[Question #7732] Help Dr Handsfield

18 days ago
U have helped me before but my wife is having symptoms so your help would be appreciated.
Let me refresh
Had a massage with sex worker. Heavy frottage with lots of vaginal fluid and oil over my penis head. She made me come with frottage and no penetration. Lets say for argument sake she has chlamidya. I live in a bad country 3rd world. 

2 to 3 days after I took 500mg zithromax for 4 days 1 a day(incorrect dosage I know)

4 weeks later I took a home chlamidya swab test from possibly not a reputable co which had an extremely faint positive line after about 5 minutes. 

Panicked and took 1g zithromax but slept with my wife 3.5 days later for the first time since original incident.(didn't wait 7 days)

I have had no symptoms but 4 months after the incident my wife is complaining now she has a yeast infection which she assumes. Pain around the vagina on the outside. Slight burning when she urinates and uncomfortable down there. 

1. I am really worried I have given her chlamidya could give me your thoughts?

2. Why is that they say penetration is necessary but frottage is low risk? Surely vaginal fluid is vaginal fluid and once it touches the male penis head and urethra entrance u get infected?

3. If I took the first course of zithromax 3 days after the incident as precaution would this have been too soon?

4. The 1g zithromax I took 4 weeks after the incident as well. Would 3.5 days been adequate to kill the chlamidya if the previous course didn't? 

I'm very worried pls help. Thanks

Edward W. Hook M.D.
Edward W. Hook M.D.
18 days ago
Welcome to our Forum and thanks for your questions.  As I suspect you may know, Dr. Handsfield and I share responsibilities on the Forum and on this occasion I happened to pick up your question.  As an FYI, we have worked together for nearly 40 years and while our verbal styles differ, the facts and basics of our recommendations and assessments are the same in all cases.  In this instance, many of your questions are quite similar to the questions you asked of Dr. Handsfield several months ago.  I agree with all that he said at that time and suspect you will find that not much has changed in the interval since your interaction with him.  The exposure you describe was virtually no risk and the azithromycin would have cured a chlamydial infection in the most unlikely circumstance that you were infected.    In answer to your specific questions:

1.  As I said above, there is no evidence that you acquired chlamydia and even if you had, the azithromycin you took would have cured the infection.  Please remember that most commercial sex workers do not have STIs and even when partners do have an STI, the majority of exposures to infected partners do not result in infection.

2.  It is harder for vaginal fluid to be introduced into the urethra than you appear to think.  As Dr. Handsfield noted, frottage is virtually never associated with urethral chlamydial or gonorrhea infections.

3.  No, it would not be too son.  In fact, taking antibiotics sooner is theoretically more likely to lead to cure.

4.  Yes

Finally, let me add that your wife's symptoms are far more suggestive of a yeast infection than chlamydial infection.  I hope that this information has been helpful.  As you know, if anything here is unclear, you may use your two follow-ups for clarification.  EWH
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18 days ago
Thanks for the comforting response Dr Hook. I guess that the weak positive home chlamidya test freaked me out. There is obviously still the belief that it could have been a true positive and although Dr Handsfield said it was almost certainly a false positive, human nature is to be concerned.  I assume u agree it was a false positive?

Although i took the wrong dosage of Zithromax in the beginning, i assume based on your response u are happy that 500mg a day for 4 days would work just as well? 
Edward W. Hook M.D.
Edward W. Hook M.D.
18 days ago
I do agree with Dr. Handsfield, both that the result was likely falsely positive as well that the azithromycin you took would have certainly eliminated infection if present.  EWH---
18 days ago
Last question just for my own knowledge. They say most people don't have symptoms with chlamidya. Surely most do but the majority don't realise they are having symptoms? I understand with HiV and HPV and Herpes u may never see symptoms. Because u may not get HPV warts or a herpes outbreak and with HIV not until u are really ill but surely chlamidya being bacterial most people get some form of a symptom although it might be too mild to notice? 
Edward W. Hook M.D.
Edward W. Hook M.D.
18 days ago
The best available data suggest that 50-60% of men with chlamydia do not report symptoms when specifically asked at the time of diagnosis.  Chlamydia lives within cells and does not cause the sort of pronounced inflammation that we see with some other STIs. Certainly in some of these cases, persons may have mild symptoms that they discount but some of these persons are certainly asymptomatic as well.  In general, the proportion of women who have chlamydia and are asymptomatic is even higher than for men.  these are the reasons that routine chlamydial screening is recommended as part of sexual health check-ups.

Of course, this in no way changes our assessments for you.  You are unlikely to have been infected and even if you were, you took therapy which would cure the infection on several occasions.

This completes this thread.  Take care.  EWH
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