Can Chlamydia Be Transmitted Orally?

Chlamydia is amongst the most commonly transmitted urogenital infections in the United States and the most common sexually transmitted disease in the world. It is twice as commonly observed in women in the US as compared to men. The age group most affected by this infection is between 15 to 25, which is proposed to be due to high sexual activity. Due to the increasing number of cases, many studies have been conducted on chlamydia and all the routes through which it may be transmitted. 

What is Chlamydia?

Chlamydia is a sexually transmitted infection caused by the bacteria Chlamydia trachomatis. This bacteria can infect both women and men, and is most commonly spread through unprotected vaginal or anal sex. Chlamydia can also be spread through oral sex, although this is less common. If left untreated, chlamydia can cause serious health problems, including infertility in women. 

However, it is easily treated with antibiotics. If you think you may have chlamydia, it is crucial to see a doctor or health care provider for testing and treatment.

The region of the body most commonly affected in females is the cervix. This may lead to cervicitis, Urethritis, proctitis, perihepatitis, and even pelvic inflammatory disease. 

Since it mainly affects the reproductive tracts in females, it may lead to a greater risk of infertility and ectopic pregnancy. (1) This may also pose a greater risk in pregnant women who catch the infection. Women who have genital chlamydia may also transfer it to their babies during vaginal delivery. This may be exhibited in newborns as pneumonia or conjunctivitis. 

However, conjunctivitis is not only limited to the babies but may also affect the adult males and females with Chlamydia infection. Chlamydia in men may most commonly present itself in the form of Urethritis, prostatitis, reactive arthritis, proctitis, and epididymitis. (2)

 

Signs and Symptoms of Chlamydia Infection

The signs and symptoms of chlamydia may be characterized on the basis of the area that is being infected. These may be unique for cervicitis, Urethritis, Prostatitis, reactive arthritis, conjunctivitis, and even pharyngitis.

• Cervicitis: 70% of the women with cervicitis may usually exhibit mild symptoms of complaining of occasional vaginal discharge. They may also experience dysuria, pain in the abdomen, and bleeding. (3) Some women may also complain of bleeding in between their periods. 
• Urethritis: Urethritis is more commonly seen in males as compared to females. It may present with signs and symptoms like dysuria and urethral discharge. This discharge may be white, grey, or clear. 
• Prostatitis: The common symptoms associated with prostatitis include pain in the pelvic region, pain during ejaculation, urinary dysfunction, and dysuria. 
• Reactive Arthritis: Reactive Arthritis may be seen in 1% of men who develop chlamydia. ⅓ of both of these men may also experience the reactive arthritis triad, which is also known as Reiters syndrome. This includes Urethritis, arthritis, and uveitis. (4)
• Conjunctivitis: Conjunctivitis of the eyes may also be found in Chlamydia infections which may be caused by direct inoculation of the genital fluids. This usually presents as a non-purulent form of conjunctivitis, with the conjunctiva having a cobblestone appearance. It is most commonly seen in newborns. 
• Pharyngitis: Pharyngitis may be caused by oral transmission of chlamydia, facilitated through oral sex. While this is asymptomatic in the majority of the cases, some individuals may experience a sore throat or an uncomfortable feeling while they talk or eat. 

 

How is Chlamydia Transmitted?

Chlamydia is a bacteria that is typically transmitted through sexual contact, including oral, vaginal, and anal sex. It can also be passed from an infected mother to her baby during childbirth. In rare cases, chlamydia may be spread through blood transfusions or sharing of contaminated needles.

However, recent studies have found the transmission of chlamydia to be much more complex than it was previously proposed to be transmitted. The three main areas of the body which are associated with transmission of the infection include the urethra, anus, and the oropharynx. While the transmission via the anus and urethra have been studied vastly in the past, more attention is now being given to its transmission orally. This is why an increasing number of studies are now being conducted on the potential practices like kissing and oral-anal sex as a possible route for transmission. (5)

Oral Transmission of Chlamydia

Oral chlamydia is relatively rare, but it can occur if the bacteria come into contact with the mucous membranes in the mouth. This can happen through kissing, sharing sex toys, or contact with infected body fluids. The oral transmission of chlamydia was further evaluated in a case-control study conducted on men attending an STD clinic between 2011 to 2013. The study aimed to assess the ratio of cases of Urethritis that were developed after oral sex. The collected data showed 27.5% of the men to have gonococcal Urethritis, 31.4 % to have Chlamydial Urethritis, and 36.9% to have non-chlamydia Urethritis after urethral exposure to their oropharynx. The study concluded by stating the oral route, including the pharynx, to be an important transmission route for chlamydia and other pathogens. (6)

Although it was previously proposed that oral activities like dry kissing, wet kissing, and oral penile sex without ejaculation may also lead to the transmission of chlamydia, recent studies have found this to be untrue. This was seen in a study conducted on HIV-negative homosexual men living in Sydney, Australia. The results showed a higher proportion of the reported infections to be caused by oral sex involving ejaculation while finding no association of infection transmission with practices like kissing and oral sex without ejaculation. (7)

 

The Bottom Line

Chlamydia infection, which is caused by the pathogen known as Chlamydia trachomatis, is frequently encountered in males and females between the ages of 15 and 25. The routes of transmission include the genital, anal, and oro-genital routes, each of which has its unique presentation. The oro-genital route of transmission may commonly cause pharyngitis; however, this is mostly asymptomatic.

 

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References:

1. Owusu-Edusei, K., Jr, Chesson, H. W., Gift, T. L., Tao, G., Mahajan, R., Ocfemia, M. C., & Kent, C. K. (2013). The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sexually transmitted diseases, 40(3), 197–201. https://doi.org/10.1097/OLQ.0b013e318285c6d2
2. Mohseni M, Sung S, Takov V. Chlamydia. [Updated 2021 Dec 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537286/
3. Detels, R., Green, A. M., Klausner, J. D., Katzenstein, D., Gaydos, C., Handsfield, H., Pequegnat, W., Mayer, K., Hartwell, T. D., & Quinn, T. C. (2011). The incidence and correlates of symptomatic and asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in selected populations in five countries. Sexually transmitted diseases, 38(6), 503–509.
4. Kobayashi, S., & Kida, I. (2005). Reactive arthritis: recent advances and clinical manifestations. Internal medicine (Tokyo, Japan), 44(5), 408–412. https://doi.org/10.2169/internalmedicine.44.408
5. Cornelisse, V. J., Fairley, C. K., Read, T., Lee, D., Walker, S., Hocking, J. S., Chen, M. Y., Bradshaw, C. S., & Chow, E. (2018). Associations Between Anorectal Chlamydia and Oroanal Sex or Saliva Use as a Lubricant for Anal Sex: A Cross-sectional Survey. Sexually transmitted diseases, 45(8), 506–510. https://doi.org/10.1097/OLQ.0000000000000800
6. Barbee, L. A., Khosropour, C. M., Dombrowski, J. C., Manhart, L. E., & Golden, M. R. (2016). An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study. Sexually transmitted infections, 92(2), 155–160. https://doi.org/10.1136/sextrans-2015-052214
7. Templeton, D. J., Jin, F., Imrie, J., Prestage, G. P., Donovan, B., Cunningham, P. H., Kaldor, J. M., Kippax, S., & Grulich, A. E. (2008). Prevalence, incidence, and risk factors for pharyngeal chlamydia in the community based Health in Men (HIM) cohort of homosexual men in Sydney, Australia. Sexually transmitted infections, 84(5), 361–363. https://doi.org/10.1136/sti.2008.032037