Chlamydia & Fertility: Early Treatment Prevents Permanent Damage

Chlamydia trachomatis is the most common bacterial STI. Untreated, it can cause irreversible reproductive damage. Early detection and treatment preserve fertility.

Female Complications (Ascending Infection)

• PID: Endometritis, salpingitis, oophoritis — 10–15% of untreated chlamydia cases
• Tubal damage: Scarring, hydrosalpinx, occlusion → infertility, ectopic pregnancy (6–10× risk)
• Chronic pelvic pain: Adhesions, nerve entrapment
• Perihepatitis (Fitz-Hugh-Curtis): RUQ pain, violin-string adhesions

Male Complications

• Urethritis: Dysuria, discharge (often asymptomatic)
• Epididymitis: Testicular pain/swelling → fibrosis, obstruction → subfertility
• Prostatitis: Chronic pelvic pain syndrome
• Reactive arthritis (Reiter's): Triad: urethritis, conjunctivitis, arthritis (HLA-B27 associated)

Treatment

• Doxycycline 100 mg BID × 7 days (preferred, non-pregnant)
• Azithromycin 1 g single dose (alternative, pregnancy-safe)
• Test-of-cure: 3–4 weeks post-treatment (NAAT) if pregnant, persistent symptoms, or rectal/pharyngeal infection
• Partner treatment: Essential — expedited partner therapy (EPT) available in many states
• Abstain 7 days after both partners treated

Screening Recommendations (CDC)

• Annual: Sexually active women <25, older women with risk factors
• Pregnant: First prenatal visit, 3rd trimester if high risk
• MSM: At least annually (urethral, rectal, pharyngeal per exposure)
• HIV+: At first visit, then annually

Key Message

Chlamydia is silent but destructive. Routine screening plus prompt single-dose treatment prevents PID, infertility, and ectopic pregnancy. If diagnosed, notify partners — it's curable and common.