Episode 55: Chlamydia: An STI that may not show symptoms - but still has effects

Dr. Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an obgyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone and welcome to the Doctor Sophia ObGyn podcast. As always, I am joined by my good friend and co-host, Touseef Mirza.

Touseef Mirza:
Hi everybody. So today we're gonna be talking about something quite specific.

Dr. Sophia:
Yes, very specific, because as always Touseef and I were talking and I was telling her how I had like three instances, like back to back to back of people with chlamydia.

Touseef Mirza:
Then I said, well, we have to do a podcast on this.

Dr. Sophia:
Well, then we need to talk about it. Yes, of course.

Touseef Mirza:
So can you tell us a little bit, what is chlamydia exactly?

Dr. Sophia:
So chlamydia is a bacterial infection. It's caused by a specific bacteria called chlamydia tracomatis, and it's a bacteria that can affect the eyes, the urethra, the vagina, the cervix, the rectum, the anus.

Touseef Mirza:
Okay. That's a lot of places. So, does it mean, can you get chlamydia aside from like genital contact or is it just through genital contact?

Dr. Sophia:
You can, well, genital contact, but that also includes oral sex. It can live in the back of the throat as well. So yes, it's, it is transmitted through sexual contact, but it doesn't have to be, that one has to have, let's say, an orgasm to transmit it because it's possible that chlamydia is in just bodily fluids. So even before, let's say a man ejaculates, there's still some fluid there that can have chlamydia inside of it.

Touseef Mirza:
Like before the man ejaculates

Dr. Sophia:
The man or, or just in the secretions of a woman who can also have chlamydia present.

Touseef Mirza:
And so it, this bacteria just lives, it could live at the level of the vulva and the vagina.
Dr. Sophia:
So more in what we consider as more like mucus membranes. So not just, it has to be intimate sexual contact. So that's why you can get it from like oral sex for example.

Touseef Mirza:
And so this is bacteria. So we say bacteria, but also when we talk about STIs or sexually transmitted infections, that's called infection. Is that different when we talk about chlamydia?

Dr. Sophia:
Chlamydia causes chlamydial infection. So it's a bacteria, it's a foreign bacteria and it's transmitted sexually. So it's not a part of what we would consider as our normal flora. It's not a bacteria that we expect to be in our genital parts.

Touseef Mirza:
So the way that you can get chlamydia is through sexual contact? Somebody gives that to you, whether it's a woman to a man or a man to a woman or a woman to a woman or a man to a man.

Dr. Sophia:
That is correct. Right.

Touseef Mirza:
And so is that something, once it's transmitted, do we feel symptoms right away?

Dr. Sophia:
So actually one of the reasons why I am so glad we're having this conversation about chlamydia is because though it's one of the most common sexually transmitted infections, 50% of people have no symptoms. Granted, those who do have symptoms may have symptoms of discharge, pelvic pain, vaginal smell–

Touseef Mirza:
That's abnormal.

Dr. Sophia:
That's right. But the other 50% can have absolutely nothing. So no change in their secretions, no pain.

Touseef Mirza:
So no itching necessarily.

Dr. Sophia:
No burning, no problems urinating, no sense of inflammation or heaviness or pelvic fullness or pelvic pain. Like they can have nothing or they can have those things.

Touseef Mirza:
Because I know with herpes for example, it stays latent, it just lives there. Is it a similar type of mechanism where the bacteria is still there and then it sort of comes up or just some people just never have symptoms?

Dr. Sophia:
Some people just never have symptoms and it's not the kind of thing where it's latent. Unlike herpes that has what we call times of active shedding versus times when you're not shedding the virus. When you have chlamydia that is untreated, you can transmit chlamydia whether you have symptoms or not. If you have chlamydia and you have unprotected sex, there is a high chance that you will transmit the chlamydia.

Touseef Mirza:
So in the cases where you do have symptoms, what does that look like?

Dr. Sophia:
Women or men who have symptoms may feel inflammation, they may feel irritated, they may have burning with urination. They may have discharge, typically a more yellowish discharge. They may or may not have an odor and they may experience pain, they may experience pain with sex. So those are some of the symptoms that they may have.

Touseef Mirza:
Okay. So it's similar to, I guess, other STIs in terms of symptoms, like just by naming those symptoms, we wouldn't necessarily know, oh, that's chlamydia.

Dr. Sophia:
That's correct. For example, let's say your vagina smells a little bit different or funny, you wouldn't necessarily say, oh, I definitely have chlamydia. If anything, most women would think that, oh, maybe my pH balance is off. And though that may be true, it's off because you have chlamydia and not necessarily because you have an infection called bacterial vaginosis, which is not an STD.

Touseef Mirza:
So then if you don't have symptoms or you could have symptoms, there's a 50-50 chance that you might have it, you might not have it after unprotected sex, for example. Then how does somebody go about figuring out if they have chlamydia or not? If there's no symptoms to do just testing STI testing?

Dr. Sophia:
Yes. So this is how we had this, how this conversation came about. Because one of my patients only found out that she had chlamydia by coming in to do her annual screening, and it was time to do her pap smear. And we did her pap smear and she had no office visit. She had no complaints and found out that she had chlamydia because of the testing.

Touseef Mirza:
Was she surprised?

Dr. Sophia:
100% surprised. She was very surprised.

Touseef Mirza:
So it showed up, but she had no symptoms. She didn't, she had no symptoms. It's not like she was ignoring anything.

Dr. Sophia:
No, no, no. She had no pain on her exam. She had no discharge. That was concerning her exam. She had no pelvic tenderness. So yeah, from both my perspective as her physician who was examining her and from her perspective as the patient, there was nothing like a light bulb. Oh, you must have chlamydia. It just kind of was a reminder. This is why it's so important to even just get yearly STI screening. And it was unfortunate because her last sexual contact was like seven months prior.

Touseef Mirza:
But we don't know if that came seven months prior or it could have been before as well.

Dr. Sophia:
Well, she was with her partner at that time. That'd been the only partner she'd had. So you're right. We don't know at what point she contracted it. But the one thing we do know is that she'd been with that particular partner for a long time and they'd broken up and this was her first presentation to a doctor for whatever reason. Like that was just her annual, her time to come in and did her screening and everything and yeah.

Touseef Mirza:
So when we say screening, you basically asked her, let's do a, a sexually transmitted screening to make sure everything's good. Yes. Okay. And did she say, well, I don't think I need it because you know, actually

Dr. Sophia:
It's funny you mentioned because she was like, oh, I'm not even, I'm not sexually active. I said, oh, okay. Well then, you know what, maybe now is a good time then to just have your baseline so that way when you go into your next relationship, you have proof that you had nothing.

Touseef Mirza:
A seal of approval.

Dr. Sophia:
Yeah. Like literally that's actually how this all went down is that, you know, she's like, oh, do I really need it? And I was like, well, I really recommend it. I said, especially, you know, you, you're not in a relationship. No. But eventually you will be. And so at least you'll know where your baseline is from now. She's like, oh yeah, that's a good point.

Touseef Mirza:
Good job Dr. Sophia. But it's true. Because I, you know, put myself in her shoes and I agree. I would've said, well, you know, I don't need to because, you know, I haven't been sexually active and there's this partner and we're fine, and I don't have any symptoms, so why bother?

Dr. Sophia:
She had no symptoms, why bother? But the thing is, is that for me, in my mind, it was just like, okay, well you, but you just had, you had a partner.

Touseef Mirza:
Yeah.

Dr. Sophia:
Right. And so before you move on to the next partner. You know and she hadn't been tested, she just, she hadn't been tested recently . You know, and so that was the kind of the way the conversation came about. But it was just, again, a reminder, hey, chlamydia can have no symptoms, but you can still have it. And so there was a small moment where it was just like between the two of us, we were like, oh, well, is this real? But yeah, no, it was real.

Touseef Mirza:
And so for example, in this situation, and she finds out that she has it, what do you do after that?

Dr. Sophia:
She gets treated.

Touseef Mirza:
So that's the good news.

Dr. Sophia:
The good news is that chlamydia is a treatable sexually transmitted infection. And it's treatable, and curable. So once you've been treated, you are cured.

Touseef Mirza:
Which cured meaning?

Dr. Sophia:
That you don't have chlamydia anymore. Not to have, it's not something that will lay dormant or latent and come back later. You know, it's not like that. It is, if you get chlamydia, if you test positive for chlamydia, again, that is a new infection.

Touseef Mirza:
Okay. So you could get reinfected, but not with what you have going on right now that will be completely cured.

Dr. Sophia:
That is correct.

Touseef Mirza:
And is it, is it a shot? Is it a pill? Is it antibiotics?

Dr. Sophia:
So antibiotics, the preferred way of treating chlamydia is with a drug called doxycycline that you would take twice a day for seven days. And we usually say to abstain from any sexual contact while you're being treated and also while your partner is being treated and to be retested at least three months later.

Touseef Mirza:
Three months later. Okay. So what's interesting with the story that you bring up is really the importance of yearly STI testing.

Dr. Sophia:
Yeah. It's always nice to feel a little sense of validation that this is why it's so important that we always test. To me, it's like when you go to your primary care doctor and you get your annual quote unquote annual blood work and check to make sure you're not anemic.

Touseef Mirza:
Even if you feel fine.

Dr. Sophia:
Even if you feel fine. Right. Even if, you know, we may not feel tired or sluggish or what have you and your doctor's like, okay, well let me just check your routine blood work. . And I feel like STI testing should just be routine blood work. We should treat it the same way we treat routine blood work for this exact reason. So for this patient, luckily, like I said, she didn't have symptoms. We've treated her, so she's cured of her chlamydia and we'll retest her afterwards to make sure that it's, she's completely treated. Chlamydia can cause something called PID, which is pelvic inflammatory disease. Chlamydia can cause scarring of the fallopian tubes, which make it give women who've had chlamydia an increased risk of having something called an ectopic pregnancy.

Touseef Mirza:
So are you saying that even if I don't have symptoms, yes, but I have chlamydia. This can happen on the back burner.

Dr. Sophia:
So eventually either a woman can develop symptoms such as pelvic pain only to find out that she then has pelvic inflammatory disease. She may end up in the hospital, the emergency room, her doctor's office for pelvic pain or for what she thinks is just pelvic pain and only to find out that she actually has PID pelvic inflammatory disease.

Touseef Mirza:
So when we say pelvic area, we're talking about the lower part around the hips where your uterus is and your vaginal canal.

Dr. Sophia:
Ovary cervix.

Touseef Mirza:
So it goes back to the question I wanted to ask you, because some people, I'm sure they're saying, well, you know, if I didn't have any symptoms then, you know, unless I start to have become sexually active again, then what's the issue? But that's one of the issues that chlamydia can evolve in different ways.

Dr. Sophia:
It definitely can evolve in different ways. It can latch on into areas such as your tubes for example. It can affect your fallopian tubes and you may or may not have any symptoms of that. And so it's actually one of the fears for this particular woman who was asymptomatic. My only thought process is that she probably got this whole, you know, within the last seven months she said she hadn't been sexually active for seven months. And so that means that there's a possibility that she has been walking around with this chlamydia for seven months. My biggest concern now is for her tubes because even though she had no particular symptoms or anything that made her think to come to the doctor any sooner, and nothing that I could potentially see on her exam that was like, oh my gosh, she definitely has something. But now she may have scarring of her tubes.

Touseef Mirza:
And what does that mean? Scarring of the tubes?

Dr. Sophia:
That the bacteria affected her tubes and that–

Touseef Mirza:
The fallopian tubes.

Dr. Sophia:
The fallopian tubes and that would make it that she has scar tissue basically that develops or adhesions or something that happens within the tube itself, that if she were to get pregnant again, the pregnancy could get trapped while it's trying to travel down the tube.

Touseef Mirza:
Because the tube is between the ovary and the uterus

Dr. Sophia:
Because the tube is between the ovary and the uterus. Yes. The ovary is what gets the egg. It travels through the tube and goes into the uterus where it ultimately implants. But most fertilization actually happens in the tubes, but the tubes then have then kind of pulse it and move that egg along. And so, and they have to be open or patent or what we call patent. Right. And so chlamydia unfortunately can cause this scarring or this like adhesions that happen or form within the tube so the egg and sperm are super small, and can pass through. And so therefore fertilization can happen. But now once it starts to divide, it then can get trapped in the tube and cause what we call an ectopic pregnancy, which is life threatening because the pregnancy gets stuck in the tube grows in the tube because–

Touseef Mirza:
They can't move out of the tube.

Dr. Sophia:
Move out the tube, the tube tube to get to the uterus. That's correct. And so that is the big fear in someone who is asymptomatic, has had an infection for so long that wasn't treated. I mean, you know, right away.

Touseef Mirza:
So even seven months can have a certain effect on the tubes.

Dr. Sophia:
Absolutely. Absolutely.

Touseef Mirza:
So the bacteria is working fast.

Dr. Sophia:
Yeah.

Touseef Mirza:
And then are there any other issues that can come about if you don't treat chlamydia?

Dr. Sophia:
So other issues that can come about? So for men, the same concept of like damage, damage to their, they can have a rare condition where they, their tubes can get damaged that travel for sperm, they can also have a more common problem, prostatitis or inflammation of their prostate. They can have swelling or inflammation, infection of the epididymis, which is a part of their reproductive system on top of the testes. And so for men, they may have a discharge, they may have painful urination or urethritis, which women can have as well.

Touseef Mirza:
And for men too, they could also be asymptomatic. They might also not have symptoms.

Dr. Sophia:
Men can be asymptomatic as well.

Touseef Mirza:
Okay. And if they're asymptomatic, there could still potentially be issues as well.

Dr. Sophia:
They can, they can certainly not just have issues, but they're, the problem with being asymptomatic is that you're transmitting it.

Touseef Mirza:
And now we can talk about the baby.

Dr. Sophia:
So with women because they can have asymptomatic infection, but the thing is, it can stay in the vaginal canal, the, and the cervix. And so as the baby is passing through that vaginal canal.

Touseef Mirza:
All right, let's just back up a second. So you're saying that the woman, she has chlamydia, she doesn't know it, she's pregnant. Yes. And now she's about to give birth.

Dr. Sophia:
Exactly. And so when she gives birth, she has the potential to pass on this chlamydia to the newborn

Touseef Mirza:
Because it's right there and the baby's like, 'cause it's right there and the baby's like can get it.
Dr. Sophia:
Yeah.
Touseef Mirza:
It's literally rubbing on the baby as it's coming out.
Dr. Sophia:
Exactly. And so it can cause a couple of infections in the baby, one of which being like an eye infection or a chlamydial conjunctivitis. The other thing that can happen is that the baby can get a chlamydial pneumonia, which is, which can be life threatening for the baby.
Touseef Mirza:
Do we not test every woman that is about to deliver a baby for chlamydia to avert this?

Dr. Sophia:
We do, we test women twice. Typically in pregnancy.

Touseef Mirza:
I'm happy to hear that.

Dr. Sophia:
Yes, we do. And this is the reason why we do this is exactly why we test women in pregnancy for these infections.

Touseef Mirza:
I'm sure when you've said that to a pregnant woman, they'd be like, what are you talking about? Why? I'm having a baby. I'm not here for an STI.

Dr. Sophia:
Well the beauty is, at least when women are pregnant, they get that, they understand that they need certain testing. Okay. And so I don't remember ever getting pushed back. Testing for chlamydia can be done either as a swab or through the urine.

Touseef Mirza:
So it's really easy.

Dr. Sophia:
So luckily it's kind of easy. Yes.

Touseef Mirza:
Okay. You don't even have to draw blood for that. No. Then there's no excuse like because you know, some people don't like needles and all that. Of course. If, if you're just gonna pee, like, okay, yeah, of course. Easy peasy.

Dr. Sophia:
Of course. Okay.

Touseef Mirza:
And then on top of that, the treatment is way simpler.

Dr. Sophia:
The treatment is simple. I mean, for a pregnant woman, it's not the same that we would use for a non-pregnant woman for we would treat with something called azithromycin, which is kind of nice in terms of, as an alternative, it's a one time dose unlike the traditional or the more common or first line treatment, which is to be treated for seven days.

Touseef Mirza:
Which is a pill.

Dr. Sophia:
Which is a pill, okay. To be taken twice a day for seven days

Touseef Mirza:
Versus just one pill and you're done. Right. Okay. All this sounds really manageable.

Dr. Sophia:
It is manageable, right. It is manageable, but you know, chlamydia is a very common STI with no symptoms. And even when it has symptoms, it's so similar to other things that even women who do have symptoms can sometimes come, you know, like, I don't wanna say blow it off, but rather think of it as something else is going on.

Touseef Mirza:
Just something natural that's happening. That's off.

Dr. Sophia:
I told you we had three patients, kind of like, or three people anyway, back to back that with the chlamydia. And here was, and one of them, she had excruciating pain around her period to the point where she actually ended up going to the ER for her pain.

Touseef Mirza:
What pain?

Dr. Sophia:
In her, in her pelvis. Okay. In her pelvis. Because of her pain for which her period was on, she had this excruciating pain. And so she went to the ER for the pain. And that's how she ended up seeing me as a, what we call an ER follow up. And when she saw me, there was never an inclination that she could potentially have some type of infection. Instead, it kind of revolved around the question of what was going on around her period, what was going on in her life, if she was particularly stressed out as, you know, periods can change just related to our environment and our conditions. And so we talked more like, kind of like in depth about her menstrual history, the fact that she'd actually had painful periods, not just in that one episode, but you know, before. And so it started to give us the concept or the possibility that we are dealing with what's called dysmenorrhea or just painful periods? Could it be that she has something called endometriosis, which can certainly lead a, a disease process that can lead to very painful periods. And so it kind of sent us down a different rabbit hole.

Touseef Mirza:
Because there could be many reasons for this.

Dr. Sophia:
Right. And it was just, her presentation was only painful. And so about two weeks after that, her partner actually told her that he had been chlamydia positive and that she needed to be treated, which was again, another just drama and whirlwind of events

Touseef Mirza:
Because people associate that with somebody having extra sexual encounters.

Dr. Sophia:
I mean they have. There's no question, right? No, but if you think that you've been, well, here's the thing, the thing to understand is that if you think you've been in a monogamous relationship, you did not have any infections beforehand or you were to let's say, let's say you got tested beforehand or earlier in the relationship, everybody was clean. So if everybody's clean, if you now have something, somebody has stepped out.

Touseef Mirza:
Right. No, no, I understand that. Oh, I'm just saying like if somebody, if the, if the male was like, you know, I just tested positive, but maybe he was a, he didn't have symptoms for a long time and didn't know about it, you know, that it was maybe prior to their relationship could, you could be a carrier.

Dr. Sophia:
I guess in this case, this girl had been in this relationship for three years. So no, that wasn't the case. We didn't have that to go on.

Touseef Mirza:
Okay.

Dr. Sophia:
And again, another reason before people get into new relationships to be tested, just to know what your status is before you move on to that next relationship. You know, for exactly that point. That what if you're carrying something from a previous relationship that you don't know.

Touseef Mirza:
Do condoms protect you pretty well from chlamydia?

Dr. Sophia:
Actually they do. They do protect you pretty well from chlamydia.

Touseef Mirza:
Right. So that's good to know. Yes. And so we talked to two of your patients that had no idea. Did you have one that they actually had some issues and they're like, something's going on down there. Yes.

Dr. Sophia:
Yes. And so for the third one actually came in with symptoms. And then not only did she come in with symptoms, she also came in and said, I've been having a lot of sex.

Touseef Mirza:
Okay, gee, just laid it all out.

Dr. Sophia:
Laid it all out, was having some discharge that was smelly. And then actually though those are not the two things, those two things definitely were concerning for her, no question. But also that sex became painful. And so those were the three conditions. And so she came in because she was like, I need to get tested.

Touseef Mirza:
And when we say sex is painful, like through penetration, like it just, that was painful. Like the vaginal canal.

Dr. Sophia:
I actually didn't ask her the details. I did not ask at which point was the sex painful. But on her exam, at least I can say that she did have something that was kind of classic for the potential that she has something called PID because she had something called cervical motion tenderness.

Touseef Mirza:
Oh boy. Say that, say that again.

Dr. Sophia:
Cervical, yes. Motion tenderness. Okay.

Touseef Mirza:
The cervix being at the bottom part of the uterus–

Dr. Sophia:
Top part–

Touseef Mirza:
Of the vagina, the vaginal of the vaginal canal.

Dr. Sophia:
Yes. And so on exams, when we do something called a bimanual exam, we are actually feeling the cervix and we also are feeling for the top of the uterus. And when we say a cervical motion tenderness, it is just when we are at the level of the cervix and we kind of push it up and down. And that typically most women don't feel anything, or they may say they have a little bit of pressure, but mostly they say nothing. But in a woman who has either what's called a cervicitis or a cervical, you know, an infection of the, at the level of the cervix or even further an infection, both of the cervix and the uterus, that would be very tender. And so we did her swab and it did come back positive also for chlamydia.

Touseef Mirza:
And what did she think it was, she knew something was off, but did she have any clue?

Dr. Sophia:
Yeah, she knew something was off. She just said, I think I need to get STI testing. Okay. The good thing is, she didn't like to put it off. It wasn't like it'd been weeks and weeks and weeks of something that was going on and she put it off. She started to feel kind of weird. It took about a week Mm. Of her feeling kind of off. And then like I said, she had a sexual experience and it was very painful and she came in right away. And that is what I would encourage people to do: don't put things off when you feel something, don't put off a weird smell or a discharge or something like that. Don't always think that you can just treat it all by yourself. Because as sexual beings, especially if you're having unprotected sex, meaning sex without a condom, then the potential is always going to be there that you can unfortunately encounter an infection.

Touseef Mirza:
Right. And what we're advocating is sex with a condom, with, with everybody that's not in a committed relationship.

Dr. Sophia:
I think even if you are in a committed relationship, it's very important to be very candid, honest, have the conversation often, and even if not, then at least get tested for sure. At minimum annually, it helps to maintain health.

Touseef Mirza:
So I think it's important what you're saying because some women might feel uncomfortable bringing this up to their male partners if they are together for a very long time. And if they're in a committed relationship. So one way to, I'm not saying that's the best way to do it, but if you can, if you feel so uncomfortable or sometimes it's just not part of your cultural background to bring this up and you just don't know how to handle it, you could still go ahead by yourself and get tested.

Dr. Sophia:
That's exactly my point. That you just make it just part of your own healthcare. You just get tested. Right. You just get tested and then hopefully you never have to have a confrontation or have to confront somebody because now you found out something that you weren't expecting. However, you know, I'm not saying that people in committed relationships, that they're not committed. This is not at all what I'm alluding to. I'm simply saying that things change, people change, pay attention, you know, and then moreover, just know your own body. And especially we're dealing with things such as chlamydia that could actually be asymptomatic.

Dr. Sophia:
So that's where at least routine, regular, you know, exams and testing can make all the difference in what you know and what you don't know. .

Touseef Mirza:
At the end of the day, we really want the women to just feel like they're worth it for their own health. Right. And to advocate for themselves no matter what. And so this is part of it as well. So we're trying to also give different options to help the woman wherever they are. And we don't wanna be alarmist. We're not saying everybody's sleeping around or anything like that, but we're just saying that there are tools out there for you,

Dr. Sophia:
There are tools out there for you. Yes. Unfortunately, chlamydia is the number one STI that is reported. And unfortunately 50% of the time people don't even know.

Touseef Mirza:
So what's interesting also with that, it means that let's say the woman goes, gets tested, now she realizes that, okay, I need to get treated. She gets treated, but the male also has to, or, or you know, the other partner also has to be treated. Yes. Because, or else you're gonna just keep it back and forth.

Dr. Sophia:
That is correct. That's correct. You will get it again if you don't treat your partner or if your partner doesn't get treated. So there's partner notification as well as treat, you know, treatment that's encouraged or recommended. And in some places you even, would you treat both parties right there

Touseef Mirza:
And then? Is there a time in which you say, okay, don't have sex? Wow.

Dr. Sophia:
During the time of treatment? . So the seven days during treatment, seven days after treatment, we say to abstain or use condoms and then check to make sure that you haven't been reinfected within three months. It's important that we keep each other safe and healthy. And so as always, we encourage you to embrace your body and embrace yourself. Thank you for joining us on the Dr. Sophia ObGyn podcast. Bye for now.

Touseef Mirza:
Bye.

Dr. Sophia:
This is General medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.