The natural history of genital Chlamydia trachomatis infection is not thoroughly understood.
Genital infections with the bacteria Chlamydia trachomatis are asymptomatic in around 70 per cent of women and 50 per cent of men. Although some infections resolve without treatment, others may persist for long periods and a proportion of these will progress to cause complications. The natural history of chlamydia has been difficult to define because a) infection is so often asymptomatic, b) the complications of chlamydia can also arise due to other causes, and c) since highly effective treatment is available, there are ethical issues with observing the (untreated) natural history of diagnosed infections.
What is known?
Chamydia infection in females
In females, chlamydia initially infects the cervix and the urethra where it can cause cervicitis (inflammation of the cervix) and urethritis (inflammation of the urethra).
From the cervix, the bacteria can ascend to the upper genital tract where it may cause pelvic inflammatory disease (PID), with or without symptoms e.g. pelvic pain. It has been estimated that 10-20 per cent of untreated infections result in PID.
Inflammation of the fallopian tubes associated with PID can cause damage (e.g. fibrosis and scarring) that may result in future ectopic pregnancy and/or tubal-factor infertility.
Other sequelae of chlamydia in females include Reiter’s syndrome (reactive arthritis) and Fitz-Hugh Curtis syndrome (also known as perihepatitis [inflammation of the lining of the liver]).
It is possible, and quite common, to be infected with chlamydia more than once, particularly if a sexual partner remains infected (i.e. is not tested/treated). The risk of complications increases with repeated untreated infections.
Treatment for chlamydia infection is highly effective and reduces the risk of complications.
Chlamydia infection in males
In males, the consequences of genital chlamydia infection may include:
- Urethritis
- Epididymitis (inflammation of the epididymis [a coiled segment of the spermatic ducts])
- Prostatis (inflammation of the prostate gland)
- Proctitis (rectal inflammation)
- Reiter’s syndrome.
There is also some evidence of a link between chlamydia and male infertility.
As for females, treatment is highly effective.
Improving the understanding of the natural history of chlamydia, in both females and males, is an important and active area of research.
Chlamydia is often asymptomatic so a large proportion of cases remain undiagnosed, but infection can be diagnosed easily (young people can do the test themselves), and treated effectively.
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