[Question #8371] Chlamydia Infection Length
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45 months ago
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Hi Dr,
I recently tested positive for Chlamydia and have been in a monogamous relationship for 6 years. I had no significant symptoms, it was just pure luck the doctor recommended it to me.
My partner is claiming she has been faithful and it must have been dormant from our past or transmitted in some other way - like someone using our sex toys.
Her last screening was in 2018, which came back negative. My last screening was well before we started seeing one another.
My doctor said it’s most likely a recent infection, although you cannot determine length of infection.
Is it possible that one of us had Chlamydia from the past (I did have a multitude of partners), have not had serious symptoms, and she received a false negative in 2018?
I find it hard to believe that we’ve both had it for almost 6 years. Although, I’ve read it’s possible to have it for multiple years without knowing.
I want to trust my partner, but I’m a very logical person.
Thank you,
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45 months ago
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Apologies, I forgot to mention that I immediately received a second test which also came back positive.
My partner also got tested and is positive, as well.
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H. Hunter Handsfield, MD
45 months ago
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Welcome to the forum. Thanks for your confidence in our services.
This situation actually is quite common -- apparently newly appearing chlamydia in a monogamous couple. This response is adapted from my reply to a similar question a month ago.
As should be obvious, the most important thing is that you both need treatment for chlamydia, preferably with doxycycline, not azithromycin -- especially for her. The reasons to prefer doxycycline will become apparent below.
There are several possible explanations for this situation. The first is already on your mind, that your partner has had other sex partner(s) recently and is the source of your infection. (I'm assuming you are being truthful in not having other partners yourself.) You're a far better judge of that possibility than I can be: you're the only one who can judge your relationship, your partner's truthfulness, and so on. In my experience, most people in your situation are pretty good at scoping out the chances: if you are confident in her fidelity and she seems honest and not on the defensive, the odds are good this isn't the explanation.
You can dismiss shared sex toys. This could transmit chlamydia only if previously used immediately (within a few minutes) by an infected person. Dried secretions don't transmit any STI. If you and your partner have not participated in group sex or simultaneous sex by other persons that involved shared sex toys, you can exclude this possibility.
Could either of your tests have been falsely positive? That't unlikely with the current chlamydia tests, and your confirmatory follow-up test rules out that possibility. For sure you both are infected.
Your partner might have been chronically infected despite her past negative test results. 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, so 6 years is possible. This can happen even with negative genital (i.e. vaginal or urethral) testing. The same is probably true in men who have sex with men (but not in straight men, i.e. sex only with female partners). Recent research has revealed a possible explanation: some chlamydial infections can reside harmlessly in the intestine, initially perhaps acquired by oral sex, or by rectal infection that then ascends upward into the intestinal tract. In other words, genital/urine testing can miss infection limited to the rectum or GI tract. And rectal infection with chlamydia doesn't require anal sex: infected vaginal fluids can come in contact with the anus and result in rectal infection. In other words, in women having either genital or rectal chlamydia can cross-contaminate the other. Much of this is quite recent research, and the frequency with which longstanding intestinal infection explains apparently new genital infections isn't known. But probably it happens.
And that comes back to the importance of doxycycline for treatment. CDC recently revised its chlamydia treatment guidelines, with doxycycline as the treatment of choice, and azithromycin to be used only when doxycycline isn't practical or must be avoided (side effects, inability to take the full 7 days of treatment, etc). One reason for the change is the rectal and gastrointestinal issue just discussed: azithromycin is unreliable for rectal or GI infection, but doxycycline is fully effective.
In summary, you both need treatment with doxycycline. (However, you could get azithromycin, which remains nearly 100% effective for urethral infection in strictly heterosexual males.) You may never know for sure when and how chlamydia (re)appeared in your relationship, and perhaps it doesn't much matter. But perhaps these comments will help you sort it out, if you choose to pursue the issue with your partner.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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45 months ago
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Thank you for the response. I just reviewed the article previously mentioned.
Couple updates.
My partner received her test results which came back positive. You mention that she could have recently been infected by me, although she’s been my only partner since her test in 2018. That should rule out a recent infection on my end?
You mention it’s uncommon for women to be infected and carry chlamydia for more than a year. Why is this? Would symptoms normally appear within that first year? Also, if my partner has had it for 6+ years, should she be concerned with fertility issues?
You also stated that this isn’t the case with straight men (which I am). Is it common for men to carry Chlamydia for many years and not show symptoms? Should I be concerned with long-term effects?
Thank you again for the insight and time to answer my questions.
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H. Hunter Handsfield, MD
45 months ago
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You may have seen my initial reply, in which I missed that your partner had tested positive (in your follow-up comment). I went back and edited my reply -- so please re-read.
I already acknowledged my assumption that you are being truthful about not having had other partners for the past 6 years. That rules you out as the source of your partner's infection.
The immune system clears most chlamydial infections, usually in a few weeks to a few months. Persistence longer than a year is unusual. As already discussed, one reason may be carriage of infection in the intestines. Such infections may be more difficult for the immune system to clear up. Such prolonged infection has not been reported in heterosexual men, because the immune system pretty quickly eradicate infection in the male genital tract (usually within a few weeks). Men having sex with men is a different story, probably because of the increased likelihood of intestinal or rectal infection.
Chronic carriage is not known to be especially risky for female infertility. And her negative test around 3 years ago makes it unlikely she has been carrying chlamydia in her genital tract, which is the only sort of infection that can cause female infertility. I cannot say there is no chance she has had tubal damage that might cause infertility, but it is unlikely if she has not had symptoms that suggest pelvic inflammatory disease (low abdominal or pelvic pain).
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45 months ago
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Dr. Handsfield,
Greatly appreciate the information. This has been extremely helpful. I recognize I only have one more response, so thank you again.
Based on this scenario, my understanding (please correct me if I’m wrong) is, most likely, this infection was recently contracted (due to infidelity) or that my partner was chronically infected in the past (not me - since I have had no intercourse with a man).
With the latter, is it possible I have been continually infected over the course of our relationship but my immune system has consistently eliminated the bacteria? I’ve never really experienced burning symptoms or discharge but understand Chlamydia is often asymptomatic.
If she has an intestinal infection, would I still be able to contract Chlamydia through vaginal, anal, or oral sex or would it have to progress to a vaginal infection.
Regarding her test in 2018, I understand it might not have shown up due to being an intestinal infection. Could these also be reasons?
(1) Would this mean the infection could have finally progressed to be identifiable in her urine sample?
(2) Cross contamination through an anal infection to cause vaginal infection.
(3) False negative. Do you happen to know statistics on this?
I’m trying to give my partner the benefit of the doubt, hence the extensive questions. I recognize I may never understand where this came from, but this helps me evaluate the probability of long-term vs infidelity. Thank you again, Dr. Handsfield.
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H. Hunter Handsfield, MD
45 months ago
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"Based on this scenario...": Correct.
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You either are infected or you are not -- there is no such thing as being "continually infected..." and also "immune system consistently eliminated". This question is really irrelevant: almost certainly that you have not been infected over the years. Conceivably that could have happened, but it's much more likely that the current infection originated in your partner, either because she has been chronically infected or she recently acquired it. As far as known, it is extremely rare that men can have continued information in the genital tract more than a few months.
Your partner has a genital infection, otherwise her test would have been negative. Once treated with doxycycline, it will be gone, both in her genital tract and intestinal (if it was ever there). Once treated, any and all sexual contact with her will carry no risk of infection.
The answers to your three questions won't really help judge your partner's fidelity. That determination is going to rest entirely on what she does or doesn't acknowledge and whether you believe her or not. But the answers are:
1) Positive urine test means genital infection is present, but says nothing about how long she had been infected, or whether she recently acquired the infection (sexually) or was carrying chlamydia over the years, either in the genital or intestinal tract.
2) Yes, cross contamination from the rectum can infect the vagina. And vice versa -- vaginal infection can contaminate the anal area, leading to rectal infection.
3) False negative results can occur: it is conceivable she had genital infection that was missed when she was tested 3 years ago. But it's impossible to know with certainty.
I understand this is a complex situation. The bottom line is that the mystery of the origin and timing of her infection won't ever be sorted out by any more detailed understanding of the lab tests and their timing. You're just going to have to decide whether you believe her. As I said in my initial reply, if her replies seem honest and non-evasive, probably you should believe her.
I'll leave the thread open for one more cycle in case you have any final questions.
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45 months ago
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Dr. Handsfield,
Thank you for leaving this post open for one final set of questions: I have an interesting update.
One of our roommates (female) decided to test herself after hearing of our situation - she also tested positive for Chlamydia and is asymptomatic. Her boyfriend is being tested immediately, as well.
My partner and I do not participate in group sex with our roommates. We have five people who share a bathroom and frequently use it right after one another; however, your responses indicate that Chlamydia cannot be transmitted outside sexual intercourse.
Could the use of, let’s say a razor, transmit the infection? I’ve read that one cannot transfer the condition from using a toilet seat or towel, correct?
Do you believe this is most likely coincidental?
Regardless, this is quite the eye-opener to be tested regularly. Our roommate also has a long-term relationship, so many of us are raising eyebrows even more. We feel like we’re living a twisted sitcom.
Thank you again!
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H. Hunter Handsfield, MD
45 months ago
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I agree this is interesting. For sure chlamydia is not transmitted through casual contact, shared bedrooms or toilets, or shared personal grooming equipment (toothbrushes, razors, etc). On the other hand, perhaps it's not totally "coincidental", which gets into the concept of sex partner networks: think of it as partners of partners of partners. Someone who doesn't have sex with her roommates might, through shared introductions, be part of a partner network with her roommates, maybe one, two, or even 3 or more partners removed. Once an STI like chlamydia is introduced into that network, it stands to reason that several people might become infected. A way to look at this is to consider a community (say a university or a town) in which 5% of all members are infected. Within a partner network in that community, at any point in time maybe 10-20% might be infected. The whole issue gets deep into statistical and epidemiological weeds, but you get the idea. But one implication is that it might be wise for other network members to be tested even if they haven't had sex with a known-infected person.
This is only a guess -- you're a better judge than I can be of whether the newly chlamydia positive woman and you (and/or your own partner) could be members of a sex partner network. And chlamydia is common enough in sexually active young singles (teens to twenties) that it isn't at all rare that any two friends, acquaintances, or roommates might be infected at any point in time, without being in the same network. (Think of TV's Sex and the City cast: nobody should be surprised if any two of them had the same STI at the same time; it wouldn't mean they'd had sex with each other's partners or that they caught it from a shared toilet. Right?) And as previously discussed, chlamydia hangs around months, so it not rare in recently monogamous persons. In any case, you can disabuse your friends and roommates of any notion of shared bathrooms, towels, showers, etc!
Interesting discussion-- but that does end this thread. I hope it has been useful for you. Best wishes and stay safe.
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