[Question #5707] Gonorr. / chlamyd clearing without treatment?

21 months ago
Hello, a friend who became a one night sleeping partner a few months ago believes i gave her gonorrhea and/or chlamydia.  She had the normal symptoms and was tested and prescribed antiobiotics on the spot by her doctor.  She brought this to my attention b4 her actual doctors visit so i got tested right away and just received negative results for both gonorrhea and chly.. so i guess my question is (assuming she actually tests positive) could i have given this sti to her a few months ago, gotten no treatment, and passed a urine test at this point?  More curious than anything else.

Since my last negative test (i test yearly), my only exposure was a couple receptive oral encounters with low end usa sex workers.

That you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Welcome to the forum. Thanks for your question.

If I correctly understand, she doesn't yet know whe has either gonorrhea or chlamydia. Symptoms alone are never reliable indicators of these infections in women; no matter how typical they may seem, other infections are more common causes of things like vaginal discharge, uncomfortable urination, spotting after sex, or low abdominal pain -- the most typical symptoms. In addition, "a few months" is a long time for gonorrhea or chlamydia symptoms to start. Many gonorrhea infections and most chlamydia remain asymptomatic, but when symptoms do occur, generally they start within a couple of weeks. 

Even if she has either infection, it seems unlikely you are the source, both because of the apparent delay in her symptoms and your current negative test results. Also, most men with genital gonorrhea or chlamydia have symptoms, so assuming you haven't been having urethral discharge or urinary discomfort in the few months since your last sex with her, that also argues against you as the source of her infection. And on top of all that, it sounds like you've had a pretty low risk (if not quite zero risk) sexual lifestyle.

So my advice is to sit tight and wait for her test results. If positive, I would recommend you explain these things to her. In the event she is infected and has a believable story that you are the only possible source, cross that bridge at that time. But I'm betting against it.

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

HHH, MD 
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20 months ago
Thank you.

Is there any knowledge about how long gonorrhea or chlamydia lasts in a man untreated?  Doesnt seem like it from my searchings, but i thought worth asking here.

Would it be possible/likely for a male to have natrually cleared either of these within a little over 2 months of aquiring them?

Im aware their may not be much of an answer, but thought it was worth asking.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
It's a great question, but you are correct in suspecting the answers are not precise. There isn't good data on this -- you can understand it would not be ethical to not treat someone just to see how long the infection lasts, so no such research has been done. The best we have is reported observations for gonorrhea before antibiotic treatment was avaialble; and more recently, chance observation, such as somone who was positive, not treated, lost to follow-up, then showed up for retesting in the future. Even then, when positive it's often not possible to distinguish between a persistent infection versus a new one.* But based on the soft data available, most gonorrhea is cleared by the immmynbe system within a few months, and in the pre-antibiotic era it was typically 6-8 weeks in men. Chlamydia wasn't known in that era, so the data are even less precise, but it appears the immune system clears almost all chlamydia over a few months to sometimes more than a year, although such prolonged infections have been seen only in women.

So indeed it is possible to have either gonorrhea or chlamydia with spontaneous cure within 2 months. However, most such infections cause obvious symptoms in men. Not having had abnormal urethral discharge or painful urination, the odds are you were infected at all, especially with gonorrhea.

You have one more follow-up comment/question coming. Have you learned anything more about your partner? Did she test positive for either infection?

* Back in the 1970s, I published a paper about an unusually infectious case of gonorrhea, a man who had infected at least 6 women, 5 of whom developed serious compications (either disseminated infection with arthritis or PID). He was lost to follow-up and never treated. Then 8 months later he reappeared in the STD clinic, with gonorrhea. We speculated he had remained infected those 8 months. However, 10 years later we had technology -- not available in the 1980s -- that allowed us to distinguish different gonorrhea strains. It turned out he had a different strain than previously. So what we thought was a prolonged persistent infection was actually a new infection, presumably with spontaneous immune system cure in between.---