[Question #10280] Confused

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24 months ago
My partner and I agreed to genital testing before engaging in sex, he tested positive for chlamydia and I tested negative. He is claiming that I gave him chlamydia from blow jobs, is this possible? I have seen answers on the forum that chlamydia is not transferred this way to a theoretical risk? 
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H. Hunter Handsfield, MD
24 months ago

Welcome to the forum. Thank you for your confidence in our services -- and also for reading other threads with questions like your own.


The bottom line here is that it is very unlikely your partner's chlamydia was acquired by receiving oral sex, from you or anyone else. Chlamydia can persist for months, so his positive result doesn't necessarily mean he caught it recently. He might have been carrying chlamydia for a long time, from a past sexual exposure.


That said, I understand your confusion. The available online information is inconsistent and often wrong, largely because research on oral chlamydia and risk of transmission from oral sex is fairly new. It will be a lesser problem if you limit your searching to professional or at least professionally moderated websites (public health agencies, academic medical centers, and so on, or those with expert moderation, like this one. But even this isn't foolproof; many otherwise expert resources don't have clear understanding. However, the answers you have seen on this forum reflect the latest scientific knowledge. Both Dr. Hook and I are immersed in the research on this topic our professional colleagues include the top investigators in the field. Here are some basic facts on the topic.


1. Oral chlamydia is rare. Chlamydia bacteria do not survive well in the throat and oral cavity. The standard tests detect chlamydial RNA, but in at least half the positive results, only RNA is present, not living chlamydia. In those cases there is no infection, just leftover RNA, probably from exposure to infected partners that didn't result in actual infection of the throat. And positive results usually become negative within 1-2 weeks, without treatment.


2. There have been almost no proved cases of transmission of chlamydia oral to genital; your partner is not likely the first! Research 20 years ago (for which I was the lead investigator) showed that nongonococcal urethritis (NGU) resulting from oral sex is never chlamydia-positive.


These facts do not prove that oral chlamydial infection never happens; it might. Because oral infection is rare, of course transmission to a partner by oral sex has to be very rare as well. Here too, maybe it happens from time to time -- but rarely.


In fact, oral chlamydia is so uncommon that CDC recommends oral chlamydia testing never be done! However, it's often done anyway, because oral gonorrhea IS quite common -- and gonorrhea testing automatically tests for chlamydia as well. And some of those tests are positive -- but as noted above, many of those results are false.


Going back to your situation, I would be happy to discuss other explanations for your and your partner's differing test results. If you want to go there, please clarify whether you're female or also male -- not clear from your question. Also what your and your partner's sexual histories are--i.e. your other partnerships up til now, what your sexual practices are together (other than oral sex), and so on.


As all this indicates, it's a complex topic. But let me know if anything isn't clear. Best wishes--


HHH, MD

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