Some questions regarding chlamydia.

As stated previously, I test every month, with a negative all the way through my Aug test, and a mysterious positive on my Sept test (previous question).

Something that was not clear to me was: my neg Aug test was 7d (not 5 as in question) after last potential exposure. How trustable is a 7d Urine NAAT chlamydia? Are false negatives likely? 

As additional questions, I was treated 1g AZ, female partner also received 1g presumptive treatment. I tested 17 days after treatment, negative.

I however took an additional course of doxy this week (last dose today Saturday morning) out of anxiety. Yesterday night ie. 6 full days after starting doxy I engaged in unprotected receipt oral and protected vaginal sex (made sure genital contact before condom). With this, is my partner at risk after my neg 3 weeks ago and 6d of doxy?

Finally, I understand AZ is effective for genital and cervical, but not rectal/GI tract infection. However, how common are those? Is it likely that a single or couple exposures ie. Fellatio, will result in GI infection that can persist and bring infection back?

You overreact in general to low risk situations. And you are over worried about chlamydia:  getting tested for chlamydia once a month doesn't make much sense, and your self treatment with azithromycin and doxycycline also seems excessive, unless and until you test positive (again) or have a proved contact with a known infected person. 

Chlamydia urine testing is valid any time more than 4-5 days after exposure, but not if you take antibiotics in the meantime; in that case you don't need testing at all.

You are non-infectious for others within a day or two of taking azithromycin or starting doxycycline.

Doxycycline is preferred over azithromycin for any and all infected sites. Azithro fails to cure 15-25% of rectal infections and up to 5% of genital infections; doxycycline never fails at any infected site, if taken for the full 7 days.

The possibility that oral exposure can result in gastrointestinal or rectal chlamdia is a theory that so far has not panned out to be an actual risk. If it happens, it is rare.

If you have anal sex exposures with other men, consider getting on doxy-PEP, i.e. a single dose of doxycycline 200 mg within 72 hours of new exposures. This also is effective in preventing syphilis and reducing the risk of gonorrhea by about half. If you only have oral or vaginal sex exposures, then instead of testing after every exposure or as often as once a month, I would suggest that twice yearly testing would be sufficiently frequent to keep you and your partners safe -- unless and until you have symptoms, or if you have sex with a person known to be infected.

Keep those thoughts in mind and let's see if you can go a year or so before needing to use the forum for questions with obvious answers. OK?

HHH, MD

Yes, I agree testing after every contact may be too much, and I agree these issues dominate my head for long periods of time, but I also think all this info helps clarify a ton of those what if questions.

If you allow me one additional non-repetitive question (at least I have searched on forum and internet) that prompted my doxy follow up:

Both myself and my partner developed a one-time diarrhea (maybe watery/loose stool as it was only once as opposed of the 3-5 times in 24 hr diarrhea definition), 2.5h and 1.5h respectively after Azi. 

* In general, is this time enough for drug absorption? What about for throwing up instead of diarrhea?

I know in this specific case doxy is better for chlamydia and neg labs show things are good, but this is more of a general question on antibiotic usage and how soon will throw up or diarrhea can prompt the need for retreatment for future ocassions.

As an additional detail, Mexico has a pretty horrible access to non HIV or syphilis testing (expensive, won't do rectal swabs, and genital is only painful swab instead of urine) this leads to a lot of untested people, even if we want to, or just avoiding it cause is painful, making these questions of "will my treatment be effective?" a little bit more common.

I doubt there is a national policy in Mexico against the tests you describe. Whatever you have been told almost certainly is the policy of particular laboratories or clinics. Certainly there are providers who understand the anatomic sites that need testing in men who have sex with men, for example.