What Are the Symptoms & Signs of Chlamydia?
The signs and symptoms of a chlamydia infection depend on the part of the body infected—vagina, penis, rectum, or throat—and can range from vaginal or penile discharge to severe abdominal and/or pelvic pain.
Often, discomfort occurs during sex or urination. But far too often there are no warning signs to alert people to the diagnosis.
Since chlamydia can still cause damage and other complications even without symptoms, regular screening is critical to make sure these issues are avoided.
Most people with chlamydia feel fine. For 70 percent to 95 percent of women and 90 percent of men, there are no symptoms associated with the infection. The lack of symptoms, however, doesn’t mean the infection is not a problem.
Symptoms of chlamydia usually appear around three weeks after exposure. In some cases, the infection can be present for months or years before it is finally detected. During this time, other partners may become infected.
Symptoms of complications such as pelvic inflammatory disease (PID) can occur much later after exposure.
- Vaginal discharge/penile discharge: The most common symptom of chlamydia in women is vaginal discharge. The discharge is usually yellowish in color, but both the consistency and color can vary. Men may have discharge from their penis that is often clear and thin but can be thick and mucousy.
- Pain with urination: Both men and women may note pain with urination (dysuria) due to inflammation of the urethra (urethritis), the tube that leads from the bladder to the outside of the body. Urinary frequency (having to urinate more often) may also occur.
- Pain, swelling, or itching of the penis or vulva: Redness, tenderness, swelling, or itchiness may occur around the opening of the penis in men or on the vulva or vagina in women.
- Pain with intercourse/painful ejaculation: The cervix is the site of infection for 75 percent to 80 percent of chlamydia cases in women. This can cause discomfort with intercourse (dyspareunia), especially with deep penetration. Pain may also be present due to inflammation in the fallopian tubes (PID). Men may note pain with ejaculation.
- Bleeding between periods or with intercourse: Chlamydia-related inflammation of the cervix can cause this.
- Abdominal and pelvic pain: Pain in the abdomen, pelvis, and back may occur with pelvic inflammatory disease.
- Pain or swelling in the testes: Testicular pain and swelling may occur when chlamydia travels up through the urethra in men and into the epididymis; epididymitis may result.
- Rectal pain, discharge or bleeding: Infection of the rectum with chlamydia due to transmission of the virus during receptive anal sex may cause pain, discharge, itching, and bleeding.
Symptoms that are less common may include:
- A sore throat: Transmission of the bacteria during oral sex may cause a sore throat, exudate (pus) on the tonsils, and pain with swallowing.
- Right upper abdominal pain (perihepatitis): Perihepatitis is a condition in which the capsule of the liver becomes inflamed. Also known as Fitz-Hugh-Curtis syndrome, it causes pain in the right upper portion of the abdomen.
- Joint pain (reactive arthritis): Symptoms of inflammation in only a few joints (oligoarthritis) combined with inflammation of the eyes and urethra may occur. This reactive arthritis is not caused by the infection. Instead, it’s due to a post-inflammatory process in which the body makes antibodies against its own tissue (autoimmune disease). It most often occurs three to six weeks after exposure to the bacteria and resolves in three to six months. It may or may not improve with antibiotics.
The complications of chlamydia infections are the most feared and serious aspect of them. And again, these issues may occur in people who never had symptoms. Fortunately, such complications are largely preventable through regular screening and prompt treatment.
Pelvic Inflammatory Disease (PID)
Chlamydia may cause abdominal and/or pelvic pain in women when the bacterium travels up through the cervix and uterus and into the fallopian tubes and ovaries, causing pelvic inflammatory disease (PID).
Roughly 10 percent to 15 percent of women with untreated chlamydia will develop pelvic inflammatory disease, either acute (symptomatic) or subacute (with few or no symptoms).
The symptoms of pelvic inflammatory disease may also include abdominal and pelvic pain, an often gnawing type of back pain, and sometimes fever or chills. On examination, a woman will experience discomfort when a physician manipulates her cervix. She may also feel pain over her ovary on one or both sides of her abdomen (adnexal pain).
Chronic Pelvic Pain
With PID, the infection and inflammation can result in scarring of the fallopian tubes. This scarring can block the passage of sperm into the fallopian tube, preventing fertilization and resulting in infertility.
Of women who develop pelvic inflammatory disease, roughly 20 percent will experience infertility. While surgery can be used to remove scarring in the fallopian tubes, doing so may increase the risk of an ectopic pregnancy.
An ectopic pregnancy or tubal pregnancy is a condition in which the embryo implants in a fallopian tube instead of in the uterus. When the fallopian tubes are scarred due to PID, the fertilized egg may become “stuck” and implant in the fallopian tube rather than travel to the uterus. An ectopic pregnancy can be a life-threatening condition, especially if it ruptures before it is discovered.
It’s not known for certain whether epididymitis due to chlamydia leads to infertility in men. Damage, however, may result in chronic pelvic or scrotal pain in men.
Women who have untreated chlamydia during pregnancy have an increased risk of several pregnancy complications. (A chlamydia test is recommended at the first OB visit for all pregnant women).
There is an increased risk of premature labor (and the complications that accompany preterm delivery). There is also an increased risk of endometritis (inflammation of the uterus) following delivery. Babies born to mothers with untreated chlamydia are more likely to be small for gestational age or have a low birth weight.
The risk of stillbirth is around 40 percent higher for pregnant women with untreated chlamydia compared to those without chlamydia. Fortunately, the risk is all but erased if a woman is treated before and during pregnancy.
When women have untreated chlamydia, the baby can become infected during vaginal childbirth. There are two issues that can occur:
- Eye infections: Conjunctivitis (ophthalmia neonatorum) is thought to occur in 18 percent to 44 percent of infants born to mothers with untreated chlamydia. Symptoms, such as swollen eyelids, red eyes, and a thick, yellowish discharge usually occur in the first 10 days of life.
- Pneumonia: This is somewhat less common, occurring in 3 percent to 16 percent of infants born to mothers with untreated chlamydia. Pneumonia most often occurs four to 12 weeks after delivery and usually begins with a cough and congestion.
It’s important to note that if a mother is treated for chlamydia before or during pregnancy, the baby should be safe from these infections. For women who are high-risk, some obstetricians recommend repeat screening for chlamydia during the third trimester.
Rectal Scarring and Fissures
Rarely, inflammation of the rectum (proctitis) may lead to scarring and fissures (a fissure is an abnormal passageway from the rectum to another region of the body or outside of the body).
Cervical Cancer Risk
There has been controversy over whether chlamydia infections might increase the risk of cervical cancer caused by the human papillomavirus (HPV).
A 2016 review of 22 studies concluded that co-infection with HPV and chlamydia doubles a woman’s risk of cervical cancer. In 11 of the studies, chlamydia was an independent predictor of a cervical malignancy.
It’s thought that the inflammation of the pelvic organs related to chlamydia enhances the cancer-causing changes caused by HPV. That said, it’s important to note that, in general, HPV infection is primarily to blame for the development of cervical cancer, not chlamydia.
Chlamydia infections (as well as other sexually transmitted infections, STIs) may also increase the risk of becoming infected with or transmitting HIV. The reasons for this are two-fold:First, the infection can cause genital inflammation that can undermine the integrity of the mucosal tissue that lines the vagina, cervix, penis (urethra), and rectum. This provides HIV a more direct route into the bloodstream and lymphatic system.
Unlike the more common serotypes of Chlamydia trachomatis that cause infections, there are some (L1, L2, and L3) that can cause a more severe syndrome known as lymphogranuloma venereum (LGV). It includes systemic symptoms and lymphadenopathy that can sometimes be confused with other diseases, like syphilis. The treatment course for LGV serovars is significantly longer than that for other serotypes.
Lymphogranuloma venereum typically begins with a bump on the genitals a week or two after exposure, progressing to an open ulcerative sore. Swollen lymph nodes and flu-like symptoms follow around two to six weeks later.
- Enlarged, tender lymph nodes in the groin (inguinal nodes)
- Fever and chills
- An open sore on the genitalia (genital ulcer) at the site where the bacteria entered the body
- Muscle aches
Complications can occur many years later due to damage to the lymphatic system in the groin.
As the leading cause of blindness worldwide, trachoma is not an STI but is instead transmitted by secretions from the eyes or nose. The infection usually begins with redness and a condition in which the eyelashes turn inward and scratch the cornea.Any eye symptoms in third world countries should be evaluated thoroughly as prompt treatment is needed to preserve vision. (Trachoma is caused by different types of Chlamydia trachomatis than genital infections).
When to See a Doctor
It’s important to talk to your doctor if you have any signs or symptoms of chlamydia (or any other symptoms that concern you).
According to the U.S. Preventive Services Task Force, women 25 and under and those who are sexually active should be screened for chlamydia every year, as should older women who have an increased risk of infection.
Screening for other STIs/STDs is important as well, as the risk factors for chlamydia also increase the likelihood of contracting these other infections. If you are treated for chlamydia, be sure to tell your healthcare provider if any symptoms persist.It can be hard to read about the potential complications of chlamydia, but many of these are very preventable with appropriate screening, speaking to your doctor about any symptoms, and receiving treatment if you are positive. Our Doctor Discussion Guide below can help start that conversation with a healthcare professional.
Chlamydia Doctor Discussion Guide
Get our printable guide for your next doctor’s appointment to help you ask the right questions.