Women and chlamydia: symptoms, diagnosis, and treatment

One of the preventable causes of infertility in women often has no symptoms. But, if you don’t have symptoms, how are you supposed to know if it’s affecting you? Well, this is often the case with chlamydia in women. Read on to learn more about the symptoms and treatment of chlamydia in women.

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Chlamydia is caused by the bacteria Chlamydia trachomatis and is a common sexually transmitted infection (STI). You probably learned about chlamydia in school and may remember some of the symptoms your teacher talked about—itching, burning, and vaginal discharge. 

What you may not remember is the statistic about how often chlamydia can be completely asymptomatic and how untreated chlamydia can lead to severe complications down the road. The good news is that once recognized, taking care of your chlamydia infection is straightforward.

In 2018, the Centers for Disease Control and Prevention (CDC) estimated approximately four million cases of chlamydia in the United States, making chlamydia the most common reportable STI in the (CDC, 2021). 

However, since most people with chlamydia don’t have symptoms, the actual number of cases in the country each year is likely much higher. Chlamydia is also particularly prevalent in females and younger individuals—approximately one in 20 sexually active females aged 14–24 have a chlamydial infection (CDC, 2021).

Chlamydia most often spreads through sexual contact. Specifically, you may become infected with chlamydia by touching the anus, mouth, penis, or vagina of a sex partner who has chlamydia—this includes participating in anal sex, oral sex, and vaginal sex.

Chlamydia may also spread from the throat of an infected individual to the genitals or anus of another individual, but it does not spread from mouth-to-mouth contact (i.e., kissing). Another method of transmission is from mother to child during birth. 

As mentioned, most cases of chlamydia in women are asymptomatic. It is estimated that only 5–30% of women have symptoms from chlamydia. Even in those who do have symptoms, signs do not show up immediately. It typically takes about 7–14 days after exposure to chlamydia for symptoms to begin in women. When symptoms or other complications are present, chlamydia is considered a sexually transmitted disease (STD) (Hsu, 2019).

Of note, the chlamydia symptoms discussed here refer to those that cis-gendered women may experience. If you are a transgender woman, depending on your anatomy, these symptoms may relate to you, or you may want to check our article on men and chlamydia. The body parts discussed here are the cervix, vagina, urethra, uterus, fallopian tubes, ovaries, lymph nodes, rectum, and throat.

Cervix

The cervix is the most common area for chlamydia to infect women. Some women have a condition called cervical ectopy, where cells from the inside of the cervix are present outside the cervix. This condition makes it more likely to get a chlamydia infection. Cervicitis can often be asymptomatic. When it does cause symptoms, they can include (Hsu, 2019):

• Yellow or abnormal vaginal discharge

• Pain during intercourse

• Bleeding after intercourse

• Abnormal bleeding between menstrual periods

Urethra

Chlamydia may infect the urethra in women as it does in men; the urethra is the tube that urine travels through to exit the body. Urethritis is also often asymptomatic. However, when symptoms do occur, they may feel like a typical urinary tract infection or UTI. Symptoms include (Hsu, 2019):

• Frequent urination

• Burning or pain while urinating (dysuria)

Uterus, fallopian tubes, and ovaries

The most dangerous complication of chlamydial infection in women is pelvic inflammatory disease (PID). PID is when the infection spreads to the internal reproductive organs (uterus, fallopian tubes, and ovaries). In many women, this may not cause symptoms. In others, it can cause (Hsu, 2019):

• Abdominal pain

• Pelvic pain

• Fever

• Nausea and vomiting

If left untreated, PID can damage the internal reproductive organs—even if you don’t have symptoms. This damage includes scarring of the fallopian tubes, one cause of infertility. PID also increases the chances of having an ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg attaches somewhere in the body other than the uterus. If the egg attaches to the fallopian tube, it can cause the fallopian tube to rupture as the egg develops. A ruptured ectopic pregnancy can lead to pain, internal bleeding, shock, and even death—it’s a medical emergency requiring immediate treatment (Hsu, 2019). 

A further complication of PID is a condition called Fitz-Hugh-Curtis syndrome. In Fitz-Hugh-Curtis syndrome, the infection spreads to the lining of the liver, which is called perihepatitis. Over time, this can cause internal scarring and adhesions that, if severe, require surgery to remove. One potential symptom of Fitz-Hugh-Curtis is pain in the upper right side of the abdomen (Hsu, 2019).

Lymph nodes

Infection of the lymph nodes by chlamydia is caused by serovars L1, L2, and L3. Serovars are different subtypes of chlamydia. Although Chlamydia trachomatis is one species, it has these different variations that cause different types of diseases. 

Serovars A–C cause a separate disease of the eyes known as trachoma, while serovars D–K cause the well-known STI. Serovars L1, L2, and L3 cause another type of STI called lymphogranuloma venereum (LGV), an infection of the lymphatic system typically seen in Africa, the Caribbean, India, and Southeast Asia (Hsu, 2019). 

Recent outbreaks have been seen in North America and Western Europe amongst men who have sex with men (MSM), but LGV can also occur in females. Symptoms may include (Hsu, 2019):

• Painless ulcer at the site where the infection entered the body 

• Painful swelling of the lymph nodes in the groin

Rectum

If you engage in receptive anal sex, you are also at risk for developing proctitis, an infection of the rectum's lining. Women who have proctitis are typically infected with serovars D–K, and their proctitis is often asymptomatic (Hsu, 2019).

Throat

Chlamydia can infect the throat and may cause a sore throat (pharyngitis). However, oral chlamydia (or pharyngeal chlamydia) usually does not cause symptoms (CDC, 2021). 

Diagnosing chlamydia requires a sample from every area at risk of infection, which depends on the type of sex you enjoy. For women, most healthcare providers usually collect a vaginal swab or a cervical swab to test for chlamydia. If you have engaged in receptive anal sex, your provider may get a rectal swab. Similarly, if you have performed oral sex, you may need a throat swab.

Detecting a condition that has no symptoms, like chlamydia in women, comes down to screening. Screening is a way to look for a disease in a person even if they don't have any signs or symptoms of the condition. The United States Preventive Services Task Force (USPSTF) recommends screening for chlamydia in sexually active females under 25. For women over 25, screening is only necessary for those at higher risk of infection (i.e., those who participate in high-risk sexual behavior such as unprotected sex and/or sex with multiple partners) (USPSTF, 2021). 

The same recommendations are in place for women who are pregnant. However, pregnant women should also be retested in the third trimester if under age 25 or at increased risk. Screening is important because, in addition to causing infertility, infection with chlamydia can cause issues during pregnancy and in the newborn. During pregnancy, chlamydia may lead to early rupture of the fluid sac containing the fetus and early (preterm) delivery of the newborn. If the infant is exposed to chlamydia during birth, it can cause pneumonia (a lung infection) or conjunctivitis (an eye infection) (Hsu, 2019).

Fortunately, chlamydia in women is easily treated with antibiotics. If you have symptoms or have a sexual partner who has already tested positive, you will likely be given treatment even before any test results come back. This type of treatment is called presumptive treatment.

The most common antibiotic used against chlamydia is a single dose of azithromycin (brand name Zithromax). Many women will also get an injection of ceftriaxone (brand name Rocephin) at the same time to treat gonorrhea; gonorrhea frequently infects women along with chlamydia. Another treatment option is a 7-day course of doxycycline (Hsu, 2021). 

If you develop complications of chlamydia, like PID or LGV, you may need a longer course of treatment. 

You can greatly reduce your chances of getting chlamydia by using barriers during sexual activity. This includes using a polyurethane or latex condom or a dental dam during all forms of sex (including oral sex). However, it is important to keep in mind that not all barrier methods entirely block contact (e.g., the diaphragm) and therefore are not effective at preventing STIs. Similarly, other forms of contraception like birth control pills and spermicidal lube do not prevent the transmission of STIs. 

Sexually active women with chlamydia have a 15–30% chance of becoming reinfected with chlamydia—this means that you have been treated for chlamydia but get chlamydia again in the future. You may need repeat testing three months after treatment to check for reinfection (Hsu, 2021).

Reinfection most often occurs because of continued contact with an untreated sexual partner. You can avoid reinfection by abstaining from sexual activity for seven days after starting antibiotic treatment. This will help prevent the further spread of chlamydia and reduce the risk that your sex partner will get chlamydia and then pass it back to you (Hsu, 2021).

Another way to avoid reinfection is to notify all of your sexual partners within the past 60 days that they might have chlamydia. This will hopefully prompt them to get tested and treated. Depending on where you live, public health workers may be available to help you reach out to your sexual partners (Hsu, 2021).

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

May 12, 2021

Written by

Mike Bohl, MD, MPH, ALM

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.