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Chlamydia: Prevention and Treatment

Posted Aug 24 2008 1:49pm
DAVID FOLK THOMAS: Welcome to our webcast. I'm David Folk Thomas. Our topic is chlamydia. Now we all know that sexually transmitted diseases or STDs are very high on our conversation list, or our preferred conversation list. But we're looking to change all of that. Chlamydia affects an estimated 3 million Americans every year. It's commonly referred to as the clap, but for those Americans who are infected, it is not joke.

Joining us to discuss chlamydia today are two experts. We're joined by two doctors. Dr. Brian Boyle and Dr. Adam Stracher. They are both attending physicians at New York Presbyterian Hospital, Cornell University Medical Center. They are both Assistant Professors in the Department of International Medicine and Infectious Diseases at Cornell University Medical College. They are not twins. One is from Los Angeles; one is from Long Island. Doctors, thanks for joining us.

This by the way is Dr. Stracher on my left and sitting next to him is Dr. Brian Boyle. Thanks for joining us today.

ADAM STRACHER, MD: Pleasure.

DAVID FOLK THOMAS: Let's just get right to the topic, chlamydia. People have heard about it. They know about the clap. We'll start with you Dr. Stracher. What is chlamydia?

ADAM STRACHER, MD: Chlamydia is a bacterial infection that causes many different symptoms in patients who get infected. It is a very common sexually transmitted disease. It affects both men and women. It can be transmitted in several different ways.

DAVID FOLK THOMAS: Dr. Boyle, go back and forth. Why don't you explain exactly how it is transmitted? I know a lot of people they know about sexually transmitted diseases -- that's one of the big things they're unsure of. Can I only get it this way? or that way? How many different ways can you get chlamydia?

BRIAN BOYLE, MD: It's generally through sexual transmission and generally through vaginal intercourse or anal intercourse can also spread chlamydia. The main problem with chlamydia is that people can carry it asymptomatically. People who have chlamydia may not know that they have it and they may be spreading it to others sexually. People who have it may have serious consequences of it, if it's not treated, in addition to spreading it to other people.

So it's generally spread sexually. Then the symptoms of it, which we'll talk about in a minute, may or may not appear which can lead to problems with detecting it and treating.

DAVID FOLK THOMAS: Now you said vaginally and you mentioned anal intercourse. What about oral sex? Is that possible?

BRIAN BOYLE, MD: Generally not. I mean you can --potentially you could get a chlamydial infection of the mouth if someone was infected. But that's generally not a problem. Generally it does not colonize the oral pharynx to any remarkable extent.

DAVID FOLK THOMAS: I mentioned that they estimate 3 million Americans are infected every year. How common is chlamydia in the realm of STDs? Do more people have chlamydia than say herpes or gonorrhea or is it an even mix, Dr. Stracher?

ADAM STRACHER, MD: It depends on whether you're talking about symptomatic disease. Chlamydia is a very common infection. More people have probably been exposed to herpes infection but may not have symptoms from herpes infection. But chlamydia, as you said, affects about 3 million people. At least half, both men and women, may have no symptoms as Dr. Boyle mentioned. The problem there is that they may spread it to other people. Then if those people are infected and don't get treated, they may develop consequences later on that may be not life-threatening but very serious.

DAVID FOLK THOMAS: Let's deal with some of the symptoms because sometimes it is asymptomatic. Let's right now focus on if you do have symptoms, what are some of the symptoms of chlamydia?

ADAM STRACHER, MD: Again, there may be none. I think that's the most important thing.

DAVID FOLK THOMAS: We'll get back to that. But for if you do have a symptom.

ADAM STRACHER, MD: I'd say the most common symptom is probably a discharge, either a vaginal discharge or a penile discharge. It is followed by such things as pain when you urinate. In general, as this disease progresses, it can lead to additional pelvic or abdominal pain as various other symptoms or complexes of symptoms develop.

DAVID FOLK THOMAS: When you talk about a discharge, what is that discharge? Is that when you're going to the bathroom? When you're walking around?

ADAM STRACHER, MD: It can be just when you're walking around.

DAVID FOLK THOMAS: What does it look like?

ADAM STRACHER, MD: It's generally a yellowish discharge. Patients who have it come in and what they complain of is I had sex with someone, unprotected sex with someone, say two weeks ago. There is a certain period that this will develop over. It's generally over about 7 to 14 days. So you may go two weeks from your last sexual encounter before you actually start to have a problem.

Patients will say, "Two weeks ago I had unprotected sex. Now I have a discharge or I have pain when I urinate." That will be a sign that they have some infection. Then you have to do an evaluation to determine exactly what the infection is because the symptoms are very nonspecific.

BRIAN BOYLE, MD: I think it's important to make that distinction which is that the symptoms can be like many other types of infections. They may be frequent urination or pain with urination. There may be discharge; there may not be discharge. So women may feel that it's very similar to symptoms of a urinary tract infection that they've had before. They may treat it like that or they may assume that it's going to go away. In fact, the symptoms may actually go away. What you're left with are the consequences of the infection. Again we can talk about those in a minute. But I think the important distinction there is that it may be like very many types of sexually transmitted infections as well as urinary tract infections. The symptoms may overlap very much.

ADAM STRACHER, MD: On that same focus, to expand that a little bit further, it's not uncommon for patients to have more than one infection as well. So they may have gonorrhea and they may also have chlamydia. Or they may have a urinary tract infection and they may also have chlamydia. These things not only do the symptoms overlap, but they can also have more than one infection at the same time causing these symptoms or complex of problems.

DAVID FOLK THOMAS: Now let's get back to what you said which I think is probably the most interesting facet of chlamydia. That it is asymptomatic. No symptoms. So the average person can be walking down the street and not know he has it. Now in that case, he probably thinks if I don't know I have it or I don't have any symptoms, what's the big deal? What is the big deal? And what do you suggest for people on a regular health checkup way to screen if they have chlamydia.

ADAM STRACHER, MD: The big deal is mostly for women. That is it is a major cause of infertility and sterility -- infertility problems for women. In men, again it can cause deeper infections like prostate infections and testicular infections. But the sort of really long-term asymptomatic consequence is that in women it's a major cause of infertility.

The bottom line is that for anyone who is at risk, they should tell their doctor and they should be screened. We can talk about the ways of doing that. But it's become very common in health clinics and in high-risk populations to screen people who are asymptomatic because infection is so common and can be asymptomatic so frequently. It can have such devastating consequences if it's not treated.

DAVID FOLK THOMAS: And you're at risk if you're having unprotected sex? Are you at risk if you use a condom? Can you still catch chlamydia?

BRIAN BOYLE, MD: The risk, as with all sexually transmitted diseases, is remarkably decreased by use of a condom. But condoms aren't foolproof for many reasons. You can still get sexually transmitted diseases despite using a condom. Condoms sometimes break.

I had a patient in the office the other day who reported that while using a condom it broke. The risk of breakage of a condom can also be associated with various sexual practices. So even though you use a condom, you're still at risk.

DAVID FOLK THOMAS: Now let's talk about what you would recommend for people. It seems to me that (a) most people are sexually active, and (b) not everybody is having protected sex but, as you mentioned, even if you're using a condom, it's not foolproof). What do you recommend from professional standpoint for people? How should they operate and handle themselves? How should they schedule appointments? How frequently and again, if there are no symptoms, what should motivate them to go see their doctor?

BRIAN BOYLE, MD: That's a difficult question to answer because it's very individualized. I think for sure if there are any symptoms or anything that seems out of place, or you've had an exposure that has been unprotected and that you feel is risky, you should see your doctor right away.

I think in other situations for routine screening, it's important to individualize that recommendation so that patients who have unprotected sex, but are married and monogamous, we obviously don't need to screen those people.

Teenagers who are sexually active with multiple partners need to be screening whenever they see their physician. Again, the types of tests we use to screen will vary depending on the risk factors and the patient population.

DAVID FOLK THOMAS: How much time if somebody wanted to go for screening for chlamydia? How long does that take? What tests are involved?

BRIAN BOYLE, MD: It's relatively simple. For most women, as Adam pointed out, the most important group is really women where the long-term consequences can be particularly serious.

Most sexually active women should see their gynecologist, probably yearly. The screening is done by the gynecologist each time they do a pelvic exam or pap smear. Every year, when they go see their gynecologist, those screening tests will be done. That's the way every sexually active woman should proceed. She should see her gynecologist every year.

For males, I think that they probably should be closer to screening if they're frequently involved with partners whom they don't know or their promiscuous or they're not using condoms. They should probably go see their doctor on a relatively frequent basis. Again six months to a year is not an unreasonable time for them to go see their doctor and discuss what kinds of problems they might be having and be screened for various things, if there is an indication for it.

DAVID FOLK THOMAS: How would you convince a man to care about this?

ADAM STRACHER, MD: Hopefully you can convince most men that it's just the right thing to do. But obviously it's difficult to do that in teenagers or in other populations. I think that is clearly a problem but I think we can convince people that it may have long-term consequences for partners that they care about. It may also have consequences for them. They may develop prostate infections. They may develop testicular infections. Nobody wants to have that. They may develop infections that become more difficult to treat if they are left longer. So I think with all of those things you can probably convince most people that they should be followed and screened, when necessary.

BRIAN BOYLE, MD: And I think that again going back to the concept that chlamydia is not something you get by itself frequently. If you're sexually active, you need to be screened and monitored for all of the various different infections that you can get. Chlamydia is just one of them.

Chlamydia may not have a serious or long-term consequence for a man as it does for a woman, but there certainly are other sexually transmitted diseases that do. And so they should not only be screened for chlamydia or monitored for chlamydia but for other things as well.

DAVID FOLK THOMAS: Good point.

Now let's wrap things up by discussing treatment. What is the treatment for chlamydia and is it different for men than women?

ADAM STRACHER, MD: The treatment is generally the same for men and women. The treatment though various based on the type of infection that people have. It is normally antibiotic pills. There are several different regimens. Some are just one dose of antibiotics. Some that we give people for seven days. It obviously varies based on allergies to antibiotics and whether someone is pregnant.

As Brian has pointed out a couple of times, these infections don't usually or don't always come on their own. So when we treat for chlamydia we often screen and/or treat for other sexually transmitted infections as well.

DAVID FOLK THOMAS: Dr. Boyle?

BRIAN BOYLE, MD: I think Adam covered it pretty well. I think that pretty much summarizes how we approach this.

DAVID FOLK THOMAS: Is it expensive? Assuming most people have health insurance, but obviously some people don't. How long does the treatment last and what kind of cost?

BRIAN BOYLE, MD: It's not expensive and it's relatively simple. One treatment regimen that's very, very effective is four pills once. That is very, very effective at eliminating most cases of chlamydia.

DAVID FOLK THOMAS: How do you prevent it from happening in the first place?

ADAM STRACHER, MD: I think the most important thing that we've talked about a little bit is obviously to know your partner. Not to have unprotected intercourse with people that you don't know or that you're in non-monogamous relations. Obviously when you do have sexual intercourse, to wear condoms every time if you're with a partner you're not monogamous with or you don't know and to be followed regularly by your doctor and screened for infection.

BRIAN BOYLE, MD: The key is condom usage and the key is to not engage in promiscuous unprotected sex. The chlamydia is one of the least pathogenic things that you're going to end up with if you do that on a regular basis.

DAVID FOLK THOMAS: As you both mentioned just recently, get tested if you think you may be at risk. But chlamydia, while you're being examined for that, it may discover you have something else which would be even more and that would be motivation to go get things checked out and see your doctor on a regular basis.

BRIAN BOYLE, MD: I think also in that situation when you are talking about chlamydia it is a perfect opportunity for you and your doctor to discuss other illnesses and other prevention mechanisms and how these diseases are spread and prevented.

DAVID FOLK THOMAS: Gentlemen, doctors, we appreciate you're coming by and shedding light on something that I know everybody hears about. They've heard the clap, chlamydia. But a lot of people don't k now exactly what it is. So I think you've enlightened everybody.

We're talking with Dr. Brian Boyle. He's on my far left. And Dr. Adam Stracher, on my near left. You've been watching our webcast on chlamydia. We hope you've learned a lot. And again, if you think you're at risk if you're having unprotected sex, or you may have some symptoms -- again it's asymptomatic -- you should definitely go see your doctor as part of a regular checkup. It could be very important to you.

I'm David Folk Thomas. Thanks for joining us.

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