Chlamydia and Sexually Transmitted Infections

Chlamydia and Sexually Transmitted Infections

All physicians want every sexually active patient to know and understand that one of the most prevalent Sexually Transmitted Diseases (STD) is Chlamydia. It occurs in about an estimated 4 million patients per year. The second most common is gonorrhea, which occurs in about 350,000 patients per year. Gonorrhea usually travels with it over 80% of the time. However, it may or may not travel with gonorrhea.
Chlamydia is called the "silent disease" because in about 90% of cases, the infected person does not know that an infection has occurred. Signs of infection may occur 1 to 3 days after sexual contact from an infected person. Left untreated, it can gradually invade the entire female reproductive system, causing tubal scarring, ectopic pregnancies, infertility, and chronic pelvic pain. The infection usually gets into the Fallopian tubes of about 40% of women with it. In males it can cause an infection of sperm tubules of the testes, causing swelling named epididymitis. Infection can occur in the throat or anal areas depending upon sexual exposure. A newborn can get it passing through an infected birth canal causing either a severe eye infection or a dangerous pneumonia. Physicians should treat all STD'S confidentiality and with concern.
Because of the frequency of infection, even some health insurance companies are specifying that screening of sexually active women for the disease is to be covered as a necessary preventative measure. Screening is directed at female patients because they have the most severe complications. Men are usually treated on a case-by-case basis or by history of contact with an infected person. Testing is done either by a swab of the urethra, swab of the cervix in women, or by testing of the urine. The bacterium may be grown in the lab for identification, or there are tests which use antibodies to look for fragments of the disease germ.
It is recommended that all sexually active women under age 25 have a test done once a year. All pregnant women should also be tested. Older women should have testing if they have restarted sexual activity, have more than one sexual partner, inconsistently use a condom, or at the physician's discretion because of symptoms. The Health Department receives confidential reports of cases and helps track contacts for treatment to hopefully limit the spread of the STD.
The clinical signs are usually rather subtle. The female may have some vaginal or urinary discomfort, some vaginal discharge, or a little bleeding or discomfort after subsequent sexual activity. When the physician examines her, he can see an inflammation of the cervix with some whitish discharge over the cervical opening. In the male, there may be some burning with urination, redness of the inside of the opening of the penis and sometimes a cloudy white or watery discharge from the end of the penis or redness of the tip of the penis. The physician must be very alert to the presence of the STD in the active patient population.
Treatment, if diagnosed early, is relatively easy. One can take a one-time dose of four antibiotic tablets or an antibiotic twice daily for 10 to 14 days. The patient should refrain from sexual activity during treatment, and until sexual contacts have been treated. Unfortunately, infection does not confer immunity. It can repeatedly cause infections. So constant safe sexual practices, limiting of sexual partners, and retesting are necessary.
There are many reasons why this STD must be treated. As mentioned, this relatively easy to treat infection can wreak havoc in the female reproductive system. It ultimately may lead to chronic pain and infertility. It can damage the male reproductive system, but with less frequency. The infant born through an infected birth canal can have conjunctivitis eye infections sometimes causing blindness. An infant born through an infected birth canal can get an infection down the lungs, causing severe pneumonia. It can cause lymphogranuloma venereum, a painful infection of the groin lymphnodes. In young men, it can become a rheumatologic disease causing joint pain, urethral discharge, and chronic eye inflammation. It can cause proctitis--an inflammation of the rectum, which can become chronic.
Many young women put off annual pelvic exams, rationalizing that diseases of the genital system can only occur in older women. Nothing could be further from the truth. Prompt treatment of STD infections will prevent many subsequent health problems. Women with this infection are five times as likely to contract HIV. The damage to the fallopian tubes can be permanent and irreversible. A tubal pregnancy can be life threatening. Consistently have your annual pelvic exams. Seek prompt treatment if you are exposed to or think you have developed an STD. Practice safe sex, and try to maintain a monogamous stable sexual relationship if you are sexually active. Teenagers and young adults should receive teaching and instructions about this and all STD's. Always talk to your doctor if you have any questions or concerns.

Douglas Beatty M.D.
Doctors Medical Center