What you feel (chlamydia symptoms)

Here, our expert doctor will answer real-life patient questions about chlamydia symptoms. The questions are grouped so it’s easier to cover more topic. Dr. Fuzayloff have been a practicing physician at a busy STD center in Midtown Manhattan in New York City for over two decades.

• What’s the difference between symptoms and signs?

  It’s important to distinguish symptoms from signs. Symptoms are subjective, meaning they are your sensations and experiences. Signs are objective features of the disease that can be detected not only by you but also by your doctor. Therefore, signs are more reliable than symptoms. Nevertheless, we still consider symptoms in making a diagnosis, and they are important because in the early stages of the disease you may experience only symptoms without any signs—signs may develop later.

• How common are chlamydia symptoms?

  According to various scientific sources, 10%–50% of males and 5%–30% of females who are infected with chlamydia develop symptoms, which means that most infected people don’t have any symptoms. In most cases, patients are not even aware that they are infected, and they can pass the infection to their sexual partners unintentionally.

• What are the common chlamydia symptoms and complications?

  Here we’ll talk about common chlamydia symptoms that most people get if they have any symptoms. Please keep in mind that most people never have any symptoms.

  
  

  First, let’s understand how the infection is contracted, and then we’ll cover different organs and their symptoms.

  How the infection is contracted

  Chlamydia bacteria come into contact with the mucosa (inner lining) of an organ and begin the invasion process. Since multiple organs can be affected, we’ll mention symptoms for each of them

  Males

  When chlamydia affects and inflames the penile urethra, the result can be a penile itch, a burning sensation, and pain during urination. If left untreated, symptoms progress, and frequent, urgent urination may occur. These symptoms typically evolve 5–10 days after exposure and may occur separately or together in any combination.

  
  

  Complications. If chlamydia affects the epididymis (the tube that carries sperm that’s located on the backside of the testicles) and causes inflammation, the person might experience pain, swelling, and tenderness of one or both testicles. This occurs mainly in untreated cases.

  Females

  In females, chlamydia first invades the cervix of the uterus and causes inflammation (cervicitis) followed by pain, vaginal itching, and painful periods. The urethra may also be involved in the inflammatory process, causing burning and pain during urination and frequent, urgent urination. Symptoms appear 5–14 days after exposure. Early on, the symptoms are usually mild, but they progress over time. All these symptoms can occur together, or there can be variations depending on which organ or organ part is affected.
  
  Complications. When untreated, in 10%–15% of cases the inflammatory process progresses and involves the uterus, fallopian tubes, and ovaries. This condition is called pelvic inflammatory disease (PID). The person might experience pelvic or lower abdominal pain and malaise.

  Oral chlamydia symptoms

  Oral chlamydia is rarely symptomatic. When it is, it causes inflammation of the pharynx (pharyngitis), resulting in a sore throat, and it may progress to cough and low-grade fever.

  Rectal chlamydia symptoms

  Rectal chlamydia manifests with inflammation of the anus and rectum (proctitis). The person might have anal pain, anal itch, rectal pain, and/or tenesmus (a sensation of incomplete emptying of the bowel). Symptoms vary depending on the infective strain. Inflammation of the rectum can be associated with various chlamydia strains. Lymphogranuloma venerum (LGV) strains are rather common in HIV-positive heterosexual males.

• How common are asymptomatic (no symptoms) chlamydia cases?

  Asymptomatic cases are quite common.
  
  Males. Statistics differ, but many sources indicate that 50% of males are asymptomatic. According to other sources, including the CDC, this number is as high as 90%. For instance, inflammation of the urethra (urethritis) may occur without symptoms in 40%–96% of cases.2
  
  Females. Among infected females, 70% to 95% have no symptoms.1
  
  Oral. People with oral chlamydia usually have no symptoms.
  
  Rectal. When we talk about symptomatic or asymptomatic rectal infection, we should first consider what chlamydial strain is involved. In males (predominantly HIV-positive gay and bisexual males) and women, chlamydia may present as lymphogranuloma venerum (LGV), which can cause a variety of symptoms. Only 5% of people with the LGV form of chlamydia are asymptomatic (do not have symptoms). With chlamydial proctitis (inflammation of the rectum) caused by non-LGV strains, about 84% of infected people are asymptomatic.

• What are the most reliable chlamydia symptoms? Why?

  The most reliable symptoms are those a doctor trusts the most in establishing a diagnosis because they better explain the pathophysiology (how the disease evolves over time).
  
  Penile chlamydia. The most reliable symptom is the sensation of pain and burning during urination. This discomfort is caused by inflammation in the urethra.
  
  Vaginal chlamydia. Painful intercourse and bleeding after sex are the most reliable symptoms. These symptoms develop due to inflammation of the vagina. In the case of pelvic inflammatory disease (PID), abdominal and pelvic pain are considered reliable symptoms because they are quite common.
  
  Oral chlamydia. Pain when swallowing food is connected with inflammation of the pharynx and is rather commonly seen in patients who are symptomatic, so it is a relatively reliable symptom.
  
  Rectal chlamydia. Rectal pain, especially during defecation, and bleeding are connected with inflammation of the rectum and are the most reliable symptoms.

• How important are chlamydia symptoms in establishing the diagnosis?

  Symptoms alone are not sufficient. One can suspect chlamydia but never be sure without testing.

• How soon do people begin experiencing symptoms?

  Symptoms may occur as early as five days after exposure, but more commonly they occur after two or three weeks.

• What does resolution of my symptoms mean?

  The resolution of symptoms doesn’t mean that you’re fully recovered. If left untreated, chlamydia may remain dormant in affected organs for several months or even years. Sometimes the infection goes away without treatment, but we lack precise data on how often and why that happens. In some studies, it was found that chlamydia clears more slowly in males than in females (2.84 and 1.35 years, respectively). Even when dormant, the infection can lead to complications, so it is always a good idea to get tested.

• Could my symptoms be psychological? How can I tell psychological symptoms apart from symptoms caused by physical disease

  We assume that your symptoms are psychological only if the disease is ruled out by testing. We always look for scientific evidence and facts. Since medicine is a science, symptoms follow patterns and rules and tend to be predictable and logical.
  
  “Logical” means that symptoms follow a certain pattern. For instance, they should appear within a certain period of time (five days to three weeks after exposure, in the case of chlamydia). If you experience symptoms immediately after sexual intercourse, we may question whether they are caused by an infection since there should be an incubation period before symptoms develop.
  
  “Predictable” means we should be able to predict what will elicit symptoms. Because chlamydia inflames certain parts of the body (the urethra, rectal mucosa, etc.), the pain should be caused by irritation (use) of that particular area; for instance, by urination if the urethra is involved in the process. In this example, every time (or at least most times) that you urinate, you should experience discomfort. If you have pain during urination only at lunchtime, that sounds quite uncommon and we would question it.
  
  We carefully consider your sexual history. There is a high chance of a psychological component if you have had a new partner (whom you do not trust), tried something new with an existing partner, or have health anxiety in general. Things that you have never tried (or rarely tried) can be stressful for your brain. When stressed, people may start reading about the disease and looking for symptoms. It’s difficult to put all your symptoms into context when you are stressed. The context, in this case, includes the following: When was the contact? Has enough time passed before symptoms appeared? Do symptoms present regularly? Do they have a logical progression? Are they predictable?
  
  Meanwhile, we never forget that diseases can have unusual and uncommon presentations, so we try to analyze all the symptoms systematically and in combination with the laboratory findings. Symptoms alone are not sufficient for making a diagnosis. We can only make an assumption by putting symptoms into context. To distinguish between psychological and non-psychological causes, we suggest testing to exclude or establish probable infection.