What are the complications of chlamydia?

Complications of Chlamydia Infection

Chlamydia trachomatis infection causes significant reproductive complications, with approximately 17% of women treated for pelvic inflammatory disease (PID) becoming infertile, an equal proportion experiencing chronic pelvic pain, and 10% of those who conceive developing ectopic pregnancy. 1, 2

Complications in Women

Immediate Complications

• Pelvic Inflammatory Disease (PID)

  • Approximately 8% of women with chlamydial infection develop clinically evident salpingitis 2
  • 30% of women with dual gonococcal and chlamydial infections who only receive treatment for gonorrhea develop salpingitis during follow-up 1, 2
  • Chlamydia has been isolated in 5-50% of women seeking care for PID symptoms 1, 2

• Perihepatitis (Fitz-Hugh-Curtis syndrome) - Inflammation around the liver capsule as PID progresses 1

• Urethral syndrome - Dysuria and pyuria with sterile urine cultures 1

• Endometritis - Particularly following abortion or childbirth 1

Long-term Reproductive Sequelae

• Tubal factor infertility

  • Strong association between anti-chlamydial antibodies and tubal etiology for infertility 1
  • Many women with tubal-factor infertility have no reported history of salpingitis, suggesting unrecognized or asymptomatic infection 1

• Ectopic pregnancy - 10% of women who conceive after PID will have an ectopic pregnancy 1, 2

• Chronic pelvic pain - Affects approximately 17% of women treated for PID 1, 2

Complications in Men

• Nongonococcal urethritis (NGU) - Chlamydia accounts for 30-40% of the 4-6 million physician visits for NGU 1
• Epididymitis - Chlamydia is responsible for 50% of the 158,000 outpatient visits and 7,000 hospitalizations for epididymitis among adolescent and young adult males 1
• Proctitis - In men who engage in receptive anal intercourse, causing rectal discharge and pain during defecation 1
• Reactive arthritis (Reiter's syndrome) - Reactive arthritis, conjunctivitis, and urethritis, occurring primarily in men 1

Complications in Infants

• Neonatal conjunctivitis

  • Nearly two-thirds of infants born vaginally to infected mothers become infected during delivery 1
  • 15-25% of exposed infants develop chlamydial conjunctivitis despite prophylaxis 1
  • C. trachomatis is the most common cause of neonatal conjunctivitis 1

• Pneumonia

  • 3-16% of exposed infants develop chlamydial pneumonia 1
  • One of the most common causes of pneumonia in the first few months of life 1
  • Associated with abnormal pulmonary function tests later in childhood 1

Complications in Pregnancy

• Postpartum PID - Pregnant women with chlamydial infection are at risk 1
• Endometritis - Develops in 19-34% of infected pregnant women who deliver vaginally at term 1
• Post-abortion complications - Endometritis and possibly salpingitis develop in 10-28% of pregnant women with untreated chlamydial infection who undergo induced abortions 1

Clinical Pitfalls and Caveats

1. Asymptomatic nature - Over 80% of chlamydial infections are asymptomatic, leading to delayed diagnosis and increased risk of complications 3

2. Unrecognized PID - Many women with tubal-factor infertility have no reported history of PID, suggesting that subclinical or mild PID often goes undiagnosed 1

3. Reinfection risk - Repeated chlamydial infections significantly increase the risk of reproductive sequelae 4

4. Dual infections - Co-infection with gonorrhea increases the risk of complications, particularly if only one infection is treated 1, 2

5. Prevention focus - Because chlamydial infections are often asymptomatic, prevention through screening and early treatment is the most effective means of preventing sequelae 1

The significant morbidity associated with chlamydial infection underscores the importance of routine screening in high-risk populations, particularly sexually active women under 25 years of age, to prevent these serious complications 1, 2.