Chlamydia is the most frequently reported bacterial infection in the United States, affecting nearly 1 in 20 women of reproductive age. Though it often doesn't show symptoms, chlamydia can cause potential complications for mother and baby if left untreated during pregnancy, which is why the Centers for Disease Control and Prevention (CDC) recommends that pregnant women be screened for chlamydia at their first prenatal appointment.
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Understanding Chlamydia
Chlamydia is a preventable and treatable sexually transmitted infection (STI) that can affect men and women. It is a bacterial infection caused by Chlamydia trachomatis that can be transmitted from person to person via vaginal, anal, or oral sex. It can also be passed from an infected mother to her child during childbirth.
Prevalence
According to the World Health Organization (WHO), the global prevalence of chlamydia among people ages 15-49 years was estimated to be 4% for women and 2.5% for men in 2020. In that same year, there were an estimated 128.5 million newly diagnosed chlamydial infections worldwide among adults.
In the United States, chlamydia is more common in women than in men. It affects women at twice the rate of men, with the highest prevalence among young people, particularly women ages 15-24 and men ages 20-24.
Other populations at higher risk for chlamydia include:
- Men who have sex with men
- Black and non-Hispanic populations
Symptoms
Most people with chlamydia are asymptomatic. If symptoms do appear, they may present weeks after exposure to the infection.
Symptoms in Women
In females, chlamydia infects the cervix most frequently. This can cause:
- Abnormal vaginal discharge
- Vaginal bleeding
- Pain during urination
Symptoms in Men
If symptoms occur in men, they may include:
- Penile discharge
- Itching
- Pain during urination
Rectal Symptoms
Infections can occur in the rectum by having anal sex or by being spread from another location. If symptoms occur, they may include rectal pain, bleeding, and discharge.
Complications
Even if chlamydia doesn't cause acute symptoms, it may increase the risk of health complications in men and women.
- In women, untreated chlamydia can increase the risk of pelvic inflammatory disease (PID), ectopic pregnancy, infertility, and chronic pelvic pain.
- In men, untreated chlamydia can lead to epididymitis and reduced fertility.
- If Chlamydia trachomatis travels into the bloodstream, it can cause reactive arthritis and increase the risk of acquiring human immunodeficiency virus (HIV).
Chlamydia During Pregnancy
Pregnancy does not protect against chlamydia.
Untreated chlamydia infections during pregnancy increase the risk of pregnancy complications:
- Pre-term delivery
- Low birth weight
- Postpartum infections, including endometritis (inflammation of the uterus's inner lining)
An infected mother can also transmit chlamydia to her baby during childbirth. Babies who are born with chlamydia can develop:
- Chlamydial conjunctivitis (18-44% of cases): an eye infection that presents with redness, swelling, and discharge
- Chlamydial pneumonia (3-16% of cases): an afebrile lung infection that presents with rapid breathing and a cough
Diagnosis and Screening
Early diagnosis and treatment of chlamydia can prevent the infection from causing irreversible damage to the mother's reproductive tract and neonatal transmission.
According to the U.S. Preventive Services Task Force (USPSTF), screening and treatment of chlamydial infection during pregnancy is associated with improved outcomes for infants and mothers, including significantly lower rates of preterm delivery, early rupture of membranes, and low birth weight infants.
Screening Guidelines
The CDC recommends annual screening for chlamydia in the following groups:
- Sexually active women under the age of 25
- Sexually active women older than 25 who are at an increased risk for infection. Risk factors include having a new sex partner, multiple sex partners, a sex partner with concurrent partners, or a sex partner who has an STI.
- Men who have sex with men
- People with HIV
For pregnant women, the CDC advises routine screening for those under 25 years of age and for older pregnant women at increased risk at the first prenatal visit. Pregnant women who remain at risk should be retested during the third trimester to prevent maternal and neonatal complications.
Diagnostic Testing
Due to its high sensitivity and specificity, nucleic amplification testing (NAAT) is the gold standard for diagnosing urogenital chlamydia.
NAATs can be performed on various clinical specimens. The preferred specimens are:
- Vaginal swabs for women
- First-catch urine for men
- Rectal swabs to screen for rectal infections in people who engage in anal sex
If chlamydia is detected and treated during the first trimester of pregnancy, repeat testing for reinfection should be performed within 3-6 months or during the third trimester of pregnancy.
Patients diagnosed with chlamydia should also be tested for the following co-infections:
- HIV
- Gonorrhea
- Syphilis
Treatment Options
Antibiotic treatment should be initiated immediately upon diagnosing chlamydia to prevent infection-related complications.
Antibiotics
Antibiotic treatment options for pregnant women include:
- Azithromycin 1 gram orally in a single dose
- Amoxicillin 500 mg orally three times daily for seven days
- Erythromycin 500 mg four times daily for seven days or 250 mg four times daily for 14 days
According to a meta-analysis, while all three medications have a similar efficacy rate, azithromycin may be associated with the lowest risk of side effects.
Doxycycline, commonly used to treat chlamydia in non-pregnant individuals, is contraindicated during pregnancy and breastfeeding due to its potential to affect fetal bone and tooth development, as well as the risk of discoloration of teeth in infants and young children.
Integrative Approaches
People undergoing chlamydia treatment should abstain from sexual activity until they and their partners have completed treatment and are asymptomatic.
- If prescribed a single dose of medication, wait at least seven days before having sex.
- If prescribed a multi-day course of antibiotics, wait until the entire course of treatment is completed before resuming sexual activity.
Sexual partners should also be referred for evaluation, diagnosis, and treatment if:
- They had sexual contact with the patient within 60 days of symptom onset or diagnosis.
- If the last sexual contact was more than 60 days before symptom onset or diagnosis, the most recent partner should be evaluated.
Prevention Strategies
The only way to completely prevent chlamydia is to abstain from vaginal, oral, and anal sex.
Sexually active individuals can reduce their risk of getting chlamydia by:
- Using condoms during vaginal, oral, and anal sex
- Using dental dams during oral sex
- Not sharing sex toys
- Being in a mutually monogamous sexual relationship with a partner who does not have chlamydia
Living with Chlamydia During Pregnancy
Receiving an STI diagnosis can have a significant psychological impact, leading to feelings of shock, shame, anxiety, and depression. Healthcare initiatives that promote sexual education and open communication can help destigmatize and alleviate fears associated with the diagnosis.
The USPSTF recommends referring all patients with current or recent STIs to high-intensity behavioral counseling.
Connecting with other expectant mothers who have similar experiences can provide emotional and social support to reduce feelings of isolation.
After treatment, regular follow-up visits are important to monitor the patient's health and ensure the infection has been fully cleared. Follow-up testing may be recommended for the woman and her baby, especially if complications arise during or after pregnancy.
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Key Takeaways
- Chlamydia is a common yet serious bacterial infection that can affect pregnancy if left untreated.
- However, with early detection, proper treatment, and preventive care, both mothers and babies can avoid many of the potential risks.
- If you're pregnant or planning to conceive, discuss your sexual health and get screened regularly to protect yourself and your baby.
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