CHLAMYDIA - a patient's guide
Dr Nicola Marris - Family Doctor

Overview

Chlamydia is a common sexually transmitted disease

It can cause no symptoms

Noticeable symptoms in women can include pain with sex, change in vaginal discharge, and irregular bleeding

Men may have no symptoms or have a discharge from the penis

Partners need treatment to stop a recurrence

The condition is cured by the use of antibiotics

What Is chlamydia?

Chlamydia is an infection that is caused by bacteria (Chlamydia trachomatis).

It causes inflammation in the lining of the cervix in females and the urethra in males. It can also infect the throat, rectum and eye.

How do you get it?

Chlamydia can be passed from person to person when they have sexual intercourse - vaginal, oral or rectal. For this reason it is known as a sexually transmitted disease or STD.

It can also be passed onto babies when they are born if the mother is infected with the bacteria.

In New Zealand it is the one of the most common STDs.

What are the symptoms?

Women

It can cause:

No symptoms
Pain with sexual intercourse
Pain when passing urine
Pain in the lower abdomen
Fevers
Changes in the vaginal discharge
Changes in the normal bleeding pattern - irregular bleeding or bleeding after sex

Most often there are no symptoms - this means it can be causing you damage without you knowing you have the infection.

Men

It can cause:

No symptoms
Discharge from the penis
Pain when passing urine
Pain and swelling in the testicles.

How can it affect the body?

Women

It causes an infection in the lining of the cervix, which can spread to infect the uterus and fallopian tubes. If this happens it is called pelvic inflammatory disease (PID). The inflammation and scarring caused by chlamydia can damage the fallopian tubes, sometimes blocking them completely. This can cause a woman to be infertile because the sperm can not reach the egg to fertilise it. It could also cause an ectopic (tubal) pregnancy or cause chronic pelvic pain.

Men

It infects the urethra and can spread to the testicles. Men can also become infertile, however this is rare. Occasionally, men can get chlamydia infections that set up a response in their body that causes joint pain and swelling (arthritis), eye irritation and rashes. This is known as Reiter's disease.

Babies

If they are infected at the time of birth, as they move through the birth canal, they can develop an eye infection or pneumonia.

How is it tested for?

Women

A swab is taken from the cervix and can also be taken from the urethra. The test is an "antigen" test.

The advantage of this test is it is quick, usually a result will be available in 2 days. The disadvantage of this test is there are "false positives " ie. you may get a result positive for chlamydia and you may not, in fact, have it. This may occur in about 5% of the tests. There can also be "false negatives" ie. You may get a result negative for chlamydia and actually have it. This may occur in about 10% of the tests, but is less likely if both the cervix and urethra are tested.

The test is very similar to having a smear test in woman and is often done at the same time. It does not usually cause a lot of discomfort.

Men

The test is done either from a urine specimen or from a swab from the penis.

How is it treated?

Chlamydia is treated with antibiotics taken by mouth.

Recently, a "one off dose" of an antibiotic, Azithromycin, has become available in New Zealand.

Two (500mg) tablets are taken, as a single dose. Side effects of this treatment are uncommon but they can cause stomach upset and rashes.

Doxycycline is the name of another antibiotic that can be used. One tablet (100mg) is taken twice daily for 10 days. This antibiotic is best taken with food or milk in the stomach. Side effects of this treatment can be upset stomach, skin rash (especially bought on in the sun), and thrush.

Neither of these treatments is appropriate, however, if you are pregnant. Erythromycin is the antibiotic of choice in pregnancy.

How do I know that I am cured?

If you have been given Azithromycin you don't usually need to be tested again. You should be cured if you have taken all of the medication and not had sex with anyone who could reinfect you.

If you have been given Doxycycline or Erythromycin you may prefer to have yourself retested to help confirm that you have been cured. Retesting should be no earlier than 3 weeks after being treated.

What about partners?

All recent sexual partners should be tested and treated for chlamydia.

It is not always easy for people to tell partners but it is extremely important in order to try and prevent any long-term damage to them and also to any of their future partners.

You or your partner may have had chlamydia for many years without knowing. It does not necessarily mean that either you or your partner has had sex with someone else recently.

How can I avoid getting chlamydia?

If you are having sexual intercourse, you are at risk of getting infected with chlamydia. By using condoms when you have sex, you help protect yourself from being infected with the bacteria.

Future trends

Vaccination may become available to protect yourself from chlamydia.

New tests may be developed which may make it far easier to check for chlamydia. This could be used to 'screen' large populations and treat infected individuals. This would help to lower the incidence of the infection.

Where can I get more information?

Your doctor, Sexual Health Clinics, Family Planning Clinics. Contact numbers and addresses are available in the telephone directory.