Chlamydia: the silent epidemic

Chlamydia is a sexually transmitted infection that is often symptomless and can affect your fertility.

It has been called 'The silent epidemic'. It is often symptomless and it poses the greatest threat to the fertility of a generation that we have ever known. It sounds like a trailer for The X-files, but it is in fact an accurate description of a sexually transmitted infection, which may be affecting up to 600,000 young people in the UK this year. It is called Chlamydia.

Unknown danger
Most young people have never heard of it or know very little about it and so are not equipped to protect themselves against it. A survey in 1997 found that only 26% of 16-24 year olds (the highest risk group) had heard of chlamydia. Of these, only 68% were aware of the symptoms and effects.

No symptoms
Chlamydia is a bacteria-like organism which can be sexually transmitted. 70% of infected females and 50% of infected males have no symptoms at all and so do not seek treatment. Some infections are detected by screening at Genito-urinary Medicine (GUM) clinics when patients have attended because of symptoms relating to another sexually transmitted infection.

Ignorance of infection
In 1999-2000 the number of chlamydia cases reported by GUM clinics in England, Wales and Northern Ireland was 64,000. The highest rates were for women aged 16-19 and men aged 20-24. Allowing for undetected cases, estimates are that 300,000 women contracted chlamydia in 1999-2000. Chlamydia currently constitutes 40% of the caseload at GUM clinics.

The Public Health Department which monitors all infectious diseases has estimated that 10% of all sexually active young people are infected with chlamydia and that between 200,000 and 300,000 young women are currently infected. Approximately 10% of infected women will become infertile as a result. Therefore up to 300,000 young women could find themselves infertile over the next 10 years.

Genital infection with chlamydia can affect the cervix and urethra (the tube which carries urine away from the bladder) in women, and the urethra in men. Chlamydia can also infect the eyes and throat. It can be passed on during sexual intercourse and during oral sex.

Help your doctor help you
Only 30% of infected women have symptoms of early infection. Early symptoms relate to infection of the urethra and cervix. There may be a slight increase in vaginal discharge due to inflammation of the cervix. Urethral inflammation may cause pain or stinging on passing water with a need to go more frequently. Often this symptom is regarded as 'a touch of cystitis' by the sufferer and is inappropriately treated by the patient or her doctor. The difficulties of accurate diagnosis are compounded by the fact that standard urine tests and standard vaginal swabs will not detect chlamydia.

Urethral infection is detected by a urethral swab and cervical infection is detected by a swab taken from inside the cervix. These swabs have to be transported in a special transport medium and tested in a very specific way in order to detect chlamydia.

It is therefore important to inform your doctor if you may be at risk of chlamydia infection, especially if you have had a new sexual partner recently. You may prefer to go to your local GUM clinic rather than see your GP.

Once diagnosed, chlamydia is easily treated with antibiotics taken by mouth. If there is any possibility that you may be pregnant, it is important to tell the doctor as it will affect which antibiotics are prescribed. It is also very important to treat current and recent sexual partners to prevent the spread of infection.

Pelvic Inflammatory Disease (PID)
If untreated at this early stage, chlamydia can lie dormant for several months before passing through the cervix to infect the fallopian tubes. Inflammation of the fallopian tubes is known as Pelvic Inflammatory Disease (PID). Chlamydia infection is now the most common cause of PID, which is estimated to affect 165,000 patients per year. Symptoms of PID vary considerably. There may be lower abdominal pain, fever, pain during sex and bleeding between periods. However, some women have a very low-grade inflammation which produces little or no symptoms and the diagnosis is only made when they have been found to have tubal blockage and scarring which has led to infertility. As mentioned previously, 10% of women who are infected with chlamydia will be infertile as a result of the infection. It is thought that 25% of all cases of infertility are due to chlamydia.

If a woman with PID does become pregnant, there is a higher risk of ectopic pregnancy (pregnancy outside the womb) due to narrowing of the fallopian tubes. There is also a higher risk of premature birth. If the mother has not been treated, the baby can be infected during delivery, causing eye or lung infection.

Stop the spread
There are three ways to halt the spread of chlamydia. Better education of young people about all sexually transmitted infections is very important. More information about the symptoms and effects of infection and where to get advice and treatment is required. Condoms are the first line of defence against infection and their use should be vigorously encouraged.

Government recommendations
The Chief Medical Officer (CMO) published a report in 1998 on the findings of an expert advisory group on chlamydia. The report recommended screening for chlamydia in sexually active women under 25 and in over 25s who have a new partner, or have had 2 or more sexual partners in the past 12 months. The Government is currently considering the recommendations.

Information on how to find your nearest GUM clinic is available from your local hospital switchboard, or you can phone the Family Planning Association (020 7608 5240) and ask for their Clinic Enquiries Service.

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