[Question #1513] Chlamydia NAAT test after taking Bactrim ds?

45 months ago
26 year old male here. I received oral sex from a stranger a two years ago. About ten months later, white blood cells and protein turned up in my urine after i got it checked because of some urinary discomfort. The doctor seeing me said I DEFINITELY had an STI without a doubt and did a blood test and urine naat tests. Everything came back negative and I was able to put it out of my head. I recently am having the same symptoms. Ive been dating the same girl during this whole ordeal. I am wondering if its possible that i gave Chlamydia to her, then naturally passed the infection myself, only to have her give it back to me? Doctors keep telling me there is no other way for white blood cells to be in my urine and for a 26 year old male to have a uti. Any other explanations for this? Also, my newest doctor actually said i could be a rare case and gave me bactrim to get rid of the potential uti. I took two bactrim pills, one wednesday night, one thursday morning before my nerves got to me and i decided to get tested for chlamydia again. Does bactrim mask chlamydia, potentially giving me a false negative? I am planning on doing a urine naat test on monday, exactly four days after taking my second and final bactrim pill. Will my naat test be accurate?
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Welcome to the Forum.  I am a bit hesitant to disagree with doctors who may have seen and examined you in the past, as long as they did thoroughly evaluate you and test for STIs, including performing a Gram Stained smear of a swab specimen from your urethra but I am going to do this.  There certainly ARE men of your age who may have urinary track infections, just as there are men who may have signs of urethral inflammation who do not have STIs,   In no particular order, let me make a number of comments which may be useful to you:

1.  Following oral sex, a small proportion of men will develop non-gonococcal urethritis (NGU) which is diagnosed based on symptoms (urethral discharge and/or burring on urination accompanied by evidence of inflammation (white blood cells) on urethral gram stain.  These problems are almost NEVER caused by chlamydia and in my business are called non-chlamydial NGU.  This problem is thought to arise from the reaction to having bacteria from a sexual partner's mouth introduced into the urethra during non-genital (in your case oral) sex.

2. White blood cells in the urine could come from a UTI (VERY rare in men of your age, as you've been told), prostate infection, or a number of rare-non-infectious illnesses. 

3.  The NAATs for chlamydia are among the most sensitive tests we have in modern medicine.  If you have been tested more than once while symptomatic and untreated, you do not have chlamydia. 

4.  The chance that you were infected, infected your partner, cleared the infection yourself, and then reacquired infection is infinitesimal. 

5.  Bactrim does have modest activity against chlamydia, as well as many of the bacteria which cause UTIs and prostatitis.  thus it may make interpretation of your tests difficult. 

I hope these comments are helpful.  If you remain symptomatic and still have bacteria in your urine, I very strongly doubt that it is related to the encounter two years ago that you describe.  I would suggest that, if the inflammation persists, you seek the evaluation of a urologist.  EWH

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45 months ago
Thanks for the response. A few more questions

1. about the bactrim, would taking a total of 2 pills before stopping have gotten rid of chlamydia or just supressed it? Either way, i want to be tested again, if my 2nd and last bactrim pill was thursday morning, when do you think i can take a naat test and expect accurate results. 

2. About ngu urethrits. So this kind of thing can happen without it being an std? Can urethra and bladder be temporarily irritated from either oral or vaginal sex for a period of a few weeks simply from general, common sexual fluids getting in my urethra? Is that what your saying?

3. When this all first happened a year ago i tracked down the woman who gave me oral sex. She sent me test results she had recently had saying she was chlamydia free. I didnt pay attention to them though because i figured that if she had it in her throat it wouldnt show up on a test. I forget what kind of test she took, but if it was a naat test would throat chlamydia still show up? Basically, would a urine naat test detect throat chlamydia?

4. What are chances of getting chlamydia from a one time blowjob in the first place? This woman was about 45.

5. In highschool while still a virgin i had an illness, either epididymitis or a varicocele. Very painful. Still flares up occasionally. Starting then, and to this day sometimes when i urinate a plume of whiteness comes out at the very beggining of me peeing. Are these white blood cells caused by some sort of chronic epididymitis?
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

1.  Typically chlamydia would still be detectable after two Bactrim but there is no way to know.

2. Yes

3. NAATs detect infection from the site that the specimen is taken from.  A person with chlamydia in the throat, (a very, very rare occurrence) would not necessarily have a positive genital test.

4.  Most women do not have infection, of those with chlamydia, less than 1% have the infection in the throat.  Overall, your chance of having chlamydia would like be between 1 in a million and 1 in 100,000.

5.  What you describe could well be the source of your white blood cells.

My sense is that your search for an STI is misdirected.   EWH

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45 months ago
Thanks again, I still plan on getting tested Monday morning and hopefully that will put me at ease, in the meantime I have developed pain in my rectum, could I be having some sort of prostate infection? Is that possible for a 26 year old? This is my last question thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Rectal discomfort and prostate tenderness are symptoms or prostate infections but not of STIs unless you have participated in receptive rectal intercourse.  And yes, 26 YO men can certainly get prostate infections - not so common as for men over 40 but still not all that unusual either. 

As you have acknowledged, and in that this is the third reply to your questions, this thread will be closed later today.  I wish you the best.  EWH

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