[Question #6161] Chlamydia and gonorrhea with 2g azi

70 months ago

Hi there Doctor,

During this week I had very brief sex with a person that I didn't know, she was reluctant to have in the first place but ended up doing it. I have girlfriend and freaked out so around 30h after I took 2g of azithromycin in one go, 1h before eating anything in the morning.

I'm going to see my girlfriend in 4.5 days after the 2g and will be difficult to avoid sex so that's why I'm here seeking advice as I sont want to put her at risk. I'm not really concerned about others than chlanydia and gonorrhea. I've had HPV before and herpes would be unlikely.

I also thought of seeking testing but I've read that is a bit pointless given the precautionary treatment that I've done.

I understand it is not very smart to treat without a proper diagnose but I freaked out and knew I couldn't get tested soon.

1 should I test on Monday anyway? 4.5 days after taking azithromycin (5.5 after the incident).

2 would this dose have prevented gono/chla?

3 if I wait till 7days after treatment and no symptoms show could I resume unprotected sex with my gf? Or should I wait longer?

Thank you for your time.

H. Hunter Handsfield, MD

70 months ago

Welcome to the forum. Thanks for your question.

I'm slighly concerned by the wording of your description of the sexual event you are concerned about ("she was reluctant...but ended up doing it"). Of course ASHA and the moderators cannot imply support for possibly coercive or non-consensual sex. But most likely this was just careless wording, in part because you obviously are genuinely concerned about your girlfriend's welfare, and the rest of my reply is in that spirit. We don't need any furhter discussion on the issue, OK?

Since you say nothing about your one-time partner's sexual history, I cannot judge the likelihood she has any STI. However, even among the most sexualy active persons, at any point in time most have no transmissible STI. But if she did, your self treatment with 2 g azithromycin is excellent protection against gonorrhea, chlamydia, and most of the known and unknown causes of nongonococcal urethritis (NGU); from the standpoint of these infections, your girlfriend will not be at risk. Depending on where you are, there may or may not be protection against syphilis; in some geographic areas, 70-80% of syphilis is resistant to azithromycin. However, syphilis is rare in most sexually active women -- although this too is highly variable from one city, state, or region to others; and between various social and race/ethnicity groups.

Of course no antibiotic has any effect on any viral infection, so taking azithro provides no protection for you or your GF for herpes, HPV, or HIV.

To your specific questions:

1,2. There is no point in testing for gonorrhea or chlamydia. Even if either infection had been acquired, the drug would have prevented it from taking hold and testing will be negative even if you had been exposed. For the same reasons, there is no risk of infecting your GF.

3. It's still a good idea to wait awhile before having sex with your GF, but 7 days may be too short. That's enough time to be reasonably confident you didn't catch herpes, but NGU resistant to azithromycin (e.g. from Mycoplasma genitalium) might not show symptoms until 2 weeks after exposure; and in the unlikely case of syphilis, it takes up to 3 or even 4 weeks for a syphilitic sore (chancre) to appear.

Don't get me wrong: in absence of symptoms by 7 days, and having taking azithromycin, there is a very low chance you have anything that you could transmit. But not zero chance, and I recommend blood tests for syphilis and HIV 6 weeks after the event, regardless of whether or not you have sex with your GF in the meantime.

Another approach is to contact your one-time partner and suggest she be tested -- or offer to go with her for mutual testing. You might find she is as worried about an STI from you as you are from her. (You might owe her a kind word and maybe flowers anyway.)

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

HHH, MD

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70 months ago

I'm really sorry for the words chosen and how it could have been interpreted. I'm not a native speaker and I understand how it might have sounded like.

What I meant was, she was okay to have sex however she wasnt sure about having without condom. She is Brazilian, we were holiday in Bali but with different groups, we met on the way home at night and as we could speak the same language (Portuguese) I joined her place and we went swimming (she wasnt very drunk or drunk at all, but i was). She was more amazed by the fact I appeared from now where ans could speak the same language. I'm 29 a s ahe should be around the same age. Seemed like a very normal person, no drugs etc.

We then had brief sex in the swimming pool and then a little bit more outside, I cant recall the duration but I think it is fair to say that wasnt more than 10min combined.

I know I cant judge this way but she didn't get drunk and hooked up from the bar (maybe she has done another times). I should have asked her about her status etc but I left and didn't see her again nor have I way of contacting her again.

1 based on this extra information does your suggestions change at all? Regarding syphils and

2 so I can be 100% confident that will be impossible to transmit gonorrhea and chlae given the treatment? Also should I avoid alcohol for now? Not sure if messes up the effect.

3 what would be the treatment for Mycoplasma genitalium? Also how often does this infection occur?

Thank you for your time and sorry once again for my chosen words. It was a consenting activity from both of us.

70 months ago

Allow me just some additional questions please.

4 is there a test for the Mycoplasma genitalium?

Also let me add that I was tested for syphilis and HIV and chla and gonorrhea previous to this events and all came negative. So this would be the only event to be concerned about.

H. Hunter Handsfield, MD

70 months ago

Thanks for the clarifications.

1) No, this additional information does not change my evaluation or advice.

2) Yes, 100% confident about gonorrhea and chlamydia, but not necssarily about the other STDs I mentioned.

3) M. genitalium is a complex issue. It's often a difficult infection to treat. OTOH, it's probably uncommon after any single exposure -- and not necssarily harmfful anyway. Don't worry about it.

4) M. gen testing is only recently comming into common use. Testing is not normally done in this situation.

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70 months ago

Thanks for your reply doctor and for dedicating your time helping.

1 You forgot to comment on the alchool effect on azithromycin. I haven't had any, but would it affect it? If yes how many days after can I start drinking after taking it?

2 Regarding syphilis, being this a rare std on woman I should just keep an eye for chancres but if none appear the transmission is not possible correct? And in terms of probabilities it is really low in this case right? I've read that most woman dont have and from my perspective and after reading a lot of your posts, this person seemed really healthy and that wouldn't engage in promiscuit sex events.

3 HIV is extremely unlikely too given a single brief exposure right? And also given the person itself, not very common. Correct me if I'm wrong.

4 let's say after 10days if no symptoms would be safe to resume sex? By no symptoms I mean clear discharge from my penis or pain while urinating?

I guess this is my last follow up so thanks once again and sorry for my use of words on the first post.

70 months ago

Sorry I forgot to add one question.

5 The azithromycin that I bought wasnt a zpack, and was bought in a pharmacy near Bali. Regardless, can I assume that all azithromycin work the same way? The dosage was 2g (4pills 500g).

Please, last 5 questions and thread can be closed without any additional questions. Thank you.

H. Hunter Handsfield, MD

70 months ago

Alcohol doesn't change antibiotic effectiveness. Chemically, it is the same drug world wide. You described your dosage above.

That conludes this thread, I hope the discussion has been helpful.

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