CAUSED BY THE bacterium Chlamydia trachomatis, chlamydia is an infection of the genital tract. It's the most common sexually transmitted disease (STD) in the United States; 1,030,911 chlamydial infections were reported to the CDC in 2006. Underreporting is common, however, because most people with chlamydia don't know they have the infection. An estimated 3 million people in the United States may be infected. The rate of infection seems to be greater in women than in men.1
When chlamydia is diagnosed and treated early, the patient is likely to recover completely. If left untreated, chlamydia can spread to a woman's uterus and fallopian tubes, causing pelvic inflammatory disease, pelvic pain, infertility, or ectopic pregnancy. Babies born to infected mothers may contract eye and respiratory infections during childbirth.
In men, chlamydia can spread to the testicles, causing epididymitis, which can cause sterility. Chlamydia may also cause Reiter's syndrome, a form of arthritis, especially in young men.
Let's review who's at risk for chlamydia, how it's diagnosed, and what you can do to help your patients recover and educate them about the disease.
Who's at risk?
Anyone who's sexually active can get chlamydia, which can be transmitted during vaginal, anal, or oral sex; it can also be transmitted to a baby during vaginal childbirth. Sexually active people under age 25 are at greatest risk. Women are three times more susceptible per episode of unprotected vaginal intercourse than men.2
Signs and symptoms of chlamydia generally appear within 1 to 3 weeks after exposure. But it's called a silent disease because about three-quarters of infected women and half of uninfected men have no signs and symptoms.1
In women who contract chlamydia during vaginal intercourse, the bacteria initially infect the cervix and the urethra. Some women experience abnormal vaginal discharge, burning sensation when urinating, lower abdominal pain, low back pain, nausea, fever, pain during intercourse, and bleeding between menstrual periods.
Signs and symptoms in men include discharge from the penis, burning sensation when urinating, and burning and itching around the penile urethral meatus.
Men and women who have receptive anal intercourse may acquire a chlamydia infection in the rectum, which can cause rectal pain, discharge, or bleeding.
Making a diagnosis
Diagnosing chlamydia in women is fairly easy. The preferred method is vaginal swabbing, which can be done during a pelvic exam. (Educate female patients that a routine pelvic exam doesn't diagnose chlamydia; many women assume that STD testing is routinely done along with the pelvic exam and the Pap test). Another effective way to diagnose chlamydia is urine testing.
The CDC recommends testing for chlamydia in:
* sexually active females under age 25 (test at least once a year)
* women ages 25 and older who have one or more risk factors (test annually). Risk factors include having new or multiple sex partners, sex with someone who has other partners, and not using barrier contraceptives, such as condoms.
* women with a cervical infection
* pregnant women
* sex partners of an infected person.
Once diagnosed, chlamydia is easily treated and cured with antibiotics. A week of doxycycline (twice daily) or 1 dose of azithromycin is a typical regimen. Teach patients to abstain from all sexual activity until they complete treatment, and their sexual partners must be treated as well.
Tell your patient to get follow-up testing in 3 to 4 months to ensure she hasn't become reinfected. Reinfection following successful treatment of chlamydia is common, so make sure your patient knows that her partner must be treated and that successful treatment doesn't make her immune to future infections.
To reduce the risk of chlamydia, teach your patients about safer sex practices, including the consistent and correct use of latex male condoms. Inform them that the surest way to avoid transmission of chlamydia is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who's been tested and is known to be uninfected. Advise patients to consult their health care provider if they have any of the signs and symptoms described above.
1. Centers for Disease Control and Infection. Chlamydia: CDC Fact Sheet. http://www.cdc.gov/std/chlamydia/Chlamydia-Fact-Sheet.pdf. Accessed July 16, 2008. [Context Link]
2. Hannigan S, Jones-Devitt S. Removing the stigma of sexually transmitted infections among women. Nursing Times. 100(26):48-50, June 29-July 6, 2004. [Context Link]