What is Chlamydia?
Chlamydia Trachomatis is a bacterial infection that is common in many sexually active individuals and can be found in the throat, vagina, urethra and anus. Majority of people infected with Chlamydia do not know they have the infection and continue to spread the infection resulting in Chlamydia being one of the most common Sexually Transmitted Diseases in the world for many years.
Chlamydia infections share many common features with Gonorrhea Infections.
How common is Chlamydia?
Based on the current data in 2018 from the Ministry of Health Singapore, Chlamydia is the most common STD in Singapore. The patient age group with the highest cases of Chlamydia are those between 20 – 29 years old, though anyone who is sexually active is at risk of contracting Chlamydia. Over the last 10 years, the average annual rate of Chlamydia infection in Singapore ranges between 40 – 60 cases per 100,000 people.
How do I get Chlamydia?
Chlamydia primarily infects the mucosal epithelium (a type of tissue common in the throat, vagina, urethra and anus). This technical point is important in understanding how you can get a Chlamydia infection because it means that you do not only get it from unprotected penetrative sex (vaginal or anal) but when the bacteria comes into contact with any mucosal epithelium.
For example, if your partner has a Chlamydia infection in his/her mouth, the infection can be passed onto your genitals (urethra, vaginal canal) and even your anus. (See more about the STDs you can get from Rimming in our previous article)
What are the symptoms?
It is estimated that of all the patients diagnosed with Chlamydia, up to 70% will report that they have had no symptoms especially in the early stages of infection. Women may notice changes in their vaginal discharge or spotting after sexual intercourse. Men may report a tingling sensation at the top of their penis or pain passing urine. If the site of exposure was in the anus, rectal bleeding and discharge can be seen in some cases.
What happens if I leave it?
Left untreated, the infection progressively spreads to the surrounding structures and damages them along the way.
Infertility from a Chlamydia infection in both men and women results from the infection given enough time to dwell within the reproductive tract and injuring the testicles and ovaries. Particularly for women, the fallopian tubes may also be compromised leading to a condition called an Ectopic pregnancy where a fertilised egg gets stuck in the previously damaged fallopian tube instead of nesting in the womb as it is supposed to. The pregnancy cannot be saved and can sometimes also lead to a rupture of the tube which can be life-threatening to the woman.
Beyond fertility, an untreated infection can also result in chronic pain in both men (Prostatitis) and women (Pelvic Inflammatory Disease). In such situations, even after the infection is cleared, the pain can still persist for months to years!
How long do I have to wait to get tested?
You have to wait for 2 – 3 days from your last exposure to test for Chlamydia. Tests done any earlier may not be accurate.
Currently, the gold-standard test used to look for Chlamydia is called a Polymerase Chain Reaction (PCR) which detects genetic fragments of the bacteria in the sample and has an accuracy of 98 – 99%. Blood tests are extremely inaccurate and should not be used to diagnose a Chlamydia infection.
If urine tests are done please ensure that methods of collection and the type of test done is correct.
What sample needs to be done?
When it comes to STD testing location matters!
Testing the correct site ensures that your doctor is able to accurately diagnose the infection and also confirm that the treatment has worked.
Many patients are too embarrassed to talk about where they may have been exposed leading to inaccurate test results. Have an open conversation with your doctor and allow him to get a sample from the area/s most at risk of an infection.
For the throat, vagina and anus, this will involve swabbing the area, while for the urethra it is a urine sample. The swabs are the same size as a cotton bud and because only a small area needs to be swabbed for each site, the process is very much painless.
Once the site of infection is confirmed, the doctor will commence treatment.
What is the treatment for Chlamydia?
Treatment for Chlamydia involves a single course of Antibiotics, the type of antibiotics and duration of treatment depends very much on the site of infection, severity of symptoms and if it is a new or repeat infection.
It is also very important that your partner/s are also tested and treated to prevent you from getting re-infected.
You should abstain from sexual intercourse while undergoing treatment because there is a chance you might not have fully cleared the infection and can still pass it on to your partner.
Why do I need to come back again after completing the medication?
Confirming that you have fully cleared the infection is call a Test of Cure and is important in Chlamydia infections because an infection that persists despite completing antibiotics may point towards a resistance to the antibiotics or a co-infection with other bacteria such as Mycoplasma Genitalium in which case more testing needs to be done and more specific antibiotics may be required.
It is recommended that you have a follow up visit 2 weeks after completing the medications to retest for Chlamydia and ensure that you have fully cleared the infection.
In Summary
Chlamydia is a very common STD which can be easily treated when detected early. Late stage disease however can have severe consequences to your fertility and overall well being.
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