[Question #6302] Pharyngeal Chlamydia

15 months ago
Hello Doctors. I have been mutually monogamous with my female partner for over 7 years, prior to this I had been intimate with 5-6 people. Prior to my current 7 year relationship, I had a blood STD test and it came back negative. I don't think chlamydia was tested for at all, I have never had swabs/urine tests until last week. Last week I saw a STD GP and he requested swabs, urine test and blood test. Following these tests, my throat swab came back positive for pharyngeal chlamydia only, everything else negative. I was prescribed Azithromycin 1g.
1 - is it possible that the pharyngeal chlamydia has been dormant for over 7 years and never produced any symptoms at all?
2 - my female partner went to her GP and was prescribed Doxycycline 100mg to take twice daily for 7 days, is this as effective as Azithromycin for chlamydia?
3 - can pharyngeal chlamydia travel down to my genitals and cause a genital infection?
4 - is it only genital infections that can potentially cause infertility? Will a pharyngeal infection cause infertility as well? I read about chlamydia in the eye and it did not mention fertility complications at all, only site specific complications like blindness.
5 - my only concerns are for my young children - both under 5 years old. The GP told me that I cannot pass pharyngeal chlamydia through kissing, but I am concerned because sometimes my children use my tooth brush accidentally (toothbrushes look similar). Also occasionally, my children will chew the toothbrushes (possibly for comfort from teething). However I always rinse my toothbrush when I finish brushing. Will Chlamydia be non infectious when mixed with toothpaste and water? Ie. after brushing will it survive on a toothbrush? I am petrified that I have somehow passed this onto my children. Please help me. Thank you very much.
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Welcome back to the Forum.  Is this question somehow related to our interaction last week relating to oral sex?  Irrespective, I will go on and answer your questions.  Before I do.  Oral chlamydial infections are rare but recent data now indicate that they do rarely occur (as recently as 3 years ago, many experts stated that oral chlamydial infection almost never occurred- since then extensive studies have indicated that while rare, they do occur, albeit less commonly than gonorrhea).  In answer to your questions:

1.  Chlamydial infections can remain present and undetectable for long periods of time.  Virtually all of these data are from studies of genital infections.  Chlamydial infections in these studies can persist for years however over time, they tend to clear, even without treatment.  After more than 5 years, over 80% of genital chlamydial infections clear.  In the absence of scientific studies, extrapolating these data, a small proportion of oral chlamydial infection could persist for years.

2.  Yes, doxycycline does work as well as azithromycin for treatment of chlamydial infection. 

3.  No

4. Oral infections would not lead to infertility.

5.  Your GP is correct.  Your children are not in danger from kissing or from chewing on your toothbrush

I hope this information is helpful.  EWH

15 months ago
Hello Dr Hook. Thank you very much for your assistance. These questions are not related to my previous post, as part of the screening for PReP I was swab rested and it returned positive for Pharyngeal Chlamydia.
If you can please clarify the following:
1 - earlier this year my son had multiple oral sores with fever and was quite unwell, he was taken to the GP and the GP stated that it was oral HSV1 initial infection, which is why it appeared much worse than my oral cold sores (fever and 3-4 sores). We all have oral HSV1 at home, the GP stated that this is most likely oral HSV1 or slight chance of hand, foot and mouth disease. No swab testing was done. The GP gave a cream that helped and some Panadol, the sores went and have not returned. In your expert opinion, is the GP assessment correct? Could this have somehow been an initial pharyngeal chlamydia infection for my son?
2 - thank you for your reassurance that I could not have transmitted the pharyngeal chlamydia to my children. Do you think they need to be tested just to be safe? Do you recommend any testing based of what I have told you?  Purely from a medical standpoint based on your expertise.
3 - Would you agree that my children had zero risk of acquiring pharyngeal chlamydia based on my questions above? Can I move on knowing I did not put them in any risk?
Thank you for your understanding and kindness.
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago
 I'm glad my comments were helpful to you. Straight to your follow-up questions. 

1.   I did not have the opportunity to examine your son and your GP dead. Everything you describe however is entirely consistent with HSV-1.   Initial episodes tend to be far more severe than recurrences. Following in the initial episode some individuals have no further recurrences while others do have cold sores recurring from time to time. Overtime (decades) the frequency of cold sores has a tendency to diminish. FYI, here in the United States,  most persons who acquire HSV-1 do so as children.   The fact that others in the family already have HSV-1 makes it quite likely that what you describe is your sons first episode. 

2.   Your children certainly do not need to be tested. On the other hand, you should be tested for cure. As a generalization, oral pharyngeal STI's are more challenging to treat then infections occurring at genital sites. I anticipate that your infection will have been cured but given your concerns and anxiety a follow up test  is probably a good idea. 

3.   I agree. Your children are not at risk. With regard to your children you should move on without any concern. 

 I hope these comments are helpful. EWH 
15 months ago
Hello Dr Hook, thank you for helping to eliminate my anxiety! I am very relieved to hear that my children were not at any risk and that they don’t need testing. Thank you. 
1 - Will Azithromycin 1g usually clear up a Pharygeal Chlamydia infection? Is there a need to retest for cure from a medical perspective or is it purely to reduce anxiety?
2 - can mycoplasma genitalium or trich be acquired through receiving unprotected oral sex? There is conflicting information online. Also, what are the tests available for mycoplasma genitalium and trich?
3 - is the urine test for chlamydia/gonorrhoea considered accurate?
4 - are there any interactions between metronidazole and azithromycin? Will they reduce each other’s effectiveness? If so, what is a safe time frame to finish one and start the other.
Thank you Dr Hook and all the best. You are a source of light when many of us experience  STD related anxiety. I sincerely hope that you are recognised for your efforts by the community, profession and all others in the STD field.

Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Final Responses:

1.  Yes.  There are occasional azithromycin treatment failures but they are rare.  For that reason I suggested a follow-up test.  That test should be done at least two weeks after treatment. 

2.  Very very rarely, even compared to chlamydia which, as explained before is also rare.

3.  Yes, urine tests are reliable and are accurate.

4.  No interaction.  You could take them simultaneously, not that you need it.

As per Forum Guidelines, this will end this thread.  I trust you will not return to the Forum with further repetitive or anxiety-driven questions.  EWH