It's the No. 1 Venereal Disease in America, but Chances Are You've Never Heard of Chlamydia
Chlamydia will infect three million to 10 million Americans this year, according to Dr. King Holmes, a leading researcher on sexually transmitted diseases. As many as 150,000 women harboring the bacteria will become infertile. It's estimated that 5 percent of all female college students have it.
Holmes, 47, is the principal researcher in a ground-breaking study of sexually transmitted diseases with emphasis on chlamydia, funded by the National Institute of Allergy and Infectious Diseases. A graduate of Harvard and Cornell University medical school, he is professor of medicine, microbiology, immunology and epidemiology at the University of Washington in Seattle. "Chlamydia has been left untreated," says Holmes, "and has continued to spread—with devastating consequences. We're just in the process of finding out what those consequences are." He discussed the chlamydia epidemic—and what can be done about it—with correspondent Maria Wilhelm.
Why do you call chlamydia the silent epidemic?
The symptoms, if there are any, often go unnoticed—though the damage can be irreversible. A woman may experience a moderately increased amount of discharge, usually yellowish, or spotting between menstrual periods or after intercourse. Several studies have shown that half of all women made sterile by the effects of the disease had such mild symptoms that no one suspected they were infected—even though chlamydia was destroying their fallopian tubes.
What about the cases where the victim does complain of symptoms?
Even then chlamydia has been difficult to diagnose. It wasn't until the mid-'70s that chlamydia screening became possible, and until recently only a few laboratories in the country were equipped to grow and test the bacteria. Chlamydia can be easily treated with antibiotics, but it's reached epidemic proportions because it has spread so silently—undiagnosed.
Who is most likely to be affected by chlamydia?
Chlamydia, like gonorrhea, is particularly common in individuals of low socioeconomic status. However, unlike gonorrhea, but similar to herpes, chlamydia is also common in middle-and upper-income individuals. Teenage girls are especially at risk. Thirty percent of sexually active teenage girls have the infection—compared to 8 percent of all women, and 6 percent of women over 21. In part, that's because at puberty the single cell lining of the cervix is normally exposed, and it is susceptible to chlamydia.
What are the consequences if chlamydia isn't treated?
For a woman, the result can be infertility or even death. Once infected, the fallopian tubes become inflamed and can be badly scarred. Eventually scar tissue can block them, making pregnancy impossible. We also know that infections in the fallopian tubes increase tenfold the chances of tubal pregnancies, and the complications from such pregnancies can be fatal. Although chlamydia is an important cause of female infertility, it does not appear that it is an important cause of male infertility.
How long does the disease last?
Somehow, the chlamydia bacteria manage to elude the body's professional killer cells—the white blood cells. We're still trying to figure out how they do it. What we do know is that the infection can last for several months, perhaps even years. In one study, women who carried the organism, but showed no symptoms, continued to harbor the bacteria for 18 months, when the study ended.
If a woman becomes pregnant while still carrying the bacteria, will her unborn child contract the disease?
We estimate that two-thirds of the babies born to infected mothers contract the infection while passing through the birth canal.
Will the baby suffer permanent damage?
The bacteria is likely to cause an eye infection, but that will usually heal on its own, without scarring of the eye. In 1978 it was discovered that chlamydia is behind one type of pneumonia in infants and, while a small number are affected, that's a serious threat.
Can the disease prove fatal for newborns?
There have not been extensive studies on chlamydia-related infant deaths, but one study shows a possible association between the infection in newborns and a few cases of sudden infant death syndrome. Several studies at the University of Washington link the infection to premature birth—the most common cause of death in newborns. One study found a relationship between chlamydia and stillbirth but other studies have not. The jury is still out.
Why has the public heard so little about this disease?
Although chlamydial infections of the eye have probably existed since biblical times, the species of chlamydia that causes infections of both the genital tract and of the eye wasn't isolated until 1957. And it is only within the last three or four years that we have become aware of the many complications it is causing.
Are sex education courses in the schools now beginning to alert students to the danger?
Public education ranges from grossly inadequate to nonexistent in the area of sexually transmitted diseases. Where they are taught, in public schools, the information is usually irrelevant, with discussion of diseases that are coming under control, like gonorrhea and syphilis, and no discussion of diseases that pose a real threat—such as chlamydia, genital warts or AIDS.
What symptoms should men and women look for?
In men, the signs can be easily confused with the symptoms of gonorrhea: discharge from the opening of the penis and burning with urination. But chlamydia will cause a thinner, smaller amount of discharge. In women, the disease causes fewer symptoms, though in some cases abnormal vaginal discharge or bleeding or abdominal pain develops. If the infection moves to the fallopian tubes, there may be pain in the lower stomach and sometimes fever. If it spreads beyond the pelvis and into the abdominal cavity, it frequently moves to the surface of the liver and may cause pain when the patient breathes and the inflamed liver edge rubs against the rib cage.
Is there a test to detect chlamydia even if the patient doesn't show symptoms?
Yes, and testing is becoming simpler. The chlamydia culture test developed in the late 1960s and introduced for widespread use in the early 1970s is painless, costs $30 to $40 and yields results within three days. The direct fluorescent slide test introduced in the last year is also painless and gives results in only 30 minutes for a cost of about $15. A third, rapid test has been introduced this year. It is my hope that with three competing tests now available, the cost will come down.
Who should be tested?
Anyone with symptoms that I've mentioned and anyone who has been exposed to someone with a chlamydial infection should be tested and treated. Also anyone who has had a sexually transmitted disease. Studies show that 20 percent of men and 30 to 40 percent of women with gonorrhea also have chlamydia. The gonorrhea is treated with penicillin, but penicillin won't cure chlamydia.
What drugs cure chlamydia?
Tetracycline for women and men, and erythromycin for pregnant women and infants. Once a patient is treated for seven to 10 days, he's cured, and the chances of spreading the disease are zero.
Is there any way of preventing the disease?
Barrier methods of contraception such as condoms or diaphragms plus spermicides will significantly decrease the risk of transmitting both gonorrhea and chlamydia. For sexually active individuals, that's the best preventive medicine available.