The chlamydial infection

Chlamydia are a group of bacteria that are made up of different subgroups. Depending on the subgroup, they affect different organ systems and can cause different clinical pictures.

They can affect the genital area and lead to inflammation of the testicles or uterus. If left untreated, the infection can even lead to infertility. In addition, chlamydia can infect the mucous membranes of the airways and cause pneumonia. Conjunctivitis of the eye is also possible.

The reasons

The cause of a chlamydial infection is an infection with the bacterium. They multiply in the human body and, depending on the subgroup of the bacterium, can trigger different symptoms.

The subgroup Chlamydia trachomatis in particular is of great importance for humans, as this bacterium is only transmitted by humans. Chlamydia is particularly transmitted during sexual intercourse. Therefore, a chlamydial infection is considered a sexually transmitted disease. One to three weeks after the infection, the chlamydial infection becomes noticeable with the first symptoms.

If pregnant women suffer from a chlamydial infection, the risk of premature birth or premature amniotic sac can increase. Infection of the child with the mother's chlamydia is possible during birth. In newborns, these bacteria then lead to eye infections and, in rare cases, to pneumonia.

Trachoma occurs when the chlamydia infects the conjunctiva of the eye and it becomes inflamed. The inflammation then spreads to the cornea of ​​the eye, and smear infection (infections that are transmitted through touch) affects both eyes in a very short time. These then change increasingly: the cornea becomes cloudy. Infection is also possible through contact with flies.

The transmission route

The ways in which the chlamydial infection is transmitted are as diverse as the manifestations of the disease.

In diseases with the bacterium Chlamydia trachomatis, the eyes as well as the urinary tract and the genital organs can be affected. The transmission takes place directly from person to person, possibly also from flies to people. In addition, sexual transmission can take place via body fluids during intercourse.

The pathogen Chlamydia pneumoniae, on the other hand, mainly settles in the lungs. It follows the so-called aerogenic transmission through the air. This also includes droplet infection, which can occur, for example, from tiny droplets of liquid when coughing or sneezing. Coughed up mucus and secretions from the nose can also transmit the bacteria

When the disease is caused by Chlamydia psittaci, the bacteria are also transmitted through the air. The pathogens stay in fine dust and animal excrement, are whirled up from there and enter the body via the airways. Therefore, this pathogen mainly triggers infectious diseases in the lungs.

The symptoms

About 80% of the female affected and about 50% of the male affected have no symptoms of the infection. As a result, the infection with chlamydia is not recognized and so spread through unprotected intercourse.

Symptoms in men:

• Inflammation of the urethra (urethritis)
• difficult urination
• increased need to urinate
• drawing pain in the urethra
• slimy-purulent discharge
• Itching and burning when urinating
• Inflammation of the epididymis (epididymitis)
• Inflammation of the prostate (prostatitis)

Read more on the subject at: You can recognize a chlamydial infection in men by these symptoms

Symptoms in women:

• increased discharge, possibly purulent
• Itching in the vagina
• Itching and burning when urinating
• possible rise of the infection in the uterus and fallopian tubes
• fever
• stomach pain
• Inflammation of the liver
• Infertility (usually due to glued fallopian tubes)

Possible symptoms for all those affected:

• Pain in the anus
• Discharge on the anus
• Joint pain (arthritis)
• Ulcers in the genital area, groin, or anus (lymph granuloma venereum)

Symptoms in infants:

The bacteria can be transmitted from the mother infected with chlamydia to the baby during birth. This can lead to purulent conjunctivitis or pneumonia in the newborn.

Fatigue as a symptom

In principle, an infection in the body can always be accompanied by general symptoms such as tiredness, malaise and headaches. Therefore, chlamydial infections are no exception.

However, the disease with chlamydia comes in different forms. Typically, local infections of the eyes or genital tract also only cause local complaints. However, if the disease spreads, general symptoms such as tiredness can also appear. Chlamydia infection of the respiratory tract (especially of the lungs) is also associated with fatigue and other flu-like symptoms.

Also read the article: The chlamydial infection of the lungs.

The itching as a symptom

A chlamydial infection in the area of ​​the genital tract can lead to bad smelling yellowish discharge. There are also other symptoms such as genital itching. A burning sensation in the genital area is not uncommon with chlamydial infections.

Depending on which parts of the urogenital tract are affected, there may be further discomfort when urinating (pain, burning, etc.) and during sexual intercourse (itching, burning, pain).

You can also read: The scrotum itches - what's behind it?

Joint arthritis as a symptom

Reactive arthritis is one of the complications of a chlamydial infection. After an infection of the urogenital tract, asymmetrical wandering pain in individual joints occurs. The joints of the lower extremities (ankle joint, knee joint, hip joint) are particularly badly affected. In addition, symptoms such as fever and inflammation of the tendons can occur. A skin reaction on the hands and feet can also be triggered by reactive arthritis after a chlamydial infection.

The symptoms usually begin about a week after the actual infection. Therapy consists of treating the chlamydial infection and mild pain relievers for the joints. The course is often protracted (around a year) and can become chronic in around 20% of those affected.

Read more about the topic here: Reactive arthritis.

The lymph node swelling as a symptom

The swelling of the lymph nodes in the groin can be a result of chlamydial infections in the genital area. The cause is, on the one hand, the infection itself, which activates the immune system and thus leads to increased work on the lymph nodes.

The so-called lymphogranuloma inguinale can also develop as a result of the chlamydial infection. Small skin lesions appear in the genital area, then after two weeks there are significant lymph node swellings with blue-red discoloration and pus formation. Here too, antibiotic therapy with doxycycline (longer than with normal chlamydial infection) is required.

The symptoms of trachoma

So-called trachoma is rather rare in Germany, but very often leads to blindness in developing countries. The infection of the eye with chlamydia manifests itself first in conjunctivitis and shows the following symptoms:

• Lacrimation
• Photophobia
• Sensation of pressure in the eye

If the trachoma is not treated, the chlamydial infection usually spreads to the cornea of ​​the eye and it comes to a deterioration of the eyesight up to blindness.

Read more about conjunctivitis caused by a chlamydial infection at: Swimming pool conjunctivitis

The diagnosis

The latest diagnostic methods use molecular genetic possibilities. For this purpose, the morning urine and the secretion of the uterus (in men in the secretion of the urethra) are examined for the genetic material of the chlamydia (DNA). Before this, this DNA is multiplied by means of the polymerase chain reaction in the preparation to be examined in order to enable a reliable diagnosis.

Before this new method was developed, the diagnosis had to be made using a cell swab from the urethra and, in women, also from the cervix. The samples obtained from these smears were grown and examined to determine whether chlamydia multiply in them.

A chlamydial infection can also be determined by means of antibodies in the blood, but if the test result is positive it cannot be determined with certainty whether it is a healed or an acute (current) infection with chlamydia.

Although symptoms of chlamydial infection are similar to symptoms of gonorrhea (Gonorrhea) is very similar, these two diseases must be treated differently. For this reason, a reliable diagnosis is extremely important.

Read more on this topic: The chlamydia test.

The quick test

The Chlamydia rapid test is available in many pharmacies and also on the Internet as a self-test. It can also be carried out by family doctors and doctors from other disciplines (gynecology, urology, venereology). This test at the doctor's office is free of charge once a year for women under the age of 25. The costs for the self-test must be borne by yourself, they are between 25 and 100 €, depending on which test set you use.

The rapid chlamydia test is based on a swab or urine test and takes about 15 minutes to show a result. However, the results of the rapid test are usually less accurate than a urine or blood test that is sent to the laboratory. For this reason, a doctor should first be consulted if the rapid test is positive. This can initiate therapy and / or have a chlamydia test carried out in the laboratory.

Read more on the subject at: Rapid test for sexually transmitted diseases

What do you see in the blood count?

In the case of a chlamydial infection, unspecific signs of inflammation may initially be visible in the blood count. This can lead to an increase in the inflammatory value CRP (C-reactive protein) and the number of leukocytes (white blood cells).

Special blood tests can also be carried out. The bacterium can be grown in a blood culture. The body's own antibodies against the bacteria can also be detected in the blood. Overall, the cultivation of chlamydia is difficult, so that the diagnosis takes a few days. Therefore, one falls back on a faster test from smears in order to be able to initiate early therapy.

The subgroups

1. Chlamydia trachomatis
   These chlamydia cause sexually transmitted diseases and also inflammation of the eye.
   To this day, chlamydia is one of the most common sexually transmitted diseases. About 10% of the population have chlamydia (Chlamydia trachomatis) infected, but about 80% of the female affected and about 50% of the male affected do not show any symptoms of the infection. As a result, the infection with chlamydia is not recognized and is thus spread more and more through unprotected intercourse.
   The pathogens Chlamydia trachomatis lead to conjunctivitis, the so-called trachoma, in tropical and subtropical regions. This is one of the most common causes of blindness there, but it can easily be prevented with antibiotics.
2. Chlamydia pneumoniae
   This subgroup of chlamydia can cause inflammation of the bronchi (bronchitis) and inflammation of the sinuses (sinusitis) and are widespread. Sometimes they also lead to pneumonia (atypical pneumonia), which, however, is usually mild and heals well.
3. Chlamydia psittaci
   This form of chlamydia is the causative agent of the so-called parrot disease (Ornithosis), from which humans can also be infected (zoonosis). However, the disease is extremely rare and the symptoms are very similar to severe pneumonia.

Chlamydial infections should be taken very seriously and treated right from the start because of the possible consequences and difficulties in the course of the disease.

Also read the articles: "Chlamydial infection of the lungs" and "What are the consequences of a chlamydial infection?".

The therapy

In the case of an infection with chlamydia, it is important that all sexual partners are examined and treated at the same time, otherwise the so-called “ping-pong effect” with repeated mutual infection occurs.

The treatment of chlamydia takes place with antibiotics, which must be taken for at least a week. In some cases, the duration of treatment is extended to 14 days. Treatment of chlamydia is only effective through consistent antibiotic therapy, but there is an exceptional active ingredient (azithromycin) that only needs to be taken once.

If a chlamydial infection is diagnosed during pregnancy, treatment with erythromycin, amoxicillin or josamycin takes place. An examination of the pregnant woman is then necessary to ensure that the therapy was successful.

If a trachoma occurs, the doctor will prescribe a tetracycline eye ointment in the early stages, but in the more advanced stages an operation is necessary.

Find out more about the topic here: Treatment of chlamydial infection.

Antibiotic therapy

The therapy of chlamydial infection depends on the specific subspecies of the bacteria. The location of the infection also plays a role.

If the respiratory tract is caused by Chlamydia psittaci, antibiotic therapy with doxycycline should be carried out for two to three weeks. The antibiotic therapy of the sexually transmitted disease, which is triggered by the Chlamyda trachomatis species, is also carried out using doxycycline. The use of other antibiotics such as macrolides is also possible.

In the treatment of the sexually transmitted disease, it is important that the respective sexual partner is also treated. In this way, a so-called ping-pong effect, in which the sexual partners infect each other again and again, can be avoided. If the chlamydial infection only affects the eyes, you can refrain from systemic therapy or combine it with antibiotic eye drops.

For more information, see: Antibiotic therapy for chlamydia.

Treatment without antibiotics

Treatment of chlamydial infection without antibiotics is not recommended. Early antibiotic therapy is important for the disease to heal well, as this can prevent the infection from spreading.

In the absence of adequate therapy, chlamydia attack can lead to a deterioration in vision and even blindness. Pneumonia caused by chlamydia can get stuck and cause severe lung damage. The bacteria may spread into the blood and thus blood poisoning.
In the case of venereal disease caused by chlamydia, the internal genital organs can be affected without therapy, so that if it spreads rapidly, it can lead to decreased fertility and even infertility.

The partner treatment

The treatment of the sexual partner only plays a role in urogenital chlamydial infection. It is important that both partners are treated at the same time. In this way, a ping-pong effect can be avoided, in which the sexual partners infect each other again after therapy.

Before, during and shortly after the therapy, sexual intercourse should be avoided or maximally protected sexual intercourse should take place so that no further transmission takes place.

Which doctor treats chlamydial infection?

A chlamydial infection is treated by different doctors, depending on which organ system is affected.

Usually the first point of contact is the family doctor, who can refer affected persons to gynecologists (gynecologists), urologists, pulmonologists or specialists in eye diseases. However, depending on how advanced the infection is, treatment can only be given by your family doctor.

Prognosis

Chlamydia infection often goes unnoticed, which is especially the case in women. Without therapy, however, the chlamydia can spread and in women can lead to an inflammation of the abdomen that sticks up the fallopian tubes so that pregnancy can no longer be achieved naturally. If the fallopian tube is stuck, an ectopic pregnancy is also possible, which is an emergency situation and requires an operation in which the unborn child is lost.

In men, chlamydial infection sometimes causes inflammation of the epididymis or prostate, which can also lead to infertility.
If women have a chlamydial infection, they are at risk of contracting HIV.

The so-called Reiter's disease is a rare complication of chlamydial infections. This results in joint pain (especially swollen knees and ankles), urinary tract infections, eye infections and skin rashes. Reiter's disease occurs mainly in young men and is triggered by a chlamydial infection, but also by an intestinal infection.
If left untreated, a trachoma (an eye infection with chlamydia) leads to blindness in most cases.

If a chlamydial infection is treated in good time, consequential damage can usually be reliably avoided.

Chlamydia in men - what are the special features? Read more here.

How often does chlamydia cause sterility?

Chlamydia can render infertile by infecting the genital organs. In men, the prostate and testicles are affected; in women, the ovaries, fallopian tubes and uterus can be infected by chlamydia. How often complications such as infertility occur depends primarily on the time of diagnosis and therapy. If the chlamydial infection is local to the external genital tract, infertility is unlikely.

With the help of antibiotics, the pathogens can be treated before they affect the other genital organs. If left untreated, the bacteria often spread, so that adhesions in the area of ​​the internal sexual organs and the resulting infertility must be expected. Inflammation of the ovaries and testicles can also cause sterility.

How long are you contagious?

With adequate therapy, the chlamydia are usually killed by the antibiotics after 10 to 21 days, so that infection can no longer occur afterwards. However, without therapy or before the end of treatment, one should be careful, as infection from sexual partners, for example, is possible.

It is important that the therapy is carried out both to the person concerned and to sexual partners, otherwise an immediate re-infection is possible after the end of the therapy. This is due to the fact that the body cannot produce its own defense substances against the chlamydia and is therefore again susceptible to the bacteria.

The prevention

You can protect yourself against a chlamydial infection and get help quickly in the event of infection:

• Only intercourse with a condom
• If there is any doubt about an infection: see a doctor!
• The partner must urgently be treated with chlamydia infection
• In tropical countries: do not use used towels and pay attention to hygiene to avoid trachoma

The check-up

Since chlamydial infections are partially symptom-free, regular check-ups are recommended in the following risk groups:

• in women who are younger than 25 years
• in pregnant women
• for people who have unprotected intercourse with new or multiple partners

Before an operation on the uterus (childbirth, use of a contraceptive coil, artificial insemination) should be examined for chlamydia. Since 2008, chlamydia screening for women under the age of 25 has been paid for by statutory health insurances. The chlamydia test in pregnant women is part of regular maternity care.

The chlamydial infection in pregnancy

Before a planned pregnancy or during an existing pregnancy, women should get tested for chlamydial infections, as the infection can have consequences for the child. As a rule, the test should be done before pregnancy and around the 32nd week of pregnancy.

The bacteria are usually transmitted from the genital area of ​​women. At birth, the child must pass through the genital tract so that it can become infected with chlamydia there. This can lead to chlamydial conjunctivitis (conjunctivitis caused by chlamydia), otitis media and pneumonia in the newborn.

Chlamydia infection should be treated during pregnancy with the antibiotics azithromycin, erythromycin or amoxicillin. The infection can also be passed on to the baby while breastfeeding, which is why breastfeeding mothers should be treated immediately.

Read more on the topic: Chlamydial infection during childbirth

Pneumonia caused by chlamydia

Chlamydial pneumonia is typically caused by the strain of Chlamydia pneumoniae or Chlamydia psittaci. Chlamydia psittaci is a bird-borne disease that primarily affects people who work with birds a lot.

As a rule, atypical pneumonia occurs, which is characterized by a less severe fever and only a slight cough. Nevertheless, early treatment of the disease with antibiotics makes sense so that no lung damage occurs. Without therapy, the pathogen can also spread to other organ systems such as the brain and heart.

Find out more about this topic here: The chlamydial infection of the lungs.

Cystitis caused by chlamydia

A bladder infection caused by chlamydia usually occurs as part of a urogenital (urinary tract and genital tract) infection. These are caused by the chlamydial subspecies trachomatis. Cystitis affects women particularly often. Since the urethra is much shorter in them than in men, the pathogens can rise more quickly to the bladder and lead to cystitis there.

A bladder infection with chlamydia should be treated early with antibiotics (for example with doxycycline). This can prevent the pathogen from spreading to other organs such as the prostate and testes in men and the uterus and ovaries in women.

How often does a chlamydial infection go unnoticed?

Because of their initially very unspecific symptoms, chlamydial infections can go unnoticed for a long time. Urogenital infections in particular are often only noticeable as a slight burning sensation in the genital area and yellowish discharge. It is not uncommon for complications such as involvement of the internal genital organs to occur because early diagnosis and therapy are not carried out.

Pneumonia caused by chlamydia is also noticed rather late, as it shows up through atypical symptoms.