Chlamydia

WHAT IS IT?
- Chlamydia is a sexually transmitted infection (STI).

- It is caused by the intracellular bacterium Chlamydia trachomatis.

- It is one of the most common STIs and the most likely identifiable cause of non-specific urethritis in men.

- It can affect the eyes, throat, and lungs.

- If chlamydia is left untreated, complications may occur.

- It may be carried asymptomatically for months or years. Diagnosis does not necessarily imply recent infection.

INCIDENCE
- It is the UK's most common treatable STI.

- It affects one in twelve sexually active women aged 16-24.

CAUSES
- Infection occurs during vaginal, oral or anal sex, or other genital contact with a partner who has chlamydia.

- Newborn babies can acquire the infection during birth.

- A conjunctive infection can follow if discharge is transferred on hands.

RISK FACTORS
Factors linked with a higher risk of infection include:

- Under 25 years of age;

- A new sexual partner;

- Lack of barrier contraception such as having intercourse without condoms;

- Use of oral contraceptive;

- Women having a termination of a pregnancy.

SYMPTOMS
- Chlamydia is often asymptomatic.

- If symptoms occur, they usually start one to three weeks after the infection is acquired.

- Symptoms may stop despite the continued presence of infection.

- Chlamydia can be passed on even when there are no symptoms.

COMMON FEMALE SYMPTOMS
Women may experience the following:

- Abnormal vaginal discharge;

- Painful intercourse;

- Painful urination;

- Occurrence of bleeding between menstrual periods;

- Bartholin glands (producer of sexual lubrication mucus) become inflamed and cysts may form;

- Pain in lower back and pelvic area.

COMMON MALE SYMPTOMS
Men may experience the following:

- Yellow urethral discharge;

- Tender and swollen testicles;

- Inflamed joints and eyes.

DIAGNOSIS
- Traditionally, diagnosis has been made from male urethral or female cervical swabs.

- DNA amplification tests, such as ligase chain reaction (LCR) and polymerase chain reaction (PCR), have led to less invasive investigations, such as urine testing.

TREATMENT
- Antibiotics (100mg doxycycline, administered orally twice a day for seven days; or 1g azithromycin in a single oral dose).

- If the patient is asymptomatic, it is important to emphasise the importance of compliance with treatment as the infection may spread and cause complications.

- Strategies to prevent reinfection, such as practising 'safer sex', should be discussed.

- Sexual partners need to be assessed and treated, even if they are asymptomatic.

- Patients should be told to avoid sex until their treatment and that of their partner(s) is complete.

COMPLICATIONS
- Ectopic pregnancies.

- Pelvic inflammatory disease (PID).

- Female or male infertility.

- Epididymo-orchitis (inflammation of the testis and epididymis).

- Chronic pelvic pain.

- Fitz-Hugh-Curtis syndrome (perihepatitis).

- Sexually acquired reactive arthritis (SARA).

WHY IS IT SO COMMON?
Possible reasons include:

- STI education is not school-based;

- No high-profile public sexually transmitted disease or infection education campaigns;

- No national screening programme.

WEBSITE
PHLS factsheet on chlamydia: www.hpa.org.uk/infections/topics_az/hiv_and_sti/sti-chlamydia/general.htm

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