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The days of sexually transmitted infection (STI) scare campaigns may be over (or maybe not, amid the recent stories about “super gonorrhea”), because most STIs caused by bacteria can be successfully treated with antibiotics. But there is a particular danger in STIs that go untreated — which is more common than you’d think because many have vague symptoms or none at all — and some can have lasting effects. One of them, chlamydia, can impact a woman’s fertility in a way that can have serious complications, one of which can even be fatal.
- According to the CDC, only 10% of men and 5% to 30% of women who test positive for a chlamydia infection will develop symptoms.
- Women can develop pelvic inflammatory disease (PID), in which the cervix, uterus, ovaries, and fallopian tubes become inflamed.
- Damage from PID can lead to chronic pelvic pain, tubal factor infertility, and potentially fatal ectopic pregnancy.
- Chlamydia can also be spread from mother to infant during childbirth, and it can cause premature delivery or pneumonia in the baby.
What is chlamydia?
Chlamydia is an STI caused by the Chlamydia trachomatis bacterium. According to the Centers for Disease Control and Prevention, it’s the most commonly reported bacterial STI in the United States: In 2017, more than 1.7 million cases were reported, and the agency estimates that 2.9 million infections occur annually (the balance being undiagnosed or unreported) (CDC, 2016). “A large number of cases are not reported because most people with chlamydia are asymptomatic and do not seek testing,” the CDC says. It’s estimated that 1 in 20 sexually active young women aged 14 to 24 have chlamydia.
Chlamydia spreads through vaginal, oral, or anal sex, and ejaculation doesn’t have to occur for it to be transmitted. Chlamydia can also be spread from mother to infant during childbirth.
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Symptoms of chlamydia
Chlamydia is known as the “silent” STI. Most people infected with chlamydia have no symptoms and seem normal upon physical examination. According to the CDC, only 10% of men and 5% to 30% of women who test positive for a chlamydia infection will develop symptoms.
In women, chlamydia tends first to infect the cervix, which can cause a vaginal discharge. The bacteria can also irritate the urethra, causing urethritis, which is often signaled by pain while urinating. Untreated chlamydia can spread to the uterus fallopian tubes, and ovaries, causing abdominal pain or pelvic pain and pelvic inflammatory disease (PID).
Men can develop urethritis, swelling in the urethra, which causes pain while urinating and discharge. Untreated chlamydia can also cause epididymitis, swelling in the tube in the back of the testicles, causing pain.
Chlamydia can also take up residence in the eyes, causing an eye infection called chlamydial conjunctivitis (a.k.a. pinkeye). The symptoms include redness, infection, and discharge.
Chlamydia can also infect the rectum, either through receptive anal sex or the spread of bacteria from the cervix or vagina. This might produce no symptoms, or pain, discharge, or bleeding.
Although chlamydia can be found in the throat of people who have oral sex with an infected partner, it generally doesn’t produce symptoms, says the CDC.
Complications of chlamydia
Untreated chlamydia can cause several complications in both women and men.
Women can develop pelvic inflammatory disease (PID), in which the cervix, uterus, ovaries, and fallopian tubes become inflamed.
Chlamydia can also be spread from mother to infant during childbirth, and it can cause premature delivery or pneumonia in the baby.
How chlamydia can turn deadly
“PID can cause permanent damage to the fallopian tubes, uterus, and surrounding tissues,” says the CDC. “The damage can lead to chronic pelvic pain, tubal factor infertility, and potentially fatal ectopic pregnancy.”
In some cases of pelvic inflammatory disease, the fallopian tubes can become scarred or blocked. That increases the chances of an ectopic (tubal) pregnancy, in which a fertilized egg implants in the fallopian tubes instead of the uterus. Because the fallopian tubes allow little room for the embryo to grow, the tube can burst, causing internal bleeding, shock, and blood loss that can be fatal.
The main symptom of an ectopic pregnancy is severe abdominal pain, and prompt treatment is essential. “The sooner you get treated for an ectopic pregnancy, the better. So if you think you have an ectopic pregnancy, or if you have lots of low belly pain (especially on one side) or abnormal vaginal bleeding, call your nurse or doctor right away,” says Planned Parenthood.
Ectopic pregnancies are pretty rare — about 2 of each 100 pregnancies, according to Planned Parenthood — and fatalities rarer still, but untreated chlamydia seems to raise the risk.
Researchers at the University of Edinburgh have found that chlamydia may lead to ectopic pregnancy because chlamydia causes women to produce a protein in their fallopian tubes. Per research published in the American Journal of Pathology, the protein (called PROKR2) makes a fertilized egg more likely to implant in the fallopian tube instead of traveling to the uterus (University of Edinburgh, 2011).
How to prevent chlamydia
The only absolute way to avoid STIs is to avoid sexual contact. Any sexually active person might be infected with chlamydia. The best way to prevent chlamydia is to use condoms consistently or to have sex with a partner who’s been tested and knows they’re uninfected. If you’re sexually active, it’s a good idea to have regular STI screenings. Talk to your health care provider about what’s right for you.