Chlamydia trachomatis — don’t catch me if you can

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Chlamydia trachomatis — don’t catch me if you can

A silent dictatress. It emerges out of the blue, doesn’t show any signs of its presence, but unfortunately knows exactly where to strike. Today, we’re discussing Chlamydia trachomatis — because we keep our friends close and enemies… well, we dissect them ;)

Dominika Olchowik

Published: 15.02.2022 7 minreading time

chlamydia - cover

Illustration: Jarek Danilenko

Chlamydia — causes

Chlamydia is a disease caused by Chlamydiales bacteria. Some of them are transmitted by sexual contact, others — by droplet transmission, or by contact with an infected animal. Our today’s antagonists are bacteria called Chlamydia trachomatis (or C. trachomatis).

Chlamydia trachomatis infection occurs most frequently during sexual intercourse (either anal or oral sex) without protection. Oral sex, in turn, can cause Chlamydia to spread in the throat. Additionally, the bacterium can easily spread by touch or during childbirth. All you need is an open wound or a brief contact between the baby and the mucosa.

How often do Chlamydia infections occur?

Chlamydia trachomatis bacteria are spread throughout the world. Therefore, they constitute the most frequent cause of sexually transmitted diseases — about 100 million infected individuals a year during unprotected sex!

The risk factors are the following:

  • Young age (below 25; the highest number of chlamydia infections is reported in people aged between 15 and 25).

  • Possible previous sexually transmitted infections.

  • Multiple sex partners, as well as unprotected vaginal, oral, or anal sex (without condoms).

The symptoms of Chlamydia are usually similar to those of other, more well-known and commonly diagnosed diseases — hence the problem of evaluating the scale of the issue.

Other infective types of Chlamydia (except for trachomatis) include:

  • Chlamydia pneumoniae — unlike its cousin trachomatis, this species of the bacterium travels by droplet transmission. It causes respiratory diseases, including: pneumonia, throat or trachea infections and inflammations, and recurrent runny nose. It can also be responsible for arthritis.

  • Chlamydia psittaci — a zoonotic bacterium (the carriers are mostly birds — both breeding and wild) that causes psittacosis (parrot disease).

As I’ve already mentioned, today we’re backbiting miss trachomatis. To be honest, I’m not feeling bad about it at all. After all, who needs such a ‘friend’? ;)

Chlamydia — symptoms of infection

In most cases, Chlamydia infection is asymptomatic in the first few weeks — the incubation period can last from 3 to 4 weeks (although it’s usually 1 to 3 weeks). The majority of writings on Chlamydia state that about 75% of infected women and 50% of infected men experience no symptoms at all throughout the entire infection! This is no good, though — the undetected bacterium can ravage and wreak havoc across the whole organism which, at one point, might find itself in a state beyond repair.

The disease can spread to various organs, not only those that are part of the urinary tract or the reproductive system. As you’ll see in a moment, ailments can also affect your respiratory system, joints, and even eyes!

Chlamydia infection in women…

As far as women are concerned, the infection starts in the cervix. In 20 to 40% of them, doctors diagnose concurrent cervicitis. In addition, Chlamydia trachomatis infections are commonly accompanied by urethritis that can be sometimes unjustly disregarded.

Sometimes, the symptoms of a Chlamydia infection won’t present themselves even when the infection has already spread throughout the organism (for example, from the cervix to the fallopian tubes or the rectum).

The most frequently reported symptoms of Chlamydia infection are:

  • Genitourinary infections and problems:

– Painful urination and painful intercourse

– Mucosal and purulent, or otherwise abnormal vaginal discharge

– Intermenstrual bleeding and increased blood flow during periods, etc.

  •  Abdominal or pelvic pain.

… and men

Chlamydia infections in men often cause problems in the genitourinary tract (urethritis, prostatitis, and even a rectal infection).

In the case of urethritis caused by bacteria of the Chlamydia order in men, the following symptoms occur most frequently:

  • Pain and sting during urination,

  • Purulent discharge from the urethra,

  • Pain in the testicles (as a symptom of epididymitis in conjunction with tenderness and swelling of the scrotum),

  • Frequent need to urinate.

Sometimes, rectal inflammation might occur (with accompanying purulent discharge or bleeding from the anus).

Additionally, as a consequence of a Chlamydia trachomatis infection, the following diseases might occur:

Chlamydial throat infection

It is usually asymptomatic, although sometimes the infected person can suffer a mild sore throat. However, the infection is difficult to treat and detect. This type of disease is rather uncommon; but there is a possibility of catching a bacterial throat infection through transmission during oral sex.

Chlamydial conjunctivitis

C. trachomatis bacteria are also responsible for a disease called inclusion (or chlamydial) conjunctivitis. Fortunately, it’s quite rare. It is transmitted sexually (through contact with genital discharge of the infected partner) or during childbirth.

The most common symptoms of the disease are:

  • Characteristic follicles (the so-called lymphocytic follicles) on the lower eyelid.

  • Corneal infiltrates.

Chlamydial conjunctivitis is diagnosed during a slit lamp test. Additionally, to recognise a particular strain, a conjunctival swab is collected for testing.

Inclusion conjunctivitis is usually accompanied by other symptoms of Chlamydia, such as cervicitis or urethritis. This results from the transfer of Chlamydia bacteria from the genital area to the eyes and conjunctivae. This is why treatment starts with the application of broad-spectrum antibiotics.

The risk factor for vertical transmission (mother–child) of the trachomatis bacterium oscillates between 50 and 70%.

Newborn babies infected with the bacteria during birth can show the following symptoms:

  • Mucus-like discharge from the eyes,

  • Swollen eyelids,

  • Eye congestion,

  • Additional ailments: pneumonia, throat infections, ear inflammations, etc.

Injection conjunctivitis in newborns must be treated in a hospital under constant supervision of the medical staff due to the necessity to apply broad-spectrum and topical antibiotics. In the event of a positive diagnosis, the treatment must be extended to the parents of the baby.

Chlamydial conjunctivitis can be fully cured. Diagnosed quickly and treated properly, visual acuity deficits, as well as scars on the conjunctiva or cornea that Chlamydia can unfortunately cause, can be prevented. Such infections tend to be recurrent, which is why untreated Chlamydia can lead to chronic conjunctivitis. Therefore, it’s important to keep this in mind and watch out for any signs of the disease recurring.

Reactive arthritis

The main symptoms of arthritis caused by C. trachomatis are pain and swelling of a single joint (or several joints) — it usually affects the lower extremities. Let’s add back pain, buttock pain, and even heel pain, and we get quite serious complications in the mobility department. In some patients, skin lesions occur (rashes, desquamation of the skin on the planta).

The way of treating arthritis depends on the stage of the disease and the type and scope of the accompanying complications. In general, non-steroidal anti-inflammatory drugs, as well as rheumatology medications, or topical drugs, are used to alleviate other extra-articular symptoms (the aforementioned skin pathologies). Of course, the crucial aspect of treatment is limiting unnecessary physical activity.

Diagnosis: Chlamydiosis

Recognising the disease

To adequately diagnose a Chlamydia infection, it is essential to determine the level of IgM and IgG immunoglobulins in the blood, as well as to take a swab from the female genital tract, including the cervix or the urinary meatus (irrespective of gender). A positive IgG antibody response is indicative of a previous infection, while the IgM antibodies inform about ongoing genital Chlamydia. Additionally, a urine sample might be taken for further tests.

Early detection of genital Chlamydia trachomatis infection is crucial for pregnant women and people planning to get pregnant. This is because genital chlamydial infections increase the risks of premature birth or ectopic pregnancy.

Treatment of Chlamydia

To get rid of the infection, caused by both Chlamydia trachomatis or Chlamydia pneumoniae bacteria, you (and all your sex partners) must use antibiotics. A venereologist is the one who’ll decide on the specific drug and dose. The treatment usually lasts 7 days — people who have Chlamydia often receive azithromycin or doxycycline.

Note: You should refrain from sexual intercourse (even with condoms) for 7 days after symptoms have ceased and treatment has ended.

Chlamydia trachomatis — complications

Untreated Chlamydia might result in serious complications. They include: cervical erosion, salpingitis, pancreatitis, cholecystitis, problems with blood vessels, and general suppression of the immune system.

Chlamydia increases the risk of infertility — the pelvic inflammatory disease caused by it can result in fallopian tube occlusion and impede the correct implantation of the fertilised egg; similarly, in men, untreated Chlamydia can cause vas deferens occlusion and impact spermatogenesis.

Prophylaxis — how to avoid contracting Chlamydia?

We already know how dangerous the complication of Chlamydia can be. And because so many people are unaware of the infection, as they show no visible symptoms, it is essential to introduce preventive practices that can help us avoid (or minimise the risk of getting) a Chlamydia infection:

  • Condom use during sexual activity,

  • Avoiding casual sex,

  • Limiting the number of sex partners,

  • Regular tests — every person who’s sexually active and has multiple sex partners should regularly test for Chlamydia trachomatis; if you have a history of Chlamydia, it is necessary to repeat the tests once every 3 to 6 months; furthermore, everyone who’s sexually active (and has more than one sexual partner) or plans to get pregnant under the age of 25 should get tested at least once a year,

  • Taking care of hygiene — by no means should you ever try vaginal douching, not least in the case of Chlamydia; such practices can disrupt the delicate pH balance in your vagina, which can lead to some unpleasant infections. Besides, let’s not forget the classic house rule ‘separate towels for everyone’. Better to be safe than sorry ;

Phew! This is a lot to process, but I’ll say this: the more you know, the better you sleep ;) May no Chlamydia ruin your joy and satisfaction of being intimate with someone!

  1. C. Bébéar, B. de Barbeyrac, Genital Chlamydia trachomatis infections, „Clinical Microbiology and Infection” 2009, vol. 15, i. 1, p. 4-10.

  2. C.D.J. Den Heijer, C.J.P.A. Hoebe, J.H.M. Driessen et al., Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease, Ectopic Pregnancy, and Female Infertility: A Retrospective Cohort Study Among Primary Care Patients, „Clinical Infectious Diseases” 2019, vol. 69, i. 9, p. 1517-1525.

  3. C. Elwell, K. Mirrashidi, J. Engel, Chlamydia cell biology and pathogenesis, „Nature Reviews Microbiology” 2016, vol. 14, i. 6, p. 385-400.

  4. E. Lanjouw, S. Ouburg, H.J. de Vries i in., Europejskie zalecenia dotyczące postępowania diagnostycznego i leczniczego w zakażeniach Chlamydia trachomatis 2015, „Przegląd Dermatologiczny” 2017, nr 104.

  5. S. Menon, P. Timms, J.A. Allan, K. Alexander et al., Human and Pathogen Factors Associated with Chlamydia trachomatis-Related Infertility in Women, „Clinical Microbiology Reviews” 2015, vol. 28, i. 4, p. 969-985.

  6. A. Parfieniuk-Kowerda, Chlamydiozy, https://www.mp.pl/pacjent/choroby-zakazne/choroby/zakazenia-bakteryjne/164865,chlamydiozy [dostęp z dn. 05.05.2021].

  7. J.A. Phillips, Chlamydia Infections, „Workplace Health & Safety” 2019, vol. 67, i. 7, p. 375-376.

  8. M. Prost, Chlamydiowe zapalenie spojówek (wtrętowe zapalenie spojówek), https://www.mp.pl/pacjent/okulistyka/chorobyoczu/chorobyspojowki/83655,chlamydiowe-zapalenie-spojowek-wtretowe-zapalenie-spojowek [dostęp z dn. 05.05.2021].

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Dominika Olchowik
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