[Question #1490] Chlamydia and treatment question

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89 months ago
Dear Doctors,
First of all, I think that this is an amazing resource here and thank you so much for providing much needed medical advice and knowledge to us worried people.

On Sunday afternoon (12/5) I had sex with a woman (I'm a man), 24 years old and during the sex the condom broke. I am not sure how long it had been broken for but it could have been broken for up to 5 minutes, meaning there could have been up to 5 minutes of unprotected sex. The next evening, (roughly 29 hours after the exposure) I went and got tested for Chlamydia and Gonorrhea. The doctor also gave me treatment for the two, a shot in the butt for Gonorrhea and 1g Azithromycin taken orally for Chlamydia. So to sum it up, I had unprotected sex and was exposed to STI's; 29 hours after this exposure I received antibiotic treatment. 

A few days go by and I'm thinking that the chances I caught an STI from that encounter were low, plus the fact that I had taken antibiotics for it and I stupidly have unprotected sex with my usual partner. However, I did not ejaculate inside of her, not sure if that makes a difference.  We had sex Thursday (12/8) around lunch time. I get a call on Saturday from the doctor's office telling my that my STI test came back positive for Chlamydia. Could I have infected my partner? We had unprotected sex 63 hours after I took 1g of Azithromycin orally for Chlamydia. Would this medication have wiped out the Chlamydia by then, making me non infectious to her? Does the fact that I took the medicine so quickly after exposure (29 hours) mean that there would have been less of the infection in me and thus cleared the infection more quickly? I do love her and would never jeopardize her health, so if I do need to tell her about this I will. I would just prefer not to as it has been a rocky time in our relationship and will cause us both a lot of pain and heartache. I would also like to mention that at no point did I experience any symptoms, no discharge, no pain while urinating, etc
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H. Hunter Handsfield, MD
89 months ago
Welcome to the forum. Thanks for your question and your kind comments about our services.

It is difficult to know how to interpret your positive chlamydia test. Your risk from a single exposure was very low, and generally it takes a few days after acquring chlamydia for tests to become positive. So I have to suspect you had it before the exposure a day previously. In that case, your regular partner had already been exposed and probably infected (and might have been the source of your infection), regardless of the treatment you had in the meantime. I would not have recommended you be treated in this situation, but if you indeed had an active or brewing chlamydial infection (or gonorrhea) the antibiotics would have aborted it, rendering you non-infectious 2 days later.

Standard policy is for all partners of people with positive test to be treated, without waiting for their own test results -- or even if those results are negative. So your regular partner needs to be informed, tested, and treated.  That's not the news you wanted to hear, but I'm afraid there's no getting around it. In any case, I think there's a pretty good chance she'll have a positive result when she is tested. I probably don't need to tell you that when relationships are stressed to the point that one partner has outside relationships, often the other has done so as well. So you may find your partner isn't much surprised by all this.

Sorry it's not what you wanted to hear. But let me know if anything isn't clear. Best wishes--  HHH, MD