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Chlamydia is the most commonly diagnosed sexually transmitted infection (STI) in New Zealand. It affects people of any gender. Chlamydia can be easily treated with antibiotics, but if not treated, it can cause infertility.

Key points

1. Chlamydia is a common sexually transmitted infection (STI). It is quite easy to catch through sexual contact.
2. Chlamydia can cause serious problems if you don’t get it treated. However, it is easy to treat.
3. When treated early, chlamydia does not cause any long-term complications. Left untreated, serious and permanent damage can occur.
4. Most people who have chlamydia don’t show any symptoms but you can still infect other people, so regular sexual health check-ups are important.

How is chlamydia spread?

In nearly all cases chlamydia is transmitted through sexual contact.

• You can get chlamydia by having unprotected vaginal, anal or oral sex with someone who has chlamydia.
• You can still get chlamydia even if the person you’re having sex with does not ejaculate (cum). 
• Chlamydia can also be spread through other types of sexual contact such as mutual masturbation, fingering or the use of sex toys.
• One simple way to protect yourself is by using a condom when engaging in sexual intercourse.

Another way of transmitting chlamydia is from mother to baby during birth. If this occurs, your baby may develop an eye or lung infection. This needs urgent treatment.

What are the symptoms of chlamydia?

Most people who are infected by chlamydia don’t notice any symptoms and so don’t know they have it.

• If you do have symptoms, they may not appear until a few weeks after you have sex with an infected person.
• Symptoms can appear 1 to 3 weeks after infection, many months later or not until the infection has spread to other parts of your body.
• Chlamydia can be transmitted to other people even if you don’t have symptoms.
• If you have the infection but no symptoms, you can remain infectious for months or even years without knowing it.

Common symptoms, if they do occur, may include the following:

• unusual vaginal discharge (fluid)
• unusual vaginal bleeding (especially after sex)
• lower abdominal pain (including pain during sexual intercourse)
• soreness or redness at the opening of your penis
• clear or whitish discharge from your penis
• testicular (ball) pain or swelling
• discomfort when passing urine (peeing)
• rectal (bottom) discharge or discomfort.

Chlamydial infection of your throat can occur, but is uncommon and usually does not cause any symptoms.

How is chlamydia diagnosed?

The best way to find out if you have chlamydia is to have a sexual health check-up.

• A urine (pee) sample is used to test for chlamydia.
• Women may also need to have an examination if a full check-up is being done.
• If rectal infection is suspected, a swab is taken from just inside your anus (bottom).

How is chlamydia treated?

Chlamydia is easily treated with antibiotics such as with doxycycline, which is taken as a course of treatment over 7 days, or with azithromycin which is a single-dose treatment.

It is important to finish all the antibiotics, otherwise the infection may not be properly treated.

Condom use during the treatment period

• Avoid having sex without a condom during treatment because the infection can still be transmitted. Use condoms for 7 days after the start of treatment and until 7 days after all current sexual contacts have been treated.
• If you are on a combined oral contraceptive pill, use a condom for 14 days when having sex, as antibiotics can affect the reliability of the contraceptive pill.

After completing the treatment, phone your doctor or return to the clinic for a follow-up after 3 months to check you have not been re-infected.

Do sexual contacts need treatment?

If you have had sex without a condom with your sexual contact/s it is very likely they are infected with chlamydia. This means they need to have a sexual health check-up and be treated for chlamydia regardless of symptoms or test results.

Why is treatment of chlamydia important?

When treated early, chlamydia does not cause any long-term complications. Left untreated, serious and permanent damage can occur.

It may lead to pelvic inflammatory disease (PID). This is when female reproductive organs, found in your pelvis, become inflamed. PID may cause ectopic pregnancies (where the pregnancy develops in your fallopian tubes instead of your uterus), infertility (when the fallopian tubes become damaged by scar tissue preventing further pregnancy) or chronic pelvic pain.

If not treated, chlamydia can spread to testicles, leading to pain and swelling. Chlamydia may occasionally cause infertility in men.

Sometimes chlamydia may trigger a condition called Reiter’s disease (sexually acquired reactive arthritis) which causes inflammation of your eyes, skin and joints.

Chlamydia can be passed from mother to baby during birth. The baby may subsequently develop eye and/or ear infections or pneumonia.

How can I prevent getting chlamydia?

Anyone who is sexually active can catch chlamydia. You’re most at risk if you have a new sexual partner or don’t use a barrier method of contraception, such as a condom, when having sex. You can help to prevent the spread of chlamydia by:

• using a condom every time you have vaginal or anal sex
• using a condom to cover the penis during oral sex
• using a dam (a piece of thin, soft plastic or latex) to cover the female genitals during oral sex or when rubbing female genitals together
• not sharing sex toys. If you do share sex toys, wash them or cover them with a new condom between each person who uses them.

Learn more

The following links provide further information on chlamydia. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Chlamydia Sexual Health Society, NZ
Chlamydia Ministry of Health, NZ
Chlamydia Family Planning NZ
Chlamydia NHS, UK
Chlamydia Healthy Sex, NZ

References

1. Chlamydia guideline Sexual Health Society, NZ
2. Treatment of sexually transmitted and other genital infections BPAC, NZ

Resources

Support

Phone Healthline for free on 0800 611 116 any time of the day or night for advice on any health issue, no matter how small. In an emergency, phone 111 for an ambulance.

Find a Family Planning clinic Family Planning, NZ 
Auckland Sexual Health Service Freephone 0800 739 432
More support groups

Brochures

 Chlamydia information guide

Ministry of Health, NZ, 2008

 Chlamydia – patient leaflet

NZ Sexual Health Society, 2017

Related topics

Sexually transmitted infections (STIs) | Mate paipaiSexual health overviewOverview of contraception methods | Rongoā ārai hapūtangaCondomsPelvic inflammatory diseaseBACK TO TOPCredits: Health Navigator Editorial Team . Reviewed By: Dr Matthew Reid, Public Health Medicine Specialist, Canterbury and West Coast DHBs

Also known as non-specific vaginosis or gardnerella vaginitis

• Overview
• Clinicians

Bacterial vaginosis is an infection in a woman’s vagina caused by an overgrowth of bacteria.

Just like on our skin, it is normal to have bacteria within the vagina. However, with bacterial vaginosis, the ‘normal or good’ bacteria are taken over by other bacteria. This change in balance results in the symptoms some women experience.

Who is at risk?

It is not completely understood why some women develop bacterial vaginosis and others don’t. It is more common:  

• in women with more than one sexual partner
• when women change sexual partner
• in women who have sex with other women.

It is also possible that the problem bacteria can be transmitted on fingers or sex toys.

Symptoms

Some women have no symptoms and bacterial vaginosis is found during examination for something else such as a cervical smear test. Other times women notice an abnormal vaginal discharge or an unusual odour which may be worse after unprotected sex.

Diagnosis

Diagnosis is usually made following a medical examination (a discharge or odour is noticed) or by taking a vaginal swab test. Another clue can be a change in the normal acidity of the vaginal fluid to become more alkaline.

In some sexual health clinics, the team can look under the microscope to see what bacteria are present on the swab. Most other clinics send the swab off to the community laboratory to be processed. Results are normally available in two to three working days.

If you do have bacterial vaginosis, ask if you can have a full sexual health check as it is common to have chlamydia or other sexually transmitted infections at the same time.

Treatment

Treatment for bacterial vaginosis varies depending on several factors. If a woman does not have any symptoms, in most cases no treatment is needed. However, if a woman is about to have a gynaecological procedure (such as insertion of an intrauterine device or termination of pregnancy) where the risk of infection spreading to the womb (uterus) is higher, then any bacterial vaginosis infection should be treated first.

Standard treatment for bacterial vaginosis is a seven-day course of metronidazole tablets. Metronidazole is an antibiotic and is best taken with meals to reduce possible side effects such as nausea or upset stomach. It is also important NOT to drink alcohol while taking metronidazole, otherwise people can suffer severe hangover effects.

Alternative treatments include vaginal creams or other antibiotics, but these may not work as well.

Does my partner need to be treated?

Treating the male partner of an infected woman does not seem to prevent recurrences so is NOT routinely recommended.

Can bacterial vaginosis recur?

Yes, bacterial vaginosis can recur, sometimes within a few weeks. If this happens, see your nurse or doctor for further treatment. This may include a longer course of antibiotics and checking for any other infections.

To prevent bacterial vaginosis recurring you could consider temporarily avoiding sexual contact or, if you have sex with a new partner, making sure he uses a condom.

Urinary tract infections (UTIs or pokenga pūaha mimi) can affect any part of your urinary system – kidneys, ureters, bladder or urethra. UTIs are also known as cystitis or bladder infections.

Key points about UTIs

1. About 1 in every 2 women will have at least one UTI in their lifetime. The most common is cystitis, an infection that affects your bladder.
2. Symptoms of a UTI include burning or pain when peeing and needing to pee more often and more urgently.
3. UTIs can be treated with antibiotics, but they are not always needed.
4. Self-care includes taking pain relief and drinking plenty of water. There is no strong evidence that cranberry products help.
5. In rare cases, the infection can spread to your kidneys. This is known as pyelonephritis and needs urgent medical care.

See other pages for UTIs in pregnancy, UTIs in men and UTIs in children.

What is a UTI?

A UTI is a bacterial infection in some part of your urinary system. Your urinary system includes all the organs involved in making and releasing urine (pee): 

• Kidneys – these filter your blood to remove waste and extra water to make urine (pee).
• Ureter – two thin tubes of muscle, one on each side of your bladder, through which urine flows from your kidneys to your bladder.
• Bladder – where you store urine until you need to pee.
• Urethra – when you pee, urine passes along your urethra, a central tube that carries urine out of your body. 

When the infection is just in the bladder (cystitis) and urethra (urethritis), this is called a lower UTI. If it travels up to affect one or both kidneys as well (pyelonephritis) then it is called an upper UTI. This can be more serious than a lower UTI, as the kidneys can become damaged by the infection.

What causes a UTI?

An infection in your urinary system may be caused by: 

• sexual intercourse
• problems in the structure of your kidneys, bladder or tubes
• irritation of the urethra by chemicals (eg, soaps, perfumes, vaginal hygiene sprays, spermicidal tubes)
• ulcers or inflammation near your urethra
• unprotected sex
• sexually transmitted infection (STI), eg, chlamydia
• radiation therapy which can irritate the lining of the bladder
• bacteria from your anal area (bottom) entering your bladder via your urethra – the urethra is shorter in women than in men so it is easier for bacteria to reach the bladder and cause infection in women. The picture below shows how this can happen.

Travel of bacteria from rectum to urethra. Image credit: 123rf

Who is at risk of developing a UTI?

UTIs can occur at any age and are more common if you:

• are pregnant (read more about UTI in pregnancy)
• have had UTIs in the past
• have diabetes, kidney failure or a weakened immune system
• have other urinary tract problems such as urinary stones or inadequate emptying of the bladder
• have a condition that makes it difficult to fully empty the bladder such as constipation
• have been through menopause – the changes in the tissues of your vagina and urethra after menopause make it harder for them to defend against infection
• use a urinary catheter (a long, thin tube used to drain urine)
• engage in unsafe sex.

What are the symptoms of a UTI? 

If you have any symptoms of a UTI, you should see a doctor. Your symptoms could mean that you have a UTI or another condition like an STI or pyelonephritis.

Symptoms of a UTI include:

• pain or burning during or immediately after peeing (dysuria)
• needing to pee more often than usual during the night (nocturia)
• pain in your lower tummy (abdomen)
• feeling the need to pee more often
• needing to pee without much notice
• suprapubic pain (pain just above your pubic bone)
• recent antibiotic use
• urine that smells bad or looks cloudy or reddish.

Older women may have no symptoms or fever. Often the only symptoms are being more muddled, sleepier, incontinent, off your food, or just feeling generally unwell. Confusion and sleepiness can put older adults at risk of falls.

How is a UTI diagnosed?

To diagnose a UTI, your GP will examine you and ask you questions about your general health. Sometimes that might be enough to diagnose a UTI. Your doctor may want you to provide a urine sample to identify what bacteria is causing the infection. Your doctor may also do a blood test and check your temperature and heart rate. 

How is a UTI treated?

The main aims of treatment are to relieve your symptoms, treat the infection and prevent the infection spreading to your kidneys.

Antibiotics

UTIs are treated with antibiotics, the common ones being nitrofurantoin, cefalexin and trimethoprim. Usually, a 3–5 day course of antibiotics is needed to treat the infection and to reduce the risk of it spreading to your kidneys and causing pyelonephritis. Your symptoms should begin to improve within the first 2 days of taking antibiotics.

If your doctor advises you to take antibiotics, it’s important to finish the whole course of antibiotics, even if you start to feel better before the course is finished. If your symptoms continue for more than 2 days after starting treatment, or if you get worse, see your doctor as soon as possible.

If you have recurrent UTIs (you keep getting them), or are at higher risk of complications, your doctor may give you a low dose antibiotic to take for a few months. How long you need to take the antibiotic depends on how often you are having UTIs.

Can I get antibiotics for a UTI from my pharmacy without a prescription?

Many pharmacists are now able to sell an antibiotic called trimethoprim for the treatment of UTIs in women. This is available without a prescription if you are a woman aged 16–65 years, you’re not pregnant and you don’t have any other complicating factors.

When ligaments and tendons are stretched, torn, or thinning the joint weakens and becomes painful. Prolotherapy repairs these areas through directed injections to the injured site. The result is growth and repair of connective tissue, and stabilization of the joint.

Joints typically do not get priority naturally from the immune system as other areas of the body do, causing joint injuries to linger. Prolotherapy stimulates a directed, strong and effective immune response for faster recovery and pain relief. Traditional treatments including steroid injections and surgery are more risky and often less effective.

This Procedure is recommended for:

• Athletic Injuries
• Low to Moderate Joint Degeneration
• Partially Torn Ligaments
• Osteoarthritis
• Joint Pain
• Decreased Mobility

Effectively Treats

• Partial Meniscal Tears
• MCL/LCL Tears
• Rotator Cuff Injury
• Plantar Fasciitis
• Adhesive Capsulitis
• Low Back Pain
• Sacroiliac Pain
• Degenerative Disc Pain
• Ankle Sprain
• More

Long-Term Pain Relief and Real Injury Repair

Prolotherapy is a regenerative therapy process that stimulates the body’s natural healing processes. It involves injecting a solution of medication to damaged tissues to induce low-grade inflammation in the affected area. It is a non-invasive alternative to surgical treatments and is used successfully for a variety of bone, muscle, and joint problems.

Prolotherapy injections typically contain a combination of dextrose (as an irritant), procaine (decreases pain signals) and B vitamins  (supports  cell regeneration) that together causes a localized inflammatory response which the immune system responds to with it’s own regenerative cells, helping to stimulate and repair the joint or site of injury. Several injections are usually indicated and are typically spaced four weeksa apart. Most patients respond best with two or three treatments.

Chronic pain and Prolotherapy ~

Chronic pain stinks.  It is down right is difficult to treat, causes high levels of stress, and negatively impacts many aspects of life.  I’ve been through chronic pain, and I have seen so many others who have been through it as well.  This is why I have sought long and hard for treatments that really work.  Among the various treatments that I have discovered that truly addresses pain, without any side effects, is prolotherapy.

Prolotherapy

Prolotherapy is an injection therapy, which triggers the body to strengthen damaged ligaments and tendons.  This in turn stabilizes and strengthens the joint, reduces pain, and improves joint and spine mobility.

So how does prolotherapy work?

The essence of how prolotherapy works is through stimulating the growth of healthy ligaments and tendons, and by removing the damaged tissue.  To best understand this process, we will use a partially torn ACL as an example here. With prolotherapy, we are helping the body remember about the damaged tissue, so it can heal the old ACL injury.  The injection, which contains dextrose, triggers the body to create a localized inflammation at the ACL. The inflammation causes the local blood vessels to open, flooding the knee with fresh blood and oxygen.  The inflammation mobilizes and stimulates the body’s tissue builders, growth factors, fibroblasts, and cytokines to rebuild collagen, and strengthen the ACL. The body’s macrophages (think cellular Pac-man) arrive to clean up damaged tissue and rid the body of cellular debris.  The procaine in the injections gives immediate relief to the painful region. With a series of injections, spaced about one month apart, prolotherapy can effectively treat many types of joint and muscle dysfunction.

What is the history of prolotherapy?

This therapy goes way back into time.  Hippocrates had a barbaric version of prolotherapy using hot pokers pressed into the armpit to treat torn rotator cuff tendons.  Ancient day Egyptians were said to treat lame animals with hot branding techniques to stimulate recovery. Since the 1930s to modern day prolotherapy, injections include a combination of dextrose and procaine or lidocaine.  Over the last several decades prolotherapy momentum has been growing, and the therapy is being utilized by MD’s, DO’s, and ND’s.

Chronic Pain!  How did I get here?!  

Ligamentous laxity

Often the underlying cause for musculo-skeletal problems is from what is called ligamentous laxity.   Ligament laxity happens when you get injured, or is a result from chronic overuse of an area of the body.   If you do not allow that area of the body to fully heal, it can become a chronic problem, causing chronic pain.  When the ligaments are overstretched or partially torn, this causes the joint to be unstable, weak, and potentially damages other structures as well.  Often with a weak joint, the surrounding muscles go into spasm, with more pain and limitation in mobility. If the problem persists, nerves can become compressed, causing numbness, tingling, weakness, and even disability.  The key to full recovery is to identify and treat the underlying ligament laxity. This is why prolotherapy is so effective at treating chronic pain, because it addresses the ligament laxity.

What about inflammation and circulation?

It’s all about inflammation, but not likely how you think of inflammation.  Often times in naturopathic medicine, we are trying to combat systemic inflammation with diet, lifestyle, and supplements.  This is also true in musculo-skeletal problems. However in chronic injuries, and musculo-skeletal pain, we absolutely need inflammation, but only in the area that is injured.  Prolotherapy and other regenerative treatments are so effective because they actually draw circulation and a small amount of inflammation to the injured area, so the tissue can heal.  As you can imagine, the conventional model of NSAIDS and RICE therapy: Rest, ice, compression, and elevation, shuts down the inflammation cascade, shunts blood away from the problematic area, and predisposes us to developing a chronic musculo-skeletal problem.  Because of this, when one of my patient’s gets injured, I recommend therapies to promote circulation and to avoid using NSAIDS, so that the injury does not become a chronic problem.

Right treatment for the right patient

Prolotherapy is a phenomenal treatment for chronic musculo-skeletal pain that is a result from an old injury or from overuse.  Below is a list of some common conditions that prolotherapy addresses:

• Sciatica
• Osteoarthritis
• Compressed vertebral discs
• Partially torn ligaments or tendons of the knee or shoulder
• Tendonitis or tendonosis of the elbow or shoulder
• Plantar fasciitis
• Carpal tunnel syndrome
• Chronic neck pain
• Chronic headaches
• TMJ syndrome
• And many more conditions

However, prolotherapy is not for everyone, and there are many conditions that cannot be addressed with prolotherapy.  Conditions that are not appropriate for prolotherapy include joint pain as a result from autoimmune diseases, fibromyalgia, Lyme disease, or completely torn ligaments or tendons.