STDs Expert Forum
Chlamydia/NSU antibiotic use
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Chlamydia/NSU antibiotic use

After 2 separate incidents (the last 2 sexual encounters Ive had),1 of frottage & 1 of mutual masturbation, a lot of vaginal fluid from a woman (of unknown status) was in direct contact with my penis. Vaginal fluid seeped through both our underwear and I had some on my hand which I used touched my penis. I also fingered her and immediately put my fingers, with her vaginal fluid on them in my mouth. I went to a GP to complain of urethral sensations/small amounts of clear discharge. He prescribed 2g azithromycin to be taken all at once. He suggested I go to a GUM clinic (Im in UK), and I did before I took the azithromycin. There they performed urine and throat NAAT tests (for GC+CT),&urethral swab. Urethral swab returned -ve for gonorrhea,but showed white blood cells. Was given 2 weeks, 100mg twice daily,Doxycycline presumptively for Chlamydia,but to clear the apparent NSU.

1)From the 2 incidents described above, what STDs am I likely to be at risk of?HIV/Syhilis?

2)1g azithromycin is the norm for NSU/Chlamydia. Does taking 2g reduce effectiveness in treating Chlamydia? The pharm dispensed the prescription in 8 250mg tablets. Taken all at once, does this equate to the 2g single dose?
3)If I picked up pharyngeal gonorrhea, will the antibiotics I am taking clear that? Could I pass pharyngeal GC on via oral to a woman?
4)I took the full 8 250mg azithro pills after my initial results from clinic (need to wait 2weeks for NAATs). I intend to start the 2 week course of doxy 24hrs after the azithro. By taking the 2 drugs in close proximity, do I reduce the effectiveness of either drug? I am concerned about interactions or interference.
5)I was tested exactly 14days after last exposure. Is that long enough for both GC&CT to become detectable on NAAT/PCR tests? Even if I tested too soon for GC&CT, would the antibiotics I am taking kill either infection if it was incubating?
6)When can I resume sexual relations?
7)Is waiting 6 weeks after last doxy pill long enough for retest?
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239123_tn?1267651214
Welcome to the forum and thanks for your question.  Having seen only the opening line of your question, most likely you are not at risk.  STDs are rarely if ever transmitted by hand-genital contact, even when genital secretions are present or used for lubrication.

Having now read the rest, if anything the details make your risk even lower.  If I correctly understnad, you were clothed.  No STDs have ever been known to be transmitted through clothing.  There are suggestions you may have had mild nongonococcal urethritis (NGU;  usually called nonspecific urethritis or NSU in the UK), but you can be quite confident it did not originate from the exposure described.  I would be concerned that you were actually infected sometime earlier, from some past sexual exposure. Or that nothing was wrong at all.  A scant amount of completely clear urethral dishcarge is not necessarily abnormal, and a few WBC can be found normally in the urethra from time to time.  The GUM clinic (and your GP) may have treated you as a precaution, without confirming you had an STD.  

I assume you asked these same questions of the GUM clinic staff.  They are as knowledgeable about all these issues as I am, and I expect the answers to be the same.

1) From your description, you were at no appreciable risk of any STD.

2) The gonorrhea dose of azithromycin is 2 grams; your GP probably gave that dose to cover both gonorrhea and chlamydia.  I'm not sure why you would suspect the larger dose would work less well against chlamydia.  Of course that doesn't happen.  And I don't understand your uncertainty about the dose.  You can multiply 250 mg (0.25 gram) x 8 as well as I can.

3) Yes, the treatments you had would be effective against pharyngeal gonorrhea.  But even untreated, pharyngeal gonorrhea is rarely if ever transmitted to female partners, because it is rarely if ever transmitted by either kissing or cunnilingus.

4) That is the correct way to take the drugs.  It does not reduce the effectiveness of either one to take them together.

5) If I correctly understand, you did not take any treatment before the tests were done.  Therefore, the results are completely reliable.  Treatment for both these STDs is equally effective taken any time after exposure, whether or not symptoms have started or the tests have had time to become positive.

6) You should ask the GUM clinic their advice about resuming sex.  Most experts advise no sex until treatment is complete and another few days have gone by without reappearnce of symptoms.  So probably around 3 weeks.

7) Assuming your gonorrhea and chlamydia tests are negative, there is no need for retesting at all.  If positive, check with the GUM clinic whether they recommend retesting and when.

I hope this has helped.  Best wishes--  HHH, MD
3 Comments
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Avatar_m_tn
Thanks very much for the quick response. I would very grateful of some follow up.

You are correct when you assume I asked the GUM clinic staff the same questions, however frustratingly, the nurse practitioner refused to answer any questions I had regarding potential interferences between simultaneous (or thereabouts) use of azithromycin and doxycycline. I want to be 100% sure I clear any potential infection so that's why I wanted to use both. It's a relief to know that using the two regimens together will not have any negative effect on either's efficacy (if I have understood you correctly). Further, I just wanted to be sure that the 8 pills made the 2g dose (to be sure I got the right amount instead of making a mistake owing to a pharmaceutical nuance in adding up doses). Frankly I am most concerned about Chlamydia. With the 2g Azithromycin followed immediately by the two week course of Doxycycline, do you agree that any potential infection would be cleared?

Also, frustratingly, the GUM clinic's literature and staff said the exposures I described to you put me at risk of all STDs, including HIV and Syphilis. They even state that I could contract Pharyngeal Chlamydia from putting potentially infected vaginal fluid in my mouth. You have stated clearly on many occasions that CT is not transmitted orally - they disagree. Further, they said that GC is readily transmitted to a female partner via cunnilingus - hence my concern. I'd like to think I can trust your advice more, due to your excellent reputation, but I hope you can understand that it's very confusing when my specialist healthcare provider adamantly insists the opposite of what you say. Why are there such differences in advice?

Because I fear I will pass on this infection to another, I will retest anyway purely for peace of mind. Current literature available indicates that NAAT tests for CT and GC have an efficacy as low as ~91% for detecting infections. I understand that current advice is to wait 6 weeks for NAAT retest following Doxycycline use. Is that long enough to avoid false postives and/or false negatives?

Lastly, I understand that Chlamydia possibly causes infertility in a woman, but only after being infected a number of times. Would you agree? Or can infertility be caused by just one infection of CT?

I look forward to putting this behind me, but I'd appreciate some rational reasoning.

Thanks again, Doc.
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239123_tn?1267651214
I'm not going to get into a debate over the GUM clinic's advice.  What I have said here, on this thread and others, is evidence-based.

The chance of infertility in women rises with each chlamydial infection, but it certainly can occur with the first infection -- but it is unlikely, especially if she doesn't develop overt pelvic inflammatory disease (PID) with abdominal pain etc.

The rest of these follow-up questions are the same you asked before, using different words.  I haven't changed my mind and I'm not going to repeat the answers.

You are fearful of outcomes that are statistically impossible.  After the combination of an exposure unlikely to transmit anything, plus your negative tests, plus the antibiotics you had, there simply is no realistic chance you still have chlamydia or gonorrhea or could transmit it to a future sex partner.  The minor differences in belief about transmission risk between me and the GUM clinic isn't going to change that basic conclusion.

That will end this thread.  Take care.
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