[Question #3804] Eye Inflammation, Chlamydia doubt.

86 months ago

Had protected sex with a girl I met in a bar. Condom broke during intercourse. I quickly replaced it. She said she is disease free, but cant verify.

A month later, my eyes turned red all of a sudden. I went to an ophthalmologist and he said it could be an eye allergy (Maybe “Phlyktenular Keratoconjuncitivitis”, not confirmed). He said a likely cause is Tuberculosis (I stay in India). I was given a corticosteroid eye drop. I had all tests done for Tuberculosis, all came negative. Ophthalmologist said to not worry and stop medicine in 4 weeks.

Now eyes are okay for a month, but slightly red often and I have to use tear drops frequently.

I read that eye allergy can happen due to Chlamydia. I did STI blood test for all major STDs. All of them came negative. For Chlamydia and Gonorrhea, I had the antibody test. I haven’t yet tested using NAA/urine test as it was not available in my city.

I think my eye problem can recur as its slightly red frequently and I still use tear drops.

What do you suggest I should do? My main doubts are -

1) What is the chance of me having Chlamydia looking at my eye inflammation symptoms? I heard Chlamydia can cause ocular inflammation and reactive arthritis

2) Shall I get a NAA test done for Chlamydia? Is the antibody test that I did accurate?

3) The girl I had sex with had a color difference on one ass cheek, almost like a skin infection. Is that sign of an STI?

4) Do you have any other suggestions for proper diagnosis or cure?

H. Hunter Handsfield, MD

86 months ago

Welcome to the forum. Thanks for your question.

Chlamydia certainly can cause conjunctivitis, much more commonly in developing countries like India, but even there most cases are in young children. It would be possible to acquire chlamydial conjunctivitis as an STD, if at risk, but to my knowledge it doesn't cause the phlyctenular type -- although this is well outside my expertise. However, if chlamydia were the cause, then without antibiotic treatment it probably would not have cleared up with corticosteroid eyedrops. (However, it is NOT true that chlamydia causes eye allergies. It can infect the conjunctiva, but is not known to trigger allergy.)

Your negative chlamydia blood test is slightly reassuring, but really not reliable., which apparently you know. Chlamydia and gonorrhea blood tests are not done in medically sophisticated settings. The result, whether positive or negative, is unreliable. Proper chlamydia testing indeed requires a nucleic acid amplification test (NAAT), i.e. DNA test. Such tests are readily available in India, at least in all major urban areas. If you want conclusive proof you don't have chlamydia, I would suggest finding a provider or clinic who understands STDs and access to a lab with proper testing. However, I really don't think it's necessary. I cannot imagine that your eye problem is or was chlamydial.

Those comments pretty well cover your first two questions, but to be explicit: 1) There is almost no chance your eye problem is (or was) due to chlamydia. 2) If it were me, or if I were advising my own patient or a family member, I would not test for chlamydia. But you certainly could seek an NAAT if the negative result would help reassure you about it.

As for questions 3 and 4, no STD causes such a skin appearance. Having had unsafe sex (unintentionally), you should consider having a urine/urethral NAATs for gonorrhea and chlamydia. additional STD testing, since the blood tests are not reliable. You could also consider HIV and syphilis blood tests; it sounds like the ones you had might have been too early. These tests are not valid until 6 weeks after exposure. But in the meantime, absence of symptoms is very reassuring, so stay relaxed while awaiting these results. You can expect them to be negative.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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86 months ago

Hello Doctor,

Thanks for the prompt reply :) Its quite reassuring.

I had a full STD panel test for around 8 diseases such as HIV, Hepatitis .etc on April. The sexual encounter happened on December, so i think i had the test after 6 weeks. So i wont need a retest right?

As for Chlamydia and Gonorrhea I will do an NAAT test from a better facility like you suggested. Just to be sure.

What got me paranoid are a bunch of articles online that i read, such as these -

- https://www.fpa.org.uk/sites/default/files/chlamydia-information-and-advice.pdf

In this article its given ....... "Rarely, chlamydia can lead to inflammation of the joints in both men and women. This is known as Sexually Acquired Reactive Arthritis (SARA) and it is sometimes accompanied by inflammation of the urethra (tube where urine comes out) and THE EYE. This is more likely to occur in men than women."

- https://www.medpagetoday.com/rheumatology/arthritis/44666

This article uses the word "ocular" all the time. Although i don't have any joint pain, i heard some eye problems can be due to reactive arthritis.

Do let me know if you have any comments on the above.

I will post back here after my NAAT tests. I do live quite far from city due to work, so I can only get the test done on 15th this month when i am back in the city. Hopefully this post will be open for me to comment then.

H. Hunter Handsfield, MD

86 months ago

Sure, chlamydia is a common trigger for reactive arthritis. However, ReA is a pretty rare condition, and you mention no symptoms that suggest it might be an issue for you. Conjunctivitis or other kinds of ocular inflammation can occur with ReA, but it is rarely the first or only symptom and undoubtedly fewer than 1 in a million cases of conjunctivitis are attributable to ReA.

I suspect that like many anxious persons, you are being led astray by things that draw your attention on the internet, without context to understand the overall picture and risks. Your concerns are sort of like someone clobbered over the head with a cricket bat who now wonders if his headache might be from meningitis or a brain tumor. Consider less time searching on the computer about chlamydia and other STDs!

We'll leave this thread open for you to post your repeat test results in a couple of weeks. But there is a maximum of two follow-up comments and replies, so no more comments or discussion until then, please.

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