[Question #5131] STD- Chlamydia

23 months ago
Hello, 
I have been treated with azithromycin, waited 7 days, and got retested, and showed up positive for chylamydia again, I then took doxycycline for 10 days and I’m still positive. The doctor has now prescribed Flagyl, and more doxyciline. Please help, as I am trying to resolve this.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Welcome to the forum. Thanks for your question.

Although your username is masculine, I think you're female, right? With genital (vaginal/cervical) chlamydia, not a male with rectal infection.

First, it is possible treatment didn't fail at all. The test can remain positive for up to 3 weeks after successful treatment. The standard tests detect chlamydial DNA or RNA, which can persist quite a while after the germs are dead. This is a good likelihood for the positive test 7 days after azithromycin, but not so good for a positive test after 10 days doxycycline -- i.e. 2+ weeks after initial treatment. Still, it's the most likely explanation. For these reasons, recommendations from experts, CDC, and the test companies is that retesting for chlamydia cure should not be done sooner than 3 weeks after starting treatment.

Metronidazole (Flagyl) has no effect on chlamydia; your doctor undoubtedly knows this. There was no point in that antibiotic, unless you also have trichomonas or bacterial vaginosis; or if your chlamydial infection progressed to cause pelvic inflammatory disease (PID, i.e. fallopian tube infection). Matronidazole makes sense if you're having pelvic pain or symptoms like abnormal vaginal odor, discharge, etc -- of if positive tests for BV or trich. But not for chlamydia itself.

The other issue is the site of your infection and the exact test done. Presumably you were tested with a vaginal or cervical swab? Or maybe urine? We're not talking about a rectal infection? Rectal chlamydia sometimes doesn't respond to azithromycin, although doxy always works. 

There has never been a proved failure of doxycycline to cure chlamydia, if taken at the proper dose (100 mg twice daily) for at least 7 days. You'll need still another test however. If that remains positive, the problem is with the test. Try to learn from your doctor, or from the lab, exactly what type of chlamydia test was done. Some tests are more accurate than others. 

Finally, all this assumes you have not continued to have sex with a partner who might be infected. Right?

I look forward to hearing back with these additional details. In the meantime, don't worry:  your chlamydia will be cured with doxycycline, regardless of what the tests show. 

HHH, MD
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Another thought:  If in fact you are a male with rectal infection, and if you're having significant anal, rectal, or abdominal pain, you need testing for lymphogranuloma venereum. LGV is a particular type of chlamydial infection and often requires prolonged treatment for cure. And rectal LGV often is associated with abscesses or other local complications that might need metronidazole.

I'm looking forward to hearing more.
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23 months ago
I am a male, and So I do not need to take the Flagyl? And does it matter if it is  doxy mono or doxy hyclate? I have been directed now to take doxy mono for 10 days. And yes I had protected sex with someone who may have had the infection. 

I plan on having no sexual activity for the next 10 days while taking doxy mono— is this ok?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Thanks for clarifying. However, I cannot advise about continuing metronidazole. We do not give direct medical advice, and anyway you didn't don't provide enough information for me to know. Follow your doctor's advice. As for duration of avoiding sex, it depends on how your infection resolves, whether your partner was treated, and so on. It could be longer than 10 days.---
23 months ago
You did not answer my question of in general does doxy hyclate or doxy mono matter for treatment? And I am no longer with that partner, so I am not having sex with anyone for at least 14 days
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Sorry I missed that part. No worries: the two forms of doxycycline are equivalent.

You didn't answer my questions about more detailed symptoms and the possibility of LGV. If your infection is rectal and you've been having lots of pain, or if fever or other complications, LGV is likely (and should be specifically diagnosed) and could explain the need for both more prolonged treatment and inclusion of metronidazole. Normally this thread would be closed at this time (two follow-up comments and replie), but I'll leave it open another cycle or two if you'd like to continue the discussion.
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23 months ago
Sorry, no I have not engaged in any form of anal activity
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
So your infection is urethral? Is it particularly severe? Any painful swelling in the groin?---
23 months ago
Yes it feels more urethral, not severe, no real burning when I pee, but a dripping feeling but nothing coming out feeling. No swelling or pain in the groin
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
So your positive test was on urine? Or a urethral swab? I hope you didn't only have a blood test. The chlamydia blood tests are very unreliable; they are almost never done in North America, but are used commonly in some countries.

Based on the clarifying information, including your symptoms, I do not understand why your doctor prescribed metronidazole, unless you have a sex partner with trichomonas. But check with him or her about whether or not to continue it.

I'll permit one last comment/question, then it will be time to close this thread.
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23 months ago
Yes it was a urine test
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
OK. I remain puzzled by the continued positive test results. As per my initial reply, you should be retested one more time. I would wait until about a week after you finish you second round of doxycycline. If that test still is positive, for sure it will be a problem the lab is having with the test. But my bet is it will be negative.

That concludes this thread. I hope the discussion has been helpful.
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