Chlamydia the silent intruder The number 1 sexually transmitted infection…

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Sexually transmitted infections (STI) are on the rise especially among the younger age groups. Some earlier reports have shown a higher incidence of STI among women aging between 17 and 24 who are sexually active. The reasons are usually due to deficient sex education, thus most of the women at that age are not using proper protection as condoms. The presence of multiple sexual partners whether successive or at the same time is a major factor.


There are various types of sexually transmitted infections;

1. Human papilloma virus (HPV) which can lead to the development of genital warts, or condylomata acuminate- up to nine months can pass from the time of infection to the actual development of warts. In women, human papilloma virus can lead to changes in the cervix and to the development of cervical cancer. Recently there has been the launch of a new vaccine in Egypt against the virus to reduce the incidence of cervical cancer. Therefore, it is important that this condition is diagnosed and treated as early as possible.


2. Gonorrhoeacaused by Neisseria gonorrhoea, bacteria that grows and multiplies quickly in moist, warm areas of the body such as the cervix, urethra, mouth, or rectum. In women, the cervix is the most common site of infection. However, the disease can also spread to the uterus (womb) and the fallopian tubes, causing pelvic inflammatory diseases leading to infertility. Gonorrhoea is most commonly spread during genital contact, but can also be passed from the genitals of one partner to the throat of the other during oral sex. Gonorrhoea of the rectum can occur in people who practice anal intercourse. In pregnant women, gonorrhoea can be passed from an infected woman to her infant during delivery if left untreated. The early symptoms of gonorrhoea are often mild, and many women who are infected have no visible symptoms of the disease. If symptoms of gonorrhoea develop, they usually appear within 2 to 10 days after sexual contact with an infected partner, although a small percentage of patients may be infected for several months without showing symptoms.

3. Another type of infection is called the Syphilis, which is a dangerous and life-threatening bacterial disease. After infection, the bacteria spread throughout the body via the bloodstream and adversely affects vital organs such as the heart, brain, nervous system and spine.

AIDSis a potentially lethal sexually transmitted disease and is caused by the HIV virus. HIV invades and destroys the immune system, which protects the body from infections. This leaves the infected person prone to many different illnesses and may die from diseases that are usually harmless to healthy people. The use of drugs and the presence of multiple sexual partners are main risk factors. The virus is found in bodily fluids such as blood, sperm and vaginal secretions, and can pass through little scratches that may occur during sexual intercourse.

5. Genital herpes is a highly contagious viral condition caused by the herpes simplex virus (HSV). It principally infects the skin and mucous membranes of the genitals and rectum, but can also appear in areas such as the mouth. It is transmitted primarily through physical and sexual contact. During pregnancy, the presence of an active infection on the genitalia or in the birth canal is a serious threat to the baby. Infection in the baby can lead to herpetic meningitis, where the outer cover of the brain is infected. The disease can reach the blood stream as well causing severe illness and chronic skin infection. The symptoms of herpes simplex virus usually occur a week after infection, but sometimes take longer time to appear.

Initially, the skin becomes reddened and multiple small blisters filled with a clear, straw-coloured fluid appear. Prior to the presence of blisters, the infected individual may also experience increased skin sensitivity, tingling, burning or pain at the site where blisters will appear. Later, the blisters burst leaving shallow, painful ulcers, which eventually scab and heal over a period of 7 to 14 days.

However, this article mainly addresses another type of STI, which is known as Chlamydia. The infection is caused by a tiny bacterium called Chlamydia trachomatis.It is the most common STI in many European countries as the UK, but many studies done in Egypt reveal a high prevalence of the disease. It affects both sexes, although young women are more at risk. Chlamydia can be treated, but it often has no symptoms in either men or women, so remains undetected.
Infection may only be diagnosed once Chlamydia has led to complications; by that time, treatment may be too late to stop permanent damage to the genital organs.

Chlamydia symptoms:

Some women may experience cystitis which is bladder infection, change in vaginal discharge, some may complain of mild lower abdominal pain.

These are very ‘non-specific’ symptoms and can be caused by other infections and diseases. If you visit your gynaecologist with such symptoms, make sure that you are tested for Chlamydia.
In men, Chlamydia is the most common cause of discharge from the penis. Sometimes Chlamydia can cause mild irritation at the tip of the penis (urethra) that disappears after two or three days. Many men will ignore their symptoms. While the discomfort may disappear, the man can still harbour the infection. If in doubt, it is better to get tested. Otherwise, men could put themselves at risk of inflamed and swollen testicles, and pass Chlamydia on to their partners.

What complications can Chlamydia cause?

In some women Chlamydia can cause pelvic inflammatory disease (PID), also know as pelvic infection. It can damage the Fallopian tubes that carry eggs from the ovaries to the womb. The tubes may stop working properly and can become completely blocked.

Chlamydia is the most common cause of infertility in women. When the Fallopian tubes are blocked, no pregnancy is possible naturally. One option is IVF (in-vitro fertilization), but it is very costly and has variable success rates depending on the centre where it is performed.

Women with damaged tubes do occasionally get pregnant, but there is an increased risk for the pregnancy developing outside the womb, usually in one of the tubes. This is called an ectopic pregnancy. The tube can burst causing serious pain and bleeding. The bleeding is very serious and can be life threatening. Some women nowadays die from haemorrhage due to undiagnosed ectopic pregnancy.

Infection sometimes leads to pain in the lower abdomen that is often mistaken for some other problem rather than pelvic infection.

Chlamydial infection can affect sperm function and male fertility. It is the most common cause of inflammation in the testicles and tubes that allow the passage of sperms in men under the age of 35. This causes pain, swelling and redness on the affected side of the scrotum, or even on both sides.


Should I be tested?
Chlamydia is almost always transmitted through sexual intercourse, so the likelihood of having the infection depends on your sexual behaviour. If you’ve had sex and not used a condom, you are at risk of Chlamydia.

The more partners you have, the more likely you will be exposed to the infection. This isn’t about promiscuity, as you only need to have unprotected sex with one person who happens to have the infection to get Chlamydia.
Chlamydia is most common and most likely to cause serious complications in younger women. If you are under 25 and sexually active, you have a 1 in 10 chance of having Chlamydia, so it is worth getting tested.

Your risk is even higher if you are under 20 and have had unprotected sex.

If you are over 25 and have had two partners within a year, or recently changed partner, your risk is also increased.


What are the available tests?
The tests available in Egypt are either a swab taken form the upper vagina using a speculum (instrument inserted into the vagina having to blunt blades that move apart) to allow the gynaecologist to reach and visualise the cervix and upper vagina. A urine sample can be tested as well. 
For men, a urine sample is good enough and avoids the discomfort of a swab from inside the tip of the penis (urethra).
Both men and women can have as well blood tests to detect the presence of chlamydial antibodies.

When being examined by your gynaecologist, make sure that the speculum is either disposable or that the package has been opened in front of you. Or if it is the metal reusable type ensure it has been kept in the sterilizer and not left in a large metal bowl with other speculums; as it has been shown that speculums can harbour a variety of sexually transmitted infections.


How is Chlamydia treated?
Chlamydia is treated with a variety of antibiotics…

Among the Tetracycline class, Doxycycline is the one usually prescribed. One tablet should be taken twice a day for a week.

Azithromycin;, another type of antibiotic, is the most convenient treatment because it is taken only once as four tablets at the same time.

During pregnancy a different antibiotic called erythromycin can be used, which is safe for the baby.
Make sure your husband also gets treatment. Otherwise, the treated partner becomes re-infected. Repeated infections can cause far worse fertility problems in women.

How to reduce chlamydial infection?
It is very important to think about the health and safety of our children. Discussing sex has never been easy for anyone, but surveys suggest that kids like to hear about sex and relationships from a parent in preference to anyone else.
Decent sex education in schools would help young people understand the consequences of their actions. Making an informed decision, and knowing where to go if there are any concerns, as it is essential to get help promptly.


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