Chlamydia: symptoms, transmission and consequences on fertility

Chlamydia infection: what are the symptoms?

In 70% of women and at least 50% of men, the symptoms of chlamydia are practically absent : we therefore speak of a “silent” or “asymptomatic” infection.

When present, however, symptoms appear 1 to 3 weeks after infection .

Symptoms of chlamydia in women

In women, when the infection affects only the cervix and the endometrium, Chlamydia can manifest itself with burning during urine output or vaginal discharge that is different from the usual (usually yellowish-white in color).

If left untreated, however, it can reach the fallopian tubes (or salpingi) causing acute inflammation (salpingitis). In this case, some women experience no symptoms, while others experience:

• pelvic or abdominal pain
• pain during sexual intercourse
• intermenstrual spotting or after intercourse
• more abundant menstruation

Chlamydial infection can also spread to the rectum , causing pain and discharge, the eyes (when in contact with infected semen), causing conjunctivitis, or the throat , usually without symptoms.

Symptoms of chlamydia in men

For men, symptoms can be:

• burning while passing urine
• whitish discharge
• itching or burning around the tip of the penis
• pain in the testicles

If left untreated, chlamydia can also cause testicular swelling , with possible fertility problems in men as well .

Furthermore, as in women, the infection can also occur in the rectum, eyes or throat.

How is chlamydia transmitted?

Infection generally occurs through vaginal, anal or oral sex unprotected by a condom , but it can also occur through simple contact between the partner’s genitals or the exchange of unwashed sex toys before being shared .

Furthermore, an infected mother can infect the baby during natural delivery, with the risk that the newborn develops conjunctivitis or bacterial pneumonia.

Sexual transmission is the most widespread way of infection and the greater the number of partners the greater the probability of infection. The fact that chlamydia is often asymptomatic unfortunately contributes to favoring the infection.

Adolescent girls are generally more at risk, since in young women the cervical tissues are not yet fully mature and are therefore more susceptible to infection.

Chlamydia and infertility

If not treated promptly, chlamydia can cause serious short- or long-term health problems, which in turn can affect female and male fertility .

In 10-15% of infected women , chlamydia travels to the fallopian tubes, where it can cause inflammation that can permanently damage the tubes themselves, as well as the uterus and surrounding tissue. This is referred to as pelvic inflammatory disease (PID).

The consequences can be:

• chronic pelvic pain;
• infertility , due to the closure of the tubes which, even if reopened, are often too damaged by the infection;
• ectopic or ectopic pregnancy .

In men, however, complications are rarer. If the infection spreads to the epididymis (the tube where sperm produced by the testicles are stored) it could in some cases cause infertility.

What if you are pregnant and test positive for chlamydia?

Some studies have shown that chlamydia can increase the risk of preterm birth .

In addition, babies born to infected mothers can contract chlamydia at birth, with the risk of early childhood pneumonia and conjunctivitis (pink eye) of the newborn .

In this case, antibiotic therapy will need to be given to the child to resolve the respiratory infection .

As far as conjunctivitis is concerned , it is important to remember that at birth all newborns receive antibiotic prophylaxis in the form of eye drops, effective against any chlamydia and gonorrhea infections (another sexually transmitted disease capable of causing conjunctivitis in the newborn).

How is chlamydia diagnosed?

The Chlamydia bacteria can be detected with a swab inside the vagina, male urethra, throat or anus, or through a urine test .

In the event of a positive test , the partner must also undergo tests to verify if he has contracted the infection and, if so, be treated in turn.

As for pregnant women , in case of known risk factors, the gynecologist will prescribe a specific blood test . This analysis is one of the tests offered free of charge to pregnant women in the first trimester (within the 14th ^week ) .

How is chlamydia treated?

Chlamydia is treated with specific antibiotic therapy prescribed by your doctor , which usually lasts 10-14 days.

It is important to abstain from intercourse at least until the end of treatment to prevent the spread of the infection.

All those who have had chlamydia should also check after a few months to verify complete recovery.

Importantly, a cured infection does not make you immune to new chlamydia infections.  Therefore, if you still have sex with an infected partner, you expose yourself to chlamydia infection again.

How can chlamydia be prevented?

The only way not to get chlamydia is to abstain from sexual contact or have sex only with uninfected partners .

Condoms reduce the risk of transmission only if used correctly and throughout intercourse (including oral sex) .

Main sources

• Higher Institute of Health: “Clamydia” (2018). [Last accessed November 2022]
• Centers for Disease Control and Prevention (CDC): “Sexually Transmitted Infections Treatment Guidelines, 2021. Chlamydial Infections”. [Last reviewed: 12 July 2021]

Questions and answers

Is it possible to get chlamydia without having sex?

Chlamydia can also be transmitted without having penetrative sex.
For example, the infection can occur through  contact between the genitals  of the two partners or with  oral sex  (in the latter case, the infection will be limited to the throat). Furthermore, indirect contagion 
can occur  through the sharing of  sex toys  (when not washed thoroughly or covered with a new condom at each exchange). Chlamydia  CANNOT be transmitted through kisses ,  hugs , contact with  towels ,  toilet seat , sharing  cutlery

 or  swimming in the sea  and  in the pool .

Can a chlamydial infection be diagnosed by semen parameters?

 Indirect signs of infection  (for example, impaired liquefaction, presence of leukocytes and/or RBCs) may be found in the semen . However,  to be sure of a Chlamydia  (Chlamydia trachomatis)  infection , a sperm culture  with a search for Chlamydia infection must be performed.