Sexually Transmitted Infections Part 1: Gonorrhea and Chlamydia
One of the most private conversations I have with my patients has to do with their concerns and exposures to sexually transmitted infections. Some patient are very savvy with managing and minimizing their exposures by carefully selecting a few partners in their lives, some even being appropriately empowered and self-protective by asking for paperwork from a prospective partner’s recent screening.
Others unwittingly expose themselves to many different infections that end up in thousands of dollars in health care resources and multiple trips to the office, sometimes over the course of many years.
In this article we’ll go over the most common of these. Just remember, the best cure is prevention. No prescription can take the place of discipline and good decisions in one’s life. Practice safe sex, and even more importantly, practice smart decisions in choosing your partner. And many infections do not have symptoms.
Developing a trusting relationship with a doctor is key. This part one article shares some basic info from government websites cdc.gov and womenshealth.gov about gonorrhea and chlamydia, two of the most common and damaging bacterial infections we see. The next articles in the series will continue to explore the other infections that we see in the office.
Gonorrhea
Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. It is usually spread by having vaginal, oral, or anal sex. Genital touching, touching the eyes after touching infected fluid and even childbirth can pass on the infection. In 2014, gonorrhea affected more than 162,000 women in the United States. Women between the ages of 15 to 24 are most likely to be affected. Antibiotics can treat gonorrhea but do not undo the permanent damage that can be caused. So it is important to get tested and treated early if you are exposed.
Most people who get gonorrhea do not have symptoms. Sometimes symptoms are confused with a urinary tract infection or another vaginal infection.
Signs or symptoms of gonorrhea depend on where you are first infected by the gonorrhea bacteria.
Signs/symptoms in the genital area can include:
- Pain or burning when urinating
- More vaginal discharge than usual
- Vaginal discharge that looks different than usual
- Bleeding between periods
- Pain in the pelvis or abdomen
Signs and symptoms in other parts of the body include:
- Anal itching, pus-like discharge, bright red blood on toilet tissue, or painful bowel movements
- Pain, itching of the eyes, sensitivity to light, pus-like discharge
- Sore throat, swollen glands in your neck
- Joint warmth, redness, swelling, pain while moving.
Gonorrhea can cause serious health problems, even if you do not have any signs or symptoms.
Gonorrhea that is not treated can cause serious health problems in women:
- Pelvic inflammatory disease (PID), an infection of a woman’s reproductive organs. PID can lead to chronic pelvic pain, pregnancy problems, and infertility, meaning you can’t get pregnant. Untreated gonorrhea is a common cause of PID.
- Higher risk of getting HIV or spreading HIV
- Although it does not happen very often, gonorrhea can cause widespread infection in other parts of the body, such as the blood, joints, heart, or brain. This can lead to death.
For pregnant women, untreated gonorrhea raises the risk of:
- Miscarriage
- Premature birth (babies born before 37 weeks of pregnancy). Premature birth is the most common cause of infant death and can lead to long-term health and developmental problems in children.
- Low birth weight
- Water breaking too early. This can lead to premature birth.
- Babies born to infected mothers are at risk for:
- Blindness. Treating the newborn’s eyes with medicine right after birth can prevent eye infection. The U.S. Preventive Services Task Force strongly recommends — and most states require by law — that all babies be treated with medicated eye ointments soon after birth.
- Joint infection
- Life-threatening blood infection
Treatment of gonorrhea as soon as it is found in pregnant women will lower the risk of these problems for both mother and baby. Your baby will get antibiotics if you have gonorrhea or if your baby has a gonorrheal eye infection.
Chlamydia
Chlamydia is caused by the bacteria Chlamydia trachomatis. Chlamydia also is usually spread through vaginal, oral, or anal sex. It can be spread through genital touching even in same-sex partners and through childbirth. Chlamydia is one of the most common STIs in women, especially young women ages 15 to 24 and can create permanent damage to the reproductive organs making pregnancy difficulty or impossible in the future. It often has no symptoms. Antibiotics can treat chlamydia but do not undo permanent damage.
Chlamydia is known as a “silent” infection, because most women who have chlamydia do not have signs or symptoms. If you do have symptoms, you may not notice them until several weeks after you get chlamydia.
Signs and symptoms may include:
- Bleeding between periods
- Burning when urinating
- Fever
- Low back pain
- Lower abdominal pain
- Nausea
- Pain during sex
- Unusual vaginal discharge
If you think you may have chlamydia, you and your sex partner(s) need to see a doctor as soon as possible.
Untreated chlamydia can cause serious health problems in women, including:
- Pelvic inflammatory disease (PID), an infection of a woman’s reproductive organs. PID can lead to chronic pelvic pain, inability to get pregnant and problems if you do get pregnant. PID affects about 10% to 15% of women with untreated chlamydia.
- Increased risk of getting HIV/AIDS virus from sexual activity
For pregnant women, chlamydia may lead to premature birth, or babies born before 37 weeks of pregnancy. Being born too early is the most common cause of death and long-term developmental and functional problems.
Babies born to mothers who have chlamydia can get:
- Infections in their eyes, called conjunctivitis or pinkeye. Signs include discharge from the eyes and swollen eyelids. The signs most often show up within two weeks after birth.
- Pneumonia. Signs include congestion, cough, and rapid or labored breathing, although these are not always present. Signs most often show up one to three months after birth.
- If you are 24 or younger and have sex, you need to get tested for chlamydia.Chlamydia is most common in women between 15 and 24 years old. You need to get tested if you have had any symptoms of chlamydia since your last negative test result or if your sex partner has chlamydia.
- If you are older than 24, you need to get tested if, in the past year or since your last test, you:
- Had a new sex partner
- Had your sex partner tell you they have gonorrhea or chlamydia
- Traded sex for money or drugs
- Have had chlamydia or another STI in the past
- Did not use condoms during sex and are in a relationship that is not monogamous, meaning you or your partner has sex with other people
Summary and Steps
You need to be tested if you are pregnant or if you have any symptoms of gonorrhea or chlamydia.
Gonorrhea and Chlamydia that does not have any signs or symptoms can still lead to future health problems (including not being able to get pregnant). The only way to know if you or a partner has these infections is to get tested.
There are two ways that a doctor or nurse tests for gonorrhea and chlamydia:
- A urine test. This is the most common. You urinate (pee) into a cup. Your urine is then tested for the infections.
- A swab test. Your doctor uses a cotton swab to take a fluid sample from an infected place (vagina, cervix, rectum, or throat). The fluid is then tested for the bacteria.
A Pap test is not used to detect gonorrhea or chlamydia and getting a speculum exam does not imply actual testing for any particular infection.
Your doctor will prescribe antibiotics to treat gonorrhea and/or chlamydia if your test is positive. Antibiotics can cure gonorrhea and chlamydia. But they cannot fix any permanent damage done to your body, so get tested and take the antibiotics as soon as possible.
For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics with anyone. If symptoms do not go away after treatment, see your doctor or nurse.
Tell your doctor if you are pregnant. Your doctor can give you antibiotics that are safe to take during pregnancy.
Tips
Chlamydia and Gonorrhea are easy to treat. But you need to be tested and treated as soon as possible.
If you think you have gonorrhea or chlamydia:
- See a doctor or nurse as soon as possible. Antibiotics will treat chlamydia, but they will not fix any permanent damage to your reproductive organs.
- Take all of your medicine. Even if symptoms go away, you need to finish all of the antibiotics.
- Tell your sex partner(s) so they can be tested and treated. If they are not tested and treated you could get chlamydia again.
- Avoid sexual contact until you and your partner(s) have been treated and cured. Even after you finish your antibiotics, you can get chlamydia again if you have sex with someone who has chlamydia.
- See your doctor or nurse again if you have symptoms that don’t go away within a few days after finishing the antibiotics.
The best way to prevent gonorrhea, chlamydia or any STI is to not have vaginal, oral, or anal sex.
If you do have sex, lower your risk of getting an STI with the following steps:
- Use condoms. Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get chlamydia, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
- Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.
- Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
- Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.
- Do not douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting STIs.4
- Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.
The steps work best when used together. No single step can protect you from every single type of STI.
Do you need more information about gonorrhea and chlamydia?
For more information about gonorrhea or chlamydia, call the Office of Women’s Health Helpline at 800-994-9662 or contact the following organizations:
- National Institute of Allergy and Infectious Diseases (NIAID), NIH, HHS
- Phone Number: 866-284-4107 (TDD: 800-877-8339)
- American Sexual Health Association
- Phone Number: 800-227-8922
- Planned Parenthood
- Phone Number: 800-230-7526
Sources
Sraddha Prativadi, MD, FACOG, ABIHM
Latest posts by Sraddha Prativadi, MD, FACOG, ABIHM (see all)
- Sexually Transmitted Infections Part 1: Gonorrhea and Chlamydia - April 11, 2016
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