Symptoms of Chlamydia

In This Article

The signs and symptoms of a chlamydia infection depend on the part of the body infected—vagina, penis, rectum, or throat—and can range from vaginal or penile discharge to severe abdominal and/or pelvic pain.

Often, discomfort occurs during sex or urination. But far too often there are no warning signs to alert people to the diagnosis.

Since chlamydia can still cause damage and other complications even without symptoms, regular screening is critical to make sure these issues are avoided.

chlamydia symptoms
© Verywell, 2018

Frequent Symptoms

Most people with chlamydia feel fine. For approximately 70% of women and 93% of men, there are no symptoms associated with the infection. The lack of symptoms, however, doesn't mean the infection is not a problem.

Symptoms of chlamydia usually appear around three weeks after exposure. In some cases, the infection can be present for months or years before it is finally detected. During this time, other partners may become infected.

Symptoms of complications such as pelvic inflammatory disease (PID) can occur much later after exposure.

  • Vaginal discharge/penile discharge: The most common symptom of chlamydia in women is vaginal discharge. The discharge is usually yellowish in color, but both the consistency and color can vary. Men may have discharge from their penis that is often clear and thin but can be thick and mucousy. 
  • Pain with urination: Both men and women may note pain with urination (dysuria) due to inflammation of the urethra (urethritis), the tube that leads from the bladder to the outside of the body. Urinary frequency (having to urinate more often) may also occur. 
  • Pain, swelling, or itching of the penis or vulva: Redness, tenderness, swelling, or itchiness may occur around the opening of the penis in men or on the vulva or vagina in women.
  • Pain with intercourse/painful ejaculation: The cervix is the site of infection for a large majority of chlamydia cases in women. This can cause discomfort with intercourse (dyspareunia), especially with deep penetration. Pain may also be present due to inflammation in the fallopian tubes (PID). Men may note pain with ejaculation.
  • Bleeding between periods or with intercourse: Chlamydia-related inflammation of the cervix can cause this.
  • Abdominal and pelvic pain: Pain in the abdomen, pelvis, and back may occur with pelvic inflammatory disease.
  • Pain or swelling in the testes: Testicular pain and swelling may occur when chlamydia travels up through the urethra in men and into the epididymis; epididymitis may result.
  • Rectal pain, discharge or bleeding: Infection of the rectum with chlamydia due to transmission of the virus during receptive anal sex may cause pain, discharge, itching, and bleeding.

Rare Symptoms

Symptoms that are less common may include:

  • A sore throat: Transmission of the bacteria during oral sex may cause a sore throat, exudate (pus) on the tonsils, and pain with swallowing. 
  • Right upper abdominal pain (perihepatitis): Perihepatitis is a condition in which the capsule of the liver becomes inflamed. Also known as Fitz-Hugh-Curtis syndrome, it causes pain in the right upper portion of the abdomen.
  • Joint pain (reactive arthritis): Symptoms of inflammation in only a few joints (oligoarthritis) combined with inflammation of the eyes and urethra may occur. This reactive arthritis is not caused by the infection. Instead, it's due to a post-inflammatory process in which the body makes antibodies against its own tissue (autoimmune disease). It most often occurs one to four weeks after exposure to the bacteria and resolves in three to twelves months. It may or may not improve with antibiotics.

Complications

The complications of chlamydia infections are the most feared and serious aspect of them. And again, these issues may occur in people who never had symptoms. Fortunately, such complications are largely preventable through regular screening and prompt treatment.

Pelvic Inflammatory Disease (PID)

Chlamydia may cause abdominal and/or pelvic pain in women when the bacterium travels up through the cervix and uterus and into the fallopian tubes and ovaries, causing pelvic inflammatory disease (PID).

Roughly 10% to 15% of women with untreated chlamydia will develop pelvic inflammatory disease, either acute (symptomatic) or subacute (with few or no symptoms).

The symptoms of pelvic inflammatory disease may also include abdominal and pelvic pain, an often gnawing type of back pain, and sometimes fever or chills. On examination, a woman will experience discomfort when a physician manipulates her cervix. She may also feel pain over her ovary on one or both sides of her abdomen (adnexal pain). 

Chronic Pelvic Pain

Pelvic inflammatory disease may lead to chronic pelvic pain. This complication is common, occurring in roughly 30% of women who have had PID due to chlamydia.

Female Infertility

With PID, the infection and inflammation can result in scarring of the fallopian tubes. This scarring can block the passage of sperm into the fallopian tube, preventing fertilization and resulting in infertility.

Of women who develop pelvic inflammatory disease, roughly 20% will experience infertility. While surgery can be used to remove scarring in the fallopian tubes, doing so may increase the risk of an ectopic pregnancy.

Ectopic Pregnancy

An ectopic pregnancy or tubal pregnancy is a condition in which the embryo implants in a fallopian tube instead of in the uterus. When the fallopian tubes are scarred due to PID, the fertilized egg may become "stuck" and implant in the fallopian tube rather than travel to the uterus. An ectopic pregnancy can be a life-threatening condition, especially if it ruptures before it is discovered.

Male Infertility

It's not known for certain whether epididymitis due to chlamydia leads to infertility in men. Damage, however, may result in chronic pelvic or scrotal pain in men.

Pregnancy Complications

Women who have untreated chlamydia during pregnancy have an increased risk of several pregnancy complications. (A chlamydia test is recommended at the first OB visit for all pregnant women).

There is an increased risk of premature labor (and the complications that accompany preterm delivery). There is also an increased risk of endometritis (inflammation of the uterus) following delivery. Babies born to mothers with untreated chlamydia are more likely to be small for gestational age or have a low birth weight.

The risk of stillbirth is around 40% higher for pregnant women with untreated chlamydia compared to those without chlamydia. Fortunately, the risk is all but erased if a woman is treated before and during pregnancy.

Newborn Complications

When women have untreated chlamydia, the baby can become infected during vaginal childbirth. There are two issues that can occur:

  • Eye infections: Conjunctivitis (ophthalmia neonatorum) is thought to occur in almost 40% of infants born to mothers with untreated chlamydia. Symptoms, such as swollen eyelids, red eyes, and a thick, yellowish discharge usually occur in the first 10 days of life.
  • Pneumonia: This is somewhat less common, occurring in 3% to 16% of infants born to mothers with untreated chlamydia. Pneumonia most often occurs four to 12 weeks after delivery and usually begins with a cough and congestion.

It's important to note that if a mother is treated for chlamydia before or during pregnancy, the baby should be safe from these infections. For women who are high-risk, some obstetricians recommend repeat screening for chlamydia during the third trimester.

Rectal Scarring and Fissures

Rarely, inflammation of the rectum (proctitis) may lead to scarring and fissures (a fissure is an abnormal passageway from the rectum to another region of the body or outside of the body).

Cervical Cancer Risk

There has been controversy over whether chlamydia infections might increase the risk of cervical cancer caused by the human papillomavirus (HPV).

A 2016 review of 22 studies concluded that co-infection with HPV and chlamydia doubles a woman's risk of cervical cancer. In 11 of the studies, chlamydia was an independent predictor of a cervical malignancy.

It's thought that the inflammation of the pelvic organs related to chlamydia enhances the cancer-causing changes caused by HPV. That said, it's important to note that, in general, HPV infection is primarily to blame for the development of cervical cancer, not chlamydia. 

HIV Risk

Chlamydia infections (as well as other sexually transmitted infections, STIs) may also increase the risk of becoming infected with or transmitting HIV. The reasons for this are two-fold:

First, the infection can cause genital inflammation that can undermine the integrity of the mucosal tissue that lines the vagina, cervix, penis (urethra), and rectum. This provides HIV a more direct route into the bloodstream and lymphatic system.

Secondly, an active chlamydia infection can increase HIV viral activity around the genitals. When this happens, a person can potentially have an undetectable viral load on a blood test but a detectable viral load in semen or vaginal secretions. Some studies have suggested that chlamydia infections have been noted in as many as 15% of men who have sex with men (MSM) newly infected with HIV.

Lymphogranuloma Venereum

Unlike the more common serotypes of Chlamydia trachomatis that cause infections, there are some (L1, L2, and L3) that can cause a more severe syndrome known as lymphogranuloma venereum (LGV). It includes systemic symptoms and lymphadenopathy that can sometimes be confused with other diseases, like syphilis. The treatment course for LGV serovars is significantly longer than that for other serotypes.

Lymphogranuloma venereum typically begins with a bump on the genitals a week or two after exposure, progressing to an open ulcerative sore. Swollen lymph nodes and flu-like symptoms follow around two to six weeks later.

Symptoms include:

  • Enlarged, tender lymph nodes in the groin (inguinal nodes)
  • Fever and chills
  • An open sore on the genitalia (genital ulcer) at the site where the bacteria entered the body
  • Muscle aches

Complications can occur many years later due to damage to the lymphatic system in the groin.

Trachoma

As the leading cause of blindness worldwide, trachoma is not an STI but is instead transmitted by secretions from the eyes or nose. The infection usually begins with redness and a condition in which the eyelashes turn inward and scratch the cornea.

Any eye symptoms in third world countries should be evaluated thoroughly as prompt treatment is needed to preserve vision. (Trachoma is caused by different types of Chlamydia trachomatis than genital infections).

When to See a Doctor

It's important to talk to your doctor if you have any signs or symptoms of chlamydia (or any other symptoms that concern you).

According to the U.S. Preventive Services Task Force, women 25 and under and those who are sexually active should be screened for chlamydia every year, as should older women who have an increased risk of infection.

Screening for other STIs/STDs is important as well, as the risk factors for chlamydia also increase the likelihood of contracting these other infections. If you are treated for chlamydia, be sure to tell your healthcare provider if any symptoms persist.

It can be hard to read about the potential complications of chlamydia, but many of these are very preventable with appropriate screening, speaking to your doctor about any symptoms, and receiving treatment if you are positive. Our Doctor Discussion Guide below can help start that conversation with a healthcare professional.

Chlamydia Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman
Was this page helpful?

Article Sources

  1. Dela H, Attram N, Behene E, et al. Risk factors associated with gonorrhea and chlamydia transmission in selected health facilities in Ghana. BMC Infect Dis. 2019;19(1):425. doi:10.1186/s12879-019-4035-y

  2. Mohseni M, Takov V. Chlamydia. StatPearls Publishing. Updated June 4, 2019.

  3. Sutton TL, Martinko T, Hale S, Fairchok MP. Prevalence and high rate of asymptomatic infection of Chlamydia trachomatis in male college Reserve Officer Training Corps cadets. Sex Transm Dis. 2003;30(12):901-4. doi:10.1097/01.OLQ.0000091136.14932.8B

  4. Malhotra M, Sood S, Mukherjee A, Muralidhar S, Bala M. Genital Chlamydia trachomatis: an update. Indian J Med Res. 2013;138(3):303-16.

  5. Moi H, Blee K, Horner PJ. Management of non-gonococcal urethritis. BMC Infect Dis. 2015;15:294. doi:10.1186/s12879-015-1043-4

  6. Parnham A, Serefoglu EC. Retrograde ejaculation, painful ejaculation and hematospermia. Transl Androl Urol. 2016;5(4):592-601. doi:10.21037/tau.2016.06.05

  7. Hicks NR, Dawes M, Fleminger M, Goldman D, Hamling J, Hicks LJ. Evidence based case report: chlamydia infection in general practice. BMJ. 1999;318(7186):790-2. doi:10.1136/bmj.318.7186.790

  8. Das BB, Ronda J, Trent M. Pelvic inflammatory disease: improving awareness, prevention, and treatment. Infect Drug Resist. 2016;9:191-7. doi:10.2147/IDR.S91260

  9. Lee YS, Lee KS. Chlamydia and male lower urinary tract diseases. Korean J Urol. 2013;54(2):73-7. doi:10.4111/kju.2013.54.2.73

  10. Karlsson A, Österlund A, Forssén A. Pharyngeal Chlamydia trachomatis is not uncommon any more. Scand J Infect Dis. 2011;43(5):344-8. doi:10.3109/00365548.2011.553243

  11. Saurabh S, Unger E, Pavlides C. Fitz -Hugh-Curtis syndrome in a male patient. J Surg Case Rep. 2012;2012(3):12. doi:10.1093/jscr/2012.3.12

  12. Hamdulay SS, Glynne SJ, Keat A. When is arthritis reactive? Postgrad Med J. 2006;82(969):446-53. doi:10.1136/pgmj.2005.044057

  13. Jennings LK, Krywko DM. Pelvic Inflammatory Disease (PID). StatPearls Publishing. Updated February 11, 2019.

  14. Risser WL, Risser JM, Risser AL. Current perspectives in the USA on the diagnosis and treatment of pelvic inflammatory disease in adolescents. Adolesc Health Med Ther. 2017;8:87-94. doi:10.2147/AHMT.S115535

  15. Shaw JL, Dey SK, Critchley HO, Horne AW. Current knowledge of the aetiology of human tubal ectopic pregnancy. Hum Reprod Update. 2010;16(4):432-44. doi:10.1093/humupd/dmp057

  16. Adachi K, Nielsen-saines K, Klausner JD. Chlamydia trachomatis Infection in Pregnancy: The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in Sub-Saharan Africa and Asia. Biomed Res Int. 2016;2016:9315757. doi:10.1155/2016/9315757

  17. Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G. Neonatal conjunctivitis - a review. Malays Fam Physician. 2008;3(2):77-81.

  18. Mishra KN, Bhardwaj P, Mishra A, Kaushik A. Acute Chlamydia trachomatis respiratory infection in infants. J Glob Infect Dis. 2011;3(3):216-20. doi:10.4103/0974-777X.83525

  19. Assi R, Hashim PW, Reddy VB, Einarsdottir H, Longo WE. Sexually transmitted infections of the anus and rectum. World J Gastroenterol. 2014;20(41):15262-8. doi:10.3748/wjg.v20.i41.15262

  20. Zhu H, Shen Z, Luo H, Zhang W, Zhu X. Chlamydia Trachomatis Infection-Associated Risk of Cervical Cancer: A Meta-Analysis. Medicine (Baltimore). 2016;95(13):e3077. doi:10.1097/MD.0000000000003077

  21. Ward H, Rönn M. Contribution of sexually transmitted infections to the sexual transmission of HIV. Curr Opin HIV AIDS. 2010;5(4):305-10. doi:10.1097/COH.0b013e32833a8844

  22. Djoba siawaya JF. Chlamydia trachomatis, human immunodeficiency virus (HIV) distribution and sexual behaviors across gender and age group in an African setting. PLoS ONE. 2014;9(3):e90174. doi:10.1371/journal.pone.0090174

  23. Ceovic R, Gulin SJ. Lymphogranuloma venereum: diagnostic and treatment challenges. Infect Drug Resist. 2015;8:39-47. doi:10.2147/IDR.S57540

  24. Hu VH, Harding-esch EM, Burton MJ, Bailey RL, Kadimpeul J, Mabey DC. Epidemiology and control of trachoma: systematic review. Trop Med Int Health. 2010;15(6):673-91. doi:10.1111/j.1365-3156.2010.02521.x

Additional Reading