[Question #2254] Questions about chlamydia

45 months ago

I was awoken at an afterparty 23 months ago by a woman who appeared to be trying to perform oral sex on me. I think she went no further than kissing the tip of my penis, when I told her to stop, but I don’t remember clearly. I have not been sexually active since.

I didn’t really worry at first, but started thinking about STIs after a few months. I figured HSV, syphilis or NG would most likely have caused obvious symptoms by that time, but was confused on CT: Different sources gave conflicting information on how readily this STI is transmitted orally, what symptoms to look for etc.

I started looking for symptoms and noticed clear, sticky fluid from the penis (once or twice a week or so). It is never much, unless I am clearly aroused. After seven months I took a PCR urine test (first void, a bit more than the recommended 15 ml, but surely less than 30 ml) for CT. It came back negative.

I probably come off as neurotic now, so I will try to ask some questions that are hopefully informative to others.

1. Some sources say that a kiss to the tip of the penis is a no-risk event for urethral STIs. Others admit to some risk. What is true?

2. A few years ago I read that no proven case of mouth-to-penis-transmission of CT has been recorded. Is that still true?

3. What is the probability of a false negative PCR test for CT? Does the amount of urine matter?

4. How is chlamydial discharge distinguished from normal urethral mucus/pre-ejaculate?

Edward W. Hook M.D.

45 months ago

Welcome to our Forum. I'll be please to comment . A few general comments first. You are correct that most chlamydial infections are asymptomatic and that chlamydia is a relatively common STI. Having acknowledged that, let me also tell you that I am confident that you did not get chlamydia from the encounter you are desribing. Although among STIs chalmydia is relatively common, the fact is that most people do not have STIs. Further, acquistion of chalmydia from oral sex is quite uncommon and the exposure you describe appears low risk because your partner did not take your penis entirely into her mouth. Finally and most importantly, you were tested correctly with a PCR test and these tests are very sensitive. Putting all of this together, your exposure was low risk and I encourage you to have confidence in your test results that you did not acquire chlamydia. Let's now address your specific questions:

1. Some sources say that a kiss to the tip of the penis is a no-risk event for urethral STIs. Others admit to some risk. What is true?

See above. There are no absolutes in science but a kiss to the tip of the penis is certainly very, very low risk for STI.

2. A few years ago I read that no proven case of mouth-to-penis-transmission of CT has been recorded. Is that still true?

I am unaware of any proven cases in which chlamydia has been proven to be transmitted by oral sex.

3. What is the probability of a false negative PCR test for CT? Does the amount of urine matter?

Very, very low. The amount of urine has been studied and variation in urine quantity does not significantly change the performance of the test.

4. How is chlamydial discharge distinguished from normal urethral mucus/pre-ejaculate?

As you seem to suggest, a small but variable amount of mucus is normal in the penis and can be seen if one looks closely. It can look a bit like pre-ejaculate. Abnormal discharge due to chlamydia is not present intermittently however.

I hope this information is helpful. I urge you not to worry further about chlamydia from the exposure you have described. EWH

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45 months ago

Thank you,

To follow up on the fourth question: Does that mean that abnormal discharge due to chlamydia would be present/obvious all the time?

Also, what is the longest recorded duration of genital chlamydia infection among men?

Edward W. Hook M.D.

45 months ago

Yes, an abnormal discharge due to chlamydia or other STI would typically be present continuously, not come and go.

There are no good data to answer the question of the longest possible duration of genital chlamydial infections in men (or women) since it would be unethical not to treat a known infection. The majority of chlamydial infections will resolve in a period of months but some (with most data from women) have been known to persist up to three years. EWH

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44 months ago

Thank you,

Last question: What is the likelihood of an infection lasting more than two years?

And finally: I appreciate the service. I have general anxiety issues, and have been advised to try and tackle them with facts. However, I find it frustrating that the information on chlamydia (the risk of different exposures, the characteristics of symptoms, the reliabilty of the tests, the typical duration of an infection etc) seems to vary quite widely between different sources. I also find the lack of certainty related to some of these questions frustrating, but I guess that's just something I will have to accept. Anyway, thanks again. Hopefully your answers will help me come to terms with the high probability that I am not infected, and you will not hear from me again.

Edward W. Hook M.D.

44 months ago

Available research suggests that withoutherapy men clear their infections faster than women. At two years I would anticipate that over 90% of of men with infection would have cleared thier infections. I would add, addressing your anxiety issues thathe topic of your clearance is irrelevantto you- your negative test is close to absolute proof that you did not get chlamydia from your encounter onearly 2 years ago.

As you know this is my 3rd reply to your questions. As a result, as per forum Guidelines, this thread will close later today. Take care. EWH

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