[Question #12656] Panic attack

6 months ago

Hi doctor,

Thank you for all that you do, I might be having a panic attack and need some advice.

On Nov.1 I gave a male coworker an unprotected blow up. He is mid 40s, and there was no ejaculation. I have read through the forums but maybe I just need more personal advice. 5 weeks after the blow job I started panicking about oral chlamydia ( gonirrhea wasn’t on my radar since 95% of male uretheral gonorrhea is symptomatic… read that here ) I took azithromycin 500mg x3 days ( which I know isn’t the correct dose, but the 1g gives me stomach aches). 3 weeks later I started a new relationship that started with unprotected blow jobs. I am now panicking that I gave my new partner genitalia chlamydia from my oral exposure. He has no symptoms

What is the realistic probably that I had oral chlamydia 8 weeks after giving a co worker a blow job ( no reason to think he had chlamydia at the time, he said nothing to worry about- but I’m not sure)

Or what is the realistic probability that if I had oral chlamydia the 500x3 days of azithromycin would have cured it.

Thank you

H. Hunter Handsfield, MD

6 months ago

Welcome to the forum. Thanks for your confidence in our services. Thanks also for scanning other questions similar to your own.

You're right about urethral gonorrhea rarely being asymptomatic. However, chlamydia also was very unlikely: it is not true that 95% of male chlamydia is asymptomatic; it's closer to 30-40%. In other words, most urethral infections do cause symptoms. Equally important, chlamydia is quite rare after age 30: the odds a mid 40s maie would have it are very low. And chlamydia does not take well to the throat: oral chlamydia is extremely rare, even in persons directly exposed by oral sex with a known infected partner. But if you had nevertheless been infected with chlamydia, the azithromycin probably would have cured it. Azithromycin is not as effective against chlamydia as once believed -- doxycycline is the drug of choice. But given the near zero chance your partner had urethral chlamydia, another near zero chance you were infected even if he did, plus the azithromycin, there is no realistic chance you ever had an oral infection. On top of that, even when oral chlamydia IS present, it almost never is transmitted to new partners by oral sex.

All these low odds considered, there is no realistic chance you had it and no possibilty you infected your new partner. At this point I would advise against any further tesing, against saying anything to your new partner, and against any further treatment. You're fine!

I hope this reply is helpful. Let me know if anything isn't clear.

HHH, MD

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6 months ago

Thanks so much for the reply!

I have also read on here that if one had oral chlamydia it would self cure. If the azithromycin didn’t take care of the chlamydia in the off chance I had it- would it have been cleared by week 8?

H. Hunter Handsfield, MD

6 months ago

Almost all chlamydial infections and gonorrhea self cure with time. For oral chlamydia, it can be as quickly as 2 weeks, usually within 6 weeks. But the possibility you ever had oral chlamydia probably is under one chance in millions. My replies would be exactly as you have seen them even if you had not taken the azithromycin.---

6 months ago

Thank you- I’m going to trust that I was never infected.

Just curious, since this is my last question- might as well use it-

You said oral chlamydia is almost transmitted to partners, have you had a patient who tested positive whose only exposure was oral sex?

H. Hunter Handsfield, MD

6 months ago

I think there's a typo -- assuming you understood my initial reply, oral chlamydia is almost *never* transmitted to partners. Not only have I never seen a case in which this happens, I was the senior investigator on one of the first studies to show that oral chlamydia rarely is transmitted: https://pubmed.ncbi.nlm.nih.gov/9153736/ Those many years ago, our research was based on culture of chlamydia, whereas we now know that nucleic acid amplification testing (NAAT) -- the main method in labs today -- picks up some infections missed by culture. Still, the complete absence of chlamydia in the urethras of men whose only exposure was fellatio was strong evidence against oral to penile transmission. Other research using NAAT has largely confirmed our findings; here is but one more recent example. Even this is nearly 20 years old, but even the most recent research shows oral to genital transmission to be very rare: https://pubmed.ncbi.nlm.nih.gov/16388480/ The problem isn't in the science, but in how the internet can give misleading impressions, especially on sites run by and for people with chlamydia or worried about it (like Reddit, for example).

That concludes this thread. I'm glad to hear you're going to trust the science!

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