She was at her prime – beautiful, courageous and a well-known national hero in Australia. After surviving the horrendous bush fire that devastated thousands of homes and killed hundreds of Australians, she was recovering well from her multiple burns in hospital. Sadly, Samantha finally passed away from a sexually transmitted disease (STD): Chlamydia infection.
The doctor who treated her reported that Samantha had severe complications in her reproductive and urinary tract that were non-operable. The four-year-old eucalyptus-loving Koala had to be put to sleep.
Now Chlamydia is no joke!
No, Chlamydia isn’t the name of the girl-next-door. And no, Hitler didn’t have Chlamydia; he had syphilis. And there is something else you need to know about Chlamydia.
Chlamydia remains the most commonly reported bacterial infection according to the Centers for Disease Control and Prevention (CDC), with an estimated three million new cases per year. In fact, Chlamydia is one of the most common bacterial STD in Singapore and several other developed countries.
Teenagers and young adults are the ones most commonly infected. Studies had shown that by the age of 30, 50% of women in the United States have antibodies indicating prior Chlamydia infection. What’s more sinister and dangerous about Chlamydia is that, the majority of C. trachomatis infections in both men and women are asymptomatic. This means that, unless you specifically test for it, you can have it for many years without knowing it.
Furthermore, in women, up to 40% of Chlamydia cervicitis will progressively involve the upper genital tract where asymptomatic destruction of the reproductive tubes (Fallopian tubes) can occur. This results in infertility.
The CDC recommends that all sexually active women under 26 years of age be screened at least annually for Chlamydia infection. Besides, all pregnant women should be tested during their antenatal visits. Pregnant women aged 25 years and younger, including those at higher risk, should have repeated STD testing done during their third trimester of pregnancy to prevent postnatal complications and transmission of infection to the infant.
Unfortunately, Samantha the koala didn’t listen to the doctor’s advice. Chlamydia infection could have been prevented.
A Case Study in Chlamydia Infection
Our case study today involves a young, successful entrepreneur in his late thirties. He is a bisexual man named Charles (not his real name).
Charles saw me for a problem with his penis (if that’s too embarrassing a terminology, consider using Willy or Dick, although I wouldn’t want to run the risk of offending a Willy or a Dick). He had a slight penile discharge for 4 to 5 days, and nothing else. He denied pain on urination, frequency of urination, and any pain and swellings elsewhere. He was still exercising regularly and felt great otherwise.
On questioning, he had a steady partner with whom he had insertive vaginal, anal and oral intercourse. He had occasional sex with men, and usually used a condom. He denied having receptive anal intercourse in the preceding year, and had negative HIV serology 6 months earlier. I skipped the small talk about the weather as he was rushing elsewhere that day.
While examining him, I observed a scanty, clear, mucoid urethral discharge, and very slight urethra meatal erythema (redness at the tip of his penis). He didn’t have any lymphadenopathy (swollen lymph nodes), rash or ulcers. Of note, the urethral discharge wasn’t very significant. It could best be described as scant, clear, urethral “moisture.” That was how scanty it was.
My initial impression was non-gonococcal urethritis (NGU), although I had to rule out other STDs or STIs (sexually transmitted infections), especially gonorrhea.
I performed urethral NAAT (nucleic acid amplification test) for C. trachomatis and N. gonorrhoeae, pharyngeal culture for N. gonorrhoeae, urine cultures for various UTI organisms, VDRL and HIV serology. All came back negative – all except C. trachomatis. Testing via NAAT for M. genitalium and T. vaginalis is neither widely available nor recommended now, but these tests might become useful in the near future.
Charles was given Doxycycline for a week to cover both Chlamydia and potential coliform urethritis while we waited for the test results to return. I advised him to ensure that his partner (and other sexual contacts) came to seek medical care for HIV and STD screening and testing. This is because C. trachomatis is a relatively infectious organism. More than two-thirds of female partners of infected men will have Chlamydia infection themselves.
The important point to note in this case study is this: Chlamydia is an insidious infection. It is usually asymptomatic, and can cause severe complications in women. Infertility, ectopic pregnancy and chronic pelvic pain in women are the consequences of Pelvic Inflammatory Disease (PID) from C. trachomatis. In fact, the risk of infertility increases with the number of infectious episodes and the severity of the pelvic inflammation.
The CDC recommends correct and consistent use of condoms to reduce transmission risk of Chlamydia. Do not expect Chlamydia to present with obvious symptoms and signs. See our board accredited Family Physician today for HIV and STD testing and screening. We also furnish advanced, up-to-date antiretroviral medications for HIV PEP (HIV Post Exposure Prophylaxis) in the event that you are exposed to the HIV virus.
