Chlamydia

What is chlamydia?

Chlamydia is a bacterial infection that is spread by sexual contact. It is the most common sexually transmitted disease (STD) in the United States. Chlamydia infects the urethra in men and the urethra, cervix, or upper reproductive organs (or all three) in women. Chlamydia can also infect the rectum and the surface of the eyes and lining of the eyelids (conjunctiva).

An infected mother can pass chlamydia to her baby at birth. Between 50% and 75% of babies born to mothers with chlamydia get the infection. They may have it in the eyes, back of the throat, rectum, or vagina. Between 30% and 40% of babies infected with chlamydia at birth develop complications, such as conjunctivitis or pneumonia. ¹

Having chlamydia increases your risk of becoming infected with human immunodeficiency virus (HIV) if you are exposed to HIV.¹

Risk factors for getting chlamydia include:

• Having unprotected sex (not using condoms).
• Having more than one sex partner.
• Having a high-risk partner or partners. This includes people who have more than one sex partner or sex partners who have chlamydia.
• Starting sexual activity before age 18.

What causes chlamydia?

Chlamydia is caused by the bacterium Chlamydia trachomatis. The disease can be spread during vaginal, anal, or oral sex with an infected partner. A pregnant woman can pass the infection to her newborn during vaginal delivery. Infection is rare during cesarean delivery, unless the amniotic sac (membranes) have broken.

You can spread chlamydia even if you do not have symptoms. You are contagious until you have been treated. Condoms may help reduce the spread of chlamydia.

What are the symptoms?

Up to 90% of women and men with chlamydia do not have symptoms.² As a result, they may unknowingly spread chlamydia to their sex partners. When symptoms do occur, they may include:

• Painful urination.
• Cloudy urine.
• Abnormal discharge from the urethra in men.
• Abnormal discharge from the urethra or the cervix (or both) in women.

How is chlamydia diagnosed?

Your doctor will ask you questions about your medical and sexual history, such as how many partners you have. You also may have a physical examination. Women have a gynecological exam to look for signs of infection. Men have a genital exam to look for discharge from the penis and tenderness in the scrotum.

Several types of tests can be used to diagnose a chlamydia infection. Most use a sample of fluid from the urethra or the cervix. This requires that a woman have a pelvic exam. A urine test also can be done if there is no other reason to have a pelvic or genital exam. Test results are usually ready in 2 to 3 days—except for the chlamydia culture, which can take 5 to 7 days.

Low-cost tests are usually available at local health departments and family planning clinics.

How is it treated?

Chlamydia is treated with antibiotics. If taken exactly as directed, antibiotics can cure a chlamydia infection. The infection will not be cured if antibiotics are not taken as directed. Prompt treatment also stops the spread of the infection and reduces complications, such as pelvic inflammatory disease (PID).

Having a chlamydia infection that was cured does not protect you from a future infection. A new exposure to chlamydia will reinfect you, even if you were treated and cured.

Experts recommend that you notify all partners with whom you had sex in the 60 days since your symptoms or diagnosis; if you have not had sex in the last 60 days, contact your last sexual partner. This prevents reinfection. If your symptoms continue after treatment, you probably have been infected again. It does not mean the first treatment failed. If you have chlamydia, avoid all sexual contact or use condoms until you and your partner (or partners) have finished the full course of medication.

Some people who have chlamydia also have the STD gonorrhea. Treatment includes antibiotics that kill both types of bacteria.

Frequently Asked Questions

Chlamydia infection is caused by the bacterium Chlamydia trachomatis. It is spread during vaginal, anal, or oral sex with an infected partner. A pregnant woman may spread the infection to her newborn during delivery.

You can spread chlamydia even if you do not have symptoms of infection. You may spread the infection until you have been treated.

Up to 90% of women and men with chlamydia do not have symptoms.²

The time between exposure to chlamydia and the start of symptoms—the incubation period—may range from days to months. If symptoms appear, it is usually 1 to 3 weeks after sexual contact with an infected person.

Symptoms in women include:

• Painful urination.
• Cloudy urine.
• Abnormal vaginal discharge.
• Abnormal vaginal bleeding with intercourse or between periods.
• Genital itching.
• Irregular menstrual bleeding.
• Lower abdominal pain.
• Fever and general tiredness.
• Swollen and painful glands at the opening of the vagina (Bartholin glands).
• Conjunctivitis.

Symptoms in men include:

• Painful urination or itching sensation with urination (often the first symptom).
• Cloudy urine.
• Watery or slimy discharge from the penis.
• Crusting on the tip of the penis.
• Tender anus or scrotum.
• Conjunctivitis.

Chlamydia does not cause long-term problems if it is treated before any complications develop. Left untreated, chlamydia can lead to many complications, especially for women. If a woman has chlamydia when she gives birth, her newborn can be infected.

Having a chlamydia infection that was cured does not protect you from a future infection. A new exposure to chlamydia will reinfect you, even if you were treated and cured.

Having chlamydia increases your risk of becoming infected with human immunodeficiency virus (HIV) if you are exposed to HIV.¹

Untreated chlamydia can cause a variety of complications.

Complications in women include:

• Inflammation of the cervix (cervicitis).
• Inflammation of the urethra (urethritis).
• Inflammation of the lining of the uterus (endometritis).
• Inflammation of the glands at the opening of the vagina (Bartholin glands).
• Inflammation in the uterus, fallopian tubes, or ovaries (pelvic inflammatory disease, or PID).
• Pelvic infection (abscess).
• Infertility.
• A rare liver inflammation (Fitz-Hugh–Curtis syndrome).

Complications in pregnant women include:

• Pregnancy outside the uterus (ectopic, or tubal, pregnancy).
• Miscarriage.
• Preterm labor.
• Premature rupture of the membranes (PROM).

Complications in newborns include:

• Premature delivery. A premature infant has an increased risk of health problems.
• Inflammation of the surface of the eyes and the lining of the eyelids (conjunctivitis). About one-half of newborns who have chlamydia get conjunctivitis.
• Infection of the nose and throat.
• Lung infections, such as pneumonia.
• Ear infection (otitis media).
• Urethritis, though this is very rare in infants.

Complications in men include:

• Urethritis.
• Inflammation of the tubes that hold sperm (epididymitis).
• Inflammation of the prostate, the gland that makes most of the fluid in semen (prostatitis).
• Infertility.

Other complications of untreated chlamydia in all people include:

• Conjunctivitis.
• Inflammation of the mucous membrane of the rectum (proctitis).
• Varied symptoms, such as joint and eye inflammation, caused by bacterial infection (Reiter's syndrome).
• Lymphogranuloma venereum, or LGV. This is caused by a type of chlamydia that is usually rare in the United States; however, it is becoming more common in men who have sex with men. It causes open sores in the genital area, headache, fever, fatigue, and swelling of the lymph nodes in the groin.

Risk factors for getting chlamydia include:

• Having unprotected sex (not using condoms).
• Having more than one sex partner.
• Having a high-risk partner or partners. This includes people who have more than one sex partner or sex partners who have chlamydia.
• Starting sexual activity before age 18.
• Having an impaired immune system.

Any child with chlamydia needs to be seen by a health professional to determine the cause and to assess for possible sexual abuse.

Call your health professional immediately if you have these chlamydia symptoms:

In women:

• Sudden, severe pain in the lower abdomen
• Lower abdominal pain with vaginal bleeding or discharge and a fever of 100° (37.8°) or higher
• Urinary burning, frequent urination, or inability to urinate and a fever of 100° (37.8°) or higher

In men:

• Discharge from the penis and a fever of 100° (37.8°) or higher
• Urinary burning, frequent urination, or inability to urinate and a fever of 100° (37.8°) or higher
• Pain, swelling, or tenderness in the scrotum and a fever of 100° (37.8°) or higher

Call your health professional if you have these symptoms:

In women:

• Vaginal discharge that becomes yellowish, thicker, or bad-smelling
• Bleeding between periods that occurs more than once when periods are usually regular
• Pain during sexual intercourse
• Bleeding after sexual intercourse or douching
• Sores, bumps, rashes, blisters, or warts on or around the genital or anal areas
• Burning, pain, or itching with urination or frequent urination lasting longer than 24 hours
• Pelvic or lower abdominal pain without a known cause, such as diarrhea or menstrual cramps

In men:

• Sores, bumps, rashes, blisters, or warts on or around the genital or anal areas
• Burning, pain, or itching with urination or frequent urination lasting longer than 24 hours
• Abnormal discharge from the penis

Also call if you think you may have been exposed to a sexually transmitted disease (STD).

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. It is not appropriate for a chlamydia infection. Chlamydia causes no long-term problems if it is treated before any complications develop; untreated chlamydia can lead to many complications. Avoid sexual contact until you have been examined by your health professional.

If you know you have been exposed to chlamydia, you and your sex partner (or partners) need to be treated. You need to be treated even if you don't have symptoms. Notify all partners with whom you had sex in the 60 days since your symptoms or diagnosis; if you have not had sex in the last 60 days, contact your last sex partner. ³

Who To See

Health professionals who can diagnose chlamydia include:

• Nurse practitioners.
• Physician assistants.
• Family medicine physicians.
• Internists.
• Gynecologists.

Low-cost diagnosis and treatment of chlamydia are usually available at local health departments and family planning clinics, such as Planned Parenthood.

Some people are not comfortable seeing their usual health professional for an STD. Most counties have confidential clinics for diagnosing and treating chlamydia and other STDs. However, it would be good for your health professional to know of this infection for your future care.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

A health professional diagnoses chlamydia using a medical history, a physical examination, and tests. During the medical history, your health professional may ask you questions such as:

• Do you think you were exposed to any sexually transmitted diseases (STDs)? How do you know? Did your partner tell you?
• What are your symptoms?
  • Do you have a discharge? If you have discharge from the vagina or penis, it is important to note any smell or color.
  • Do you have sores in the genital area or anywhere else on your body?
  • Do you have any urinary symptoms, including frequent urination, burning or stinging with urination, or urinating in small amounts?
  • Do you have any abdominal or pelvic pain or cramping during intercourse?
• What method of birth control do you use? Did you use condoms to protect against STDs?
• Which high-risk sexual behaviors do you or your partner engage in?
• Have you had an STD in the past? How was it treated?

After the medical history is taken:

• A woman may have a gynecological exam.
• A man may have a genital exam for urethritis and epididymitis.
• You may have a urine test for chlamydia if there is no other reason to have a pelvic or genital exam.

Several types of tests can be used to diagnose a chlamydia infection. Test results are usually done in 2 to 3 days, except for the chlamydia culture. It can take 5 to 7 days.

Other infections can occur along with a chlamydia infection. Your health professional may recommend testing for:

• Gonorrhea
• Syphilis.
• Human immunodeficiency virus (HIV), which causes AIDS.
• Bacterial vaginosis, a condition caused by a change in the normal bacteria in the vagina.

In the United States, your health professional must report that you have chlamydia to the state health department so the department can inform your sex partner or partners that they also need treatment.

Early Detection

The Centers for Disease Control and Prevention (CDC) recommends screening every year for sexually active adolescents and women up to age 25. Women older than 25 who have high-risk sexual behaviors also should be screened every year.³ You may have a urine test for chlamydia (if it is available in your area) even if you do not have a full pelvic or genital exam.

The CDC recommends tests for pregnant women with high-risk sexual behaviors so they do not spread chlamydia to their babies. All pregnant women should be screened during their first prenatal visit. If a pregnant woman is at high risk for chlamydia, she may be tested again during her third trimester.

The CDC also recommends you have the test again 4 to 6 months after you finish treatment. Women may get chlamydia again if they have sex with the same partner or partners.

Chlamydia can be cured with antibiotics. The disease does not cause long-term problems if it is treated before complications develop. Untreated chlamydia can lead to many complications.

Treatment is recommended for:

• People who have positive chlamydia tests.
• Sex partners within the last 60 days of people diagnosed with chlamydia—even if they do not have symptoms.
• Newborns of women who have chlamydia at the time of delivery.

It is important to not have sex for 7 days after treatment for chlamydia.

If you are treated for chlamydia and your sex partner is not, you will probably become infected again. Encourage your partner to get treated. Use condoms to lower the chance of reinfection.

What To Think About

Some people who have chlamydia may also have gonorrhea. In that case, treatment includes antibiotics that kill both chlamydia and gonorrhea. For more information, see the topic Gonorrhea.

Reinfection can occur. Symptoms that continue after treatment are probably caused by another chlamydia infection rather than treatment failure. To prevent reinfection, sex partners need to be evaluated and treated.

Repeated chlamydia infections increase the risk for pelvic inflammatory disease (PID). Even one infection can lead to PID without proper treatment. Make sure to take your antibiotics exactly as prescribed. Take the full course of medicine, even if you feel better in a couple of days.

Some health professionals recommend retesting 3 to 4 months after treatment to reduce the risk of complications from reinfection.³

In the United States, your health professional must report that you have chlamydia to the state health department so the department can inform your sex partner or partners that they also need treatment.

You can reduce your risk of becoming infected with chlamydia or another sexually transmitted disease (STD) and spreading the disease.

Practice safe sex

Preventing an STD is easier than treating an infection once it occurs.

• Talk with your partner about STDs before beginning a sexual relationship. Find out whether he or she is at risk for an STD. Remember that it is possible to be infected with an STD and not know it. HIV, for example, may not be found in the blood for up to 6 months after initial infection.
• Be careful.
  • Avoid sexual contact if you have symptoms of an STD or are being treated for an STD.
  • Avoid sexual contact with anyone who has symptoms of an STD or who may have been exposed to an STD.
• Do not have more than one sex partner at a time. Your risk for an STD increases if you have several sex partners.

Male condom use

Condoms reduce the risk of becoming infected with an STD. A condom must be put on before beginning any sexual contact. Use condoms with a new partner until you are certain he or she does not have an STD.

Female condom use

Even if you are using another birth control method, you may want to use condoms to reduce your risk of getting an STD. Female condoms are available for women whose partners do not have or will not use a male condom.

There is no home treatment for chlamydia. Antibiotics, taken exactly as prescribed, normally cure chlamydia infections. Chlamydia does not cause long-term problems if it is treated before complications develop. Untreated chlamydia can lead to many complications.

Finding out that you have chlamydia may cause you to have negative thoughts or feelings about yourself or about sex. You may feel embarrassed, be angry at the person who infected you, or feel frustrated with treatment. You may want to seek counseling or join a support group for people with sexually transmitted diseases (STDs). You may get counseling from a psychologist, a social worker, or another counselor; STD health clinics also may offer counseling and support groups.

Antibiotic treatment, when taken exactly as directed, normally cures chlamydia infections. If antibiotics are not taken properly, the infection will not be cured. Prompt treatment prevents the spread of the infection and reduces the risk of complications, such as pelvic inflammatory disease (PID).

Avoid sexual contact or use condoms until you and your partner have finished the full course of medication.

Medication Choices

Antibiotics

What To Think About

Call your health professional if symptoms continue or new symptoms develop 3 to 4 weeks after treatment. To prevent reinfection, your sex partners need to be tested and treated.

Treatment in a hospital with intravenous (IV) medications may be needed for women who have pelvic inflammatory disease (PID) and men who have epididymitis.

Untreated chlamydia can causes complications, such as an abscess. Surgery may be used to drain or remove the abscess.

There is no other treatment for chlamydia at this time.

Organizations

• Exposure to Sexually Transmitted Diseases
• Gonorrhea
• Syphilis

Citations

1. Low N (2004). Chlamydia (uncomplicated, genital). Clinical Evidence (11): 2064–2072.

2. Peipert JF (2003). Genital chlamydial infections. New England Journal of Medicine, 349(25): 2424–2430.

3. Centers for Disease Control and Prevention (2002). Sexually transmitted diseases treatment guidelines 2002. MMWR, 51(RR-6): 32–36.

Other Works Consulted

• American Academy of Pediatrics (2003). Chlamydia trachomatis. In LK Pickering, ed., Red Book: 2003 Report of the Committee on Infectious Diseases, 26th ed., pp. 238–243. Elk Grove Village, IL: American Academy of Pediatrics.

• Miller WC, et al. (2004). Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA, 291(18): 2229–2236.

Author:	Marianne Flagg	Last Updated February 17, 2005
Medical Review:	Martin Gabica, MD - Family Medicine Jeanne Marrazzo, MD, MPH - Infectious Disease
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