Chlamydia

Chlamydia is a sexually transmitted infection (STI) caused by the bacterium chlamydia trachomatis. In the UK, the number of new diagnoses has been steadily increasing each year since the mid-1990s, and it has now become the most commonly diagnosed STI.

Between 2004 and 2005, the number of confirmed cases of chlamydia rose by 5%, from 104,733 to 109,958. Sexually active women aged under-25, have a 1 in 10 chance of getting chlamydia, and men who are aged between 20 and 30 are most at risk of becoming infected.

As chlamydia sometimes has no symptoms in both men and women, it can often go undiagnosed, unless it leads to complications. However, once the infection has been diagnosed, it can be treated.

Women

In women, genital chlamydia does not often cause any symptoms. However, some women may have 'non-specific symptoms' such as:

• cystitis,
• a change in their vaginal discharge, and
• mild lower abdominal pain.

If you visit your GP, or family planning doctor with any of these symptoms, you can ask to have a chlamydia test taken, even if you are not offered one.

If left untreated, the chlamydia infection may lead to the following symptoms:

• pelvic pain,
• pain during sexual intercourse, or occasionally,
• bleeding between periods.

The chlamydial infection can also spread to the womb, and cause Pelvic Inflammatory Disease (PID). PID is a major cause of infertility, ectopic pregnancy and miscarriage.

Men

A man with chlamydia commonly experiences a urethral discharge from the penis.

You may also have inflammation of the tube leading from the bladder to the tip of the penis (urethritis), and inflammation of the tube leading from the testes to the penis (epididymitis).

You may also experience mild irritation at the end of your penis that will usually disappear after two or three days. However, after the discomfort disappears, you may still have the chlamydia infection. This means that you can pass it on to a sexual partner. You also risk the complication of inflamed and swollen testicles.

In rare cases, chlamydia can also cause an uncommon condition that affects the eyes and joints, known as Reiters syndrome. Chlamydia can also cause fertility problems in men; approximately half of all men with symptoms have impaired fertility, such as epididymitis.

As chlamydia is a sexually transmitted infection (STI), it is transmitted (passed on) from one person to another during intimate sexual contact. You can catch chlamydia through:

• having unprotected vaginal sex,
• having unprotected anal sex,
• having unprotected oral sex, or
• having genital contact with an infected partner.

As it is common for someone with the chlamydia infection not to have symptoms, it is possible for him or her to infect a partner without knowing.

You cannot catch chlamydia by using the same toilet seat as someone who is infected, and it cannot be transmitted through swimming pools or saunas.

Chlamydia can be passed from a mother to her baby during childbirth. Although no obvious symptoms are immediately apparent, the infection will often develop two weeks after birth, and can result in complications such as pneumonia.

Women

Up until five years ago, women were tested for chlamydia by taking a swab from the cervix (neck of the womb) using an instrument called a speculum (similar to a spatula).

However, in recent years newer tests have been developed that allow a woman to carry out a simple procedure at home, using either a urine sample, or by taking a swab from the lower vagina. The sample is put into a container and sent to a laboratory to be tested. The need to have an intimate and embarrassing examination is therefore avoided.

Men

For men, in the past, the test for chlamydia involved putting a swab into the opening of the urethra at the tip of the penis. However, a urine test is now commonly used, and although it is slightly less reliable than using a swab, it is a much easier and less painful procedure.

Tests for sexually transmitted infections (STIs) are usually carried out at STI clinics (also known as genito-urinary medicine or GUM clinics). They have special testing facilities, and can also sometimes provide you with assistance in contacting your previous sexual partners, and getting them tested and treated. You can find details of your nearest sexual health clinic in the phone book, or by using the local health service search on the home page to find a sexual health clinic. You can attend these clinics at any age, even if you are less than 16 years of age (the age of consent for sex), and all results are treated confidentially.

National Chlamydia Screening Programme

In 1998, two pilot tests, one carried out in Portsmouth and the other in the Wirral, found that chlamydia was more common than expected. In the years since the studies were conducted, the number of diagnosed cases of chlamydia, have risen steadily. In addition to this, there are a large number of people with the condition, who do not have any symptoms, and therefore do not know they have been infected.

In response to the 1998 study, and the increase in the number of diagnosed and undiagnosed cases of chlamydia, the Department of Health implemented a national screening programme for the condition.

In England, in 2002, 10 chlamydia screening programmes were launched in Primary Care Trusts (PCTs), with a further 16 being added at the beginning of 2004. During 2006, further screening programmes have been introduced, bringing the total number of areas covered to 85.

Antibiotics

After being diagnosed with chlamydia, the uncomplicated infection can usually be successfully treated using antibiotics, commonly, azithromycin and doxycycline. Research has shown that 80-90% of people with chlamydia are cured after taking one of these antibiotics.

Azithromycin is taken as a single dose, and doxycycline is taken twice a day for seven days. You should consult your GP who will be able to provide you with advice about which antibiotic is the most suitable for you. For example, if you are pregnant, some antibiotics may not be suitable, but alternative antibiotics are available. Again, you should consult your GP.

The most common side effects of antibiotics include:

• stomach upsets,
• stomach pain,
• diarrhoea, and
• feeling sick.

However, the side effects of antibiotics are usually mild. Occasionally, if you take doxycycline, you may get a skin rash if you are exposed to sunlight (photosensitivity).

Sexual partners

Chlamydia can be easily passed on through intimate sexual contact. Therefore, if you have the infection, anyone who you have recently had sex with (in the last six months) may also have it. It is therefore vital that your partner is tested, regardless of whether they have any symptoms or not.

Any of your previous sexual partners will also need to be tested. Your local GUM clinic may be able to help by notifying any of your previous partners on your behalf. If you or your current partner is diagnosed with chlamydia, you should not have sex until you have both finished your course of the treatment.

Other treatments

Other antibiotics that may work for treating chlamydia include amoxicillin, ampicillin, clarithromycin, lymecycline, minocycline, ofloxacin, pivampicillin and rifampicin. However, the effectiveness of these medicines has not yet been determined.

The complications that can arise from long-term chlamydial infection are much more difficult to deal with than uncomplicated chlamydia. However, early diagnosis and treatment will reduce the risk of complications, so you should make sure you have any symptoms investigated as soon as possible. Genito-urinary medicine (GUM) clinics, or sexual health clinics, can provide you with the necessary advice, tests and treatment.

Women

Pelvic Inflammatory Disease (PID)

In women, chlamydial infection is one of the main causes of Pelvic Inflammatory Disease (PID). PID is an infection of the uterus, ovaries and fallopian tubes. It can cause infertility, persistent pelvic pain and, if you become pregnant, there is also an increased risk of ectopic pregnancy. If you have PID, the condition is usually treated using antibiotics. The earlier your treatment starts, the better. Sexual partners should also be treated.

Chlamydial infection can also cause inflammation of the neck of the womb (cervicitis), the fallopian tubes (salpingitis), and the glands that produce natural sexual lubricant (Bartholinitis).

Cervicitis

Cervicitis often causes no symptoms, but you may have a vaginal discharge, containing pus and, sometimes, pain during intercourse. You may also experience urinary symptoms, such as the need to urinate more often, and a burning pain when you urinate. In chronic cervicitis, the cervix becomes enlarged, and cysts can develop which may become infected. You may also have backache, deep pelvic pain, and a persistent vaginal discharge.

Salpingitis

If chlamydial infection causes a blockage of the fallopian tubes, it may prevent eggs from passing along, or entering the tube. Even a partial blockage will increase the risk of pregnancy occurring in the tube (ectopic pregnancy). However, microsurgery can sometimes be used to effectively treat a blockage.

Barttholinitis

The gland that produces the lubricating mucus to make sexual intercourse easier is known as the Bartholin gland. It is situated on either side of the vaginal opening, and if you have chlamydia, it can become blocked and infected. If it does, it will lead to a Bartholin cyst. This is usually painless, but may also become infected, causing a pus-filled Bartholins abscess.

Treatment during pregnancy

The treatment of pregnant women with chlamydia is an area that is not fully understood. It is not certain whether some of the medicines that are usually used to treat the condition affect the unborn baby. However, if you are pregnant you should not take doxycycline or tetracycline because there is a risk that they can harm the development of the baby's teeth and bones. However, alternative medicines are available, and you should discuss these with your GP.

Men

Urethritis

Male urethritis is inflammation of the urine tube that runs along the underside of the penis. There is usually a urethral discharge that can consist of yellow pus, mucus and pus, or clear mucus at the opening. If urethritis is left untreated, complications can occur, such as a urethral stricture. This means that the urethra becomes narrow. A urethral stricture can seriously interfere with the flow of urine, and can lead to back pressure, which can damage the kidneys.

Epididymitis

Epididymitis is inflammation of the tubular part (epididymis) of the testicle. The epididymis is located next to the testicle, which becomes inflamed following an infection. The inflammation makes the testicle hot, swollen and extremely tender, and it can lead to an accumulation of fluid in the area (hydrocele), or even an abscess. Epididymitis can also lead to sterility.

Reiter's disease

Reiter's disease is a condition that mainly affects men. Its symptoms include inflammation to the joints (arthritis), the urethra and, quite often, the eyes. The condition usually occurs one to three weeks after a person has been infected with the chlamydial infection. Reiter's disease is the most common cause of arthritis in young men, occurring in about 2% of those with urethritis.

Chlamydia can be successfully prevented by using condoms. If you have a new partner it is a good idea for you both to be tested for STIs before having sexual intercourse.

If you have any of the symptoms mentioned in the symptoms section, you should visit your local sexual health or GUM clinic to have them checked out. You should also ensure that your friends and family are aware of chlamydia and its consequences and, if necessary, encourage them to get tested.