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What is chlamydia infection?

Chlamydia is one of the most common sexually transmitted diseases in the U.S and the UK. This infection is easily spread because it often causes no symptoms and may be unknowingly passed to sexual partners. In fact, about 75% of infections in women and 50% in men are without symptoms.


How is chlamydia infection acquired?

The infection is transmitted in 2 ways:
- From one person to another through sexual contact (oral, anal, or vaginal).
- From mother to child with passage of the child through the birth canal. Chlamydia can cause pneumonia or serious eye infections in a newborn, especially among children born to infected mothers in developing countries.


What are chlamydia symptoms?

Most people who have chlamydia don’t notice any symptoms.

If you do get signs and symptoms, these usually appear between one and three weeks after having unprotected sex with an infected person. For some people the symptoms occur many months later, or not until the infection has spread.

Chlamydia symptoms in women

Around 70-80% of women with chlamydia don't notice any symptoms. If women do get symptoms, the most common include:
- pain when urinating (peeing)
- a change in vaginal discharge
- pain in the lower abdomen
- pain and/or bleeding during sex
- bleeding after sex
- bleeding between periods
- heavier periods than usual

If left untreated, chlamydia infection will greatly threatens women's health: it can spread to the womb and cause pelvic inflammatory disease (PID). PID is a major cause of infertility, miscarriage and ectopic pregnancy (when a fertilised egg implants itself outside the womb, usually in one of the fallopian tubes).

Chlamydia symptoms in men

Around half of all men with chlamydia don't notice any symptoms. If men do get symptoms, the most common include:
- pain when urinating (peeing)
- discharge from the tip of the penis (this can be a white, cloudy or watery discharge)
- pain in the testicles

Chlamydia in the rectum, throat or eyes

Some men have mild symptoms that disappear after two or three days. Even if the symptoms disappear you will still have the infection and be able to pass it on. If chlamydia is left untreated in men they are at risk of complications such as orchitis (swollen testicles), reactive arthritis (inflammation of the joints) and infertility.

If possible complications (like PID, prostatitis, etc. ) are triggered by chlamydia infection, more symptoms would develop.

Chlamydia can infect the rectum, eyes or throat if you have unprotected anal or oral sex. If infected semen or vaginal fluid comes into contact with the eyes you can also develop conjunctivitis.
Infection in the rectum can cause discomfort, pain, bleeding or discharge. In the eyes chlamydia can cause irritation, pain, swelling and discharge the same as conjunctivitis. Infection in the throat is less common and usually causes no symptoms.


How is chlamydia infetion diagnosed?

The test for chlamydia is simple. Most people can have the test carried out on a urine sample. Some people have a swab test (a small cotton bud). The swab is used to gently wipe the area where you might have chlamydia, to collect some cells. The cells are then tested for infection.

The doctor or nurse will explain which is the best test for you to have. You don’t always have to be examined by the doctor or nurse – this will depend on your situation and where you go to get tested.
People who have had anal or oral sex might have a swab taken from their rectum or throat. This isn’t done on everyone.

If you have symptoms in your eye, such as discharge or inflammation, a swab test might be taken to collect cells from your eyelid.

Tests for women

Chlamydia tests on women can be done with a urine sample or swab test. If a woman has a swab test, it can be taken from the cervix, or inside the lower vagina. Occasionally the doctor or nurse may advise you to have a swab test from the urethra (where urine comes out). Usually you can do a lower vaginal swab yourself, although sometimes a nurse or doctor may do it.

If you have had anal or oral sex you might also be offered a swab test taken from the rectum or throat. This isn’t done on everyone.

Routine cervical screening tests (smear tests) do not detect chlamydia. You will need to tell the doctor or nurse if you would also like to be tested for chlamydia at the same time.

Tests for men

Men will usually have a chlamydia test on a urine sample. Occasionally, a swab test may be taken from the urethra (the tube where urine comes out) at the tip of the penis.

If you have had anal or oral sex you might also be offered a swab test taken from the rectum or throat. This isn’t done on everyone.


How reliable is a chlamydia test?

The accuracy of tests varies, depending on the type of test that is used. Recommended tests are 90-95% sensitive. This means that they will detect chlamydia in most people who have the infection. Some tests you can buy may be less reliable.

Remember that no test is 100% accurate. There is a small chance that a test may show negative even when you have chlamydia. This is called a false negative test result. It is also possible for a test to be positive even when you do not have chlamydia. This is called a false positive test result. Both of these false tests are very rare but can sometimes explain why you get a different result to your sexual partner.


How is chlamyda infection treated?

Chlamydia infection is often treated with antibiotics. A convenient single-dose therapy for chlamydia is 1 gm of azithromycin (Zithromax, Zmax) by mouth. Alternative treatments are often used, however, because of the high cost of this medication. The most common alternative treatment is a 100 mg oral dose of doxycycline (Vibramycin, Oracea, Adoxa, Atridox and others) twice per day for seven days. Unlike gonorrhea, there has been little, if any, resistance of chlamydia to currently used antibiotics. There are many other antibiotics that also have been effective against chlamydia. As with gonorrhea, a condom or other protective barrier prevents the spread of the infection. Latest researches show that genital chlamydia infection can be treated with appropriate herbal formulas as well.

What are fibroids?

Uterine fibroids (leiomyomata) are non-cancerous growths that develop in or just outside a woman’s uterus (womb). Uterine fibroids often appear during childbearing years and aren't associated with an increased risk of uterine cancer and almost never develop into cancer.

Although these tumors are called fibroids, this term is misleading because they consist of muscle tissue, not fibrous tissue. The medical term for a fibroid is leiomyoma, a type of myoma or mesenchymal tumor.

Fibroids start in the muscle tissues of the uterus. They can grow into the uterine cavity (submucosal), into the thickness of the uterine wall (intramuscular), or on the surface of the uterus (subsersoal) into the abdominal cavity. Some may occur as pedunculated masses (fibroids growing on a stalk off of the uterus).

They can occur anywhere in the womb and are named according to where they grow:

Intramural fibroids grow within the muscle tissue of the womb. This is the most common place for fibroids to form.
Subserous fibroids grow from the outside wall of the womb into the pelvis.
Submucous fibroids grow from the inner wall into the middle of the womb.
Pedunculated fibroids grow from the outside wall of the womb and are attached to it by a narrow stalk.
 

What are fibroids causes?

The cause of uterine fibroids remains unknown, but research and clinical experience point to these factors:

Genetic changes. Many fibroids contain changes in genes that differ from those in normal uterine muscle cells. There's also some evidence that fibroids run in families and that identical twins are more likely to both have fibroids than nonidentical twins.

Hormones. Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.

Other growth factors. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.
 

What are fibroids symptoms?

Most often, uterine fibroids cause no symptoms at all -- so most women don’t realize they have them. When women do experience symptoms from uterine fibroids, they can include:
- Prolonged menstrual periods (7 days or longer)
- Heavy bleeding during periods
- Bloating or fullness in the belly or pelvis
- Pain in the lower belly or pelvis
- Constipation
- Pain with intercourse
- Miscarriage or infertility
- Problems during pregnancy

Some experts believe that some uterine fibroids can occasionally interfere with fertility and pregnancy. Rarely, a uterine fibroid projecting into the uterus might either block an embryo from implanting there, or cause problems with the pregnancy later.
 

What are the usual ways of diagnosing fibroids?

Uterine fibroids are diagnosed by pelvic exam and even more commonly by ultrasound.

If you have symptoms of uterine fibroids, you doctor may order these tests:

Ultrasound. If confirmation is needed, your doctor may order an ultrasound. It uses sound waves to get a picture of your uterus to confirm the diagnosis and to map and measure fibroids. A doctor or technician moves the ultrasound device (transducer) over your abdomen (transabdominal) or places it inside your vagina (transvaginal) to get images of your uterus.
Lab tests. If you're experiencing abnormal vaginal bleeding, your doctor may order other tests to investigate potential causes. These might include a complete blood count (CBC) to determine if you have anemia because of chronic blood loss and other blood tests to rule out bleeding disorders or thyroid problems.

If traditional ultrasound doesn't provide enough information, your doctor may order other imaging studies, such as:

Magnetic resonance imaging (MRI). This imaging test can show the size and location of fibroids, identify different types of tumors and help determine appropriate treatment options.
Hysterosonography. Hysterosonography (his-tur-o-suh-NOG-ruh-fee), also called a saline infusion sonogram, uses sterile saline to expand the uterine cavity, making it easier to get images of the uterine cavity and endometrium. This test may be useful if you have heavy menstrual bleeding despite normal results from traditional ultrasound.
Hysterosalpingography. Hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee) uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images. Your doctor may recommend it if infertility is a concern. In addition to revealing fibroids, it can help your doctor determine if your fallopian tubes are open.
Hysteroscopy. For this, your doctor inserts a small, lighted telescope called a hysteroscope through your cervix into your uterus. Your doctor then injects saline into your uterus, expanding the uterine cavity and allowing your doctor to examine the walls of your uterus and the openings of your fallopian tubes.
 

How to treat fibroids?

There's no single best approach to uterine fibroid treatment — many treatment options exist.

Some medicines are used to treat heavy periods with whatever the cause, including heavy period that are caused by fibroids. Some women are given a gonadotrophin-releasing hormone (GnRH) analogue in order to shrink the fibriods. Sometimes a low dose of HRT is also given to reduce the incidence of menopausal side-effects.

Surgeries and other operative treatments including:

Hysterectomy
This is the traditional and most common treatment for fibroids which cause symptoms. Hysterectomy is the removal of the womb. This can be done by making a bikini scar in the lower abdomen. Or, if the fibroids are small enough, the womb can be removed through the vagina so there are no scars. A hysterectomy may be a good option for women who have completed their family. See separate leaflet called 'Hysterectomy' for more detail.

Myomectomy
This is a possible alternative, especially in women who may wish to have children in the future. In this operation, the fibroids are removed and the womb is left. This procedure is not always possible. This operation can be done through an incision (cut) in the abdomen, via keyhole surgery (laparoscopically) or through the vagina (hysteroscopically). The type of operation depends on the size, number and position of the fibroids. Recurrence of the fibroid is fairly common after a myomectomy. There is a risk of very heavy bleeding with this operation. Your surgeon should advise you that a hysterectomy may be needed if that situation arose.

Endometrial ablation
This procedure involves removing the lining of the womb. This can be done by different methods. For example, using laser energy, a heated wire loop or by microwave heating. This method is usually only recommended for fibroids close to the inner lining of the womb.

MRI-guided focused ultrasound
This treatment sends pulses of high power ultrasound through the skin of the lower abdomen. It is targeted at the fibroid, using the MRI scanner. It is effective but there is no research yet on the long-term outcome for women trying to conceive.

Uterine artery embolisation
This procedure is done by a specially trained radiologist (X-ray doctor) rather than a surgeon. It involves putting a catheter (a thin flexible tube) into an artery (blood vessel) in the leg. It is guided, using X-ray pictures, to an artery in the womb that supplies the fibroid. Once there, a substance that blocks the artery is injected through the catheter. As the artery supplying the fibroid becomes blocked it means the fibroid loses its blood supply and so the fibroid shrinks. The complete process of fibroid shrinkage takes about 6-9 months but most women notice a marked improvement in their symptoms within three months. There is a good chance of success with this procedure but it does not work in every case.

Other techniques
MRI-guided laser ablation is a newer technique. In this procedure a small needle is put through the skin into the centre of the fibroid. The correct position of the needle is shown by the MRI scan. The laser energy is then passed down the needle, which destroys the fibroid. This technique is not suitable for all types of fibroid. There is not enough evidence currently to justify using this technique routinely.