What is Chlamydia?
Chlamydia is a hidden bacterial infection which affects the neck of the womb (cervix), womb lining, fallopian tubes and pelvis in women. It is sexually transmitted, affecting the urethra in men and women, and occasionally it causes eye infections (conjunctivitis). It can persist for many years and, if left untreated, it can lead to pelvic infection, fertility problems, ectopic pregnancy and chronic pelvic pain. It is thought to be responsible for about half of all ectopic pregnancies, particularly in women under 25 years of age.
It is transmitted through sexual intercourse and, the more people have sex with an infected partner, the more likely they are to get it but they only need to have unprotected sex once to be at risk. It’s important to understand that sexually transmitted infections are NOT necessarily diseases of people who are promiscuous, but a simple consequence of unprotected sexual intercourse between two otherwise healthy people. Making sure you are checked out, especially if you believe you might be at risk of infection, will protect your fertility and wider sexual health.
Who is at risk?
Anyone who has been sexually active is at risk of getting Chlamydia. It is most common at the ages when people are most likely to change partners, with about 1 in 10 twenty year olds infected at any time. By the age of 40, at least one-third to half of all women and men will have had it at some time. The number of new cases has doubled in the past 5 years probably because more people are being tested, with more accurate tests.
Approximately 80% of people infected with Chlamydia are unaware that they have the infection as there are rarely any obvious symptoms. It can therefore remain undetected for many years. If you have, or have had, Chlamydia, you probably wouldn’t know it, and nor would your partner, so most people who have Chlamydia get it from someone else who didn’t know they had it! Thus Chlamydia is widespread precisely because it can be silent.
What are the symptoms of Chlamydia?
Even though 80% of people don’t get any signs of the infection when they have Chlamydia you may notice some changes 1-3 weeks after having sex. You might have noticed:
The difficulty in trying work it out yourself is that these symptoms can also be caused by lots of other things as well. Guesswork cannot give you an answer so you need to ask yourself, am I actually at risk of having caught Chlamydia or any other sexually transmitted infection in the last year or so? If the answer is yes, then get checked out.
How can I protect myself from Chlamydia?
Using condoms during sexual intercourse is the only way of preventing the transmission of sexually transmitted infections (STIs). Other methods of birth control, like ‘the pill’ and diaphragms only protect against pregnancy. However, condoms only protect if you use them every time, in short-term or one-off situations. If you have a new partner, remember Chlamydia is symptomless, so ensure that you are both checked out for Chlamydia before you stop using condoms.
How is Chlamydia treated?
You and your partner must take a simple course of antibiotics simultaneously (both at the same time). This ensures that you are not re-infecting each other. You will also be asked for your sexual history so that your contacts can be traced and treated to prevent the spread of this infection. Treatment is free at sexual health/genitourinary (GU) clinics and there are no prescription charges. These services are totally confidential and you don’t need to be referred by your GP. Find your nearest clinics.
How do I tell my partner?
The most difficult thing is often telling your partner. At the time of the ectopic pregnancy, it is often difficult to identify Chlamydia by testing, and Chlamydia may not have caused YOUR ectopic. Among male partners of women proven to have Chlamydia, up to 90% are infected with no symptoms. Remember that Chlamydia can persist for a long time, and either of you might easily have acquired the infection before you met. It is impossible to tell from tests how long the infection may have been there.
How does Chlamydia cause an ectopic pregnancy?
Anything which damages the fallopian tubes, such as endometriosis or previous pelvic surgery, can cause an ectopic pregnancy. Chlamydia causes inflammation within the tubes, damaging the tiny hairs which waft the eggs down the tube. The egg gets stuck and this is how an ectopic pregnancy occurs.
How will I know if Chlamydia caused MY ectopic pregnancy?
It is normal to look for a reason why you experienced an ectopic pregnancy but, for more than half of the UK’s ectopic pregnancies, there is no link, risk or factor known to cause the condition associated with the ectopic pregnancy.
For any woman who has had Chlamydia, it may have contributed to tubal ectopic pregnancy but it is impossible to tell if this was the case because the only way we would know would be to remove the tube and examine it to see if there was evidence of scarring associated with the infection.
Could I have had Chlamydia and not even know it?
The short answer to this is yes. Chlamydia is a bacteria and our bodies are designed to fight bacteria very effectively so our bodies can successfully overcome Chlamydia without treatment. Given the infection is symptomless in 80% of cases and that the infection can self-resolve, it is possible to have had Chlamydia without realising it.
If an ectopic pregnancy was caused by Chlamydia, the infection that did the damage may be long gone and so will not be detectable on a Chlamydia test which is done by testing urine or taking swabs. There will be evidence of antibodies in the blood in anyone whose had Chlamydia but, because testing blood will not alter the doctors assessment or treatment or give them any more information than they already have, testing for antibodies isn’t routinely available. What’s more, even if you did have the blood test and it showed positive antibodies, it doesn’t mean that it was the cause of your ectopic pregnancy.
I have had Chlamydia, will my remaining tube after an ectopic pregnancy be affected?
It is important to remember that even after an ectopic pregnancy there is a chance that your remaining tube is unaffected, even if the tube you lost was damaged by the disease. Chlamydia does not necessarily cause damage equally to both tubes.
Should I test for Chlamydia after I have had an ectopic pregnancy?
If there is a chance you have been infected with Chlamydia then it is always worth taking a test. Although treatment will not correct the damage already done, it may prevent further damage. Some hospitals routinely take swabs after an ectopic pregnancy but many do not.
If I have Chlamydia does it mean I will become infertile or will have an ectopic pregnancy?
Most women who get Chlamydia do not become infertile or suffer an ectopic pregnancy. The reasons for this are unclear, but women’s bodies react differently, similar to an allergy. Risk of ectopic pregnancy is increased by repeated infection with Chlamydia or lack of treatment.
The more times that you get Chlamydia the higher your chances of not being able to have a baby (even if treated). If left untreated, there is evidence to suggest that Chlamydia may affect men’s fertility as well.
What about other Sexually Transmitted Infections (STIs)?
Sexually transmitted infections (STIs) are diseases passed on through intimate sexual contact. They can be passed on during vaginal, anal and oral sex, as well as through genital contact with an infected partner. Common STIs in the UK include chlamydia, genital warts and gonorrhoea.
It’s important to understand that sexually transmitted infections are NOT necessarily diseases of people who are promiscuous, but a simple consequence of unprotected sexual intercourse between two otherwise healthy people. Making sure you are checked out, especially if you believe you might be at risk of infection, will protect your fertility and wider sexual health.