Like genital herpes, chlamydia is one of the most common bacterial sexually transmissible infection (STI) worldwide with an annual global incidence of more than 90 million cases. The asymptomatic nature of this disease and long-term complications due to undiagnosed infections have rendered this disease to be a major public health issue worldwide.
Aetiology
Many genital infections with chlamydia are asymptomatic. More than 70 percent of women with cervicitis are asymptomatic and half of them will have endometriosis, and risk developing pelvic inflammatory disease (PID) as a result of undiagnosed infections. Other complications include chronic pelvic infections, tubal damage, risk of ectopic pregnancy and infertility.
Diagnosis
Diagnosis involves collecting samples of cells for analysis and are collected by either using a swab to wipe over the infected area – throat, rectum and cervix. A first voided urine (FVU) test is also taken by collecting urine in a container to test for the presence of chlamydia.
The nucleic acid amplification test (NAATs), apart from the polymerase chain reaction (PCR) test, is used to detect the presence of chlamydia.
Clinical Features
Chlamydia in females is largely an asymptomatic infection where only 10-30% of women develop symptoms. Sexually transmitted Chlamydia trachomatis primarily infects the cervix, urethra, endometrium, fallopian tubes, pharynx and anal canal.
Typical symptoms include:
- Vaginal discharge
- Vaginal itching
- Post coital or inter-menstrual bleeding and pain
- Painful urination (dysuria)
- Pelvic pain
- Increased menstrual volume
Chlamydia in males
Chlamydia in males display symptoms that are suggestive of the site of infection.
Non-gonococcal urethritis (NGU)
Patients that experience dysuria and discharge usually indicate non-gonococcal urethritis where the urethra has been infected. 30-50% of patients with NGU will display symptoms.
Epididymitis
Infection can inflame the tube located next to each testicle called the epididymis. Fever, scrotal pain and testicular pain are highly indicative of epididymitis where the epididymis has been infected. C. trachomatis presents in 70% of infected males that are usually younger than 35 years of age and are more sexually active.
Proctitis
Proctitis is common in 15% of homosexual men and can present as rectal pain, discharge and bleeding of the rectum.
Complications
The asymptomatic nature of chlamydia often results in untreated infections in females, which risks development of severe complications such as pelvic inflammatory disease (PID), salpingitis and possible permanent tubal damage.
The risk of developing PID from untreated cervical chlamydial infections is 10-40%. PID is an infection of the uterus and fallopian tubes that cause pelvic pain and fever. It can lead to tubal infertility, ectopic pregnancy and chronic pelvic pain.
Infection in pregnancy can lead to postpartum maternal infection, endometritis and severe foetal complications such as:
- Perinatal infection of infant
- Premature rupture of membranes
- Preterm labour
- Low birth weight
- Neonatal conjunctivitis
- Neonatal pneumonia
The newborn can also become infected by contact with infected secretions during passage through the birth canal that can lead to conjunctivitis and pneumonitis.
Reactive Arthritis
An infection with C. trachomatis predisposes one to a higher risk of developing reactive arthritis (Reiter’s syndrome). Reactive arthritis affects the eyes, urethra and joints.
Treatment
Treatment mainly revolves around relieving symptoms, preventing onward transmission and the development of complications such as PID and epididymitis. Most patients with chlamydia are usually co-infected with gonorrhoea. Medication prescribed will usually cover both diseases as they are likely to exist in the same person.
Chlamydia can be treated effectively with antibiotics. Patients are usually treated with azithromycin as a single dose that can also cover other mycoplasma types that cause chlamydia. Doxycycline is prescribed as a 7-day course but cannot be used by those who are pregnant.
Sexual partners of infected patients are also treated to prevent further reinfection.
Patients who developed PID as a complication would require intravenous administration of antibiotics and more aggressive forms of treatment to target a wider range of organisms.
Management
- Sex should be avoided, even with a condom, until a week after both patients and their partners have completed treatment. This window period helps to ensure that reinfection does not occur immediately after treatment.
- For those under 25, repeat tests for chlamydia are usually run 3 months after finishing treatment.
- If someone tests positive for chlamydia, it is essential to notify recent sexual partners and ensure that all parties are tested and treated.
- Proper condom usage, either a male latex condom or a female polyurethane condom used during sex can help to reduce the risk of infection.
- Limiting the number of sexual partners can also reduce the chances of contracting other sexually transmitted diseases.
- Regular screenings are recommended for those who have multiple sexual partners.
