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CHLAMYDIA - NON-SPECIFIC URETHTITIS (NSU)

What is Chlamydia ?

Chlamydia is a sexually transmitted infection. It most commonly infects the urethra (water passage) in men. It can spread to the epididymis and testicles. The epididymis is a long coiled tube in which sperm are stored. It is connected by another tube to the urethra. Infection of the epididymis and testicles is called epididymo-orchitis . In women the urethra and cervix (neck of the womb) are the usual sites of infection. If spread occurs, then the Fallopian tubes which connect the ovaries to the uterus (womb) are involved. This is called salpingitis , or pelvic inflammatory disease. Chlamydia can infect the eye, the throat and the rectum (back passage) in men and women. Chlamydia can spread from mother to baby during delivery causing an eye infection in the baby. Infection usually causes no symptoms in women. They may experience slight pain on passing water and notice a change in the colour and amount of vaginal discharge.

Symptoms are more likely if infection has spread to the Fallopian tubes and ovaries: then lower abdominal pains, fever and chills may occur. Men usually have mild symptoms: a white/yellow discharge from the penis and pain on passing water. If spread has occurred to the testes and epididymis, then these may be red, painful and swollen. Up to half of men with chlamydia have no symptoms. Chlamydia in the rectum causes a discharge and irritation around the back passage. Urethritis describes a set of symptoms and/or test results. The symptoms are discharge from the penis and pain on passing water. When a specimen from the urethra is examined under the microscope, pus cells (neutrophils) are identified. Pus cells appear in body fluids in response to infection. There are a lot of different germs that can cause urethritis. About half the cases are due to chlamydia, but trichomonas, herpes simplex virus and wart virus infection. When no germ can be found, the condition is called non-specific urethritis (NSU). This happens in 20 to 30 % of men with urethritis.

How does Chlamydia occur ?

Chlamydia is caught through having sexual intercourse with an infected person. Symptoms develop 10 to 12 days after contact but can appear as late as 42 days. Infection occurs at the site of sexual contact.

Why does Chlamydia occur ?

The risk of catching chlamydia increases with the number of sexual partners. It is passed on very easily so once infected, it is highly likely that the partner(s) will also be infected. Using a condom during sexual intercourse offers good, but not complete, protection.

Treatment Involved for Chlamydia

Usually your GP will refer you to a department of genito-urinary medicine (special clinic, STD clinic). If infection is suspected, a visit to the local clinic without a referral letter is possible. The address of the clinic can be found in the telephone book.

INVESTIGATIONS Chlamydia usually causes urethritis in men which is easy to diagnose on the spot. A small swab is used to collect a specimen from the tip of the urethra. This can be looked at under the microscope to make the diagnosis. If necessary the doctor may take a specimen of discharge for culturing. The result of this takes up to 2 weeks. In women, specimens for chlamydia are taken from the cervix (neck of the womb) and/or urethra (water passage). Results of these tests take 2 weeks so it is not possible to diagnose chlamydia straight away in women. It is important to be screened for other sexually transmitted diseases at the same time.

TREATMENT Provided there are no complications, chlamydia can be cured by tetracycline or erythromycin taken as a course of tablets. A single dose of azithromycin is just as effective. Because NSU is usually due to chlamydia, this is also treated with tetracyclines or erythromycin. It is essential that the sexual partner(s) are seen and treated. It is impossible to know from whom the infected person caught chlamydia. Ideally all sexual partners within the previous 6 months should be seen and treated.

During Treatment for Chlamydia

Symptoms usually settle within a week, unless infection has spread. It is very common to get some nausea and diarrhoea after taking erythromycin and this is nothing to worry about. It is better to take the erythromycin after meals. Tetracyclines should be taken on an empty stomach, and should not be taken by children or pregnant women. If pregnancy is a possibility, the doctor should be informed. Rashes can occur and these can be brought on by sunshine. Women may get vaginal candidiasis (thrush) and the doctor may screen for this as part of the follow- up. Tests of cure can be done 3 weeks after completing treatment. These tests are not always needed but you should not have sexual intercourse until after the follow-up visit..

After Treatment for Chlamydia

Protection from chlamydia does not result from a previous infection: it is possible to catch it again from an infected or untreated partner. Using a condom with casual partners will protect from subsequent infection. Sometimes NSU does not respond to a particular antibiotic. This may be because it is due to a different germ which requires a different antibiotic. If symptoms return or don't improve, you should tell your doctor. He will take more extensive tests and may prescribe a different treatment.

If Chlamydia is Left Untreated

If chlamydia is not treated then spread can occur to the testicles in men and the Fallopian tubes in women. These reproductive organs are very sensitive to infection and permanent damage may result. This may lead to infertility in men and women. Women can also develop ectopic pregnancy (a pregnancy occurring outside the womb) and chronic pelvic pain.

Effects on Family of Chlamydia

Sexual partners are the only people who need to know about the infection. It is the responsibility of the infected person to inform them. The information given to the doctor is treated in the strictest confidence. He or she is not allowed to pass this on to the partner(s). The doctor will usually recommend that the partner(s) be treated even if their initial test is negative. The partner may prefer not to have treatment and to wait for a second set of test results. This is alright as long as they do not have sex with anyone until the results are back (usually 4 weeks).