[Question #1174] azithromycin time to cure

48 months ago
hi, I was exposed to chlamydia Monday night (could not be any other time as I was abstaining from sex) , Friday out of concern but without any symptoms I went to get tested and was treated with 1g azythromycin (I took it right away). Sunday morning (48 hours after treatment) I had unprotected vaginal sex with another girl (I did not know I was positive, went to get treated just out of concern). Monday lab calls, the test is positive for chlamydia. Question is: Sunday morning, 48 hours after treatment, less than a week after exposure, and asymptomatic, what are the chances I was still contagious to my partner? I know the standard response is no sex for 7 days, but I read that 48 hours after treatment usually you are all cleared and non contagious. I will alert her she has been exposed but I do not have an easy access to her, before I mount a tracking campaign i wanted to get a sense of relative risk. Thanks a lot
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
 Welcome to the forum. I will be happy to comment.   48 hours after taking a dose of azithromycin, it is unlikely that you would transmit your infection to a new sex partner with whom you had unprotected sex.   Dead or dying bacteria might certainly be present in your ejaculate at that time however these damaged bacteria would be unlikely to cause infection.   However, my comments are based on logic, as well as the fact hat the majority of single exposures do not lead to infection and this situation has not been carefully studied.  Therefore I believe it is important for you to tell your most recent partner that she has been exposed and that she should be tested in the not-too-distant future.   I hope you will make every effort to encourage here to seek testing as soon as possible.   In our clinic in this situation, despite the low probability of infection we would also administer her a 1 g dose of azithromycin when she was seen to take care of the very small possibility that she might have been infected. Better to be safe than sorry.  

I hope these comments have been helpful.  EWH
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48 months ago
Dear Dr Hook, thanks for your reply. It is what I thought and I told her this morning, so she will be tested and treated.
One comment on your reply, I did not ejaculate, does that change the risk profile?
I have a couple follow up questions on efficacy.
I know the cure rate of azithromycin has been questioned (Dr Handsfield himself! Sexually Transmitted Diseases: November 2011 - Volume 38 - Issue 11 - pp 1028-1029) 

Should I be worried about not being cured? I thought the Az 1g was extremely effective! Should i test for cure? how long should I wait? can I have unprotected sex until a negative test of cure? Sorry about all these questions, it is a combination of anxiety and scientific curiosity (bad combo I know)
Thanks a lot
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
Ejaculation does not change my assessment or advice.  Men can certainly spread infection without ejacualtion.  

With regard to the efficacy of azithromycin, I would not be worried. Careful studies show that azithromycin remains highly effective for chlamydia treat them with curates exceeding 97%. No test of cure is recommended  with regard to the efficacy of azithromycin, I would not be worried. Careful studies show that azithromycin remains highly effective for chlamydia treatment with curates exceeding 97%. No test of cure is recommended.  EWH
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48 months ago
Thanks Dr Hook. I really appreciate your advise, I read all your responses in the other forums too. One last question (then I think we should close this thread). I developed balanitis after the azithromycin (I am uncircumcised). Swollen foreskin, white dots on glans, itchy. Could this be because of the antibiotic? This is not the first time it happens to me, once doctor said that after antibiotics it can happen because the good bacteria die too and yeast and fungus can take over. Can I use lamizil for it? Or monistat? Or more antibiotics needed? Thanks!!
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
I'm glad that you found my comment helpful.  Thanks for your thanks.  The balanitis that you describe sounds very much like yeast balanitis which is common following use of powerful antibiotics for treatment of infections.  Most people do have small amounts of yeast (which are fungi) on their skin and when they take antibiotics, good bacteria which are normally present on the skin die, allowing the yeast to grow and cause balanitis.  All of this is more common among uncircumcised men because growth of the yeast is favored by the dark, moist environment found under the foreskin.  You do NOT need more antibiotics. I would work to keep the involved area clean and dry and suggest treatment with monistat of a single 300 mg dose of fluconazole.  With this your balanitis should improve in a day or two.  EWH
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