Chlamydia

Chlamydia is a sexually transmitted disease (STD). Chlamydia is the most common STD in the UK. This highly contagious disease can occur in both men and women. Chlamydia can go unnoticed, so people do not know that they are infected and can pass on the infection through unprotected sexual contact. A long-term untreated infection with chlamydia can lead to infertility in women and rarely to infertility in men. 

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What is Chlamydia?  

Chlamydia is a sexually transmitted disease (STD) caused by a bacterium called Chlamydia trachomatis. After an infection, this bacterium settles in the mucous membrane of the penis, vagina or anus. Chlamydia is highly contagious. Not everyone experiences complaints with Chlamydia. Only a quarter of the women and half of the men experience symptoms of Chlamydia infection. It is important to have a Chlamydia infection treated, because a symptom-free Chlamydia is also contagious. The incubation time, the time between the moment of infection and the first symptoms of the disease is between 1 - 3 weeks in women and from the 4th day to 3 weeks in men. You do not have to wait for this time to get tested. If you have had unsafe sexual contact you can get tested after the 10th day. An untreated Chlamydia infection can lead to infections of the testicles, epididymis or prostate in men. In women, untreated Chlamydia can cause infections of the fallopian tubes and abdomen. 

What is the cause of Chlamydia? 

The cause of Chlamydia is the bacterium Chlamydia trachomatis which is transmitted by unprotected sexual contact. In oral sex, infection is rare.  

What forms of Chlamydia are there? 

There are three forms of Chlamydia:  

  • Chlamydia transmitted by unprotected sexual contact. 
  • Perinatal Chlamydia is transmitted at birth from the infected mother to the child. 
  • LGV (lymphogranuloma venerum) caused by a particular Chlamydia bacterium. This condition is rare in Europe and occurs mainly in tropical areas such as Africa, South Asia and the Caribbean islands. In the UK, however, there has been an increase in LGV infection among men who have unprotected sexual contact with one another over the past 10 years.  

 

How do you recognise Chlamydia?  

Chlamydia often does not cause any symptoms. Half of the men who have the condition show no symptoms. Less than a quarter of women who are infected have symptoms. The symptoms in men and women are different. When the symptoms do occur in men it is often after 4 days. The symptoms in men are: 

  • Pain or burning sensation when urinating
  • Watery to pussy discharge from the urethra especially in the morning
  • Itching at the anus
  • Bloody secretion in the stool
  • Diarrhoea
  • Sometimes pain in the scrotum or pain when pooing

The bacteria can rise and enter the prostate and epididymis via the vas deferens. Although it is not common, it is possible that an inflammation of the epididymis causes an inflammation of the testicles. This is accompanied by swelling and pain. Also, inflammation of the prostate may occur, this is accompanied by fever, difficulty urinating and pain in and around the genitalia. Infertility caused by Chlamydia is rare in men. When there are symptoms in women it is between 7 and 21 days. The symptoms in women are: 

  • Pain or burning sensation when urinating
  • Pain during and after sexual contact
  • Blood loss during and after sexual contact
  • Blood loss between menstruations
  • More or abnormal discharge
  • Itching at the anus
  • (bloody) Discharge in the faeces or diarrhoea
  • Severe pain in the lower abdomen with or without fever
  • Pelvic inflammation with fever

The infection can spread to the fallopian tubes and the lower abdomen, often accompanied by fever. The fallopian tubes can become closed due to scarring. This can lead to infertility and ectopic pregnancy. If a pregnant woman is infected or becomes infected during pregnancy, this can increase the risk of premature contractions, prematurely broken membranes, premature birth and low birth weight. The mother can also infect the baby during childbirth, which can cause eye infection and respiratory infections in the baby. The mother has an increased risk of inflammation of the endometrium after pregnancy. 

Is there anything I can do myself against Chlamydia? 

Chlamydia can be prevented by having safe sexual contacts. Use a condom if you have different sexual partners. Have Chlamydia treated when you know that you are infected and inform your former sexual partners so that they can also be tested and treated if necessary. For men with symptoms, we recommend that you warn all partners with whom you have had sexual contact (with or without a condom) 4 to 6 weeks prior to the onset of the symptoms, so that they can have themselves tested and treated. For women without symptoms, or if the infection has been around for a long time, we recommend that you warn all partners from the last 6 months, so that they can be tested and treated if necessary. Have yourself tested for Chlamydia and other STDs once every six months when you have different sexual contacts. 

What are the forms of treatment? 

Choice of the doctor  

If you suspect that you are infected with Chlamydia, you should be tested for it. In men, a urine test is often sufficient. In women, some secretion is taken from the vagina with a kind of cotton swab. When anal sex has taken place, a kind of cotton swab is used to remove the secretion from the anus. In case of serious complaints, medication can be started immediately without waiting for the result of the examination.  

Medication  

Chlamydia is easy to treat with antibiotics. Your partner(s) will be given a course of treatment at the same time as you, so that you do not infect each other. It is very important to finish the course. It is advisable not to have sex until one week after starting the treatment, not even with the mouth or with the hands, because Chlamydia is contagious until one week after starting the treatment.  The antibiotics used depend on the form of Chlamydia, where the infection spreads, and the gender of the person. For all antibiotics, if they cause allergies, another antibiotic has to be found. 

Treatment of Chlamydia in women with vaginal or urethra infection

  • Azithromycin: once, the preferred form of administration via the mouth, or 
  • Doxycline: 7 days long, oral administration.

Doxicycline is strongly advised against in the 2nd and 3rd trimester of pregnancy due to adverse effects on the mother and the unborn child. As a precaution, use in the first trimester of the pregnancy is not recommended. It is also not recommended in case of severe liver dysfunctions and in case of combined severe kidney and (some degree of) liver failure. 

When antibiotics falling under the 1st choice give allergies, it is advisable to choose antibiotics from the 2nd choice: a treatment of 7 days, with the form of oral administration of one of the following medicines: 

  • Amoxicillin 
  • Levofloxacin 
  • Ofloxacin 

Amoxicillin and levoflaxin are strongly advised against in case of severe hypersensitivity, jaundice, liver dysfunction and severe skin reaction in the past.  

Ofloxacin is strongly advised against in epilepsy and tendon diseases. In case of pregnancy, you can choose between the following antibiotics that are taken via the mouth: 

  • Azitromycin: one-time dose 
  • Amoxicillin treatment 
  • Erytromycine treatment 

Amoxicillin is strongly advised against in case of severe hypersensitivity, jaundice, liver dysfunction and severe skin reaction in the past.  Erythromycin is strongly advised against in case of severe liver failure. 

In case of infection of the anus/rectum: 

  • Doxycycline treatment administration form to take through the mouth

Doxycycline is not recommended in the 2nd and 3rd trimester of pregnancy because of adverse effects on the mother and the unborn child. As a precaution, the use in the first trimester of pregnancy is also not recommended. It is also not recommended in case of severe hepatic impairment and in case of combined severe kidney and (some degree of) liver failure. 

With LGV 

21 days of treatment can be given for one of the following medicines by mouth: 

  • Doxycycline 
  • Erytromycine 

Doxycycline is not recommended in the 2nd and 3rd trimester of pregnancy because of adverse effects on the mother and the unborn child. As a precaution, the use in the first trimester of pregnancy is also not recommended. It is also not recommended in case of severe hepatic impairment and in case of combined severe kidney and (some degree of) liver failure. 

Erythromycin is strongly advised against in case of severe liver failure. After treatment or during a long-term treatment (LGV) we recommend a check-up for persistent or recurring complaints. Or when there has been unsafe sexual contact in the meantime. 

Alternative treatments 

There are no alternative treatments for Chlamydia. The only thing you can do is to prevent the sexual transmission as much as possible by using condoms when you have different partners. Condom use, however, is not 100% safe. Therefore, have yourself tested at least twice a year if you have different sexual contacts or if there was a problem with the condom during the sexual contact.  

Lifestyle changes 

Contracting an STD depends to a large extent on someone's sexual risk behaviour. Sexual risk behaviour includes having sex with different partners without using a condom. Lifestyle changes may in that case be safe sexual with the use of condoms, and possibly restricting sexual partners.  

Additional risks and side effects 

Additional risks and side effects of Chlamydia can only occur when Chlamydia is not treated. There is a high risk of spreading. The Chlamydia bacterium is passed on to another person, who can also pass it on, and so on. Individually, the side effects spread the infection elsewhere in the body. This can have serious consequences for women, such as infertility and ectopic pregnancy.  

How to prevent Chlamydia 

You can prevent Chlamydia by having safe sex. If you have a new partner, always use a condom. Both of you should be tested to make sure that you do not have Chlamydia without it being noticed. If you are both negative and you are regular and sole partners, you can have sex without a condom.   

 

 

References

NHG (z.j.). Table 2 Partner warning. (Consulted on 14/04/2019).  https://www.nhg.org/?tmp-no-mobile=1&q=node/1779 

Pharmacotherapeutic compass (z.j.). STDs/treatment plan/medication. (Consulted on 14/04/2019).https://www.farmacotherapeutischkompas.nl/bladeren/indicatieteksten/seksueel_overdraagbare_aandoeningen 

Rivm (Publication date 25-03-2011 | 00:00 Amendment date 02-11-2018 | 18:53). LGV; a special form of Chlamydia Trachomatis. (Consulted on 14/04/2019). https://www.rivm.nl/chlamydia-trachomatis/lgv-bijzondere-vorm-van-chlamydia-trachomatis 

Rivm (Publication date 25-03-2011 | 00:00 Change date 18-02-2019 | 14:59). Chlamydia and pregnancy. (Consulted on 14/04/2019)  https://www.rivm.nl/chlamydia-trachomatis/chlamydia-en-zwangerschap 

Soa aisd nl (z.j.). Symptoms of Chlamydia. (Consulted on 14/04/2019). https://www.soaaids.nl/nl/soas/veel-voorkomende-soas/chlamydia 

Thuisarts.nl (z.j.). What is Chlamydia? (Consulted on 14/04/2019). https://www.thuisarts.nl/chlamydia/ik-heb-chlamydia 

Thuisarts.nl (z.j.). Investigations (Consulted on 14/04/2019).https://www.thuisarts.nl/chlamydia/ik-heb-chlamydia#hoe-wordt-chlamydia-vastgesteld