Sexually transmitted diseases: Chlamydia

By Cristiano Antonino On Mar 28, 2023

Chlamydia is among the most common sexually transmitted diseases. Caused by the obligate intracellular bacterium Chlamydia Trachomatis, it is transmitted through vaginal, anal and oral intercourse

Often asymptomatic, if left untreated it can cause pelvic inflammatory disease which – in 10-20% of cases – can lead to infertility.

Chlamydia, what is it and how is it transmitted?

Chlamydia is an infectious disease that mainly affects adolescents and young adults, and which is transmitted mainly through unprotected sexual intercourse (although maternal-foetal transmission is also possible).

According to WHO estimates, 131 million people worldwide contract it every year.

Caused by the Chlamydia Trachomatis bacterium, chlamydia has very mild clinical manifestations: only in 10% of cases it is diagnosed, as generally the affected person does not have symptoms or presents them very lightly.

For this reason it is defined as a “silent” pathology.

However, while serious consequences are rare in men, this is not the case in women and it can even lead to infertility.

There is not just one type of chlamydia. Indeed, there are several serological variants:

L1 L2 and L3 are associated with lymphogranuloma venereum;
A, B, Ba and C are associated with trachoma;
D, E, F, G, H, I, J and K are associated with forms of conjunctivitis, genital infection and pneumonia of the newborn.

Lymphogranuloma venereum

Caused by some serotypes of Chlamydia Trachomatis, lymphogranuloma venereum occurs 3-21 days after contracting the infection.

Initially it affects the entry site of the bacterium (vagina, vulva, glans, rectum), and then spreads to the inguinal lymph nodes which swell and become painful.

Typical symptoms include fever, headache, and abdominal pain.

Treatable with antibiotics, if left untreated it can cause difficulty in lymphatic drainage resulting in permanent swelling of the genitals and narrowing of the urethra and anus.

There are generally three stages of evolution:

ulcer at the injection site, without sequelae;
Satellite, inguino-crural or anorectal adenopathy, with fever, headache and arthralgias;
progressive chronic lymphagin, which can cause irreversible damage.

The trachoma

Infectious eye disease, trachoma occurs when Chlamydia Trachomatis localizes in the mucous membrane of the conjunctiva.

Those affected experience an itchy sensation in the eyes and eyelids and sometimes eye pain and blurred vision.

Highly contagious, the disease is transmitted by contact with the eyelids, eyes, ocular secretions, nose and throat (for example, by exchanging towels or handkerchiefs), but it can also be transmitted by flies.

If left untreated, it can lead to blindness.

The first cause of transmission of chlamydia is unprotected sexual intercourse

An infected person can infect a healthy partner through the transmission of biological fluids, even indirectly: vaginal, oral and anal intercourse are therefore at risk, but the disease can also be contracted through petting, exchanging sex toys and (although the eventuality is very rare) in public toilets, and it is obviously not necessary that the person with whom you have an intimate approach reaches orgasm to become ill in turn.

Contagion is also possible by maternal-fetal route: the pregnant woman can infect her child at the time of delivery, while the cases of contagion to the fetus during the pregnancy period are rarer (cases, these, which increase the risk of abortion and of pre-term delivery).

If a newborn is infected with Chlamydia, the most common manifestations are conjunctivitis, septic arthritis (bacterial infection of a joint, which can cause a purulent exudate in the joint space) and pneumonia.

However, there is no risk of contracting the infection through saliva.

Chlamydia: what symptoms does it present?

Chlamydia infection is in most cases asymptomatic: 70-80% of women who contract it do not experience symptoms (in men the percentage of asymptomatic is 50%).

Any clinical manifestations can occur 1-3 weeks after infection (during this incubation period, the subject can easily infect other people).

The subjects most at risk are young people, from the beginning of sexual activity and up to 30-35 years of age.

Above all, those who have many sexual partners, those who do not use a condom and those who already have (or have already had) other sexually transmitted diseases are at risk of contracting it.

Often, the symptoms of chlamydia are absent or vague: they can be confused with symptoms of urethritis or cystitis, or leucorrhoea in women.

Or, they can be downplayed as typical of a trivial irritation to the private parts.

When present, in men they can include fever, testicular pain, itching and discharge from the penis; in women, typical symptoms are:

intimate burning and itching
feeling of irritation
copious yellowish-white discharge
frequent urination
darker urine
difficult, slow, and painful urination
nausea
pain in the lower abdomen, radiating to the back
fever
blood loss
pain during sexual intercourse

If transmitted through oral intercourse, chlamydia can cause a throat infection; if transmitted by the anal route, it can cause an infection of the rectum with pain, bleeding and mucopurulent discharge.

Chlamydia throat infection usually manifests with sore throat and dysphagia; anal infection with pain, discharge and anal spasms.

If there is eye involvement, the patient complains of the typical manifestations of conjunctivitis (redness, pain, secretions); Chlamydia infection of the newborn is among the main causes of neonatal conjunctivitis but it can also lead to pneumonia or serious ear infections.

Chlamydia: complications

If left untreated, this type of infection can lead to unpleasant (and sometimes serious) complications, especially in women.

The most serious forms can give rise to Reiter’s syndrome, which generally resolves in a few months but which – in some patients – gives rise to numerous relapses over the years.

Characterized by a triad of inflammatory processes (arthritis, conjunctivitis, urethritis), and also called “reactive arthritis” when the inflammation stops in the joints, but generally affects – in addition to these – also the eyes and the urethra.

Diagnosed through blood tests and radiological tests, it has healing times between 3 and 12 months and can be treated with:

NSAIDs
corticosteroids (if NSAIDs have no effect)
antirheumatics
antibiotics

In women, chlamydia can also spread to the cervix and uterus, passing through (and causing localized inflammation of) the fallopian tubes and ovaries.

If this happens, the patient develops pelvic inflammatory disease (PID) which has among its typical symptoms:

abdominal, back, navel, ovarian pain
asthenia (tiredness, weakness or lack of energy)
dysmenorrhea
pelvic pain
pain during sexual intercourse
fever
backache
iridodonesis (flickering of the iris that occurs when you move the eye)
itching and vaginal bleeding
metrorrhagia (abnormal bleeding from the uterus, in non-menstrual periods)
vaginismus
foul-smelling vaginal discharge

If left untreated, pelvic inflammatory disease tends to become chronic.

And it can also cause infertility, sterility and the risk of ectopic pregnancies.

In men, the infection can instead extend to the prostate, epididymis and seminal vesicles, resulting in prostatitis, epididymitis and vasculitis (conditions, these, which in rare cases lead to infertility).

Chlamydia diagnosis and treatment

The reference tests for the diagnosis of Chlamydia infection are molecular laboratory tests based on the amplification of nucleic acids on a swab of biological material.

However, the doctor may also prescribe specific cultures and tests from urine samples or from vaginal, rectal, urethral, conjunctival and ural swabs.

If the patient has chlamydia, serologic testing for HIV is also usually recommended.

The infection is treated with antibiotic therapy, as prescribed by the attending physician.

This is established by analyzing the results of the susceptibility test, which makes it possible to evaluate the response of the bacterium to the various antibiotics in order to identify the most effective drug.

Azithromycin or doxycycline are usually used, but the doctor may also prescribe amoxicillin, erythromycin, tetracycline, or ofloxacin, also by mouth.

After 3 months of treatment, the test is repeated (after 4 weeks if the patient is a pregnant woman).

The treatment must also be extended to sexual partners had in the 60 days preceding the diagnosis of infection, and it is essential to abstain from intercourse until total recovery.

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