Two general types of genital chlamydia infections affect females. The first of these, infection of the mucosa of the lower reproductive tract, commonly takes the form of an inflammation of the urethral tube or an infection of the cervix. In both cases women experience few or no symptoms (Centers for Disease Control, 2009b). When symp­toms do occur, they include a mild irritation or itching of the genital tissues, a burning sensation during urination, and a slight vaginal discharge.

The second type of genital chlamydia infection in women is invasive infection of the upper reproductive tract, expressed as pelvic inflammatory disease (PID). PID typi­cally occurs when bacteria that cause chlamydia or gonorrhea spread from the cervix upward, infecting the lining of the uterus (endometritis), the fallopian tubes (salpingitis), and possibly the ovaries and other adjacent abdominal structures (Gottlieb et al., 2011; Wendling, 2011). An estimated 40% of women with untreated chlamydia will develop PID (Centers for Disease Control, 2009b).

PID resulting from chlamydia infection often produces a variety of symptoms, which can include disrupted menstrual periods, chronic pelvic pain, lower back pain, fever, nausea, vomiting, and headache. Salpingitis caused by chlamydia infection is the primary preventable cause of female infertility and ectopic pregnancy (Gottlieb et al., 2011). Even after PID has been effectively treated, residual scar tissue in the fallopian tubes can leave some women sterile.

A woman who has had PID should be cautioned about the use of the IUD as a method of contraception. An IUD does not prevent fertilization (see Chapter 10 for an explanation of how the IUD prevents pregnancy); thus a tiny sperm cell could negotiate a partially blocked area of a scarred fallopian tube and fertilize an ovum that, because of its larger size, subsequently becomes lodged in the scarred tube. The result is an ectopic pregnancy, a serious hazard to the woman. The incidence of ectopic pregnancies in the United States has increased dramatically in the last two decades, largely because of an escalation in the occurrence of chlamydia infections. Chlamydia also often reduces fer­tility in women without detectable fallopian tube damage (Coppus et al., 2011).

In men, untreated chlamydia may result in a variety of symptoms, including a dis­charge from the penis and/or a burning sensation during urination, itching around the opening of the penis, and, less commonly, pain and swelling in the testicles (Centers for Disease Control, 2009b).

One of the most disheartening aspects of chlamydia is that symptoms are either minimal or nonexistent in a majority of infected women and about half of infected men

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(Centers for Disease Control, 2009b). Most women and men with rectal chlamydia infections also manifest few or no symptoms (Kent et al., 2005).

Another complication associated with Chlamydia trachomatis is trachoma (truh-KOH-muh), a chronic, contagious form of conjunctivitis (kun-junk-ti-VIE- tus) (inflammation of the mucous membrane that lines the inner surface of the eyelid and the exposed surface of the eyeball) (Kari et al., 2011). Trachoma is the world’s leading cause of preventable blindness; it is particularly prevalent in Asia and Africa (Karpecki & Shechtman,

2008). Chlamydia trachomatis is a common cause of eye infections (conjunctivitis) in newborns, who can become infected as they pass through the birth canal (Workowski et al., 2010). In addition, many babies of infected mothers will develop pneumonia caused by chlamydia infection (Workowski et al., 2010). Chla­mydia infection in pregnant women can also lead to

premature delivery (Ball, 2011; H. Johnson et al., 2011). The CDC recommends that pregnant women be tested for chlamydia during their first prenatal visit.

The Centers for Disease Control (2009b) estimates that women infected with chla­mydia are up to five times more likely to become infected with HIV (the virus that causes AIDS) if exposed to it.

Treatment

CDC guidelines suggest treating uncomplicated chlamydia infections with a 7-day reg­imen of doxycycline taken by mouth or a single 1-gram dose of azithromycin. All sexual partners exposed to chlamydia should be examined for STIs and treated if necessary.