[Question #571] Chlamydia Transmission

44 months ago
Yesterday (3/2) I was told by a girl I had been dating that she tested positive for Chlamydia. Gonorrhea was negative. We had unprotected vaginal and mutual oral sex.  She was tested on or about 2/16. After we started sleeping together (not sure of time frame) I developed a slight pain/discomfort in the head of my penis but had no discharge nor pain when urinating. The pain/discomfort has since passed. Additionally, some time after oral sex (unsure of timeframe) I also had a sore throat that lasted for about 8-10 days. 

On the day that I was told, 3/2/16, I went and got tested. I am awaiting on my results, but when I was tested I was given 4 250 mg tablets of Azithromycin, which I took in one dose. Additionally, even though she tested negative for gonorrhea, I was given a shot of Rocephin. My questions are:

1. Assuming I have Chlamydia, after taking the Azithromyacin on 3/2 at 10:00 p.m., how long until I am cured? I know the guidelines are 7 days, but I have read other places, including past posts from Dr. Handsfield on MedHelp that 1-2 days is a good guess. While I know this is an educated guess, the post was dated and I was wondering if any new studies/evidence support this claim or support a different timeframe?

2. I have also read (posts from Dr. Handsfield and Dr. Hook), that while genital to oral transmission is rare, it is possible. I have also read that a lingering sore throat is a symptom of oral chlamydia infection. Does my sore throat and exposure appear indicative of that?

3. Assuming I have oral chlamydia, can I spread this through kissing? I have been dating a new girl and while we have not had intercourse we have french kissed? Is she at risk? Can I kiss her now that I have started antibiotics?

4. Related to Question 1, when would I be safe, in your opinion, to have protected vaginal sex again?

Thank you

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Welcome to the forum. Thanks for your question. I happened to log on shortly after it came in:  most users shouldn't expect nearly real-time replies!

I'm not sure what to make of your symptoms, which aren't typical for a chlamydial infection. But you were treated correctly:  the precaution against gonorrhea (ceftriaxone/Rocephin shot) probably was unnecessary, but certainly won't hurt anything. Azithromycin 1 gram is exactly right for chlamydia. To your questions:

1,4) This depends on what you mean by "cured". Probably you would be non-infectious within a day, but this hasn't been studied in detail and it is generally advised that sex shouldn't be resumed for a week, either with the original or a new partner. If cure is defined as certainty that the infection is gone entirely, 5-7 days would be a good estimate. And if you mean time to a negative test, that can take up to 3 weeks. That's because chlamydial DNA, which is detected by routine testing, can persist quite a while after all chlamydia organisms have been killed by the antibiotic.

2) Partly right, partly wrong. No data have ever shows that oral chlamydia causes sore throat or any other symptom. Even oral gonorrhea, which is a much more inflammatory bacteria than chlamydia, usually (>90%) causes no sore throat or other symptoms. In any case, although genital to oral transmission of chlamydia is possible, it has been documented clearly only for fellatio (penile-oral exposure) and not by cunnilingus (vaginal to oral). The chance you have (or had) chlamydia orally is very low -- and in any case, would be cured by azithromycin.

3) Chlamydia has never been known to be transmitted by kissing, both because oral chlamydia is rare, and the mechanics of transmission probably don't allow it. There is definitely no risk to your new partner by kissing.

I hope these comments have helped. Let me know if anything isn't clear.

HHH, MD

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44 months ago
Dr. Handsfield, 

Thank you for your reply. I guess my only follow-up questions are as follows:

1. When you talk of a negative test taking up to 3 weeks and the residual Chlamydial DNA, does this mean that I could still test positive but it would be a false positive? Is the residual chlamydial DNA contagious or harmful or has infection been cured in 5-7 days and the residual DNA is harmless matter?

2. So even if I have an oral chlamydia infection I would be at no risk of transmitting it through kissing? 

3. Can an oral infection be passed through oral sex on a female? I know the transmission from genital to oral during cunnilingus hasn't been documented but is there any evidence of it transferring from an oral infection to the vagina via cunnilingus?

Again, thank you for your reply. I have followed you and Dr. Hook's publications for years and I truly thank you for your clear insight. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
1) You correctly understand. That would be a harmless false positive result. This is why it is always recommended that if follow-up testing is done, it be delayed until at least 3 weeks after completing treatment.

2) That's what I said. I haven't changed my mind in the last couple of hours!

3) Why keep asking about an infection that a) you almost certainly don't have and b) would be cured if you did? In any case, oral to female genital transmission has never been reported and probably doesn't occur, or rarely enough to be ignored. Let it go.

Thanks for the thanks. I'm glad to have helped. 

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44 months ago
Dr. Handsfield,

I just got my test results back and I was negative for Chlamydia and Gonorrhea. While my results were negative, I have read in some of your previous writings that Chlamydia infections often clear on their own . I have also read that Chlamydia infections in men tend to clear on their own faster in men than women.

My ex girlfriend (girl who tested positive for Chlamydia) started sleeping together in January and she was tested on 2/16/16. I was tested on 3/2/2016. With this in mind, my question is:

1. Is it possible that I infected her with Chlamydia in January but it cleared out of my system before I was tested on 3/2/2016?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Yes, that's possible. However, it probably is less likely than two other possible explanations: that she had chlamydia before January and you were not infected; and that you had a false negative test result, especially if your test was on urine and not a urethral swab. Urine testing misses 5-10% of chlamydial infections in men.

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44 months ago
This is my last follow up and Please don't think I'm beating a dead horse, but I just want to make sure I clearly understand what you are saying. The more likely scenarios are that: (1) she was infected before we started sleeping together and I never got infected; or (2) I had a false negative since it was a urine test. ? 

Out of those two scenarios which one do you believe is the most likely?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Hard to judge which scenario is more likely, in part because I have no information about her sexual lifestyle and risks and thus the chance she was infected before you were exposed. Maybe you don't either, but I doubt it's in your interest to try to find out. That you had symptoms that cleared with azithromycin suggests you had chlamydia, which would favor a false negative test. In any case, I really don't see that it matters at this point. You both were treated and it's now a done deal.

We've gone beyond the two follow-up questions included with each new question, so that ends this thread. Best wishes.

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