[Question #3455] Chlamydia post exposure prophylaxis

35 months ago

Greetings Doc, On Tuesday  3/13 I had protected sex with  the same partner that gave me Chlamydia over a year ago. I know we both have been treated since then. However, I believe the condom that he had was too large beceause when he pulled out the condom was not on him and it was still in my vagina. When I pulled out the condom I noticed there was some semen inside of it but there was also semen at the opening of my vagina. Naturally, I freaked out. Especially after he told me that he had unprotected sex with a stripper. Within twelve hours of less of the incident, I took one gram of azithromycin. I understand it is not good to take antibiotics without a confirmed diagnosis, however I also had a sinus infection so I know it has something to kill and my sinuses felt much better within a day.  What I want to know is, say that my partner did actually have chlamydia. If I took azithromycin within the twelve hours would it kill the potential Chlamydia bacteria right away? Is there an incubation period for Chlamydia?  In other words, would I be infectious within those 12 hours had I not taken the antibiotics. And since I took the antibiotics right away would it clear a potential infection right away or stop it from growing/ Surpress the bacteria?  Or would those 12 hours be too soon for the bacteria to multiply and would the antibiotics stop it from growing and make it non-contagious. The reason I am asking is because I am in an open relationship. So if there was a potential Chlamydia infection that I may have contracted Tuesday night, took the antibiotics Wednesday noon, and had unprotected sex with my partner with whom I’m in an open relationship Saturday night,  what are the chances that I could pass the infection to my partner even after taking the antibiotics soon after the incident? To recap, if I took azithromycin within 12hrs of exposure would it clear or prevent the infection from spreading by Saturday?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome back to the forum. I'm happy to help once again.

I glanced at your previous thread a year or so ago. Unless new evidence has come up since then, you don't really know that your recent partner is the one from whom you caught chlamydia at that time -- indeed, it was never certain you had chlamydia at all. In any case, if you both were treated since then (and especially if you both had doxycycline), and if neither of you has had other partners since that time, then it is extremely unlikely either of you current has chlamydia. In addition, chlamydia is cleared by the immune system within a few weeks or months (especially in men. So even if your partner had not been adequately treated, there is little chance he still is carrying it now.

Second, condom protection is considered complete when the penis is withdrawn, leaving the condom behind in the vagina. I can't say there was zero chance of chlamydia, if he is infected. But even with direct deposition of chlamydia infected semen deep into the vagina, mos exposures don't result in transmission.

Finally to the main question on your mind:  IF your partner had chlamydia, and IF you were exposed because of the condom problem, taking azithromycin 12 hours after the event, it definitely would have prevented chlamydia from taking hold and therefore would definitely prevent any possibility of transmission to another partner 3-4 days later.

So no worries about this event and I do not recommend you be tested at this tie. Given your recent azithromycin treatment, there is no chance you would have a positive test result.

But I'm going to close with the advice that you and your partner(s) be tested for chlamydia and other common STDs sometime in the next few weeks or month. Any "open relationship" carries STD risk, and you mark yourself as being at high risk for STDs by having such a relationship with your regular partner and by having sex with another partner recently. (And perhaps with others in the past year, who you haven't mentioned?) This is a situation that calls for all of you to be tested from time to time, e.g. once a year, for gonorrhea, chlamydia, HIV, and syphilis. But not necessarily because of the specific exposures mentioned in your question.

I hope this information is helpful. Lt me know if anything isn't clear.

HHH, MD

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35 months ago
Thank you for your quick reply Dr. Handsfield. 

It’s true, it was never certain that I did have chlamydia, but I was treated with doxycycline and my partner that may have given it to me (the one who I had the condom problem with last week) was treated with amoxicillin after that time for strep throat so I’m assuming IF there was Chlamydia it would have cleared that too. 

As far as testing goes, I actually got tested for everything a little over a month ago. All my results came back negative and my partner that I’m in an open relationship did the whole panel in December and all came came back negative. 

The only problem now is that he doesn’t have insurance this year and we do not have free clinics in the area, except one catholic clinic for women only. I know you said that there is no need for me to test since I took azithromycin. So I guess my concern is whether my partner needs to be tested?

 I’m sorry I know I am kind of repeating questions but how confident are you that IF I was exposed to Chlamydia, took the antibiotics within 12hrs  and had sex with him 3-4 days later that nothing would be transmitted to him? Is there a need for him to be tested (and spend lots of money) for this incident specifically, especially if he hasn’t had new partners since he last got tested, therefore only testing for the possibility that I may have been exposed to something due to the condom problem?
And would the azithromycin also prevent other bacterial infections such as gonorrhea from taking hold? 

I’m sorry for all the questions. I just want to make sure that we’re in the clear so that we don’t end up with something. And as far as condoms, we are adamant about using them with new partners. Hence why I am so worried about this incident. 

Thank you so much for your time and patience. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Thanks for clarifying things.

Amoxicillin is not reliable against chlamydia -- it sometimes works, sometimes doesn't. However, as discussed above, the large majority of chlamydial infections would be cleared by the immune system within a year. With that fact plus your negative test a month ago, you can be confident you don't have it. And as I also said above, taking azithromycin definitely would prevent you getting chlamydia if exposed 12 hours earlier, if your partner had been infected. You really needn't worry about it!

As for my general advice about testing from time to time (on account of your open relationship, i.e. your and your partner's overall sexual lifesyle), I see no hurry. You can do that next time you're in a location where appropriate medical services are easier to access.

Finally, you definitely should not be especially concerned by your partner's adamant attitude about condoms. That's just smart practice for all sexually active people outside permanent, mutually committed and mutually monogamous relationships. I would not interpret that attitude as meaning he suspects he is infected.
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