Chlamydia: The Silent STD

Sexually transmitted infections (STIs) and diseases (STDs) are frequently discussed among adults with multiple sexual partners, but when people form monogamous couples, these conversations wane and may eventually disappear.

The stereotypical understanding is that we get STIs and STDs from "sleeping around."

However, the reality is chlamydia and other sexually transmitted infections can be present in the body without showing symptoms. In fact, chlamydia is known as the "silent infection" because most infected people are asymptomatic and lack abnormal physical examination findings, according to the Centers for Disease Control and Prevention (CDC).

Why chlamydia is so different

Many STIs and STDs cause rashes or other physical changes to the body that we can actually see and know to look out for.

Unfortunately, chlamydia is different because it can take weeks to incubate before showing any symptoms. This gap between contraction and changes in the body can contribute to a patient missing the connection of how the infection may have happened, or even with whom.

In women, this initial change can cause an increase in vaginal discharge, painful urination and possibly inflammation of the cervix, which would only be detected during a pelvic exam. These symptoms can be so subtle that many women confuse them with regular events that correspond with their menstrual cycle.

Conversely, when vaginal irritation combines with these changes in discharge, it's easy to assume it could be nothing more than a simple yeast infection, something that can be treated at home with an over-the-counter antifungal cream. However as the misdiagnosed infection spreads from the vagina to the cervix and eventually to the uterus, these subtle symptoms may mimic those of an ovarian cyst and change into pelvic pain.

Symptoms can be equally confusing for men, as the most common ones include painful urination and testicular pain or tenderness. For some men, these symptoms may not occur simultaneously or with enough intensity to cause them to even seek medical attention.

Treatment for chlamydia

Typically, most patients learn about their infection only after an annual visit with their doctor or an annual screening for sexually transmitted infections and diseases.

Chlamydia is the most commonly reported STI in the United States, according to the American College of Obstetricians and Gynecologists, but it's not the only STI that's difficult to detect, which is why it's so important for even monogamous couples to be tested every year.

Chlamydia is highly contagious, and once you test positive, you shouldn't have sex until you finish your treatment. While most chlamydia infections clear up with antibiotics, many physicians recommend getting tested following treatment and before having sex again to verify the infection has cleared.

Like any infection, it's important to continue taking your antibiotics as prescribed by your doctor and take all of the prescribed doses of the medication, and not just stop when you think you're cured.

Chlamydia is a bacterial infection, and there is always a risk that the bacteria can become resistant to antibiotics when not treated properly, such as by stopping the antibiotics when you feel better or when your symptoms go away. This stoppage could risk regrowth of the bacteria and an increase in the length of treatment to eliminate the infection.

The confusion around testing

Most healthcare recommendations advise annual STI and STD screenings for sexually active adults. However, as we learn more about the contraction of sexually transmitted infections, incubation periods and progression of these infections to diseases, organizations such as the National Coalition for Sexual Health recommend testing based on your personal sexual activities.

While current guidelines advise that you should be tested annually for chlamydia, you should also be tested before and after contact with a new sexual partner.

Unfortunately, many adults feel overwhelmed by the idea of receiving frequent STI and STD testing because they fear they cannot afford it or insurance might not cover it.

"The long-term health impacts of sexually transmitted diseases and infections are well-known," said Anne Rompalo, M.D., Sc.M., of the American Sexually Transmitted Diseases Association. "For this reason, every state provides [STD] screenings, but not everyone knows."

Your local health department can provide information about state and federal organizations that provide STI and STD testing.

Another concern for some people is how little we understand STDs and how to recognize the symptoms. Chlamydia's long incubation period sometimes causes it to be missed in testing even if it's part of your STD panel.

"The truth is that some of the most common STDs will only be part of your testing if your doctor orders it," said Melissa Reed, CEO of Planned Parenthood Keystone in Pennsylvania.

As patients, we assume our doctor will screen for everything when they order bloodwork and take samples and swabs, but the only way to know what you're being tested for is to ask.

Knowing when something is wrong

Don't assume you'll always know when something is not quite right with your body. Whether you're meeting with a doctor at a clinic or you have a primary care provider (PCP), it's essential to your health to fully disclose your symptoms honestly, which will allow better decisions to be made on your behalf.

Remember, everything you say at the doctor's office regarding your sexual partners, behavior and bodily functions are completely confidential between you and your PCP.

Individually, rashes, pain, discomfort, or changes in urination, discharge, arousal or genital appearance may not set off an alarm. But when they happen in concert, these are warning signs of chlamydia or possibly another infection. Presenting all of this information to your doctor will ensure they also screen for STDs that are not part of a regular panel.

These minor details could make a difference in how quickly you're diagnosed and treated, which is important because in extreme cases, untreated chlamydia can cause reactive arthritis, reproductive organ damage and permanent infertility.

Avoiding STI and STD screenings and any consequent treatment increases the risk that your partners could also contract an infection. Caring for your partner means taking care of your health, and if you do have an STI, your partner has a right to know immediately, and you should stop all sexual contact until you can confirm the infection is cured.