Introduction

The World Health Organization (WHO) estimates that over a million individuals worldwide get sexually transmitted diseases (STIs) daily, indicating that the incidence of STIs is still high. Infertility, difficult pregnancies, and malignancies can all be caused by STIs. Those who already have an STI are often co-infected with numerous bacteria, which can increase their infectivity and cause more severe clinical symptoms. The most common bacterial STI identified globally in both men and women is Chlamydia trachomatis (CT).¹

Contact with vaginal fluid or semen containing chlamydia bacteria can transmit the infection from an infected person to a non-infected person during sex.

Although many are aware that this can happen during vaginal and anal intercourse, fewer people are aware that even oral sex may also spread chlamydia. This article will explore how chlamydia can be contracted through oral sex, the risks involved, and the steps you can take to prevent it.

What is chlamydia?

Chlamydia is an infectious disease caused by the bacteria, Chlamydia trachomatis which can be transmitted sexually.² 

Globally Chlamydia trachomatis causes the majority of cases of infection-related blindness and accounts for the majority of sexually transmitted infections. Chlamydia is contracted through having unprotected sexual interactions with a partner carrying the infection, or by a mother-to-child route; in the womb or during delivery. 

Adults who are sexually active and often change partners have the highest rates of infection. Although the infection is common, mostly hidden due to its lack of obvious symptoms and not easily diagnosed, it is one of the most treatable and curable sexually transmitted infections.³ Early detection and effective treatment can prevent complications that arise from chronic chlamydia infection. 

How can I become infected?

The source of chlamydia is an infection with the bacteria Chlamydia trachomatis which is transmitted by sexual intercourse with an infected individual. This means that if precautions are not followed, any type of sexual activity with an infected person – vaginal, anal, or oral – has the potential to spread the infection.

Symptoms of chlamydia 

It is difficult to control the spread of chlamydia in populations because it frequently causes no symptoms, earning it the moniker "silent" infection. In 2020, globally, an estimated 128.5 million new infections with Chlamydia trachomatis occurred among adults aged 15 to 49 years. When symptoms do occur, they may include:

In people assigned female at birth (AFAB):

• Abnormal discharge from the vagina
• Pain when urinating
• Bleeding between periods
• Pain during sex

In people assigned male at birth (AMAB):

• Discharge from the penis
• Pain when urinating
• Enlargement or discomfort in one or both testicles

Many people might not know they have chlamydia because symptoms can be non-existent or subtle, which creates the possibility of inadvertent transmission of the infection and silent illness progression.

Chlamydia and oral sex

In oral sex, the partner's genitalia or adjacent erogenous zones are stimulated using the mouth, and tongue, such as during cunnilingus (oro-vaginal contact), fellatio (oro-penile contact), and anilingus (oro-anal contact). 

Oral sex can spread chlamydia when body fluids from infected people come into contact with uninfected individuals. You run the risk of contracting chlamydia if you give oral sex stimulation to someone who has the infection. On the other hand, you can also get chlamydia in your genital region if you have received oral sex from someone who has an infection in their throat. 

Since oral STIs are asymptomatic, a lot of complications may potentially result, such as conjunctivitis, reactive arthritis, epididymitis, and infertility, but remain unnoticed or unattributed to chlamydia. 

Risk factors for chlamydia infection through oral sex

Some behaviours can increase the risk of contracting chlamydia through oral sex. These include:

• Having unprotected oral sex: Not using barrier techniques (such as condoms or dental dams) increases the risk of contracting a chlamydia infection⁴
• Multiple sexual partners: Having multiple sexual partners increases the risk of coming into contact with a person with a chlamydia infection
• Having a history of other STIs: Because previous STIs may cause damage to mucous membranes, a history of STIs can increase the risk of contracting chlamydia⁵

Common misconceptions about oral sex and STI transmission 

• Enhancement misconception: Oral sex is viewed as a way to enhance sexual experience before penetrative sex, leading to underestimation of STI risks
• Erection concerns: Belief that condoms hinder erection, reducing sexual pleasure and discouraging their use
• Trust and intimacy symbol: Swallowing semen is seen as a trust token, with condoms perceived as diminishing this act
• Symbol of love: Unprotected sex is viewed as a symbol of love and fidelity, leading to reluctance to use condoms with romantic partners
• Negative sensory experience: The unpleasant taste and odour of latex condoms discourage their use during oral sex
• Perceived harm from lubricants: Fear that condom lubricants are harmful and can cause stomach issues discourages their use
• Zero risk misconception: Many believe oral sex carries no risk of STI transmission, reducing condom use^4,8

Symptoms of chlamydia in the mouth acquired through oral sex include:

• A chronic sore throat that is not accompanied by other common cold symptoms
• Redness in the throat
• Swelling in the throat and tonsils
• Pain and discomfort in the throat
• Visible white spots on the tonsils

Risks and complications associated with chlamydia from oral infection 

• Health complications: Redness, discomfort, and swelling are typical symptoms of a sore throat, which can also result from chlamydia infections in the throat. Chlamydia can cause more severe health issues if left untreated. It is the number one infectious cause of blindness globally, causing the eye infection trachoma²
• Tonsils and mouth infections: Chronic sore throats and other problems with oral health might be brought on by persistent infections
• Spread to other parts of the body: If the infection spreads to other parts of the body, it may result in sexual health disorders such as pelvic inflammatory disease (PID) in women which can lead to infertility. In men, long-term chlamydia infection causes epididymitis, a condition of the testicles that can also lead to infertility. Increased risk of other STIs such as HIV, is also evident in chlamydia infection. Prolonged chlamydia infection can lead to carcinogenesis⁷
• Pneumonia: Can occur in newborns whose mothers have a cervical Chlamydia trachomatis infection

Diagnosis of chlamydia

Most of the time, a chlamydial infection has no symptoms.⁶

Chlamydia is often easily diagnosed with a simple test. Free chlamydia home test kits are available and sources are locatable in England using the NHS website, in Wales, using the Sexual Health Wales website and in Scotland using the NHS Inform website. A urine sample or swab from the afflicted location (e.g., throat, vagina, cervix, urethra, or rectum) may be taken by your healthcare professional for testing to confirm diagnosis.⁶

How to manage chlamydia infection

• The simple course of therapy for chlamydia infection is an antibiotic regimen, generally consisting of azithromycin or doxycycline. Even if symptoms go away fast, it's important to take the antibiotics as directed for the entire prescribed duration
• Three weeks after the end of therapy, the cure should be confirmed by a physician, and three months later, retesting should take place
• If symptoms don't go away after treatment, it should be considered whether reinfection or coinfection with a different bacterium has occurred

Preventive measures

• The practice of frequent screening and early diagnosis can help control infection transmission and aid treatment
• Affected people need information about high-risk activities, the importance of abstaining from sexual activity for a week following the start of medication, and advice for considering getting tested for HIV
• Affected people having their partners tested and treated, if necessary, helps prevent spread 
• Practising safe sex – using barrier methods such as condoms or dental dams

Risks and complications associated with chlamydia from oral infection 

• Health complications: Redness, discomfort, and swelling are typical symptoms of a sore throat, which can also result from chlamydia infections in the throat. Chlamydia can cause more severe health issues if left untreated. It is the number one infectious cause of blindness globally, causing the eye infection trachoma²
• Tonsils and mouth infections: Chronic sore throats and other problems with oral health might be brought on by persistent infections
• Pneumonia: Can occur in newborns whose mothers have a cervical Chlamydia trachomatis infection
• Spread to other parts of the body: If the infection spreads to other parts of the body, it may result in sexual health disorders such as pelvic inflammatory disease (PID) in women which can lead to infertility. In men, long-term chlamydia infection causes epididymitis, a condition of the testicles that can also lead to infertility. Increased risk of other STIs such as HIV, is also evident in chlamydia infection. Prolonged chlamydia infection can lead to carcinogenesis⁷

FAQs

How frequently should I get tested for chlamydia?

Consider being tested at least once a year if you engage in sexual activity, particularly if you have several partners.

Can chlamydia be avoided by maintaining good dental hygiene?

A healthy mouth is not enough to ward off chlamydia. Regular STI testing and the use of protection during oral sex are essential for prevention.

Is it possible to confuse other throat illnesses with oral chlamydia?

Yes, oral chlamydia symptoms can mimic those of other throat diseases. Therefore, testing is necessary to ensure an accurate diagnosis.

Can you get chlamydia again?

Yes, there is no vaccine for chlamydia so it is likely you may contract chlamydia again if you are exposed to the bacteria again. To lower the chance of a recurrence, it's critical to use protection and adhere to preventive measures.

Can I get chlamydia from kissing?

No, kissing does not spread chlamydia. Sexual contact involving the anus, throat, or genitalia is the main way that it spreads.

Summary

Oral sex is one of the many ways that chlamydia, a common STI, may be transmitted during sexual activity. Preventative actions and awareness of the risks are essential for safeguarding sexual health. You may significantly reduce your risk of contracting and transmitting chlamydia through oral sex by using barriers like condoms and dental dams, being screened frequently, and having good open lines of communication with your partners. Doctors prescribe antibiotics to treat chlamydia. 

Consider being tested at least once a year if you are sexually active, particularly if you have several partners. Always keep in mind that managing your sexual health is a big responsibility. Don't be afraid to ask for medical counsel if you have any concerns; instead, become educated to make good decisions. Chlamydia is easily treated and curable.