Blood Test for Chlamydia/Chronic Chlamydia

I am a 62 year old woman from the U.S. who has been living in Central America for 18 months. For the past 8 months I have been having unprotected sex with a local man. Prior to this it was 3 years since I had sexual relations, again unprotected. I knew this man was having sex with other women,but I kept seeing him anyway. After a particularly painful infection which I assumed was a bladder infection and for which I received treatment with 7 days of  Cipro, the uro-genital pain and the pain upon urination came back, together with rectal itching. I finally stopped seeing this man. I then went to a local lab and received blood tests for HIV, syphilis, chlamydia, and herpes simplex. All the results were negative except for ANTI CHLAMYDIA TRACHOMATIS IgG which was Positive 1:512 with a range of reference of less than 1:16. I was told this was an indication that I had chlamydia in the past. The test for current chlamydia ending in -IgM was negative. My first question is how reliable are blood tests for chlamydia? My second question is could recurring painful urination, vaginal itching and pain, and rectal itching be symptoms of chronic chlamydia? It is easy to buy drugs OTC here so I have treated these problems as urinary infections with Cipro and have taken anti-parasite drugs for the rectal itching. My third question is--is it possible that I have chronic chlamydia and if so, what would be an appropriate course of treatment? Rachel

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your confident in our advice.

For a variety of fairly complex reasons, sexually transmitted chlamydial infections are uncommon in women over 30 and quite rare at your age.  On that basis alone, and especially if your partner over the past year is of similar age, it is very unlikely you have chlamydia at this time.

To your specific questions.

1) The chlamydia blood tests are unreliable.  It is true that a positive result only means past infection with chlamydia, and maybe not even that; the test can be positive as a result of infection with Chlamydia pneumoniae, a nonsexually transmitted cause of respiratory tract infections.  You may have had chlamydia sometime in your life; if so, it wasn't necessarily a genital infection.

2) Chlamydia rarely if ever causes persisting symptoms like yours.  Ciprofloxacin isn't an ideal drug against chlamydia, but would cure most infections.  Although chlamydia can sometimes mimic urinary tract a bladder infection, when symptoms are as typical as yours usually it's just that -- a garden-vareity urinary tract infection.  Cipro and other antibiotics also can trigger vaginal yeast infections, which are a common cause of ongoing or recurrent symptoms like yours.

3) There is no such thing as "chronic chlamydia" of the genital tract.  Once treated with the proper antibiotic, the infection is gone and doesn't come back except by a new sexual exposure.

My advice is that you stop treating yourself with OTC drugs.  Speak with your doctor and have a proper chlamydia test for reassurance -- i.e. a urine or vaginal swab specimen to look for the organism.  I am quite confident it will be negative.  Also discuss evaluation for possible yeast infection.  Finally, you are at an age where vaginal discharge, irritation, itching, and other genital symptoms are increasingly common due to natural decline in estrogen levels.  This also is something for your to address with your doctor.

I'll be happy to comment further if you would like to post a follow-up comment after further medical evaluation.

Best wishes--  HHH, MD