Chlamydia

Chlamydia is a sexually transmitted disease or infection that affects the genital parts in both males and females.

It is caused by Chlamydia bacteria. There are several species of the bacteria, each causing a different set of problems.

Chlamydia trachomatis infects the genital region and the eyes (trachoma). It is common in young, unmarried, less educated urban population. It spreads through sexual contact such as vaginal, oral or anal intercourse. It may also spread from an infected mother to a newborn. It commonly infects urethra in both female and males. Urethra is a passage through which the urine flows out. In females, the cervix or the opening of the womb is also affected. Eyes, anus or lymph nodes may also be involved in some cases.

There may be irritation or itching in the cervix and the vagina, frequent passage of urine, burning sensation or pain while passing urine, redness or irritation in the eyes, and whitish discharge from the urethra or the vagina. However, there may be no symptoms in many people with the infection.

Some species such as Chlamydia Pneumoniae involve the airways and the pharynx. Chlamydia psittaci mainly causes infection in birds but may spread to humans who come in contact with the birds. It affects the lungs, liver, or the spleen.

This article primarily addresses Chlamydia Trachomatis infection.

Infectious origin, contagious, acute (rapid onset of symptoms and they remain for a short time) or chronic (slow onset of symptoms and they remain for a prolonged time), non-genetic, non-fatal.

The womb (uterus), the neck of the womb (cervix), other reproductive organs such as the fallopian tubes in the females; penis in the males; and urethra or anus in both males and females may be involved. The eyes and the lymph nodes may also be involved. A lymph node is a part of the lymphatic system. It is a small organ consisting of white blood cells and is found all throughout the body.

The person may acquire Chlamydia trachomatis through sexual contact with an infected person through vaginal, oral or anal intercourse. Infection of urethra, cervix or penis may occur by penis to vagina contact. Infection of the anus or penis may occur by penis to anus contact.

Transmission of Chlamydia trachomatis may also occur from an infected mother to a newborn through genital secretions.

In some cases, using the clothing or the towels of an infected person may transmit the infection. Also, eyes can be infected when they are touched hands that are infected with genital secretions.

After entering the body, the bacteria attach to the tissues, get inside the cells, and damage them. They also spread to the lymph nodes and drain the lymph from the infected site. This activates the immune cells to secrete various chemicals. These chemicals try to kill the bacteria and they also attract more immune cells. This results in the symptoms of Chlamydia.

Certain people are at a higher risk of contacting Chlamydia Trachomatis infection:

• People who have unprotected sex and sex with multiple partners.

• Young adults especially of low socioeconomic status.

• People who have oral or anal sex with the partner.

• People who follow poor hygiene and share clothes or towels with others.

• People who use illegal or banned drugs such as heroine, afeem or ganza. The drug addicts are in the habit of sharing needles as well as having unprotected sexual intercourse.

The symptoms vary with the type of infection.

Chlamydia Trachomatis Genital Infection

In many cases of infection of urethra or cervix, there may be no symptoms. However, the usual symptoms, when present, are:

In Women: Itching in the vagina, irritation and redness of the cervix and vagina, burning sensation while passing urine and frequent urination, white or yellow discharge from the cervix or the urethra, bleeding between periods, pain in the lower part of abdomen, or pain during sexual intercourse.

In Men: Burning sensation while passing urine, frequent urination or pain while passing urine, and white or yellow discharge from the urethra.

When the rectum is involved, both males and females may have fever, pain in anus while passing stool, or pus discharge from the anus.

Chlamydia Trachomatis Infection may also cause a raised painless vesicle or an ulcer on the penis in males and on the labia or the vagina in females. There may be pain and multiple small deep bumps on the inside region of uppermost part of the thigh. This is due to swelling of the lymph nodes in the upper part of the thigh. These nodes drain lymph from the infected region. Fever, chills, headache, bodyache or joint pain may also be present. This condition is known as Lymphogranuloma Venereum (LGV).

Chlamydia Trachomatis Eye Infection

When eyes are involved it is called Adult Inclusion Conjunctivitis. There may be redness, pain or irritation, excess watering or pus discharge from the eyes. In newborns, similar symptoms occur in the eyes after 7 to 10 days from the birth.

In some people, the eye infection may persist resulting in a condition known as Trachoma. There may be itching or irritation of the eyes, discharge containing mucus or pus, and swelling of the eyelids in the initial stages. In later stages, there may be light sensitivity (photosensitivity), blurring of vision, pain in the eyes, and scarring of the eyelids. The cornea may also be involved. Long term Chlamydia infection also results in dry eyes as the lacrimal glands are also involved.

Diagnosis may start with general physical examination of the person. Further to that, following tests may be done:

• Complete Blood Count: Levels of hemoglobin, red blood cells or white blood cells in the blood may be assessed. In cases of Chlamydia, the number of white blood cells is usually higher.

• Depending on the site of infection, a sample of urine or of the secretions from the urethra, or vagina (vaginal swab), or cervix (cervix swab), or rectum (rectal swab) or the eyes may be collected, and put to culture. Culturing means a trial to grow the bacterium in the lab, if it is present in the sample. This helps in not only identifying the infective organism but also in choosing an appropriate antibiotic to kill the organism.

• The samples may also be subjected to nucleic acid amplification tests (NAAT), such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement amplification (SDA). They help in the same way as the culture test does. But, these tests are very accurate, easy to do, and take lesser time compared to culturing.

The primary aim of the treatment is to relieve the symptoms, cure the infection and prevent complications.

Medications

The primary treatment for genital as well as eye infection is antibiotics. Usually, they are administered orally. The common antibiotics used are azithromycin (single dose) or doxycycline (to be taken daily for 7 to 14 days). It is also common to have Gonorrhea along with Chlamydia. In such cases, antibiotics such as ceftriaxone, cefixime, ciprofloxacin or ofloxacin are given. 

Medications such as paracetamol or brufen may be given to relieve fever or pain, if any.

Surgery

Surgery may be needed to treat complications such as blockage of the fallopian tube, narrowing of the urethra (Urethral Stricture), Trichiasis, Entropion or Corneal Damage.

• In females, infection may spread to the uterus, fallopian tubes and/or ovaries resulting in pelvic inflammatory disease (PID). The person may have fever, pain in lower abdomen and vaginal discharge. This may result in Infertility or Ectopic Pregnancy (fertilized egg grows outside the uterus, usually in a fallopian tube due to blockage in the fallopian tubes). Infection of the internal organs in the abdomen may also occur (Peritonitis). There may be infection near the liver (Peri-hepatitis), which results in Fitz Hugh Curtis Syndrome. In some women, there may be chronic pain in the lower abdomen, also known as Chronic Pelvic Pain. 

• In males, the infection may spread to the prostate glands, epididymis, or the testes causing damage to these organs (Epididymo-orchitis). This may result in severe pain and infertility. There may be scarring inside the urethra which causes Urethral Stricture. It causes difficulty in urination.

• Chlamydia infection in the mother may result in abortion or pre-mature birth. 

• Chlamydia infection of the eyes in newborns may cause blindness if not managed appropriately. Chlamydia infection in newborns may involve lungs (Pneumonia) resulting in fever and cough with discharge.

• Trachoma may result in infection of the eyelids (Trichiasis) or inward bending of eyelashes (Entropion). The inwardly bent eyelashes damage the eye due to continuous scratching, which may result in blindness if not treated. Trachoma may also affect the cornea. This may also cause blindness if not treated.

• In some cases, Arthritis, Conjunctivitis, Urethra, and ulcers on the mouth or the genital area may occur together. This is known as Reiter Syndrome or Reactive Arthritis. 

• People with Chlamydia Trachomatis infection are at a higher risk of contacting other sexually transmitted diseases such as Gonorrhea, Syphilis or HIV infection.

• One can prevent Chlamydia by practicing safe sex. Using condoms while having sex with several partners, avoiding sex with prostitutes, avoiding sex with multiple partners are some measures that help. Other than that one should not share clothing or towels with others.

• Eye infection or its complications can be prevented by adopting good hygiene. Some measures can be not sharing clothing or towels with others, not rubbing eyes frequently, and keeping the hands clean. Early and appropriate treatment is also important to prevent blindness.

• Infection can recur if one has sex with another infected person. That is why it is important to test and treat all the sex partners of an infected person. Testing should also include other sexually transmitted diseases such as Gonorrhea, Syphilis or HIV infection.

• An infected person should avoid sex till completely treated.

• Early detection and treatment prevents complications and also spreading the disease. One should immediately consult a doctor if symptoms such as itching and whitish discharge from the vagina, burning sensation and frequent urination, or discharge from the urethra occur.

• The course of antibiotics should be completed even if the symptoms disappear, or if one feels alright before the completion.

• A person with Chlamydia should go to a hospital immediately if there is fever or severe abdominal pain, joint pains, or swelling or pain in the testes.