[Question #2273] Chlamydia Re-Infection

44 months ago
Hi, and thank you for your help. I began sleeping with my ex unprotected in February in March I had symptoms of  an ear infection, I was prescribed Augmentin on March 13th BID for 7 days, I took the full dose. On April 17th I had a STD test which I was positive for Chlamydia. I took the full treatment on April 19th 1G of Azithromycin. My partner took his dose on April 26th and hours later he had vomiting and continued to have vomiting for a couple days that actually put him in the ED on May 2nd. He told the doctor he had taken 4 250mg tablet of Azithromycin and the ED doctor did not retreat him. A week later we began having oral and brief (5-10) seconds of penetration, no ejaculation. On June 1st I had some abdominal discomfort with 1 episode of discharge.  I went to an urgent care and was swabbed, my test came back positive for chlamydia again. My dr now has me on 100mg BID of doxycycline for 7 days, I am on day 3. My question is it possible that my partner did not tolerate the full treatment as he vomited hours later and reinfected me during oral and brief episodes of penetration? We never had full on sex that ended with ejaculation or a lot of thrusting.  Also is it possible that because I took Augmentin in March that I was resistant to the Azithromycin? And should I be on a longer course of doxycycline now? How common are resistant chlamydia infections? I am very concerned for PID, although I have mild intermittent abdominal pain and no episodes of discharge now. I am extremely concerned about fertility. 
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Welcome to our Forum.  I'll be happy to comment.  For you to have a positive repeat test for chlamydia about 6 weeks after your treatment is a strong indication that either your treatment failed or your partner's therapy was unsuccessful and you were re-infected during your recent exposure.  Both are possible but if I had to guess it would suspect that your partner's vomiting may have prevented his azithromycin therapy from successfully treating your chlamydia an that you were then re-infected during your brief contact.  Careful research studies show that azithromycin cures about 98% or chlamydial infections but vomiting (a well described side effect of the drug) can result in poor absorption and therefore treatment failure.  If he failed therapy, he certainly could have re-infected you even without ejaculation (ejaculation is not required to transmit chlamydia -even a little, brief penetration can sometimes transit infection).

Your Augmentin would no make you resistant to azithromycin therapy.   Resistant chlamydial infections are very, very rare and it is not clear why the small proportion of persons who fail therapy do so. 

You will need to discuss with your doctor as to whether of not she/he believes you have PID.  If you do, it would be recommended that you be treated for 14 days rather than 7.  If you had PID typically the abdominal discomfort would NOT be intermittent and would begin to improve after about 3-4 days of treatment. 

finally, with respect to your concerns about fertility- first you do not know that you have PID and secondly, even if you do, most women who have had PID do not become infertile. 

I hope this information is helpful.  It sounds like you might do well to go see your regular doctor to address some of the questions you raise.  In addition, please be sure that your BF is treated and that you abstain till you both have completed therapy.  EWH
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44 months ago
Thank you for your response. My follow up question is even in people with resistance is it something that is eventually cleared with multiple or IV antibiotics or is it something they end up having to live with? Also does it matter that it was a couple hours after he took the medication that he threw up?
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
The likelihood that your chlamydia is resistant is miniscule.  Even if you were one of the fraction of 1% of infected persons with a resistant chlamydia however, it would not be untreatable.  I am not aware of any chlamydial infections that could not be treated. 

Your question about the timing of his vomiting is a "what if" question.  The azithromycin can actually cause the vomiting, even after an hour or so.  The closer to taking it the less likely it is that the medicine got into his system but to make precise estimates of the relationship between the timing of his vomiting and the medicine effect is difficult  EWH
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44 months ago
Thank you. And how long does it take doxycycline to resolve symptoms? I am half way through now and still have (although improving) vaginal discomfort. Also I normally have about 7 drinks per week, although have maybe had 1 or 2 drinks while on this treatment. Do people who consume excess amounts of alcohol require more treatment usually? 
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Vaginal discomfort is rarely a sign of chlamydial infection.  On the other hand, drugs like doxycycline can increase risk for problems like yeast infections.  I would suggest that you ask your doctor about this. 

Alcohol does not keep doxycycline (or azithromycin) from working (unless it leads a person to forget to take their medications).

I hope my comments have been helpful to you.  This is my third reply to your questions and therefore, as per Forum Guidelines, this thread will be closed later today.  Take care.  EWH
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