[Question #4948] Question about recurrence of Chlamydia

26 months ago
Hello,

In April 2017 I was infected with chlamydia treated with Azithromycin (failed) and re-treated with Doxycycline twice a day for 7 days, after which I tested negative for chlamydia multiple times. I was never given an explanation as to why Azithromycin failed in myself and successfully treated my partner (we were not active in between finding out I tested positive the first and second time).

Since then I had one brief encounter with anal frottage (no penetration just rubbing) and brief vaginal insertion. Afterwards, in August and in October I was tested twice via urine samples, NAAT, and both were negative for chlamydia/ghonorrhea and all other STDs. However, I've had some anal irritation for the last couple of months.

I've read about chlamydia living in the gut and reinfecting women due to their anatomy.



My questions are
1. Is it possible that chlamydia could live in my gut and reinfect me rectally then vaginally?
2. Would doxycycline cure a GI infection?
3. Would a rectal infection spread quickly to my vagina, and therefore be detected on the urine samples mentioned?
4. Should I return for further testing?

Thanks!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome to the forum. Thanks for your confidence in our services, and for a sophisticated, insightful questioin.

First, frottage rarely if ever transmits any STDs, and anal irritation is almost never an STD symptom. Most cases of anal itching are simple pruritus ani -- which is Latin for itchy anus, so it doesn't mean much, i.e. itching without any obvious visible abnormality. It's extremely common and probably occurs in all humans from time to time. If there is irritation beyond itching, yeast infections are common. You could try washing with soap and water twice daily plus an over the counter yeast medication (e.g. clotrimazole), perhaps combined with hydrocortisone cream. If the problem continues after that, you'll need to be professionally evaluated. In any case, chlamydia generally doesn't cause such symptoms.

So even if you had not recently tested negative for chlamydia, I would not have considered that a likely cause. For sure your multiple negative tests are valid, despite your previous treatment failure with azithromycin. There may be no particular reason that happened.  Although early research suggested azithro is almost 100% effective against chlamydia, we now know that it's closer to 95% -- that is, failure occurs in 1 in 20 patients, so it's not all that rare. It's still a very valuable medication for chlamydia, because it's a single dose. Doxycycline still is virtually 100% effective, but many people won't stick with the full week of doxycycline, which is why azithromycin remains the most common treatment.

It is true that if chlamydia gets into the gastrointestinal tract -- by oral or anal sex -- it is more resistant to treatment. But is only a problem for azithromycin, not doxycycline. Most mammals commonly have chlamydia or related bacteria, mostly in their intestines, and those infections are hard to eradicate with macrolides (the group of antibiotics that includes azithromycin) but easily cured with the tetracyclines, including doxy. And we know the failure rate for known rectal chlamydia in humans is even higher than genital infection, around 15%. It is currently recommended that known rectal infection be treated with doxy, not azithro. Therefore, it is possible that undetected intestinal infection explains many or most azithromycin treatment failures. And your question about testing is right on track: because the anus and vagina are so close, rectal infection may result in positive test results on vaginal swabs or urine.

Active research is underway to sort out the importance of rectal or intestinal chlamydia in humans. But we already know for sure that doxycycline is 100% effective, even if the rectum or GI tract is infected. So you needn't worry further:  your original infection for sure is gone. Of course it and other STDs remain potential risks, depending on standard risks (new partners, unprotected sex, etc), and you shoudl be tested periodically if at risk. But no worries about non-penetrative sex.

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

HHH, MD


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26 months ago
Your response is clear, but just to be even clearer, If I did have rectal chlamydia or any chlamydia, it would show on either of the urine tests?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
To be completely certain about rectal chlamydia, a rectal specimen (swab) must be tested. But given the doxycycline treatment and your sexual history, there is no chance you have it and no need for testing. Don't worry about it!---
25 months ago
So the penis actually has to enter the rectum to infect, direct contact or rubbing does not transmit disease unless penetration is involved?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
I didn't say that. Many (most) rectal infections are from penile penetration, but some rectal chlamydial infections probably result from infected vaginal fluids coming in contact with the anal area. Others may result from oral exposure, with the organism passing down the intestine to the rectum. (This is a theory, not proved -- research is underway.)

That concludes the two follow-up comments and replies included with each thread and so ends this thread. I hope the discussion has been helpful.
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