Chlamydia: The Silent Disease

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Chlamydia : Background Chlamydia : Antibiotic Treatment
Chlamydia : Risk Factors Chlamydia : Alternative Treatments
Chlamydia : Signs and Symptoms Chlamydia : Prevention
Chlamydia : Complications Chlamydia : References
Chlamydia : Diagnosis

Background

 ChlamydiaChlamydia is the most common bacterial sexually transmitted disease in the world. It is sometimes called the “Silent Disease” because most people who have chlamydia do not have any outward signs or symptoms. About 2.8 million new cases of chlamydia occur in the United States every year, according to an analysis published by the Centers for Disease Control (CDC) in February 2013. According to STD Trends in the United States 2010, from 2000 to 2010, the Chlamydia trachomatis screening rate among young women nearly doubled (from 25% to 48%). Especially alarming is the skyrocketing incidence in teenagers and young adults; approximately 63% of new cases are reported in the age group 15-24.

Chlamydia is caused by the Chlamydia trachomatis bacteria, which lives and multiplies inside our cells. A person can become infected with chlamydia by having vaginal, oral, or anal sex with an infected partner or by sharing infected sex toys. Chlamydia can also be passed from an infected mother to her infant during childbirth. Children can become infected when they experience an episode of sexual abuse.

Risk Factors

Although both men and women are susceptible to the disease, chlamydia is at least three times more common in women. Additionally, African American women have rates of infection seven times higher than white women. The disease tends to be most prevalent in poor, uneducated women living in big cities. Previous induced abortions also increase a woman’s chance of getting the disease.

Because chlamydia is a sexually transmitted disease, sexually active individuals who have multiple partners are most susceptible. Individuals with another STD, especially gonorrhea, are at even greater risk.

Increased risk of contracting chlamydia is observed during the period immediately after giving birth or undergoing an induced abortion. This risk arises because the cervix is not entirely closed, allowing a greater chance for infection. Other risk factors include douching and smoking.

Signs and Symptoms

About 75% of women infected do not experience any symptoms. Almost 50% of men infected have no symptoms. Chlamydia typically infects the cervix of women and the urethra (urine passageway) of men, although symptoms can also appear in the testicles, prostate, anus, throat, and eyes. When the disease does cause symptoms, they generally appear within 1-3 weeks of exposure.

In women, symptoms can include a whitish or yellowish vaginal discharge, abnormal menstrual bleeding (including bleeding between menstrual periods), unusually painful menstrual periods, painful sexual intercourse, painful or more frequent urination, and fever. Some women also experience lower abdominal discomfort.

Men may experience irritation or burning in the penis during urination, more frequent urination, a whitish or yellowish discharge from the penis, and a tender scrotum.

On rare occasions, symptoms can develop outside the genital areas in both men and women. With anal sex, chlamydia can cause an infection of the rectum resulting in bleeding, discharge, pain with bowel movements, and diarrhea. Oral sex can produce an inflammation of the throat (pharyngitis). If a contaminated hand touches the eyes, there could be itching and redness of the eyes, and sometimes even blindness.

Complications

In women, one of the most serious complications of chlamydia is pelvic inflammatory disease (PID), which can cause severe abdominal pain and damage to the fallopian tubes. According to the CDC, approximately 40% of women infected with chlamydia develop PID.

Scarring in the fallopian tubes can cause blockage and prevent an egg from being fertilized. As a result, one of every five women with PID is unable to conceive. Tubal scarring may also cause the fertilized egg to be trapped inside the tube, resulting in an ectopic pregnancy (pregnancy outside the uterus). The condition is potentially fatal if the tube ruptures. In the United States, tubal pregnancy is the number one cause of death of women in early pregnancy.

Untreated chlamydia in men typically causes infection of the urethra, which can be quite painful and occasionally lead to kidney or bladder complications. In some cases, the infection spreads to the tube that carries sperm from the testis, resulting in pain and swelling of the testicles (epididymitis). This may cause pain, fever, and even infertility. A small percentage of men with epididymitis develop reactive arthritis, which causes joint pain and swelling and can become disabling. Men may also get abscesses, or pus-filled lesions, in their scrotum.

Chlamydia can cause eye infections and pneumonia in newborns whose mothers have an active infection during the last part of their pregnancy. Chlamydia is also associated with an increased rate of pre-term births.

Chlamydia can facilitate the transmission of other sexually transmitted infections, especially HIV. Research has shown that women with chlamydia who are exposed to HIV are five-times more likely to become infected. This is because it is easier for HIV to pass into the bloodstream when inflammation is present.

Like all STDs, chlamydia can have devastating emotional consequences, including depression, loss of self esteem, anger, betrayal, and even thoughts of suicide. Very often, the psychological trauma will continue long after the disease itself has been successfully treated.

Diagnosis

After you report your symptoms, your health care provider will do a pelvic examination and check your cervix or urethra for inflammation and abnormal discharge. A specimen of cervical or penile discharge will be collected using a cotton-tipped applicator. In some instances, urine tests can be performed instead. Because patients with chlamydia are more likely to contract other STDs, your health care provider may also perform tests for HIV, gonorrhea, and hepatitis B.

Because of the possible serious complications, the CDC recommends testing for chlamydia at least once a year in sexually active women.

Antibiotic Treatment

Fortunately, chlamydia is one of the most curable STDs if it is detected early enough and there is no indication of pelvic inflammatory disease. A simple regimen of oral antibiotics is usually very effective. However, it is essential that infected persons make positive life style changes so they don’t get re-infected.

Antibiotics used to treat chlamydia include azithromycin (Zithromax, Zmax), doxycycline (Vibramycin), erythromycin (E-Mycin, Erithrocin), and ofloxacin (Floxin). The CDC recommends azithromycin or doxycycline as first-choice antibiotics. Azithromycin is expensive but much more convenient to administer, since only a single dose is needed. Because many patients tend to stop taking drugs after a few days, drugs requiring a longer treatment regimen are usually less effective. The cure rate for azithromycin is approximately 96%. Doxycycline, taken twice a day for 7 days, is a proven and reliable treatment that is less expensive and has cure rates exceeding 90%. However, doxycycline is contraindicated during pregnancy and breastfeeding, so pregnant or nursing women are usually given azithromycin. Erythromycin is very inexpensive but has a more complicated dosing regimen (4 times daily for 7 days) and can make many people sick to their stomach. It is the standard treatment for infants who get chlamydia eye infections during childbirth. Ofloxacin is similar in efficacy to azithromycin and doxycycline, but is more expensive and cannot be taken in pregnancy.

For most people, the symptoms go away within 1-2 weeks after treatment. Followup testing is usually done four weeks after treatment to ensure that the infection is completely eradicated. If tests continue to be positive, the patient is given another course of antibiotics.
All sexual partners should be notified and treated, and intercourse should be avoided until both partners have finished their course of treatment and have been re-tested.

Alternative Treatments

Although not recommended by the CDC, other alternative treatments are occasionally suggested. These treatments are seldom effective in eradicating the infection, but may help the body fight the disease or relieve symptoms. Some practitioners suggest dietary changes such as following a low-fat, high fiber diet and limiting intake of sugar, highly processed foods, caffeine, and alcohol. Others may advocate vitamin and mineral supplements, drinking cranberry juice, and eating fresh garlic.

Other alternative therapies include herbal remedies (which can assist the action of prescription antibiotics) and traditional Chinese medicine.

Prevention

Because chlamydia is transmitted during sexual activity, the most reliable way to prevent infection is to abstain from oral, vaginal, and anal sex or to have a mutually monogamous relationship with an uninfected sex partner. When used consistently and correctly, male latex or polyurethane condoms are highly effective (although not 100%) in preventing the sexual transmission of infection. Condoms should be used for all types of sexual contact, even if penetration does not occur, and a new condom should be used after each ejaculation.

Most other birth control methods – including the pill, IUD, diaphragm, and spermicides – don’t protect against chlamydia and other STDs. Washing genitals and douching after sex are not reliable preventive measures. In fact, douching can actually be a risk factor for chlamydia.

Washing hands after sex, although not a preventative measure, can keep the infection from spreading to other parts of the body, such as the eyes.

If you have had sex without a condom and are worried that you may have been infected, you should see your doctor or healthcare provider even if you don’t have symptoms. If either you or your partner have had other sexual partners in the past, get tested before becoming sexually active. Seek immediate medical care if you have fever, repeated vomiting, or severe abdominal pain.

References:

1) Chlamydia – CDC Fact Sheet
Source: Centers for Disease Control and Prevention.

2) Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States – CDC Fact Sheet
Source: Centers for Disease Control and Prevention.

3) Chlamydia Infection
Source: Drugs.com

4) Chlamydia Fact Sheet
Source: Womenshealth.gov

5) Chlamydia
Source: Kidshealth.org

6) Sexually Transmitted Diseases
Source: The Center for Menstrual Disorders and Reproductive Choice

7) Antibiotics for Chlamydia Infection
Source: eMed Expert

8) Chlamydia
Source: Aetna InteliHealth

9) Chlamydial infection in women. (Adult Advisor 2011.1) David W. Kaplan, Phyllis Cooper. RelayClinical Patient Education.

Posted in STI.