[Question #4066] Chlamydia question

33 months ago
Hello 

I had sex with a 22 year old and during the condom broke. The sex was fairly brief and As soon as noticed the sex was halted (matter of minutes). 

I then took 2mg of Azithromycin within an hour. 

Would that stop any potential chlamydia infection?

16 hours later I had unprotected sex with my long term partner. Could i have passed on a potential chlamydia infection or is that too soon?

Many thanks


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Welcome to the forum. Thanks for your confidence in our services. I'm pleased to answer. I'm going to address gonorrhea as well as chlamydia; the risk is lower, but but not trivial, and azithromycin is active against both.

My first reaction is to congratulate you on the wisdom of using a condom in the situation described. It happened to fail, but your intent was both honorable and wise. 

The likelihood of chlamydia or gonorrhea is generally low for any single encounter. Although STDs certainly are common in settings like this, at any point in time most any particular sexually active 22 yo woman is unlikely to be infected (in most settings roughly 5% chance for chlamydia, 1% for gonorrhea, as ballpark figures). And transmission risk for any single exposure, if she were infected, is under 50%, perhaps only 10-20% -- and perhaps a lot lower than these estimates given the brief exposure after the condom broke. So the odds were heavily in your favor, regardless of your self treatment with azithro. (Undoubtedly you mean 2 grams, not milligrams [mg].)

If you were exposed, would azithromycin have prevented an infection from taking hold? Yes, highly effective. However, its efficacy after only 16 hours is unclear (it's a slowlly acting antibiotic) and there has been no research on such early treatment. Probably it would still be effective, but there has been no research on such early treatment. I would say that given both the statistically low risk you were infected plus the likely but unproved efficacy of azithro that soon, your partner is not at risk and need not be informed, tested, or treated. However, I cannot guarantee it. But if somehow I were in your situation, I would not feel a need to inform or treat my wife. The analysis is similar for syphilis, but that's currently so rare in partners like yours that it's not a serious consideration.

Of course neither azithromycin nor other antibiotics have any effect on viral infections, so herpes, HPV, and HIV are theoretical considerations. The odds of herpes are very low after any single such encounter; and HPV is so common tnat you can assume both you and your regular partner have had one or more HPV infections already, and the additional risk from any single event is very low. HIV is so uncommon in this situation that it also is not a serious concern. However, given its seriousness testing might be a consideration, even with exceedingly low risk. If you'd like reassurance about it, have a routine antigen-antibody (duo, "4th generation") HIV test 6 weeks after the event. (And all sexually active persons should be tested for HIV from time to time, so it makes sense while it's on your mind. But it's optional in terms of this particular exposure.)

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

HHH, MD

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33 months ago

H. Hunter Handsfield, MD

Thank you for your concise reply. I have read your work before online and find your no-nonsense, factual and practical advice absolutely top class. I also admire your ability to see when people are focused on their own anxiety rather than the facts at hand. 

I applied this logic into dealing with this situation and was satisfied to do nothing. However, there has been a small development, this morning my long term partner complained of a potential cystitis style feeling when urinating (she has suffered from this many times and it has come and gone before with no incident and fairly common with her and her sisters) and she said its likely because she didnt pee after sex last night. 

Given the situation it did make my sit up and take notice, and I have further questions to ask;
 one - could this be chlamydia symptoms as early as 4 and a half or 5 days after exposure
 secondly, since this morning she has urinated with no issue, does this shed any light
last, if she was given antibitoics for the cystitis would it clear any potential Chlamydia infection? 

Thank you and apologies for the extra work. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
There was no need to post and pay for a new question. I deleted it; you can use the contact link to request reimbursement for the new one. See reply blow.

Thanks for the compliment.

Your concerns are understandable, given the situation. However, almost certainly this is simply another recurrence of your partner's occasional UTI-like symptoms. She might or might not have actual infections as the cause, perhaps just urethral irritation (potentially triggered by sex); or "urethral syndrome", which is a form of UTI in women limited to the urethra, without bladder involvement (cystitis), and which often clears spontaneously in a day or two. Not urinating after sex could in fact be partly responsible. Although chlamydia and gonorrhea can mimic both these and more typical UTI symptoms in women, it's not the main set of symptoms; and for sure this started too soon for chlamydia, which typically requires 7-10 days for symptom onset. Gonorrhea could do it, but I've already addressed how unlikely that is in this situation. Anyway, if this is a typical and common situation for your partner, you can safely assume that's all it is.

The usual treatments for UTI/cystitis (or urethral syndrome) would not adequately treat either chlamydia or gonorrhea. But if her symptoms quickly clear up, with or without treatment, that would be additional evidence against an STD.

Don't overthink all this -- and avoid the very human inclination to attribute every itch and twinge, genital or elsewhere, to the sexual decision you apparently regret.


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33 months ago
Thank you for another logical response. It is true that despite attempting to apply logic, this turn of events did concern me. I will follow your advice. The help is greatly appreciated. All the best.