Chlamydia

What Chlamydia Is

Chlamydia trachomatis is a bacterial infection and one of the most common sexually transmitted infections in the United States. It spreads through any sexual activity that exposes mucous membranes, including oral sex, anal sex and vaginal sex. The bacteria can live in all three of those locations. This is important because many people still think of chlamydia as a genital-only problem, which is not accurate.

One study found that about eight percent of heterosexual women had chlamydia detected in the anus when they were actually tested there. Our own data at Shameless Care does not show numbers that high, but the study still proves the point. Chlamydia is not limited to the genitals. It can live in the throat and in the rectum and these infections often have no symptoms at all.

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Incubation Period

Chlamydia usually becomes detectable about one to two weeks after exposure. Some people may test positive sooner, but most guidelines use this timeline. This is why high quality testing matters. If you test too early, you may miss an active infection that is still developing. Shameless Care’s STI panels are designed to help people test at the correct time and at every site where chlamydia can actually live.

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Symptoms When They Occur

Most people with chlamydia have no symptoms, but when symptoms do show up, they vary by location.

• Genital infections may cause discharge, burning during urination, spotting between periods or pelvic discomfort.
• Rectal infections may cause rectal pain, itching or discharge, although many cause nothing noticeable.
• Oral infections almost never produce symptoms and are usually discovered only through screening.

Because chlamydia is usually silent, the only reliable way to detect it is with routine, site specific testing. Shameless Care offers full site testing that includes oral, anal and genital samples so nothing important is missed.

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Complications if Untreated

Untreated chlamydia can cause serious health problems. These include pelvic inflammatory disease in women, infertility, chronic pelvic pain, ectopic pregnancy, infections during pregnancy that can affect the baby, epididymitis in men which can also affect fertility and reactive arthritis. These complications are preventable through early detection and proper antibiotic treatment.

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Why Doxycycline Is First Line

Doxycycline is the preferred treatment for chlamydia because it is consistently effective across genital, rectal and oropharyngeal sites. Older single dose azithromycin regimens do not perform as well, especially for rectal infections. Chlamydia has developed some resistance over the years, but nothing like the crisis seen with gonorrhea. When treated correctly, chlamydia does not require retesting for cure.

If you want to reduce your risk even further, Shameless Care offers DoxyPEP, a scientifically proven strategy that lowers the chance of acquiring chlamydia, syphilis and even some gonorrhea infections when used correctly after sex.

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Reportable Infection Requirements

Chlamydia is a reportable sexually transmitted infection in all fifty states. When a person tests positive, both the laboratory and the diagnosing clinician are legally required to report the case to the local county health department. The report includes identifying information such as name, address and race. This is not optional. Every lab, doctor and telemedicine service in the country must follow the same law. Physicians are also required to treat the patient.

This is one reason why discreet, patient centered testing matters. Shameless Care handles reporting exactly as required, never more and never less.

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Site Specific Testing Requirements

Chlamydia is a site specific infection. This means a genital test only checks the genitals, an anal test only checks the rectum and an oral test only checks the throat. Any competent STI panel must test every site where exposure occurs. A genital-only test will miss a significant number of infections, especially in the throat and rectum, which are usually asymptomatic.

Shameless Care’s STI testing always includes oral, anal and genital testing so nothing is overlooked.

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Reinfection and Partner Treatment

Most repeat chlamydia infections are reinfections, not treatment failures. This happens when partners are not treated at the same time or when testing is incomplete. Expedited partner therapy, where legal, allows clinicians to provide treatment for partners without requiring an exam. Treating everyone at the same time dramatically reduces reinfection.

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Pregnancy Considerations

Doxycycline is not used in pregnancy. Pregnant patients receive safer alternatives. Because chlamydia in pregnancy can affect both the pregnant person and the baby, screening and appropriate treatment are especially important.

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How Common Chlamydia Really Is

The CDC reports about 1.7 to 1.8 million chlamydia diagnoses every year, but this number does not reflect the actual burden. A CDC modeling study by Kreisel in 2021 combined urine testing from national surveys, the fact that most infections cause no symptoms and the fact that many infections self resolve before anyone is tested. When these factors are included, the number of true infections in people aged 15 to 39 is closer to four million per year.

A second study by Clay in 2023 used prevalence data and serology and reached the same conclusion. Reported cases represent the floor, not the ceiling.

There is another important factor. National surveys that feed these models only test genital sites. They do not test the throat or the rectum. Yet we know from modern clinics that extragenital infections are real, measurable and frequently missed. Many people have a perfectly negative urine test while still carrying an infection in another site.

This means four million is almost certainly an underestimate. The United States is missing entire categories of infections simply because we do not test where the bacteria often live.

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Contagiousness and Testing Timelines

People are generally considered infectious until they have completed treatment and symptoms, if present, have improved. For most antibiotic regimens this is about one week. People who take doxycycline should avoid sexual contact until the medication course is complete.

Most guidelines recommend retesting about three months after treatment, not because treatment fails, but because reinfection is extremely common.

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The Bottom Line and Protect Yourself 

Chlamydia is common, silent and far more widespread than official statistics suggest. It can infect the throat, rectum and genitals. It is reportable in every state. It has real complications if missed. And it is only reliably detected when all exposed sites are tested.

If you want to protect yourself, the smartest strategy is simple.

Use a complete STI testing panel that checks every site. Use DoxyPEP if you are sexually active in ways that increase your risk. And test regularly so infections are caught early, treated correctly and not passed along.

Shameless Care provides the most comprehensive at home STI testing available and offers DoxyPEP through our network of experienced, board certified clinicians. If you want evidence based tools that actually prevent infections instead of relying on outdated advice, we are here to help.