Rectal Chlamydia

We need to talk about an uninvited guest you may have lurking in your back passage.  You might have a funky discharge, or some bleeding or pain in your arse, or there may be no clues it’s there at all.

That’s right, it’s rectal chlamydia.

Usually (but not always) if you get this infection in your urethra, where your pee comes out, you will know about it. It might hurt to pee, and there might be a clear or white discharge from your penis. Sometimes the symptoms are quite subtle – there might just be a little stinging or discomfort.

However rectal chlamydia is not always so obvious, in fact in the majority of cases there are no obvious symptoms. It is well known that chlamydial infection of the lining of the rectum actually makes the tissue there more susceptible to HIV infection.  Many people who end up testing positive for HIV have had at least one episode of rectal chlamydia in the preceding year.

Not all rectal chlamydia is the same.  Some people have a variant of chlamydia called LGV.  This variant is more difficult to treat, and whilst standard chlamydia gets better after a single dose of an antibiotic, LGV needs at least a week of a different antibiotic.  LGV doesn’t show up on a regular test swab, so if you test positive for rectal chlamydia your doctor will want you to have a second swab to look for LGV.

Chlamydia infection can also be associated with arthritis and eye inflammation.

Now that a lot of guys are on PrEP to prevent HIV, it’s important not to forget about the other potential infections that you can prevent by using condoms.  If you’re on PrEP, you will have been advised to have STI testing every 3 months as a routine. However, given the high incidence of rectal chlamydia, I recommend that you come in for testing sooner if you get any suspicious symptoms, no matter how trivial they may seem.

Dr Fiona Bisshop specialises in LGBT health and writes courtesy of Holdsworth House Medical Centre.

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