Hook-up culture and why chlamydia is on the rise

Young adults raised on condom ads – remember the one with the horny balloon animals? – may have the false impression that sexually transmitted infections are under control. But cases of chlamydia, among other STIs, have been on the rise across Canada for more than a decade, disease experts caution.

In Ontario, 36,395 cases of chlamydia were reported in 2011 – a 122-per-cent jump from 10 years earlier. In Alberta, government statistics show a 125-per-cent increase in chlamydia cases over the same period. The trend is similar in other provinces, including British Columbia, where reported cases of chlamydia have risen by 62 per cent in the past decade.

The surging numbers are due in part to growing populations and improved testing methods for chlamydia. Nevertheless, the number of reported cases is "only the tip of the iceberg," because the majority of people with chlamydia have no symptoms, says James Talbot, Alberta's chief medical officer of health. "Most of the people who are infected don't even know it."

Rates of chlamydia, a bacterial infection spread through sexual contact, are highest among sexually active people aged 15 to 35. Left untreated, chlamydia can have serious health consequences, especially for women. The infection can cause pelvic-inflammatory disease, increasing the risk of infertility as well as ectopic pregnancy, in which a fertilized egg becomes implanted in a fallopian tube instead of the uterus.

Chlamydia is easy to treat with antibiotics, but early detection is key. Doctors recommend routine screening for chlamydia, especially after unprotected sex, and condom use to prevent the spread of chlamydia and other STIs.

Unfortunately, "safe sex" is not a buzzword for today's teens and young adults, who no longer perceive HIV as a major threat, says Vera Etches, associate medical officer of health for the city of Ottawa. Among sexually active youth at risk for chlamydia, she says, "most people are not using condoms."

Although condom use is the first line of defence against STIs, routine testing is a close second. Ottawa streamlined the process in late 2011 by offering online lab forms for chlamydia and gonorrhea testing at GetTestedWhyNot.ca. Instead of visiting a family doctor or clinic, users can print out requisition forms to get tested and then go straight to a lab to give a urine sample. The service, a Canadian first, has been promoted on bus ads, at universities and via social media. Hundreds have used it, Etches says, but "we're hoping for thousands."

Similar services are in the planning stages in Alberta and B.C., provincial spokespeople say.

Etches notes that improved tests for chlamydia are less invasive for patients. The newer tests are more sensitive – they can detect chlamydia within days of infection – and no longer require a swab of the penis or vagina, she says. "Now you just need to pee in a cup."

Nevertheless, up to 70 per cent of women with chlamydia and 50 per cent of men don't know they're infected, she adds.

In today's hook-up culture, Talbot says, people exposed to chlamydia are less likely to be notified by a sexual partner. Years ago , health-care workers could track down an infected person's sexual partners with as little as a physical description and the name of a bar. The job is a lot harder now that people find partners in online chat rooms for anonymous sex, he says. "There are just so many ways of hooking up on the Net."

Even so, Alberta has had success in reducing syphilis, which dropped to 97 cases in 2011 from a peak of 280 in 2009. Talbot speculates the decline may be due in part to a 2011 awareness campaign, Plenty of Syph, which featured a mock-dating website with syphilis-infected clients.

But unlike syphilis, which has dramatic symptoms, including ulcers on the genitals, chlamydia may go undetected for years and remain infectious, he points out. "Preventing the spread of chlamydia is an uphill battle."

Nevertheless, Mark Gilbert, a physician epidemiologist at the BC Centre for Disease Control, says it's unclear whether chlamydia is spreading as much as the numbers suggest. Although chlamydia cases have been rising in B.C., provincial data indicate a coinciding drop in pelvic-inflammatory disease and ectopic pregnancy. "We've actually seen the complications dramatically decrease," Gilbert says, adding that it's possible health agencies are simply getting better at detecting and treating chlamydia.

Another theory, proposed by the centre's scientific director, Robert Brunham, is that reinfection is causing the spike in chlamydia cases. According to his hypothesis, published in 2008 in the journal Sexually Transmitted Diseases, early and effective treatment rids people of the infection before the body has a chance to develop an immune response to chlamydia, putting them at risk for reinfection.

The theory, if true, is yet another argument for routine condom use.

Red flags

People with chlamydia may have no sign of the disease, or experience one or more of these symptoms.

Women:

Change or increase in vaginal discharge

Vaginal itch

Bleeding between periods

Bleeding during or after vaginal sex

Pain in lower abdomen pain

Pain during urinating

Men:

Burning feeling during urination

Watery or milky discharge from the penis

Burning or itching around the hole of the penis

Pain in testicles

Source: Public Health Agency of Canada