[Question #1001] Following question 950, Chlamydia infection!!!

88 months ago
Hello doctor, thanks again.  This question is related to number 950. After a few days and following my negative tests (culture and chlamydia antigen, gono, myco and ureaplasma) and as the symptomps are still here (slight burning after urination, discomfort around anus, and pressure on the bladder; all waxed and waned) I decided to take another test: PCR. I have been treated so far with 2G Azytro, 400 mg cefixime. After a week, levofloxacin and tinidazol, andI inmediatly with 10 days of doxy, finishing the doxy 27 days ago. 

The thing is that the PCR I did yesterday came back positive for chlamydia. I only had recieved oral sex, so It's very confusing. I called my doc and he did not have an explanation, he thinks it could be a false positive, with the test picking up dna of dead chlamydia. But can it happen almost a month after finishing the doxy and having another negative antygen test three weeks ago?

So my questions are:
1) could this be a false positive?
2) The doc gave me 1g azytro for today and 500 mg for tomorrow, and the order to repeat the treatment next week, even though he thought It is not necessary. Better safe tan sorry, he said.
3) Regarding my wife, I had unprotected sex with her after the oral insertive exposure (a female sex worker give me a fellatio) but before the symptomps began. She took 2g azytro plus 400 mg cefixime. Since then, we have had only protected sex. Is she ok? If Azytro seemed to have failed for me (I took the 2 gr pills on june 9th) could it have failed for her too??? My doc thinks she is alright, but I better ask you, doctor.
4) Never had a discharge, only a drop of White mucus came out of my penis three days ago.  Only time. Seems rare?
5) I dont think if I can trust the laboratoy, cost me a fortune, and as far as I am concerned, chlamydia is rarely if ever acquired through oral sex.

Please, I need you point of view over this bloody nightmare I am going through. Many thanks in advance,

H. Hunter Handsfield, MD
88 months ago
Welcome back. I reviewed your recent discussion with Dr. Hook and agree with all he said.

Given the drugs you had, it was impossible that you would have had persisting gonorrhea or chlamydia, and I would have recommended against another round of tests. I'm afraid you are now experiencing the consequences of the anxieties or other motivations that led you to do it. To your specific questions:

1) Your doctor is correct. A false positive result is the most likely explanation for your positive chlamydia test. However, there is also a slight possibility your pre-treatment test was falsely negative; chlamydia DNA persists for a while after treatment, so it is conceivable your later positive result, while still false, reflected an infection missed by the first test. It is also conceivable that your wife has chlamydia, i.e. your outside oral sex exposure was irrelevant, and you caught it from your wife -- whether during the most recent condom protected exposure or sometime before that. (I'm not sure I fully understand the timing of who had sex with whom, and you haven't said anything about whether your wife might be at risk because she also has outside sexual partners. So this may or may not be a realistic possibility.)

2) I would have agreed with your doctor that additional treatment wasn't necessary. Instead, I would have recommended a repeat chlamydia test, which I would have expected to be negative.

3) I'm glad your wife was treated. Better safe than sorry. In any case, her treatment should have been effective, if she was infected. (She should have been tested before being treated. Was she?)  Azithromycin isn't quite 100% effective (closer to 95-98%), but the occasional treatment failures are not because chlamydia is resistant to it. Therefore, even if you had failed treatment with azithromycin, that would not raise the chance it would happen in your partner(s). 

4) Most men can occasionally squeeze a drop of mucus from the penis; or maybe leftover sexual secretions if you had been aroused or ejaculated recently. In any case, a single such episode without other symptoms and continuing discharge generally does not indicate infection.

5) You are correct that it's rare to acquire urethral chlamydia by oral sex. It can happen, but rarely; but even if you had it, the subsequent (over) treatment would have been effective. But also note my comments/speculation above about other possibilities.

Given these test results, my final advice is that both you and your wife be tested again for chlamydia in a few weeks (but not sooner than 3 weeks after you both were treated).

I hope this has helped. Best wishes--  HHH, MD

88 months ago
Many thanks doctor Handsfield. I will try to clarify things in order to get your propper response. My wife and I are in a monogamous relationship since 2014, apart form the fellatio I recieved form a female sex worker on may 25th. She is been faithful to me, I am sure. So, when the symptomps began I went to a doc who took a sample from my urethra (swab), saw WBC and right away told me I had Chlamydia (I know now that it is imposible to know withaout a propper testing). But I trusted him and I took all the drugs he precrisbed: first 2g azytro plus cefixime 400. Next week Levofloxacin and tinidazol (to cover trich although I did not have vaginal contact), and the next week 10 days of doxy, two pils a day. I ended the treatment 28 days ago.

I did not feel better, I mean, not as bad as the begining (severe pain after urinating, needles-like bladder, pain below the testicles), but still having pain when urinating, so I changed the doctor who told me to have a culture test with antigen. This test was done 4 days after finishing the doxy, and came back negative for everything except candida albicans (I am diabetic). He told me the test was not done too soon because it was not a PCR.
The PCR came back positive yesterday, 27 days after finishing the doxy, so I freaked out.
1) To your questions: my wife was treated but never tested, she took the medicines and no explanation was given to her related to the sexual encounter. I hope she is alright, and I am sure I am not being reinfected from her because I was extremely careful using the condoms (no oral sex either, no contact) after she was treated. It has been my only extra marital exposure, I don't know how this is happening to me.
2) Could the Chlamydia have reached the prostate and being more dificult to erradicate? I have experiencied some changes in eyaculation, and currenly burning feeling around anus. My doc check the prostate and thinks is ok. Yesterday I took the 1 g azytro the doc prescribed, and today 500 mg more: fingers crossed.
3) Could this be a yeast infection? or mycoplasma?
4) I really dont know what to do, I am desperate to feel ok again, and of course extremely worried for my wife. I am thinking in having contracted a multi resistant chlamydia but at the same time I think this is not a realistic possibility.

88 months ago
Update: today I am having high intensity burning after urination and intense pain under the testicles... Took the 1G azytro 16 hours ago. I am feeling much worse than the previous days. Desperated. 
H. Hunter Handsfield, MD
88 months ago
Thanks for the follow-up information. The bottom line, howver, is that it doesn't change my opinions or advice.

1) If there is anything sexually acquired at all, it likely is urethral inflammation due to exposure to oral bacteria which are foreign to the urethra. This can happen from a new or regular partner. It probably is harmless, including no risk to one's sexual partners. (This is theory, not proved. But most STD experts believe this is a common scenario.)

2) Chlamydia does not regularly infect the prostate. If and when it does, it does not reduce effectiveness of the standard treatments.

3) Conceivably yeast at the present time; probably not mycoplasma, which is not acquired by oral sex. If it's yeast, additional antibiotic treatment, including the azithromycin you just took, not only won't help but could make things worse. 

4) At this point, I would advise against taking no further treatment of any kind for at least a month, and that you continue to follow up with yoru doctor and follow his or her advice. My guess is that your symptoms will resolve off of antibiotics. To the extent there may be a psychological component to your symptoms, they probably will resolve once you come to understand (emotionally/psychologically, as well as intellectually) that you have nothing that will ever be harmful for either you or your wife -- which at this point is for sure the case.

88 months ago
Thanks again doctor Handsfield. I discussed your opinion with my doctor and he thinks the same. He tested my semen yesterday (PCR), nothing was found, I am clean. What a relieve. By the way, he is now sure there is a prostatic link to my symptoms (he told me it could be a post chlamydia prostatitis), so put me on diclofenac for the pain and permixon for a few weeks. I have stopped the antibiotics, I did not take the 500 mg azytro.
He encouraged me to have a relaxed life, enjoy the holidays with my wife and resume normal unprotected sex with her in a couple of weeks. He thinks she is alright after the treatment she took.
I really hope that this is the end of this terrible story.
I really appreciate all your support (including Dr. Hook's), you helped me a lot. I couldn't thank you enough. THANKS!

H. Hunter Handsfield, MD
88 months ago
Thanks for the follow-up, the happy outcome, and for your thanks. Best wishes and stay safe.