What are the complications of untreated Chlamydia (Chlamydia trachomatis) infection in a female?

From the Guidelines

Untreated chlamydia in females can lead to severe complications, including pelvic inflammatory disease (PID), ectopic pregnancy, and infertility, emphasizing the need for prompt treatment and regular screening. The most common complication is PID, which can cause chronic pelvic pain, tubal scarring, and infertility. According to 1, untreated cases of C. trachomatis infection in women frequently progress to PID, which can lead to ectopic pregnancy, infertility, and chronic pelvic pain. Additionally, chlamydial infection during pregnancy is associated with adverse outcomes, including miscarriage, premature rupture of membranes, preterm labor, low birth weight, infant mortality, neonatal chlamydial infection, and postpartum endometritis.

Some key points to consider:

• PID is a major complication of untreated chlamydia, affecting up to 40% of untreated cases, and can cause chronic pelvic pain, tubal scarring, and infertility.
• Ectopic pregnancy risk increases 7-10 fold in women with previous chlamydial infection due to damaged fallopian tubes.
• Pregnant women with untreated chlamydia may experience premature rupture of membranes, preterm birth, and can transmit the infection to their newborns during delivery, potentially causing conjunctivitis or pneumonia.
• Untreated chlamydia increases the risk of acquiring or transmitting HIV by creating inflammation and microabrasions in genital tissues.
• Treatment with doxycycline (100mg twice daily for 7 days) or azithromycin (1g single dose) can prevent these complications, highlighting the importance of regular screening and prompt treatment, as recommended by 1.

The importance of screening and treatment is further emphasized by the fact that chlamydial infection is usually asymptomatic, and many cases remain undetected and unreported, with the actual number of new cases of chlamydial infection thought to be more than 2.8 million per year, as stated in 1.

From the Research

Complications of Untreated Chlamydia in Females

• Untreated Chlamydia trachomatis infection can lead to severe complications, including:
  • Pelvic inflammatory disease (PID) 2, 3
  • Infertility 2, 3, 4
  • Ectopic pregnancy 2, 3
  • Chronic pelvic pain 2, 3
• The risk of developing these complications can be reduced with prompt and effective treatment 2, 5
• Repeated Chlamydia infections can increase the risk of complications, highlighting the importance of ensuring partner treatment 3, 6

Treatment and Prevention

• Empiric treatment with antibiotics, such as azithromycin or doxycycline, is recommended for women with suspected PID or Chlamydia infection 2, 5
• Patient-delivered partner treatment with azithromycin can be an effective strategy for preventing repeated infections 6
• Screening for Chlamydia and other sexually transmitted infections is crucial for preventing complications and promoting reproductive health 2

Disease Progression and Risk Factors

• The incidence and timing of PID and long-term sequelae from untreated Chlamydia infection are not fully understood 3
• High-risk settings, such as sexually transmitted disease clinics, may have a higher incidence of PID and complications 3
• Repeated Chlamydia infections can increase the risk of complications, particularly in women with a history of PID or infertility 3, 4