Chlamydia

Chlamydia: Understanding a very common and often silent infection

Chlamydia is one of the most common bacterial sexually transmitted infections (STIs) in Quebec, especially among young adults. Caused by bacteria, it is transmitted during unprotected oral, vaginal, or anal sex. Its main challenge is that it often presents no symptoms, which facilitates its transmission.

How is it transmitted?

Chlamydia is caused by bacteria that are transmitted during unprotected sexual intercourse (without a condom), whether it is oral, vaginal, or anal.

It can be transmitted even in the absence of penetration or ejaculation. A simple contact between genital mucous membranes can be sufficient. A pregnant person can also transmit it to their baby during childbirth.

What are the possible symptoms?

When they do appear, symptoms generally manifest 1 to 3 weeks after infection.

• For women or people with a vagina:

  • Abnormal or heavier vaginal discharge
  • Burning sensation when urinating
  • Pain in the lower abdomen
  • Pain during sexual intercourse
  • Bleeding between periods or after sexual intercourse

• For men or people with a penis:

  • Clear or milky discharge from the penis
  • Burning sensation when urinating
  • Pain or swelling in the testicles

It is also possible to have a throat or rectal infection, which are almost always asymptomatic.

The challenge: a mostly asymptomatic infection

This is the crucial point: most people do not know they have chlamydia. It is estimated that up to 75% of women and 50% of men have no symptoms.

So, why screen for and treat a silent infection?

Even without symptoms, untreated chlamydia can cause significant long-term damage. Treatment is essential to:

• Avoid serious complications: For women, the main risk is developing Pelvic Inflammatory Disease (PID), which can lead to chronic pain, risks of ectopic pregnancy, and infertility.
• Protect reproductive health.
• Reduce your risk of acquiring HIV: Having an STI like chlamydia can increase vulnerability to HIV.
• Break the chain of transmission to protect your partner(s).

Choosing your treatment: what you need to know

The treatment is simple and consists of an antibiotic. Here are the two main options, presented according to current recommendations.

1st Choice: Doxycycline (7-day treatment)

• Advantage: This is the most frequently recommended treatment for its sustained effectiveness at all sites of infection.
• To consider: It requires rigor (all doses must be taken). This treatment is contraindicated for pregnant women.

Your pharmacist's advice: If you are taking doxycycline, take it with food and a full glass of water, and avoid lying down for 30 minutes afterward to minimize stomach upset.

2nd Choice: Azithromycin (single-dose treatment)

• Advantage: Very simple (a single dose), which eliminates the risk of missed doses. It's an excellent option if treatment adherence is a concern and the treatment of choice for pregnant women.
• To consider: Its effectiveness can be slightly lower than doxycycline's, particularly for non-genital infections. The single dose can also cause more digestive discomfort.

I've been diagnosed with chlamydia. What is the procedure to follow?

The treatment

It is crucial to take the antibiotic treatment as prescribed. An improvement in symptoms should be felt within 24 to 48 hours. In case of intolerance or if symptoms do not improve, it is important to contact one's pharmacist or doctor.

Resuming sexual activity

It is necessary to abstain from all sexual activity during treatment. The recommendation is to wait 7 days after all partners have completed treatment and all symptoms have completely disappeared before resuming sexual activity.

Partner notification

Notifying recent partners is an essential and responsible step. This allows them to get screened and treated quickly to break the chain of transmission.

Prevention: your best strategy

Can chlamydia be prevented?

Yes, absolutely. The best approach is often a combination of several tools.

Combined prevention: your options

• The condom: Remains the most effective protection against the majority of STIs.
• Regular screening: Getting tested regularly (every 3 to 6 months if you have multiple partners) is a pillar of prevention.
• Doxy-PEP (for certain populations): For gay men, bisexual men, and other men who have sex with men (MSM), Doxy-PEP is an emerging prevention option that involves taking an antibiotic after risky sex to reduce the chances of contracting chlamydia and syphilis.
• Vaccination: Vaccination against other STIs like HPV and hepatitis A and B is essential for overall good sexual health.