Chlamydia is a very common sexually transmitted disease that can infect both men and women. Unfortunately, the main complication of untreated Chlamydia infections is the permanent damage that it might cause to your reproductive organs, especially in the case of women – making it harder for them to conceive a baby later on. It might also cause other complications and more serious conditions such as pelvic inflammatory disease (PID), tubal factor infertility, ectopic pregnancy, and chronic pelvic pain among various others.
According to the Centers for Disease Control and Prevention, there were around four million estimated cases of Chlamydia in the United States in 2018. However, this is not representative of the actual reported number as some cases are asymptomatic and are left unreported unless it results in some type of complications.
The disease itself is caused by the bacteria known as Chlamydia trachomatis, shortened as C. trachomatis in most references. Its manifestation in women is known as either cervicitis or urethritis, while proctitis is a manifestation in both men and women. Like an STD, it is easily transmitted through sexual contact, and ejaculation is likewise not necessarily a requirement to transmit the disease. In addition to that, it could likewise be transmitted to the baby of infected pregnant women (vertical transmission), leading to a condition known as ophthalmia neonatorum or pneumonia in some infants.
Fortunately, although most cases of Chlamydia infections are asymptomatic – garnering the name of being a “silent” infection – symptomatic manifestations are easily treatable with a standard course of antibiotics combined with abstinence and other non-pharmacological regimens that would help in alleviating the symptoms of the disease. While the treatment is pretty much standard, even for HIV-positive individuals who are severely immunocompromised, self-medication with antibiotics is not recommended at all due to the possibility of antimicrobial resistance development. With the vague incubation period of C. trachomatis, there is no one way to be sure about when and how the recurrence of the disease will occur – making it critical that the efficacy of the readily available therapy is maintained. Consult your doctor before choosing any treatment option.
According to the Centers for Disease Control and Prevention, there were a total of 1,808,703 cases of Chlamydia infections that were reported in 2019 – immediately bumping it to the position of the most number of detected cases for a condition in the United States in that year. This saw a 2.8% increase in the number of cases as compared to the previous year’s record. Based on their data, most of their recorded cases are generally attributed to women, with men lagging in the number of reported infections, but there was also an observed 32.1% increase in the male infection rates from 2015 to 2019 – indicating that either homosexual relations are more prevalent around this period or the accessibility to testing options such as urine tests and extragenital screening is now better than before.
Based on the CDC’s 2019 data, around 61% of their reported cases are from the age range of 15 to 24 years, indicating an increased prevalence of STDs among younger generations. As such, US Preventive Services and Task Force now recommends annual screening for all sexually active women under 25 years of age and as well as those who are older but are exposed to an increased risk of contracting the infection or developing severe complications.
Considering how Chlamydia is easily transmitted through sexual contact, any sexually active individual is considered susceptible and at risk of contracting the disease. Based on the CDC’s reported data of 2019, the number of Chlamydia cases has skyrocketed within the younger age group – implying that it is no longer an issue that is mainly restricted to adults but rather concerns anyone who participates in any form of sexual activity.
The reason for such is attributed to multiple reasons including behavioral, biological, and cultural factors. Younger individuals usually opt-out from using a condom during intercourse, some teenagers are sexually active with multiple partners, younger women are subject to cervical ectopy (a condition where the cells of the endocervix are present within the ectocervix causing increased susceptibility), and younger people have lower access to STD prevention and diagnostic options – there are multiple factors in play as to why this demographic is steadily increasing their infection rates. Nevertheless, it is now the age group that is subject to the CDC’s monitoring recommendation to mediate this prevalence that has been observed lately.
According to the Centers for Disease Control and Prevention as well as the US Preventive Services Task Force, all sexually active females under the age of 25, as well as other women who are at high risk of contracting the disease, should receive annual screening to prevent permanent damage due to the disease. In addition to that, men who participate in rectal sex should likewise be screened annually on top of the targeted urogenital screening of young men in clinics with an increased number of reported cases. Routine screening of partners of those who have had a previous Chlamydia infection should likewise be observed as reinfection is a legitimate risk with such a condition.
Chlamydia infections are often hard to diagnose since screening tests are the only way to identify whether an asymptomatic individual is indeed infected by C. trachomatis. Nonetheless, the treatment options for Chlamydia are easily accessible following an accurate diagnosis – making for an easily manageable disease once the patient is screened. The treatment regimen is mainly composed of a standard course of antibiotics for around 7 days, but this may vary depending on the clinical opinion of the examining physician. Overall, the treatment for Chlamydia is aimed at preventing severe complications that could result in permanent irreversible damage and prevent the reinfection or infection of your current or future sexual partners.
The general recommendation for those with Chlamydia infection is abstinence for 7 days following a single dose therapy or abstinence within the 7 days that are taking the standard antibiotic therapy. However, some references would likewise point out that due to the possibility of recurrence, abstinence should still be employed until the symptoms completely subside. Complete diagnosis and treatment of your sexual partners should likewise be performed beforehand as Chlamydia infections do not induce immunity. A follow-up consultation may also be necessary depending on the progression of your condition.
Chlamydia is known as the "silent" STD because the vast majority of people experience no symptoms. It can be easily cured with antibiotics; get tested today if you think you may have been exposed.Get tested for STDs today
Chlamydia infections are mainly caused by a microorganism known as Chlamydia trachomatis, a bacteria that can only live intracellularly. The genus Chlamydia is composed of three microorganisms that could likewise cause infections in humans: C. trachomatis, C. pneumoniae, and C. psittaci. Chlamydia trachomatis exclusively infects humans, causing various diseases depending on the organ that proliferated in. For example, it can cause trachoma in all individuals, it can cause anogenital infections lymphogranuloma venereum, and conjunctivitis in adults, and conjunctivitis and pneumonia in neonates.
The species C. trachomatis usually target columnar epithelial cells in mucosal areas, developing a chronic infection as it is left untreated for years on end. Its complete life cycle would last for around 48 to 72 hours, the time wherein it will attempt to invade the columnar epithelial cells of your genital tract, then proceed to undergo lysis to then proliferate and infect other cells within the vicinity.
Chlamydia is easily transmitted through contact with any of the mucosal sexual tissues such as the penis, vagina, mouth, or anus of an infected person. It has an approximate rate of transmission of around 55%, while its per act transmission rate is estimated at roughly 10%. However, these rates are still susceptible to multiple variables as most infections remain asymptomatic and unreported.
Ejaculation is likewise not a requirement for an individual to transmit the disease to their partner. As long as there is contact with the infected mucosal tissue of your partner, the risk of transmitting the causative agent is ever so evident. Chlamydia is likewise transmitted perinatally wherein an infected pregnant mother could pass on the infection to their child upon delivery. According to certain studies, the presence of Chlamydial conjunctivitis is evident in 18-44% of infected pregnant cases while Chlamydial pneumonia has been found in around 3 to 16% of infants. Do note, however, that this prevalence is only evident for infected pregnant women who were left untreated even until delivery – increasing the risk by a huge margin due to the presence of the agent itself in the tissues during labor.
It should also be noted that while Chlamydia infections in infants usually persist for a year or more after birth (assuming that perinatal transmission was evident), it is still a standard protocol to check prepubertal children beyond the neonatal age for signs of sexual abuse due to the inherent transmission method of the disease. It is not 100% indicative of such cases, but physicians would have to wonder as to why a sexually transmitted disease is manifesting in an individual too young to be sexually active in the first place.
Chlamydia has been branded as the “silent” infection due to its poor reproductive ability resulting in asymptomatic instances for most of its cases – making it hard for physicians to even diagnose the disease with a simple physical examination due to the lack of abnormal physical findings. The only reliable way to identify the occurrence of the infection is through screening and testing but testing for asymptomatic individuals is usually only done through routine check-ups – an option that many even opt-out of. As such, knowing the first clinical manifestation, if ever there are, of Chlamydia is essential in making sure that its progression is stopped as early as possible. It may take several weeks to develop symptoms, but it would a handy tool in your arsenal to know what you are dealing with when it is time to cross the bridge.
Most infected women would remain asymptomatic for weeks, or even until the disease subsides on its own. However, symptomatic manifestations are likewise possible, and these could even progress along with uncomplicated infections when the bacteria sufficiently proliferate. The bacteria would initially infect the cervix to cause cervicitis wherein a mucopurulent discharge and easily induced cervical bleeding is evident, as well as the urethra to then cause urethritis, characterized by a painful burning sensation while urinating. The infection could then infect the upper reproductive tract, causing complications such as Pelvic Inflammatory Disease that is characterized by pelvic pain and cervical motion tenderness. The following are an in-depth discussion of each manifestation in women:
Cervicitis is the manifestation of a Chlamydia infection in the cervix, affecting 75 to 80% of women who are infected with the bacteria. It is usually asymptomatic in most cases, and the physical diagnosis of someone with an asymptomatic variation will not yield a distinguishing quality between infected and uninfected ones. If the condition does progress into its symptomatic state, it usually presents as a mucopurulent discharge or a spontaneous or easily induced cervical bleeding that can be compared to a vague feeling of discomfort and spotting. Some women also report cases of post-coital bleeding and premenstrual bleeding on top of everything else.
Urethritis in women is likewise initially asymptomatic, but they could also develop what is known as the “dysuria-pyuria” syndrome, also known as an acute urethral syndrome. In this case, the symptoms would mimic acute cystitis or urinary tract infections – presenting as dysuria and urinary frequency. Unfortunately, the physical manifestations of urethritis are extremely similar to other urinary tract infections, leading to misdiagnosis especially if sample culturing and screening is not performed. Although standard antibiotic therapies are indicated for both, those indicated for UTI are not effective at all for treating Chlamydia, allowing it to persist and develop various complications.
Symptomatic manifestations in men are mainly attributed to urethritis, and this causes a mucoid or watery urethral discharge along with a painful sensation while urinating. However, some individuals also develop various advanced conditions such as epididymitis when the condition is left untreated.
Urethritis is the most common manifestation in men who partake in heterosexual intercourse, presenting as either a clear, mucoid, or mucopurulent urethral discharge. This collection of symptoms is usually categorized under non-gonococcal infections due to the subtle similarities between the symptoms of Urethritis and a gonococcal infection. While it is hard to distinguish the two conditions without a conclusive examination of the bacterial strain present, most non-gonococcal infections would usually produce a variety of discharge types while gonococcal infections are mainly limited to purulent urethral discharge.
Epididymitis is a local complication of Chlamydia infections in men, and this commonly presents as unilateral scrotal pain, epididymal swelling, and tenderness at the genital region. Possible hydrocele and fever could likewise be observed in such conditions. It is important to note, however, the epididymitis could likewise be caused by other conditions such as N. gonorrhoeae.
Chlamydia could likewise proliferate in the rectum, especially for those who often partake in anal sex with their partners. Such cases are commonly asymptomatic much like most of the instances, but they could also cause symptoms similar to proctitis such as rectal pain, discharge, and/or bleeding.
In addition to that, it has also been found that Chlamydia could present as conjunctivitis in both men and women when the area is exposed to infected bodily fluids. Oral sex could likewise cause oral symptoms such as pharyngitis, albeit it is commonly asymptomatic in the majority of cases.
In the diagnosis for Chlamydia cases, several diagnostic tests are available in various laboratories including Nucleic Acid Amplification Tests, Cell Culture, and Physical Examination among others. The NAATs are considered as the most reliable and sensitive ones, and they can also be performed using an easily collected sample such vaginal swabs and urine samples – vaginal swabs in women and urine in men as the preferred sample choice.
Culture tests, while is available for most samples, are unfortunately no widely available for rectal and pharyngeal specimens. In addition to that, NAAT testing is likewise not FDA-approved for pharyngeal sample testing.
Despite the “silent” initial stage of Chlamydia infections, untreated conditions could progress to more damaging and long-term complications that could have heavy implications on an individual’s future quality of life. As such, it is important to perform routine screening to ensure that the progression of the disease is identified early on and managed eagerly – preventing irreversible and permanent damages that accompany severe complications.
The following conditions are common complications that are associated with a C. trachomatis infection:
Pelvic inflammatory disease is a severe complication of genital infections wherein the causative agent can reach the upper reproductive tract. It is usually indicated as a complication of infections such as Chlamydia and Gonorrhea, and its manifestations are commonly mild depending on how severe the extent of the damage is. Upon contracting this condition, the symptoms are usually minimal, but severe manifestations could likewise be included such as abdominal pain and fever. A few indicative symptoms for PID include:
PID is likewise attributed to more severe conditions such as scar tissues that block the fallopian tube and disrupts conception, ectopic pregnancy or pregnancy outside the womb, infertility, and chronic long-term pelvic and abdominal pain. It is imperative that patients who have been diagnosed or are experiencing symptoms of PID be managed immediately as late-stage treatments could no longer repair the damages caused by the condition.
Perihepatitis, also known as Fitz-Hugh-Curtis syndrome happens when a Chlamydia infection is allowed to proliferate until it reaches the liver – causing inflammation of the liver capsule and the peritoneal surfaces nearby. While it is commonly found concurrently with manifestations of Pelvic Inflammatory Disease, it is also associated with an upper right quadrant or “pleuritic” pain. However, unlike most liver-affecting conditions, perihepatitis does not cause any imbalances in the amount of liver enzymes – making it harder to diagnose than most conditions associated with liver damage.
The condition has been initially attributed to gonococcal infections, but it has recently been associated with chlamydia infections as well. Upon contracting the condition, the following signs and symptoms could be expected:
Antibiotic therapy is the treatment of choice for perihepatitis, but it is still generally aimed at resolving the specific symptoms and underlying conditions that are apparent in an individual. Antibiotic medications may include Tetracycline, Doxycycline, Ofloxacin, and Metronidazole, while pain medications or analgesics like Acetaminophen could likewise be provided to combat the pain associated with the condition.
Endometritis is generally characterized as the inflammation of the endometrial lining of the uterus, affecting even the myometrium and even the parametrium. It is often associated with the prevalence of PID, but it could also be associated with the inflammation of the fallopian tubes and ovaries.
Cases of endometritis are usually diagnosed based on their clinical presentations which might include:
Following diagnosis, endometritis cases can be addressed by a standard course of broad-spectrum antibiotics that could then resolve the condition within 48 to 72 hours in 90% of women treated with an approved regimen.
Salpingitis is classified as a variation of Pelvic Inflammatory Disease wherein the bacteria cause an inflammation in one or both fallopian tubes – causing further complications when left untreated. Although this is a complication of Chlamydia, it could likewise remain asymptomatic despite remaining active and damaging to the condition of the patient. The condition usually presents as:
Much like other Chlamydia complications, the main goal of the treatment regimen for this condition is to address the underlying bacterial infection through oral or intravenous antibiotic medication. In addition to that, Salpingitis that has been complicated with the presence of abscesses could likewise require minor laparoscopic surgery to drain the pus in the fallopian tubes. Do take note, however, that while the condition could remain asymptomatic, untreated cases could lead to further complications including:
Immediate treatment upon diagnosis is imperative to ensure that no permanent damage is induced in the fallopian tubes – a complication that could cause permanent infertility when not managed early on.
Reactive Arthritis, also known as Reiter’s syndrome, is a complication in men associated with a prolonged urogenital chlamydia infection. It is described as an inflammatory response triggered by an ongoing infection in other parts of the body, targeting the knees, joints of your ankles and feet, eyes, skin, and urethra. The term Reiter’s syndrome was previously used to characterize the triad that accompanies reactive arthritis:
The manifestations of this condition usually appear a few weeks after the onset of an infection, and this may include:
Apart from the standard antibiotic therapy that is indicated for Chlamydia infection complications, your physician may likewise prescribe non-steroidal anti-inflammatory drugs for the pain, corticosteroids and topical steroids for the inflammation, and rheumatoid arthritis drugs for the arthritis-like manifestations of the condition.
The primary goal of all treatment regimens for Chlamydia infections is the prevention of further proliferation and development of severe complications. As such, treatment guidelines must consider not only the manifestations of the patient, but the condition of their sexual partners as well. In addition to that, it is also imperative that the treatment regimen is provided immediately as any delay in the management process could potentially risk the development of a more severe complication that could then cause permanent damages to the structures of the infected person’s body.
To start, the recommended regimen of the Centers for Disease Control and Prevention 2015 Treatment Guidelines for all Chlamydia-related infections are:
On the other hand, if the provided recommended therapy is incompatible with the patient due to multiple factors such as sensitivity, appropriateness to condition, concurrent medications, etc., the following treatment options can then be administered:
The use of Azithromycin and Doxycycline have comparable efficacies and are therefore interchangeable depending on the preference and adherence of the patient. It was provided that the single-dose administration of Azithromycin could improve patient adherence due to the minimal amount of doses that the patient is bound to take. However, it was likewise proven in certain studies that although the administration of Doxycycline is extended over a 1-week period, there were adequate clinical outcomes still – showing that both treatment options are equally effective in addressing the situation.
The alternative options are likewise only administered in the cases of special precautions, allergic reactions, and adverse events related to the use of the recommended agents. This is in line with the findings of various studies that no significant C. trachomatis strains have developed resistance against these agents – making them perfectly viable for the treatment of such conditions even until now.
Do note, however, that there may be some side effects to taking these medications such as stomach pain, rash, nausea, and diarrhea, but these are relatively rare and are, most often than not, safe when a pregnant woman experiences these presentations.
Do take note that rectal chlamydial infections are likewise treated using the same recommended therapy for urogenital infections, albeit there is evidence that Doxycycline might have greater efficacy than Azithromycin in such situations.
Oropharyngeal chlamydial infections are still poorly understood and vague at best on top of having no FDA-approved or recommended screening routine for oropharyngeal cases. However, considering that the transmission of C. trachomatis is still possible within the oropharyngeal tract, the presence of the microorganism within the area should warrant a standard treatment regimen of Azithromycin 1g orally as a single dose or Doxycycline 100mg orally twice for 7 days.
Considering that Chlamydia is an easily transmitted STD that infects hundreds and thousands of individuals in the United States alone, it is imperative that the sexual partners in the past 60 days of individuals who tested positive for Chlamydia be screened and provided with a presumptive treatment that is effective in preventing the development of Chlamydia. The most recent partner, regardless of the time gap between the diagnosis and the last sexual intercourse, should likewise undergo the same process of evaluation and presumptive treatment to guarantee that any infection, symptomatic and asymptomatic alike, are addressed thoroughly.
In cases where Expedited Partner Therapy is legal in your State, it is also recommended for partners of individuals who are unavailable to attend a comprehensive check-up and diagnostic session. An expedited partner therapy is a process by which the infected individual is the one that opts to provide the medication and the information regarding the condition to their partner instead. Do take note, however, that this option is not recommended or probably not even legal with men who participate in homosexual intercourse due to the high rate of recurrent infections, or in women who are showing signs of PID – a complication that could prove to be detrimental to the patient when left unchecked.
According to the 2015 CDC Treatment Guidelines for Chlamydia Infections, a test-of-cure routine procedure is not necessary for previously non-infected individuals after completing their treatment regimen. However, it is recommended that all patients undergo repeat testing for the presence of the bacteria after 3 months as multiple studies have shown that recurrence and re-infection are most prevalent at the 3-month mark following treatment. These re-infection cases are typically associated with:
In the case of pregnancy, the only recommended medication is Azithromycin (following the same dose and duration) as Doxycycline is an FDA Pregnancy Category D Drug – a medication that is bound to cause abnormalities in fetal bone development along with potential toxicity. Erythromycin estolate is likewise contraindicated due to the increased risk of hepatotoxicity.
Do take note that for pregnant women, a test-of-cure should be performed 3 weeks after finishing the treatment. Younger women should likewise be retested during the 3rd trimester.
In cases where the baby is infected by an existing Chlamydia infection of the mother, the recommended treatment regimen is a standard course of Erythromycin base or ethylsuccinate at a dose of 50mg/kg/day orally divided equally into four doses for 14 days. However, constant monitoring upon administration should likewise be performed as the administration of this medication has been found to cause infantile hypertrophic pyloric stenosis in rare instances.
With the treatment regimens being heavily reliant on antimicrobials, it is imperative that you should NEVER, and we repeat, NEVER SELF MEDICATE. Although C. trachomatis resistance against the recommended first-line medications is still not evident, improper use of these drugs could lead to resistance and reduced efficacy. Always consult your doctor before taking any medication for your condition.
Considering that Chlamydia is a sexually transmitted disease, the core preventive measure for such a condition is the ABCs of STDs.
Opting out of sexual intercourse is the best way to prevent the transmission of the disease completely. Without contact, the bacteria could not proliferate to other cells – effectively eliminating the risk of contracting the bacteria completely.
While it is not necessarily consistent in all cases, having multiple sexual partners could likewise expose you to multiple potential sources of infection. Having one sexual partner allows you to monitor where you are exposing yourself to and effectively trace back the infection in cases where you contract it.
Consistent with the concept of abstinence, if there is no contact between the mucosal tissues of your genitals, then the risk of contracting the disease is reduced greatly. Condoms, when used effectively and properly, could protect you from contracting most STDs for that matter.
Ensure that your private areas are always hygienic by employing proper washing techniques, such as washing from front to back in women during defecation.
How long can you have chlamydia without knowing that you have it?
The result could vary for each individual as some cases might naturally resolve themselves while still being asymptomatic, while others would suddenly progress to a more severe complication if the condition is left untreated. There is no standard length of time to determine this, but to be sure, routine screening for STDs is recommended.
Is recurrence possible after treatment?
Yes, and this is the exact reason why the CDC recommends a re-testing procedure 3 months after the treatment regimen has ended.
How long is chlamydia contagious?
On average, physicians claim that chlamydia infections are no longer contagious 7 days after the beginning of treatment. However, this is still purely anecdotal and abstinence during the treatment period should still be observed.
Can you still conceive even if you had chlamydia before?
Absolutely. Infertility is only observed in cases where the infection has progressed into more severe complications such as PID, salpingitis, and endometritis.
How do you know if your chlamydia infection has subsided?
If the condition is asymptomatic in the first place, the only conclusive way to determine the absence of the microbe from your area is through screening and testing. In the case of symptomatic conditions, although testing should still be performed as a confirmatory test, the subsiding symptoms such as the absence of discharge and pain or lack of cervical bleeding are indicative of an improving condition.
Are diagnostic tests susceptible to false-negative results?
Yes. The average proliferation time necessary for C. trachomatis is 14 days. Within this period, thenumber of microbes in your sample might be too little to even be detected by standard tests. As such, it is important to continuously monitor your condition for possible distinctive symptoms during this period as testing could still prove to be a little unreliable until then.
How long until a chlamydia infection causes permanent damage?
There is no standard timeframe for how long an infection could cause complications as this is mainly dependent on the response of the patient’s body to the presence of the causative agent. It is imperative that potentially infected patients be diagnoses and treated immediately to resolve the issue before it progresses to its later stages.
Can you get chlamydia from kissing?
No. Chlamydia is not transmitted through casual contact such as kissing, hugging, holding hands, coughing, or sneezing.
How soon can you get tested for chlamydia?
To ensure that the test will come back with accurate results instead of false-negative ones, it is recommended that potential patients be tested 1 to 2 weeks after initial exposure. Within this period, although false-negative results are still possible, the microorganism is now sufficiently proliferated for it to be detected by the standard tests.
Can contraceptive pills fight off chlamydia infections?
No. Contraceptive pills do not offer protection against sexually transmitted infections.
At what age group is chlamydia predominant in?
Chlamydia is a condition that affects all age groups, but it is more common among women aged 25 years and below.
Centers for Disease Control and Prevention
National Institute of Allergy and Infectious Diseases
Lab Tests Online
Learn more in-depth information regarding the various diagnostic procedures for Chlamydia, as well as its quirks and limitations that make one stand out over the other. Preparatory recommendations for testing are likewise indicated to help guide you throughout the procedure.
Written by Mark Riegel, MD
Yes. Chlamydia is easily treated with a course of antibiotics.
Bacterial. Caused by the Chlamydia trachomatis bacterium.
Antibiotics. A single dose of Azithromycin or seven daily doses of Doxycycline.
1 to 2 weeks. One to two weeks may be required for symptoms to fully disappear.
No. Sexual activity should be avoided until treatment is successful.
Yes. Re-infection is possible from sexual activity with an infected person.
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