Overview

Chlamydia is a sexually transmitted disease, affecting those assigned male or female at birth (AMAB/AFAB) and symptoms, if present, vary with gender. Like many other sexually transmitted diseases (STDs), the risk of transmission can be reduced via condoms, or dental dams, as well as frequent testing, which is widely available for free in the UK. Antibiotic treatment is fast, effective, and also free of charge via the NHS. There are also nationwide initiatives to lower chlamydia spread in AFABs and to raise awareness of the disease within schools.

Background information

What is chlamydia?

Chlamydia is caused by the bacterium Chlamydia trachomatis. It is a sexually transmitted disease, which means that it is spread through different forms of sexual contact; these include vaginal, anal and oral intercourse, as well as the use of other body parts, like the fingers.¹

To put it simply, chlamydia is spread via sexual contact between one person who has the disease (regardless of testing for it), and another, who does not have it. It is not transmitted via skin-to-skin contact, kissing or sharing non-intimate clothing or towels. Any physical contact with genitalia has the risk of transmission, even if it is not sexual activity.

Symptoms

Chlamydia affects those assigned male at birth (AMAB) differently from those assigned female at birth (AFAB), notably due to the presence of different genitalia.¹

In AMABs, there may be cloudy, white discharge from the penis. Burning while peeing may also be experienced as well as itching/burning in the urethra (the tube within the penis that delivers urine). Chlamydia may also result in pain in the testes.

In AFABs, there may also be itching in the urethra, as well as cloudy vaginal discharge. Other symptoms include bleeding, which can also occur between periods and abdominal pain. If pregnant, there is a high chance of transmitting chlamydia to your unborn baby. Newborns may contract pneumonia or eye infections.

Primary strategies

Abstinence

The only way to ensure there is no risk of chlamydia infection at all is by practising abstinence (restraint of any sexual activity); there is no way for the bacteria to reach you if you make no sexual contact. As straightforward as this sounds, this may be difficult for some who believe this clashes with their lifestyle choices.^1,2

Abstinence may not be permanent; someone with chlamydia may abstain until adequate treatment has removed the infection.

Monogamy, limiting casual activity

The more sexual partners that you have, the higher the chances of contracting STDs, including chlamydia. Also, the rate at which sexually transmitted infections (STIs) spread increases with sexual activity among more partners, meaning that if you have chlamydia (whether you have tested for it) those people are at risk.²

Sexual monogamy is another method of reducing the risk, if both people involved are known not to have chlamydia, the chance to contract it is zero (provided there is no activity with other parties).¹

Aside from knowledge of having chlamydia, trust is just as important of a factor. Some people who know they have tested positive may still engage in sexual activity with others. Some people may be ashamed or afraid to tell others, or in rarer cases, have intentions to transmit. Intentional or reckless sexual transmission of infection is seen as a sexual offence in the eyes of UK law.

Ultimately, monogamy or any sexual relationship with established boundaries and transparency is an effective way of minimising, if not negating, the likelihood of receiving chlamydia infection.² 

Safer sex practices

There are two widely available resources you can use to reduce the chances of chlamydia spread; condoms and dental dams.

Condoms are sheaths, typically made of latex or polyurethane that are meant to be worn onto the penis, creating a physical, liquid-proof barrier with the vagina, anus or mouth. Condoms are intended to prevent bodily fluids from each partner from contacting each other, which may carry the pathogens responsible for STIs.³ These fluids are primarily vaginal lubricant or discharge, pre-ejaculate or semen. Condoms are also used as birth control, regardless of STIs presence.

Dental dams are small sheets, also made from latex or polyurethane, that can be laid onto the vagina or anus as a physical barrier during oral sex.⁴ Their name comes from the fact they were originally used in dentistry to isolate a single tooth from the rest on the jaw, however, they are now widely available to the public for safer sex. Condoms are somewhat more common to obtain, but they can be fashioned into dental dams simply by cutting them into sheets.

Condoms reportedly offer between 50% and 90% protection against chlamydia, and despite there being few statistics for dental dams, they are still recommended by different organisations.² 

While these methods can reduce the risk of STD transmission, it is not guaranteed as you may still contact with bodily fluids accidentally.

Secondary strategies

Testing and screening

Sexual health testing is widely available, and encouraged as routine, for those who engage in casual sex. Free home test kits are offered by the NHS, and typically, they are for detecting multiple STDs, usually HIV, gonorrhoea and syphilis, alongside chlamydia. For the last of these, you can send off a urine sample, which can be analysed for the presence of Chlamydia trachomatis.⁵ This diagnostic test is usually processed swiftly and you can be notified of the result as early as the same day.

If you are going to have a casual encounter or with someone new, both of you should ensure you are tested before the activity. If this is not possible, you should wait at least a week after the activity to test otherwise the infection may not show up in tests. If you are unsure, you can also get tested before and after the encounter, since one before can always be an assurance to your partner that you are negative.⁵

Regular screenings (tests for healthy individuals to ensure they maintain their health) are suggested for those under 25, who have HIV, and/or currently/plan to engage in casual sex with multiple partners.⁵

Partner notification services

Sexual health clinics offer anonymous services that can notify you if your sexual partner has tested positive for an STD. You can use this information to get tested to ensure this has not been transmitted to you.

You and your partners are not told any personal information regarding who got infected. Your notification can be shown at a clinic to ensure treatment is received. These services are beneficial for those who are asymptomatic, who may otherwise, get tested once they notice symptoms. 

Treatment options

If you have tested positive for chlamydia and seek treatment, you are most likely to be prescribed azithromycin and/or doxycycline, which are antibiotics. It is important to stick to the doses that you are advised by your doctor, otherwise, it may take longer for the infection to clear. You should also refrain from sexual activity while on treatment, even with a partner or someone you know to have chlamydia.

You may be offered testing three to six months after treatment is proven successful if you are under 25, since young adults have a higher chance of being infected with chlamydia again. Treatment only takes one or two weeks but you will not know for sure until a negative test result confirms this.

Public health and education initiatives

National chlamydia screening programme

The UK government funds the National Chlamydia Screening Programme, which encourages AFABs or people with ovaries to test for chlamydia, offering these at GPs or pharmacies. Rates of chlamydia are higher in AFABs than in AMABs, this may be due to the vagina being easier to infect than the penis.⁶ AFABs may also prefer intrauterine devices for contraception as opposed to condoms, meaning there is no barrier to prevent chlamydia from transmitting.

Sex education

While not compulsory in primary or secondary schools, sex education is highly recommended by different sexual health and family planning organisations. It is urged that STDs be part of this curriculum, especially for adolescents. From 2020, Relationships and Sex Education became compulsory within UK secondary schools and are commonly taught in PSHE (Personal, Social, Health and Economic) lessons. Clinics and your GP offer sex education resources that can be found in the form of pamphlets or via websites.

Summary

While not life-threatening, chlamydia has noticeable symptoms in both AMABs and AFABs and can be spread easily. This can be prevented via various measures that you can take alongside your partner(s). These ultimately lie in your attitude when it comes to sexual activity, i.e., taking the necessary precautions, such as getting tested or condom/dental dam usage, and even transparency when it comes to other people. While treatment is easily accessible for those who do have chlamydia, it is also easy to implement measures in your sex life to ensure you may never be in that position.