Lloydspharmacy.com Health

Written by Dr Angela Robinson, consultant in sexual health

What is chlamydia?

Chlamydia is a sexually transmitted infection (STI) caused by a tiny bacterium, Chlamydia trachomatis.

If you haven't heard of chlamydia, you're in good company – a substantial proportion of the UK population hasn't either.

Many people who are at risk of this infection don’t really know what it is, or understand it, even if they are aware of the name.

Why should I know about it?

Chlamydia is the most common STI in the UK. It affects both sexes, although young women are more at risk.

Chlamydia can be treated, but it often has no symptoms in either men or women, so remains undetected.

Infection may only be diagnosed once chlamydia has led to complications - when treatment can sometimes be too late to stop permanent damage.

Are there any symptoms?

Good advice

Get yourself tested if you think you have been at risk of infection.

Some women may experience:

cystitis
change in vaginal discharge
mild lower abdominal pain.

These are very 'non-specific’ symptoms and can be caused by other infections and diseases. If you go to a GP or family planning doctor with these symptoms, make sure you have a chlamydia test. You are entitled to ask for the test if you aren't offered it.

In men, chlamydia is the most common cause of discharge from the penis. Sometimes chlamydia can cause mild irritation at the tip of the penis (urethra) that disappears after two or three days.

Many men will wait to see if the discomfort goes away. While the discomfort may disappear, the man can still harbour the infection.

If in doubt, get tested. Otherwise, you could put yourself at risk of inflamed and swollen testicles, and pass chlamydia on to your partner.

What complications can chlamydia cause?

In some women chlamydia can cause pelvic inflammatory disease (PID), also know as pelvic infection. It can damage the Fallopian tubes that carry eggs from the ovaries to the womb. The tubes may stop working properly and can become completely blocked.
Chlamydia is the most common preventable cause of infertility in women. When the Fallopian tubes are blocked, no pregnancy is possible naturally. One option is IVF (in-vitro fertilisation), but availability on the NHS is patchy and has variable success rates.
Women with damaged tubes do occasionally fall pregnant, but there is an increased risk of the pregnancy developing in the tubes rather than the womb. This is called an ectopic pregnancy. The tube can split apart causing serious pain and bleeding. This is an emergency, because the bleeding can be life threatening.
Infection sometimes leads to pain in the lower abdomen that is often mistaken for some other problem rather than pelvic infection.
Chlamydia infection can affect sperm function and male fertility. It is the most common cause of inflammation in the testicles and sperm-conducting tubes (epididymo-orchitis) in men under the age of 35. This causes pain, swelling and redness on the affected side of the scrotum, or on both sides.
Chlamydia can also trigger joint inflammation in some men. Although this is uncommon, it can be difficult to treat.

What problems do the lack of symptoms cause?

The UK's genitourinary medicine (GUM) clinics form one of the best networks in Europe to diagnose and treat STIs. But people often have no reason to suspect they have chlamydia, so they don't seek advice at one of these clinics.

Apart from sexual health experts, many doctors may not suspect chlamydia when assessing a person’s symptoms, so don't do an appropriate test.

Healthcare professionals are often unaware of how common chlamydia is and that it can be present without causing symptoms.

How do I know if I should be tested?

Chlamydia is almost always transmitted through sexual intercourse, so the likelihood of having the infection depends on your sexual behaviour.

If you've had sex and not used a condom, you are at risk of chlamydia.

The more partners you have, the more likely you will be exposed to infection. This isn't about promiscuity - you only need to have unprotected sex with one person who happens to have the infection to get chlamydia.

In a recent survey of young male army recruits, almost 10 per cent proved positive on chlamydia urine tests. Eighty eight per cent of the men who tested positive had no symptoms whatsoever.

Good advice

Make sure your friends have heard about chlamydia and its consequences.

Encourage them to get a check-up if they think they are at risk.

If you have concerns, act on them and get yourself checked out.

Young women

Chlamydia is most common and most likely to cause serious complications in younger women.

If you are under 25 and sexually active, you have a 1 in 10 chance of having chlamydia, so it is worth getting tested.
Your risk is even higher if you are under 20 and have had unprotected sex.
If you are over 25 and have had two partners within a year, or recently changed partner, your risk is also increased.

Men

Not so much is known about the risk of infection in men. Those at highest risk are men between the age of 16 and 30.

How is chlamydia diagnosed?

Smear tests

A chlamydia test is not routinely carried out when you have a smear test.

Many women are under the illusion that it is, and are falsely reassured.

If you are unable to get the test at your local practice, get a check-up at your nearest GUM clinic.

This is really important if:

you are under 25

you changed sexual partner recently and developed symptoms a few months later

you have had more than two partners in the last year.

Women

Five years ago, the test for chlamydia was similar to a smear test: a doctor or nurse would take a swab from the cervix (neck of the womb).

Now tests can be done on urine samples or on swabs that a woman can insert into her vagina. The swab is then placed into the container provided and sent to the laboratory.

The new tests avoid the need for an intimate and uncomfortable examination and make testing much easier for women.

Men

For men, a urine sample is good enough and avoids the discomfort of a swab from inside the tip of the penis (urethra).

Some clinics continue to do the swab because it can give a more accurate result and is cheaper to process when there are many samples.

The new test methods are more expensive than the old ones, but are recommended by the Chief Medical Officer.

Not all clinics use the newer tests. The government has provided some extra money so laboratories can adopt the newer technology.

How is chlamydia treated?

Chlamydia is treated with antibiotics.

Make sure your sexual partner also gets treatment. Otherwise, the treated partner becomes re-infected. Repeated infection can cause far worse fertility problems in women.

Not all antibiotics are effective. There are two major groups of antibiotics that work, so make sure you get one of these.

Tetracyclines: the usual prescribed drug is doxycycline. One tablet should be taken twice a day for a week.
Macrolides: azithromycin is the most convenient treatment because you take four tablets at the same time.

If you have chlamydia, do what you can to encourage any ex-partners to get tested. This infection can stay unrecognised for months, if not years.

How can I make sure I don't get chlamydia?

Use condoms with new sexual partners.
Before you stop using condoms, make sure you and your partner get checked out for STIs by your local GUM clinic or GP.

How common is chlamydia?

In the UK chlamydia infections are rising. Between 2000 and 2005 the number of chlamydia infections increased by 14 per cent, with an estimated 1 per cent of women aged 16-19 having the infection.

Overall the rates of chlamydia in other Western European countries are lower than those in the UK.

The higher number of cases in the UK may partly be due to the national screening programme for chlamydia being rolled out in England. This should identify more people with the infection. Similar initiatives are underway in Scotland.

There have been high profile education campaigns targeted at the younger age group as part of the screening programme. STIs are now discussed in school-based sex education programmes.

Where can I get help?

Often the best place to get help is from the health advisers who work in sexual health (GUM) clinics.

To find your nearest clinic, check the phone book or NHS Direct (NHS 24 in Scotland).

Who offers chlamydia testing?

Home test kits

Home testing kits are not the same as home sampling kits.

A home test kit will give you a result as soon as you take the test.

In home sampling, you take the sample and send it back to an accredited laboratory for testing.

Some kits that are sold online and in pharmacies are not very accurate and may give a false reading.

Take a conventional sampling test until a good home test kit becomes available.

There is a national chlamydia screening programme for men and women under 25 who can access the tests in a variety of places other than GUM services.

It aims to make chlamydia tests more available for young people, but availability still depends on your local health trust's priorities - and budget.

Genitourinary medicine (GUM) clinics can screen for all STIs, including HIV tests. This is a free, confidential and open access service for all ages. You can walk in and book an appointment without a referral from GP. These services are very popular so you may have to wait to be seen.
GPs are able to test for chlamydia, irrespective of age group. They may also offer tests for other sexually transmitted diseases. Some GPs may be funded to offer tests to under 25s as part of national screening.
Family planning clinics usually only offer chlamydia screening for the under 25s. But if you are older than this and have symptoms that could be due to chlamydia, you may be able to get a test.
'Outreach services' for young people, eg men in youth clinic settings, and school clinics may provide chlamydia tests.
Your local pharmacy may offer chlamydia testing as part of the national screening programme.
There are some private labs and clinics offering rapid screening for chlamydia and other STIs. These may be of variable quality.
Innovations such as sending samples in by post are being tried, but this is mainly done as part of research. In Lothian, excellent results were achieved by a pilot study offering free postal urine test kits in outlets such as colleges and record stores.

How can we improve the current situation?

We could do with some patient power. The government has given money for chlamydia screening, but because of financial problems this money is not being spent on what was intended.

If you ask for a test and your GP is unable to provide it, demand may lead to a change in priorities in your local area.

As well as thinking about your own situation, don't forget the health and safety of your own children. Discussing sex isn't easy for everyone, but surveys suggest that kids like to hear about sex and relationships from a parent in preference to anyone else.

About half of under 16-year-olds are having sex. Some do not use any contraception at first, or they use condoms inconsistently. With a high teenage pregnancy rate, you expect a high chlamydia rate.

Celibacy may be the greatest protection against sexually transmitted diseases, but at that age the desire to have sex is considerable. It is unrealistic to expect adolescents to always make sensible, rational decisions, but many will if they are provided with information they can identify with.

Decent sex education in schools would help young people understand the consequences of their actions. Making an informed decision, and knowing where to go if you are concerned, is essential to get help promptly.

Other sources of information

To find your nearest GUM clinic visit the fpa site.
For more information on the national screening programme, visit the HPA website.
For more information on chlamydia, visit chlamydiae.com.

Last updated 30.04.2007