[Question #6239] Chlamydia

18 months ago
Dear Doctor, 

Unfortunately, I was diagnosed with c. trachomatis two months ago. I noticed something was wrong when I felt a minor sting in my penis at the start of urination in the morning. For the rest of the day, I didn't notice anything unusual. However, it happened the next morning. Therefore, I went to an Urgent Care clinic where the NP didn't notice anything wrong visually with my genital area. However, they tested me for c. trachomatis, Syphilis, Hep C, and Hiv. Three days later, I received my results, with everything coming back negative, except for c. trachomatis. I was devasted. I began treatment for myself (and partner) with doxycycline 100 mg orally twice a day for ten days. On day six of my treatment, I did a full panel PCR test and everything, including c. trachomatis came negative. However, on day 10, I went to a urologist, because of concern for potential long-term damage, he provided me with Ceftriaxone 250 mg IV in a single dose and Azithromycin 1g orally in a single dose. His rationale was that I might have also been co-infected with gonorrhea. Although I had done two full panel PCR tests that did not come up with gonorrhea. After three weeks, I was still feeling some discomfort in my urethra. My urologist suspected m.genitalium and prescribed me moxifloxacin1g and clarithromycin 500g two times daily for two weeks. Again, the PCR tests had not detected m.genitalium. However, my urologist said that it is challenging to detect m.genitalium even with PCR. After completing the treatment, I was still feeling urethral discomfort, which persists, on and off, until today (two months later). In the past week, I wake up at least once every night to urinate, noticing only urgency in my urethra. My question is the following: is it possible that my urethra is still healing from the initial c. trachomatis infection? Should I give it more time to feel 100 percent again, hopefully, or am I scarred for life (sorry for sounding dramatic, but it has really impacted my emotional and mental state)? How common are long-term complications, in men, from this infection? Is it possible that I may have developed chronic bacterial prostatitis? 
Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago

You have been over tested and over treated for STIs.  Currently available PCR-type tests are the most sensitive tests for gonorrhea, chlamydia and M. genitalium ever known and a single negative test effectively rules out the possibility of ongoing, active infection.  Many of our clients experience persisting infections as a result of the fact that they pay far closer attention to possible urogenital sensations than usual, leading them to become aware of otherwise normal sensations which are more typically overlooked.  I suspect this is the case for you.  My advice is to have confidence in both your tests and the treatment (much of it unnecessary) that you have had and move forward with confidence that you have been effectively treated for your chlamydial infection.

Prostatitis is rarely, if ever due to STIs.  Your urologist should be able to tell you if you have prostatitis.  Most people with prostatitis have abnormal urinalyses showing increased numbers of white blood cells in urine.

Hope this helps.  Have confidence that you do not have an STI at this time. EWH

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18 months ago
Dear Dr. Hook, 

Thank you for your response. Its been a struggle, but I will take your advice and try to move on from the horrible experience. However, I would like to know the following, based on your experience: Do most symptomatic men, diagnosed and treated for C.T, end up having long-term urinary issues? For example, slow stream or perhaps later develop urethral strictures? It seems the scientific literature focuses more on long-term health implications for women. But practically speaking, from your experience, how often have you seen complications arising out of symptomatic men, diagnosed and treated for C.T? Moreover, does C.T cause damage even if you're not symptomatic? Is there any scientific evidence to suggest that the body can get rid of the infection on its own? 

Kind regards, 
Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
No, following successful treatment of chlamydial there are few, if any continuing effect of the infection. ,my advice s t put these events behind you.  EWH---