What does “ascending infection” mean?

One of the most common complications is something known as an “ascending infection.” The bacteria spread from the place that was initially infected. In women, this is usually the cervix. From there, the infection works its way up (“ascends”) along the internal sex organs.

The bacteria can spread to the lining of the womb (endometrium), resulting in pain and heavy (irregular) bleeding. If the infection continues to spread, the fallopian tubes and ovaries can become inflamed too. This can cause abdominal pain, stomachache, fever and/or constipation.

Over time, the infection can cause scarring and adhesions (where scarring causes tissue to stick together). This can prevent the woman from being able to have children and can also increase the risk of ectopic pregnancy (where the egg gets stuck in one of the fallopian tubes).

Sometimes the chlamydia spread throughout a woman’s pelvis and cause inflammation there. The symptoms can be mild but they can also include severe pain, a high fever and chills. The area around the liver and the peritoneum (the membrane that lines the abdominal cavity) can become inflamed too.

In men, the infection can spread through the urethra (urine tube) to the prostate gland. The symptoms can include pain around the rectum, fever and problems when peeing or having sex. The seminal vesicles and sperm duct can also become infected and tender. If the epididymis is affected, the scrotum can swell up painfully and redden.

What other possible complications are there?

It is possible to spread the infection from one part of your body to another. One way this can happen is if you get infected fluid on your hands and then rub your eyes. This results into conjunctivitis with pus in your eyes. The cornea can also become inflamed, which causes problems with your vision and, potentially, if left untreated, blindness.

Another possible complication is when the immune system triggers a reaction to the infection in parts of the body that aren’t actually infected, like painful swelling in joints. When this happens as well as inflammation in the urethra and eyes (conjunctivitis), the medical term is “reactive arthritis.”

What are the potential effects on pregnant women and newborn babies?

Pregnant women with chlamydia infections have an increased risk of premature birth or miscarriage. If a woman terminates a pregnancy without realizing she has chlamydia, it can spread during the procedure and cause severe pelvic inflammatory disease (PID).

If the infection isn’t treated, the baby can get it if it comes into contact with chlamydia bacteria in the mother’s genital area during birth. This happens in roughly two thirds of cases where the mother has chlamydia. Then, the baby often develops conjunctivitis, sometimes a middle ear infection too and, more rarely, a lung infection (pneumonia).

So chlamydia testing is part of prenatal screening.

How can complications be prevented?

Diagnosing and treating chlamydia early on can prevent complications and stop the bacteria from being passed on to others. For this reason, it’s a good idea to get tested if you are sexually active and have symptoms such as pus-like or watery discharge.

People who have a higher risk of getting STIs should also get tested regularly, even if they don’t have any symptoms. That way you can detect symptomless infections and get treatment before serious complications develop.

Sources

• Deutsche STI-Gesellschaft (DSTIG). Infektionen mit Chlamydia trachomatis (S2k-Leitlinie, in Überarbeitung). AWMF-Registernr.: 059-005. 2016.
• Moll I. Duale Reihe Dermatologie. Stuttgart: Thieme; 2016.
• Robert Koch-Institut (RKI). RKI-Ratgeber Chlamydiosen (Teil 1): Erkrankungen durch Chlamydia trachomatis. 2010.
• Weyerstahl T, Stauber M. Duale Reihe Gynäkologie und Geburtshilfe. Stuttgart: Thieme; 2013.

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