[Question #5826] Chlamydia re-infection, only one partner positive

72 months ago

My boyfriend and I both tested positive for chlamydia in October, just a few months after we had started dating. I got treated right away, but he was between jobs/without insurance, so it took him about 6 weeks before he was able to get tested & get medication. We’re long distance so don’t see each other that often, but we did have sex once after I took medication & before he did (so he was still infected) but we used a condom. The second time we had sex was after he had taken the medication, but we didn’t wait the full 7 days we were told to, it was probably on about day 5, and without a condom. I got tested about two weeks after that and had a negative chlamydia test.

Fast forward to a couple months ago, I got tested again and had another positive chlamydia screening. Again, I got treated right away and told him as soon as I could. He’s now in the military and it took about a week for him to go to the clinic on base, but turns out his test was negative. He even went back and got a second test, which was also negative.

My question is, how could this have happened? I know for a fact that I have only been with him, so there’s no way I would’ve gotten it from someone else (though of course that’s what his military doctor is telling him). How could I have gotten re-infected? I do have vibrators, but I did clean them after my first positive test, would that have re-infected me? And how could he have not gotten it? Like I said, we’re long distance so it’s not like we see each other a lot, but hypothetically I could’ve had this for a good six months, and we usually spend a weekend or two together per month (having unprotected sex multiple times).

My other concern is, is this going to keep happening? What can we do to prevent this in the future? I’ve been so constantly worried that I’m going to keep having positive tests, even though he’s my only partner. I don’t know how to convince him that I haven’t cheated when that seems like the obvious answer from his perspective.

I hope this all makes sense – thank you for your help, it’s been a hellish last couple weeks.

H. Hunter Handsfield, MD

72 months ago

Welcome to the forum. Thanks for your question.

First, let me reassure you that this will not keep happening. Every case of chlamydia can be cured. Second, all this probably can be explained without either you or your BF having sex with anyone else. That stress probably is not part of the problem!

This situation might be sorted out quite easily, depending on what treatment you were given when chlamydia was first diagnoed. For reasons that will be clear below, I'm guessing single dose azithromycin (usually 1 gram). But it could have been doxycycline (100 mg twice daily for 7 days), or something else. If not azithromycin, did you stick with the program, i.e. all doses taken with no more than a few misses?

Azithromycin has the major advantage of single dose treatment, a convenience for patients and one that assures their doctors that taking drug reliability for a week isn't an issue. However, we now know that it fails to cure chlamydia more often than once believed. The infection persists in up to 5% of women (1 in 20). Treatment failure is especially common if chlamydia has infected the rectum. I'm guessing you had only a vaginal or urine test, but when the rectum is infected azithro fails 15-20% of the time. Assuming your negative test two weeks later was on a vaginal swab or urine, you could still have had it rectally. If you and your BF sometimes have anal sex, that increases the chance of rectal infection. But anal sex isn't necessary: vaginal infection can easily spread to the rectum, and vice versa, simply because the two openings are so close. In other words, persistent rectal infection, subsequently spreading to your vagina, could explain your newly positive test result.

If you were given doxycycline and took all of it as directed, that lowers the chance of this explanation. But it's still possible; even doxy isn't 100% successful, with perhaps 1% of infections not being cured.

What to do now? Your current infection should be treated with doxycycline, for both you and your BF. (Even though his recent test was negative, it is routine and common sense to treat both partners.) If you've already been treated with azithromycin, I would still recommend doxycycline. Discuss this with your doctor. (You might print out this explanation to discuss with your doctor. The research on rectal chlamydia and effectiveness of azithromycin is quite new. Many doctors aren't aware of it, even with lots of experience in managing patients with chlamydia or other STDs.)

I look forward to your answers to my questions above about the treatment you and your BF received last fall and perhaps I'll have more to say. In the meantime, I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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72 months ago

I was treated with Azithro both the first time and this last time. Your explanation about the re-infection could’ve happened definitely makes sense, but I’m still confused as to how he could be testing negative? How could he not have gotten it?

H. Hunter Handsfield, MD

72 months ago

There are several possibilities. If you had rectal chlamydia, it might not have spread to your genital tract for a long time. STDs are not always transmitted -- it's common to have many exposures and not catch a partner's infedtion. (For HIV, for example, it's transmitted less than once for every 1,000 vaginal sex exposures.) Chlamydia often is cleared by the immune system, without antibiotic treatment, so your BF might have caught it from you, but it cleared up before he was tested. Finally, chlamydia urine testing in men misses up to 10% of infections, so he might have it despite his negative test result. The last is the main reason that he needs treatment with doxycycline, as you do, despite his negative test.---