[Question #9917] I’m sorry to have returned

27 months ago

Hello Drs.

I am very sorry to have returned, I would just like some clarification as to keep my partner safe.

I understand that my risk was very low or near zero… and I am sorry my obsession has my mind befuddled.

1 day after the event I was prescribed augmentin, I took 3 days worth and had terrible stomach pains, so I was given azithromycin… thinking I was smart ( which I was not) I took 1g about day 6 after exposure. I preceded to violently vomit about an hour later for 20-30 mins ( possibly due to nerves or bad food) fearing that I vomited up the azithromycin I took an additional 500mg the next morning. Would I have enough medication to clear infection if exposed or should I retest?

Once again concerning oral chlamydia, does most truly clear spontaneously in 2ish weeks?

Lastly could chlamydia be transmitted through saliva, ei someone having oral chlamydia- using it as lube for condom protected handjob before condom protected vaginal sex?

H. Hunter Handsfield, MD

27 months ago

Welcome, but I'm sorry to see you back.

As discussed, you were at no risk for chlamydia and therefore it is irrelevant whether or not azithromycin would have been effective. But in any case, early research with azithromycin showed that it remains fully effective against chlamydia if vomiting occur more than 30 minutes after taking it. So that treatment, especially supplemented by another 500 mg dose the next day, would have cured chlamydia if somehow you had it. It wasn't nerves or bad food: vomiting is a fairly common reaction due to the drug itself when given in the dose required for chlamydial infection. That's why the research was done to make sure it remains effective.

Yes, positive oral chlamydia tests usually become negative within two weeks, without treatment. I haven't changed my mind! There is no evidence chlamydia can be transmitted by saliva, but nobody can say it never happens. If it does, it is rare -- simply because oral chlamydia is so rare.

There will be no further discussion. And please note that repeated questions on the same topic are not permitted, and this is your fourth. Another would be deleted without reply, and without refund of the posting fee. This policy is based on compassion, not criticism, and is intended to reduce the temptation to keep paying for questions to hear the same answers. Also, repeated questions and replies often fuel anxiety rather than resolving it, especially in persons with underlying OCD. Finally, such questions have low educational value for other users, one of the goals of the forum. I do hope the several discussions help you move along without further worry.

Best wishes and stay safe.

HHH, MD

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27 months ago

Thank you for the reply, I understand it is very annoying to respond to repeated questions. I just wasn’t sure if the massive amount of vomiting would change your opinion on the absorption rate. Again I appreciate the response.

H. Hunter Handsfield, MD

27 months ago

It isn't merely annoyance! Anyway, I'm glad my reply was helpful.---

27 months ago

Since I have your mind- and I am a curious person and I research alot... If the peak absorption time of Azithromycin is 2-3 hrs and you say that vomiting after 30 mins of ingestion does not negate the effect of Azithromycin ( does ingestion with or without food matter?) would it be safe to assume that the recommended dose of 1g is slightly more then what is actually needed for chlamydia clearence?

again, I would like to thank you and your team for the help that you have given people, especially people with OCD that would go insane with testing if it weren't for the advice given. I find it very comforting in your many years as an infectious disease doctor that you have never had a patient with oral or genital chlamydia whose only exposure was from oral sex.

H. Hunter Handsfield, MD

27 months ago

I'm confident that doses lower than 1g would be effective for most infections, but there have been no studies at lower doses so difficult to predict. In any case, azithromycin is no longer the recommended first choice option for chlamydia because 1g fails to cure 5-10% of infections (20-25% of rectal infections, and doxycycline for 7 days is now the treatment of choice.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe. Also please note the forum rule that repeated anxiety driven questions are not permitted. This should be the last about your non-exposure event(s) and your concerns about chlamydia and its treatment.

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