Symptoms of Chlamydia

chlamydia symptoms
© Verywell, 2018

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.

Frequent Symptoms

Most people with chlamydia feel fine. For 70 percent to 95 percent of women and 90 percent of men, there are no symptoms associated with the infection. The lack of symptoms, however, doesn't mean the infection is not a problem.

When chlamydia causes genital symptoms, they usually appear around three weeks after exposure, but the bacteria can be present for months or years before it is detected. 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 75 percent to 80 percent 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, formerly known as Reiter's syndrome, 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 three to six weeks after exposure to the bacteria and resolves in three to six 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 percent to 15 percent of women with untreated chlamydia will go on to develop this issue.

PID may either be acute, causing significant symptoms, or subacute (subclinical), having 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 percent of women who have had PID due to chlamydia.

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 PID, roughly 20 percent will experience infertility. Sometimes surgery can remove some of the scarring, but this, in turn, may also increase the risk of the next complication.

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 and Chronic Scrotal Pain

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 Issues

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. Sadly, the risk of stillbirth (intrauterine demise) appears to be around 40 percent higher for mothers with chlamydia than average. Fortunately, recent studies have found that these complications are not more common if a woman is treated before or during pregnancy.

Newborn Problems

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 18 percent to 44 percent 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 percent to 16 percent 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).

Increased Risk of Cervical Cancer

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 suggested that the answer is yes and that co-infection with HPV and chlamydia roughly doubles the risk of developing cervical cancer. In 11 of the studies, chlamydia was an independent predictor of cervical cancer. 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. 

Increased Risk of HIV

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 percent of men who have sex with men (MSM) newly infected with HIV.

Lymphogranuloma Venereum (LGV)

Unlike the more common serotypes (serovars) 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 (death of cells in the tissues of the lymph nodes) that can sometimes be confused with other diseases. LGV is increasingly recognized as a cause of severe rectal symptoms in MSM. The treatment course for LGV serovars is significantly longer than that for other serotypes.

Symptoms of lymphogranuloma venereum are similar to some presentations of syphilis and often begin with a bump on the genitalia (which can become an open sore) one to two weeks after exposure. 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).

Regardless, women who are age 25 and under and sexually active should be tested every year, as should older women who have any risk factors for the 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.

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