Chlamydia

Introduction 

Chlamydia is one of the most common sexually transmitted infections (STIs).

It’s passed on from one person to another through unprotected sex (sex without a condom).

Chlamydia symptoms

Most people who have chlamydia don’t notice any symptoms, and so don't know they have it. Research suggests that 50% of men and 70-80% of women don't get symptoms at all with chlamydia infection. 

Symptoms of chlamydia could be pain when you urinate (pee), unusual discharge from the penis, vagina or rectum or, in women, bleeding between periods or after sex.

Getting tested for chlamydia

Testing for chlamydia is done with a urine test or a swab test. You don't always have to have a physical examination by a nurse or doctor.

Treating chlamydia

Chlamydia is easily treated with antibiotics. If chlamydia isn’t treated, the infection can sometimes spread to other parts of your body and lead to serious long-term health problems such as pelvic inflammatory disease and infertility (not being able to have children).

The National Chlamydia Screening Programme

Chlamydia is most common in people under 25 years old, although people of any age can get it. 

Symptoms of chlamydia

Most people who have chlamydia don’t notice any symptoms.

If you do get signs and symptoms, these usually appear between one and three weeks after having unprotected sex with an infected person. For some people the symptoms occur many months later, or not until the infection has spread. 

Symptoms in women

Around 70-80% of women with chlamydia don't notice any symptoms. If women do get symptoms, the most common include: 

• Pain when urinating (peeing)
• A change in vaginal discharge
• Pain in the lower abdomen
• Pain and/or bleeding during sex
• Bleeding after sex
• Bleeding between periods
• Heavier periods than usual

If chlamydia is left untreated in women, it can spread to the womb and cause pelvic inflammatory disease (PID). PID is a major cause of infertility, miscarriage and ectopic pregnancy (when a fertilised egg implants itself outside the womb, usually in one of the fallopian tubes).

Symptoms in men

Around half of all men with chlamydia don't notice any symptoms. If men do get symptoms, the most common include: 

• Pain when urinating (peeing)
• Discharge from the tip of the penis (this can be a white, cloudy or watery discharge)
• Pain in the testicles

Some men have mild symptoms that disappear after two or three days. Even if the symptoms disappear you will still have the infection and be able to pass it on. If chlamydia is left untreated in men they are at risk of complications such as orchitis (swollen testicles), reactive arthritis (inflammation of the joints) and infertility.

Chlamydia in the rectum, throat or eyes

Chlamydia can infect the rectum, eyes or throat if you have unprotected anal or oral sex. If infected semen or vaginal fluid comes into contact with the eyes you can also develop conjunctivitis.

Infection in the rectum can cause discomfort, pain, bleeding or discharge. In the eyes chlamydia can cause irritation, pain, swelling and discharge the same as conjunctivitis. Infection in the throat is less common and usually causes no symptoms.

Causes of chlamydia

Chlamydia is caused by bacteria called Chlamydia trachomatis.

Chlamydia is a sexually transmitted infection (STI), which means that you get it through having unprotected sex (sex without a condom) with someone who has chlamydia.

How you get chlamydia

You can get chlamydia through: 

• Unprotected vaginal sex
• Unprotected anal sex
• Unprotected oral sex
• Your genitals coming into contact with your partner's genitals
• Sharing sex toys when they are not washed or covered with a new condom between each person who uses them

Sexual fluid from the penis or vagina can pass chlamydia from one person to another even if the penis does not enter the vagina, anus or mouth. This means you can get chlamydia from genital contact with someone who has the infection even if there is no penetration, orgasm or ejaculation.

It isn’t clear if chlamydia could be passed on by transferring infected semen or vaginal fluid on the fingers.

Infected semen or vaginal fluid can cause conjunctivitis if it gets into someone’s eye.

Chlamydia and giving birth

During childbirth, a woman with chlamydia can pass the infection on to her baby. If chlamydia develops in the baby there might not be any obvious symptoms at first. Chlamydia in a newborn baby can cause inflammation (swelling) and discharge in the baby’s eyes (known as conjunctivitis) and pneumonia. Dr. B C Shah can arrange a simple swab test for chlamydia from the baby.

Diagnosing chlamydia

The only way to find out if you have chlamydia is to get tested. You can get tested whether or not you have symptoms.

What does the chlamydia test involve?

The test for chlamydia is simple. Most people can have the test carried out on a urine sample. Some people have a swab test (a small cotton bud). The swab is used to gently wipe the area where you might have chlamydia, to collect some cells. The cells are then tested for infection.

Dr. B C Shah will explain which is the best test for you to have. You don’t always have to be examined by the doctor or nurse – this will depend on your situation and where you go to get tested.

People who have had anal or oral sex might have a swab taken from their rectum or throat. This isn’t done on everyone.

If you have symptoms in your eye, such as discharge or inflammation, a swab test might be taken to collect cells from your eyelid.

Tests for women

Chlamydia tests on women can be done with a urine sample or swab test. If a woman has a swab test, it can be taken from the cervix, or inside the lower vagina. Occasionally Dr. B C Shah may advise you to have a swab test from the urethra (where urine comes out). Usually you can do a lower vaginal swab yourself, although sometimes a nurse or doctor may do it.

If you have had anal or oral sex you might also be offered a swab test taken from the rectum or throat. This isn’t done on everyone.

Routine cervical screening tests (smear tests) do not detect chlamydia. You will need to tell Dr. B C Shah if you would also like to be tested for chlamydia at the same time.

Tests for men

Men will usually have a chlamydia test on a urine sample. Occasionally, a swab test may be taken from the urethra (the tube where urine comes out) at the tip of the penis.

If you have had anal or oral sex you might also be offered a swab test taken from the rectum or throat. This isn’t done on everyone.

How soon after sex can I get a chlamydia test?

Don't delay getting tested if you think you might have chlamydia.

You can get a chlamydia test at any time whether or not you have symptoms. You might be advised to repeat the test if it was less than two weeks since you had sex, as sometimes the infection could be in its early stages.

It is recommended that you get tested for chlamydia if:

• You or your partner think you have any symptoms
• You've had unprotected sex with a new partner
• You’ve had a split condom
• You or your partner have unprotected sex with other people
• You think you have a sexually transmitted infection(STI)
• A sexual partner tells you they have an STI
• You're pregnant or planning a pregnancy
• You have a vaginal examination and your doctor or nurse tells you that the cells of your cervix are inflamed or there is vaginal discharge

Don’t put off having a test for chlamydia – getting diagnosed and treated as soon as possible will reduce the risk of developing any complications of chlamydia. Complications that occur because of long-term chlamydia infection are more difficult to treat.

Where can I get a chlamydia test?

Anyone can get a chlamydia test at:

• A sexual health clinic
• A GUM (genitourinary medicine) clinic
• Most contraceptive clinics

You can go to whichever place is the most comfortable and convenient for you.

How reliable is a chlamydia test?

The accuracy of tests varies, depending on the type of test that is used. Recommended tests are 90-95% sensitive. This means that they will detect chlamydia in most people who have the infection. Some tests you can buy may be less reliable.

Remember that no test is 100% accurate. There is a small chance that a test may show negative even when you have chlamydia. This is called a false negative test result. It is also possible for a test to be positive even when you do not have chlamydia. This is called a false positive test result. Both of these false tests are very rare but can sometimes explain why you get a different result to your sexual partner.

Treating chlamydia 

Chlamydia is usually treated with antibiotics. Antibiotics are very effective for treating chlamydia. More than 95 out of 100 people with chlamydia will be cured if they take their antibiotics correctly.

The two most commonly prescribed antibiotics to treat chlamydia are: 

• Azithromycin (single dose)
• Doxycycline (a longer course, usually two capsules a day for a week)

Dr. B C Shah may give you different antibiotics if you have an allergy, or are pregnant. A longer course of antibiotics may be used if Dr. B C Shah is concerned about complications of chlamydia. Other common antibiotics are ofloxacin and erythromycin.

If there is a high chance that you have been infected with chlamydia (for example, your partner has been diagnosed with chlamydia and you have had unprotected sex with them) you might be started on treatment before you get your test results.

Pregnant or breastfeeding

Tell Dr. B C Shah if you are pregnant or breastfeeding, as this will affect the type of antibiotic you can be given. Azithromycin, amoxicillin and erythromycin are all safe for pregnant women to take.

Antibiotics and contraception

Most antibiotics are safe to use with contraception. If you vomit or have severe diarrhoea they may be less effective and put you at risk of pregnancy, especially if you have unprotected sex. 

Talk to Dr. B C Shah about whether the antibiotics you are given might affect your contraception.

Having sex again

You should not have sex for at least one week after you have finished your antibiotic treatment. You may need to avoid having sex for longer if your sexual partner has not been treated so that you do not become re-infected. You should also avoid having sex until your symptoms have gone.

Side effects of chlamydia treatment

The side effects of antibiotics are usually mild. The most common side effects include: 

• Stomach pain
• Diarrhoea
• Feeling sick
• Vaginal thrush (vaginal yeast infection, also called candida)

Occasionally, doxycycline can cause a skin rash if you are exposed to too much sunlight (photosensitivity).

Treatment for sexual partners

If you test positive for chlamydia, it's important that your current sexual partner and any other recent sexual partners are also tested and treated.

Do I need another test to check chlamydia has gone?

If you take all your antibiotics correctly then you should not need a follow-up test. The doctor or nurse will advise you to have a repeat test if:

• You were treated for chlamydia and you are pregnant
• You forgot to take any of your medication or did not take it properly
• You had sex before you and your partner had finished treatment
• Your symptoms have not gone or if they have come back

Complications of chlamydia

If chlamydia is not treated, it can sometimes spread and cause long-term problems.

This page explains about:

• Complications in women
• Complications in men

Complications in women

In women, chlamydia can spread to the womb (uterus), ovaries or the fallopian tubes. This can cause a condition called pelvic inflammatory disease (PID). Women may also develop an inflammation of the cervix (cervicitis), or an infection in the Bartholin’s glands near the vaginal opening. Very rarely women can develop a reactive arthritis.

PID

Chlamydia is one of the main causes of PID in women. PID is an infection of the womb (uterus), ovaries and fallopian tubes. It can cause infertility, persistent (chronic) pelvic pain and it increases the risk of miscarriage and ectopic pregnancy. PID can be treated with antibiotics, and the risk of infertility is reduced if PID is treated early. 

Inflammation of the cervix (cervicitis)

Chlamydia can cause inflammation of the cervix (the neck of the womb), known as cervicitis. Cervicitis often causes no symptoms, but if you do get symptoms these may include: 

• Bleeding during or after sex
• Bleeding between periods
• Discomfort in your lower abdomen
• Vaginal discharge
• Pain during sex

Blocked fallopian tubes

Chlamydia can spread to cause inflammation in the  fallopian tubes (known as salpingitis). This can make it difficult for an egg to travel from the ovary to the womb and can make becoming pregnant more difficult. 

Even if a fallopian tube is only partially blocked, this will increase the risk of ectopic pregnancy (when a fertilised egg implants outside the womb, usually in a fallopian tube). Blocked fallopian tubes can sometimes be treated with surgery.

Swollen Bartholin’s glands (Bartholinitis)

The glands that produce a woman's lubricating mucus during sex are known as the Bartholin’s glands. They sit on either side of the vaginal opening. Chlamydia can cause the glands to become blocked and infected, leading to a Bartholin’s cyst.

The cyst is usually painless, but if it becomes infected it can lead to an abscess. An abscess is usually red, very tender, painful to touch, and can cause a fever. An infected abscess needs to be treated with antibiotics. Very occasionally an operation is needed to drain the abscess.

Complications in men

Urethritis

Urethritis is inflammation of the urethra (urine tube) that runs along the underside of the penis. Symptoms include: 

• A white cloudy discharge from the tip of the penis
• Pain or a burning sensation when you urinate
• The urge to urinate often
• Irritation and soreness around the tip of the penis

There are many causes of urethritis but chlamydia infection is the most common. If you have urethritis and the cause is not known then this is called a “non-specific urethritis” (NSU). NSU is often treated with the same antibiotics as chlamydia.

Epididymitishey

The main symptoms of epididymitis are swelling and tenderness in the epididymis. The epididymis is part of a man’s reproductive system and carries sperm from the testicle. If the testicles are affected it is called epididymo-orchitis.

A chlamydia infection in the epididymis can cause inflammation, swelling and tenderness inside the scrotum (ball sack). A few men will notice that the whole of the scrotum is red and tender. Infection can lead to a build-up of fluid in the affected area, or even an abscess. If left untreated, epididymitis can sometimes lead to infertility.

Reactive arthritis

Chlamydia can cause a reactive arthritis (inflammation of the joints). In some people the arthritis develops as part of a syndrome and they also develop inflammation of the urethra (urethritis) and the eyes (conjunctivitis).

Reactive arthritis is more likely to occur in men than women. Symptoms usually get better in 3-12 months although they can return after this. Symptoms can usually be controlled by painkillers known as non-steroidal anti-inflammatory drugs(NSAIDs), such as ibuprofen. Some people will need to see a joint specialist if their symptoms are severe.

Preventing chlamydia

You can protect yourself against chlamydia by:

• Using a condom every time you have vaginal or anal sex
• Using a condom to cover the penis during oral sex
• Using a dam (a piece of thin, soft plastic or latex) to cover the female genitals during oral sex
• Not sharing sex toys

If you do share sex toys, wash them or cover them with a new condom between each person who uses them.

These measures can also protect you against other sexually transmitted infections (STIs) such as genital herpes and gonorrhoea.