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If you’ve landed on this page, you may be experiencing symptoms that you think are due to an infection with chlamydia. Perhaps you have some burning or itching when you urinate, or even penile or vaginal discharge. What’s worse, you may be experiencing testicular pain, abdominal pain, or swelling in places where you didn’t even know you could swell!
Or, maybe you’re just here to learn. Either way, we’re here to help. Knowing about a disease can be the first step in preventing the disease, so we’re glad you’re here to brush up on your signs and symptoms of chlamydia.
- It’s estimated that only 10% of men and only 5–30% of women experience symptoms of a chlamydia infection.
- Most commonly, chlamydia infects the urethra or the cervix. This is known as either non-gonococcal urethritis or as cervicitis.
- Urethritis leads to increased frequency of urination and pain or burning with urination (known as dysuria).
- Cervicitis can lead to pain during intercourse, bleeding after intercourse, or other bleeding that occurs between menstrual periods.
- Discharge from the penis can show up anywhere between 5–10 days after exposure. Discharge from the vagina can show up anywhere between 7–14 days after exposure.
What is chlamydia?
Chlamydia is a sexually transmitted infection (STI) caused by the bacteria Chlamydia trachomatis. It is often mentioned alongside gonorrhea. However, it occurs more than three times more frequently than gonorrhea. In fact, according to the Centers for Disease Control and Prevention (CDC), chlamydia is the most common reportable bacterial infection in the United States. Chlamydia is often asymptomatic, which contributes to its spread since most people may not even know they have chlamydia. And while it is easily cured with antibiotics, untreated chlamydia can lead to serious complications including infertility and even death.
Chlamydia trachomatis can further be divided into several different subtypes, called serovars. The different serovars can cause various diseases and symptoms depending on the part of the body they infect. Although the exact number of serovars is different depending on the source you’re reading, they are generally broken down into the following:
- Serovars A-C: Cause trachoma (roughening of the inner part of the eyelid). Typically seen in the developing world
- Serovars D-K: Cause infection of the internal and external genitalia, urethritis (inflammation of the urethra), proctitis (inflammation of the lining of the rectum), and conjunctivitis (a.k.a. pinkeye).
- Serovars L1, L2, L3: Cause lymphogranuloma venereum (infection of the lymphatic system, abbreviated LGV) and proctitis in men who have sex with men (MSM). Typically seen in Africa, the Caribbean, India, and Southeast Asia with more recent outbreaks in North America and Western Europe.
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How long after I am exposed to chlamydia will I see symptoms?
Chlamydia is spread sexually by coming into contact with the anus, mouth, penis, or vagina of somebody who is infected. This includes anal sex, oral sex, and vaginal sex. In medicine, the term that is used to describe the period between acquiring an infection and seeing symptoms is called the incubation period. The incubation period for chlamydia is poorly defined, especially since the majority of people never see symptoms at all. Not seeing symptoms does not mean you aren’t contagious, though. If you are infected with chlamydia, it is possible to pass it to a partner even if you aren’t experiencing discharge or anything else you might expect with the infection.
In those who do show symptoms, they generally appear within the first couple of weeks of exposure. Discharge from the penis can show up anywhere between 5–10 days after exposure. Discharge from the vagina can show up anywhere between 7–14 days after exposure. Remember, these are not hard-and-fast rules. Some people may have a shorter incubation period, while others have a longer incubation period. If you think you may have been exposed to chlamydia (or any STI), it is best to see your healthcare provider to get checked – even if you do not have symptoms yet.
What are the signs and symptoms of chlamydia?
In the majority of cases, chlamydia is asymptomatic. In fact, it is estimated that only 10% of men and only 5–30% of women experience symptoms of the infection.
When chlamydia does cause symptoms or complications it is known as a sexually transmitted disease (STD). Symptoms depend on where chlamydia is infecting the body. From head to toe, the list of symptoms is:
- Eye redness, irritation, or tearing
- Sore throat
- Abdominal pain
- Pelvic pain
- Swollen and painful lymph nodes in the groin on one or both sides
- Non-painful genital ulcer
- Increased frequency of urination, incontinence, or difficulty urinating
- Pain or burning with urination
- Pain with ejaculation
- Penile or vaginal discharge, with or without itchiness in the region
- Abnormal vaginal bleeding
- Scrotal pain and swelling on one or both sides
- Rectal pain, discharge, bleeding, constipation, or the sensation of always needing to go to the bathroom
- Premature rupture of the membranes or premature delivery (if pregnant)
- Joint pain
Let’s break these down a little more.
Most commonly, chlamydia infects the urethra or the cervix. This is known as either non-gonococcal urethritis or as cervicitis. Urethritis leads to increased frequency of urination and pain or burning with urination (known as dysuria). When it infects the penis, chlamydia can cause itchiness around the opening of the penis and discharge. The discharge associated with chlamydia is generally low in volume and watery. Many people may not notice the discharge unless they are specifically looking for it, or they see stains on the inside of their underwear. This is in contrast to the discharge associated with gonorrhea, which is usually thicker, pus-like, and higher in volume. Similarly, cervicitis can lead to vaginal discharge, although this discharge may be indistinguishable from other forms of vaginal discharge. Cervicitis could also lead to pain during intercourse, bleeding after intercourse, or other bleeding that occurs between menstrual periods.
Chlamydia may infect the sex organs of both men and women. An infection of the epididymis (the coils of tubes attached to the back of the testicles that contain sperm) causes epididymitis. This leads to testicular pain and scrotal swelling that may occur on one or both sides. Infection of the prostate by chlamydia is believed to be one of the possible causes of chronic prostatitis, which is long-term inflammation of the prostate. This can lead to pain with urination, pain with ejaculation, pelvic pain, incontinence, and difficulty urinating. Cervicitis may spread to the female sex organs, infecting the uterus, fallopian tubes, and ovaries. This causes a condition called pelvic inflammatory disease (PID). The symptoms of PID include pelvic pain and abdominal pain, and it can lead to serious complications, including scarring of the fallopian tubes, infertility, and ectopic pregnancy. An ectopic pregnancy is a pregnancy in which the fertilized egg attaches somewhere other than the uterus. As it grows, this can potentially rupture, causing severe abdominal pain and putting the mother at risk of internal bleeding, shock, and even death. PID can also spread higher in the abdomen, causing inflammation of the lining of the liver. This is a condition called perihepatitis or Fitz-Hugh-Curtis syndrome. It leads to pain on the right side of the abdomen may progress to cause scarring and adhesions in the abdomen. What is particularly worrisome is that some people with PID may not have symptoms at all, even if the damage is silently occurring inside the body. Because it is a preventable cause of infertility, this is one important reason even asymptomatic individuals should consider getting screened for chlamydia.
Infection of the lining of the rectum is also possible with chlamydia and is called proctitis. This can be a result of receptive anal intercourse or the infection spreading from the vagina. When it is caused by serovars D-K, proctitis is typically asymptomatic. However, proctitis can also be caused by serovars L1, L2, and L3 (the same serovars that cause LGV), particularly in MSM. When this happens, symptoms include rectal pain, rectal discharge, rectal bleeding, constipation, and the sensation of always needing to go to the bathroom (tenesmus). This can be severe and if left untreated can lead to fistulas (abnormal connections between the intestines and the skin) and strictures (areas of narrowing at risk for blockage) in the colon and rectum.
Chlamydia can also cause a few other symptoms around the body. If it infects the eye, chlamydia causes conjunctivitis, which includes redness, irritation, and tearing of one or both eyes. It is also possible for chlamydia to infect the throat (called pharyngitis), but it is not considered a common cause of sore throat. Lastly, in approximately 1% of men who experience urethritis, chlamydia can cause an immune reaction called reactive arthritis. This leads to inflammation of the joints that is typically seen in the knees and ankles but can occur anywhere in the body. In some cases, urethritis and arthritis are accompanied by conjunctivitis or uveitis, which is inflammation of a portion of the eye that can cause blurred vision. When these three things occur together, it is a condition known as Reiter’s syndrome.
What is lymphogranuloma venereum?
LGV is a different type of chlamydial infection that is caused by serovars L1, L2, and L3. It is an infection of the lymphatic system, which typically presents as a painless ulcer on the genitals followed by pain and swelling of the lymph nodes in the groin. The infection can spread through the body and also cause fever. When LGV is suspected, a longer course of antibiotics is given than would typically be prescribed for chlamydia.
What is trachoma?
Trachoma is a different type of chlamydial infection that is caused by serovars A-C. It is not sexually transmitted; instead, it is spread by contact with the ocular or nasal discharge from somebody else who has trachoma. It is more prevalent in the developing world and is uncommon in the United States and Europe. Trachoma causes thickening and roughness of the inside of the eyelid, which can lead to scarring, eye irritation, and eventual blindness. Trachoma is the leading cause of infectious blindness in the world. The World Health Organization estimates that trachoma has caused visual impairment in 1.9 million people worldwide (WHO, 2019). Trachoma should not be confused with conjunctivitis, which is caused by serovars D-K and results from sexual fluid contact with the eyes or exposure during birth.
How is chlamydia diagnosed?
Chlamydia is diagnosed by performing what is called a nucleic acid amplification test (NAAT) on a sample. Other tests can also be done, but NAAT is the most effective at identifying cases of chlamydia.
Samples should be taken from every site where an infection is suspected. This is typically determined by the type of sex an individual engages in. Samples may include a urine sample, vaginal swab, rectal swab, or throat swab.
How is chlamydia treated?
Chlamydia can be easily treated with antibiotics. In some cases, treatment is presumptive – this means that an individual is treated even before the test results come back. Presumptive treatment is typically given if an individual has symptoms or if a sexual partner has tested positive for chlamydia.
The most common treatment for chlamydia is a single dose of an antibiotic called azithromycin (brand name Zithromax). If there is a concern for a possible co-infection with gonorrhea, a single injection of an antibiotic called ceftriaxone (brand name Rocephin) is also given. This is typically the case when treatment is presumptive.
Sometimes, a healthcare provider may feel that treatment with an antibiotic called doxycycline (brand name Vibramycin) is more appropriate than using azithromycin. For a simple infection, doxycycline is prescribed for a 7-day course. If epididymitis is suspected, doxycycline is prescribed for a 10-day course. If PID is suspected, doxycycline is prescribed for a 14-day course (although additional interventions may be necessary depending on the severity). And if LGV is suspected, doxycycline is prescribed for a 21-day course.
In modern times, there has been growing concern regarding the emergence of drug resistance or antibiotic resistance. These terms refer to a situation in which bacteria have evolved in such a way that certain antibiotics are no longer effective. Strains of drug-resistant chlamydia have begun emerging in parts of the world, however at this time the recommendation is still to treat with azithromycin or doxycycline.