[Question #1653] Antibiotic resistance and Chlamydia?

91 months ago

I cheated on my partner once. I noticed heavy discharge and treated it like a yeast infection but it didn’t go away. My ob-gyn diagnosed me with BV and chlamydia. I was prescribed metronidazole and 1 gr of azithromycin. I found a way to get another prescription of azithro so that I could treat my partner without him fully knowing. I gound up the medication, told him it was a supplement and put it in his coffee and he drank almost all of it. After I took my medication, my discharge went away within a few days. I waited a week before resuming sex with him. My plan was to have lots of sex with him after the week and get retested 3 weeks after to see whether his chlamydia was cured or not. I got retested after having sex about 6 times with my partner (he came inside of me) and my results were negative. I assumed neither of us had chlamydia and I continued sex with him. However, I noticed discharge again and got retested at a different facility. As it turns out, I have chlamydia again. They prescribed me another gram of azithro. It seems like my partner did not ingest the whole 1 gram last time so, without too much detail, I convinced him to take an entire gram of azithro this second time around. It has been 7 days since we took our meds and it seems like my discharge has lessened a little bit but is still very much there. I’m fearful that by not taking the entire 1 gr dose the first time, his chlamydia (and now mine) is now immune to this second round of azithro and that we will need to take different medication. Is having discharge after the 7 days normal? Is it likely that our chlamydia is resistant to azithro now? I'm really terrified that I will have to confess my indiscretion under these circumstances. Please help.

H. Hunter Handsfield, MD

91 months ago

Welcome to the forum. Thanks for your question.

Your question raises both medical and ethical questions, but they are closely related and difficult to separate. My first advice is exactly what you don't want to hear: there is no getting around the need to tell your partner everything. You could probably skip the information about your other partner, at least initially -- but you must tell him you tested positive for chlamydia what happened after that. Of course you should also be truthful about your other partner if he asks. But who knows: maybe he also has had other partners, in which case he could have been the one who brought chlamydia into the relationship. By not being honest from the start, probably you have made things worse for your relationship and perhaps medically as well, because prolonged and recurrent chlamydial infections carry higher risks of complications. But the longer you keep trying to deceive him and the longer you delay telling him, the worse it will be. And from a basic moral standpoint, most would consider it unethical to not tell a partner about an STD. (That said, I can imagine a valid reason, and this sort of thing is more common and perhaps more expected in some countries and cultures than others. It probably would be a valid reason if you would have been at risk for abuse or even violence if he knows the truth. But I assume that's not the case, since you haven't said anything. All things considered, almost always complete and open communication is the best strategy.) In addition, chlamydia often is accompanied by other STDs. Even though that's the only STD found in you (not counting the BV), he should have been professionally examined for others, including gonorrhea and syphilis. And you both need testing for HIV.

Turning to your main question: Fortunately, antibiotic resistance is never a problem with chlamydia, which is always susceptible to the standard treatment, including azithromycin. Some cases (about 2-4%, one in 25 to 50 patients) are not cured with azithromycin even when the full dose is received. So although biological antibiotic resistance itself isn't a problem, standard practice is that recurrent chlamydia or nongonococcal urethritis (NGU) after azithromycin normally are treated with doxycycline for a week, not a repeat dose of azithromycin. So there's yet another reason you need to inform your partner so he can get proper medical care.

Therefore, my specific advice is to 1) stop further attempts at self treatment of either you or your partner; 2) inform him what's going on, with as much sensitivity and understanding as you can muster; and 3) that the two of you visit a doctor or clinic, preferably together, so your diagnostic tests and treatments can be coordinated from here on.

I'm sorry much of this isn't what you hoped to hear, but that can't be helped. Let me know if anything isn't clear.

Good luck-- HHH, MD

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