What is chlamydia?
Chlamydia is a sexually transmitted disease caused by a tiny bacterium Chlamydia trachomatis. If you haven't heard of chlamydia, you're in good company. The vast majority of the UK population hasn't heard of it either. More worrying is that those most at risk of this infection and its serious complications are also the least likely to know about it, let alone take appropriate action.

Why should I know about it?

Chlamydia is the most common, treatable, sexually-transmitted infection. It often presents no symptoms in men or women unless it leads to complications - when treatment can sometimes be too late to stop permanent damage.

In some women, infection can damage the fallopian tubes (which conduct eggs from the ovaries to the womb), which stop working properly and can become completely blocked.

Sometimes, infection leads to pain in the lower abdomen that is often mistaken for some other problem rather than pelvic infection.

Chlamydia is the most common, preventable cause of infertility in women. When the fallopian tubes are blocked, no pregnancy is possible naturally. One option is in vitro fertilisation (IVF) but this is usually not available on the NHS and has variable success rates (usually no more than 20 per cent of women end up with a baby).

Occasionally, women with damaged tubes do get pregnant but the pregnancy can develop in the tubes rather than the womb. This is called an ectopic pregnancy. The tube can split apart causing serious pain and bleeding. This is an emergency as the bleeding can be life threatening.

Men can also run into trouble. Chlamydia is the commonest cause of acutely inflamed testicles (epididymitis) in men under 35 and a well-recognised cause of joint problems in some young men.

Why don't I know about it?
In the UK, we have one of the best networks of clinics in Europe to diagnose and treat sexually-transmitted infections (genitourinary or sexual health clinics). But, women often have no reason to suspect they have chlamydia so do not seek advice at one of these clinics. Apart from sexual health experts, many doctors do not have sufficient knowledge and training to suspect that symptoms can be caused by chlamydia and to do an appropriate test. More importantly, health-care professionals are often unaware of how common the problem is and that it does not usually cause symptoms.

An education campaign for professionals is badly needed. Some clinicians find it difficult to talk about sex or to put their patients at ease. Most general practitioners are so pushed for time that the thought of embarking on a discussion about a sexually-transmitted infection is a bridge too far.

The best place to get help and advice is from the health advisors who are part of the team working in sexual health clinics. To find your nearest clinic, check the phone book or contact the Association of Genitourinary Medicine or the LoveLife programme of Health Promotion England.

How is chlamydia diagnosed?
Until five years ago, testing for chlamydia in women involved taking a swab taken from the cervix (neck of the womb) during a speculum examination (using an instrument to hold open the vagina similar to a smear test). More recently, new tests have been developed that are done on urine samples, or on swabs that a woman inserts into the vagina herself, which is then put into a container and sent to the laboratory. These new tests avoid the need for an intimate and uncomfortable examination and makes testing much easier for women.

Previously for men, the only sample that was satisfactory was from a swab put into the urethra. Now a test can be done on urine, although this is not as reliable as one done on a swab. A urine test is easy and doesn't hurt!

Unfortunately, the new tests are twice as expensive as the old ones and the government has not provided the extra money to adopt the newer tests. Some clinics, hospitals and general practices have found resources to use the newer tests.

How do I know if I should be tested?
Chlamydia is almost always transmitted through sexual intercourse and the likelihood of having the infection depends on your sexual behaviour. The more partners you have, the more likely you are to be exposed to infection. However, you only need to have unprotected sex with one person who happens to have the infection and you can catch it. You don't have to be promiscuous to get chlamydia.

The infection is most common and most likely to cause serious complications in younger women. If you are under 25 and sexually active, you have a 1-in-10 chance of having chlamydia, so it may be worth getting checked out. Your risk is even higher if you are under 20 and have had unprotected sex. If you are over 25 and have had two partners within a year, or recently changed partner your risk is also increased.

Not so much is known about risk of infection in men. The highest risk group in men is between 20 and 30 years.

What are the symptoms?
Some women may have symptoms such as cystitis, change in vaginal discharge, mild lower abdominal pain. These are very 'non-specific symptoms' and can be caused by other infections and diseases. If you go to a GP or family planning doctor with these symptoms, make sure you have a chlamydia test taken. This test is not routinely carried out when you have a smear test. Many women are under the illusion that this is the case and are falsely reassured. If you are unable to get the test from these health care settings, then find where your nearest genitourinary medicine (sexual health) clinic is situated and go and have a check up. This is really important if you are under 25 or if you have recently changed sexual partner and the symptoms coincided or came a few months after the change in partner.

In men, chlamydia is the commonest cause of urethral discharge from the penis. Sometimes chlamydia can cause mild irritation at the end of the penis, which disappears after two or three days. Many men suffering some discomfort will wait to see if it goes away. Unfortunately, the discomfort may disappear but the infection can still be present. They can, therefore, transmit it to a sexual partner and also risk the complication of swollen testicles. Chlamydial infection can affect sperm function and fertility in men.

Remember: If in doubt go and have a test taken.

How can I avoid getting infected?
Condoms are effective in preventing spread of the infection. Obviously there is no point in one half of a sexual partnership getting treated for sexually-transmitted infection unless the other half also gets treated. Otherwise the untreated partner just gets re-infected. Getting repeated infection can cause far worse consequences from the point of view of fertility in women.

What about 'the Public Health'?
Over the past few years, there has been more publicity given to chlamydia infection and its consequences. However, between 1998 and 1999 in England reports from the genitourinary medicine clinics suggest at least a 20 per cent increase in chlamydia. In other Western European countries, particularly Scandinavia, Denmark and Holland, chlamydial infections have decreased over the last 15 years, in some instances to almost zero. There has been a dramatic decrease in women being admitted to hospital with pelvic infection and in the number of ectopic pregnancies in some countries. Meanwhile in the UK, ectopic pregnancies have shown no reduction and the data collection for pelvic infection is so unreliable as to be almost useless. But what is available suggests very little change over the last few years.

Why is it that other countries have made some inroads into controlling the chlamydial epidemic, whereas the reverse is true in the UK?
There are many contributing factors - sexually-transmitted infections are discussed in school-based sex education programmes, wide-spread availability of tests, high profile public education campaigns, attention has been paid to educating practitioners who may deal with the consequences of chlamydial infection (particularly obstetricians and gynaecologists). In Sweden these initiatives were started more than 20 years ago. Now the new tests have been introduced in most Western European countries and the USA. In the UK, the previous government, following increased publicity about chlamydia, set up a working group in 1996 to discuss whether we should screen for this infection and whether it would be cost effective to do so. The report was published two years later. We are now two years further on and awaiting the result of a pilot study in the Wirral and Portsmouth before decisions are made about whether to go to national screening. Meanwhile, most tests currently used for detecting chlamydia are inaccurate. Although some educational initiatives have been started for both professionals and public, these are piecemeal.

The UK situation is pretty dire. It might not be clear which is the best way to undertake screening, how to ensure that sexual partners get treated, but the first step along the way must be to inform the people who are at risk.

So what can we do?
If you have concerns, then act on them and get yourself checked out. Make sure that your friends have heard about the infection and its consequences. Encourage them to get checked up if they think they may be at risk. Make sure that your sexual partner gets treated if you are infected and if possible encourage your ex-partners to also get checked as this infection can stay unrecognised for months, if not years. Use condoms and before you stop using them, make sure you and your partner get a sexually-transmitted-infection screen.

We could do with some patient power. If you ask for a test and your GP is unable to provide it, then demand may hopefully lead to a change in resource. Surely it makes more sense to spend money trying to prevent the complications of chlamydial infection by detecting it early rather than spending large amounts of money on the complications? Your local Public Health department at your Health Authority may be a place to lodge any problems you may have encountered.

It is about time that we grasped the nettle and accepted that about half of under 16 year olds are having sex. Many do not use any contraception when they first start having sex and those that have been given contraception do not use it consistently. With a high teenage pregnancy rate you would also expect a high chlamydia rate. The drive to have sex is considerable and sex is usually pleasurable. It is unrealistic to expect adolescents going through emotional turmoil to make sensible, rational decisions. But knowing the potential consequences of your actions is one step on the way to weighing up the risks and benefits and being able to make an informed decision. And knowing where to go if you are concerned is essential to get help promptly.

And as well as thinking about your own situation, don't forget the health and safety of your own children. Discussing sex isn't easy for everyone but surveys suggest that kids like to hear about sex and relationships from a parent in preference to anyone else.

BACK

How to give up smoking

The documents contained in this web site are presented for information purposes only. The material is in no way intended to replace professional medical care or attention by a qualified practitioner. The materials in this web site cannot and should not be used as a basis for diagnosis or choice of treatment. Conditions for use