Related Pages

Chlamydia contents

Essential facts

More information

Diagnosis and management

Statistics

Pamphlet
(pdf format)

Pelvic inflammatory disease

PID diagnosis and management

STD for information for students

Chlamydia
More details/information for students

Definition

Statistics

Signs and Symptoms

Complications

Transmission

Testing

Treatment

Prevention

Definition

Unlike most other bacteria, Chlamydia trachomatis is an intracellular organism (it grows within cells). Chlamydia usually infects the cervix and fallopian tubes of women, and the urethra of men.

Statistics

Chlamydial infections are believed to be the most common of all notifiable STDs. It is generally thought that in a population of 15 million, there are up to 300,000 cases of chlamydia each year. Thus there are many undiagnosed cases of chlamydia in the community. It has been estimated that the true prevalence of chlamydia in the sexually active population may be in the order of 5% to 10%. See Statistics Section for recent data.

Signs and symptoms

Chlamydia often produces no symptoms. Approximately 60% of women and 40% of men have no symptoms. 

Infection of the cervix and fallopian tubes occurs commonly, and chlamydia can also cause urethral infection. Symptoms can include dysuria (pain on urination), cystitis (bladder infection), a thin vaginal discharge and/or lower abdominal pain. Mucopurulent cervicitis (inflammation of the cervix with pus) is very common. Eye infections can occur in infants born to infected mothers.

In men, chlamydia may produce chlamydial urethritis (inflammation of the urethra) similar to that of gonorrhoea. Symptoms may include dysuria and a mucopurulent discharge.

Complications

The most severe complication of chlamydia (as with gonorrhoea) is the risk of pelvic inflammatory disease (PID) in women, as a result of the infection ascending into the upper genital tract. Chlamydia has been deemed responsible for 200,000 cases of infertility in women in the USA each year.

Chlamydia can also ascend the genital tract in men, causing epididymitis, although upward spread of infection is much less common in men than women.

Transmission

The risk of infection from person-to-person is similar to that of gonorrhoea. It can also be passed to the eye by a hand moistened with infected secretions. Chlamydia can be transmitted during anal intercourse causing proctitis (inflammation of the rectum) (Crowe & Norsigian, 1984).

Testing

Recently developed tests have made more effective intervention against chlamydia possible. The main methods of testing are based on nucleic acid detection, polymerase chain reaction (PCR) ligase chain reaction (LCR) on either a genital swab or a urine specimen. Other tests include fluorescent antibody (FA) examination of a direct smear, the enzyme immunoassay test (EIA) and culture .

Because chlamydia is an intracellular organism (it exists inside cells, not in the pus), the correct swab technique is very important in order to obtain a positive test result. Any discharge should be removed as this may interfere with the immunoassay. 

In women a swab is placed just into the cervical canal and rotated gently in order to collect cervical cells. The swab is then placed into the appropriate container.

In men a urethral swab may be required. Some men find this a painful and unpleasant procedure, particularly if there is urethral inflammation. Gentle persuasion as to the necessity of the test may be required. A special urethral swab is inserted 2 cm to 3 cm into the urethra and gently rotated, so that some urethral cells adhere to the swab. The swab is placed into the appropriate laboratory container.

In both men and women, the swab for chlamydia should be collected last if a series of swabs are being performed for STD diagnosis. Women can be tested for chlamydia by cervical canal swab even if they are menstruating (unlike a Pap smear which cannot be performed during menstruation).

Treatment

Chlamydial infections are treated most effectively with the drugs azithromycin or doxycycline. More complicated infections, such as PID, require longer treatment.

Prevention

• Use condoms during vaginal and anal intercourse.

• Sexual practices other than intercourse carry less risk of transmitting chlamydia.

• Because chlamydia can infect the eyes, care must be taken to avoid spreading sexual fluids into them.

• Where infection has occurred, it is important to avoid sexual contact involving the genitals during the course of treatment, until a negative test result is obtained. This will aid healing and prevent transmission.

Top of Page