[Question #6999] Can Chlamydia Return

8 months ago
Hi,

Three years ago I was treated for chlamydia infection. Azithromycin didn't work and so I was treated successfully with Doxycycline. I was wondering if it's possible for it to return. I get nervous every time I have vaginal irritation that it may have returned from possibly still being in my GI tract. I have irritation now  but haven't had any sexual contact since the last time I was tested and that's why I'm nervous.

Thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago

Welcome to our Forum and thanks for your question.  I'll be glad to comment.  Let me start by saying that I'm a (little) bit surprised to hear that azithromycin did not work.  In the studies evaluating the drug it cured well over 95% of all infections and when person were subsequently found to have repeated positive tests for chlamydia it appears that those infections were more often due to re-acquisition of infection than from drug failure.  I presume that your experience of failed treatment was based on a follow-up test which was still positive more than 3 weeks after treatment (the diagnostic tests for chlamydia can remain positive for up to three weeks after successful treatment).  Recent studies now suggest that doxycycline taken for a week is slightly more effective in chlamydial infections than azithromycin (After all, there's not much room for improvement when more than 19 out of 20 cases are successfully treated with the "less effective" drug).   Once cured however, chlamydia stays cured and late recurrence has not be described.

I should also add that recurring vaginalis irritation is far more likely to be due to other processes, such as bacterial vaginosis which, unfortunately recurs relatively frequently.  When you have experienced vaginal irritation have you been tested?  Such testing should include not only testing for chlamydia and gonorrhea but also for bacterial vaginosis and trichomoniasis. 

this may be a longer and more nuanced reply than you were expecting.  I hope you find it helpful.  If anything is unclear or there are additional questions, please use your up to two follow-ups for clarification.  EWH

---
8 months ago
The only thing I can think of is a frottage episode that occurred after I was treated that led to reinfection with the same partner who had yet to be treated for chlamyida at the time. Is this possible? There was no penetration and no oral. Just grinding. I have been tested when having this irritation and everything remains negative. They say it may be due to stress. But I have not been tested since this recent feeling of irritation, although, I haven't been active.
8 months ago
My Main question is it possible for chlamydia to remain in the GI tract and reinfect me after being treated with doxycycline. But please answer the questions I asked in the first follow up. Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago

Thanks for the additional information.  Frottage is safe sex and without penetration there is no known risk for acquisition (or re-acquisition) of chlamydia. 

Most chlamydial infections are asymptomatic as well.  The irritation you are experiencing deserves a thoughtful, comprehensive examination once or twice but need not occur repeatedly, particularly if you have not been sexually active.  In some instances persons who are concerned about STIs tend to look extra hard for signs and symptoms and, in this situation, find themselves becoming aware of otherwise normal sensations which would normally be overlooked. 

Concerns about the persistence of chlamydia in the GI tract (rectum) are based on studies in experimental animals where this has been demonstrated - even in that situation doxycycline should be curative.  I would not be worried about chlamydia at this time.  I hope this response is helpful.  EWH

---
8 months ago
Okay, my understanding was that chlamydia gets into your GI tract from oral sex and from swallowing semen and reinfecting the vagina from exiting the rectum and traveling there. Last question: why is testing for M. Genitalium not standardized yet? Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago

The thesis that chlamydia enters the GI tract through oral sex and then spreads throughout the GI tract in humans is not substantiated by research studies.  While GI infection does happen with a different chlamydial species which infects mice and guinea pigs, genital to GI tract transmission even in these animals has not been substantiated and many investigators are skeptical of the relevance of these observations to humans.  I take no stance and have watched the research for years and, for the moment find it inconclusive.  We do KNOW that chlamydial infections are less efficiently transmitted through oral sex than genital-genital or ano-genital contact however.  The strongest evidence is that nearly, if not all rectal chlamydia is the result of direct sexual contact or, in women, contamination of the rectum with genital secretions spreading from the vagina to the rectum.

Regarding M. genitalium, there are now several highly accurate, FDA-approved tests available to detection of M. genitalium and while research clearly shows that the organism can infect the male urethra to be a cause of persistent urethritis which does not response to anti-chlamydial therapy, the data to suggest that it is an important cause of reproductive tract morbidity in women or that it causes complications is less clear.  In fact, we do not even know precisely where M. genitalium actually causes infection in women - the vagina?, the cervix, other?.  As a result the CDC has been, in my opinion, appropriately cautious is recommending widespread testing for M. genitalium

both of the areas you refer to are areas of active research.  they are also areas where there is a lot of misleading information on the internet.  I hope that the information I have provided above is helpful.

As you know, the forum  permits up to three response as part of each thread.  This is my 3rd reply.  thus, as per Forum guidelines, this thread will be closed shortly without further replies.  Thank you for your questions.  I hope the information provided is helpful.  EWH


---