[Question #7030] Chlamydia

61 months ago

Hi Drs

Unfort I am back but with some not so good news.

Some background:

1 April 2020 - Negative full STD tests

23 May 2020 - Unprotected vaginal intercourse with wife

11 June 2020 - Unprotected receptive oral sex from female acquaintance

17-18 June 2020 - Symptoms feeling burning and discomfort in urethra (no visible discharge nor burning urination).

18 June 2020 - PCR Urine test for Gon and Chlam

18 June 2020 - Was put on treatment by my Urologist (1.5g Azithro single dose and 500mg Levofloxacin daily for 7 days)

23 June 2020 - Results came out with Chlam detected (Gon not detected).

23 June 2020 - Urologist told me to restart 1g Azithro single dose and take 500mg Azithro daily for the next 7 days).

Since the unprotected oral on 11 June until today, I have had no intercourse or otherwise with my wife - and will refrain until I see a negative PCR.

I informed my female acquaintance when I received my results. I am not in a relationship with her, so I do not know what risks, if any, she takes in her spare time. She told me that she has not had unprotected oral with anyone for a long time. I told her that I understand that, although it is rare, scientifically Chlam can infect the throat and stay there if untreated for months on end and can rarely but possibly pass to a partner through oral sex. She told me that this would be the first time in her life that she will be doing an STD test, whereas I do the tests every 3-6 months.

Timing-wise, I am inclined to assume that my Chlam was (most likely) due to this oral exposure and my sheer bad luck, and not the vaginal sex I had with my wife 4 weeks prior to developing symptoms. I have had vaginal sex several times with my wife prior to my negative results and still tested negative.

Am I correct that symptoms rarely appear, but when they do, this occurs on average between 7-10 days for men?

Since my last negative tests, these are my only 2 exposures.

Thank you in advance.

H. Hunter Handsfield, MD

61 months ago

Welcome back. Sorry you found it necessary, and sorry to hear about your chlamydial infection.

You can rely on the test result. The current chlamydia nucleic acid amplificaiton tests (NAAT -- not actually PCR, but the same sort of technology) are highly accurate, and false positive results are rare. Had you been asymptoamtic, I would be worried about a false positive, but with the symptoms described, there is little doubt you were infected. So what is the source? You are correct in your understanding that chlamydia is rarely transmitted by oral sex, both because oral chlamydia is uncommon and even when present appears to be infrequently transmitted. To my knowledge I have never cared for a patient whose positive chlamydia result appeared to result from an oral exposure. That doesn't mean it can't happen -- just illustrating how uncommon it is. All that said, there is a very small possibility of non-chlamydial urethritis from the oral exposure, plus a false positve lab test. At this point there is no way to know.

Because of the rarity of acquiring chlamydia by oral sex, you also need to consider the possibility that your wife is the source. Of course you're in a much better position than I am to judge the possibility she acquired it reccently from another partner, but I will point out an obvious fact about sexual relationships: when one member of a couple finds a need for other partnerships, often the second also has done so. Even if you consider that unlikely, in recent years it has also become apparent that chlamydia can seemingly appear anew in a person not at risk of new infection -- i.e. the result of a distant past infection, without recent reexposure, and often with negative intervening test results.

Putting all this together, I would judge it as roughly equally likely that your infection is from your recent oral sex exposure or from your wife. Accordingly, both your "female acquaintance" and your wife need treatment, and preferably both should be tested as well. As a corollary, you'll need to consider having an open, honest, and sensitive discussion with your wife about your sexual exposures and perhaps her own.

The chance you'll have recurrent symptoms or persistent infection is extremely low, zero for all practical purposes. The treatments you had were quite atypical (suggesting your urologist may not be up to speed on STDs). That said, it amounts to over-treatment, not under, and undoubtedly will be effective.

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

HHH, MD

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61 months ago

Thank you Dr, very clear. I have to figure something out.

I've now started to worry about any potential for syphilis, I know this is a low chance from hetero oral but I'm still worried considering other low chances that seem to have bore fruit with me! What are the odds if I may (or dare to) ask?

If this was to be an issue, how quickly would the Azithro 1.5g that I took on day 1 have acted to tackle it? Few hours? I assume based on the treatment that I'm now on, I will never know if I acquired it from this oral exposure. I did a vdrl test either way 1 week post exposure as a baseline which was negative, but I know that's not enough time.

If I did acquire this, even with the treatment i'm receiving, will a VDRL at 6 weeks post show positive in all cases?

Thank you again.

H. Hunter Handsfield, MD

61 months ago

Syphilis is zero risk from this event for all practical purposes. In the last 10 years, I'd bet not 5 people in the US have acquired syphilis from an equivalent exposure. On top of which, azithromycin would abort or cure 80% of syphilis. And you took it quickly enough that even if you had been infected, there's no way you could ever know -- as you correctly suspected. Just let it go and deal with the important issues as per my first response.---

You have one follow-up comment and reply coming, and owing to the policy about repeated questions on the same topic, this is your last and only question about your chlamyidal infection and the exposures described. I suggest not blowing it on an irrelevant issue like syphils or any other STDs. OK?---
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61 months ago

Hi Dr HHH

Just a quick update, since my last post:

23rd June: My wife received 400mg Suprax (for an unrelated gyno medical procedure that she underwent) (was supposed to be for 6 days but she took it 4 days and had to stop with the approval of her gyno. because she developed a yeast infection from the antibiotics).

27th June: My wife took 1g Azithro in a single dose.

30 June: I finished my Azithro course, but I was still feeling some lingering discomfort at the tip after urinating (no pain just felt like I was leaking when I was not). I was worried that maybe the Azithro didn't work to clear the Chlam.

1 July (today): I visited my Urologist this morning and had a long talk with him. I asked him about the Azithro and he said surely it would have cured my Chlam and the reason why he "over-medicated" was so that he could, as far as possible, reduce the chances of me developing prostatitis which is a nuisance.

So he conducted a urethral swab and a urine test, I also asked for a Chlam test (first catch after 2 hours of not urinating) which was an Antigen test and we did that as well as part of the urine test; results came out a few hours later and were negative for Chlam thankfully. My Dr told me that I can trust this result and I do not need to follow up with a PCR DNA test for Chlam.

Otherwise, all else clear, except the results showed that I have a minor UTI (I guess this explains my lingering discomfort). We need to wait a few days for the swab and culture results to see if it is in fact a simple UTI or worst case scenario, prostatitis.

My Urologist said not to worry about this. He prepared a prescription of Doxy (2x100mg over 10 days) and Suprax (400mg over 6 days) but told me not to buy or take anything until the swab and culture results are out in the next 2 days then he can decide what I need, if anything.

Questions:

(1) Can I trust from the negative Antigen test that I have been cured and not need to repeat the PCR DNA test for Chlam next week (3 weeks after commencing treatment)?

(2) Would the meds that my wife took have likely covered her in case the Chlam came from her (which I still personally doubt that it did)?

(3) Is the minor UTI concerning? Could this be caused as a result of the impact from the Chlam or perhaps could have been due to introduction of normal oral bacteria from my oral incident that ran concurrent with the Chlam infection?

(4) My Urologist suspects the culture will be negative, however says if positive, the swab will give us a lot of info. Do the prescribed meds seem about right to deal with this kind of situation?

(5) Since the Chlam has now cleared, would the minor UTI (or worse prostatitis) be contagious or harmful to my wife at all if we were to resume intercourse after her 7 days post the 1g Azithro? Or best to hold off until the UTI has been totally cleared?

(6) Anything I can do at home to deal with the UTI or speed up recovery?

(7) Finally, can I breathe again and get on with my life?

Any thoughts you may have would be most welcome. At the time of writing this message, I feel nearly back to normal, but I guess i'm still shell-shocked by this whole experience so surely aside from the UTI, anxiety/guilt has played an important role.

Despite everything, I have not been sexually active in any way since the oral incident - I know whatever I have is curable and I am not worried about myself as must as I am for my wife's well-being. My Urologist told me that she took meds which would have covered her for these risks and she will be fine and not to worry. I'm inclined to believe him.

I haven't slept in 2 weeks, and really want to get a good nights sleep once this is all over.

Dr HHH, as always, thank you in advance for your valued guidance and support.

H. Hunter Handsfield, MD

61 months ago

1) Yes, that negative result is conclusive. The problem with early retesting after treatment is a potential for false positive result due to persisteing DNA. But a negative result is reliable.

2) Azithromycin is slightly less effective in women than men -- about 95% cure rate, leaving 1 chance in 20 it might fail. Too bad she wasn't tested for chlamydia before treatment. She should be tested afterward, at least 3 weeks after treatment.

3-6) You've not described the evidence for your "minor UTI" (symptoms only? WBC in urine?). If your urologist diagnoses continuing urethritis, you'll need testing for trichomonas and Mycoplasma genitalium. Should either be positive, your wife would need treatment in addition to yourself. But most likely it indeed is just residual symptoms from your chlamyidal infection. A non sexually acquired UTI is very unlikely and lilke your urologist, I'll be surprised if anything shows up on urine culture. Neither chlamydia nor other STDs cause prostatitis, which is not a likely outcome here. However, if your symptoms persist and if continuing urethritis (not UTI) is documented, it might be wise for your wife to be treated when you are, even if M gen and trich are not documented. I would advise not resuming sex with your wife until all this is sorted out, which might take a couple of weeks.

7) "Breathe again"? From a chlamydia standpoint, yes -- as long as your wife is tested for it after 3+ weeks and has a negative result. From a syphilis standpoint, also yes. But it sounds like you and your urologist need to sort out your continuing symptoms and potential causes and treatment, which might involve your wife as well as yourself.

That completes the two follow-up exchanges included with each question. I hope the discussion has been helpful.

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