Chlamydia Trachomatis Infection Complication

“A patient presented with recurring eye discomfort, pain, redness, and mucous eye discharge. Despite multiple treatments with eye drops for conjunctivitis, there was little improvement. His symptoms worsened, leading to blurry vision. Subsequently, he sought the expertise of an ophthalmologist who recommended sexual health tests due to concerns about an undiagnosed sexually transmitted disease. The test results confirmed a chlamydia trachomatis bacterial infection [1]. Given the seriousness of the situation, especially with ophthalmic involvement, the patient was prescribed appropriate antibiotics and experienced an uneventful recovery.” 

Question: Chlamydial infection is always known to be a silent medical condition that most people tolerate with minimal or subtle symptoms. Are there potential sinister complications that we may not be aware of?

What is Chlamydia Trachomatis?

In 1907, chlamydia was discovered by Halberstaedter and Von Prowazek from a conjunctival sample taken from an orangutan. In Greek, 'chlamydia' means 'cloaked' or 'hooded.' Over the years, with its 'hooded' nature and evolutionary resilience, the bacterium has survived for centuries in both animals and humans. It is considered one of the most elusive bacteria that spreads surreptitiously when we are least aware. 

How can I contract chlamydia trachomatis infection?

Chlamydial infections are transmitted through sexual contact, including vaginal, rectal, or oral routes. A pregnant mother with untreated chlamydial infection can also transmit the infection to her baby during a vaginal delivery.

Am I at risk of acquiring a chlamydial infection?

Theoretically, anyone who engages in sexual activity is at risk of acquiring a chlamydial bacterial infection. However, the risk of infection increases with the number of sexual partners, a history of unprotected sex, and those who also engage in oral and rectal sex.

What are the usual symptoms of chlamydial infection?

One can be asymptomatic or develop only mild symptoms during the early stages of chlamydial infection. Occasionally, one may experience symptoms such as:

• Painful urination or itching during urination (men and women)
• Abnormal vaginal discharge (women)
• Intermenstrual spotting or bleeding (women)
• Painful intercourse (women)
• Lower pelvic pain (women)
• Urethral discharge (men)
• Painful or swollen testicles (men)

What complications can result from an undiagnosed chlamydial infection?

Chlamydia bacteria can go unnoticed for a while, as the bacterial infection does not initially cause many symptoms. However, chlamydial infection can lead to more serious health issues with long-term complications. 

Women

• A person can develop a condition known as pelvic inflammatory disease (PID) [2], where the bacterial infection ascends upward to the uterus, fallopian tubes, ovaries, or even the pelvic cavity and peritoneum, leading to inflammation and scarring. This can result in chronic pelvic pain, infertility, or a higher risk of ectopic pregnancy.
• Less commonly, one may develop a condition known as 'Fitz-Hugh-Curtis Syndrome.' In this condition, there is an upward spread of the chlamydial bacterial infection, leading to inflammation of the surrounding liver and peritoneal tissues. Patients typically present with perihepatitis symptoms such as right-sided upper abdominal pain, poor appetite, feeling unwell, or even fever.
• In pregnant women, untreated chlamydial infection can be associated with miscarriage, preterm labour, conjunctivitis (ophthalmia neonatorum), and pneumonia in newborns.

Men

• Untreated chlamydia can lead to epididymitis (infection of the testicle), which in the long term can be associated with organ scarring, resulting in chronic testicular pain, swelling, and male infertility [3].

Both women and men

• Patients can present with arthritis secondary to chlamydial infection (Reiter's syndrome or reactive arthritis). One may present with a triad of joint pain or swelling, a red eye, and abnormal urinary symptoms in Reiter's syndrome.
• Less commonly, patients can also present with chlamydial bacterial (adult inclusion) conjunctivitis. If a sexually active person continues to experience unresolved conjunctivitis despite compliant usage of antibiotic eye drops, one may want to consider broader differentials, such as an underlying chlamydial infection. If chlamydial bacterial conjunctivitis is left untreated, one can develop complications such as eye blurriness or corneal ulceration.
• Occasionally, one can also present with ulcers and sores in the genital region associated with systemic symptoms such as fever and lymph node swelling, known as lymphogranuloma venereum.
• Unfortunately, it is medically known that untreated chlamydia infection also predisposes a person to other forms of STDs, including HIV.

When should I see my doctor if I am concerned about chlamydia?

You should consider seeing your doctor and getting screened for chlamydia if you have had a sexual encounter that may suggest exposure to STDs [4]. You should also get screened if you are experiencing symptoms such as:

Women

• Abnormal vaginal discharge
• Vaginal itching
• Painful urination or abnormal urinary symptoms

Men

• Urethral discharge
• Painful urination
• Pain or swelling in the testicles

Women and men

• Persistent sore throat
• Rectal or anal itching or pain
• Anal mucus discharge or bleeding
• Persistent red eye

As a general piece of advice, if you notice abnormal lumps and bumps in your genital region, unusual discharge, or abnormal urination, you should seek advice from your doctor.

What tests will my doctor offer to screen for chlamydial infection?

Depending on your medical history, risk of exposure, and sexual history, your doctor may offer you chlamydia tests such as:

• Swab tests (high vaginal swab, cervical swab, rectal swab, urethral swab, pharyngeal swab) to obtain samples from the possible infected sites
• Urine test

If there is a risk of exposure to other STDs, your doctor may further advise you to screen for infections such as gonorrhoea, HIV, syphilis, herpes, hepatitis, HPV, etc. 

What are the treatments for chlamydial complications?

Chlamydia infection can be effectively eradicated with medicines [5], such as antibiotics. Antibiotics may include azithromycin, doxycycline, or erythromycin, depending on a patient's drug history and medical compliance rate.

Unfortunately, in some health complications secondary to chlamydia infection, even with the resolution of the bacteria, there may be long-term scarring or chronic inflammation in the affected organ. This is unlikely to be reversible even with medical treatment.

How long can chlamydia last in our body if left untreated?

Chlamydia infection can persist in our body without treatment, and one can have chlamydial infection for years. If chlamydial infection is not treated, you remain infectious and can transmit the infection to your sexual partner(s).

Key points to note

• While the chlamydial infection is generally a benign STD infection that is easily treatable, the longer the infection is left untreated, the higher the risk of developing chlamydial complications.
• Always practice safe sex.
• Consider regular STD screening.
• Seek treatment early.

References

1. Satpathy, Gita, et al. “Chlamydial Eye Infections: Current Perspectives.” Indian Journal of Ophthalmology, vol. 65, no. 2, Feb. 2017, pp. 97–102. PubMed, https://journals.lww.com/ijo/fulltext/2017/65020/chlamydial_eye_infections__current_perspectives.6.aspx  
2. Paavonen, J., and M. Lehtinen. “Chlamydial Pelvic Inflammatory Disease.” Human Reproduction Update, vol. 2, no. 6, 1996, pp. 519–29. PubMed, https://academic.oup.com/humupd/article/2/6/519/708087  
3. Goulart, Ana Carolina Xavier, et al. “HIV, HPV and Chlamydia Trachomatis: Impacts on Male Fertility.” JBRA Assisted Reproduction, vol. 24, no. 4, 2020, pp. 492–97. PubMed Central, https://doi.org/10.5935/1518-0557.20200020. 
4. Clarke, Ian N. “Evolution of Chlamydia Trachomatis.” Annals of the New York Academy of Sciences, vol. 1230, Aug. 2011, pp. E11-18. PubMed, https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.2011.06194.x 
5. STD Facts - Chlamydia. 4 Oct. 2022,  
   https://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm.