[Question #5443] Chlamydia risk- male receiving oral sex one time from female

74 months ago

I am actually asking for a friend who does not know whether or not she was cheated on.

Her and her BF have been in a monogamous (she hopes) relationship for 2+ years, and they have been sexually active the entire time. She was screened last year (1 year into the relationship) for all STD's via urine and blood test and all of the results were negative.

This past year, and since that test, they were "long distance" as he was away for college. After one of her visits to his college, where they engaged in a lot of sexual intercourse, she developed period like symptoms even though she wasn't on her period. Over the course of a couple weeks, the painful symptoms got so bad she thought she was either pregnant or had cancer. Finally she went to the ER where they diagnosed her with Chlamydia. The Doctor was very clear that since she had only had sex with her BF since her last Chlamydia test (which they had on record), and over the past two years, there must have been infidelity on his part. She made the call to her bf and broke up with him.

3 days later he came up with a story that during their one-weekend breakup a month or two before she visited him, he met a random girl at a party and received unprotected oral sex one time, which is when he must have acquired it.

My brain says that the odds of this "random" girl acquiring Chlamydia via her throat is really low. Then for him to have acquired it from her, during a one time unprotected oral (receiving) encounter seems like lightning striking in the same place twice. Can you please enlighten me on the odds of this story adding up vs him lying about his exposure?

Thank you

H. Hunter Handsfield, MD

74 months ago

Welcome to the forum.

Chlamydia is rare from oral sex. Oral/throat infection is rare, hence few cases of urethral infection can be expected. All things considered, it is likely your friend's partner has had exposures with other partners, other than oral sex.

That said, a small proportion of chlamydial infections, especially in women, may appear without recent sexual contact. Recent research suggests that some people acquire chlamydia, which then infects the intestinal tract, probably sometimes by oral sex and others by rectal infection, either from anal sex or local contamination with vaginal fluds. Intestinal chlamydia may persist for year. It really isn't yet known whether or how frequently it results in re-infection of the female genital tract from the rectum. Probably not very often, but it might be a possible explanation that doesn't requrire an unfaithful partner. However, if I were a betting man, I would wager a pretty large amount on her partner having more than just the one oral sex event he admitted to.

Sorry I can't be more optimistic about it. Good luck to your friend.

HHH, MD

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74 months ago

Hunter, thank you for your honesty.

I would also place a large amount of money on that bet. I think he read (online) that Chlamydia can technically be acquired from receiving oral sex and used that information to lie to her.

Can you provide more context to the rarity of these occurrences so the information can not be misconstrued?

Also, as far as the Chlamydia without recent sexual contact:

How rare is this?

And if this were the case, would that mean her urine test one year ago was negative because the infection was residing in her intestines rather than in her genital tract?

And then, if she was infected in her intestines all this time, would it then have to be reintroduced to her genital tract by having anal-vagina sexual contact? because they don't do "butt stuff" ...

I think this part is really confusing to me.

Also, since he admitted to hooking up with someone else at least once, and since her symptoms showed up after visiting him, this option seems highly unlikely. The ER doc also told her that she was lucky to have a body that showed symptoms quickly, before permanent damage occurred.

Anyways, it seems like all signs point to her partner having more than just the one oral sex event he admitted to. I would just like more clarification and context is possible.

thank you again

H. Hunter Handsfield, MD

74 months ago

All the business about chronic GI infection and its frequency and origins are theoretical -- research is underway, but hard to say more than I did above. As far as the rectum being the source of an apparent new vaginal infection, this does not imply anal sex. The vaginal opening and anus are in close proximity and probaly either site can be infected by local exposure to secretions from either site. Most women with positive rectal chlamydia testing have not had anal intercourse, mostly probably acquired by local contamination. Same for gonorrhea. It is logical to assume cross contamination can occur in the other direction, although there has been no speciific research on it. (To do such research would require patients known to be infected at only the vagina or rectaum, not treating them, and observing how often the other site becomes positive. and how long it takes. Pretty much impossible because it would be unethical to withhold treatment from such persons for this purpose.)

I'm not sure why you're involved, and or why you think you might be responsible to sort out the details for your friend. At this point, I think all she should know is that somehow or other her partner was infected and she caught it from him; and that both of them need treatment. Further details about their sexual partnerships and practices really dont make much difference at this point -- they may be interesting to her, but perhaps not your business. In any case, this forum does not try to sort out such details.

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74 months ago

ok, that all makes sense, and you are probably right about it not being any of my business. She just confides in me a lot and I wanted to use my resourcefulness to help. I knew about you 3 (you, Dr. Hook, and Dr. Warren) as being the "people to ask". That being said, it's not my job to bring liars to justice, nor is it yours. I most likely won't be sharing this information with her, but thank you for clearing it up for me.

H. Hunter Handsfield, MD

74 months ago

Thanks for your understanding. That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful.---