Chlamydia Complications: PID, Fertility, Epididymitis and More

Chlamydia Complications: PID, Fertility, Epididymitis and More

What can happen if chlamydia isn’t treated, the warning signs that need urgent help, and how to prevent complications.

Part of our Chlamydia condition guide.

How chlamydia causes damage without symptoms

Chlamydia lives inside the cells lining the genital tract, which lets it avoid triggering strong inflammation. That’s why most people feel well. But the body’s immune response to a long-lasting infection can slowly inflame and scar the tissues involved, particularly the fallopian tubes. This can happen with no symptoms at all, so feeling fine is no guarantee that no harm is being done.

That’s the main reason NHS advice is to test regularly if you’re at risk, rather than waiting for symptoms. Our chlamydia testing guide explains when and where to test.

Pelvic inflammatory disease (PID)

PID happens when infection spreads up from the cervix to the womb, fallopian tubes and ovaries. Chlamydia is one of its most common causes, though other bacteria, including gonorrhoea and Mycoplasma genitalium, can cause it too.

Symptoms of PID

• pain or tenderness low in the tummy, usually on both sides;
• pain deep inside during sex;
• bleeding between periods or after sex;
• unusual vaginal discharge;
• a high temperature and feeling unwell, in more severe cases.

PID can also be mild or cause no symptoms, which is one way fertility can be affected without anyone noticing.

How PID is treated

PID needs an examination and a broader course of antibiotics than chlamydia alone, because several bacteria may be involved. The usual UK outpatient treatment is a single ceftriaxone injection, followed by doxycycline and metronidazole tablets for 14 days (BASHH). Severe PID is treated in hospital. Partners from the last 6 months should be tested and treated. PID isn’t suitable for treatment through an online service: please see your GP or a sexual health clinic.

Fertility

Scarring from PID can partly or completely block the fallopian tubes, making it harder to get pregnant. The risk rises with each episode of PID (Weström et al.). Antibiotics clear the infection but can’t reverse scarring that has already happened, which is why early treatment matters.

Many women with tubal damage never had recognised PID, which suggests silent infection can be enough to cause it. It’s worth keeping this in proportion, though: most women who have had chlamydia, especially if it was treated promptly, go on to conceive normally. If you’re worried about your fertility after a past infection, talk to your GP.

Ectopic pregnancy

An ectopic pregnancy is one that develops outside the womb, usually in a fallopian tube. A tube that has been scarred by PID makes this more likely, because a fertilised egg can get stuck on its way to the womb. The tube can’t support a growing pregnancy, and if it bursts, it causes dangerous internal bleeding.

Epididymo-orchitis in men

In men, chlamydia can spread from the urethra to the epididymis (the coiled tube at the back of each testicle that stores and carries sperm), and sometimes the testicle itself. This is called epididymo-orchitis.

• pain and swelling in one testicle, usually coming on over hours or days;
• a tender, swollen area at the back of the testicle;
• sometimes discharge from the penis or pain when peeing;
• a high temperature in more severe cases.

When chlamydia or gonorrhoea is the likely cause, treatment is usually a ceftriaxone injection plus doxycycline for 10 to 14 days, which is longer than the standard chlamydia course (NICE CKS). It needs an examination, so see a sexual health clinic, GP or urgent care service rather than an online service. Whether chlamydia affects male fertility is less clear than for women, but prompt treatment of epididymo-orchitis reduces the risk of lasting damage.

Reactive arthritis

Reactive arthritis is inflammation of the joints triggered by an infection elsewhere in the body, including chlamydia. It usually starts within a few weeks of the infection (NHS) and is more common in men. It can cause:

• painful, swollen joints, most often the knees, ankles and feet;
• pain at the back of the heel or under the foot, where tendons attach;
• sore, red eyes (conjunctivitis); eye pain with blurred vision or sensitivity to light can be uveitis, which needs same-day assessment;
• pain when peeing, which can continue after the chlamydia has been treated.

Most people recover within a year (NHS). Treatment includes anti-inflammatory painkillers and treating the underlying chlamydia; a few people need specialist care from a rheumatologist.

Fitz-Hugh–Curtis syndrome

Rarely, in women with PID, inflammation spreads to the lining around the liver. This causes pain under the ribs on the right side, which can be sharp and worse when breathing in, and is easily mistaken for gallbladder or liver problems. It’s treated in the same way as PID. Pain under the right ribs with pelvic pain or a fever needs same-day medical assessment.

Infection in newborn babies

Chlamydia in pregnancy can be passed to the baby during birth, causing an eye infection (conjunctivitis) or, less often, a chest infection (pneumonia) in the first weeks of life. Testing and treating chlamydia during pregnancy prevents this. Our chlamydia in pregnancy guide explains more.

Preventing complications

Almost all of these complications can be prevented by finding and treating chlamydia early.

• Test regularly: every year if you’re under 25 and sexually active, and whenever you have a new partner.
• Treat promptly after a positive result. UK guidance recommends doxycycline first, with azithromycin for people who can’t take it.
• Make sure partners are treated, so you don’t catch it again. Each repeat infection adds to the risk. See our guide to telling your partners.
• Use condoms with new or casual partners.
• Don’t ignore warning signs such as pelvic pain, pain during sex or testicle pain: get seen the same day.

UK safety, support and free NHS options

Doxycycline and azithromycin are prescription-only medicines in the UK. Before anything is prescribed, a GPhC-registered pharmacist independent prescriber reviews your consultation, including your allergies and the other medicines you take. Always read the patient information leaflet in the pack. Never share antibiotics with anyone else, even a partner with the same infection, and don’t keep leftovers for another time: return unused tablets to a pharmacy.

If you think you’ve had a side effect from a medicine, tell your pharmacist or doctor. You can also report it to the MHRA through the Yellow Card scheme, which helps keep medicines safe for everyone.

NHS sexual health clinics test and treat chlamydia free of charge across the UK, and you don’t need a GP referral: use the NHS website in England, NHS inform in Scotland, Sexual Health Wales in Wales and nidirect in Northern Ireland to find one. Our private chlamydia treatment online service is an alternative for adults aged 18 and over.

If anything about how you got this infection doesn’t feel right, for example if sex wasn’t your choice or a partner pressures or controls you, you can talk to someone in confidence. See support, if you need it for free, confidential helplines. If you’re in immediate danger, call 999.

Chlamydia treatment from Access Doctor

If you’ve tested positive for chlamydia, or a sexual partner has, and you have no signs of a complication, our pharmacist independent prescribers can assess you online. You need to be 18 or over and not pregnant or breastfeeding.