[Question #8288] Chlamydia question
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46 months ago
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Ive been married 9 yrs. I slept with no one but my husband. I frequently experience issues with BV due to period, after sex, etc. I noticed I had abnormal symptoms so I went to the dr Aug 24 to get tested for BV and STI’s just to be cautious. BV test was positive day of appt. A day or 2 later I was told chlamydia test was positive as well. I asked my husband if he was unfaithful sexually and he told me no. Aug 28 he went to urgent care to get tested and got treated. It took more than a week to receive test results for my husband but his results were negative. A family member was staying with us for awhile and during his stay he contracted chlamydia from a woman he slept with. I’m concerned of a possible transmission with a bath cloth that I may have accidentally used that belonged to him. How is it possible? I’m positive and my husband is negative and we haven’t had any outside sexual encounters.
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H. Hunter Handsfield, MD
46 months ago
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Welcome to the forum. Thank you for your question and your confidence in our services.
This situation actually is quite common -- i.e. one member of a couple infected with chlamydia, the other testing negative. There are several possible explanations. Almost certainly the first is already on your mind, that your husband has had at least one other sex partner recently and is the source of your infection. His negative test could be false, especially if his urine was tested and not a urethral swab: urine testing misses up to 10% of chlamydia in males. Or perhaps he was treated before being tested. Of course this probably is the least palatable option, but not the only one. You're the only one who can judge your relationship, his truthfulness, and so on (you know him and I don't!). However, in my experience, most spouses in your situation are pretty good at scoping out the chances. If you're confident in his fidelity and he seems honest and not on the defensive, the odds are good this isn't the explanation.
The possibility that your test is falsely positive needs to be considered. However, this is very rare with the standard chlamydia tests these day. We should assume your test result is accurate and that you indeed had chlamydia. (I'm assuming that by now it has been treated. For reasons that will become clear below, you need treatment with doxycycline for 7 days, not single dose azithromycin.)
That you had a house guest who had chlamydia about the same is an interesting coincidence, but probably no more than that. Chlamydia and other STIs are never transmitted by environmental contamination, shared towels or toilets, etc. That possibility can be dismissed with confidence.
Finally, you might have been chronically infected. It's uncommon for women to be infected and carry chlamydia for more than a year, but it happens. Four years has been documented, and if it can persist 4 years, probably it can go quite a bit longer. This can happen even with negative testing from time to time. Recent research has revealed a possible explanation: some chlamydial infections can reside harmlessly in the intestine, initially perhaps acquired by oral sex, or rectal infection that then ascending upward into the intestinal tract. And rectal infection with chlamydia doesn't require anal sex. Just having the infection in the vaginal area can contaminate the anal area and result in rectal infection. And the infection can move in the opposite direction as well -- that is, a chronic intestinal infection can re-involve the anal area, from which the vaginal area can then be infected.
This is all quite recent research, and the frequency with which longstanding intestinal infection explains apparently new genital infections isn't known. But probably it happens.
At this point, the main thing is that both you and your husband need treatment. (Even with his negative test, he still might be infected, whether from another partner or from you.) And as noted above, treatment should be with doxycycline, not azithromycin. Additional recent research has found that azithromycin often fails to cure rectal chlamydia, and it also is not reliable in clearing chronic intestinal chlamydia. So for sure you need doxycycline, even if you have already been given azithromycin. (This is less important for your husband: azithromycin still works very well for male urethral infection.)
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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