Why common STI can easily go undetected

Chlamydia is a common STI.

Photo credit: Shutterstock

What you need to know:

  • Many infected people may live with the infection for months without symptoms.
  • Women may have abnormal vaginal discharge, pain while passing urine and lower abdominal pain.

Lola* called me in a panic. She was at the office but calling form the washrooms. The way she was whispering on the phone, you would be forgiven for thinking she was reporting an ongoing terror attack. I could not understand a thing she was saying until I had calmed her down.
Two hours later, Lola was on my examination table, no calmer than before. She came wearing a sanitary towel because she had developed anal bleeding at work. She had felt some mild discomfort on and off for the past few days but nothing remarkable. However, that afternoon, after a bowel movement, she noted blood while cleaning herself up. It had since been bleeding slowly but steadily.
Lola was supposed to be on the general surgeon’s table but she would hear none of that. So I took her history and then settled in for the examination. The anal bleeding was now minimal. She had mild pain, with moderate perianal inflammation. What was interesting though was that she had no obvious haemorrhoids, neither did she have anal fissures (a longitudinal tear on the anal opening).

Pain medication

Since she was stable, we agreed on treatment with pain medication, antibiotics and rectal suppositories. She was to see a general surgeon thereafter if symptoms recurred. Lola hated to see doctors and getting her to build new relationships with a new specialist was impossible. She came to me with all manner of mild complaints.
Two weeks later, Lola was back, but this time she was lot more calm. She said the bleeding stopped, as did the discomfort, but she had a new symptom. She was having some abnormal discharge from the rectum. 
This got me concerned. Examining her again revealed that in addition to the discharge, the redness and inflammation was still there. My interest was piqued. What followed was an interesting conversation.
Lola was a virgin at 24. In the past one year, she had been dating a young man who was abroad, pursuing his master’s degree. With respect to her religious affiliation, the couple had to wait until marriage to indulge in sex. He had come home briefly the previous month before going back to finish his course.
Lola had told me all about the young man in her previous visits and she was deliriously in love. But the Lola lying on my couch right now was exploding in anger! She could not believe the possibility that she could be harbouring Chlamydia trachomatis, a sexually transmitted infection (STI). And even worse, rectally.
She had no choice but to come clean with me. Her boyfriend’s visit had veered a little to the wild side. Knowing that the two could not compromise Lola’s virginity, he had suggested anal sex. Lola may have been a virgin but she had had her fair share of online forays into the adult world. She agreed to it, more out of curiosity. Now here she was, weeks later, confronting the reality of her adventures. She was angry with her boyfriend but angrier at herself for trusting him. 
Chlamydia is a common STI, estimated to affect one in 20 people between 15 and 25 years old in America. Locally, a 2013 study by Ruchika et al., put the prevalence of the disease at 6 per cent among women in Nairobi. A more recent study by Yuh et al., published in 2020 and involving adolescents and young women aged between 16 and 20, reported approximately 10 per cent of them testing positive for chlamydia.
Chlamydia infection can go undetected even for years due to the nature of the symptoms. Many infected people may live with the infection for months without symptoms. Even when symptoms are present, they may be mild enough to be ignored.
Women may have abnormal vaginal discharge, pain while passing urine and lower abdominal pain. Long-term complications may include increased risk of ectopic pregnancy and fallopian tube blockage. Men generally have mild symptoms with urethral discharge, pain while passing urine and rarely, pain in the testicles. Very rarely, this may lead to infertility too. Despite having mild or no symptoms, they remain infectious.
In less common instances like for Lola, anal sex results in anorectal chlamydia infection. It can also occur as pharyngeal (throat) chlamydia transmitted during oral sex. Unfortunately, pregnant mothers can also pass chlamydia onto their babies during birth, causing eye infection and chlamydial pneumonia.
No one is exempt from catching chlamydia. Screening is recommended for all persons with high risk sexual behaviour and their partners. All newborns are routinely given prophylactic eye ointment at birth to protect them.
Lola’s anal swab tested positive and she took antibiotics for 10 days. It does not mean she cannot contract it again, but she is now a lot more careful. She knows that all human orifices are equally at risk of chlamydia!

Dr Bosire is an obstetrician/gynaecologist


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