Chlamydia is the most common sexually transmitted disease in the world today, but until recently little was known about this devastating, silent scourge. We explain the causes, the effects – and the means of cure and prevention.
Chlamydia is a micro-organism halfway in size between a bacterium and virus. Like a virus it can only multiply inside the cells of a living host and can lie dormant and undetected for years. Like a bacterium, however, it has cell walls and is sensitive to antibiotics. In the developed world chlamydia is best known for its effects on the reproductive organs of both sexes and for the problems it can cause newborn babies.
Scientists have known about chlamydia for years. As long ago as 1911 it was discovered that the same organism could infect the urethra in men and the cervix in women. However, over the last 30 years more sophisticated techniques to isolate chlamydia have revealed just how destructive it can be.
In men, it has been discovered that chlamydia is responsible for around 50 per cent of non-specific urethritis (NSU) and can also cause epididymitis, an inflammation of the sperm duct and a major cause of male infertility.
In women, untreated chlamydia can spread from the cervix into the Fallopian tubes and womb. It can then cause pelvic inflammatory disease (PID) and the tubes may become scarred and blocked, which can cause infertility.
Damage to the Fallopian tubes can also result in ectopic pregnancy, when the fertilized egg becomes stuck, and grows inside the tube instead of in the womb.
Chlamydia can also be passed on from mother to baby during birth. Infected babies can develop severe conjunctivitis, respiratory infections and pneumonia, and have an increased risk of perinatal mortality, (death in the first week of life).
The effects of chlamydia are now seen all over the world. In parts of Africa and Asia, where hygiene is often poor, it has been discovered that certain strains of chlamydia are causing the eye disease trachoma, the main cause of blindness worldwide.
A type of chlamydia also affects birds and is occasionally passed on to humans. Chlamydia psittaci, usually contracted from birds such as parrots and pigeons, causes psittacosis, which is a form of pneumonia.
Pregnant women are especially at risk of catching chlamydia if they come into contact with sheep. It is important, in particular, for pregnant women to avoid petting newborn lambs or coming into contact with sheep fetuses.
Although chlamydia is primarily transmitted through sexual contact it can also be carried into the womb on surgical instruments during any gynaecological procedure which requires the cervix to be opened.
A hidden problem
Although chlamydial infection can have devastating effects it has only relatively recently hit the headlines. This is because the organism is difficult to track down and the disease is often symptomless, especially in women. The symptoms are often so minor that they can be ignored or confused with less serious complaints such as cystitis. Symptomless carriers can then pass the disease onto their partners who in turn may have no symptoms. In this way the disease is able to spread like wildfire within the sexually active community. Chlamydia is now four times more common than it was 30 years ago, and in the USA it is estimated that between three and four million people contract the infection each year. In the UK, the bulk of infections are diagnosed in men and women aged 16-34 with the highest rates being in women aged 20-24 years and in men aged 25-34 years. Younger sexually active people are particularly at risk, and prevalence in teenagers attending clinics for termination of pregnancy has been found to be as high as 25 per cent.
Because chlamydia has reached almost epidemic proportions, some healthcare experts believe that screening should be available to ‘at risk’ groups. The Swedes, for example, test all women about to have an abortion, those seeking contraceptive advice and all those with vaginal discharge. As a result the number of teenage girls infected with chlamydia has dropped significantly. Until screening becomes more widely available in this country, all sexually active women must look out for symptoms of the disease in themselves and in their partners.
Signs and symptoms
The awkward fact is that because up to 40 per cent of women with chlamydial infection have no symptoms at all, the first sign that something is wrong may appear in their partner. If he has a discharge from his penis, painful testicles or pain on passing urine, it is vital that you are both tested immediately and treated if necessary, even if you have no symptoms.
The first sign that you are infected may be an unpleasant-smelling yellow discharge. If the infection is left untreated and develops into PID the symptoms may become more obvious. You may suffer from back pain, abdominal pain and fever, experience vaginal soreness or bleeding after making love, or perhaps a stinging sensation when passing urine. If you experience any of these symptoms it’s important you get treatment before irreparable damage is done. One of the major reasons women have to turn to in vitro fertilization (where the egg is fertilized outside the body and then replaced into the womb) is PID. Although PID does not stop the production of eggs, the eggs are unable to travel down from the ovaries into the Fallopian tubes, thus making unassisted conception impossible.
For diagnosis and treatment you should go to your GP or your local sexually transmitted diseases (STD) clinic where they have the most experience and best facilities. You could phone your local hospital to find out if they run one. STD clinics run like any other hospital clinic but you may not have to make an appointment and absolute confidentiality is ensured. You will have to answer some questions about your sex life, but the staff are specially trained to deal with the situation and you don’t have to give your name and address to get sympathetic and expert help and advice.
You will be examined and a sample of mucus will be taken from the cervix. The sample is then tested and if antibodies to chlamydia are found, you have the infection. Once a diagnosis is made chlamydia can be simply and completely cured with a course of antibiotics. Your doctor will probably prescribe doxycycline, two tablets a day for ten days. As with any antibiotic it’s vital you complete the course of medication even if your symptoms disappear. It’s important that your partner is treated too, even if there are no symptoms, as the infection could be passed back to you when you next make love. If you have several sexual partners they must be contacted and treated if necessary. Many STD clinics will trace and contact sexual partners if you prefer.
How to avoid chlamydia
As with most STDs, you can lesson the risk of contracting chlamydia by practising safer sex. This is to say, if you are sexually active outside a monogamous relationship in which both partners have been screened for infections, use a condom.