Many thanks to Peter Greenhouse for his time and cooperation in producing this article.

Research has shown that there is 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.

So now you know that there is a link between chlamydia and ectopics, you may be feeling too nervous to actually go and get yourself checked out. Questions flying through your head, such as: have I got it? If so, how did I get it? If it was my partner, how did he get it?

Well, we hope that we can banish the stigma and help you to do something to help yourself, so read on.

Why do I feel so embarrassed?

Of course it is not pleasant to have an infection and traditional societal views of sexually transmitted infections as shameful don't help. However it may be of some consolation to know that you aren't alone. The number of diagnoses has doubled in the past five years and according to a pilot study that has been carried out, 10% of sexually active people under 25 are infected. It is probable that at least one third to half the population now in their forties will have had it at some time. Most people have sex and don't spend their whole lives with the same partner: if serial monogamy is the societal norm and most infections are hidden, then it's normal to get an infection.

But how do I know whether I have got it?

You or your partner probably wouldn't know you had an infection, as there are rarely any symptoms - it is known as the 'silent' disease. But the good news is that the infection can be detected through a simple urine or swab test - at a sexual health/genitourinary medicine clinic (GUM clinic) - look in your yellow pages for your nearest clinic or go to your GP practice as many are now able to offer this test.

So how does the infection affect my fertility?

'Most women who get chlamydia do not become infertile or suffer an ectopic pregnancy,' states Peter Greenhouse, consultant in sexual health medicine at Bristol Royal Infirmary. 'There are many reasons why one woman's fertility could be damaged rather than another's: We know that repeated infections are most important, that delaying treatment worsens the outcome and that women who are on the pill are five times less likely to sustain tubal damage from chlamydia than those who aren't.' Chlamydia works by inflaming the lining of the fallopian tubes. This then damages the hairs which waft the eggs down the tubes. The damage may happen immediately, or could take years to have an effect. Either the egg just cannot get down the tube because of a complete blockage, or it gets part way down and then implants - and this is when an ectopic will occur. 'To help you imagine how this works, under the microscope, the lining of the tube looks like long grass blowing in the breeze; after being damaged by chlamydia it looks like a parched lawn after a hot summer.' describes Peter Greenhouse.

So if I have it how will I be treated?

A simple course of antibiotics must be taken at the same time as your partner; this ensures that you are not re-infected. The difficult thing is telling your partner: obviously either of you might have picked up the infection recently. However, chlamydia can hang around for a long time with about 50% of cases caught within the last year; 40 % between 1-5 years and 10% more than 5 years previously. So, for younger couples, you might easily have had the infection at the time you met and for older women the damage may have been done years previously.

So if it's relatively easy to detect, simple to treat, why wasn't I aware of its existence to stop me getting it in the first place, or treat it sooner?

'The official view is that about 50% of ectopics are directly caused by chlamydia,' states Peter Greenhouse. 'But in Sweden, a massive campaign has taken place over the past 15 years to both educate and screen the population. Chlamydia is now rare - about 3% down from 15% - and ectopics have reduced at all ages, most markedly in women under 30. This means that, for women under 25, almost all ectopics are due to current or very recent infection.' 'The problem in the UK is that there is a lack of public awareness and understanding of the infection and particularly its impact on ectopics,' states Peter Greenhouse. After an operation, doctors rarely tell patients that chlamydia may be the cause of their ectopic and that they should be checked out. The damage may already have been done, but treatment with a simple course of antibiotics will clear the infection and can prevent further complications. The AIDS campaign in the 1980s promoted the use of condoms, but made no mention of getting check-ups. Although cases of gonorrhoea fell rapidly, there was NO significant reduction in the cases of chlamydia or pelvic infection. This is because condoms only protect if you use them meticulously, in short-term or one-off situations. So if you have a new partner, ensure that you are both checked out for chlamydia, before you stop using condoms.

It appears to be a pretty depressing picture. But how can we ensure that things change for the next generation? And is there anything being done to address this issue? Well, the good news is that it is now being recognised as a problem health professionals. An aware-ness and screening pilot campaign has taken place in Liverpool and Portsmouth, and further research is being commissioned. A decision to roll out the education and screening campaign across the country is one of the first priorities of the National Sexual Health Strategy, so watch this space. If you have any concerns please contact the Ectopic Pregnancy Trust.

More information:

Information about Chlamydia for Medical Professionals
Information 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.

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