Chlamydia is one of the most common sexually transmitted infections (STIs) worldwide, caused by the bacterium Chlamydia trachomatis. It can affect men and women of all ages, but it is particularly prevalent among sexually active young adults. Despite being highly treatable, chlamydia often remains undiagnosed due to its asymptomatic nature in many individuals, which can lead to serious complications if left untreated.
Cause and Pathophysiology
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Chlamydia is caused by the obligate intracellular bacterium Chlamydia trachomatis, which infects the epithelial cells of the urogenital tract, rectum, and conjunctiva.
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The bacterium has a unique life cycle alternating between two forms:
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Elementary body (EB): infectious but metabolically inactive.
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Reticulate body (RB): non-infectious but metabolically active, replicating within host cells.
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The infection leads to inflammation, tissue damage, and in some cases, chronic scarring if untreated.
Modes of Transmission
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Sexual contact (vaginal, anal, or oral sex) with an infected person.
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Vertical transmission from mother to newborn during vaginal delivery.
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Less commonly, through contaminated fingers leading to eye infections (trachoma).
Risk Factors
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Age under 25 years.
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Multiple or new sexual partners.
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Inconsistent condom use.
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Previous history of STIs.
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Engaging in unprotected sex.
Symptoms
Chlamydia is frequently asymptomatic (up to 70% of women and 50% of men show no symptoms). When present, symptoms usually occur 1–3 weeks after exposure.
In Women:
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Abnormal vaginal discharge.
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Dysuria (painful urination).
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Intermenstrual or post-coital bleeding.
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Pelvic or abdominal pain (may suggest pelvic inflammatory disease).
In Men:
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Urethral discharge (clear, cloudy, or mucoid).
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Dysuria.
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Testicular pain or swelling (epididymitis).
Other Sites:
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Rectal infection: pain, discharge, or bleeding (often asymptomatic).
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Ocular infection: conjunctivitis, redness, irritation.
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Pharyngeal infection: usually asymptomatic, rarely sore throat.
Complications
Untreated chlamydia can cause significant morbidity:
In Women:
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Pelvic Inflammatory Disease (PID).
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Tubal factor infertility.
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Ectopic pregnancy.
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Chronic pelvic pain.
In Men:
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Epididymitis.
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Infertility (rare).
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Reactive arthritis (Reiter’s syndrome).
In Neonates:
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Conjunctivitis (ophthalmia neonatorum).
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Pneumonia.
Diagnosis
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Nucleic Acid Amplification Tests (NAATs): gold standard for diagnosis, performed on urine or swab specimens.
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Specimens:
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Women: vaginal swab (self- or clinician-collected).
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Men: first-catch urine.
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Rectal and pharyngeal swabs for at-risk populations.
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Other tests: culture and antigen detection are rarely used now due to lower sensitivity.
Treatment
Chlamydia is highly treatable with antibiotics. Current guidelines recommend:
First-line treatment:
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Doxycycline 100 mg orally twice daily for 7 days
Alternative regimens (for pregnant women or if doxycycline is contraindicated):
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Azithromycin 1 g orally in a single dose
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Amoxicillin 500 mg orally three times daily for 7 days (in pregnancy)
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Erythromycin 500 mg orally four times daily for 7 days (less tolerated due to GI side effects)
For neonates with chlamydial conjunctivitis/pneumonia:
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Erythromycin 50 mg/kg/day orally in 4 divided doses for 14 days
Follow-Up and Partner Management
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Patients should abstain from sexual contact until 7 days after starting treatment and until partners are treated.
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Test of cure: not routinely required except in pregnancy, persistent symptoms, or suspected reinfection.
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Retesting: advised at 3 months due to high reinfection rates.
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Partner notification: all sexual partners within the last 60 days should be tested and treated.
Prevention
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Consistent and correct condom use.
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Regular screening, especially in high-risk groups:
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Women under 25 years.
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Men who have sex with men (MSM).
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Limiting number of sexual partners.
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Prompt treatment and partner therapy to prevent reinfection.
Prognosis
With timely antibiotic therapy, the prognosis is excellent. However, recurrent infections increase the risk of long-term complications, especially infertility in women.
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