This month we re-visit in depth the most commonly detected sexually transmitted infection (STI) - Chlamydia. Although we British usually blush at the mere mention of STIs, it is important that we have open discussion as currently we have by far the greatest transmission of STIs in Western Europe (and the highest rate of teenage pregnancies), a statistic not to be proud of. It is foolish to believe that talking about safe sex and making condoms easily available for teenagers promotes earlier sexual behaviour - teenagers will engage is sex anyway, and is better that they do so safely without the risk of pregnancy or transmission of STIs. It is society's reluctance to promote safe sex that has led to the UK's devastating record, and teenagers are contracting Chlamydia (as well as other STIs) in alarming numbers - indeed because of poor education in some areas it is seen as a 'badge of achievement' (reference to a recent Channel 4 documentary) - having Chlamydia is not something to be proud of - repeated infections (often without symptoms) can lead to infertility in both sexes and chronic pelvic pain in women.
What is Chlamydia?
Chlamydia is caused by a bacteria called Chlamydia trichomatis and is passed on to others, often without knowing, by coming into contact with the semen or vaginal fluid of a person who has Chlamydia. It is now so common that 1 in 14 people under the age of 25, who are tested, are positive. The number continues to rise and the reason for this is that 70% infected women and 50% of infected men have no symptoms, so do not realise that they are passing Chlamydia on. Wearing a condom would help prevent Chlamydia and other STIs - but unfortunately condom use is still erratic amongst young adults - the very group who are most at risk.
What are the symptoms?
If symptoms occur in women (30% of infected individuals), they include vaginal discharge (due to inflammation of the cervix), pain or burning when passing urine (similar to cystitis - due to inflammation of the urethra - the tube connecting the bladder to the outside), vaginal bleeding after sex or between periods, and lower abdominal or pelvic pain, especially during sex (due to pelvic inflammatory disease). Symptomatic men (50%) experience pain or burning when passing urine, a discharge from the end of the penis and pain and discomfort at the end of the penis (urethral meatus).
What will happen if it is not treated?
If left untreated, Chlamydia can cause pelvic inflammatory disease - severe inflammation of the uterus and Fallopian tubes in women - this occurs in one in 5 with Chlamydia. It can cause acute fever and pain if it develops suddenly, or develop slowly over time, leading to chronic pelvic pain, infertility and an increased risk of ectopic pregnancy. If present during pregnancy it can cause miscarriage and stillbirth, and can infect the child during childbirth, causing severe eye or lung infections in the baby. It can cause infertility in men and Reiter's syndrome in both sexes - a rare condition causing arthritis and eye inflammation. The risk of complications is greatly reduced by early detection and treatment.
How can Chlamydia be tested for?
Chlamydia can now be easily tested by urine testing in both men and women. This is much more acceptable than the previously quite unpleasant swabbing of the urethra in men, or the cervix in women, but unlike the sample collected to test for urinary tract infections (MSU - mid stream urine), it is the first flow of urine which is sampled and sent off. The sample should be returned to the practice nurse who will check that the forms have been filled in correctly (and prevent delays in obtaining results if not all the correct information is available), and the sample itself is sent to the local lab, and the paperwork is sent to the Terrence Higgins Trust which will inform all those tested with the result and arrange treatment if this is required (usually just a single dose of the appropriate antibiotic treatment - Azithromycin). Sex should be avoided for 7 days after the infected individual and their partner have finished treatment, to avoid re-infecting themselves. Any sexual contacts that may have been potentially exposed during the previous 6 months should be traced, tested and treated - if the person testing positive do not want to contact partners from previous relationships, then the staff who sort out their treatment can contract previous partners without disclosing their details. After treatment person testing positive for Chlamydia will be contacted by a nurse to make sure they have recovered and not had any problems with the treatment. The result does not go to their GP, so will not go on GP records if the test is positive for Chlamydia - no-one apart from the person submitting the test sample will be informed of the result.
Who should get tested?
Because teenagers are the most likely to become infected, the Government has rolled out a
program to offer testing for all 15-24 year olds free of charge, and to make it more available, anyone in this age group can collect the form and sample tubes from their local GP surgery. The test is also offered to anyone aged 25 or over who is the partner, or who has been identified as a contact of someone testing positive that has been picked up by the program. The test is fully confidential and the result will be sent directly to the patient - they can even receive the results by text messaging. It is suggested that young people should ask for the test on an annual basis, and with every new partner. Hopefully if all infected people are picked up and treated promptly, and if people use condoms more consistently, Chlamydia and other STIs will go into decline, and stop the risk of inflicting unpleasant complications. If you fall into the above category, or know of others that do, then please let them know about the availability of testing.