Can Untreated Chlamydia Lead to Death?
Untreated chlamydia does not directly cause death in the general population, but it leads to serious long-term complications that significantly impact morbidity and quality of life, particularly infertility, ectopic pregnancy (which can be fatal), and chronic pelvic pain in women. 1
Primary Morbidity Concerns
The CDC guidelines emphasize that chlamydia's major health burden comes from serious long-term sequelae rather than mortality 1:
- Pelvic inflammatory disease (PID) accounts for most of the serious acute illness and morbidity from chlamydial infection 1
- Approximately 8% of women with chlamydia develop overt salpingitis, and among women with dual gonococcal and chlamydial infections treated only for gonorrhea, 30% developed salpingitis during follow-up 1
- 17% of women treated for PID will become infertile 1
- Chlamydia is isolated from 5-50% of women seeking care for PID symptoms 1, 2
Life-Threatening Complications
While death from chlamydia itself is rare, ectopic pregnancy resulting from tubal scarring can be fatal 3, 4:
- Untreated genital chlamydia can ascend into the upper genital tract, increasing risk for ectopic pregnancy, infertility, and chronic pelvic pain 3
- Approximately 2% of women with chlamydial lower genital tract infection develop adverse pregnancy outcomes 4
- The sharp worldwide increase in PID has led to secondary epidemics of tubal factor infertility and ectopic pregnancy 4
Asymptomatic Nature Increases Risk
The insidious nature of chlamydia makes complications more likely 1, 3:
- Chlamydia is asymptomatic in over 80% of cases 3
- Symptoms are absent or minor among most infected women and many men 1
- Many women with tubal infection have symptoms too mild or nonspecific to seek treatment, leading to unrecognized PID and subsequent infertility 1, 2
- Untreated infections among women often persist for months, during which complications may develop 1
Additional Serious Sequelae
Beyond reproductive complications, untreated chlamydia causes 3, 4, 5:
- Epididymitis and orchitis in men 3, 5
- Proctitis in both sexes 3, 4
- Reactive arthritis (chlamydia-induced) in men and women 4, 5
- Chronic pelvic pain affecting approximately 4% of infected women 4
Economic and Public Health Impact
The CDC reports that direct and indirect costs of chlamydial illness exceed $2.4 billion annually 1, with PID prompting 2.5 million outpatient visits annually and more than 275,000 hospitalizations and 100,000 surgical procedures yearly 1.
Clinical Caveat
The highest risk populations are adolescents and young adults, with prevalence highest (>10%) among sexually active adolescent females 1. Age is the sociodemographic factor most strongly associated with chlamydial infection 1.