Chlamydia, caused by the bacterium Chlamydia trachomatis, is a common sexually transmitted infection (STI) that frequently presents without noticeable symptoms, often referred to as a “silent” infection. Despite often being asymptomatic, the infection can significantly affect the female reproductive system. Changes to the menstrual cycle are one of the most frequent noticeable signs of the infection. Recognizing these changes can be the first step toward diagnosis and treatment, preventing more serious health problems.
How Chlamydia Disrupts the Menstrual Cycle
The primary way Chlamydia affects the menstrual cycle is by causing inflammation of the cervix, known as cervicitis. This inflammation makes the delicate tissue of the cervix more fragile and prone to bleeding. The infection often targets the cells of the cervix, leading to irritation and swelling of this tissue.
This irritation manifests most commonly as bleeding or spotting that occurs between expected menstrual periods, medically termed intermenstrual bleeding. The inflammation can also cause bleeding immediately following sexual intercourse, which is known as post-coital bleeding.
While the infection may not directly change the timing of the actual period, the inflammation can lead to periods that are heavier or last longer than usual. The infection can progress from the cervix to the lining of the uterus, causing endometritis, which is inflammation of the uterine lining. This inflammation within the uterus itself can contribute to irregular or heavier menstrual bleeding.
Other Symptoms of Chlamydia Infection
Many women with Chlamydia never experience any symptoms at all; estimates suggest up to 70% of women may be asymptomatic. For those who do experience non-bleeding symptoms, they generally relate to irritation in the genital and urinary tracts. A common symptom is painful or burning sensations during urination, known as dysuria, which can be mistaken for a urinary tract infection (UTI).
The infection can also lead to an unusual vaginal discharge. This discharge may change in color, consistency, or odor, often being described as yellowish, gray, or having an abnormal smell. Painful sexual intercourse, or dyspareunia, is another sign that can occur due to the inflammation of the cervix and surrounding areas.
Sometimes, the infection spreads to other areas, causing pain or discharge in the rectum or throat. A persistent, dull pain in the lower abdomen can also be a sign of the infection. These varied symptoms underscore the importance of testing, as they are often mild and easily overlooked.
When Chlamydia Leads to Pelvic Inflammatory Disease
Untreated Chlamydia can ascend from the cervix into the upper reproductive tract, leading to a serious complication called Pelvic Inflammatory Disease (PID). PID is an infection of the uterus, fallopian tubes, and/or ovaries that occurs when the bacteria spread upward. Mathematical modeling suggests that around 22% of women with untreated Chlamydia may progress to developing PID.
Symptoms of PID are typically more severe and include fever, chills, and intense pain in the lower abdomen or pelvis. This severe pain may be constant or feel like sharp cramping. PID can also cause nausea and vomiting, especially when the infection is acute.
The long-term consequences of PID stem from the resulting inflammation and scarring of the fallopian tubes. This damage can cause chronic pelvic pain. Scarring in the fallopian tubes can block the passage of a fertilized egg, leading to an ectopic pregnancy, a life-threatening condition. The damage also significantly increases the risk of tubal factor infertility.
Diagnosis and Treatment Options
Diagnosing a Chlamydia infection typically involves a nucleic acid amplification test (NAAT). This highly accurate test is performed using either a urine sample or a swab. For the urine test, a sample is collected and analyzed for the presence of the Chlamydia trachomatis bacteria.
For the swab test, a sample is collected from the cervix, vagina, or other affected sites like the rectum or throat. Vaginal swabs can often be self-collected, making the testing process more comfortable and convenient. Given the high rate of asymptomatic infection, annual screening is recommended for all sexually active women under the age of 25, as well as for older women with risk factors.
Treatment for Chlamydia is highly effective and involves a course of antibiotics. The most common regimens are a single, one-gram dose of azithromycin or a seven-day course of doxycycline taken twice daily. Patients must complete the full course of medication, even if symptoms disappear quickly, to ensure the infection is fully eradicated.
Partner referral is a crucial component of treatment, involving notifying and treating all sexual partners from the last 60 days to prevent reinfection and further spread. Patients should abstain from all sexual contact until they and their partners have completed treatment. Retesting three months after treatment is advised due to the high risk of reinfection.