Chlamydia
Chlamydia
(pronounced clam-id-ee-a) is a sexually transmitted infection.
Officially, it is a bacterium, but it
is more like a virus in being very small and unable to multiply
outside living cells. Chlamydia is not life-threatening, but
it can do serious damage to a woman’s Fallopian tubes.
If this happens, the woman could become infertile (unable to
become pregnant). The results of chlamydia infection cost the
NHS in the UK about £50 million a year.
Is chlamydia common?
In the UK and USA, chlamydia is the commonest sexually transmitted
infection.
-
In
2003, 89 431 new cases were seen at sexual health clinics
in England,
Scotland and Northern Ireland. This is
an 8% rise compared with 2002.
-
Of
those affected,
55% of the men and 73% of the women were in the 16–24-year
age group.
-
Chlamydia
is not just a disease of young people.
Among 45–64-year-old
women, chlamydia
infections increased by 177% between 1995
and 2003.
The
true figure must be even higher than the clinic figures suggest,
because chlamydia is often a ‘silent’ infection – not
causing any symptoms – especially in women.
There must be hundreds of thousands of people
with the infection who are
unaware they have it, and therefore do not go
to a clinic. When doctors in Portsmouth, UK,
tested
urine samples from all
sexually active women under the age of 25 (who
were visiting their family doctor for any reason),
they found about 1 in
10 had chlamydia (Sexually Transmitted Infections 2003;79:22–27).
How you get chlamydia
Chlamydia is passed on during sex, but using a condom gives
good protection if you use it properly. You can also catch
chlamydia during oral sex, because
it can be carried in the back of the mouth. Because
most people with chlamydia do not know that they have it, they
can pass it on to someone else unknowingly. It
is not caught
from toilet seats or swimming pools.
How
do you know if you have chlamydia?
-
About 50%
of men with chlamydia have no symptoms, and do not know that
they have the infection. In the
other 50%, chlamydia irritates the urethra (the tube inside the penis), causing
a discharge and making it painful to pass
urine. Occasionally
(in about 2% of cases), chlamydia spreads
to the testicle (usually only on one side), where it causes pain and inflammation;
some
doctors think that if this happens, the
man’s
fertility could be affected.
-
In
women, chlamydia infection is usually completely silent, so
they are unaware that they have it – 80% of women
with chlamydia have no symptoms at all.
Some women notice a slightly increased discharge, or slight
bleeding between periods
or after sex. If it has reached the Fallopian
tubes (see below), it can cause pain in the lower part
of the abdomen (tummy).
-
Some men
(and a few women) develop ‘Reiter’s
syndrome’.
This is a reaction to the chlamydia bacterium,
and consists of painful joints (usually knees or ankles)
and sore eyes (conjunctivitis).
It normally clears up within 6 months,
but may keep recurring over several years, even if you never
get chlamydia again.
Whether or not you develop Reiter’s
syndrome depends more on your genes than
on the severity of your chlamydial
infection.
Tests for chlamydia
The best way of knowing if you have chlamydia is to be tested.
This can be done at a genitourinary
medicine clinic or, possibly, by your
family doctor. There are several types of
test.
-
In
women, the cervix (neck of the womb) is wiped with a cotton
wool
bud, which is then sent to the laboratory
for testing. To do this test, the doctor
or nurse will insert a speculum into the vagina, like having
a smear test. In men,
the cotton wool bud is inserted into the
end
of the urethra (pee hole) to obtain the sample.
-
A urine
sample can be tested. However, this test is not available
everywhere and, for women, it is not as
reliable as taking a sample from the cervix. For this test
you must hold your
urine for at least an hour beforehand.
-
A sample
from the vagina in women can be tested using a new more accurate
test (NNAT). This means that
women could take their own samples.
In Sweden, they
have had a screening programme for chlamydia for 25 years.
At present, in the UK, you can be screened for
chlamydia at a genitourinary
medicine clinic and at some other places
(such as colleges). Free screening in pharmacies
is to be tried out in London and Cornwall
for 16–24-year-olds. If this works well, it will be extended
to the rest of the UK.
When to have a chlamydia test
Several situations in which it would be sensible to have a
chlamydia test are:
-
if
you have symptoms, such as discharge or lower abdominal
pain (women), pain on passing urine (men)
or pain
in the testicles (men)
-
if your
partner has symptoms
-
if you
had sex with a new partner without a condom in the past year
-
if
your partner has had a chlamydia infection and you are
not sure if he/she was properly treated
-
if you
had treatment for a chlamydia infection, but your partner
did not have
treatment
-
if you
and your partner had treatment for a chlamydia infection,
but had sex before the treatment
was completed
-
if
you have another sexually transmitted infection (such as genital
warts)
-
if you
are about to have a termination of pregnancy (abortion).
What happens if chlamydia infection is not treated?
If you have a chlamydia infection, it may or may not give you
symptoms. If you have symptoms, such as a discharge, the
symptom may disappear in a few days. This does not mean that
your body has cured the infection. You are probably still
carrying the chlamydia bacterium and can pass it on to other
people. Also, if you are a woman, it can start to travel
towards your Fallopian tubes. So go for a test, even if the
symptoms have gone.
Pelvic
inflammatory disease. In most women who have it, chlamydia travels no
further than the cervix (neck of the womb at the
top if the vagina). But in about 1 in 10, it travels further
upwards through the uterus (womb) into the Fallopian tubes.
In the Fallopian tubes it can cause inflammation known as ‘pelvic
inflammatory disease’ or PID. Other types of bacteria
may then move in making the inflammation worse. PID may be
painful, but can occur without any pain at all. If the infection
is treated at this stage, the tube may recover completely,
or some scarring and other damage may remain.
In Sweden, where young women are screened for chlamydia, the
number of women with PID has halved.
Infertility. The
Fallopian tube is where the sperm meets the egg, and where
fertilization occurs. So if a woman’s
tubes have been damaged by PID in the past, the egg and sperm
will not be able to travel along it easily, and she may not
be able to conceive. If she does conceive, there is a possibility
that the fertilized egg could get stuck in the tube, and the
baby would start to develop in the tube instead of in the uterus.
This is called ‘ectopic pregnancy’ and is a bad
situation, because the developing baby almost always dies in
early pregnancy, and there will be dangerous internal bleeding.
However, while it is true that chlamydia can cause infertility,
this happens in only a small number of women who have it. The
risk is not precisely known, but a Swedish study in the early
1990s suggests the following figures.
-
If 100
women get a chlamydia infection,
20 will develop PID.
-
Of these
20 who develop PID, 2 will have difficulty conceiving and
1 will have an ectopic
pregnancy.
-
The more
times a woman has PID, the greater the damage to the tubes
and the greater the chance
of later problems. So if those 20 women had another attack of PID, 4 would
become infertile
and 2 would have ectopic pregnancies.
-
If those
same 20 women had three or more attacks of PID, 8 or 9 would
become infertile and 4 would have ectopic pregnancies.
Treatment for chlamydia and talking to your partner
The good news is that chlamydia is easily treated, usually
with doxycycline antibiotic. This treatment is over 95% effective
if you take the full course (usually twice a day for 7 days)
exactly as instructed by your doctor. Other antibiotics (azithromycin,
erythromycin) are sometimes used instead; if you are pregnant
or breastfeeding your doctor will probably give you erythromycin.
It is essential that your partner is treated as well. If your
partner is not treated at the same time as you, you can catch
it again from him/her. This is a bad thing for women, because
the more times a woman has a chlamydia infection, the greater
her risk of later infertility. So do not have sex (even with
a condom) until both of you have completed your treatment.
You may
feel anxious about telling your partner about the infection.
Sometimes partners do not believe they could have
it themselves, because they probably
have no symptoms. So explain that most people with chlamydia
do not know that they have
it. If you think that telling your
partner would be problematic, talk to a health advisor at
your local genitourinary
medicine clinic.
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