Jyoti Kinghorn 
Chlamydia is a sexually transmitted infection (STI) caused by the bacterium Chlamydia trachomatis. The infection is very common, and in most cases has no symptoms. But chlamydial infection does not get better on its own. Without antibiotic treatment, the infection silently spreads and can have long-lasting effects. The infection can cause permanent damage to the female reproductive system making it difficult or impossible to get pregnant. Newborns can get chlamydia from an infected mother during vaginal birth which can cause conjunctivitis and pneumonia.
Prevalence
Chlamydia is the most frequently reported bacterial STI in the U.S. and the most common STI worldwide. In the U.S. a total of 1,649,716 cases of chlamydia were reported in 2021. WHO estimates the global prevalence of chlamydia for people aged 15-49 years to be 4% for women and 2.5% for men. The majority of the cases are reported in young people– women between 15-24 and men between 20-24 years of age.
Modes of transmission
Chlamydia is transmitted by having oral, anal, or vaginal sex with an infected person. The infection can spread whether or not there is semen involved in the sexual contact. In rare cases, people can get chlamydia by touching their eyes with fingers that have infected fluids on them. Pregnant women who have untreated chlamydia can transmit it to their newborns upon vaginal birth.
Chlamydia trachomatis, the bacterium that causes chlamydia infects the squamocolumnar epithelial cells that line the upper genital tract and endocervix in women and the conjunctiva, urethra, and rectum in both males and females. The bacterium has two developmental forms- a metabolically inactive elementary body and a metabolically active reticulate body. The elementary body infects squamocolumnar epithelial cells. Once inside the host cells, it changes into the reticulate body form that uses the host’s cellular machinery and energy to generate new EB forms which can then infect another person as well as spread to other parts of the host’s body.
Why chlamydia can go unnoticed
About 70% of women and 50% of men who have chlamydia feel no symptoms at the time of their diagnosis. This is why many are unaware that they are carrying and spreading chlamydia. Sometimes the symptoms do not appear for months after sexual activity with an infected person. In other cases, symptoms appear but go away on their own in a few days falsely indicating that the infection is gone. However, the disease stays active until it is treated and cured by antibiotics and continues to harm the body.
Long-term effects of untreated chlamydia
Infection with chlamydia can be easily treated and cured with antibiotics. However, when left untreated, chlamydia can have serious and worsening consequences, especially for females.
In females, the most commonly affected site is the cervix. Chlamydia can cause cervicitis (inflammation of the cervix), urethritis (inflammation of the urethra), proctitis (inflammation in the lining of the rectum), pelvic inflammatory disease, and perihepatitis (chronic pelvis inflammatory disease). Pelvic inflammatory disease refers to the infection of one or more parts of the reproductive system, such as the uterus, fallopian tubes, and ovaries. Such inflammation can cause the formation of scar tissue that can cause infertility or lead to a life-threatening ectopic pregnancy. Often the inflammation can be painless with few or no symptoms. When experienced, symptoms include unusual vaginal discharge, burning when peeing, and pain or discomfort in the lower abdomen.
Males generally have less severe symptoms of chlamydia. However, infection can lead to urethritis (inflammation of the urethra), epididymitis (inflammation of the epididymis which is the sperm-carrying tube at the back of the testicles), prostatitis (inflammation of the prostate gland), or proctitis (inflammation in the lining of the rectum). About half the cases of chlamydia in males are asymptomatic. When present, symptoms include burning when peeing, unusual discharge from the penis, and pain or discomfort in the testicles.
In both males and females, anal symptoms include pain, bleeding, or unusual discharge from the anus. Chlamydia can also affect the mouth resulting in pain, redness, or formation of sores or white spots.
Chlamydia can also cause reactive arthritis which is inflammation of the joints, though it is more common in men than women. Reactive arthritis can cause pain and swelling in joints, especially the hips, knees, ankles, feet, and toes.
Both males and females can develop conjunctivitis (inflammation of membranes that line the eyes and eyelids resulting in pink eye), pharyngitis (inflammation of the pharynx resulting in a sore throat), and lymphogranuloma venereum as a result of untreated chlamydia infection. Lymphogranuloma venereum (LGV) is a complication caused by some serovars of Chlamydia trachomatis. Initially characterized by painless ulcers in the genital area, anal area, mouth, or throat, the infection later causes enlarged lymph nodes and severe symptoms including pain during urination or while passing stools, rectal bleeding, anal or abdominal pain, body aches, headaches, fever, and tenesmus (frequent urges to urinate or pass stools even when you don’t need to go). LGV is most often reported when chlamydia is contracted by anal sex.
Newborns who get chlamydia infection from an infected mother during birth can develop conjunctivitis or pneumonia.
In some parts of the world where chlamydia is extremely common, people also experience trachoma. Trachoma is an eye disease caused by chlamydia which can cause visual impairment and blindness. Usually, trachoma develops between the ages of 30 and 40. But in communities where chlamydia is very prevalent (hyperendemic), it can show up in preschool-aged children.
While a few episodes of trachoma can be cleared by the immune system, repeated infections can cause blindness. Repeated infections can occur when someone comes in contact with fluids from the eyes of an infected person. This can happen by fingers touching secretions from infected eyes and then touching healthy eyes, through shared bedding or even hard surfaces, and flies. After repeated infections over many years, the inside of the eyelid can get severely scarred and turn inward, and the eyelashes can start rubbing against the eyeball. This causes constant pain, light intolerance, and eventually scarring of the cornea and blindness. Globally, 42 countries have cases of trachoma, and 1.9 million people have been blinded because of it.
According to WHO, “Trachoma is hyperendemic in many of the poorest and most rural areas of Africa, Central and South America, Asia, Australia, and the Middle East”.
The critical role of testing
Anyone who is sexually active can get infected by chlamydia. Sexual partners may not be aware that they are carrying chlamydia. The best ways to prevent chlamydia is to be in a long-term sexually monogamous relationship, or practicing safe sex by correctly using condoms and dental dams while having oral, anal, or vaginal sex. However, even long-term sex partners may be carrying chlamydia and not know because of a lack of symptoms. The only way to know if you have chlamydia is by getting tested.
Testing can be done in your doctor’s office. Alternatively, you can use an at-home test collection kit where you collect your urine sample according to the instructions of the kit and send it to the lab for testing.
Alternatively, you can use one of the testing locations near you listed by the CDC.
https://gettested.cdc.gov/
Testing at these locations may be free or provided for a very low price.
How to bring up STI testing with your partner
The best time to talk to your partner about getting tested is before getting sexually intimate. However, it is never too late. You can save yourself and your partner from long-term adverse effects of STIs if you both get tested and treated.
Bringing up the topic of STI-testing is understandably awkward, but one that needs to be addressed to ensure safe sex going forward.
Some helpful tips for bringing up STI testing with your partner include:
- Bring up the topic during a neutral time, not just as you are engaging in sex.
- Offer to get tested together.
- You can choose to get tested using home collection kits and both of you can collect your samples in the comfort of your own home.
- Keep health as the main topic of discussion. Your goal is to ensure that you are both free of treatable and curable infections.
- Don’t attack or accuse your partner. STIs can be sneaky. Infections such as chlamydia can be “silent” and asymptomatic for years without the person’s knowledge.
The information provided in our blog posts is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.
