Chlamydia is a most silent scourge: there are millions of new infections worldwide each year, but the infected often have no inkling of a problem until complications result. It is caused by a microscopic organism called Chlamydia trachomatis that has some properties of both bacteria and viruses. This organism is a delicate creature that does not readily survive outside the body; it is transmitted only by sexual contact. Its unique culture needs defied our ability to diagnose infection until the late 1970s. Even then, culture was not feasible unless the specimen was very quickly transported to a lab with the technical capabilities to perform these cultures; this effectively meant that diag-nostic testing was not available in most rural areas.
George is a college student in a large university town. One morning, he experienced a terrible burning when he tried to pee. George was lucky; he went to the student health services and the doctor there did a swab from his urethra (which hurt like hell, he’s quick to tell you) and within 48 hours had the news from the lab that he had chlamydia. Two weeks of a cheap antibiotic cleared it right up. Of course, the doctor also insisted that George contact the two young women students with whom he’d had sex in the previous two weeks, so they could be tested too. This was highly embarrassing for George, though he could see it was only right, and it had the effect of making him decide he’d always use condoms in the future.
Non-specific or non-gonococcal urethritis is characterised by inflammation of the urethra, leading to burning on urina¬tion and sometimes a discharge from the penis. We know now that the vast majority of these cases are caused by chlamydia, as in George’s case, but some may be due to other organisms. These cases also often respond to antibiotics. Unfortunately, there is a tendency for the symptoms of urethritis to recur, and occasionally for symptoms to appear elsewhere, including a combination of inflamma¬tion of the eyes (conjunctivitis), inflammation of the joints (arthritis) and skin rashes, especially on the feet. This little collection of goodies is called Reiter’s syndrome and requires the ongoing care of a specialist physician—it is also yet another good reason to always use those condoms in the first place.
Many women never know that they have been infected with chlamydia until they need to investigate their inabil¬ity to make babies. To avoid this situation, many doctors and clinics routinely screen young women for chlamydia. We now have simple swab and urine tests that rely on DNA typing. These have good accuracy and can easily be done at the same time as a Pap smear.
If chlamydia is detected on a routine screen, a course of antibiotics will cure it and prevent the complications of infertility. Follow-up testing to ensure it has cleared is also a good idea.
