15/11/2025
As a STI Chlamydia trachomatis requires antibiotic treatment, what happens after the pathogen is gone is where holisitic clinical focus is required.
Chlamydia doesn’t just infect, it reshapes the v*ginal mucosal environment. During and after infection, studies consistently show:
• Loss of Lactobacillus dominance, especially L. crispatus, and a rise in anaerobes (Gardnerella, Atopobium, Prevotella).
• Increased inflammation, epithelial barrier damage, and cytokine shifts that make recolonisation by protective flora more difficult.
• Even after negative PCR results post-treatment, microbiome composition often remains disordered, a “silent aftermath” that increases risk for BV recurrence, reinfection, and impaired reproductive outcomes.
Untreated or recurrent Chlamydia can move beyond the lower tract, disturbing the upper reproductive tract microbiome, uterus, tubes, peritoneum.
• Chronic low-grade inflammation and biofilm formation can persist.
• Evidence suggests pelvic microbiota dysbiosis may link to tubal factor infertility and pelvic pain syndromes long after initial infection clearance.
While macrolide and doxycycline resistance remains low, microbial persistence is also problematic and is more about hiding than mutating.
• C. trachomatis can enter a “cryptic” state under antibiotic pressure, metabolically inactive but viable.
• Extra-ge***al sites (oral, an*l) can act as secondary reservoirs, silently sustaining reinfection cycles despite standard uroge***al treatment.
Post-treatment care needs consider both just the “test of cure” but also the requirement for microbiome rehabilitation.
• Restoring a Lactobacillus-dominant state (especially L. crispatus) is essential for epithelial healing, mucosal immunity, and pathogen exclusion.
• Strategies under study include targeted probiotics, prebiotic substrates, postbiotics, and partner-aware ecosystem repair.
Have you treated Chlamydia and need support to stabilise the microbiome? Connect to an Intimate Ecology practitioner today.
