have a sexually transmitted infection (STI)
• a sexual partner tells you they have an STI
• you’re pregnant or planning a pregnancy
• you have a vaginal examination and your doctor or nurse tells you that the cells of your cervix are inflamed or there is vaginal discharge

Treating chlamydia

Chlamydia is usually treated with antibiotics. Antibiotics are very effective for treating chlamydia. More than 95 out of 100 people with chlamydia will be cured if they take their antibiotics correctly. The two most commonly prescribed antibiotics to treat chlamydia are:

• azithromycin (single dose)
• (a longer course, usually two capsules a day for a week)
• Other common antibiotics are ofloxacin and erythromycin.

If there is a high chance that you have been infected with chlamydia (for example, your partner has been diagnosed with chlamydia and you have had unprotected sex with them) you might be started on treatment before you get your test results. The side effects of antibiotics are usually mild and these include: stomach pain, diarrhoea, feeling sick, vaginal thrush (also called candida). Also, occasionally, doxycycline can cause a skin rash if you are exposed to too much sunlight (photosensitivity).

Resuming Sex, and Treatment of Sexual Partners

You should not have sex for at least one week after you have finished your antibiotic treatment. You may need to avoid having sex for longer if your sexual partner has not been treated so that you do not become re-infected. You should also avoid having sex until your symptoms have gone.If you test positive for chlamydia, it’s important that your current sexual partner and any other recent sexual partners are also tested and treated. In the UK, it’s advised that you contact any sexual partners you’ve had within the past six months.

Complications of chlamydia

If chlamydia is not treated, it can sometimes spread and cause long-term problems. Chlamydia can spread to the womb (uterus), ovaries or the fallopian tubes. This can cause a condition called pelvic inflammatory disease (PID). Women may also develop an inflammation of the cervix (cervicitis), or an infection in the Bartholin’s glands near the vaginal opening. Very rarely women can develop a reactive arthritis.

PID – Chlamydia is one of the main causes of PID in women. PID is an infection of the womb (uterus), ovaries and fallopian tubes. It can cause infertility, persistent (chronic) pelvic pain and it increases the risk of miscarriage and ectopic pregnancy. PID can be treated with antibiotics, and the risk of infertility is reduced if PID is treated early.

Inflammation of the cervix (cervicitis) – Chlamydia can cause inflammation of the cervix (the neck of the womb), known as cervicitis. Cervicitis often causes no symptoms, but if you do get symptoms these may include: bleeding during or after sex, bleeding between periods, discomfort in your lower abdomen, vaginal discharge, pain during sex

Blocked fallopian tubes – Chlamydia can spread to cause inflammation in the fallopian tubes (known as salpingitis). This can make it difficult for an egg to travel from the ovary to the womb and can make becoming pregnant more difficult. Even if a fallopian tube is only partially blocked, this will increase the risk of ectopic pregnancy (when a fertilised egg implants outside the womb, usually in a fallopian tube). Blocked fallopian tubes can sometimes be treated with surgery.

Swollen Bartholin’s glands (Bartholinitis) – The glands that produce a woman’s lubricating mucus during sex are known as the Bartholin’s glands. They sit on either side of the vaginal opening. Chlamydia can cause the glands to become blocked and infected, leading to a Bartholin’s cyst. The cyst is usually painless, but if it becomes infected it can lead to an abscess. An abscess is usually red, very tender, painful to touch, and can cause a fever. An infected abscess needs to be treated with antibiotics. Very occasionally an operation is needed to drain the abscess.