[Question #4274] Chlamydia Symptoms Persistent--Something Else?

29 months ago

Hello Doctor(s)- thank you for your work and attention to detail here.  Has certainly been a good resource for me, as the STD world is new for me. I am sure I speak on behalf of everyone when I say—thank you!

 

Details on my situation are below, I look forward to your feedback. 

 

I am a 31 year old heterosexual male. Never had an STD, in good health.

 

8/2 - Had unprotected vaginal sex with Female 1. 

 

8/6- Began experiencing weird symptoms (discomfort in tip of penis, sensitive/swollen testicles, minor pain while urinating)

 

8/7 - Received full panel STD test

 

8/9 - Received test results back, positive for Chlamydia. Everything else negative. Prescribed 1g of Azithromycin, which was taken at 10 PM on 8/9.

 

8/16 - Symptoms has mildly decreased, but still remained. Went to PCP, received finger prick/antibody test for HIV. Negative. Received unprotected oral sex from Female 2.

 

8/17 - Began taking 100g of Doxycycline, for 7 days

 

8/23 - Had unprotected vaginal sex with Female 2

 

8/24 - Completed full course of Doxycycline as prescribed (symptoms have subsided, yet still not gone)

 

8/25 - Receive unprotected oral sex from Female 2

 

8/27 - Still having symptoms (although to a lesser extent than before) I begin my second course of 100mg of Doxycycline, for 7 days.

 

8/30 - Both Female 1 and Female 2 receive and take 1g of Azithromycin to ensure they are not infected. No symptoms were shown by either.

 

9/3 - Completed full course of Doxycycline as prescribed (symptoms still linger)...swollen feeling in testicles, sensitive tip of penis, some flashes of increase urination frequency

 

9/7 - Begin to develop abdominal pain/pelvic pain

 

9/13 - Swollen lymph nodes in neck, minor soreness in quadriceps, pain in both elbow regions. Received 4th Gen HIV test (blood work)...day 42 from exposure. Negative. Received unprotected oral sex from Female 2

 

As of today 9/16, I still maintain testicular discomfort that goes off and on. Still some minor tenderness at the tip of the penis, and still occasionally have the urge to urinate somewhat frequently. It can generally be described as feeling something in the urethra—something that I have never experienced. I plan on having another full panel STD test on 9/24 to confirm I do not have Chlamyda, and am clear of all other STDs. My questions are as follows…

1. Can I assume, based on the information provided above, that I no longer have Chlamydia?

 

2. Can I safely assume that both Female 1 and Female 2 no longer have Chlamydia?

3. Based on your previous posts, and assuming that you will state we all are negative for Chlamydia, what would explain the symptoms I have described? Is it likely that Urethritis/Epididymitis could develop this quickly (one week from exposure to the date Azithromycin was originally taken) despite my quick and aggressive treatment?

4. If the causes for my current discomfort are NOT Chlamydia, is it safe to resume unprotected sexual activity?

5. After taking the 4th Generation HIV blood test at 6 weeks—can I assume that I have officially been cleared of my HIV risk?

If you were me—how do you proceed from here? Obviously would like to clear up the existing uncertainties and discomforts, and move on with my life. Thank you very much in advance!

Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Welcome to our Forum and thanks for the detailed history.  You are getting a more rapid reply than is usually the case as I happened to be on the site when your question arrived.  Typically we try to respond in 12 hours or less after a question.  Before I get to your specific questions, let me make a few comments.  Your positive chlamydia test is hard to argue with.  Your symptoms however do not match up entirely and may or may not be related to the infection that was diagnosed.  In particular, intermittent testicular discomfort, while common among persons who worry about STIs and are on the lookout for them, are not associated with ANY STI. When an STI causes testicular symptoms, they tend to be persistent and unremitting, not intermittent.  In addition, when you seek follow-up testing, which will provide a definitive answer as to whether or not you have been cured to your STIs, I would suggest that you also request a test for Mycoplasma genitalium which is an emerging STI which can cause symptoms similar to those caused by chlamydia. 

1. Can I assume, based on the information provided above, that I no longer have Chlamydia?
Given the therapy that you have taken, unless you have been re-infected since completion of antibiotics, your chlamydia should be cured.  Azithromycin is 97% effective and doxycycline reliably cures all chlamydial infections.  Given your three courses of antibiotics, I am confident that chlamydia would be cured.  Repeat testing will prove this.

 

2. Can I safely assume that both Female 1 and Female 2 no longer have Chlamydia?

Yes. As described above, azithromycin is highly effective for chlamydia treatment and, if anything, is more effective for women than for men. Thus if you have not re-infected them after treatment by having sex with them, and they do not have other partners, you should be in the clear.  It would have been preferable for them to have been tested before they were treated.

3. Based on your previous posts, and assuming that you will state we all are negative for Chlamydia, what would explain the symptoms I have described? Is it likely that Urethritis/Epididymitis could develop this quickly (one week from exposure to the date Azithromycin was originally taken) despite my quick and aggressive treatment?
See above. Your symptoms are really not classical for ANY STI. You may have had an asymptomatic chlamydial infection (chlamydia is asymptomatic in over half of infected men) and your symptoms may have been unrelated or the result of looking hard for infection and noting otherwise normal sensations that most people tend to overlook.


4. If the causes for my current discomfort are NOT Chlamydia, is it safe to resume unprotected sexual activity?

See comment about M. genitalium above.  I would suggest you continue with protected sex until you have been re-tested for chlamydia and mycoplasma genitalium.

5. After taking the 4th Generation HIV blood test at 6 weeks—can I assume that I have officially been cleared of my HIV risk?

Yes, your 6 week results are conclusive. 


Hope this helps.  EWH


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29 months ago
Dr. Hook-

Thank you for the prompt reply. It helps ease the associated anxiety that has cloaked the last 2 months. 

I should have been more clear--the testicular discomfort still remains DAILY., as do all of the symptoms I described. If Chlamydia is gone, what potential causes do I stand against today?

There is not a day that goes by (or has in 2 months) where I do not experience pain from the sources described above (swollen testicles, urethra discomfort, abdominal pain). That said, it is more tolerable at some times as opposed to others. I certainly appreciate and respect your thoughts listed above. That said, I can attribute this abnormality to having occurred almost immediately (3-4 days) after my exposure to Female 1...as no symptoms were present in any stage prior to this encounter. Is this quickness of a Chlamydia infection (and corresponding symptoms) normal? Could other infections (Epididymitis, Urethris) develop this quickly?

Another question stems strictly from curiosity while investigating the infection. If Azithromycin is INEFFECTIVE in Person 1, and they pass it on to their partner (Person 2)...is it safe to assume that Person 2 will also have an INEFFECTIVE treatment from this antibiotic when it comes to the infection? That is--is the antibiotic reactive to the infection, the person, or a combination of the two? In my case, obviously I am concerned that  the  lackluster results of my Azithromycin treatment would then be ineffective/similar for those of someone else who I may have passed the infection on to.

I should also mention that within a week or so of exposure, I developed a chronic itch at the base/top of my butt cheeks that is still persistent today, despite consistent wash, Neosporin, etc.  Hard for me to attribute this to my sexual interaction described above, but want to provide all the commentary that I can. 

Many thanks once again!
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Thanks for the clarification on your testicular symptoms.  This being the case and given your apparent non-response to antibiotics, my advice is to get the follow-up testing I suggested but also to see a urologist.  I would not start additional antibiotics until you have had the specimens for STIs taken in follow-up.  The presence of "urethral discomfort" and abdominal discomfort suggest that this may not be an STI.  This really does not sound at all typical of chlamydial infection.

In answer to your second "what if" question - most chlamydial treatment failures reflect undefined host factors, not the bacteria.  Therefore just because one person fails therapy (which I remain skeptical of), a person they had infected would not necessarily fail. 

EWH
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29 months ago
Thanks for the clarification, Dr. Hook.

Last question—assuming I took the full dose of 1g Azithromycin, and exactly 7 days later had unprotected sex...what is the likelihood of passing Chlamydia to the partner? Assuming the worst, and that the Azithromycin did not work...

Are my descriptions and timelines demonstrative of Urethritis/Edididymitis?
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
If you failed azithromycin, then your risk for transmitting it to an uninfected sex partner through a singe act of insertive intercourse is between 20 and 40%.

Urethritis is a medical term for urethral infection which this entire conversation has been about.  Similarly epididymitis is a term used to describe infection of the testes and its surrounding structures (the epididymis).  As I've already told you, your signs and symptoms would be a bit unusual for epididymitis, not to mention your symptoms onset was sooner than is typical for epididymitis.

As you know, we permit up to three questions per thread. This is your 3rd question and thus this thread will be closed shortly without further replies.  I hope my comments have been helpful.  Your questions are beginning to be a bit repetitive and I hope you will not feel the need to return until you have taken some of the steps I have suggested.  If you return with further repetitive questions, there is a risk that your question will be deleted without return of your posting fee.  Take care.  EWH
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