Chlamydia Diagnosis

  • Diagnosis

    Chlamydia is the most common sexually-transmitted bacterial disease (STD) in the U.S. Chlamydia is a bacterial infection that is transmitted during contact with the genital or rectal area of an infected person. The majority of people who contract chlamydia are under the age of 25. It is a disease that often does not produce symptoms, so it possible to have it, not realize it, and pass it to someone else unknowingly. The one absolute way of preventing chlamydia is to avoid genital sexual contact. Chlamydia is treated with antibiotics.

    Chlamydia is often called "the silent epidemic." People with chlamydia may have very mild symptoms or no symptoms at all, so the condition is often overlooked. If left untreated this infection can lead to serious damage to the reproductive organs. For women these complications include pelvic inflammatory disease (PID), infertility, and a dangerous condition of pregnancy called ectopic pregnancy. This happens when the embryo starts growing outside of the womb, usually in one of the fallopian tubes. As the fetus develops, it can cause a life-threatening rupture of the tube.

    Men may suffer from an inflammation of the duct that drains the testis, a condition called epididymitis. Less common is inflammation of the testicles (orchitis). There is also a risk of infertility.

    Chlamydia can be treated and cured with antibiotics easily and quickly. Sexual partners of a person with chlamydia should also receive antibiotic treatment to prevent transmitting the disease back to their partner.

    Chlamydia is transmitted from bacteria carried by humans. Chlamydia is usually passed from person to person through sexual activity. The infection is transmitted during contact with the genital or rectal area of an infected person. It can also be transmitted from a mother to her baby during birth. Chlamydia is not transmitted through casual contact (toilet seats, hot tubs, saunas, or swimming pools).

    Chlamydia can be present for months without producing any uncomfortable symptoms Table 01. Because chlamydia does not always cause symptoms, it is called an asymptomatic disease. Symptoms of chlamydial infection, when and if they do occur, are discharge from the penis or vagina, and pain and burning with urination in women and men. Although less common, pain and swelling can occur that is localized in the eye (conjunctivitis), sex organs, (swelling of the fallopian tubes) or rectum (proctitis). Pain and swelling in the liver has been known to occur but it is very rare.

    Up to 70% of women and 25% of men with chlamydial infection have no symptoms. However, some people have symptoms as soon as seven to ten days after exposure to the bacteria.

    Table 1.  Symptoms of Chlamydial Infection

    Women Men
    An unusual, yellowish vaginal discharge Pus or watery or milky discharge from the penis
    Itching or burning in the genital area Burning with urination
    Abdominal or pelvic pain Swollen and/or painful testes
    Burning with urination Frequent urination
    Low-grade fever Burning or itching at the opening of the penis
    Urge to urinate more than usual
    Bleeding between menstrual periods
    Bleeding after intercourse

    Young people who engage in high-risk sexual activity have the greatest risk of acquiring chlamydia Table 02. If you are sexually active and have more than one partner, you put yourself at greater risk for getting chlamydia. However, certain types of sexual behavior increase your risk even further. The type of contraception, if any, that you use, your rate of acquiring partners, your number of casual partners, your sexual preference, and type of sexual practice are factors to consider when trying to determine your risk. For example, gay men are less likely to get chlamydia because the rectum and the throat are much less susceptible to the bacteria than is the inner cervical area of women (located in the upper part of the vagina). Vaginal sex, as opposed to anal or oral sex, is the way that chlamydia is most commonly spread.

    Women are at a greater risk of chlamydia than men. The internal part of the cervix is the most susceptible to infection. A penis is protected by skin, which is not as porous. The penis has only one small opening at the tip that reveals any tissue that the bacteria is able to enter through.

    The rate of infection is highest among women ages 15-19, and is especially high among members of lower socioeconomic groups.

    Table 2.  Risk Factors for Chlamydial Infection

    Age (under 25)
    Being female
    Multiple sex partners
    Infected sex partner
    Inconsistent use of barrier contraceptives
    Sex while under the influence of drugs or alcohol
    High rate of acquiring new partners
    Having partners who have multiple partners themselves

    Your health care professional will ask you for a thorough sexual history Table 03. The idea of describing your sexual history to someone that you may or may not be familiar with is one of the more uncomfortable aspects of the visit. Your health provider will want to know how many sexual partners you currently have, what kind of sex you engage in, and your history of other STDs. Even though this might be embarrassing to talk about, it will be difficult to help yourself or your partners if you are not honest about your sexual practices. By going to see your medical provider, you have decided to take care of yourself and to take responsibility for your decisions. Having a mature discussion about your sexual behavior can ensure that you receive proper treatment. Should you choose to continue to engage in high-risk sexual practices, it is crucial that you understand how your lifestyle affects your health and the health of others. The visit and discussion is an opportunity to become educated.

    Your sexual history is important to the doctor even if you do not display any symptoms. If you are in a high-risk group for getting chlamydia, your doctor will want to test you for a number of STDs, as it is possible to have several at the same time.

    Table 3.  Elements of a Sexual History

    Number of sexual partners:
    Since past evaluation
    In the past 60 days
    In the past year
    In your lifetime
    Sexual preference:
    Do you have sex with men only, women only, or both men and women?
    Types of partners:
    Do you have sex with the same partners on a regular basis, or are your relationships more casual; that is, do you have sex with one person only once, another person every once in a while, etc?
    How recent is your newest sexual partner?
    Within 30 to 60 days?
    Sexual Practices
    Do you have vaginal intercourse, oral, or rectal intercourse?
    Types of contraception:
    Do you use the barrier methods of condoms or diaphragm? How often do you use condoms or diaphragms? Every time you have sex, or only some of the times you have sex?
    History of sexually transmitted diseases:
    What STDs, if any, have you already had? (chlamydia, gonorrhea, pelvic inflammatory disease, herpes, syphilis, and warts)

    After taking your sexual history, your health provider will perform a physical examination. In a physical examination, your health professional will: 1) look for discharge or sores (lesions) in your pubic area and your external genital and rectal area; 2) carefully apply mild pressure around the groin area and other areas of the body to check for swelling and discharge; and 3) obtain samples of genital secretions for laboratory testing. If you are a woman, it is likely that a pelvic examination will be done as well.

    Screening can also be done without a physical exam using urine specimens or, in women, with a self-obtained vaginal swab.

    Laboratory tests are used to confirm a diagnosis. Tests are performed on either a urine sample or a discharge sample from a woman's cervix or a man's urethra, which is obtained by using a cotton swab. The sample is then sent to a lab for examination.

    Avoid engaging in high-risk sexual activity. Do not have sex with people whom you think have multiple partners. Do not have sex while you are under the influence of drugs or alcohol. You are less likely to use a condom if you are intoxicated and, because your judgment will be impaired, you are less likely to be careful about whom you decide to sleep with.

    Limit your number of sex partners. Because chlamydia is transmitted through sexual contact with infected individuals, if you stop having casual sex with multiple sexual partners, you will reduce your risk of acquiring the disease.

    Use barrier methods of contraception, preferably a condom every time you have sex to prevent chlamydial infection. Use a reliable backup method of birth control, such as the pill, to prevent pregnancy. Using barrier methods of birth control, such as latex or polyurethane condoms or a diaphragm, can decrease the chances that bacteria will be transmitted from your partner to you or vice versa. It is highly recommended that you use condoms instead of a diaphragm if you are sexually active, but not in a monogamous relationship. The diaphragm may protect you against chlamydia, but it won't protect you from other diseases, such as AIDS. Condoms are easier to use than a diaphragm, and are readily available in your local drugstore or supermarket. Condoms should only be used before their expiration date, and when no obvious signs of defects or damage are visible. They should be worn before any sexual contact is made with the penis, and each condom should be used only once.

    The U.S. government's Centers for Disease Control and Prevention recommend the following:

    • Use a new condom with each act of intercourse.
    • Carefully handle the condom to avoid damaging it with fingernails, teeth, or other sharp objects.
    • Put the condom on after the penis is erect but before any genital contact with your partner.
    • Ensure that no air is trapped in the tip of the condom.
    • Ensure adequate lubrication during intercourse, possibly requiring use of lubricants such as KY Jelly or glycerine. Never use oil-based lubricants such as petroleum jelly, shortening, mineral oil, massage oils, body lotions, or cooking oil. Oil can weaken latex, leading to tears in the condom.
    • Hold the condom firmly against the base of the penis during withdrawal. Withdraw while the penis is still erect to prevent slippage.
    • Besides using condoms, it is also recommended that you protect yourself against pregnancy by using a very reliable method of birth control, such as the pill or Depo-Provera injections. Talk to your health care professional about options.

    If you have more than one partner, and particularly if you are under the age of 25, get tested regularly, even if you do not have symptoms. Tests are affordable, easily obtained at any clinic or doctor's office, and highly recommended for women under the age of 25 whenever pelvic examinations are done.

    If you have recently been treated for a chlamydia infection, make sure your sex partner also receives treatment. Even in the absence of symptoms, your sex partner should be tested and treated if necessary. To avoid being reinfected with chlamydia, avoid sexual intercourse or use condoms for at least one week while you and your partner(s) are taking medicine.

  • Prevention and Screening

    Avoid engaging in high-risk sexual activity. Do not have sex with people whom you think have multiple partners. Do not have sex while you are under the influence of drugs or alcohol. You are less likely to use a condom if you are intoxicated and, because your judgment will be impaired, you are less likely to be careful about whom you decide to sleep with.

    Limit your number of sex partners. Because chlamydia is transmitted through sexual contact with infected individuals, if you stop having casual sex with multiple sexual partners, you will reduce your risk of acquiring the disease.

    Use barrier methods of contraception, preferably a condom every time you have sex to prevent chlamydial infection. Use a reliable backup method of birth control, such as the pill, to prevent pregnancy. Using barrier methods of birth control, such as latex or polyurethane condoms or a diaphragm, can decrease the chances that bacteria will be transmitted from your partner to you or vice versa. It is highly recommended that you use condoms instead of a diaphragm if you are sexually active, but not in a monogamous relationship. The diaphragm may protect you against chlamydia, but it won't protect you from other diseases, such as AIDS. Condoms are easier to use than a diaphragm, and are readily available in your local drugstore or supermarket. Condoms should only be used before their expiration date, and when no obvious signs of defects or damage are visible. They should be worn before any sexual contact is made with the penis, and each condom should be used only once.

    The U.S. government's Centers for Disease Control and Prevention recommend the following:

    • Use a new condom with each act of intercourse.
    • Carefully handle the condom to avoid damaging it with fingernails, teeth, or other sharp objects.
    • Put the condom on after the penis is erect but before any genital contact with your partner.
    • Ensure that no air is trapped in the tip of the condom.
    • Ensure adequate lubrication during intercourse, possibly requiring use of lubricants such as KY Jelly or glycerine. Never use oil-based lubricants such as petroleum jelly, shortening, mineral oil, massage oils, body lotions, or cooking oil. Oil can weaken latex, leading to tears in the condom.
    • Hold the condom firmly against the base of the penis during withdrawal. Withdraw while the penis is still erect to prevent slippage.
    • Besides using condoms, it is also recommended that you protect yourself against pregnancy by using a very reliable method of birth control, such as the pill or Depo-Provera injections. Talk to your health care professional about options.

    If you have more than one partner, and particularly if you are under the age of 25, get tested regularly, even if you do not have symptoms. Tests are affordable, easily obtained at any clinic or doctor's office, and highly recommended for women under the age of 25 whenever pelvic examinations are done.

    If you have recently been treated for a chlamydia infection, make sure your sex partner also receives treatment. Even in the absence of symptoms, your sex partner should be tested and treated if necessary. To avoid being reinfected with chlamydia, avoid sexual intercourse or use condoms for at least one week while you and your partner(s) are taking medicine.

Recommended Reading

Meet the Pharmacists

I'm Kristen Dore, PharmD. Welcome to PDR Health!

Check out my latest blog post on heartburn medication

Chlamydia Related Drugs

Chlamydia Related Conditions