Chlamydia is a common sexually transmitted infection (STI) caused by the small gram-negative obligate intracellular organism Chlamydia trachomatis. There are 18 serologically variant strains. Serovars D through K cause genital tract infections and will be discussed herein; serovars L1-L3 are the cause of lymphogranuloma venereum. Chlamydiae may infect the genital tract if acquired through unprotected vaginal sex, or the mouth or anus if acquired from oral or anal sex. Chlamydia can also be spread from an infected mother to their baby at birth.
Most of the time, chlamydia is a "silent" infection and has few symptoms. In women, infection may manifest as urethritis, vaginitis, or cervicitis, leading to dysuria, vaginal bleeding, cervical discharge, or abdominal pain.
Chlamydial infection is the most frequently reported bacterial infectious disease in the United States, and prevalence is highest among persons younger than 25 years with new or multiple sexual partners, particularly if protection with condoms is inconsistent. Re-infection happens easily if a sex partner is not treated. Chlamydial infection is a risk factor for other STIs and can increase the risk of acquiring HIV by increasing inflammation of the genital mucosa. There is also an association with the development of reactive arthritis (Reiter syndrome).
Chlamydial infections are common in both sexes, but serious complications are more commonly seen in women. Such complications may include pelvic inflammatory disease (PID) and/or tubo-ovarian abscess, Fitz-Hugh-Curtis syndrome (retrograde spread leads to frank peritonitis and perihepatitis), and septic abortion. The sequelae of PID include infertility and an increased risk of ectopic pregnancy. Pelvic or lower abdominal pain is a marker for such an ascending infection.
ICD10CM: A56.2 – Chlamydial infection of genitourinary tract, unspecified
Chlamydia is a common sexually transmitted disease caused by the bacterium Chlamydia trachomatis, which affects the genital tract if acquired through vaginal sex, or the mouth or anus if acquired from oral or anal sex. Chlamydia is spread through unprotected sex with an infected person; it can also be spread from an infected mother to her baby at birth.
Most of the time, chlamydia is a "silent" infection and has few symptoms. However, it is the leading cause of infertility as permanent damage may be done to the woman's reproductive tract. In men, chronic infection can lead to sterility.
Who’s At Risk
Chlamydia affects more than 3 million Americans each year; infection is most common in teens and young adults (aged 15-24) with new or multiple sexual partners, particularly if protection with condoms is inconsistent. Re-infection of chlamydia happens easily if a sex partner is not treated.
Signs & Symptoms
If symptoms occur, they are usually 1-3 weeks after becoming infected. 75% of women and up to 50% of men have no symptoms (asymptomatic).
Women with infection of the genital tract (cervix, the mouth of the womb; or urethra, the urinary opening), may have a yellow-white vaginal discharge, spotting between periods, fluid discharge from the urethra, or burning with urination. Other symptoms might include belly or low back pain, nausea, fever, or pain with sexual intercourse.
Men with infection may have pus or fluid from the opening of their penis (urethra) or itching or burning with urination.
Infection of the anus (rectum) presents with rectal pain, discharge, or bleeding.
Seek medical care if you suspect chlamydia. Avoid any sexual activity until a week after treatment is finished. If you are infected, your sexual partner(s) should be checked and treated.
To prevent chlamydia infection:
Abstinence, monogamy (single partner), or limiting the number of sexual partners all reduce your risk.
Consistent and correct use of latex condoms reduces risk.
All pregnant women, all sexually active women under age 25, and older women with new or multiple partners should have an annual screening test for chlamydia.
When to Seek Medical Care
Seek medical care if there is any chance you are infected with chlamydia, whether or not you have symptoms. As previously noted, sexually active women should have an annual check for infection.
A test will be done on the urine or from fluid from the penis or vagina or cervix.
If the test is positive, treatment will be prescribed with oral antibiotics (usually azithromycin or doxycycline). All sexual partners should also be tested and treated if positive. If a partner is infected and not treated, re-infection is common.
Persons with infection should not have sexual intercourse until 1 week after treatment is finished in both partners.
Bolognia, Jean L., ed. Dermatology, pp.1290. New York: Mosby, 2003.