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What if we told you that one of the preventable causes of infertility in women is often asymptomatic. This probably sounds pretty worrisome. If it’s asymptomatic, how are you supposed to know if it’s affecting you, and what can you do about it? Well, this is the case with chlamydia. Chlamydia is a sexually transmitted infection (STI) that is caused by the bacteria Chlamydia trachomatis. You probably learned about chlamydia in school and may remember some of the symptoms your teacher talked about – itching, burning, and vaginal discharge. What you may not remember is the statistic about how often chlamydia can be completely asymptomatic and how, even then, untreated chlamydia can lead to severe complications down the road. The good news is if you know you have chlamydia, taking care of it is straightforward!
- Only 5-30% of women experience the symptoms of chlamydia.
- The most dangerous complication of chlamydial infection in women is its spread to the internal reproductive organs, which causes a condition known as pelvic inflammatory disease (PID).
- PID increases the chances of having an ectopic pregnancy. A ruptured ectopic pregnancy is a potentially life-threatening medical emergency requiring immediate treatment.
- The United States Preventive Services Task Force (USPSTF) recommends screening for chlamydia in sexually active females under the age of 25 (USPSTF, 2014).
In 2017, approximately 1.7 million cases of chlamydia were reported to the Centers for Disease Control and Prevention (CDC). This makes chlamydia the most common reportable bacterial infection in the United States. Also, since the majority of cases of chlamydia are asymptomatic, it is estimated that the actual number of cases in the country each year is much higher. Chlamydia is also particularly prevalent in younger individuals as well as in females. It’s estimated that 1 in 20 sexually active females aged 14-24 has a chlamydial infection.
Detecting a condition that has no symptoms comes down to screening. Screening is a way to look for a disease in an individual even if they don’t have any overt signs of the disease. The United States Preventive Services Task Force (USPSTF) recommends screening for chlamydia in sexually active females under the age of 25 (USPSTF, 2014). For those who are older, screening is recommended in those who are at higher risk of infection (i.e., those who participate in high-risk sexual behavior such as unprotected sex and sex with multiple partners). The same recommendations are in place for women who are pregnant. However, pregnant women should also be retested in the third trimester if under the age of 25 or at increased risk. This is important because, in addition to causing infertility, infection with chlamydia can cause issues during pregnancy and in the newborn. During pregnancy, chlamydia may lead to early rupture of the fluid sac containing the fetus and early (preterm) delivery of the newborn. If the infant is exposed to chlamydia during birth, it can cause pneumonia (a lung infection) or conjunctivitis (an eye infection).
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How is chlamydia spread?
As mentioned, one way in which chlamydia can be spread is from mother to child during birth. Other than this, chlamydia is transmitted from person to person through sexual contact. Specifically, you may become infected with chlamydia by touching the anus, mouth, penis, or vagina of an infected person. This includes participating in anal sex, oral sex, and vaginal sex. While chlamydia may spread from the throat of an infected individual to the genitals or anus of another individual, it does not spread from mouth-to-mouth contact.
The chances of acquiring a chlamydial infection can be reduced by using barriers during sexual activity. This includes using a polyurethane or latex condom or a dental dam during all forms of sex (including oral sex). However, it is important to keep in mind that barrier methods that do not entirely block contact (e.g., the diaphragm) are not effective at preventing STIs. Similarly, other forms of contraception like birth control pills and spermicidal lube do not prevent the transmission of STIs.
What are the signs and symptoms of chlamydia in women?
As mentioned, the majority of cases of chlamydia in women are asymptomatic. It is estimated that only 5-30% of women actually experience the symptoms of chlamydia. Even in those who do, signs do not show up immediately. It typically takes about 7-14 days after exposure to chlamydia for symptoms to begin in women. When symptoms or other complications are present, chlamydia is known as a sexually transmitted disease (STD).
Of note, the symptoms discussed here refer to those that may be experienced by cisgendered women. If you are a transgendered woman, depending on your anatomy, the symptoms that relate to you may be described here or on the Men and Chlamydia page. The body parts discussed here are the cervix, the vagina, the urethra, the uterus, the fallopian tubes, the ovaries, the lymph nodes, the rectum, and the throat.
The most common area for chlamydia to infect women is the cervix. Having a condition called cervical ectopy, in which cells from the inside of the cervix are present on the outside of the cervix, makes an infection more likely. Cervicitis can often be asymptomatic. When it does cause symptoms, they include:
- Yellow or abnormal vaginal discharge
- Pain during intercourse
- Bleeding after intercourse
- Abnormal bleeding between menstrual periods
Chlamydia may infect the urethra in women like it does in men. This type of infection is also often asymptomatic. However, when symptoms do occur, they may feel like a typical urinary infection. This includes:
- Frequent urination
- Burning or pain with urination (dysuria)
The internal reproductive organs
The most dangerous complication of chlamydial infection in women is its spread to the internal reproductive organs, which causes a condition known as pelvic inflammatory disease (PID). PID happens when the infection spreads from the cervix to the uterus, fallopian tubes, and ovaries. In many women, this can be asymptomatic. In others, it causes:
- Abdominal pain
- Pelvic pain
- Nausea and vomiting
If left untreated, PID can damage the internal organs – even if symptoms aren’t felt. This includes scarring of the fallopian tubes, which is one cause of infertility. This also increases the chances of having an ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg attaches somewhere in the body other than the uterus. If the egg attaches in the fallopian tube, as it develops, it can cause the fallopian tube to rupture. This leads to pain, internal bleeding, shock, and even death. A ruptured ectopic pregnancy is a medical emergency requiring immediate treatment. Gonorrhea can also be a cause of PID, infertility, and increased risk of ectopic pregnancy, however, these complications are more commonly caused by chlamydia.
A further complication of PID is a condition called Fitz-Hugh-Curtis syndrome. In Fitz-Hugh-Curtis syndrome, the infection spreads to the lining of the liver, which is called perihepatitis. Over time, this can cause internal scarring and adhesions that, if severe, require surgery to remove. A possible symptom of Fitz-Hugh-Curtis is pain in the upper right side of the abdomen
The lymph nodes
Infection of the lymph nodes by chlamydia is caused by serovars L1, L2, and L3. Serovars are different subtypes of chlamydia. Although Chlamydia trachomatis is one species, it has these different variations that cause different types of diseases. Serovars A-C cause a separate disease of the eyes known as trachoma, while serovars D-K cause the well-known STI. Serovars L1, L2, and L3 cause another type of STI called lymphogranuloma venereum (LGV), an infection of the lymphatic system that is typically seen in Africa, the Caribbean, India, and Southeast Asia. Recent outbreaks have been seen in North America and Western Europe amongst men who have sex with men (MSM), but LGV can also occur in females. Symptoms include:
- Painless ulcer at the site where the infection entered the body (although this does not always occur).
- Painful swelling of the lymph nodes in the groin
If you engage in receptive anal sex, you are also at risk for developing proctitis, which is infection and inflammation of the lining of the rectum. MSM are at risk of proctitis caused by serovars L1, L2, and L3, which can lead to serious symptoms and complications. However, women who have proctitis are typically infected with serovars D-K. In these cases, proctitis is often asymptomatic.
Chlamydia can infect the throat and may cause a sore throat (pharyngitis). However, chlamydial infection of the throat is more commonly asymptomatic.
How is chlamydia diagnosed in women?
To diagnose chlamydia, a sample needs to be taken from every area that is at risk of infection. The type of sex somebody engages in determines the symptoms he or she is experiencing. In women, a vaginal swab or a cervical swab is typically collected. If a woman has engaged in receptive anal sex, a rectal swab may be obtained. Similarly, if a woman has engaged in oral sex, a throat swab may be obtained.
How is chlamydia treated in women?
Chlamydia is treated with antibiotics. If you are exhibiting symptoms or have a sexual partner who has already tested positive, you will likely be given treatment even before your test results come back. This type of treatment is called presumptive treatment.
The most common antibiotic used against chlamydia is a single dose of azithromycin (brand name Zithromax). If treatment is presumptive, an injection of ceftriaxone (brand name Rocephin) is typically also given. Ceftriaxone does not treat chlamydia; instead, ceftriaxone is given to treat gonorrhea, which frequently infects people along with chlamydia.
Instead of azithromycin, a different antibiotic called doxycycline may be given. A 7-day course of doxycycline is prescribed. For PID, a 14-day course of doxycycline is prescribed to treat a typical chlamydial infection. However, more aggressive therapy may be required depending on how severe the disease is and if an abscess (infection-filled pocket) has formed, which could come from a different type of bacteria. For LGV, a 21-day course of doxycycline is prescribed.