I have follow up serious question. First I want to say I tested negative for HIV (my main original worry)2 months after this encounter On sep 17th in which  I had unprotected sex with a female and a month later experienced testicle swelling, malaise, painful urination, dry skin on penis. I got std tested on Oct 20th (due to symptoms I was having) and tested negative for all stds except for Chlamyida. I took a week of doxycycline 100mg taken twice daily (from October 24-October 31st) and symptoms got better. Since then I’ve had general malaise and have felt very sick..but starting two days ago I started getting the exact same swelling in testicle, painful urination, and dry skin on  penis and sore throat but all worst compared to first time . I’ve had no sexual encounters whatsoever since September 17th. Is it possible to doxy didn’t get rid of chlamdiya ? Getting tested again tmmrw for it and not sure what to do if it comes back positive..what’s your thoughts and recommendation for treatment? Scared of antibiotic resistance/why it’s not gone away completely.  

I'm sorry to hear of your recurrent symptoms, but you should not assume you still have chlamydia. However, it is very unlikely that persistent or recurrent chlamydia is the cause of your symptoms. There is no such thing as chlamydia strains that are not cured by doxycycline. One possibility is gonorrhea, which also causes epididymitis (the usual cause of testicular pain in this situation) and often is not effectively treated with doxycycline. On the other hand, it is rare for gonorrhea to persist without obvious symptoms (pus from the penis, painful urination). I'm glad you're being tested; that is exactly the right thing to do. But for the reasons just stated, I predict your chlmaydia test will be negative -- and probably your gonorrhea test as well. (Make sure they test for gonorrhea as well as chlamydia.) I would also advise testing for Mycoplasma genitalium, another common sexually transmitted problem; and for standard urinary tract infection bacteria (E. coli etc).

Also, dry skin of the penis and sore throat are not caused by chlamydia -- or by other STDs.

I hope you're being seen by a physician or clinic who understands STDs -- for sure you should not be testing yourself through a lab without professional medical evaluation and advice. What have those doctors said about your situation? Have you been professionally examined? Urinalysis done? Urethral swab to look for increased white blood cells? All these are necessary in proper evaluation of this problem.

I'll be happy to comment further if you'd like to tell me what your doctor or clinic has said so far, and again when your lab test results are available. In the meantime, don't be overly worried. In the long run, this isn't dangerous and effective treatment will be available once the diagnosis become clear. Good luck in the meantime.

HHH, MD

Thanks for your response. When I tested positive for chlamydia on Oct 20th they tested me for ghonnorhea and I was negative but they gave me a shot of rochephine  just in case and prescribed me a week of doxy for the positive chlamydia test on Oct 20th which i took.  I saw Vanderbilt walk in clinic today and they did a test called poct perform urine dipstick which was negative for everything and retested for all stds which I’m waiting for the results (my pcp is at vandy but since it’s Sunday and holidays coming up I can’t get in to see him yet). The person at walk in clinic wanted me to take doxy for a week again but I told them I’d like to wait for results for std panel and to try to get a hold of my doctor or his nurse via health portal tmmrw for what he advises. They didn’t test me for mgen saying they couldn’t at walk in. It’s literally exact same symptoms as when I tested positive for chlamydia on October 20th but I have had no sexual contact or anything with anyone since Sep 17th. I’m worried about chlamydia affecting my eyes/blindness since I have conjunctivitis and other long term complications if the doxy didn’t cure my chlamydia and what next step are.

Pain from Crohn's or other kinds of intestinal inflammation could be referred to the testicular area (because of nerves that serve both areas), e.g. from an inflamed bowel segment near the prostate gland. I'm not making such a diagnosis from this distance, but you might discuss it with your docs. Did you ever have urethral discharge or painful urination? Or was the testicular pain the only symptom?

You were wise to defer the doxycycline treatment. The apparent absence of white blood cells, indicating no inflammation in your urethra, is strong evidence against any infection in your lower genital tract; I continue to be confident that the final gonorrhea/chlamydia result will be negative. That finding also makes M. genitalium very unlikely. Given the similarity of your symptoms in October and now, I think it likely that your chlamydial infection might have been asymptomatic, with your discomfort both then and now due more to the Crohn's. This also is something to discuss with your providers. This also would be consistent with the rather long delay (nearly 4 weeks?) from your last sexual exposure to onset of symptoms; and with the possibility you had chlamydia even longer than that.

Neither Crohn's disease nor any other intestinal inflammation would reduce absorption or effectiveness of doxycycline.

There is no such thing as non-curable chlamydial infection. And in my 50 years in the STD business, I've never seen nor heard of a case of chlamydial epididymitis that wasn't cured or whose symptoms returned after treatment with doxycycline. I can't say it's impossible -- but if I correctly recall one of your earlier threads, you actually took a full two weeks of doxy, right?

Threads normally are closed after two follow-up exchanges, but I'm just as interested in your test results as you are in telling me! But let's hold off on additional discussion until you have those results -- both the STD tests and urine culture for UTI bacteria -- and ideally also after you have been reexamined with those results in mind.

Sorry to respond so soon.. to clarify I took 100g doxycycline 2 times a day for a week when I tested positive in October. I took the whole thing exactly as prescribed and haven’t had any contact with a female since the 9/17 encounter. I am currently  in a predicament and need some advice. My pcp is out of office until Thursday. So far,  my hiv and syphillis already came back negative but still waiting for the chlamdyia and ghonnorhea test results. My symptoms are exactly identical to last time I had chlamydia and If  the results come back positive for chlamyida (then the doxy didn’t wipe it out completely) Should I g2 ER/walk in clinic before Thursday ?(when my pcp is back in office) and should I take the doxycycline for a week again like they gave me the first time or what alternative antibiotic is there? Or should I wait till Thursday until I can contact my pcp? I can start another thread once I get all my results back I don’t mind. Just insanely anxious about what to do as I have these symptoms and on top of it I have lost some weight  and have not been feeling well (just general malaise/tiredness) so if it’s Chlamydia my body is struggling.

3. What is the difference between a dna and an rna test?

Thanks and this will be my last response to the thread or if I need to buy and open a new threat to ask the above questions I will. I appreciate your insight! 

Your negative chlamydia test undoubtedly is conclusive:  something else explains your testicular pain. False negative results are very rare, and probably never occur in the presence of overt symptoms like yours. The proper general name for DNA or RNA testing is "nucleic acid amplification test (NAAT). All chlamydia NAATs detect chlamydial RNA; there are no DNA tests. (However, some physicians don't know this, or they use "DNA" meaning NAAT, i.e. including RNA tests.) To illustrate how sensitive the chlamydia NAAT is, many years ago a scientist involved in designing the very first such test claimed that if a lump of chlamydial RNA the size of a small sugar cube were diluted in the entire volume of Lake Michigan (the scientist was in Chicago), a sample of lake water would test positive. I don't know if the current tests are quite THAT sensitive, but you get the idea:  if infection is present, the test is positive.

You still have not described your doctors' findings on physical examination. Did they look for urethral (penile) discharge? What was found on examination of your testicles? Do you have enlargement and tenderness on the involved site? If the latter is present, the full urinalysis results need to be known. Has epididymitis been diagnosed? And aside from STI testing, do you have results of urine culture for UTI bacteria? All these are necessary in evaluating problems like yours.

At this point, I am not convinced you ever had chlamydia. As perhaps implied by the sensitivity of NAAT, false positive results sometimes occur. And chlamydia is almost never acquired by oral sex, because it doesn't infect the mouth or throat very well, therefore no infection to be transmitted by oral sex. As I said above, maybe you actually had chlamydia going back a year or more, from a different sexual exposure than the more recent oral sex events. 

If epididymis is has indeed been confirmed by exam and urinalysis, you should be on an antibiotic -- but doxycycline would not be a good choice. It might work, but it isn't reliable against many UTIs and the bacteria that cause them. And you absolutely must not take any antibiotic until after all tests are completed, i.e. the urine culture for UTI bacteria. Consultation with a urologist also would make sense for this problem.

That takes this discussion as far as it can go. Discuss all these issues with your own doctor(s) then follow their advice. Good luck.