[Question #9911] Chlamydia timeline
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27 months ago
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I am in a long-distance relationship. We have been exclusive since the beginning of November 2022. The first time I visited my girlfriend since that time was a few days around February 20, 2023. I visited her again for the last two weeks of March 2023. About 5 days after returning from the March visit, I tested positive for chlamydia. I followed up with another test a few days later, and that came back positive too. I got treatment and told my girlfriend and she got treatment too.
My question is this: how possible is it that my girlfriend did NOT cheat? She is the only person I have had sex with since August 2022. So I almost certainly contracted it from her, either during my mid-February visit or my late March visit. Is it reasonably possible that she contracted it from an exposure that occurred before November and infected me in February? If not, what is the earliest time it’s reasonably possible she was exposed? I know “reasonably possible” is subjective, so let’s say with probability of 10% or greater. If you can give confidence intervals (e.g. she contracted it within the last 2 months with 60% certainty, within the last 3 months with 75% certainty….), even better.
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Edward W. Hook M.D.
27 months ago
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Welcome to the Forum. Thanks for your questions. I'll do my best to help. Chlamydia is the most common bacterial STI in both the United States and Worldwide. Most persons who acquire chlamydia acquire it from partners who do not know that they are infected. This is, in large part, because most chlamydial infections, in both men and in women have no symptoms of infection and are only detected as the result of routine screening (testing in the absence of symptoms) of otherwise asymptomatic persons. We know for a fact that persons can carry asymptomatic chlamydial infection for years.
Determining whether or not your GF cheated is something that the two of you need to sort out through honest and open discussions, not by quizzing each other on who had another patter last. The good news here is you have both had your infections detected and treated. EWH.
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27 months ago
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Thank you for the reply, Dr. Hook. I’m doing my best to have open and honest discussions with my girlfriend and hopefully am succeeding. I can’t be sure, though. On this last point, the medical profession agrees with me. Why else would the doctor tell me “always wear a condom; don’t trust anyone” when she informed me of my positive chlamydia result?
To those doctors with deep knowledge of chlamydia- imagine someone you care about who had been in an exclusive relationship for x amount of time and got tested regularly told you that they recently tested positive chlamydia, that they had never cheated, and that their partner said they hadn’t cheated, either. There is a value of x above which you’d say, or at least think to yourself, “while not totally impossible, this scenario is quite improbable. At least one of these people is most likely lying.” Could you please share what the value of x is?
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Edward W. Hook M.D.
27 months ago
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Your follow-up is a bit difficult to follow. For a person to develop a positive nucleic acid amplification test following multiple prior negative tests suggests either that they have acquired chlamydia from their partner who became infected in the interval since the person's past negative test or that there has been a lab error. Lab errors do happen but are uncommon and can be due to a falsely positive test reaction, due mishandling of the specimen in the lab, or due to mistakes made in recording the result (all have, all are rare and can be ruled out if both partners have positive tests or a second test is performed and is positive).
Statements like "“always wear a condom; don’t trust anyone” are easy to make and help health care professionals avoid difficult discussions. I find them irritating. That said, you are correct that some people do not tell the truth about their past sexual exposures, more often when there has been a misstep by a partner who had previously been monogamous. In most more casual, newer relationships, it is more likely that persons will tell the truth. Sorting this out can be challenging.
I hope this information and perspective is helpful. EWH
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