• Dr Peter Chew

The Curse of Chlamydia: Infertility

F had always wondered why she had a “burning sensation” after urination for a few days after sexual intercourse. This had happened soon after she got married 5 years ago. But the symptom had become more frequent for the past six months. She had been treated by the general practitioner for urinary tract infection with antibiotics. Although the symptom had subsided somewhat with treatment, it kept on recurring.


F, 35, had also been grappling with a fertility issue. She had been admitted to the hospital a year ago for fever and lower abdominal pain, which subsided after conservative treatment. Gynecological examination of her reproductive system was normal.


Her husband’s semen analysis showed that the sperm count was slightly below average. The number of motile sperm (motility) and normal-shaped sperm (morphology) were also reduced.

Her hysterosalpingogram (HSG), an X-ray test of the uterus and tubes, showed that the uterine cavity was normal but both her fallopian tubes were blocked. The blockage was subsequently confirmed by laparoscopy, a key-hole surgery to examine the organs inside the abdomen. It was due to scar tissue from a previous pelvic infection. Swab test from the cervix indicated that the F had been infected by the bacteria Chlamydia trachomatis.


Chlamydia is a very common sexually transmitted disease. The bacteria are passed from one person to another through vaginal, anal and oral sex.


Symptoms and signs (please refer to the article Chlamydia Revisit in this website)

Complications:

In four out of 5 women and one in two men, chlamydia infection does not have any obvious signs or symptoms, or may have symptoms that are so mild that they often go unnoticed. In these patients, the bacteria continues to grow and may progressively damage the reproductive system resulting in the following complications:

  • Pelvic inflammatory disease (PID): Up to 30% of women with untreated infection develop PID. Chlamydia spreads from the cervix up to the uterus and fallopian tubes. The infection causes severe abdominal pain and fever in the acute stage. Once the infection is treated with antibiotics, the inflamed tissue may become scarred, resulting in damage to the tubes and ovaries.

  • Infertility: Complete obstruction of the fallopian tubes from scarring will make natural conception impossible. This has happened in F’s case.

  • Ectopic pregnancy: This occurs when there is partial obstruction of the fallopian tube when the fertilized egg implants and grows there. The condition is life-threatening if the tube ruptures with massive internal bleeding.

  • Chronic pelvic pain: Scarring and adhesions of the ovaries and tubes from pelvic infection may result in backache, congestion and lower abdominal pain, especially during menses.

  • Epididymis infection: Chlamydia infection can cause inflammation of the epididymis, the coiled tube at the back of the testicle that stores and carries sperm. The infection can result in fever, scrotal pain and swelling. Sperm production and quality will be affected.

  • Prostate gland infection. Rarely, chlamydia can spread to the prostate gland. Prostatitis can cause pain during or after sex, fever and chills, painful urination, and lower back pain.

Diagnosis

  • Culture: Diagnosis can be made by isolating the bacteria from the swab specimen of the discharge from the cervix and penis for men. However, 10 to 30 % of cases may have false negative results. This may be because the bacteria may not survive the transit to the laboratory, the sampling may be inadequate or the number of bacteria is too low in asymptomatic infection.

  • The polymerase chain reaction (PCR) test from the swab samples is usually performed to identify the bacteria in cells and secretions from the genital tracts. This is 95% accurate.

Both F and her husband, who had not been treated previously had a full course of antibiotics together. Her urinary symptom did not recur since.

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