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Chlamydia: The Silent Infection

Nigeria's most underdiagnosed STI — and its hidden toll on fertility

Chlamydia trachomatis is probably the most common STI in Nigeria — yet it receives almost no attention. Why? Because 70–80% of infected women and 50% of infected men have no symptoms whatsoever. Chlamydia silently scars the fallopian tubes, causing infertility, ectopic pregnancy, and chronic pelvic pain — often years after the original infection. It is easily treated with a single dose of antibiotics, but only if it is found.

Signs and Symptoms

✓ Usually NO symptoms — the hallmark of chlamydia
✓ In women (when symptomatic): vaginal discharge; burning urination; pelvic pain; pain during sex
✓ In men (when symptomatic): urethral discharge (clear or cloudy); burning urination; testicular pain
✓ Pelvic inflammatory disease (PID): lower abdominal pain, fever, and discharge — from untreated chlamydia ascending to the uterus and tubes
✓ Reactive arthritis (Reiter's syndrome): joint pain, eye inflammation, urethritis — an autoimmune complication
✓ Rectal chlamydia: rectal discharge, soreness — often asymptomatic

Risk Factors

When to Seek Help

Any STI symptomsTest for chlamydia alongside gonorrhoea — co-infection is common.
Before trying to conceiveBoth partners should be tested — undiagnosed chlamydia in either partner reduces conception chances and risks ectopic pregnancy.
Pelvic inflammatory diseaseUrgent treatment — PID causes permanent tubal scarring with each episode.
Routine sexual health screeningAll sexually active women under 25, or older women with new/multiple partners, should have annual chlamydia testing.

Tests & Diagnosis

🧪 NAAT (nucleic acid amplification test) on urine or vaginal swab
The gold standard — highly sensitive for chlamydia. A self-taken vaginal swab is as accurate as a doctor-collected sample.
🧪 Chlamydia rapid test
Point-of-care test — less sensitive than NAAT but provides same-day results. Useful where NAAT is unavailable.
🧪 Combined chlamydia and gonorrhoea NAAT
Most STI clinics test for both simultaneously — sensible given frequent co-infection.

Treatment Options

1
Uncomplicated chlamydia
Doxycycline 100 mg twice daily for 7 days — the current preferred treatment (superior to single-dose azithromycin for genital chlamydia per updated guidelines). OR Azithromycin 1g single dose — still used in resource-limited settings.
2
Chlamydia with PID
Doxycycline 100 mg twice daily + metronidazole 400 mg twice daily for 14 days. Severe PID requires hospitalisation and IV antibiotics.
3
Partner treatment
All sexual partners within the past 60 days must be tested and treated.
4
Test of cure
Not routinely needed if doxycycline is used, but re-test at 3 months to check for re-infection.
5
Abstain from sex for 7 days
During and 7 days after treatment completion — prevents re-infection before treatment is complete.

Frequently Asked Questions

If I have no symptoms, do I need to worry about chlamydia?
Yes — the absence of symptoms does not mean absence of infection or damage. Untreated asymptomatic chlamydia causes tubal scarring, infertility, and ectopic pregnancy silently. Testing is the only way to know.
Can chlamydia cause infertility?
Yes — each episode of PID (pelvic inflammatory disease) from chlamydia scars the fallopian tubes. After one episode of PID: 12% infertility. After three episodes: 50% infertility. Preventing PID means treating chlamydia before it ascends.
Is chlamydia permanent?
No — it is completely curable with antibiotics. The damage it causes to the fallopian tubes may be permanent, but the infection itself clears with treatment.
Does my partner need treatment even if they have no symptoms?
Yes — absolutely. Treating yourself without treating your partner results in reinfection when you resume sexual activity. Partner treatment is as important as self-treatment.
Is chlamydia the most common STI in Nigeria?
Probably yes — but formal surveillance is very limited. Based on sexual health clinic data and studies among antenatal women and STI clinic attendees, chlamydia prevalence is high (10–25% in sexually active young adults). Most infections go undetected and unreported.

Related Pages

Genital Herpes in NigeriaGonorrhoea in NigeriaSexual Health Checks: Who Needs Them and WhySyphilis in Nigeria

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