Chlamydia and Men’s Health: What You Need to Know

Chlamydia in men is generally not prioritized and most of the chlamydia research and screening efforts focus on women. It is understood that women’s health and fertility suffer greater damage from untreated chlamydia infection. However, men also get chlamydia and can have health and fertility problems resulting from untreated chlamydial infection.

In 2021, about 1.65 million cases of chlamydia were reported in the U.S. About half of these were from men. This trend resembles the breakdown of chlamydia by sex worldwide. According to WHO, the global prevalence of chlamydia for people aged 15-49 years is 4% for women and 2.5% for men.

Symptoms of chlamydia in men

Half the cases of chlamydia in men are asymptomatic. In the other half, chlamydial infection in tissues causes inflammation which can result in one or more of the following symptoms:

1. Urethritis. Urethritis is the inflammation in the urethra and is a symptom more commonly seen in men than women with chlamydia. It causes pain or burning while passing urine. The penis also releases an unusual white, gray, or clear discharge.
2. Reactive arthritis. Reactive arthritis refers to the inflammation in the joints caused due to chlamydial infection. The joints impacted are often in the knees, hips, ankles, feet, and toes.
   Reactive arthritis affects about 1% of the men who have urethritis due to chlamydial infection.
3. Epididymitis. Epididymitis is the inflammation of the epididymis, the sperm-carrying tube at the back of the testicles. It results in testicular pain, swelling, tenderness, and possibly fever. Sometimes fluid may collect in the sheath that surrounds the testicle (hydrocele) causing swelling.
4. Prostatitis. Prostatitis is the inflammation of the prostate gland. The condition can cause pain or burning during urination, urinary dysfunction, painful ejaculation, and pain in the pelvic area.
5. Lymphogranuloma venereum (LGV). LGV is caused by specific serovars of the chlamydia pathogen. The first indication is painless genital or anal ulcers, though ulcers can also appear in the mouth or throat. The ulcers are small and have a stellate shape. They generally heal on their own but the infection continues to spread to the lymph nodes in the groin area and then to the surrounding tissue. The resulting inflammation in the lymph glands can cause painful swelling, and the lymph glands may drain and bleed. LGV is often contracted by anal sex.
6. Proctitis. Proctitis is inflammation of the lining of the rectum. Chlamydia spreads to the rectum during anal intercourse. Depending on the serovar of the chlamydia pathogen, proctitis from chlamydia may or may not be symptomatic. Rectal infection with serovars D-K can be asymptomatic. However, serovars L1-L3 (that cause LGV) cause pain in the rectum, rectal bleeding, discharge, and fever.
7. Conjunctivitis (pink eye). Contact of genital secretions containing the chlamydia pathogen with the eyes can cause an eye infection called conjunctivitis. It is seen in a subset of men with chlamydia, though it is more common in newborns who contract chlamydia during birth from an infected mother.
8. Pharyngitis. Pharyngitis refers to the inflammation of the pharynx resulting in a sore throat. The chlamydia pathogen has been detected in the pharynx of some patients with chlamydia using molecular tests such as PCR. However, sore throat due to chlamydia is not commonly observed.

Impact of untreated chlamydia on male fertility

While chlamydia is not considered an important factor affecting male fertility, the infection in the testes and prostate may cause a deterioration of the quality of the sperm, which may affect fertility. Other sperm characteristics such as the proportion of DNA fragmentation are also seen to deteriorate during chlamydia infection, indicating that the infection may directly damage sperms. In studies with infertile couples, the proportion of male partners with chlamydia is larger than that in the general population. Men with chlamydia can also contribute to the couple’s infertility by infecting the female partner.

Testing and treatment

Since a lot of cases of chlamydia are asymptomatic, it is important to get tested annually for STIs such as chlamydia. If you have a new sex partner of unknown STI status, or if your partner acquires new sex partners, retesting is recommended. Men who have sex with men bear the heaviest burden of getting infected with LGV serovars, so they should make it a priority to get tested. If the test comes positive for chlamydia infection, treatment should begin immediately.

Chlamydia is a bacterial infection readily treated and cured with antibiotics. The typical treatment for uncomplicated chlamydia is a single-dose therapy with azithromycin. However, physicians may determine the best treatment based on all the symptoms and the medical background of the patient. Alternate antibiotics include doxycycline, ofloxacin, erythromycin, and levofloxacin.

Physicians may also test and treat for gonococcal infection, which often exists with chlamydial infections. Treating both gonococcal and chlamydial infections together may be beneficial for men in particular.

Patients should not engage in sex while they are undergoing treatment. Once the infection is gone, patients should consult with their physicians on when they can resume sexual activity.

It is important to ensure that all of the patient’s sexual partners also receive treatment. Having sex with an infected partner can easily reinfect a person as previous treatment will not protect someone from getting re-infected. The best outcomes are achieved when sexual partners receive treatment at the same time, which decreases the chances of them passing the infection back and forth to each other.

Chlamydia can be prevented by practicing safe sex and correctly using condoms and dental dams when having sex with partners of unknown STI status.