[Question #9824] Oral Chlamydia
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28 months ago
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Hi Doctors,
Two weeks ago a regular sex partner told me he tested positive for anal chlamydia after sleeping with someone else (we are both MSM on PREP). I had pretty extensive oral contact with his anus and protected intercourse so my main concern was if I had acquired oral chlamydia (which I read was on the rare side- but, like I said, my oral exposure to his anus was pretty extensive). I went to urgent care where they had me self-swab my throat and anus and I took a urine test for uro-genital. They also gave me a prescription for prophylactic doxycycline
About three or four days into my doxycycline I was out to dinner with a friend when I had a very bad coughing fit and watched as a piece of food flew from my mouth onto his plate. I mentioned this to him and he kinda shrugged off and kept eating. I have been racked with guilt that I casually passed oral chlamydia to this friend from this incident.
My tests all came back negative but I now have what I am hoping is a sinus infection with major orange colored mucus production and a bad mucus-y cough. I am concerned that I have oral chlamydia after all and that my test was a false negative because it was self-administered and I just didn't do it right. Now for my questions:
1. Am I right that this incident is nothing to worry about and that even if I HAD oral chlamydia my friend ingesting a bit of food/mucus/spittle that I coughed up onto his plate wouldn't pass it?
2. What are the symptoms of oral chlamydia? Does oral chlamydia cause this very phlegmy cough that I am having?
3. Out of curiosity- would kissing, deep or otherwise ever spread oral chlamydia if one partner had it?
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Edward W. Hook M.D.
28 months ago
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Welcome to the Forum. Thanks for your thoughtful question, as well as evaluating your risk for oral chlamydial infection through your own research. You are right on target,: for reasons that remain unclear, chlamydia does not appear to "like" to infect the oral cavities and oral chlamydial infections are quite rare. Given your exposure history, it is quite reasonable for you to be prescribed doxycycline as a recent contact to a partner with chlamydia. At the same time, the likelihood that you were infected is very low. Your testing appears to prove that you were not infected despite your recent contact.
My advice is to put your concerns about transmitted infection to your dinner partner aside. There is no evidence that you were infected, if you were 3-4 days of doxycycline would likely render you non-infectious, and finally, transfer of oral chlamydia to partners, directly or indirectly such as on coughed up food, is most unlikely. I would not have ANY concern about the consequences of your coughing episode whatsoever. Thus, in response to your specific questions:
1. Am I right that this incident is nothing to worry about and that even if I HAD oral chlamydia my friend ingesting a bit of food/mucus/spittle that I coughed up onto his plate wouldn't pass it?
Absolutely, as described above.
2. What are the symptoms of oral chlamydia? Does oral chlamydia cause this very phlegmy cough that I am having?
Oral chlamydia is most commonly asymptomatic. A productive cough does not raise any concerns about oral chlamydia.
3. Out of curiosity- would kissing, deep or otherwise ever spread oral chlamydia if one partner had it?
This is a controversial topic as to how likely transmission is to occur and whether or not, when it occurs, it is important. Certainly there is a chance that deep kissing might transmit oral chlamydia to others however, when it happens it is likely VERY rare and not something I'd worry about.
Ihope this information is helpful. EWH
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28 months ago
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Dear Dr Hook
Thank you so much for this information! I have two more quick questions:
As I mentioned, the urgent care doctor I saw prescribed me Doxycycline twice a day for 7 days. While I was at work on the 7th day I realized that I had forgotten to take my morning pill. So I took my evening pill on the 7th evening and then took the remaining pill on the morning of the 8th day. Do you think missing my morning dose on day 7 mattered to the effectiveness of my treatment?
You mentioned that there was debate around whether or not oral chlamydia was even important at all. Can you elaborate on this? Is the debate about whether or not oral chlamydia has any long term health implications, or that it goes away on its own, or something like that?
Thanks again Doctor Hook!
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Edward W. Hook M.D.
28 months ago
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The blood levels of doxycycline are such that missing one dose wil not reduce the effectiveness of the drug.
There are many facets to the debate. These include just how transmissible oral chlamydia might be (although all agree the transmissibility is low), how long it takes for the infection to go away on its own, and finally whether or not oral chlamydia leads to any complications for infected persons. We have much to learn about oral chlamydia. EWH
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28 months ago
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Got it!
Thanks again, Dr Hook!