CHLAMYDIA CAN BE ASYMPTOMATIC, SO GET TO KNOW MORE!!

Are you aware that at least 70% of women and 50% of men infected with Chlamydia are asymptomatic?- Meaning they do not present with any symptom? And are you also aware that, worldwide, chlamydia is the most common bacterial sexually transmitted infection?

CHLAMYDIA CAN BE ASYMPTOMATIC, SO GET TO KNOW MORE!!

Written by Bukola/ Published 13/10/22

There were an estimated 127 million new cases of chlamydia infection in 2016.

[WHO, 2019]

WHAT IS CHLAMYDIA?

Genital chlamydial infection is the most commonly reported, curable, bacterial sexually transmitted infection (STI) in the UK. It is caused by the obligate intracellular bacterium Chlamydia trachomatis.

CHLAMYDIAL INFECTION IS TERMED:

‘UNCOMPLICATED’ when the infection has not ascended to the upper genital tract.

‘COMPLICATED’ when the infection has spread to the upper genital tract, causing pelvic inflammatory disease (PID) in women and epididymo-orchitis in men.

Epididymo-orchitis simply means (pain, swelling, or inflammation of the epididymis and/or testicles) which can result from untreated chlamydia infection in men.

HOW COMMON IS IT?

In the UK in 2018:

There were 242,386 new diagnoses of chlamydia — 104,527 in men and 136,028 in women.

Rate of diagnosis was highest in the 15–19 and 20–24 years age groups.

 

In England in 2019:

229,411 new diagnoses of chlamydia infection were reported to Public Health England — 101,429 in men and 126,067 in women.

Young adults aged 15–24 years accounted for around 60% of reported cases

[BASHH, 2018; PHE, 2020; PHE, 2019a; PHE, 2019b].

 

HOW DO YOU GET INFECTED?

Infection is primarily through penetrative sex, but can also occur via autoinoculation or splash from genital fluids.

[ BASHH, 2018; BMJ Best Practice, 2019]

 Untreated infection may persist or resolve spontaneously.

Clearance increases with the duration of untreated infection, with up to 50% of infections resolving within 12 months of diagnosis.

However in some people, untreated genital infection may result in serious complications — risk of developing complications increases with repeated infection.

 RISK FACTORS INCLUDE:

Age under 25 years.

A new sexual partner.

More than one sexual partner in the last year.

Lack of consistent condom use.

INFECTION OF THE UROGENITAL TRACT TYPICALLY CAUSES INFLAMMATION OF THE:

Urethra in men.

Cervix and/or urethra in women.

  1. trachomatis can also infect the conjunctiva, rectum, and nasopharynx.

 

WHEN SHOULD YOU SUSPECT AND TEST FOR CHLAMYDIA?

Suspect chlamydia in sexually active women with:

Increased vaginal discharge.

Post-coital or intermenstrual bleeding.

Purulent vaginal discharge.

Mucopurulent cervical discharge.

Deep dyspareunia.

Dysuria.

Pelvic pain and tenderness.

Cervical motion tenderness.

Inflamed or friable cervix (which may bleed on contact).

 

Suspect chlamydia in sexually active men with:

 Dysuria.

Mucoid or mucopurulent urethral discharge.

Urethral discomfort/urethritis.

Epididymo-orchitis.

Reactive arthritis.

Symptoms of lymphogranuloma venereum (LGV) include:

Tenesmus.

Anorectal discharge (often bloody) and discomfort.

Diarrhoea or altered bowel habit.

Symptoms of rectal chlamydia include:

Anal discharge and anorectal discomfort, although rectal infection is usually asymptomatic.

Symptoms of adult chlamydia conjunctivitis include:

Unilateral chronic low grade conjunctival irritation (may be bilateral).

Symptoms of oropharyngeal infection include:

Pharyngitis and sore throat but oropharyngeal infection is usually asymptomatic.

 Current partner(s) must also be treated for chlamydia to reduce the risk of re-infection and onward transmission.

Sexual intercourse (including oral sex) should be avoided until partner(s) have completed treatment (or waited 7 days after treatment with azithromycin).

 

COMPLICATIONS

Chlamydia infection can lead to complications such as:

Pelvic inflammatory disease (PID), including endometritis and salpingitis — occurs in up to 16% of women with untreated chlamydia infection. PID increases the risk of tubal infertility, ectopic pregnancy, and chronic pelvic pain.

The risk of tubal infertility after PID is estimated to range from 1–20%.

Prolonged exposure to C. trachomatis by persistent infection or frequent re-infection are major risk factors for tubal tissue damage.

Epididymo-orchitis (pain, swelling, or inflammation of the epididymis and/or testicles) can result from untreated chlamydia infection in men.

Lymphogranuloma venereum (LGV).

LGV is most common in men who have sex with men (MSM), with highest rates in men with HIV.

Sexually acquired reactive arthritis (SARA).

SARA is a seronegative spondyloarthropathy. It is a sterile inflammation of synovial membranes, fascia, and tendons that is triggered by infection (enteric or sexually transmitted) at another site. Up to two-thirds of cases of SARA are due to chlamydia infection.

Perihepatitis (Fitz-Hugh-Curtis syndrome).

Inflammation of the hepatic capsule associated with right upper quadrant abdominal pain.

Adverse outcomes in pregnancy — chlamydia infection in pregnancy is associated with adverse outcomes including:

Increased risk of premature rupture of membranes, pre-term delivery, and low birth weight in the infant.

Increased risk of intra-partum pyrexia and late post-partum endometritis.

Infections of the eyes, lungs, nasopharynx, and genitals in the neonate, due to exposure in the birth canal during delivery.

Conjunctivitis — can occur via autoinoculation or splash from genital fluids.

Anxiety and psychological distress.

[ WHO, 2016;  BMJ Best Practice, 2019; Páez‐Canro, 2019; BASHH, 2020]

 

PLEASE REFER TO YOUR PRIMARY CARE PROVIDER FOR ADVICE, DIAGNOSIS AND TREATMENT.

  • MORE INFORMATION IS AVAILABLE ON:
    •  
      • The British Association for Sexual Health and HIV (BASHH)
      • The Family Planning Association

 

 

REFERENCE

  • BASHH (2018) UK national guideline for the management of infection with Chlamydia trachomatis (updated 2018). British Association for Sexual Health and HIV. 
  • BASHH (2020) British Association for Sexual Health and HIV National guideline on the management of sexually acquired reactive arthritis 2020. British Association for Sexual Health and HIV. 
  • BMJ Best Practice (2019) Genital tract chlamydia infection
  • Páez‐Canro, C., Alzate, J.P., González, L.M., et al.(2019) Antibiotics for treating urogenital Chlamydia trachomatis infection in men and non‐pregnant women. Issue 1. John Wiley & Sons, Ltd. 
  • PHE (2018) National chlamydia screening programme standards (seventh edition). Public Health England. 
  • PHE (2019a) Selected STI diagnoses and rates in the UK by gender and age group 2014-2018. Public Health England. 
  • PHE (2019b) Sexually transmitted infections and screening for chlamydia in England, 2018. Public Health England. 
  • PHE (2020) Sexually transmitted infections (STIs): annual data tables. Public Health England. 
  • UKTIS (2019) Use of erythromycin in pregnancy. UK Teratology Information Service. 
  • WHO (2016) WHO guidelines for the treatment of chlamydia trachomatis. World Health Organization.
  • WHO (2019) Sexually transmitted infections. World Health Organization. 
  • Wong, W.C.W., Lau, S.T.H., Choi, E.P.H., et al.(2019) A systematic literature review of reviews on the effectiveness of chlamydia testing. Epidemiology Review 41(1), 168-175.