Introduction

Chlamydia is one of the most commonly sexually transmitted infections (STIs). The infection can be asymptomatic but it can also prove to be very dangerous to a woman's reproductive system if left untreated. Nowadays, due to the lack of sexual education at a young age but also the lack of important relative knowledge from previous generations to pass on, many teens are exposed to chlamydia when they start navigating their sexuality, with the result being a rapid rise in cases. It can initially affect a person and their at-the-time sexual partner, and then affect more people through their future sexual partners, forming a chain reaction. Infected people are not aware of its symptoms and complications, transmission, and treatments available. Furthermore, those matters are sadly still taboo in our society, therefore it is hard for people to talk about them and seek help. To rise against that and equip ourselves with powerful knowledge, in this article, we will dive into what chlamydia actually is, what its symptoms are, what the prevention methods, treatments, and modes of transmission are, and the importance of sexual health education and awareness. 

What is Chlamydia?

Chlamydia is a sexually transmitted infection caused by the bacteria Chlamydia trachomatis.

Transmission

Chlamydia is transmitted through unprotected (without a condom) sexual contact, including oral, vaginal, or anal sex with an infected person. Another way chlamydia can be passed on is from an infected pregnant person to their child during birth. 

Symptoms and complications

A chlamydia infection can be asymptomatic (without symptoms), while in other cases there are various symptoms that can manifest. Symptoms slightly differ for people assigned male at birth (AMAB) and assigned female at birth (AFAB) due to the anatomy of their reproductive systems. Interestingly, chlamydia symptoms appear not only in the genital area as many mistakenly believe, but also in the rectal and abdominal areas, the upper aerodigestive tract (mouth, lip, tongue, and the upper part of the throat), and even the eyelids. 

Reproductive system and rectal symptoms:

• Abnormal discharge (vaginal or from the penis, rectal) - this can be thicker, white, cloudy, yellowish or greenish, or even bloody
• Irritated skin around the infected area
• Burning, stinging, or itching sensation during urination
• Pain or swelling in the testicles
• Painful sexual intercourse (dyspareunia)
• Inflammation of the cervix (cervicitis)
• Bleeding between periods or after sexual intercourse
• Pain in the lower abdomen
• Rectal pain

Upper aerodigestive tract symptoms:

• Sore throat (can resemble tonsillitis, cold or flu symptoms) - swollen tonsils or lymph nodes
• (Dry) cough
• Dental problems
• Mouth pain
• Sores around the mouth
• Fever
• Fatigue

Ocular symptoms

Chlamydia can also infect the eyes through hand-to-eye contact with genital fluids of an infected person. It usually affects one eye, although it can affect both. Symptoms of such an infection include:

• Eye redness (conjunctivitis)
• Pain
• Discharge (watery or pus) - crusting of lashes, eyelids "glued" together
• Itchiness
• Swelling
• Tearing
• "Foreign-body" sensation
• Blurred vision
• Photophobia (sensitivity to light)

There are several variants of chlamydia, some of them can even lead to blindness. 

If a chlamydia infection is left untreated, there are serious and irreversible potential complications that can occur for both AMAB and AFAB people.

For AMAB people, the infection can lead to swelling in the epididymis (tubes that carry the sperm from the testicles) and the testicles, causing swelling, pain, and fever, and ultimately affecting their fertility. This is known as epididymitis or epididymal-orchitis and is treated with antibiotics.

For AFAB people, the infection can spread all the way to the fallopian tubes, which may cause pelvic inflammatory disease (PID). Its symptoms include; fever, burning feeling during urination, severe pelvic pain, nausea, painful intercourse, and abnormal vaginal bleeding between periods or after sex. This condition is considered a medical emergency and is a major cause of difficulty getting pregnant, infertility, blocked fallopian tubes, chronic pelvic pain, and ectopic pregnancies among AFAB people. PID is usually treated with antibiotics, over the course of two weeks.

Lastly, chlamydia can lead to reactive arthritis, where your joint, eyes or urethra become inflamed. There is no available treatment for this, however non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can alleviate the symptoms. Most people get better within a few months. Untreated chlamydia may also increase one's chances of getting or giving HIV.

If a pregnant person carries chlamydia, then they can pass it on to the baby during childbirth. The baby can develop an eye or lung infection (pneumonia). Premature labour and birth or low birth weight of the baby may also be caused by chlamydia in the pregnant parent. 

Testing and diagnosis

Due to the possibility of serious implications following a chlamydia infection, and the easy transmission between people, it is generally recommended that individuals get tested at least once a year, even if there are no suspicions or symptoms present. However, one should not merely rely on this recommendation if they fall in one of the following categories:

• Sexually active individuals
• Individuals with new or multiple sexual partners
• Those who have had unprotected sex or a condom broke/split
• Those whose sexual partner informs them they are infected or suspect so
• Those who have not been tested in a long time
• Those who have had chlamydia infections in the past
• If they notice symptoms manifesting either in themselves or their partner
• Those unsure of their own or their partner's medical history 
• If they are pregnant or planning a pregnancy

To diagnose chlamydia a doctor may conduct a physical exam (observation of the area for any discharge, sores, or unusual spots) and review the individual's medical and sexual history, especially recently, as well as check to see if any symptoms of chlamydia are present.

The tests available for chlamydia are urine tests and swabs. They are simple and painless. 

Swab

The area that might be infected, like the inside of the vagina or anus, is gently sampled with a cotton swab. In the case of an infected throat or eye, a doctor may swab that area.

Urine tests

You will be asked to urinate in a container. For an accurate test result, you should have lastly urinated 1-2 hours before the test.

AFAB people can perform both tests, whilst AMAB people are usually asked to provide a urine sample. 

The sample is then sent to a laboratory for analysis and tested for the presence of DNA from the bacteria that cause chlamydia. The results are normally available in 1-10 days. 

Treatment

Luckily, chlamydia can be easily treated with antibiotics. Popular antibiotics used as treatment for chlamydia include: 

• Doxycycline: this is taken over the course of 1 week
• Azithromycin: this is usually taken in a single dose

The doctor may prescribe other antibiotics such as tetracycline, erythromycin or amoxicillin. Whichever antibiotic is taken, dosage and duration instructions should be strictly followed to make sure the infection clears up completely, even if the symptoms improve. This typically happens after around 1-2 weeks. For AFAB people, it is recommended to accompany their antibiotics routine with probiotics, to avoid side effects such as yeast infection. During treatment, it is advised to not participate in any sexual activity, even when using protection, as it is possible to transmit and contract chlamydia if exposed again. 

Although the treatment will fight off the infection, it can not undo any permanent damage caused by it, hence, early diagnosis and treatment are crucial. 

Risks and prevention

The spread of chlamydia usually occurs among sexually active teens and adults of ages between 15 and 35 years old, however age is not a defining factor, as anyone can contract chlamydia. The risk factors can include:

• Having multiple sexual partners
• Engaging in unprotected sexual activities
• Having an asymptomatic sexual partner
• Not washing hands following sexual contact
• Not getting tested often
• Sharing sex toys

Therefore, the preventive measures include: 

• Use of condoms during sexual activity
• Regular testing
• Open conversation with your partner(s)
• Sexual education
• Not sharing sex toys, and if you do share, always wash them or put a condom on them before use

The role of education and awareness

To enjoy healthy relationships, young people need more knowledge about sexuality and everything that comes with it. However, it is something that they are often not provided with. With the constantly evolving development of sciences, there is so much information available about sex-related issues, yet, most seem to not know what is available, where it is available, and how to acquire it. 

Due to the stigma associated with sex and sex-related matters, like STIs, more and more people turn to digital platforms for relevant information because of the privacy and anonymity the online environment offers. While internet searches are an easy and fast way to get answers, the answers available are not always monitored and verified. This has led to children and young people becoming increasingly exposed to incomplete, inaccurate, and even harmful content about sex online. Reliable online sources include the CDC, WHO, and UNESCO, among others. 

Sexual health information should be provided, ideally, from multiple sources. Parents and teachers, as important figures in the adolescent’s life, can help ensure that young people have access to valuable and accurate information to build critical skills and make informed choices. Additionally, in more formal settings, sexual education can be further supplied by trained social workers, healthcare professionals (doctors, local sexual health clinics, sexual health organisations), and counsellors. The purpose of all these is to help people develop a positive and respectful experience of sexuality and sexual relationships. A study demonstrated that when young people are better informed about sexuality, healthy sexual relationships and their rights, they are more likely to initiate sexual activity in a safer manner and continue this later on in life.¹ 

Comprehensive sexuality education (CSE) is a method of teaching, centered on the cognitive, emotional, social, and physical aspects of one’s sexuality. It aims to provide young people with accurate and age-appropriate information about sexuality and their bodies, to benefit their health and overall life. It is a curriculum that is comprehensive, scientifically accurate, and adjusted to different audiences. Adolescence is rightfully considered a period of emotional, cognitive, physical and social exploration and development. CSE teaching targets audiences throughout childhood to adolescence. Their areas of focus include familial relationships, anatomy, puberty, menstruation, contraception and pregnancies, consent, STIs, and where to seek help. 

Issues like STIs, are often associated with terms like “dirty”, which pushes people to self-stigmatisation and isolation when they find out they have contracted them. This makes the expression of health concerns and symptoms to healthcare professionals a challenge, although it is a crucial step for early diagnosis, treatment and stopping the spread of infection. Some individuals might even avoid referring their partners for treatment, or even informing them of their health status. As social psychologist and stigma researcher Valerie Earnshaw gracefully put it: “Humans create a stigma to enforce social norms.” Besides sexual education resulting in initiating protected sex at an older age as mentioned previously, another study revealed that sex education increased the likelihood of having a history of STIs testing and decreased the likelihood of having experienced unplanned pregnancy.²

FAQ’s

Can I get chlamydia from kissing?

No, you can’t get chlamydia from mouth-to-mouth kissing.

When should I get tested if I suspect I have chlamydia?

Generally, it may take several weeks before symptoms appear, but typically this happens 5 to 10 days after exposure. If you suspect you might have contracted chlamydia, you will probably be advised to wait 2 weeks after your suspected day of infection to get tested, because the infection might not be detected in its early stages.

Where can I get tested for chlamydia?

You can get checked for chlamydia and other STIs at a doctor's office or a sexual health clinic. In many countries, you can order chlamydia tests at home. 

Why is regular screening for chlamydia important?

A person who frequently gets tested can better keep track of their health status, but also possibly identify who they contracted the infection from, if that is the case. The latter of these benefits can also benefit the future sexual partners of both individuals involved. Moreover, somebody who gets tested regularly can identify and treat their infection early on if they are positive, minimising the chances of serious complications and symptoms that can put one at unease. In contrast to other non-transmissible medical conditions, chlamydia presents a chain reaction effect, as the health status of one individual can affect another and so on. Therefore even if one person is asymptomatic, the person they might give chlamydia to might not be, and irreversible damage can follow. All of this can be prevented by following prevention measures, regular screening and spreading awareness. 

When can I have sex again after completing my treatment for chlamydia? 

You should not have sex, even with a condom, until you and your sexual partner(s) complete treatment, to avoid the risk of transmission or reinfection. If the doctor prescribes the one-dose medication, you should wait 7 days after taking the medicine before having sex again, including oral sex. If the healthcare professional prescribes the medication taken over 7 days, you should wait until you finish all the doses.

Should I get tested again for chlamydia after completing my treatment? 

Yes, after you complete your treatment for chlamydia you should get tested again to ensure that the infection is fully cleared, and there is no danger of spreading it to others. 

Should I inform my sexual partner(s) if I test positive for chlamydia?

Yes, you should inform your recent sexual partners (up to 3 months) since they might have gotten infected or might have infected you without knowing. Some clinics offer the choice to inform your partner(s) for you with anonymity. They will just inform them that a person they came to contact with has tested positive and that they should get checked.

If I test positive for chlamydia, should my partner get tested and treated too? 

Yes, your current sexual partner and any other recent sexual partners you have had should also be tested and treated to help stop the spread of the infection. Besides others getting infected, if the partner is not treated, it is highly likely that you will get reinfected even if you get treatment after the first time. If there's a high chance they also have chlamydia, if you have had unprotected sex for example, it is possible to start treatment before the results of the test are available. 

Can I get chlamydia again if I have had it before?

Yes, even if you have had chlamydia in the past and received treatment, you can get it again. Moreover, usually, if you have chlamydia, you are offered another test 3-6 months after the completion of your treatment. This happens because someone who has tested positive for chlamydia is at an increased risk of catching it again. That is why it is important for the partner of an infected person to get treated as well. Keep in mind that the more antibiotics you take, the more your body becomes resistant to them, so the best way to fight chlamydia is to prevent (re)infections.

Summary

Chlamydia is a prevalent sexually transmitted infection (STI). The infection is primarily spread through unprotected sexual contact and can also be passed from a pregnant parent to their child during birth. While it is typically asymptomatic, if left untreated, it can cause severe complications, particularly for AFAB people and their reproductive system. Symptoms vary by biological sex due to differences in the anatomy of their reproductive system, and can affect the genital, rectal, aerodigestive tract, and even ocular regions. Early diagnosis through regular testing and appropriate antibiotic treatment is crucial to prevent further complications such as pelvic inflammatory disease (PID) and infertility. The lack of sexual education contributes to the rising cases of chlamydia, highlighting the need for open discussions and accurate information to promote sexual health awareness. 

In a nutshell, educating the public about sexual health matters aims to:

• Encourage open conversations about sexual health
• Guide people on where to seek help from
• Inform people about what happens in their body and what they can do about it
• Help people understand and ensure the protection of their rights 
• Make people realise their choices affect their own well-being and that of others
• Reduce stigma associated with STIs and sexual activity in general

Lastly, if you suspect you have contracted chlamydia or any other STI, inform the possibly affected people (i.e. your recent sexual partner(s)), seek professional guidance for testing and treatment plans, and do not merely rely on the internet as a source of information. It is nothing to be ashamed of and thankfully it is something that can be treated if dealt with appropriately. Help the people around you, care about the people around you, by spreading awareness and reducing the stigma of such common issues.