Chlamydia is a common sexually transmitted infection (STI) caused by the bacteria Chlamydia trachomatis. An estimated 4 million new chlamydia infections occur each year in the United States. Chlamydia is known as a “silent” infection because most infected people have no symptoms. If left untreated, chlamydia can cause serious health problems in women, including pelvic inflammatory disease, infertility, and ectopic pregnancy. The good news is that chlamydia can be easily cured with antibiotics. Getting tested and treated for chlamydia is important to avoid long-term health consequences. Here is information on how to tell if a girl might have chlamydia.
Common Symptoms
Many women with chlamydia do not have any noticeable symptoms. When symptoms do occur, they often appear 1-3 weeks after exposure. The most common symptoms in women include:
- Abnormal vaginal discharge that may have an odor
- Burning sensation when urinating
- Light vaginal bleeding or spotting between periods
- Pain during sexual intercourse
- Rectal pain, bleeding, or discharge (if rectal infection)
Some women may also experience stomach pain, nausea, fever, and pain in the lower back. Symptoms in the throat may occur if chlamydia was transmitted through oral sex. Keep in mind that it is possible to contract and transmit chlamydia even if there are no symptoms present.
Who is at Risk?
Any sexually active person can get chlamydia, but some women are at higher risk. Factors that increase a woman’s risk include:
- Having a new sex partner
- Having more than one sex partner
- Having a sex partner who has other partners
- Having sex without a condom
- Having an STI in the past
- Exchanging sex for money or drugs
The highest rates of infection are seen in young women under age 25. This is likely due to a combination of behavioral and biological factors. Young women are more likely to have new partners and engage in unprotected sex. The cervix (opening to the uterus) in younger women is not fully matured, increasing susceptibility to organisms.
Getting Tested
The only way to know for sure if a woman has chlamydia is by getting tested. There are two main types of tests available:
Nucleic acid amplification test (NAAT)
This is the preferred test for chlamydia diagnosis and can be performed on urine samples or vaginal swabs. The high sensitivity of NAATs allows detection of even very small amounts of genetic material from the bacteria. Results are usually available within a few days.
Culture test
This test tries to grow (culture) chlamydia bacteria from a mucus sample. It is more time consuming and less sensitive than NAAT. Culture tests are not routinely recommended for chlamydia screening unless specifically requested by a provider.
| Test Type | Sample Type | Detection Time | Pros | Cons |
|---|---|---|---|---|
| NAAT | Urine, vaginal swab | 1-5 days | High sensitivity, non-invasive sample collection | Does not determine antibiotic susceptibility |
| Culture | Cervical/urethral swab | 3-7 days | Confirms viable bacteria, can test antibiotic susceptibility | Lower sensitivity, slower turnaround time |
Screening for chlamydia is recommended annually for all sexually active women under age 25. Older women with risk factors should also be tested. Pregnant women should be screened as part of their routine prenatal testing.
Retesting several months after treatment is important to confirm the infection has been cured. Sex partners from the preceding 60 days should also be notified, tested, and treated.
Physical Exam
A pelvic exam may help reveal signs of a chlamydia infection. The provider will examine the vagina and cervix for discharge, swelling, or redness. Samples can be collected during the exam for laboratory testing. Women may also have a rectal exam to check for chlamydia if they engage in anal sex.
Keep in mind that many chlamydia cases produce no abnormal exam findings. Testing is still needed to confirm or rule out infection.
Complications
Without treatment, chlamydia can lead to serious medical problems. Potential complications in women include:
Pelvic inflammatory disease (PID)
PID is an infection of the uterus, fallopian tubes, and ovaries. Symptoms include fever, pelvic pain, and unusual vaginal discharge. PID occurs in 10-15% of women with untreated chlamydia. It can cause scarring in the reproductive organs, potentially leading to infertility and chronic pelvic pain.
Ectopic pregnancy
If chlamydia spreads to the fallopian tubes, it can cause inflammation and scarring. This damage increases the risk of an abnormal pregnancy located outside the uterus (ectopic pregnancy). Ectopic pregnancies are serious, life-threatening conditions.
Infertility
The buildup of scar tissue in the fallopian tubes from PID can impede the travel of fertilized eggs to the uterus. This can make it difficult or impossible to get pregnant. Up to 20% of infertility cases may be attributable to untreated chlamydia.
Proctitis
Rectal chlamydia infections can lead to inflammation and discharge from the rectum (proctitis). While usually not serious, proctitis can be quite uncomfortable. It occurs more commonly in women who engage in anal sex.
Reactive arthritis
In rare cases, chlamydia may trigger reactive arthritis after the infection has resolved. This condition causes inflammation of joints throughout the body. It usually goes away on its own after several months.
The potential for severe, permanent reproductive consequences is why screening and timely treatment for chlamydia is so important.
Treatment
Chlamydia is easily cured with common antibiotics. The recommended treatments are:
- Azithromycin – Single 1 gram oral dose
- Doxycycline – 100 mg orally 2x/day for 7 days
Partners should abstain from sex for 7 days after single dose azithromycin treatment or until completion of the doxycycline regimen. All partners should also be tested and treated to prevent reinfection.
Women who are pregnant or breastfeeding require special treatment considerations and should follow up closely with their prenatal provider. Expedited partner therapy may be recommended to prevent reinfection.
Repeat testing should be done 3 months after treatment to confirm the infection has resolved. Yearly screening for chlamydia should continue even after a positive test.
Prevention
Practicing safe sex is the best way to prevent getting chlamydia. Suggestions include:
- Use condoms correctly every time you have sex
- Limit your number of sexual partners
- Ask partners to get tested before having sex
- Talk openly with partners about STIs
- Have regular STI screening if sexually active
Getting vaccinated against human papillomavirus (HPV) may also help reduce the risk of chlamydia infection.
The consistent and correct use of male latex condoms has been shown to reduce, but not eliminate, the risk of catching or spreading chlamydia.
Conclusion
Chlamydia is a prevalent but treatable STI, especially among young women. Many chlamydia cases cause no symptoms, underscoring the importance of annual screening. Testing can identify infections before complications develop. With early diagnosis and antibiotic treatment, outcomes are excellent. All recent sex partners should also be informed and treated. Practicing safe sex by using condoms, limiting partners, and regular STI testing are key prevention measures.