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I know. Reading an online article about how chlamydia impacts men probably isn’t what you thought you were going to be doing today. Whatever it is that brings you here— whether you have symptoms or just want a refresher on your “sex ed” class from high school—we’re here to help.
- The majority of cases of chlamydia in men are asymptomatic with only 10% of men experiencing symptoms.
- When symptoms do show up, the most typical are frequent urination, burning or pain with urination (dysuria), an itchy feeling near the opening of the penis or scant, watery, white discharge.
- More rarely, chlamydia can infect the epididymis, which is the coiled tube filled with sperm attached to the back of each testicle. This can cause scrotal swelling and/or testicular pain on one or both sides.
- It is thought that chlamydia may also be one of the organisms that contribute to chronic prostatitis, which is long-term inflammation of the prostate gland.
Chlamydia is a sexually transmitted infection (STI) caused by the bacteria Chlamydia trachomatis. When you learn about it in school, it’s typically mentioned alongside gonorrhea, syphilis, herpes, human immunodeficiency virus (HIV), and human papillomavirus (HPV). However, chlamydia is far more common than the other STIs (with the exception of HPV), with an estimated 1.7 million cases reported to the Centers for Disease Control and Prevention (CDC) in 2017. This makes it the most common reportable bacterial infection in the United States. Part of the reason for this is that chlamydia is most often asymptomatic, which means you or somebody you know may be infected without even knowing it.
Screening can help detect the disease, and it is recommended that men who have sex with men (MSM) be screened as frequently as every 3-6 months. However, the United States Preventive Services Task Force (USPSTF) states that there isn’t enough evidence to support or reject screening for chlamydia and gonorrhea in other sexually active men (USPSTF, 2014). If you are interested in getting screened, talk to your healthcare provider. In the meantime, staying aware of the symptoms of chlamydia and how it can be spread is an excellent step to take.
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How is chlamydia spread?
Chlamydia is transmitted from person to person through sexual contact. More specifically, chlamydia is spread by touching the anus, mouth, penis, or vagina of an infected person. This includes having anal sex, oral sex, and vaginal sex. Chlamydia cannot be spread through kissing (mouth-to-mouth contact), but an infection of the throat can spread to a partner who is receiving oral sex.
The risk of getting chlamydia can be reduced by using methods that form a complete barrier between partners. This includes using a polyurethane or latex condom or a dental dam during all forms of sex. Barrier methods that do not entirely block contact, such as the diaphragm, are not effective at preventing STIs. Similarly, other types of contraception, like birth control or spermicidal lube, do not prevent the transmission of STIs.
Chlamydia may also be passed from mother to child during birth if the mother is infected. In these cases, chlamydia can cause pneumonia (a lung infection) or conjunctivitis (an eye infection) in the newborn.
What are the signs and symptoms of chlamydia in men?
As mentioned, the majority of cases of chlamydia in men are asymptomatic. In fact, it is estimated that only 10% of men do actually experience the symptoms of chlamydia. Even in those who do, signs do not show up immediately. It typically takes about 5-10 days after exposure to chlamydia for symptoms to begin. 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 men. If you are a transgendered man, depending on your anatomy, the symptoms that relate to you may be described here or on the Women and Chlamydia page. The body parts discussed here are the urethra, the epididymis, the prostate, the lymph nodes, the rectum, and the throat.
The most common area for chlamydia to infect men is in the urethra, the tube that runs along the inside of the penis. Infection of the urethra is called urethritis. In medicine, it is also sometimes referred to as non-gonococcal urethritis, which means urethritis that is caused by something other than gonorrhea. The most common symptoms of urethritis are:
- Frequent urination
- Burning or pain with urination (dysuria)
- Itchy feeling near the opening of the penis
- Scant, watery, white discharge (as opposed to the more voluminous, pus-like discharge of gonorrhea)
You may experience all, some, or none of these symptoms. You may notice the discharge as a dried film on the tip of your penis if you have not urinated for a while or as a stain on the inside of your underwear.
More rarely, chlamydia can infect the epididymis, which is the coiled tube filled with sperm attached to the back of each testicle. Infection of the epididymis is called epididymitis and can cause:
- Scrotal swelling on one or both sides
- Testicular pain on one or both sides
It is thought that chlamydia may also be one of the organisms that contribute to chronic prostatitis, which is long-term inflammation of the prostate gland. Symptoms of prostatitis include:
- Pain with urination
- Pain with ejaculation
- Difficulty urinating
- Pelvic pain
The lymph nodes
Chlamydia trachomatis is one species of bacteria, but it actually comes in several subtypes, called serovars. Serovars D-K cause the symptoms we have already discussed. However, serovars L1, L2, and L3 cause a separate disease called lymphogranuloma venereum (LGV). LGV is also an STI and is spread in the same way the typical chlamydia infection is spread. LGV is an infection of the lymphatic system and requires more aggressive treatment than serovars D-K. 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
Typically, lymphogranuloma venereum (LGV) was found heterosexuals in tropical and subtropical regions of the world (Africa, the Caribbean, India, and Southeast Asia). However, since 2003, outbreaks have been seen in North America and Western Europe. These outbreaks are primarily amongst MSM and those who also have HIV.
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. When caused by serovars D-K, proctitis is often asymptomatic. However, proctitis in MSM has been seen with serovars L1, L2, and L3 (the same serovars that cause LGV) and this can be a much more serious condition. Symptoms include:
- Rectal pain
- Rectal discharge
- Rectal bleeding
- Tenesmus (the sensation of needing to have a bowel movement)
Chlamydia can infect the throat, causing pharyngitis. This is typically asymptomatic but may cause a sore throat in some people.
What are the complications of untreated chlamydia in men?
If left untreated, chlamydia infection may cause complications in men.
It has been suggested that untreated epididymitis can lead to infertility. This may stem from the fact that chlamydia can cause pelvic inflammatory disease (PID), scarring of the fallopian tubes, and infertility in women. There are two proposed ways that infection with chlamydia leads to infertility in men. First, it has been suggested that untreated epididymitis can lead to scarring of the ducts that carry sperm. Second, it has been suggested that chlamydia directly impacts the sperm and causes changes in sperm DNA (Gallegos, 2008). However, a 2017 study that looked into the matter found that infection with chlamydia did not have any negative impact on sperm, nor did it affect fertility (Suarez, 2017).
On the other hand, untreated proctitis that is caused by serovars L1, L2, or L3 does lead to long term complications. Without appropriate antibiotic treatment, proctitis can cause fistulas (abnormal connections between the intestines and the skin) and strictures (areas of narrowing at risk for blockage) of the rectum.
Chlamydia may also be a cause of urethral stricture disease in men. This is a condition in which the urethra narrows, which can cause several issues with urination (pain, blood, decreased stream, etc.). Surgery may be necessary to correct urethral stricture disease.
Lastly, in men who have urethritis, chlamydia can cause an immune reaction called reactive arthritis. This occurs in approximately 1% of men. Reactive arthritis causes pain, swelling, redness, and stiffness of the joints. It typically affects the knees, ankles, and feet but can also occur in other joints. Men with reactive arthritis may experience lower back pain, pain where tendons and ligaments connect to the bone (called enthesitis), and swollen “sausage fingers” (called dactylitis). Reactive arthritis can be caused by several types of bacterial infection, but chlamydia is one of the most common. In some people with urethritis and arthritis, they also develop conjunctivitis or uveitis (swelling of a portion of the eye which can lead to blurred vision). This triad of symptoms is called Reiter’s syndrome.
How is chlamydia diagnosed in men?
To diagnose chlamydia, a sample needs to be taken from every area that is at risk of infection. This is determined by the type of sex somebody engages in or the symptoms he or she is experiencing. In men, a urine sample is typically collected. Healthcare providers often specify that this should be “first catch” to indicate that urine from the beginning of the stream should be included in the sample. However, one study in women showed that first catch urine is not as important as suspected since the test for detecting chlamydia (known as the nucleic acid amplification test or NAAT) is effective enough at identifying the disease anyway (Mangin, 2012).
If a man has engaged in receptive anal sex, a rectal swab may be obtained. Similarly, if a man has engaged in oral sex, a throat swab may be obtained.
How is chlamydia treated in men?
Chlamydia is treated with antibiotics. If you are exhibiting symptoms or you have a sexual partner who already tested positive, it is likely you will be given treatment even before your test results come back (this is called presumptive treatment).
The most common antibiotic given by a healthcare provider is a single dose of 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.
An alternative treatment regimen is a 7-day course of doxycycline (brand name Vibramycin). This replaces the single dose of azithromycin. In cases in which epididymitis is suspected, doxycycline is prescribed for a 10-day course. If LGV is suspected, doxycycline is prescribed for a 21-day course.