Chlamydia in women: symptoms, risks and treatment

What is chlamydia?

Chlamydia trachomatis is a bacterium passed on during sex: vaginal, anal or oral, with or without full penetration. It mainly infects the cervix (cervicitis) and the urethra. It can also affect the anus, the throat and, in newborn babies, the eyes.

In women, the main risk is that the infection spreads upwards to the womb and tubes. This is called upper genital tract infection, or pelvic inflammatory disease, and it can leave lasting damage. That damage is sometimes discovered years later, during fertility tests or gynaecological surgery that reveals adhesions or damaged tubes.

What are the symptoms of chlamydia in women?

In most cases the infection is silent. This is what makes it dangerous: it can last for months without being treated. When there are signs, they are often mild:

• heavier or yellowish vaginal discharge;
• light bleeding between periods or after sex;
• burning when passing urine or needing to go often, which can be mistaken for cystitis;
• pain during sex;
• lower abdominal pain and fever, if the infection has reached the womb and tubes.

Infection of the anus or throat almost always goes unnoticed. Testing these sites depends on your sexual practices, so it helps to talk about them openly with your doctor.

In men, the infection can cause a discharge or burning when urinating, but it is also often symptom-free.

What happens if chlamydia is not treated?

These complications can be prevented by early testing and treatment. The risk of lasting damage rises with how long the infection has been present and with the number of episodes: every reinfection counts. That is why treating your partner and having a follow-up test a few months later matter as much as the antibiotic itself.

Who should get tested for chlamydia, and how?

In France, the French National Authority for Health (HAS) recommends routine screening for all sexually active women aged 15 to 25, repeated every year after unprotected sex with a new partner. Testing is also offered at any age if there is a risk factor: several partners in the past year, a new partner, a previous STI, or a partner who has an infection.

The test looks for the bacterium's DNA using an amplification technique (PCR):

• in women, with a vaginal self-swab, which is as reliable as a swab taken by the doctor, or with a cervical swab during an examination;
• in men, with a first-catch urine sample.

Gonorrhoea is tested on the same sample. Tests for HIV, syphilis and hepatitis B are offered at the same time. A swab is also recommended before an IUD (coil) is fitted, before an abortion and before hysterosalpingography.

In France, testing can be done at the practice, at a laboratory with a prescription, or free of charge at a free information, screening and diagnosis centre (CeGIDD).

How is chlamydia treated?

Uncomplicated infection is treated with an oral antibiotic. Doxycycline for 7 days is the first-line treatment in the US CDC guidelines (2021), which consider it more effective than a single dose of azithromycin, particularly when the anus is infected. Azithromycin remains an alternative, particularly in pregnancy, when doxycycline is not advised. Your doctor will choose the treatment that suits your situation.

An upper genital tract infection (salpingitis) needs a different, longer treatment combining several antibiotics.

Important rules to follow

• Treat your partner or partners from the past 60 days, even if they have no symptoms, to avoid passing the infection back and forth.
• Avoid sex until the 7-day course is finished (or for 7 days after a single dose) and until your partner or partners have been treated.
• Take the full course, even if the symptoms go away.
• Get tested again 3 to 6 months later, because reinfection is common. In pregnancy, a follow-up test is done about 4 weeks after treatment.

Chlamydia in pregnancy: what do I need to know?

Chlamydia found during pregnancy is treated straight away, with an antibiotic that is safe in pregnancy. Your partner must be treated too. A follow-up test after treatment checks that the infection has cleared, and it is repeated in the third trimester if the risk continues.

Treatment protects the baby from infection during birth. It is not a reason for a caesarean section. If you are planning a pregnancy and have risk factors for STIs, testing before conception is useful, especially as an old, unnoticed infection can make it harder to get pregnant.

If you have difficulty conceiving, fertility tests look for damage to the tubes, in particular with a hysterosalpingogram. A history of chlamydia is important information to share with your doctor.

How can I protect myself from chlamydia?

• Condoms, external or internal, every time you have sex with a new partner, until both partners have been tested.
• Regular testing, especially under the age of 25.
• Telling your partner if you are diagnosed: it is a health step, not an accusation.

Having had chlamydia does not protect you against a new infection: you can catch it more than once.

An STI diagnosis can be hard to cope with and to talk about. In France, the free, anonymous abortion, sexuality and contraception helpline (0 800 08 11 11) answers questions about sexuality and STIs.

When should I see a doctor urgently?

• Unusual discharge, bleeding after sex or burning when urinating that does not go away.
• Unprotected sex with a new partner or a partner who has an infection.
• Your partner has been diagnosed with an STI.
• Lower abdominal pain, especially with fever: see a doctor the same day. If the pain is severe, or you feel faint or have a high fever, call 15 (SAMU) or 112 in France, or your local emergency number.

For other causes of abnormal discharge, read our article on vaginal discharge.

Frequently asked questions

General information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.