Chlamydia

Table of Contents

Disease Information

Overview

Also known as: Chlamydia trachomatis, "Silent" STD

Responsibilities

  • Hospital: Report cases by mail, phone or in IDSS
  • Infection Preventionist:  Report cases by mail, phone or in IDSS
  • Lab: Report positive lab results by mail, phone or in IDSS
  • Physician: Report cases by mail or phone

IDPH or specified local health departments conduct investigations

Cases may be reported to your Local Public Health Agency (LPHA) or to Iowa Department of Public Health

Iowa HHS
Sexually Transmitted Disease Reporting Hotline: (515) 281-3031

A. Agent

Chlamydia is a common sexually transmitted disease caused by a bacterium called Chlamydia trachomatis. Chlamydia are obligate intracellular bacteria sensitive to broad-spectrum antimicrobials.

B. Clinical Description

Symptoms:  Chlamydia is known as a “silent” disease because more than half of persons diagnosed have no symptoms. 

  • Men with signs or symptoms may have a discharge from the penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis. Pain or swelling of the testicles is uncommon.  Most men have no symptoms.
  • Women often have no symptoms, but if symptoms exist they may include an abnormal vaginal discharge or a burning sensation on urinating. When infection spreads to the fallopian tubes, some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods.
  • Men or women who have receptive anal intercourse may acquire chlamydia in the rectum, which can cause rectal pain, discharge, or bleeding. Chlamydia can also be found in the throats of men and women having oral sex with an infected partner.

Onset: If symptoms are present, they usually appear within 1 - 3 weeks after exposure.

Complications: If untreated, chlamydia can progress to serious reproductive and other health problems, with both short-term and long-term consequences.

  • In women, untreated infection can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). PID can cause permanent damage to the fallopian tubes, uterus, and surrounding tissues, leading to chronic pelvic pain, pain during intercourse, infertility, and potentially fatal ectopic pregnancy. Women infected with chlamydia are at increased risk for HIV infection if exposed to HIV while infected with chlamydia.
  • To help prevent the serious consequences of chlamydia, an annual screening test for chlamydia is recommended for all sexually active women age 25 years and younger. An annual screening test is also recommended for women over 26 years of age with a new sex partner, multiple sex partners, if signs and symptoms are present or with sex partner(s) who are known to have had chlamydia, urethritis, or another STI.
  • Complications among men are rare. Infection sometimes spreads to the epididymis (the tube that carries sperm from the testis), causing pain, fever and, rarely, sterility.
  • Rarely, genital chlamydia can cause a severe arthritis (Reiter’s syndrome) that may be accompanied by skin lesions and inflammation of the eye and urethra.

C. Reservoirs

Common reservoirs: Humans are the only known reservoir.

D. Modes of Transmission

Person-to-person:  Chlamydia is spread through contact between the penis, vagina, mouth, and anus. Ejaculation does not have to occur for chlamydia to be transmitted or acquired. Chlamydia can be spread from mother to baby during birth.  An infected infant usually has signs and symptoms of conjunctivitis or pneumonia.

Any sexually active person can be infected with chlamydia. The greater the number of sex partners, the greater the risk of infection. Because the cervixes of teenage girls and young women are not fully matured, they are at particularly high risk of infection if sexually active. Since chlamydia can be transmitted by oral or anal sex, men who have sex with men are also at risk for chlamydia. In rare cases, women who have sex with women have contracted chlamydia from a female partner through oral sexual contact or the sharing of sex toys.

E. Incubation period

The incubation period is highly variable and poorly defined.  A range of 7 - 21 days has been documented, but 7 - 14 days is more common.

F. Period of Communicability or Infectious Period

A person can spread the disease from the time he/she is infected with chlamydia, until properly treated. Re-infection is common if partners are not adequately treated in a timely manner.

G. Epidemiology

Chlamydia is one of the most frequently reported sexually transmitted infections in the United States. In 2013, 1, 401,906 chlamidial infections were reported to CDC from 50 states and the District of Columbia. Under-reporting is substantial, becuase most people with chlamydia are not aware of the infection and do not seek testing. Testing is not often done if patients are terated for symptoms. An estimated 3 million Americans are infected with chlamydia each year. Women are frequently re-infected if their sex partners are not treated.

H. Additional Information

Treatment information

Chlamydia can be treated and cured with antibiotics. A single dose of azithromycin, or 7 days of doxycycline (twice daily), are the most common treatments.  Refer to the current “CDC Guidelines for Treatment of Sexually Transmitted Diseases” for appropriate treatment.  HIV-positive persons with chlamydia should receive the same treatment as those who are HIV negative.

All sex partners within 60 days of onset of symptoms or within 60 days of a positive test (whichever is greater) should be evaluated, tested, and treated if necessary. When there has been no sexual partner in the last 60 days, the most recent partner should be evaluated, tested, and treated if necessary.  The CDC recommends presumptive treatment at the time of exam for all exposed partners to a known infected patient.  Persons with chlamydia should abstain from sexual intercourse until they and their sex partners have completed treatment to avoid re-infection.

Women whose sex partners have not been appropriately treated are at high risk for re-infection. Multiple infections increase a woman’s risk of serious reproductive health complications, including infertility. Women, especially adolescents, should consider retesting for chlamydia three to four months after treatment is completed. This is especially true if they are uncertain whether sex partners received treatment.

Laboratory criteria for diagnosis

The Council of State and Territorial Epidemiologists (CSTE) surveillance case definitions for Chlamydia can be found at:  https://ndc.services.cdc.gov/conditions/cholera/

CSTE case definitions should not affect the investigation or reporting of a case that fulfills the criteria in this chapter. (CSTE case definitions are used by the state health department and the CDC to maintain uniform standards for national reporting.)

I. Additional Resources

CDC Website with most current guidelines for prevention, surveillance, and treatment:  www.cdc.gov/nchstp/dstd/chlamydiaInfo.htm

Iowa STI Program web site

Fact Sheets and Forms

References

Centers for Disease Control and Prevention.  Sexually Transmitted Diseases Treatment Guidelines 2010.  MMWR 2010; 59, RR-12 

Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2006: Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections - MMWR April 13, 2007

Heymann, D.L., ed. Control of Communicable Diseases Manual, 20th Edition. Washington, DC, American Public Health Association, 2015.

Notification And Surveillance of Reportable Communicable and Infectious Diseases, Poisonings and Conditions.  Iowa Code 2010 Section 139A.

Stamm, W.E. Chlamydia trachomatis infections of the adult. In: K. Holmes, P. Mardh, P. Sparling et al (eds). Sexually Transmitted Diseases, 3rd edition. New York: McGraw-Hill, 1999, 407-422.