[Question #238] Possible reactive arthritis

36 months ago
Dear Doctor,

I will try to be direct since my English is not good.

I had chlamydia from prostitute (unprotected oral and protected vaginal sex) two years ago (urethral swab by pcr). I toke antibiotics and my cure test was  negative. My wife was negative.

Year 2015:
July 17: unprotected oral from massage parlour
July 19 and 24: unprotected oral, vaginal and anal with my wife
July 28: unprotected oral from the same massage parlour 
July 31: my wife has ankle pain without apparent trauma (she was treated as ankle sprain, a midly pain remains today)
August 2: my wife gets conjuntivitis (mucopurulent discharge and eye pink). She starts a tobramicin drops treatment. A mild better improvement is seen next day.
In panic, August 3: I test positive for chlamydia (antigen urine test)
August 3: my wife and I take 1g of azytrhomicin 
August 4: I test negative for chlamydia with the same method (antigen urine test). My wife and I take 500mg of cefuroxime-a. For covering a possible gonorrea.
August 10: real improvement of my wife eyes. I test negative for chlamydia, mycoplasma and gonocco (first catch urine by pcr).
Today: my wife conjunctivitis ( she put cipro drops for 10 days. A little improvement but now the eyes are red with watery discharge) and ankle discomfort remains.

I have geo tongue from my first episode of chlamydia In 2012.

My fear is that my wife has reactive arthritis.

What is your profesional opinion? Next steps?

Thank u
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago

Welcome to our Forum. I will try to help.  The events that you describe, your having gotten chlamydia and your wife's conjunctivitis and ankle pain may be unrelated.  You did precisely the right thing to  have both you and your wife be treated with azithromycin, this should and has apparently, resolved your chlamydia infection.  Good work!

For your information, geographic tongue is a normal finding and is not related to any STI, including chlamydia. 

Whether or not your wife has reactive arthritis (and conjunctivitis)  is unclear, as is the possibility that her illness is related to possible chlamydia.  There are many possible causes of recurring conjunctivitis which can and should be evaluated by your regular doctor.  Conjunctivitis may be due to infection (most often viral), to vasculitis, or to other causes originating within the eye. Reactive arthritis is very rare, is less common in women than men, and when it is present can be related not only to chlamydia infection but also to other infections (like campylobacter, a non-STI gastrointestinal infection)..  I hope she does not have reactive arthritis as this does not respond to further antibiotic therapy but, instead, should be managed by a rheumatologist with anti-inflammatory medications.

As a next step it may be worthwhile for your wife to be evaluated by an internist or rheumatologist to evaluate the cause of her conjunctivitis and ankle pain.  To allow the doctor to consider all possible causes, it would be best to make sure that he is aware that she may have recently had chlamydia.  Take care.  EWH

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36 months ago
Dear Doctor,

Thank yoy very much for your response. 

two further questions:

Is there the chance of not getting chlamydia since my first urine test (by antigen) was positive and 20 hours later (after taking 1g azhytromicin) the same test was negative? the following test (by naat-pcr) 1 week later was negative too.

Is possible that my wife acquired chlamydia conjunctivitivis by touching her eyes with my/her secretions? I read that the conjuctivitis associated to RA lasts only one week/10 days and it is autolimited and . So she could have chlamydial conjuctivitis not resolved by the 1g of azythromicin taken.

Best regards
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago

Chlamydia antigen tests are rarely used, particularly to test urine specimens because of problems with their accuracy.  There are occasional falsely positive test results with these tests.  Your negative PCR test a week later following treatment however is strong evidence that, whether or not you had chlamydia, you did not have it after taking the azithromycin,

If your wife had chlamydia conjunctivitis, the azithromycin would have cured it.  Transfer of STIs of any sort from an infected genital site (i.e. your penis or her genitals) to the eye on a person's fingers however is very, very unusual. 

My sense is that you are asking "could this be" questions which will not help you to find out what is going on.  As I said before, if your wife has continuing conjunctivitis, my suggestion would be for her to be seen by her regular doctor or, if appropriate, a rheumatologist.  eWH

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36 months ago
Thank you doctor. I am afraid that it could be RA and it become chronic. I will try to move on. Best regards