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By Dr J Kabyemela, MD

Sexually transmitted infections (STIs) are a quite serious problem among teenagers and young women in general. A study reported by the CDC in the United States in early 2008 showed that a quarter of all teenagers in the US have  at least one sexually transmitted infection. While Human Papilloma Virus (HPV), responsible for cervical cancer, is the commonest, Chlamydia is a close second. In the UK, approximately 10% of all sexually active young people under 25 are believed to be infected.

 

In the United States, Chlamydia infection has been reported since 1984. While in 1996 just under half a million cases were reported, nine years later in 2005, this had gone up by 98% to just over 970,000 recorded cases. It is also acknowledged that Chlamydia is the most common STI in the US and that these figures may be conservative.

 

In Japan, a study carried out among high school students in Hokkaido in 2004 found 11.4% of them testing positive for Chlamydia. This was thought to reflect the state of prevalence of the infection among teens in the whole of Japan.

 

In some countries, there are established Chlamydia screening programs. Sweden has had such a program for over 25 years. A similar scheme (The National Chlamydia Screening Programme (NCSP).  is in the process of being finalised for implementation in England.

 


Chlamydia Symptoms

Probably the most challenging aspect of Chlamydia infection is that it tends to remain symptom-free in the majority of cases. This is why it is sometimes called the ‘silent infection’. The infection can, indeed, remain silent and undiscovered for years. Between 70 and 90% of infected individuals will have no symptoms. This is partly why, among the young sexually active age-group, this infection is passed on so easily.

 

When symptomatic, the features include

     Vaginal discharge

     Light bleeding after sexual intercourse

     A burning sensation when passing urine

     Pain during sexual intercourse

     Light vaginal bleeding between periods

     Lower abdominal pain or discomfort


Effect of Chlamydia infection

Chlamydia infection, especially when not detected early, can have devastating long term consequences especially with regard to fertility. The inflammation inside the fallopian tubes is known to cause such damage that the functional capability of the tubes is seriously compromised. This might result in permanent scarring of the tubes leading to an increased risk of ectopic pregnancy and even complete inability to conceive naturally.

 

The Pelvic Inflammatory disease (PID) aftermath might be widespread adhesions (scarring) in the pelvic cavity resulting in chronic pelvic pain and/or pain with sexual intercourse.

 

Both of these are likely to be long-term problems regardless of whether the infection has been cleared or not. This is why it is crucial to have the infection treated early and to avoid repeat infections.

 

Acquiring Chlamydia infection

The infection is acquired through having unprotected (without a condom) sexual intercourse. Sexual behaviour involving unprotected sexual intercourse with multiple partners increases the risk of acquiring the infection significantly.

 

Chlamydia Test

There are several ways that a test for Chlamydia infection can be carried out. The established test involves taking a swab from the neck of the womb (cervix). This is done by a nurse or doctor at the local health centre, Genital Urinary Medicine (GUM) clinic or other Sexual Health Clinic. Results are usually available in a couple of days.

 

A urine sample can also be used to test for Chlamydia but this is less preferred because it is not as reliable

 

Chlamydia Self-Test

Since 2006 there is a self-administered test where a woman takes her own vaginal sample, performs the test and gets the results in less than half an hour. Another variant of the self-test involves the postal service whereby the collected sample is sent back to the laboratory and results sent back to the individual a few days later. In the UK, these tests are available to buy from High Street Chemists and on the internet.

 

Treatment for Chlamydia

Chlamydia is a bacterial (not viral) infection. It is easily and successfully treated using antibiotics. It is crucial that the full course of the antibiotics is completed to ensure that the infection has been cleared from the systemAzithromycin effectve for chlamydia.

 

Antibiotics commonly used for Chlamydia include Doxycycline (Vibramycin®), Azithromycin (Zithromax® or Clamelle) and Erythromycin. Many physicians currently prefer Azithromycin because it is given as a single dose. In the UK, it was announced in August 2008 that, Azithromycin (Clamelle) was soon to be available over the counter without prescription. This is another step to combat this menace. As mentioned earlier, this medication, apart from being highly effective, is very convenient in the sense that it is a once only course as opposed to such medications as Doxycycline which needs to be taken for an average of two weeks

 

The sub-fertility aftermath of Chlamydia

As shown above, the most feared complication of Chlamydia is sub-fertility. Between 10 and 30% of woman infected with Chlamydia will develop Pelvic Inflammatory Disease (PID).  Many of these women do present for the first time with an ectopic pregnancy. Surgery to deal with this will show that the tubes have been damaged. Removal of the tube affected by the ectopic pregnancy is usually not the end of the matter because the woman remains at risk of ectopic pregnancy in the remaining tube.

 

In some cases, the gynaecologist may suggest removing the other tube as well to prevent the likelihood of a repeat ectopic pregnancy. Damage caused by the inflammation from the infection is not usually amenable to corrective surgery.

 

Other women will present with inability to conceive and investigations may reveal that the damage to the tubes from the infection has left both blocked and non-functional.

 

In all these cases, the woman is usually left with only the option of assisted conception via IVF. This, of-course, is an expensive option likely to take a considerable financial and emotional toll. It is also not guaranteed to succeed. In some poorer countries, this option may simply be unavailable leaving the woman permanently infertile.

 

Chlamydia and the Knee

Apart from the genital tract, Chlamydia can also cause problems in other parts of the body. The knee and other large joints sometimes develop inflammation, swelling and pain as a result of Chlamydia infection in the pelvic cavity.

 

This is actually reactive arthritis as the joint itself is not infected. It is therefore an autoimmune condition in reaction to an infection somewhere else in the body, in this case, the genital tract. There could also be inflammation of the eyes (conjunctivitis or uveitis) forming a condition known as Reiter’s Syndrome. This is far more common in men than women.


Last update: March 22, 2013

 

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Chlamydia infection and fertility