Chlamydia: what are the symptoms

Chlamydia trachomatis infection often starts asymptomatically, but can cause serious complications.

The term Chlamydia commonly indicates a bacterium, whose scientific name is Chlamydia trachomatis, mainly responsible for infections of the genital organs and the last stretch of the urinary tract in both women and men. In addition, it can cause a particular form of conjunctivitis and pneumonia in newborns of affected mothers.

In truth, there are several subtypes of the bacterium, identified with the letters from A to L; of these some (A, B and C), mainly present in the poorest regions of Africa and Asia, are the cause of a serious eye infection (trachoma) that is transmitted by direct contagion or through insects and which can lead to blindness.

Most of the subtypes widespread in the Western world (D, E, F, G, H, J, K, L) have as their primary target the genital and urinary tract and currently constitute the most frequent among sexually transmitted bacterial infections.

Very widespread, but elusive

According to the most recent reports by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization, cases of sexually transmitted Chlamydia trachomatis infection reported each year represent only a fraction of the real ones: many escape national surveillance systems because they run asymptomatically.

The fact that very often the infection does not cause symptoms does not mean that it is harmless, since, if it is not treated, in a high percentage of cases it can determine long-term even serious outcomes and compromise reproductive capacity in both sexes.

It is precisely in view of its dangerousness and the growing diffusion in young people that national and international health organizations now identify it as a public health problem.

Although it has been shown that early diagnosis of the infection allows to limit the spread of the bacterium and to prevent the development of the most feared complications in those already infected, there are still few countries that offer screening programs to detect the infection, even when it is not manifest, in the population groups most at risk.

From the available data it is estimated that the infection is identified only in 10% of the people actually infected; In addition, the diagnosis is predominantly made in adolescents and young adults, aged 15 to 24, with higher rates among women aged 20 to 24 years.

In England, the nation with the most extensive screening program, the diagnostic test positivity rate applied in young people aged 16 to 25 was 10-11% of the subjects examined.

Beware of risky sexual intercourse

The individuals most at risk of contracting the infection are therefore sexually active under-25s, especially if they practice sexual intercourse not protected by condoms, with partners affected by the disease or carriers of the bacterium. In addition, Chlamydia trachomatis infection is often present in individuals suffering from other sexually transmitted diseases at the same time, such as gonorrhea.

In adolescents and adults, contagion always occurs through sexual intercourse, in whatever way it is practiced: vaginally, anally and oro-genital. In fact, the bacterium is present on the surfaces of the genital organs and in secretions (vaginal secretions, pre-coital fluid, semen) and during sexual intercourse it is transferred from one partner to another by direct genital contact or possibly even through hands or objects recently contaminated by infected biological fluids.

It is important to remember that the infection is transmitted even when the partner who is a carrier is asymptomatic (and therefore may not know that he has contracted it).

In women infected with Chlamydia trachomatis, an additional risk of contagion should be considered, which concerns a possible pregnancy and involves the newborn. The transmission of the bacterium from mother to child occurs at the time of delivery if this is carried out vaginally: in the passage through the birth canal, in direct contact with the contaminated maternal genital mucous membranes, the newborn can become infected. This occurs in 30-40% of pregnancies at risk.

Non-specific (and often absent) symptoms

In adolescents and adults of both sexes, more than 70% of infections start asymptomatically, i.e. without causing disorders that could lead to the suspicion of a sexually transmitted disease.In initially asymptomatic cases in which the infection, undiagnosed and untreated, progresses, it becomes manifest only when the most serious complications arise.

When, on the other hand, symptoms attributable to genital infection by Chlamydia trachomatis appear early (1-3 weeks after infection), these disorders are partly similar to those present in other sexually transmitted diseases (for example gonorrhea).

In women, the most frequent initial symptoms are due to the state of inflammation of the mucous membranes of the lower genital tract, especially of the vagina and uterine cervix (cervix) and of the last stretch of the urinary tract (urethra): yellowish-white vaginal secretions, small blood vaginal discharge (spotting) in the intermenstrual period of the cycle or following sexual intercourse, itching genital, feeling of discomfort or vaginal tenderness during coitus (dyspareunia), pain and burning during urination.

As the infection persists, local symptoms may become more intense and abdominal pain in the pelvic (lower abdomen), lower back tenderness, nausea and fever may be added. In the absence of adequate treatment, the infection can in fact spread, going up along the genital tract, up to the internal organs and cause a chronic inflammatory state.

In humans, the initial symptoms of infection are more often due to the involvement of the urinary tract and a little less frequently to that of the genital organs: urethral secretions, pain and burning during urination, itching in the genital area. Subsequently, pain, edema and inflammation may appear in the testicles due to the spread of the infection along the epididymis, the duct in which the sperm fluid collects before flowing outwards during ejaculation.

	Women	Men
Initial symptoms	Yellowish-white vaginal discharge Small vaginal discharge blood (spotting) in the intermenstrual period of the cycle or follow-up of sexual intercourse, genital itching Feeling uncomfortable or vaginal tenderness during coitus (dyspareunia) Pain and burning during urination	Urethral secretions Pain and burning when urinating Itching in the genital area
Subsequent symptoms	Abdominal pain in the pelvic (lower abdomen) Lumbar soreness Nausea Fever	Pain, edema and inflammation in the testicles

Following oral-genital intercourse or intercourse, Chlamydia trachomatis can infect respectively the mucous membranes of the pharynx or the last stretch of the intestine (rectum): often these infections are asymptomatic, but sometimes they determine an inflammatory state, with sore throat and difficulty swallowing in the first case and symptoms attributable to proctitis (pain during defecation, presence of mucus and blood in the stool) in the second.

A particular manifestation of Chlamydia trachomatis infection, which is caused only by bacteria of the L serotype, is venereal lymphogranuloma. In this case the infection affects the lymphatic circulation and causes inflammation, with an increase in volume and pain, of the lymph nodes close to the area of penetration of the germs (groin, neck or region, depending on the type of sexual intercourse), which can be preceded by the appearance at the level of the corresponding mucous membranes (genital, pharyngeal or) of small ulcers that heal spontaneously in a few days.

The dangers if you don’t care

The danger of the infection, if it is not treated in time, is mainly related to possible long-term complications.

In women, the most feared pathology, due to the extension of the infection to the internal genital organs, is pelvic inflammatory disease (MIP), which can lead to a condition of infertility due to increased risk of miscarriages and ectopic pregnancies or even sterility due to occlusion of the fallopian tubes.

In humans, the propagation of infection from the urethra, where it is initially localized, to the epididymis and testicles can lead to chronic inflammation of the genital apparatus (epididymo-orchitis) and also in this case compromise reproductive capacity.

Another possible sequel to Chlamydia infection, also common to other bacterial diseases, is the so-called Reiter syndrome, a systemic inflammation caused by an abnormal reaction of the immune system, which simultaneously affects the joints, eyes and urinary tract.

In pregnancy the infection can involve fetal growth retardation, preterm birth, premature rupture of membranes, postpartum endometritis, low fetal birth weight, neonatal death.

In addition, newborns infected during childbirth can have a bacterial colonization at the ocular, oto-nasopharyngeal, uro-genital and rectal level: up to 50% of them develop conjunctivitis 1-2 weeks after birth and 10-20% severe interstitial pneumonia 1-3 months later.

The diagnosis comes from the laboratory

In the presence of the symptoms described above or if you suspect that you have been exposed to infection, it is advisable to contact your doctor immediately.

The diagnosis of Chlamydia trachomatis infection is achieved through laboratory tests. Some techniques allow to directly identify the microorganism in the cells of the mucous membranes of the genital or urinary tract, but require the collection of biological material through a swab inside the uterine cervix or urethra.

The most used tests today, however, are those that use the techniques of amplification of the genetic material of the microorganism: they are considered more reliable and are easier to perform and less invasive because they can also be carried out on vaginal secretions, easily taken by the patients themselves through a swab or on a urine sample (to be collected are those of “first jet” of the morning).

In neonates, the diagnosis can be made from material taken with a swab from the nasopharynx or conjunctiva or with tracheal aspiration in case of pneumonia.

How to heal

The treatment of the infection, being of bacterial origin, involves the use of antibiotics.

Therapy is recommended in the presence of suspicious symptoms (to be started immediately, even without waiting for the test result) or in the presence of a positive test result (even if there are no symptoms); It is also recommended as a precaution in sexual partners of infected people and in subjects suffering from gonorrhea (due to the high probability that the two infections coexist).

Obviously in affected women the treatment, with the appropriate antibiotics, must also be carried out during pregnancy.

The important thing is to prevent

The main recommendation with respect to Chlamydia trachomatis infection, valid for all sexually transmitted diseases, is not to expose it. The only effective prevention tool in this regard is abstention from risky intimate relationships.

It goes without saying that, when you are not sure of your infectious status or that of your partner, protected sex is the only means that can decrease the risk of infecting your partner or being infected. The use of condoms and attention to the ways in which sexual intercourse is practiced represent in this case a form of respect for one’s own body and that of one’s partner and an investment to protect one’s own and others’ health, including sexual health.

There are no other ways in this field to avoid getting sick and there is, for example, no diet capable of preventing or treating the infection. The only general advice, always appropriate to support the immune system, is to follow a balanced diet, varied and rich in vitamins, minerals, amino acids and essential fatty acids, prebiotic substances and probiotic microorganisms.