Chlamydia

Dr Howard Lee looks at a genital infection that can cause pelvic inflammatory disease (PID) and infertility

Genital chlamydia is the most common, curable, bacterial sexually transmitted infection in the UK but, if left untreated, it can cause serious complications. Chlamydia is certainly on the increase - 1 in 12 women between the ages of 16 and 24 are affected and the NHS spends millions of pounds each year treating complications that arise from the disease. But the real tragedy is that many more women go undiagnosed, unaware that chlamydia can be treated simply and effectively.

Chlamydia is known as an 'ascending' condition as it first affects the cervix and womb, before travelling up further to infect the fallopian tubes, the ovaries and eventually the inner lining of the abdominal cavity.

Who gets chlamydia, and how is it passed on?

Anyone who has unprotected sex with a number of partners can get genital chlamydia infection. It's most common in women 16-19 years of age.

  • Pregnant women can pass the infection on to their babies during birth
  • Those infected can pass the disease on to other partners even if they don't have any symptoms.
Symptoms and signs of Chlamydia
  • Vaginal discharge
  • Bleeding following sexual intercourse
  • Mid-cycle or irregular menstrual bleeding
  • Inflammation of the cervix, which bleeds on contact
  • Urethritis (inflammation of the tube which conducts urine from the bladder to the exterior)
  • Pelvic Inflammatory Disease (PID)
  • Lower abdominal pain in those who are sexually active
The problem is that up to 70% of women with an infection won't notice any symptoms in the early stages but they can still pass the disease on to a partner. The incubation period (the interval between the exposure to the infection until the appearance of the first symptoms) for men is between one and three weeks but up to 50% of them won't notice any symptoms either. Once symptoms appear, they usually persist, but in some cases, they may only last a few days and then disappear again. This doesn't mean that the disease has gone away.

How serious is chlamydial infection?

Untreated infection can persist for months or even years and there's a strong link between asymptomatic (no symptoms) infection and reduced fertility.

  • Up to 30% of untreated cases go on to develop PID
  • 10% have ectopic pregnancies, in which a fertilised egg becomes stuck and implants in a Fallopian tube
  • Damage to the fallopian tubes can cause a blockage that prevents sperm and eggs coming into contact. This cause of infertility is easily missed because of 'mild' or absent symptoms.
PID occurs when the bacteria spread up the vagina to the cervix (the neck of the womb) damaging the reproductive tubes which lead to the ovaries. It can cause chronic pelvic pain, infertility and ectopic pregnancy. Although PID can result from other infections, about 45% of cases are caused by genital chlamydia infection and unfortunately, the long-term complications are difficult to treat.

Both men and women with genital chlamydia infection can also develop painful arthritis due to inflammation of the joints.

Diagnosing and treating chlamydia

  • Often a swab is taken from the genital tract for examination at a laboratory, but this isn't the most reliable means of diagnosing chlamydia.
  • Recently, more accurate (95% sensitive) urine tests have been introduced which are carried out about 2 weeks after exposure.
  • Uncomplicated chlamydial infection is treated with an effective antibiotic given twice a day for up to 10 days or as a single one-off dose.
  • Pregnant women who have an uncomplicated infection of chlamydia can also receive treatment for seven days without risk to their baby
  • If patients have symptoms and signs of chlamydial infection, doctors usually recommend starting treatment before a laboratory confirms the diagnosis because of the serious consequences of the condition.
  • Partners are usually treated as well.
Remember that the best way to protect yourself against chlamydial infection is to use condoms and reduce the number of partners you sleep with. If you are concerned about any abnormal symptoms, go to your GP immediately and you may be able to prevent the long-term consequences of chlamydia developing.