The Biomarker Handbook is a curated series that seeks to provide readers with insights on each biomarker we cover in our blood test packages and its relation to our body.
Did you know that more than one million sexually transmitted infections (STIs) are acquired each day across the world? According to the WHO, each year there are about 357 million new infections with one of four most prevalent STIs: gonorrhoea, syphilis, trichomoniasis, and chlamydia. Untreated chlamydia infection can cause many complications but testing and timely diagnosis and treatment can help prevent health consequences.
What is Chlamydia?
Chlamydia is defined as a bacterial STI that affects both men and women. The condition is caused by the bacteria called Chlamydia trachomatis. Men can get this STI in their urethra (inside of the penis), throat, and rectum while women can develop it in the cervix, rectum, and throat.
Both men and women get infected by the bacteria and develop this STI through sexual contact (oral, anal, or vaginal sex) with a person who is infected. People who have already had chlamydia in the past can get re-infected if they have unprotected sex.
Chlamydia is the most common notifiable disease in the United States. In 2016, a total number of 1.6 million cases were reported to CDC. Many more are likely unreported as most people infected either have no symptoms or so mild they do not seek medical help for diagnosis.
Fortunately there is a highly sensitive and highly specific laboratory test that can quickly and conveniently detect chlamydia infection from your urine sample. This simple test, called chlamydia nucleic acid amplification test (or chlamydia PCR or DNA test), detects even the most minute quantity of bacterial DNA in your urine (or vaginal/throat/rectal swab). The urine sample ideally should be collected early in the morning and only the first 20-30 mL. When the test is positive, it means that the bacteria is detected in your urine and you should be treated for the infection.
Since many symptoms of chlamydia are the same as those of gonorrhoea, your doctor often sends your urine or swab to test for both STIs. It is also not out of the question to be positive for both these tests at the same time!
Importance of Testing for Chlamydia
Chlamydia infection is mostly either without symptoms or with symptoms so mild that people do not seek medical help. And being highly contagious, you can see why chlamydia continues to be a highly prevalent disease worldwide despite efforts from authorities (governments and WHO) to eradicate it.
Yearly screening is strongly recommended for sexually active people, and homosexual/bisexual men who have unprotected sex. Screening and early detection for treatment are paramount to prevention of health complications from untreated chlamydia infections (see below).
Pregnant women should also be screened for STDs in order to minimise the risk of affecting your baby. It is important to inform the doctor if you’re using vaginal douches and creams or if you’re taking antibiotics. Your doctor will probably ask you not to use any of that 24 hours prior to your test.
Signs and Symptoms to Watch Out For
As mentioned above, chlamydia can be mostly asymptomatic, but in some cases, patients do experience different symptoms. Signs and symptoms of chlamydia appear within five to ten days after contracting the infection.
Symptoms and signs of infection in women are:
- Lower abdominal pain
- Bleeding between periods
- Painful intercourse, bleeding during sex
- Burning sensation while urinating
- Frequent need to urinate and discomfort while urinating
- Low-grade fever
- Swelling in the vagina or around the anus
- Vaginal discharge in large quantities appears yellow with bad odor
Symptoms and signs of infection in men are:
- Tender and swollen testicles
- Penile discharge (milky, watery, or pus)
- Burning sensation and pain while urinating
- Itching and burning around the opening of the penis
Consequences of an Untreated Chlamydia Infection
This STD is associated with a number of complications, with the most notable being infertility in men and women. People with chlamydia are at higher risk of getting other STIs (such as HIV).
Chlamydia, if not treated early, is also associated with:
- Pelvic inflammatory disease (PID) which is an infection of the uterus and fallopian tubes that causes fever and pelvic pain. Severe PIDs may require hospitalization.
- Prostatitis and epididymitis – in men, chlamydia infection can spread to the prostate gland causing symptoms such as lower back pain, fever and chills, painful urination, pain during sexual intercourse, and others.
- Reactive arthritis – or Reiter’s syndrome. Reactive arthritis usually affects our joints, urethra, and eyes.
- Infections in newborns – pregnant women with chlamydia may spread the infection to their baby too which can lead to eye infection and pneumonia.
- Ectopic pregnancy and pre-term delivery- pregnant women with untreated chlamydia often have pre-term labour; they are also more at risk of ectopic pregnancy.
Ways to Manage Chlamydia
First and foremost, chlamydia management begins with proper preventative sexual practices (safe sex with barrier contraception and abstaining from sleeping with risky partners); screening for early detection and treatment so you do not transmit the infection to your partners, and also avoid the consequences of untreated chlamydia. See your doctor if you are sexually active regarding to chlamydia screening test every year.
After being tested positive for chlamydia PCR, some people consume garlic, drink sage tea, and enrich their diet with anti-inflammatory foods. The best thing you can do is to avoid having sex until your infection goes away.
Thankfully, this STD is easily treated with antibiotics. Azithromycin is an antibiotic usually prescribed in a single, large dose, but the dose may also be spread out over five days. Doxycycline is an antibiotic that must be taken twice per day for about one week.
Unlike some other types of infections, having suffered from chlamydia infection does not mean you will not get infected again. If your partner is infected and untreated, you are at risk of being reinfected. So treating one partner should also involve screening and treating the other.
When to See the Doctor
If you’re a sexually active man or woman, it’s strongly recommended to see your doctor and get tested once a year. This is particularly important for women who are younger than 25 and people with multiple sex partners and who tend to engage in unprotected intercourse. Of course, it’s useful to consult the doctor if you suspect that you have chlamydia and in case you experience the above-mentioned symptoms.
What Further Testing to Do to Check for Related Ailments
Due to a number of complications associated with chlamydia, further tests may be useful. For example:
- Testing for other STIs (HIV blood test, gonorrhea PCR, trichomonas PCR, etc)
- Ultrasound for diagnosis of PID
- A laparoscopy that allows the doctor to view your pelvic organs
- Blood tests for PID, prostatitis
- Imaging tests (CT scan, x-ray)
This STD is highly prevalent in all parts of the world. Its nature of being mostly asymptomatic or mild symptoms ensures that we don’t get tested and just continue to spread it. And there are health consequences with untreated chlamydia infection.
The message should be clear: screening of all sexually active people once a year is highly recommended. Treatment of chlamydia revolves around the use of antibiotics, but the timely diagnosis is necessary. PCR urine test is the most reliable detection method and it is highly unlikely to show false positive results, unlike other methods.
Screen yourself and your partner if you are sexually active – you will be glad if you do!
If you want to find out more about this particular STD and how you can prevent it, take a look at our lifestyle article here!
Interested in other biomarkers? Check out the rest of The Biomarker Handbook.
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