Chlamydia
Chlamydia is the most common sexually transmitted infection and also the quietest one. Most infected people have no discharge, no pain and not the faintest…
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Medicines commonly prescribed for Chlamydia
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 500 mgActive substance: azithromycinManufacturer: Arafarma Group S.A.Prescription requiredDosage form: TABLET, 100 mgActive substance: doxycyclineManufacturer: Laboratorios Normon S.A.Prescription requiredDosage form: CAPSULE, 50 mgActive substance: doxycyclineManufacturer: Industrial Farmaceutica Cantabria S.A.Prescription required
Chlamydia is the most common sexually transmitted infection and also the quietest one. Most infected people have no discharge, no pain and not the faintest hint that anything is going on, and that can carry on for years. It is usually found by accident: during pre-pregnancy testing, after a call from a former partner, or once a complication has already developed. The bacterium itself clears without a trace after a short course of antibiotics. The harm is done not by the germ but by the months it spends in the body unnoticed.
Why it is missed so often
Chlamydia lives inside the cells lining the mucous membranes and provokes almost no dramatic reaction. Roughly three out of four infected women have no signs at all, and half of infected men. When signs do appear, they show up one to three weeks after exposure, sometimes months later, and they look so unremarkable that people blame cystitis, chafing or a bad dinner.
The second trap is that having no complaints says nothing about what happens next. The infection does not clear on its own: it quietly travels up the genital tract and damages the tubes or the epididymis without sending any signal. All that time the person feels perfectly well and keeps passing it on. That is why the only way to catch chlamydia in time is to test, not to wait for symptoms.
What you might notice
The signs depend not on your sex but on where the bacterium has settled.
Cervix and urethra in women:
- vaginal discharge has changed: heavier, thinner, with an unfamiliar smell;
- bleeding after sex or in the middle of the cycle;
- burning and stinging when passing urine, while the urine culture comes back clean;
- a dragging ache low in the abdomen, especially during sex.
Urethra in men:
- clear or slightly cloudy discharge from the urethra, most noticeable in the morning;
- stinging inside the urethra when passing urine, itching at the opening;
- a dull ache or swelling in one testicle.
The bacterium settles just as readily wherever semen and vaginal fluid reach. The rectum answers with pain, a constant urge to open the bowels, mucus and blood; the throat usually stays silent and only occasionally feels sore; the conjunctiva turns red, waters and sticks shut overnight, and a long-running conjunctivitis in one eye in an adult is a reason to think about sexually transmitted infections.
One separate note about testicular pain. If it comes on suddenly, sharply and severely, do not wait even an hour: that is how testicular torsion presents, and it needs surgery within the first few hours. That is no longer chlamydia, but the two are easy to confuse.
Who should test even while feeling fine
- sex without a condom with a new partner, or a change of partner;
- a partner has been diagnosed, or simply asks you to get tested;
- you are planning a pregnancy or are already pregnant;
- you are young and sexually active: the infection is found most often in the first years of sexual life, so once a year, with no particular trigger needed;
- you have had several partners over the past year, or your partner has other partners;
- you are due to have a termination, an intrauterine device fitted, or fertility investigations;
- men who have sex with men: regularly, and with swabs taken from the rectum and throat as well as the urethra.
How testing works
The test looks for the bacterium's DNA, and the sample depends on the site: for women a vaginal swab, which they can take themselves; for men the first part of the urine stream, collected at least an hour after last passing urine. After anal or oral sex a rectal and a throat swab are added: a urine test does not cover those sites, and that is where the infection is missed most often.
A blood test for antibodies is no use for diagnosis, although it is still sometimes ordered. Antibodies only show that the body met chlamydia at some point and cannot tell an active infection from one that ended years ago.
The test has a blind window: immediately after exposure there are still too few bacteria. If there is a specific reason to test, it makes more sense to do it about two weeks later, and to repeat it if the result is negative but the worry remains. It is worth adding tests for gonorrhoea, syphilis, HIV and hepatitis at the same time: these infections often travel together, and one visit is easier than coming back.
Treatment and what your partner needs to do
Treatment is a course of antibiotics, usually around a week. The single-dose tablet that was the standard for many years is now used less often: it works less well when the infection sits in the rectum. The class of drug is chosen by the doctor, because regimens differ in pregnancy and in rectal infection. The course must be finished, even if by the second day nothing bothers you any more.
Sex has to wait: until the course is finished and for a week after that, otherwise partners simply hand the infection back and forth.
Partners are treated alongside you. Everyone you have had contact with over the past six months should be tested and treated; if there has been no one, then your most recent partner. Treatment is given even when their test is negative: often it has not had time to turn positive, and an untreated partner is the commonest reason the whole thing starts again a month later.
A test of cure is not needed by everyone. It is done in pregnancy, in rectal infection and when there is doubt that the course was completed, and never sooner than several weeks after treatment, or the test picks up the remains of dead bacteria. Retesting at around three months, however, makes sense for almost everyone: it checks not the treatment but whether the infection has come back.
What happens if it is left alone
In women the infection climbs into the womb, the tubes and the ovaries. Pelvic inflammatory disease develops, sometimes with pain and fever, but often with almost nothing to feel. It leaves scarring in the tubes, and with the scarring come three things: ectopic pregnancy, tubal infertility and chronic pelvic pain. The risk rises with every episode. Less often the inflammation reaches the capsule of the liver and causes pain under the right ribs that gets treated as a gallbladder problem for years.
In men it is usually the epididymis that suffers: it swells, hurts, and the skin of the scrotum turns red. It responds well as long as it is not left too long.
Sometimes, a few weeks after the infection, reactive arthritis is triggered: joints become inflamed, most often a knee or an ankle, joined by sore, gritty eyes and burning in the urethra. It settles over months but needs treatment of its own.
Chlamydia also has an aggressive form, lymphogranuloma venereum. For a long time it was seen only in the tropics, but over the past two decades there have been outbreaks in Europe as well, mainly among men who have sex with men. It causes severe rectal inflammation with pain, blood, pus and a constant false urge to open the bowels, or it swells the groin lymph nodes dramatically, sometimes until they discharge. It is worth knowing about for one reason: this picture gets mistaken for Crohn's disease and treated with the wrong thing for years, when an ordinary antibiotic is enough, simply given for three times as long.
Chlamydia and pregnancy
Untreated infection raises the risk of premature birth and low birth weight, and it passes to the baby during delivery. In the newborn it shows up as a sticky, purulent conjunctivitis in the first or second week of life, or as a persistent cough without fever in the second or third month: chlamydial pneumonia of infancy. Both are treatable with antibiotics, but it is far better not to get there.
That is why the test is part of pre-pregnancy and antenatal checks, and why a positive result is treated straight away with a drug that is safe at that stage. A test of cure is mandatory in pregnancy, about a month after the course ends.
What lowers the risk
- condoms for vaginal and anal sex: not a hundred per cent protection, but a several-fold reduction in risk;
- a barrier for oral sex: a condom or a latex sheet;
- sex toys kept personal, or washed and covered with a fresh condom before anyone else uses them;
- testing once a year and with each new partner, not only when something starts to hurt;
- a course finished properly, yours and your partner's.
What not to do: douching after sex. It does not protect against infection, it disturbs the normal vaginal flora and if anything raises the risk. Hormonal contraception and the coil protect against nothing here either: they are about pregnancy, not about infections.
Online consultation
A remote appointment handles the commonest questions well: which test exactly you need, which site the sample should come from, and how many days after exposure it is worth doing, which is where most time gets lost. The doctor can go through a result you already have, explain what your partner should do and how long to abstain, and say when a test of cure is useful and when it will only confuse matters. Symptoms that persist after a treated infection are also sensible to discuss online. Sudden testicular pain, severe lower abdominal pain with fever, or pelvic pain in pregnancy are not assessed remotely: those need a face-to-face examination the same day.
This material is for information only and does not replace medical advice.
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Discuss your symptoms and possible next steps for Chlamydia with a doctor online.
