Dear Dr G,

I am a 23-year-old university student who is emailing you with a bit of embarrassment. I am having the time of my life and embarking on sexual adventures.

Even though I am always cautious, I had a shock recently when I started having some painful twitches in my left testicle.

I thought nothing of it until it started getting excruciatingly painful and massively swollen and while I was initially embarrassed to see a doctor, I gave in when I developed a fever.

The doctor thought it was a simple urinary tract infection and gave me penicillin, which did not help much. Additionally, the urine culture turned up negative.

I then went back, and the doctor I saw told me that such infections are quite rare among young men and I was rather dismissive when he said that I may have contracted chlamydia.

To my horror, the test results turned up positive.

How can this be the case considering that I am always cautious and use protection when it comes to sex? Additionally, how can I show symptoms when I have not had sex for at least three months?

As such, I am putting Dr G on the spot to ask what is chlamydia and how did I contract it? Also, how can chlamydia affect the testicles?

What is the treatment for chlamydia and would it be any different if the testicles are involved?

Finally, what are the long-term consequences I face?

Yours truly,

Swollen Sam

Chlamydia is one of the most common bacterial infections worldwide, and is ranked the most common sexually transmitted infections (STI). It accounts for 55% of all such bacterial infections with an estimated 131 million new infections contracted each year.

The World Health Organization (WHO) reports that young adults, particularly those aged 15-24, are

disproportionately affected by chlamydia and it often goes unnoticed due to its asymptomatic nature, which poses a significant challenge in terms of prevention and control.

Some reports have estimated that up to 7% sexually active men and 20% of sexually active women are infected with chlamydia in the US. One report even highlighted that 9% female students from certain American colleges are oblivious of dormant chlamydia.

In the realm of sexually transmitted infections, chlamydia is notorious for complications. One of these consequences in women include Pelvic Inflammatory Disease and Chronic Pelvic Pain. In men, the infection can result in epididymal orchitis, which is a painful condition that affects the male reproductive system. Epididymal orchitis occurs when the infection spreads from the urethra or bladder to the epididymis, a tightly coiled tube responsible for carrying and storing sperm. Chlamydia trachomatis, the bacterium responsible for chlamydia, can ascend in the genital tract, leading to inflammation and swelling of the epididymis. This condition can result in severe pain and discomfort, affecting fertility if left untreated.

The classic initial symptoms of chlamydia-induced epididymal orchitis are unilateral or bilateral pain and tenderness in the testicles. The pain can range from mild discomfort to an intense, throbbing sensation. The affected testicle and the adjacent one then become swollen and tender to touch, leading to a visibly larger and distorted appearance.

Individuals may experience a fever accompanied by chills, indicating an inflammatory response to the infection.

The diagnosis of chlamydia infection is often delayed as the symptoms may mimic common bacterial infections of the urinary tract such as E. Coli. The urine culture for the identification of bacterial types often fails due to chlamydia trachomatis being an obligate intracellular organism that does not survive on a petri dish. The only definitive diagnosis of a chlamydia infection is the PCR identification of the bacterial DNA. Such investigations are often costly and time consuming.

That said, chlamydia infections and epididymal orchitis are completely treatable and curable.

Seeking medical attention promptly is crucial for an accurate diagnosis and appropriate treatment. Resting with elevation of the scrotum and pain management using non- steroidal anti-inflammatory drugs (NSAIDs) are often recommended to alleviate symptoms. The most commonly prescribed treatment for chlamydia is a course of antibiotics, such as doxycycline. However, due to issues with non-compliance with medications or delays in treatment, a single high dose of Azithromax or Ceftriaxone may be warranted.

Sexual partners should also be notified and tested for chlamydia to prevent reinfection.

The key for prevention in the spread and recurrence of chlamydia infections is practising safe sex, and regular screening for sexually-transmitted infections is highly recommended, especially for sexually active individuals who engage in unprotected sexual activity or have multiple partners. However, such strategies often fail as the cost of screening is prohibitive.

While the topic of chlamydia infections and epididymal orchitis may evoke laughter after the infection has resolved, it is crucial to approach the lesson with awareness and seriousness. Understanding the prevalence and risks of emergence of this contagious bacteria is the key to prevent more dormant infections causing epididymal orchitis, and the unintentional spread of the disease.

When Dr G is put on the spot, his response is when it comes to safe sex is to not make it easy and to never let that which is dormant get anywhere near your crown jewels!

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