Chlamydia: Signs, Symptoms, and Complications - Verywell Health
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The signs and symptoms of a chlamydia infection depend on the part of the body infected, be it the vagina, penis, rectum, or throat. They can range from vaginal or penile discharge to severe abdominal and/or pelvic pain. Often, discomfort occurs during sex or urination. But far too often there are no warning signs at all.
Since chlamydia can cause damage and other complications even without symptoms, regular screening is critical to make sure an infection is caught and treated early, so these issues are avoided.
Frequent Symptoms
Most people who have chlamydia feel fine. For approximately 70% of women and 93% of men, there are no symptoms associated with the infection. However, a lack of symptoms doesn't mean the infection is not there or that it is not problematic.
Symptoms of chlamydia usually appear around three weeks after exposure. In some cases, the infection can be present for months or years before it is finally detected. During this time, other partners may become infected.
Symptoms of complications from chlamydia can occur much later after exposure.
Some possibilities include:
- Vaginal discharge/penile discharge: The most common symptom of chlamydia in women is vaginal discharge. It is usually yellowish in color, but both the consistency and color can vary. Men may have discharge from their penis that is often clear and thin, though it can also be thick and mucousy.
- Pain with urination: Both men and women may note pain with urination (dysuria) due to inflammation of the urethra (urethritis), the tube that leads from the bladder to the outside of the body. A more frequent need to urinate may also occur.
- Pain, swelling, or itching of the penis or vulva: Redness, tenderness, swelling, or itchiness may occur around the opening of the penis in men, or on the vulva (outer part of the genitals) or vagina in women.
- Pain with intercourse/painful ejaculation: The cervix is the site of infection for a large majority of chlamydia cases in women. This can cause discomfort with intercourse (dyspareunia), especially with deep penetration. Pain may also be present due to pelvic inflammatory disease (PID) or inflammation in the fallopian tubes. Men may experience pain with ejaculation.
- Bleeding between periods or with intercourse: This can be due to chlamydia-related inflammation of the cervix.
- Abdominal and pelvic pain: Pain in the abdomen, pelvis, and back may occur with pelvic inflammatory disease.
- Pain or swelling in the testes: Testicular pain and swelling may occur when chlamydia travels up through the urethra in men and into the epididymis, a duct at the back of a testicle. Inflammation (epididymitis) may result.
- Rectal pain, discharge, or bleeding: These may occur when the rectum becomes infected with chlamydia due to transmission during receptive anal sex.
Rare Symptoms
Symptoms that are less common include:
- A sore throat: Transmission of the bacteria during oral sex may cause a sore throat, pus on the tonsils, and pain with swallowing.
- Right upper abdominal pain (perihepatitis): This is a condition in which the capsule of the liver becomes inflamed. Also known as Fitz-Hugh-Curtis syndrome, it causes pain in the right upper portion of the abdomen.
- Joint pain (reactive arthritis): Symptoms of inflammation in only a few joints (oligoarthritis) combined with inflammation of the eyes and urethra may occur. This reactive arthritis is not caused by the infection. Instead, it's due to a post-inflammatory process in which the body makes infection-fighting proteins that mistakenly target its own tissue. It most often occurs one to four weeks after exposure to the bacteria and resolves in three to 12 months. It may or may not improve with antibiotics.
Complications
The complications of chlamydia infections can be serious. These issues may affect you whether or not you experienced chlamydia symptoms. Such complications are largely preventable through regular screening and prompt treatment.
Pelvic Inflammatory Disease (PID)
Chlamydia may cause abdominal and/or pelvic pain in women when the bacterium travels up through the cervix and uterus and into the fallopian tubes and ovaries, causing PID.
Roughly 10% to 15% of women with untreated chlamydia will develop PID that either produces symptoms (acute case) or few or no symptoms (symptomatic case).
The symptoms of PID may also include abdominal and pelvic pain, a gnawing type of back pain, and sometimes fever or chills.
On examination, a female may experience discomfort during a pelvic examination.
Chronic Pelvic Pain
Pelvic inflammatory disease may lead to chronic pelvic pain. This complication is common, occurring in roughly 30% of females who have had PID due to chlamydia.
Female Infertility
With PID, the infection and inflammation can result in scarring of the fallopian tubes. This scarring can block the passage of sperm into the fallopian tube, preventing fertilization and resulting in infertility.
Ectopic Pregnancy
An ectopic pregnancy or tubal pregnancy is a condition in which a fertilized egg implants in a fallopian tube instead of the uterus. This can occur when the fallopian tubes are scarred due to PID.
An ectopic pregnancy can be a life-threatening condition, especially if it ruptures before it is discovered.
Of females who develop PID, roughly 20% will experience infertility. While surgery can be used to remove scarring in the fallopian tubes, it may increase the risk of an ectopic pregnancy.
Male Infertility
It's not known for certain whether epididymitis due to chlamydia leads to males infertility. It may result in chronic pelvic or scrotal pain.
Pregnancy Complications
Females who have untreated chlamydia during pregnancy have an increased risk of several pregnancy complications. A chlamydia test is recommended at the first obstetrician visit for all pregnant females because of this.
There is an increased risk of premature labor and the complications that accompany preterm delivery. There is also an increased risk of endometritis, or inflammation of the uterus, following delivery.
Babies born to mothers who have untreated chlamydia are more likely to be small for gestational age or have a low birth weight.
The risk of stillbirth is around 40% higher for pregnant females who have untreated chlamydia compared to those without chlamydia. Fortunately, the risk is all but erased with treatment before and during pregnancy.
Newborn Complications
When a pregnant mother has untreated chlamydia, the baby can become infected during vaginal childbirth. There are two issues that can occur:
- Eye infections: Conjunctivitis (ophthalmia neonatorum) is thought to occur in almost 40% of infants born to mothers with untreated chlamydia. Symptoms such as swollen eyelids, red eyes, and a thick, yellowish discharge usually occur in the first 10 days of life.
- Pneumonia: This is somewhat less common, occurring in 3% to 16% of infants born to mothers who have untreated chlamydia. Pneumonia most often occurs four to 12 weeks after delivery and usually begins with a cough and congestion.
It's important to note that if a mother is treated for chlamydia before or during pregnancy, the baby should be safe from these infections. For those who are high-risk, some obstetricians recommend repeat screening for chlamydia during the third trimester.
Rectal Scarring and Fissures
Rarely, inflammation of the rectum (proctitis) may lead to scarring and fissures, abnormal passageways from the rectum to another region or outside of the body.
Cervical Cancer Risk
There has been controversy over whether chlamydia infections might increase the risk of cervical cancer caused by the human papillomavirus (HPV).
A 2016 review of 22 studies concluded that co-infection with HPV and chlamydia doubles the risk of cervical cancer. In 11 of the studies, chlamydia was an independent predictor of cervical malignancy.
It's thought that the inflammation of the pelvic organs related to chlamydia enhances the cancer-causing changes caused by HPV. That said, it's important to note that, in general, HPV infection is primarily to blame for the development of cervical cancer—not chlamydia.
HIV Risk
Chlamydia infections (as well as other sexually transmitted infections, STIs) may also increase the risk of becoming infected with or transmitting HIV.
The reasons for this are two-fold:
First, the infection can cause genital inflammation that can undermine the integrity of the mucosal tissue that lines the vagina, cervix, urethra, and rectum. This provides HIV a more direct route into the bloodstream and lymphatic system.
Secondly, an active chlamydia infection can increase HIV viral activity around the genitals. When this happens, a person can potentially have an undetectable viral load on a blood test but a detectable viral load in semen or vaginal secretions.
Some studies have suggested that chlamydia infections have been noted in as many as 15% of men who have sex with men (MSM) newly infected with HIV.
Lymphogranuloma Venereum
Unlike the more common subtypes of Chlamydia trachomatis that cause infections, there are some (L1, L2, and L3) that can cause a more severe syndrome known as lymphogranuloma venereum (LGV).
It involves systemic symptoms and lymph node swelling that can sometimes be confused with that due to other diseases, like syphilis.
The treatment course for LGV variations is significantly longer than that of others.
Lymphogranuloma venereum typically begins with a bump on the genitals a week or two after exposure, progressing to an open ulcerative sore. Swollen lymph nodes and flu-like symptoms follow around two to six weeks later.
Symptoms include:
- Enlarged, tender lymph nodes in the groin (inguinal nodes)
- Fever and chills
- An open sore on the genitalia (genital ulcer) at the site where the bacteria entered the body
- Muscle aches
Complications can occur many years later due to damage to the lymphatic system in the groin.
Trachoma
As the leading cause of blindness worldwide, trachoma is not an STI but an infection that is transmitted via secretions from the eyes or nose. It usually begins with redness and a condition in which the eyelashes turn inward and scratch the cornea.
Trachoma is caused by different types of Chlamydia trachomatis than genital infections.
Any eye symptoms in third world countries should be evaluated thoroughly as prompt treatment is needed to preserve vision.
When to See a Healthcare Provider
It's important to talk to your healthcare provider if you have any signs or symptoms of chlamydia, any other symptoms that concern you, or if you know or think you've been exposed to the infection.
According to the U.S. Preventive Services Task Force, women 25 and under and those who are sexually active should be screened for chlamydia every year, as should older women who have an increased risk of infection.
Screening for other STIs/STDs is important as well, as the risk factors for chlamydia also increase the likelihood of contracting these other infections. If you are treated for chlamydia, be sure to tell your healthcare provider if any symptoms persist.
A Word From Verywell
It can be hard to read about the potential complications of chlamydia, but many of these are very preventable with appropriate screening, speaking to your healthcare provider about any symptoms, and receiving treatment if you are positive. Our Doctor Discussion Guide below can help start that conversation with a healthcare professional.
Chlamydia Doctor Discussion Guide
Get our printable guide for your next doctor's appointment to help you ask the right questions.
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