[Question #13688] Question about chlamydia transmission

2 days ago

Hello,

I got a question: As you can see in my post history, I did a stupid thing a year ago: I had sex with a CSW in Germany. It was all protected, no petting, kissing, unprotected oral/vaginal/anal.

After a year, I noticed some discomfort in my urethra. It feels like it's always a little "wet". But when I check, there is nothing to see/smell. Once I spread the opening of the urethra a little and saw some fluid in it, but nothing "came out".

Now I was worried: What if I catched chlamydia from my date with the csw? I remember that I took good care using the condom and while taking it off after we were done (well, it was quite a short activity, not longer than 3min and not "hard" at all) I took care that the outside of the used condom does not touch my skin.

Well... And still here I am, after I read that condoms do not really protect that well from chlamydia. And I am not sure if I am looking at my body too often and "imagine" things that aren't actually there. Or if I possibly catched something.

So my questions are:

1. How likely is a transmission after all?
2. If I am unlucky: Is it a thing that I develop "symptoms" after a year?

3. What if other parts of my body touched her vagina without protection? E.g. my scrotum. Does the chlamydia "move" to my urethra?

4. I washed myself after I finished. I took a shower with soap. Does this help or does this make things worse, because I touched myself

H. Hunter Handsfield, MD

2 days ago

Welcome back but I'm sorry you found it necessary. I'm sorry to learn that you continue to worry -- far more than you should -- about a sexual decision you regret.

We discussed the zero risk of gonorrhea in this situation in your previous thread. All those comments -- including for example condoms as prevention -- apply to chlamydia as much as gonorrhea. I can't imagine any scientifically valid websites or other sources saying that condoms are not excellent protection against chlamydia. They are. To your numbered questions:

1. How likely is chlamydia transmission in this situation? Zero for practical purposes.

2. Your symptom do not fit with chlamydia. Had you acquired it over a year ago, it would be gone by now. And your comment about "looking at my body too often" is significant. Whenever someone suspects their symptoms have a psychological or emotional origin, usually they are right. Anxiety makes people more aware of minor symptoms or even normal body sensations that otherwise would not be bothersome and perhaps not even noticed.

3. No STI, including chlamydia, can be transmitted by contact of "other parts of the body" with a partner's genital area.

4. Washing after sex doesn't hurt, but its benefit isn't great. For practical purposes it neither helps nor hurts.

You and your wife do not have chlamydia. Put that worry -- and worry about any and all STIs on account of your single sexual indiscretion -- out of your mind. I hope these comments are helpful. Let know if anything isn't clear.

HHH, MD

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1 days ago

Hello Dr. Handsfield,

I think for me the lack of a 100% safety is something I cannot really handle mentally and I already reached out for help here - it takes some time here in Germany to get psychological help in cases that are not super urgent.

Regarding your answer: This is reassuring. Thank you very much. The sources I read are official statements from the German Aidshilfe and the Robert Koch Institute and the website liebesleben, which is run by the federal institute for public health.

They say:

There is no complete protection against infection with chlamydia. However, using condoms can greatly reduce the risk of infection.

Other sources state that condoms can help but they are not as safe when it comes to chlamydia compared to when it comes to HIV.

However, I know that people are more defensive when it comes to public statements and I do get that there will always be a chance that a condom does not work correctly, which is basically the case if used incorrectly or if my penis gets in contact with fluids, e.g. if I rubbed my penis unprotected on the vagina of an infected woman (which I did not).

You also state that that infection, if present, would be gone by now. The aidshilfe website tells that chlamydia can be undetected oved years and cause severe issues which may cause the inability to have children in the future. This is basically something I do not really get yet: There are sources telling me that asymptomatic chlamydia can stay in my body for years or even start causing symptoms after months or years. And then there are sources that tell the exact opposite. As I am not a medical professional, I do not understand why trusted sources come to different conclusions.

H. Hunter Handsfield, MD

1 days ago

Of course some people who always intend entirely safe sex still acquire STIs, including chlamydia. Generally it is because condoms are not used correctly or break; because some people just forget safe sex sometimes (e.g. alcohol, drugs) but don't remember those events; or because they have a monogamous partner who has had other partners. Therefore, of course it is technically that "there is no complete protection" among people who have sex outside mutually monogamous partnerships. And some public health agencies, governments, etc intentionally have conservative statements about sexual safety -- which might be the case for the statement you quote. (I know nothing about any of the 3 sources you mention or about other German public health authorities.)

Chlamydia is inherently much more infectious than HIV; in that sense, condoms may fail to protect more often for chlamydia than HIV. Still, a properly used condom that doesn't break is close to 100% effective in preventing chlamydia.

Chlamydia can last for years in women, but 4 years is the longest documented; and most infections are cleared within a year. I am unaware of male genital chlamydia lasting longer than a year. If it happens, it is rare. However, there are no conclusive data on this -- no studies have attempted to test large numbers of males for chlamydia who have not been sexually active for many years. So theoretically there are uncertainties that contribute to some agencies' conservative advice.

Trust me on this: STI specialists rarely if ever encounter males with chlamydial infection that a) had been present for more than a year or b) was present despite negative testing for it. I certainly have not, in my 50 years in the STI business.

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1 days ago

Thank you for your response. So I just checked a blood test result and I saw that there was an antibody test for chlamydia included in this test after about 13 weeks. But those seem to be not as accurate.

I agree with you regarding the conservative statements of authorities. They do most likely never say "it is guaranteed".

So I will summarize:

- My exposure was not very high risk

- It would be unlikely that this infection would have no symptoms for a year and after that year symptoms are beginning

- Condoms are "good, but not perfect" to prevent chlamydia.

Is that a correct summary?

As this is my last post: Thanks for your help :-)

H. Hunter Handsfield, MD

1 days ago

Correct -- chlamydia blood tests are not reliable. Your summary is correct, except I would say condoms that are properly used and do not break are nearly perfect protection against chlamydia.

As you expected, that concludes this thread. I hope the discussion has been helpful. Please note the forum rule against repeated questions on the same topic. This being your second about a sexual exposure more than a year ago, it should be your last about that exposure its STI risks. Thank you for your understanding.

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