Chlamydia guide

Chlamydia is a very small spherical bacteria that causes one of the world’s most common sexually transmitted diseases during unprotected sex. However, an infection is not always noticed as it rarely shows symptoms. The consequences can be varied and dramatic.

Abstract

• Chlamydia infections are among the most common sexually transmitted diseases (STDs or sexually transmitted infections, STIs) worldwide .
• In Germany, around 300,000 women are thought to be infected with the pathogen every year.
• Transmission occurs through unprotected sex (vaginal, anal, oral) and through the use of sex toys by several people without protective measures.
• Chlamydia infections are transmitted by the bacterium Chlamydia trachomatis.
• It mainly affects men up to the age of 35 and women up to the age of 25.
• 70 to 90 percent of infected women and up to 50 percent of infected men are said to show no symptoms.
• Sexually active women are recommended to have a chlamydia test (chlamydia screening) once a year. The costs are covered by health insurance for women up to the age of 25 and for pregnant women.
• Chlamydia infections are easily treatable with antibiotics.
• If left untreated, an infection can lead to permanent damage, including infertility (infertility) and, in individual cases, infertility in men.
• There are initial indications that chlamydia favors the development of ovarian cancer.
• A condom can reduce the risk of infection by around 60 percent.

Definition

Chlamydia is the colloquial term for an infection with very small spherical bacteria belonging to the Chlamydiaceae family. The bacterium Chlamydia trachomatis or its subtypes (serotypes) D-K can spread to the genital tract and rectum in adults and, if left untreated, to the pelvis, respiratory tract, eyes and joints. Chlamydia trachomatis occurs exclusively in humans as a pathogen.

An infection with chlamydia is known as chlamydiosis. In Germany, around 300,000 women are said to become infected with the pathogen every year; with the exception of Saxony, there is no obligation to report the disease.

Causes

Unprotected sexual intercourse (oral, vaginal, anal) is the most common route of transmission. In addition, the sharing of sex toys without appropriate protective measures, e.g. the cleaning of potentially infectious body fluids such as vaginal secretions, semen and urine. People with frequently changing sexual partners can be infected with several serotypes of the C. trachomatis family at the same time.

Chlamydia attaches to the cells of the mucous membranes, multiplies inside the infected cells and spreads rapidly in the human organism. The incubation period lasts between one and three weeks, occasionally up to six weeks. Mucous membranes of the urinary tract, genital organs and rectum colonized with the C. trachomatis serotype D-K bacterium are infectious.

Unknowingly infected pregnant women can transmit the bacterium to their child during birth. The consequences include inflammation of the conjunctiva in various degrees of severity, the nasopharynx and, in the worst case, the lungs. The probability of infection in the birth canal is 60 to 70 percent.

Symptoms

A chlamydia infection is often completely asymptomatic or only causes minor or non-specific symptoms. In 70 to 90 percent of infected women and up to 50 percent of men, there are said to be no symptoms; the infection can persist for months or even years and be discovered almost by chance.

Possible complaints in women

• Frequent urge to urinate or difficulty urinating
• Watery, glassy-cloudy or purulent discharge, often with an unpleasant odor
• Itching, burning, pain when urinating
• Pain during intercourse
• Bloody discharge during or after intercourse
• Diarrhoea
• Fever
• Pain in the abdomen
• Intermediate bleeding
• Back pain

Chlamydiosis usually begins with an inflammation of the cervix (cervicitis), which may be indicated by an increased temperature and abdominal pain.

Pictures of chlamydia

Possible complaints in men

• Acute painful inflammation of the urethra with watery, glassy-cloudy to purulent discharge from the penis
• Reddened opening of the urethra
• Burning, itching or pulling pain when urinating
• Pain during vaginal and anal sex
• Inflammation of the urinary bladder

Possible complaints in the rectum in men and women

• Itching
• Diarrhea or constipation with a decrease in stool frequency and quantity
• anal discharge
• Anal bleeding
• Anal eczema
• Bright red, bloody or slimy deposits in the stool
• Pain during anal intercourse

Infections of the intestinal mucosa are without relevant symptoms in around 60 percent of those affected, and the time from infection to the onset of potential symptoms is between one and six weeks.

Course

If undetected and untreated, the consequences of a chlamydia infection can be dramatic.

For women

• Inflammation of the fallopian tubes and ovaries, with the result that the fallopian tubes become blocked
• Chronic inflammation of the entire pelvis affecting the cervix, uterus, fallopian tubes and ovaries (Pelvic Inflammatory Disease, PID)
• Infertility due to blocked fallopian tubes
• Tubal and ectopic pregnancies
• Genetic changes in fallopian tube cells towards tumor cells that can spread to the ovary
• Pregnancy complications such as premature rupture of the membranes
• Premature births and miscarriages

For men

• Inflammation of the prostate
• Inflammation of the epididymis
• Inability to conceive in individual cases

For women and men

If symptoms occur outside the genital tract, these are rather rare and relate to

• Respiratory tract: Infections of the pharyngeal mucosa caused by oral sex are non-specific
• Eyes and ears: chronic conjunctivitis with purulent secretions, inflamed eyelids, swollen lymph nodes in the ears
• Joints: Inflammation in the area of the knees and feet, especially in the small joints of the toes. This so-called reactive arthritis develops on the genitals one to four weeks after infection.

Diagnosis

As a rule, the gynecologist or urologist receives important information about C. Trachomatis bacteria. They are then reliably detected by the Nucleic Acid Amplification Test (NAAT). NAAT analyses are carried out in urine and semen, but are also approved for swabs from the cervix and, in men, from the urethra. As infections of the rectal mucosa often go unnoticed, a rectal swab is taken from patients who have regular anal intercourse, even if there are no symptoms. Blood samples are also examined if necessary.

The samples are analyzed molecularly in the laboratory. The aim is to detect serotypes D-K.

Chlamydiosis can also be diagnosed by detecting antibodies. This takes into account the fact that the immune system only reacts to the penetration of the bacterium a few weeks after the infection. Gynaecologists arrange for a corresponding test to be carried out, particularly in the case of late effects or as part of the search for causes of infertility.

Chlamydia test for women of childbearing age

Women under the age of 25 are entitled to an annual chlamydia test (chlamydia screening) as a health insurance benefit. This is carried out using a urine sample.

Chlamydia screening is also part of statutory antenatal care in the first trimester of pregnancy to prevent the disease from being transmitted to the child during birth.

Treatment

A chlamydia infection can be successfully treated with antibiotics. Active substances from the following groups are primarily used:

• Tetracyclines (doxycycline)
• Macrolides(azithromycin, erythromycin)
• Fluoroquinolones (ofloxacin)

The duration of treatment depends on the severity of the infection. You will receive the antibiotic as a single dose or as multiple doses to be taken over a period of up to seven days. To rule out re-infection, an even longer course of therapy may be indicated. If the infection is detected and treated early, it usually heals without permanent damage.

Sex is taboo during treatment and for seven days afterwards. And: To avoid the ping-pong effect, a diagnosis and treatment of the partner or all sexual partners of the past six months is required.

Prevention

Chlamydia is passed on quickly during sex. An infection can be reliably prevented if

• use condoms with new partners during vaginal, anal and oral sex
• Condoms are used when sharing sex toys
• sexually active women should take a chlamydia test once a year, which is also available as a self-test
• you take good care of yourself and ensure meticulous personal hygiene

A condom can reduce the risk of infection by around 60 percent.

When to see a doctor?

As soon as you suspect an infection, you should see your gynecologist or urologist immediately. Sexually active people with changing partners should have regular check-ups.

Questions and answers

Can a chlamydia infection increase the risk of contracting HIV?

Yes, the inflamed mucous membranes make it easier for HI viruses to penetrate the body.

Does a chlamydia infection increase the risk of cervical cancer?

According to current scientific knowledge, there is no confirmed evidence that a chlamydia infection would increase this cancer risk. However, there are initial indications that the development of ovarian cancer is favored.

Sources

• https://www.apotheken-umschau.de/Geschlechtskrankheiten/Chlamydien-Unerkannte-Gefahr-106659.html
• https://www.aerzteblatt.de/nachrichten/60198/Chlamydien-Infektionen-bei-MSM-moeglicherweise-haeufiger
• https://www.aerzteblatt.de/archiv/153139/Sexuell-uebertragbare-Infektionen-Ein-Unglueck-kommt-selten-allein
• https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Chlamydiosen_Teil1.html;jsessionid=0169D84EA3246CD6CCE0B743F1C6BCD1.1_cid363#doc2382764bodyText2
• https://www.aidshilfe.de/chlamydien
• https://www.profamilia.de/fileadmin/publikationen/Reihe_Koerper_und_Sexualtitaet/chlamydien.pdf
• https://www.awmf.org/leitlinien/detail/ll/059-005.html
• https://www.gesundheitsforschung-bmbf.de/de/chlamydien-die-unterschatzte-gefahr-9257.php