Written by Dr Peter Burridge. The following material is primarily aimed at doctors, medical students, nurses, midwives, and health ancillaries. It presupposes a slight knowledge of medical matters on the part of the reader.

Dr Peter Greenhouse, Consultant in Sexual Health at Bristol and a medical adviser to the Ectopic Pregnancy Trust, stated in February 2001 on BBC television that he thinks this bacterium may be responsible for up to 90% of ectopic pregnancies in young women. A December 2000 story in the Guardian newspaper illustrates his view of this difficult subject.

It's easily caught (by having normal sex) but most women (70%) and many men (30%) get no symptoms from an infection, which may last for weeks or months. Have a look at the NHS Direct website to find out about symptoms. Many Chlamydia websites are listed on the Google website.

Since one in twenty of the young adult population carries this bug (usually without knowing it) then it is easy to understand how normal men and women get infected, since most adults are not celibate and it is normal to want to have sex with someone we like. Latex condoms properly (i.e. always) used can be effective to prevent infection. The peak age for infection is said to be fifteen years in the USA.

Chlamydia infection may not be detected until years later when a woman's fallopian tubes have been damaged. Since this bug likes to live in the tubes which convey sperm to eggs and eggs from a woman's ovary to her uterus, and since moreover it likes to live inside cells, the body's immune system finds it hard to kill it, and it is thought that much of the tubal damage is actually done by attempts to rid the body of the bacterium. Infection starts in the cells of the cervix, and spreads up the uterus and into (and through) the tubes. Pelvic infection (known as Pelvic Inflammatory Disease or PID) is most often due to this bug and has serious consequences to fertility. Infected women may only get spread from the cervix inwards after childbirth, which is why many ectopics occur after a normal delivery of a baby.

In a country such as Sweden which has started nationwide screening, contact tracing and antibiotic treatment, the incidence of ectopic pregnancy in some areas has been shown to drop. In the UK it is rising and may double over the next ten years. Read the Swedish experience yourself from the British Medical Journal.

The UK Department of Health has two pilot Chlamydia screening studies in Portsmouth and The Wirral where young women who come to medical attention for any reason are offered a test and contact tracing etc goes on from there. The best screen for both men and women uses first-void urine and a DNA amplification test known as a LCR (Ligase Chain Reaction) or PCR test (Polymerase Chain Reaction) which detects DNA sequences unique to Chlamydia. It is very sensitive (missing few infections) and highly specific (positive test means Chlamydia is present) but is more expensive than the current test (ELISA - needs swabs or light scrapings) still used in many parts of the U.K. There is a very long .pdf file concerning the design and aims of these pilots available.

An interesting development is targeted postal screening by sending out empty urine containers to young men and women and asking the containers to be filled with first-void urine and returned by pre-paid post. The vast majority (82%) of young adults will send a urine specimen for testing since it is easy and quick. If they test positive they can easily get rid of the bug, getting a simple prescription for antibiotics. More details of this Chlamydia screening studies project at various British and Swedish Universities led by Bristol Social Medicine Department.

There are guidelines from the Royal College of Obstetricians and Gynaecologists for the management of Early Pregnancy Loss. Ectopic pregnancy is only a special form of miscarriage and is therefore subject to these screening guidelines for Chlamydia, especially pertinent because management of ectopic pregnancy is usually surgical, and it is instrumentation which is likely to spread existing infection.

Meanwhile some influential researchers in the US are urging sexually active women aged 25 and younger to be screened for chlamydia infection every six months! {"CDC makes new recommendations on chlamydia screening: Researchers from the Centers for Disease Control and Prevention, Atlanta, Georgia, led by Dr Gale Burstein, are urging sexually active women aged 25 and younger to be screened for chlamydia infection every six months (Sexually Transmitted Infections 2001;77:26-32)."} It is also increasingly recognised that having more than one partner can give problems.

It is certain that UK national screening will be started but how much it costs, how it is done and when it should start are not yet decided by the government itself. Much serious thought and discussion is taking place since the risks to reproductive health and happiness for so many of our young adult population are at risk from a relatively easily treated infection. These are agreed National guidelines for diagnosis, treatment and retesting. They are written for doctors and are not easy to read.

More information

Questions and Answers about Chlamydia & Ectopic Pregnancy
Research has shown a direct link between chlamydia and ectopics. So if you've had an ectopic, you ask the inevitable questions: Why? How did it happen? Can I do anything to stop it happening again? We can't answer all those questions, but if you read on this may be food for thought, or action.

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