The Lowdown on STD’s: Chlamydia
Chlamydia is the third most common sexually transmitted infection (STI) in the United States.  It is the most common bacteria causing an STI.  According to a 2007 Center for Disease Control report, South Carolina ranks 3rd out of the 50 states in chlamydial infections.  Those at most risk of infection are single, minority women between ages 15-21 with new or multiple sexual partners.  However, Chlamydia affects women and men of all backgrounds. 

Like all sexually transmitted infections, Chlamydia enters a woman’s body during intercourse.  Chlamydia trachomatis is different from most bacteria in that it must live inside cells, making it difficult to grow in a culture. In this way, it is more similar to a virus.  Chlamydia prefers to live inside the cells of the cervix (the opening of the uterus) and the cells that line the bladder. 

Symptoms
Most women infected with Chlamydia are asymptomatic. Cervical infection may present with pain or bleeding during intercourse or a change in vaginal discharge.  Symptoms of chlamydial infection of the bladder and urethra can mimic a urinary tract infection.  Similar to women, men do not usually have symptoms.  If symptomatic, they may present with a discharge from the penis or pain during urination or ejaculation.

Diagnosis
Prenatal diagnosis and treatment of Chlamydia is extremely important. Women with untreated Chlamydia can develop postpartum fever and uterine infection.  Forty percent of babies born to mothers with untreated Chlamydia will develop eye infections.  Worldwide, Chlamydia conjunctivitis is a leading cause of preventable blindness.

The majority of cases are diagnosed during routine gynecologic exams and pregnancy screening.  At the time, physicians may note a discharge from the cervix.  Because Chlamydia does not grow in routine culture, standard diagnostic tests use nucleic acid amplification to detect the proteins that make up the bacteria.

Treatment
The CDC recommends immediate treatment of Chlamydia and encourages expedited treatment of known partners.  The most commonly prescribed antibiotics are macrolides, tetracyclines, and fluoroquinolones.  Because Chlamydia often accompanies a gonorrheal infection, patients diagnosed with gonorrhea are often treated for both.  For those in a relationship, both partners should complete treatment and wait approximately 1-2 weeks after their last dose to have sex to avoid re-infection.  Couples can also use condoms to prevent re-infection.  Condoms are the only reliable method for prevention of Chlamydia transmission.

Effects of Untreated Chlamydia
Due to the absence of symptoms, many women are unaware of current or past chlamydial infection.  Untreated Chlamydia can have devastating effects on the reproductive organs.  Although it initially infects the cervix, Chlamydia can migrate upward into the uterus and fallopian tubes. Upper genital tract infection can lead to infertility, pelvic inflammatory disease, and chronic pelvic pain. 

Women concerned they have been infected with Chlamydia or another sexually transmitted disease can be tested at their physician’s office, the state health department or a non-profit clinic such as Planned Parenthood of America.  MUSC Women’s Health offers a specialty clinic for STI testing and treatment of women and their partners.

by:  Gweneth Lazenby, M.D.

Do you have HPV?  We just heard about a new online support group.  Share your dilemmas, your feelings and experiences at:  mdjunction.com/hpv.

Human papillomavirus (HPV) is the most common newly acquired sexually transmitted infection (STI) in the United States.  Furthermore, the incidence of HPV infection has increased during the past two decades, with approximately 6.2 million newly diagnosed cases annually.  HPV infection has a very high prevalence rate in sexually active adolescent girls and young women. One study showed that 36% of women 25 years of age or younger are HPV-positive. Although HPV can cause genital warts, cervix dysplasia (a precursor to cervical cancer) and cervical cancer, most HPV infections do not cause symptoms.

Transmission typically occurs at the time of sexual intercourse.  Increased risk for contracting HPV has been associated with multiple sex partners, younger age of sexual debut and failure to use condoms.  One study reported that 20% of women became infected with only one lifetime sex partner, suggesting that both partners must be sexually naïve to prevent infection.  The risk of infection increases substantially when initiating a new sexual relationship. The transmission of HPV infection can be blocked by latex condoms if the infected area is physically covered.  However, HPV lesions often occur on external genital sites not covered by a condom, and so the latter does not prevent all infections.

The currently available HPV vaccine is effective in preventing infection with HPV types 16 and 18, the types that cause abnormal Pap smears and are related to cervical dysplasia and 70% of cervical cancer.  The vaccine also prevents infection due to types 6 and 11, the types responsible for 90% of genital warts.  Since other HPV types are not covered by the vaccine you should continue to have regular Pap smears. 

Girls and women aged 9 to 26 years old are candidates for the vaccine.  The vaccine is administered in three separate doses with an initial dose followed by additional doses at 2 months and again at 6 months.

Women with a history of an abnormal Pap smear are still candidates for the vaccine.  Most abnormal Pap smears are due to infection with a single type of HPV.  Since the vaccine covers 4 different types of HPV (types 6, 11, 16, and 18) it will offer protection against the types of HPV not causing the prior abnormal Pap smear.

by:  David Soper, M.D.

Request an appointment with a MUSC provider.