Chlamydia infections are among the most common sexually transmitted diseases. With one major pitfall: Very often, infection with the bacteria is asymptomatic, but can lead to infertility if left untreated. Teenagers and young women in particular can become infected unnoticed and possibly suffer long-term consequences. According to current estimates, about 100,000 women in Germany are infertile as a result of a chlamydia infection.
Who is affected?
In principle, both men and women can become infected with chlamydia. However, young women are particularly affected. It is estimated that one in five young women between the ages of 17 and 24 is infected with chlamydia. The more frequent the sexual activity with changing sexual partners, the greater the risk of becoming infected with chlamydia.
Why is chlamydia so dangerous?
In women, an infection often remains asymptomatic for anatomical reasons: Chlamydia attaches itself to the cervix, the junction between the vagina and the uterus. The cervix and the mucous membrane surrounding it are traversed by only a few nerves. Therefore, possible stimuli, such as an inflammation triggered by chlamydia, cause little to no pain at this site. Even the purulent discharge that occurs may go undetected, especially in women who are more prone to increased natural discharge.
If the chlamydia infection remains undetected and thus untreated, the chlamydia can travel to the fallopian tubes. Auch hier lösen sie Entzündungen aus, die dann vernarben können. Diese Vernarbungen beeinträchtigen die Funktion der Eileiter.
Doch die Eileiter sind essentiell, um schwanger zu werden, denn hier findet die Befruchtung statt. Beim Eisprung wandert die reife Eizelle in den Eileiter, gleichzeitig werden Spermien in den Eileiter gesogen. Im Eileiter treffen also die Eizelle und die Spermien aufeinander. Scarring due to chlamydia infection can hinder this process to varying degrees:
The fallopian tubes are scarred, but not closed:
Despite scarring, the egg and sperm meet and fertilization occurs. Then the fertilized egg tries to migrate to the uterus to implant. Due to scarring, the fertilized egg gets stuck in the fallopian tube and an ectopic pregnancy occurs, which cannot be carried to term.
The fallopian tubes are scarred and closed:
The mature egg is in the upper part of the fallopian tube and the sperm is in the lower part or uterus. Due to the scarring and the resulting closure of the fallopian tubes, they can no longer meet. Thus, fertilization is not possible.
Symptoms of a Chlamydia infection
In women, 80% of infections are asymptomatic for the reasons described above. In the remaining 20%, the following symptoms may occur in the first three weeks after infection:
purulent discharge
itching
pain during urination
Chlamydia can travel higher to the fallopian tubes or even the peritoneum and cause inflammation in each case. Symptoms such as intermittent bleeding, (unilateral) abdominal pain, fever and nausea may occur. A doctor should be consulted at this point at the latest.
In men, chlamydia infection leads to inflammation of the urethra and can cause similar symptoms as in women:
purulent discharge
pain when urinating
strong urge to urinate
Here, the chlamydia can continue to rise in the urethra and lead to inflammation of the prostate and epididymis. This leads to severe (unilateral) pain and possibly swelling of the testicle. If the inflammation is not treated in time, it can lead to male infertility.
Diagnosis and treatment
The gynecologist or urologist will take a smear test if an acute chlamydial infection is suspected. In a precautionary test for chlamydia, the urine is examined. If chlamydia is detected, treatment with antibiotics is given. After treatment, testing is done again to make sure that chlamydia is no longer detectable. In the meantime, sexual intercourse should be avoided to prevent re-infection or further spread. Aus diesen Gründen sollte auch der*die Partner*in bzw. die Sexualpartner*innen der letzten 60 Tage über die bestehende Chlamydien-Infektion aufgeklärt und mitbehandelt werden. If chlamydia is detected and treated in time, there is a high probability that the infection will not leave any permanent damage.How can you find out if your fertility has been affected by chlamydia?
First of all, a voluntary, precautionary test for chlamydia is useful. Gynecologists and urologists perform these tests and examine the urine for this purpose. If chlamydia is detected, treatment with antibiotics is given. After that, the current function of the fallopian tubes can be examined. Unfortunately, possible scarring is not visible on a normal ultrasound at the gynecologist’s office. Instead, a special ultrasound or laparoscopy should be done.
How can you protect yourself from chlamydia?
Since chlamydia is transmitted through sexual intercourse, protection is only possible by using condoms. Chlamydia can also infect the throat and rectum without symptoms, so condoms should also be used during oral and anal intercourse. In case of regular unprotected sexual intercourse, especially with changing sexual partners, voluntary annual testing for chlamydia is recommended. For sexually active women up to 25 years of age, the examination is also covered by the health insurance under certain conditions.
Good to know: Chlamydia infection during pregnancy
As part of the screening in the first trimester of pregnancy, every woman is tested for chlamydia. This is one of the standard maternity care services provided by statutory health insurers. If chlamydia is detected, it is treated with antibiotics suitable for pregnant women. This is because infection with chlamydia during pregnancy carries an increased risk of premature birth, miscarriage and other complications. During birth, the newborn can also be infected with chlamydia in the birth canal. The consequences are conjunctivitis and pneumonia in the newborn.
References
Robert Koch Institute (RKI). RKI Guide to Chlamydioses Part 1. https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Chlamydiosen_Teil1.html#doc2382764bodyText5 Accessed 09/15/2020.
Leading Medicine Guide. Chlamydia. https://www.leading-medicine-guide.de/erkrankungen/infektionen/chlamydien Accessed: 15.09.2020
Schweitzer, Rudolf (2014): Infectious Diseases. 2nd edition, Munich.
