[Question #13783] Likelihood of Delayed Chlamydia Transmission After Multiple Prior Negative Tests

18 days ago

I am seeking clinical guidance regarding the likelihood of delayed detection versus recent transmission of chlamydia.

I tested negative for chlamydia in 2021 (before entering my current relationship), again in 2023, and again in 2024. I recently tested positive for chlamydia for the first time.

My partner and I have been together since 2022. He reports never having been tested for STIs and states he has not been treated with antibiotics during our relationship. He maintains he has been faithful and suggests the infection may have existed in his body prior to our relationship and remained asymptomatic for several years before being transmitted to me.

From a clinical and epidemiological standpoint, how likely is it for an untreated chlamydia infection to remain active and transmissible for 4+ years without symptoms, compared to the likelihood of more recent acquisition and transmission?

Additionally, how should multiple prior negative tests in one partner be interpreted when evaluating timing of transmission?

Thank you for your guidance.

Edward W. Hook M.D.

18 days ago

Welcome to the Forum. Thanks for your questions. I'll be glad to provide some inforamtion.

Chlamydia can certainly be present and asymptomatic for periods of years however, existing infections gradually clear over time. After 3-4 years the majority of asymptomatic infections would have resolved even without treatment.

It sounds as though you have been tested on multiple occasions since the beginning of your current relationship and those tests have been negative for chlamydia. It is unlikely that those tests would have missed chlamydia, if it had been present- they are highly sensitive and it is unlikely that an infection, if present, would have been missed on more than one occasion.

Thus, while in science one can never say never, it is scientifically unlikely that your recent positive test for chlamydia would have been missed on multiple occasions. Similarly, if your partner had negative tests before this time, it is unlikely that those tests would have missed infection if present.

I hope that this information is helpful. EWH

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4 days ago

Thank you again for your prior guidance. I have one focused follow-up question:

Based on the scenario I posed, If my partner recently transmitted chlamydia to me but two weeks after the I tested positive twice, he subsequently tested negative, how likely is a false negative result in that scenario? Specifically:

Could timing (e.g., testing soon after exposure or after partial bacterial clearance) affect detectability?
From a probability standpoint, does a single negative test rule out recent transmission?

I’m seeking clarity on the likelihood of recent transmission given a negative result in the partner.

Edward W. Hook M.D.

4 days ago

In science there are few absolutes and strange things things happen. I can provide information on test performance and epidemiology. The current tests for chlamydia are among the most sensitive tests in medicine and falsely positive tests are very, very rare. From what you say, with two positive tests there is virtually no question but that you were infected and had become infected since your last negative test.

Research shows that about 2-3 weeks after a woman has a positive test for chlamydia, without treatment the bacteria can no longer be found. As mentioned above however, there are also solid data that the bacteria can persist asymptomatically for months or even years.

In response to your specific questions:

1. Testing too soon ( a day or two after an exposure that leads to infection) tests may fail to detect infection. After 3-5 days tests are very, very reliable. As explained above spontaneous clearance of established infection does occur over time.

2. As mentioned above however, current tests for chlamydia are very accurate and rarely miss infection when present

I appreciate you are struggling with your situation. I hope this information is helpful. EWH

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