Chlamydia trachomatis (CT) causes a urogenital infection known as Chlamydia (C. trachomatis), one of the most common sexually transmitted diseases (STD). C. trachomatis is a bacterial pathogen and the causative organism of a widespread public health problem. The bacteria is easily transmissible and spread by sexual contact, vaginally, orally, or anally. C. trachomatis prefers to live in the warm, damp, and dark places of the genitals.
Most cases of Chlamydia can be found in those aged 15 to 24 years. These young people are coming to terms with their sexuality, facing peer pressure and learning how to prevent STD’s and pregnancy. Health experts say that this age group is facing a Chlamydia epidemic, but that this common infection is easily prevented with condoms, easily diagnosed and easily curable.
The disease occurs in men and women equally. However, men are often the carriers and spread the disease to women. Men rarely suffer long term health problems but women often do. Women are at a much higher risk to develop complications if chlamydia is left untreated. Most people are asymptomatic or do not have any symptoms to warn them of the infection. Left untreated, C. trachomatis commonly causes infertility in women and blindness.
Other Types of Chlamydia:
- Chlamydia pneumonia is a different pathogen (intracellular bacterium) than Chlamydia trachomatis. This respiratory infection causes frequent cases of pneumonia in all age groups and races.
- Chlamydia psittaci is also a different species than Chlamydia trachomatis. It affects bird species and is an occupational hazard for poultry farmers and similar workers.
Genital Chlamydia is one of the most common infections, regardless of the resources of the country. Rich or developed countries have just as many cases as do less developed countries. Rural populations and poor communities are often hotbeds for Chlamydia, though. Without proper health care, complications and severe health problems ensue. Many areas also do not have access to running water, limiting efforts at personal hygiene. The US diagnoses one or two million new cases each year with a 3% increase lately. Australia found seventy-five thousand new cases last year, up a whopping 17%. Actual numbers of disease prevalence may not be known due to discrepancies in screening rates and undiscovered cases.
- Male – 190 men in 100,000 are likely to contract Chlamydia. Men in the age group 20 to 24 years are at the highest risk with 1150 cases in 100,000.
- Female – 187 women in 100,000 are likely to contract Chlamydia. Women in the age group 16 to 19 years are at the highest risk with 1337 cases in 100,000.
Chlamydia trachomatis is almost always transmitted by sexual intercourse or sexual contact. During sexual contact, the organism transfers from the host or carrier, usually male, to the sexual organs of the sexual partner. This type of bacteria is called an obligate intracellular parasite, meaning that it is obliged to live within the cell’s wall. The incubation period is about 7 to 21 days. Within a few days after infection, after the bacteria matures, the cell ruptures and frees the bacteria to invade other cells in a process known as lysis or extrusion. C. trachomatis is divided into biovars and serotypes which have different risk factors and complications:
Biovars – biochemically or physiologically different strains of Chlamydia.
- Lymphogranuloma (LGV) biovar – associated with lymphadenopathy.
- Trachoma biovar – associated with epithelium infections.
Serotypes – antigenically different strains of Chlamydia, wherein the immune system produces a different response.
- Ocular trachoma – serotypes A, B, Ba, C
- Oculogenital disease in adults and children, infant pneumonia – serotypes B, Ba, D through to K
- Genital ulcers, proctitis with rectal infection, inguinal lymphadenopathy – L1-L3
The sequence of nucleotides in the C. trachomatis gene is known. However, because the bacteria lives inside the cell wall, under the protection of cellular and bacterial membranes, scientists have not had much luck in researching and manipulating the gene. Indirect approaches to manipulating the gene are underway in order to develop new strategies to prevent and treat C. trachomatis.
How is it Transmitted?
STDs like Chlamydia are spread through the mucous membranes of the mouth, vagina, anus, and penis. But, most cases of C. trachomatis are spread genitally. In other words, people who have vaginal or anal sex often get the disease. However, oral sex can also transmit the infection. Sexual contact is defined as putting the mouth on someone else’s vagina, penis or anus, or insertion of the penis into the vagina, anus or mouth. Kissing may also be a culprit in transmission. For instance, if one partner performs oral sex on an infected person, then kisses another person, the bacteria may transfer in the mouth, although this is unlikely as Chlamydia prefers to live in the genital regions.
Inanimate objects like toilet seats, doorknobs, and eating utensils are not likely to be transmission risks. An infected person may leave microdroplets of Chlamydia on an object (called a fomite, a surface that acts as a host for transmitting disease). Theoretically, another person could touch that object and transfer the bacteria to the eye, nose or mouth or other mucous membrane.
However, Chlamydia can only survive briefly on a surface before drying out. How long the virus survives outside a mucous membrane depends on the environmental humidity. Hard surfaces are less risky than porous surfaces like towels or clothes. Even if someone were to touch a surface with Chlamydia on it, the bacteria would still have to be transferred to a mucous membrane, especially the genital area. Frequent hand washing can prevent transfer.
Children may acquire the disease when passing through the birth canal of their infected mother. In the absence of maternal infection at birth, children infected with Chlamydia may have been sexually abused by someone with the infection. Self-infection is a common problem. For instance, when someone touches their infected genitals and then touches their eye before washing their hands. Or, when wiping the genital area with toilet tissue and then touching the anus with the tissue. Chlamydia lives in the vagina, urethra, cervix, endometrium, the fallopian tubes, anus, eyes, and the throat. Contact with any of these tissues confers a risk for spreading the disease.
If Chlamydia is not treated, the infection can spread or become progressively worse. The complications can be serious and last long term. Sometimes the complications are just as silent as Chlamydia itself, asymptomatic. A common complication is an infection in the urogenital tract which causes inflammation for both men and women in the urinary tissues, called urethritis. Listed below are conditions which can affect both men, women and children, followed by sections which detail complications according to gender and life stage.
- Nongonococcal urethritis (NGU) – the Chlamydia infection spreads into the urethra, the tube by which men and women pass urine.
- Peri-hepatitis (Fitzhugh-Curtis’ syndrome) – occurs almost always in women, but sometimes in men. For women, cervical mucus thins and allows bacteria into the uterus, causing infection. Sometimes, inflammation causes scar tissue to form around the liver.
- Reactive arthritis (Reiter’s Syndrome or Reiter’s arthritis) – the body reacts to the Chlamydia infection with an inflammatory response or an autoimmune response. A very small fraction of men may develop this condition, and it is extremely uncommon in women. Arthritis may be accompanied by skin lesions. About 30 percent of people with reactive arthritis may suffer long term.
- Joint inflammation – less severe arthritis may cause inflammation, pain and swelling in the joints.
- Pneumonia – mild or severe bronchitis and upper respiratory distress may occur or reoccur. Other symptoms include headache, cough, laryngitis and sinusitis.
- HIV/AIDS – If exposed to HIV, the virus which causes AIDs, having Chlamydia may increase the chances of becoming infected with HIV.
- Conjunctivitis – genital discharge is transferred to the eyes and causes a conjunctival infection that does not progress to blindness. The entire eye, ear, and nose and their sub-systems are vulnerable to complications from Chlamydia.
- Trachoma – one of the most common causes of blindness. This condition is often spread in families. Trachoma has caused millions to go blind especially in third world countries with poor sanitation. The disease starts in the eyelid and is spread to the cornea which causes blindness. Women are much more likely to develop this condition, often in middle age, which are normally very productive years.
Complications for Children
Children born to mothers who have an active Chlamydia infection are susceptible to the infection and its complications. During childbirth, as the neonate passes through the vaginal canal, it can come in contact with the bacteria and develop infections later. Conjunctivitis, trachoma, eye infection, and blindness may occur. Babies often develop an eye infection within a week of birth. Babies can also develop pneumonia.
Complications for Women
Untreated chlamydia infection causes inflammation and infection in the vulnerable tissues of the female body. The bacterial infections may be silent, lay dormant and spread without any symptoms. These silent infections can cause permanent damage to the reproductive organs. Complications for women:
- Infertility – women may become unable to have children. About 5 percent of female Chlamydia patients lose the ability to reproduce. Each infection of Chlamydia thereafter confers an even stronger likelihood of infertility.
- Ectopic pregnancy – a potentially fatal complication when the embryo implants outside of the uterus. The child cannot develop outside of the uterus and continue to birth (term). The developing fetus must be removed for the mother’s health. If the ectopic pregnancy ruptures, the mother’s health may be at grave risk. A protein known as PROKR2 causes Chlamydia induced ectopic pregnancy.
- Premature births – giving birth prematurely may also occur due to a dormant, active or previous Chlamydia infection. Scarring and blockages in the reproductive tract can cause premature births.
- Pelvic inflammatory disease (PID) also known as salpingitis – when the infection spreads to the uterus, fallopian tubes and other reproductive tissues. This serious condition causes pain, scarring and permanent damage. About 15 percent of women with untreated Chlamydia will develop PID.
- Cervical squamous cell cancer (SCC) – an uncommon, but documented complication of untreated Chlamydia.
Complications for Men
Men rarely have complications from untreated Chlamydia. They are often carriers of the bacteria but have far less vulnerable tissues to infect than women. Men are subject to complications of:
- Epididymis – the tube that carries sperm from the testis may become infected, which can cause pain, fever and sterility.
- Proctitis – the rectum may become inflamed or infected causing bleeding, pain, discomfort, constipation or a mucus discharge.
Developing a diagnosis of Chlamydia is based on history and risk factors, as eighty-five percent of women and men have no symptoms. When symptoms do develop, they usually occur within one to three weeks after infection. A person is infectious from the moment they are exposed to the bacteria, until treatment is finished.
Strong Risk Factors
- Sexual activity with infected partner – having sex with an infected person greatly increases the likelihood of infection. Women who have sex with infected men, or men who have sex with infected men, have the highest risk as men are often carriers or hosts of the disease.
- History of prior infection – any person with a prior sexually transmitted infection is more likely to have a repeat infection or a similar infection. These individuals should be screened regularly for re-exposure.
- Age – people under the age of 25 years have a high risk of infection. Young people are under peer pressure to have sex, commonly have sex without condoms and are undereducated about the risks of unprotected sex. Young women aged 15 to 19 years and slightly older men aged 20 to 24 have the highest risk.
- Sexual partner – people who have multiple partners or who have just changed partners are suspect for STD’s.
- Condoms – women and men who do not use a condom each and every time have an increased risk for Chlamydia.
Weak Risk Factors
- Urban residence – education or employment levels do not increase the likelihood of contracting Chlamydia. However, people who live in urban locations are more likely to be infected.
- Ethnicity – Asian people have the lowest risk. White people have a higher risk than Asians, and Black people have the highest risk.
- Low socio-economic status – People living in high poverty areas or who have low socio-economic status have increased risks. Women living in high poverty areas have increased risks for multiple infections.
Most people have no symptoms of Chlamydia. Some people find Chlamydia when some other condition flares, like a severe cold or pneumonia. Some cases are found during routine physician visits. Others live their life with Chlamydia lying dormant but ready to infect someone else. When people do have symptoms, the disease has matured and is in danger of spreading and causing complications. The symptoms listed below can affect both men and women. Some are symptoms that are noticed by the patient and some are noticed by the physician. Further details according to gender are listed following the unisex symptoms.
Symptoms for Men or Women
- painful urination (dysuria)
- muscle pain
- pelvic or abdominal pain
- reactive arthritis
- rectal pain, discharge, or bleeding
- inflamed eyelid
- soreness and redness in the throat or mouth
- bleeding cervix (friable cervix)
- cervical inflammation
- discharge – odorless or having an odor, thick, yellow, or cloudy.
- intramenstrual bleeding – bleeding between periods
- postcoital bleeding – bleeding after sex
- dyspareunia – painful sexual intercourse
- pain during pelvic exam
- cervical ectopy – cells from inside of the cervix migrate to the outside.
- abnormal vaginal flora (AVF) – aerobic microorganisms
- painful periods
- abdominal pain with fever
- itching or burning in or around the vagina
- lower back pain
- discharge – the penis may have a clear or white odorless discharge. The discharge may be clearly evident to the patient and physician, or if the penis is lightly squeezed. The pus may be watery or thick, milky or yellow.
- dysuria – painful urination
- inflamed rectum – bleeding, pain, discomfort, constipation or a mucus discharge.
- scrotal pain – mild or severe pain. The scrotum may be warm, swollen, and tender to the touch.
- burning and itching – in the tip of the penis.
The goal of screening is to find Chlamydia infections since most people do not have symptoms. Some screening programs invite people to participate (proactive screening), while others look for Chlamydia when an individual visits a physician or clinic (opportunistic screening). Many national health organizations worldwide recommend annual screening for sexually active people under the age of 25 years. Screening for those aged older than 25 is not widely recommended. Recent studies provide additional details about screening practices:
- Annual screening for Chlamydia may be ineffective, as people can become infected at any time during the year. People with high risk factors should be screened more frequently, or people should be tested whenever they have a new sexual partner.
- Screening based on risk factors and history may not be effective as many people do not like to talk about their sex lives, and often lie about their partners and condom use. Researchers recommend offering the test to everyone, not singling out individuals, and not asking about sexual practices.
- Screening young women in urban and high poverty areas is not helping infection rates. Screening every three months does little to stop Chlamydia infections in this group. Researchers speculate that these women did not realize that they could be re-infected. Also, screening women without screening the men that infect them, is ineffective.
- Screening is best accomplished during visits to the regular family doctor, instead of at a gynecologist, family planning clinic, or at a specialty clinic.
- Males prefer screening in person with a clinician, giving samples in person, receiving results in person or on the telephone, and prefer personal reminders to repeat screening at designated intervals.
- 81 percent of Chlamydia infections occur among people who do not use a condom. Evaluating high risk groups can take this factor into account, researchers say. However some people do lie about condom use, so screening based on condom use may be ineffective and miss Chlamydia cases.
- Only half of women under age 25 are routinely, annually screened.
- Black and Hispanic women receive more screening than white women, which puts the documented incidence of Chlamydia in doubt.
Finding Chlamydia is very simple. Men give a urine sample or a penile swab while women can give a urine or vaginal sample, with the vaginal sample preferred. Testing is accomplished primarily with a nucleic acid amplification test (NAAT), as this test has a high rate of sensitivity. You can collect the sample yourself with a urine cup, vaginal or rectal swab and turn it into your physician, or the physician can collect the sample.
A positive NAAT indicates that a person is infected with Chlamydia bacteria and should be treated. A negative test in the presence of positive clinical findings, indicates that the test should be repeated. A test given after treatment is finished may find traces of bacteria up to three weeks after treatment. This usually indicates the presence of residual DNA, and not a repeat infection or unsuccessful treatment.
Alternatives to NAAT
- Nucleic acid hybridization and transformation tests – cervical or penile swab.
- Enzyme immunoassays – cervical or penile swab; 50% less sensitive than NAAT.
- Direct fluorescent antibodies tests – cervical or penile swab; less sensitive than NAAT.
- Cell culture – cervical or penile swab, expensive, very accurate and used in legal cases.
The goal of treatment is to cure the infection, and to find and cure the infection in partners. Treatment for Chlamydia is usually begun immediately after diagnosis, with antibiotics. Your physician will probably not delay antibiotics while further testing and identification of the bacteria is incomplete. Chlamydia is responsive to many antibiotics including erythromycin, azithromycin and tetracyclins. Antibiotics are used orally (pills, swallowed by mouth) or topically (a medicine-laced lotion). Complications are treated as necessary, including surgery for trachoma. Patients are advised to abstain from sex until treatment is complete.
After Chlamydia has been diagnosed and treatment has begun, patients are advised to tell their current partner and possibly their previous partners. This process is called contact tracing and is important to help partners get treatment. Telling partners may be difficult, but is the best way to contain the infection. Not telling partners only serves to pass infection back and forth indefinitely. Many people co-exist in small communities, or groups of friends who may at some point have sex with each other. Not telling a partner could conceivably wind up hurting one of your friends in the future.
Telling a partner is voluntary and many times can be accomplished confidentially. Some clinics will send out anonymous letters or emails to an infected person’s partner(s). A few websites exist solely for the purpose of anonymously informing partners. Having sex with someone while knowing that you have an STD, is criminal in some communities or carries civil penalties, meaning that you can be sued.
In the US, Chlamydia is a reportable disease, meaning that the physician is required by law to report the infection to the authorities. Some clinics offer partner packs, doses of antibiotics to be given to the partner. Women often ask for one partner pack and men usually ask for at least two packs. Some people do not take advantage of partner packs for various reasons, but it is helpful to know that they are sometimes available.
The most commonly used, 1st line prescriptions for Chlamydia:
- Azithromycin – one dose, 1 g orally, safe for pregnant women, too.
- Doxycycline – two doses daily for seven days, 100 mg orally, not used for pregnant women.
- Erythromycin – 500 mg orally four times daily for 7 days, safe for pregnant women.
- Ofloxacin – 300 mg orally twice daily for 7 days.
- Levofloxacin – 500 mg orally once daily for 7 days.
- Metronidazole : 2 g orally as a single dose.
- Tinidazole : 2 g orally as a single dose.
Treatment rarely fails. If re-infection occurs it usually happens as a result of re-exposure to the bacteria. If symptoms persist or get worse, another infection or pathogen may be the cause. Trichomonas vaginalis and Mycoplasma genitalium are common culprits in persistent infections.
Re-tests and Screenings
People diagnosed with Chlamydia are usually re-tested after three months and monitored because of the possibility of re-infection. Pregnant women especially must undergo increased testing and monitoring for their health and the babies’ health. Pregnant women are tested 3 weeks after treatment is completed and at their physician’s discretion afterwards, but commonly in the third trimester.
Sex education is the primary means to prevent Chlamydia and other STDs without moralizing about behavior. Since half of all teenagers are having sex, whether they admit to it or not, government and private agencies intervene to provide comprehensive sex education. Sex education is controversial with the debate framed in moral arguments. Religious groups often protest sex education efforts but authority groups quietly continue to educate young people about the dangers and responsibilities of having sex.
Different countries approach the problem in a variety of ways. However, all communities seek to provide sex education as a means to helping their citizens lead healthy, disease-free and productive lives. These efforts are having some success as lately, teenagers are waiting slightly longer to have sex for the first time. However, the bad news is that STD’s are rising, suggesting that even though teenagers are delaying their first sexual experience, they are not using condoms. Research suggests that girls are more likely to have unprotected sex their first time, making them likely to be infected by male carriers of Chlamydia.
The only way to never contract Chlamydia is to never have sex. In this scenario, you choose not to engage in sexual contact, either orally, vaginally, or anally. Choosing abstinence may be difficult and impractical. Pronouncing that you have chosen abstinence and acting contrary to that, may be very dangerous. You may not be getting proper sex education and be prepared for the possibility of having sex. Abstinence programs in America have failed as people who say they are abstinent, have sex earlier than those who do not profess abstinence. Abstinence professors do not use condoms as much and therefore have a higher rate of STDs. A better way would be to avail yourself of sex education and be prepared if the desire to have sex arises.
Male condoms are the only proven way to prevent sexually transmitted diseases including Chlamydia and HIV/AIDS. Men often prefer not to use condoms, so females have to negotiate in the heat of the moment and insist upon use. Women who are honest with themselves and realistic about having sex, can take control and be self-reliant. They can carry condoms with them and be prepared for sexual encounters. They also may want to practice or role play with a friend, in order to be prepared for male objections to condom use.
Condoms must be obtained in advance and are sold over the counter in most localities, without proof of age. Condoms come in many varieties and sizes, with or without lubrication. Different types of materials and lubricants can increase or decrease pleasure but only latex or polyurethane condoms are protective against STD’s. Condoms should be used for every instance of sexual contact, including giving or receiving oral sex.
Test Before Sex
The most practical and honest way to have pleasurable, worry-free sex is to form a monogamous relationship. Before sex takes place, both individuals should visit a physician or clinic to be tested for STDs. Simple urine tests are easy to accomplish and provide a sure way to avoid getting an STD or transmitting one. Having a partner who has been tested and is known to be uninfected, may increase sexual pleasure by eliminating worry. Testing can also eliminate the use of a condom, as long as birth control methods are being used. Monogamy must be maintained though. If fidelity is broken, and partners wish the relationship to continue, re-testing for STD’s must take place. More tips for avoiding STD’s:
- Wash hands after sex.
- Wash genitals and anus.
- Do not rub toilet tissue on your genitals and then rub tissue on your anus.
- Avoid touching nose, mouth, eyes and other mucous membranes without washing hands.
- Speak up and talk to your friends about the dangers of unprotected sex.
- Inform your friends if you know their partner is cheating or has an STD.
A vaccine to prevent human papillomavirus virus (HPV) has succeeded in preventing the virus in a large number of young women. Researchers are working to find a safe vaccine for Chlamydia. However, C. trachtomatis is difficult to study as it hides behind the cell membrane. This area of research is well funded and active, as a vaccine would be extremely helpful in preventing Chlamydia and its dangerous complications.
Currently, hospital emergency rooms do not test for STDs enough, researchers say. Women who arrive at the emergency room with abdominal pain, genital problems or difficulty urinating are not always tested. Scientists say that this occurs because emergency room personnel are not aware that these symptoms may be caused by an STD like Chlamydia. Even though young women have the highest risk for sexually transmitted diseases, providers are either unaware or unconcerned about testing for infection. Many young people do not have a primary care doctor and use the emergency room for their only medical care. If hospital personnel fail to test at this time, many cases of Chlamydia go undiagnosed and may lead to dangerous complications.
People may be more inclined to have open discussions with others about sexual health after watching TV shows with favorite characters that discuss sex. One study showed a group of college students a popular show with female characters who have sex and talk about sex with their friends. After watching the show, the participants in the study said they had more conversations with their friends about sexual health. Researchers say that watching TV show characters, who talk about sex with their friends, doctors, and partners, leads young people to be more open about sexual health issues. Watching the show seemed to provide a script that young people could follow even long after watching the show. Even male viewers were more open to frank discussions about sex after watching. Sex Education teachers may be able to use popular media to encourage conversations and better sexual practices.
Researchers have designed a new molecule which could aid in preventing Chlamydia infections. This molecule is designed to take away the self defense mechanism of hiding within the cellular walls. Chlamydia produces a virulence factor, CPAF, that helps the bacteria hide in the vacuoles of the human cell. CPAF also helps the virus survive by preventing the cell from committing suicide, a self-defense mechanism, when it detects an invader. CPAF gives Chlamydia life and gives it a chance to multiply. This factor allows Chlamydia to co-exist with normal cells, stay hidden and dormant, and cause serious complications later. Researchers believe that if they can shut down CPAF, the natural healing functions of the body will take over and eliminate Chlamydia by itself, without antibiotic intervention. This new molecule is called a CPAF inhibitor, and blocks the action of CPAF. When CPAF is blocked, the invaded cell accomplishes suicide and the Chlamydia bacteria dies with it.
A bacteria similar to Chlamydia, and also sexually transmitted. The bacteria prefers the genital areas but can be found in mouth, throat, eyes, and anus. Vaginal and penile discharge, difficulty or pain urinating, itching, soreness and bleeding are common symptoms. This condition may be life threatening and causes vulnerabilities to other infections like HIV. Samples of discharge, a urine test, or a microscopic examination confirms diagnosis.
Antiobiotics, pregnancy, diabetes and obesity can cause favorable conditions for yeast infections, most commonly Candida Albicans. A thick white discharge and an itching and burning sensation may alert the woman to the condition. A sample of the discharge is examined by microscope to confirm. Yeast is not sexually transmissible but men may notice some itching and burning after contact with an infected woman.
Itching, odor, and a yellow, grey or green frothy discharge should alert a woman and her physician to this related condition. The discharge may be worse after completion of the menstrual cycle. Upon examination, the cervix is likely to be inflamed and reddish. Microscopic examination reveals active and mobile trichomonads, protozoa-like organisms. Men may be carriers but are usually symptom free.
The organiscm Mycoplasma Genitalium attaches to genital epithelial cells with an adhesion protein and enters cells to cause an inflammatory response. Sexual intercourse spreads the organism when infected sperm enter the female reproductive organs. PID, vaginosis, and cervicitis in women are usually the results. Many women are unsymptomatic, though. Males often have urinary difficulties.
Pelvic inflammatory disease (PID)
Many bacterial infections not due to Chlamydia can cause PID. When the cervix is manipulated and causes pain, and a bacterial infection is present, PID is diagnosed. Infection spreads through the female reproductive tract, causing abdominal pain, fever, vomiting, nausea and bleeding. PID causes scarring and blockages in the reproductive system and may cause infertility and premature births.
Women of all ages may experience a discharge and a fishy odor from the vagina. Yeast, viruses, bacteria, and other pathogens are common culprits. Poor hygiene and allergens to soaps and perfumes may also be the cause. Discharge may be grey, brown, yellow or green in color and be thin or thick in texture.