[Question #10107] Chlamydia questions

Avatar photo
25 months ago
Hi- I have read on the intranet that chlamydia infections can be asymptomatic for years, is this true? Or would people most likely get symptoms at some point? For asymptomatic people, are they truly asymptomatic or are symptoms just not noticed? Does circumcision affect odds of becoming infected or affect odds of symptoms? 
Avatar photo
H. Hunter Handsfield, MD
25 months ago
Welcome to the forum. These are good questions -- and the answers should be reassuring.

Chlamydia certainly can persist for a long time, but "years" overstates it. Few infections in males persist longer than a few months, and in women the longest duration reported in the scientific literature is 4 years. And in that study of a couple hundred women, the large majority had cleared within a year or so. If it can sometimes persist four years, probably sometimes it can be even longer -- but probably very rarely.

Can chlamydia persist despite negative testing? Maybe yes, but this also is rare, if it happens at all, especially in males. Negative results of genital testing (urethral swab or urine in males, cervical or vaginal swab in women) is solid proof that there is no genital infection. A current topic in chlamydia research is whether it might persist in the intestinal tract without symptoms, whether acquired by oral sex or receptive anal sex. If this happens, most such infections probably remain without symptoms and probably have health impact. Some "asymptomatic" chlamydia indeed involves mild symptoms that some persons don't notice. This is more common in women than men. But in either sex, complete absence of symptoms often is the case.

You don't say anything about your sexual exposures, but if you have no genital symptoms it is unlikely you have a genital infection, especially if you have had negative testing by urine or urethral swab. There has been no research on whether circumcision status changes the likelihood of longstanding or asymptomatic chlamydial infection, but probably it does not. Finally, you don't say anything about your sexual lifestyle and choices. If you have sex with other men, you might consider rectal testing in addition to urine/urethra. Oral testing isn't necessary, but could be done (along with a throat swab for gonorrhea) if you have been at risk.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
---
---
Avatar photo
25 months ago
Thanks for the reply. I don’t have any worrisome exposures, have been in a committed relationship for years without symptoms. 

I just happened to find an article on rising std rates, and was curious on the length of infection as we have both had other partners. My partner is female, and states she has had testing years ago- you mention oral chlamydia, is that a thing? Could my partner have it orally from a previous relationship and then give it to me by giving me a bj?

If that is the case, could I have them infected her genitally from her giving it to me from a bj? 


Avatar photo
H. Hunter Handsfield, MD
25 months ago
There's a lot of scientific interest recently in oral chlamydia. Most positive oral (actually pharyngeal, i.e. throat) positive tests are in very low amounts, not associated with sore throat or other symptoms, and when re-tested more than 2 weeks later, negative (without being treated). It is rarely if ever transmitted by oral sex: to my knowledge, there still has never been a proved case of genital chlamydia in anyone whose only possible exposure was receiving oral sex. Chlamydia is the cause of about 30% of nongonococcal urethritis (NGU) in men; but for NGU following oral sex, none have chlamydya -- that is, chlamydial NGU is acquired only by vaginal or anal sex. (I was the senior scientist in the main research on this.)

If it is certain neither you nor your partner have had other sex partners since you became a couple, there is almost no chance either of you has chlamydia, and certainly no possibility of oral infection. You really needn't worry about it.
---
Avatar photo
25 months ago
Wow, thanks for the information. I have no worries about exposures since becoming a couple. My only real concern was her giving it to me via oral sex ( I don’t think she has ever been tested orally) and then me transmitting it to her vaginally. 
Avatar photo
25 months ago
Which based off of your answer isn’t really possible ? 
Avatar photo
H. Hunter Handsfield, MD
25 months ago
Correct, not possible. And if you or she ever had chlamydia, it is long gone. This really shouldn't be a concern for you at all.

That completes the two follow-ups included with each question and so ends this thread. I hope the discussion has been helfpul.
---