A new approach to stopping the silent chlamydia epidemic

A “Perspective” published in the Medical Journal of Australia today calls for patient-delivered partner therapy for chlamydia to be made legal across Australia. This approach could be just the right way to tackle the growing problem posed by this sexually transmitted infection.

Patient-delivered partner therapy entails the person being treated for chlamydia receiving antibiotics for her partner (for reasons you will learn below, it’s usually a woman who is being treated for the infection). Chlamydia is a bacterial infection that can damage a woman’s reproductive organs; it can result in a discharge through the urethra for men.

It’s not a “one-off” infection, so people can be reinfected a number of times. Chlamydia is transmitted through sexual contact – vaginal, oral or anal – and can also be passed to a baby by an infected mother during vaginal birth.

Reinfection from partners is common for the illness but providing patients with medication for their partner has uncertain legal status in most Australian states and territories.

Upward trajectory of harms

Chlamydia has become the most common sexually transmissible infection in Australia; nearly 80,000 infections were reported in 2011, compared to only around 17,000 in 2001.

In women aged between 15 and 19 years, the rate increased fivefold over this period, while for the same male age group, it increased fourfold.

Chlamydia is often asymptomatic, which means people with the disease may not know they have it, even though it’s easily detectable through a urine test and treatable with antibiotics.

Because it is often asymptomatic, chlamydia causes little immediate pain and discomfort. But it can cause pelvic inflammatory disease in women, which can be painful and damage the uterus and fallopian tubes through scarring of tissue. And this can lead to tubal infertility and ectopic pregnancy.

Research evidence suggests that around two-thirds of cases of tubal infertility and one-third of ectopic pregnancy cases could be linked to past chlamydial infection.

While pelvic inflammatory disease can be treated with antibiotics, it’s better to prevent it by screening for, and treating, chlamydia.

With more women waiting until they are older to have their first child, some are finding that undiagnosed chlamydia has had a negative impact on their fertility and are faced with undergoing difficult and expensive IVF treatment.

Why no treatment?

There are three big problems when it comes to detecting and treating chlamydia.

The first is the “silent” nature of the infection, which means it’s not easily detected because there are no symptoms. This also means that there’s a lack of awareness among young people (in particular) about chlamydia and its potential impact.

The second issue is the limited nature of screening options. Although screening is available at doctors’ clinics, women are most often screened when they go for a script for the pill or for a Pap test.

Very few men, particularly young men, ever go to a doctor or a sexual health clinic for a test, so their chlamydial infection often goes undetected. This means they can infect any woman or man they have unprotected sex with.

Research has shown that screening for chlamydia where young people congregate, such as higher education institutions, can be effective. Other venues, such as car rallies and sporting clubs have also been shown to be feasible when targeting young men for chlamydia screening.

Other research suggests community pharmacies may be effective for screening high-risk groups and those who do not regularly see a doctor.

A possible solution

The third difficulty is providing treatment for the sexual partners of people getting treatment. Treating chlamydia in one sexual partner and not the other will lead to reinfection or the infection of future sexual partners.

And here’s where the Perspectives piece in the MJA is interesting. In 2006, the US Centers for Disease Control and Prevention recommended partner-delivered therapy and it’s now legal in most US states.

But it’s either illegal or has an ambiguous legal status in Australian states and territories. Even though a 2007 meta-analysis of five studies of the approach showed it was effective.

There are guidelines for the approach endorsed by the Australasian Chapter of Sexual Health Medicine (a chapter of the Royal Australasian College of Physicians), and the Australasian Society for Infectious Diseases.

Partner-delivered therapy has the potential to treat more people infected with chlamydia and help curtail the infection rate in the population.

We need a multi-faceted approach to deal with the chlamydia epidemic. Educating young people and providing screening in accessible and places that are convenient for them is a start.

But we also need to keep in mind that, for every notified infection, there’s probably at least one infected sexual partner.

The longer we fail to provide treatment for both patients and partners, the greater the burden of infection we will have in the community. And the more we risk chlamydia impacting the fertility of young women, both in terms of private pain and the cost of infertility treatment.