STDs Expert Forum
Chlamydia Reinfection?
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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 Reinfection?

Dear Dr.

Five weeks ago, my partner and I (both men) did a threesome with another man. 10 days later I had urgency to pee and ticklish feeling, also clear discharge, so went to clinic, tested positive for chlamydia, and was given 1g Azithromycin. My partner and the other guy were also treated (other guy with doxy), and we all tested neg for other stds.

Three weeks later, we repeated the threesome with condoms for anal but some unprotected oral. Two days later, the ticklish feeling returned. I returned to clinic, and doctor said I was probably re-infected and so gave me 1g Azithro again and a shot of Rocephin. I thought this was slightly odd since I didn't know chlamydia could become symptomatic in 48 hours. But I took the medicine, and symptoms cleared. I later called back the clinic and found out that, in fact, my test results were negative for chlamydia and gonorrhea.

A week later my partner gave me an unprotected ********, and 48 hours later, the ticklish feeling returned. The watery discharge never returned, but now I'm getting a bit of discharge that looks and feels like pre-***. No pain or burning with urination, but at times a feeling that I haven't quite emptied my bladder with a bit of urinary dribble.

So I'm stumped. I could return to the clinic, but i don't want to take more antibiotics if they aren't necessary. What could this be if it's not chlamydia? I have a long history of hypochondria, and so I'm wondering if my mind is playing tricks on me; but at the same time, even as I write this to you, I have what can only be called a 'urethral awareness' that I never had before that initial chlamydia infection. I should add that neither my partner nor the third guy ever had any symptoms. Your advice is greatly appreciated.
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239123_tn?1267651214
Welcome to the forum.

I agree chlamydia symptoms don't normally start as soon as 48 hours.  However, repeat chlamydial infections may indeed cause earlier symptoms.  This hasn't been studied, but it fits with the normal immune response to chlamydia, which is more vigorous with repeat infections than initial ones.  (The symptoms of most infections, including chlamydia, are largely due to the body's immune response.)  But at the same time, the lab tests for chlamydia are highly reliable.  So most likely the second episode was nonchlamydial, nongonococcal urethritis (NGU).

As for the recent symptoms following oral sex, it is conceivable you acquired yet another episode of NGU, which can be caused by oral sex, perhaps caused by normal oral bacteria.  However, it is also possible that the problem is repeated sexual activity in the presence of a gradually resolving immune response to the initial chlamydial infection.  This also has not been studied, but most of us in the STD business see occasional patients with continued or repeated symptoms not unlike yours -- usually without any obvious cause.  And I agree that heightened "urethral awareness" might indeed be the only problem here.

The good news is that these problems never seem to lead to anything serious -- no complications, no infertility, no other important health problem.  Generally the symptoms eventually seem to fade.  My advice is that you plan to abstain from sex entirely for at least 2-3 weeks.  If your symptoms persist more than a few more days, you'll need to be reexamined.  But you may find they fade away and don't return when you do resume sexual activity.

Sorry I can't be more helpful -- but this is a difficult area without clear answers.

Regards--  HHH, MD
8 Comments
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Avatar_m_tn
Dear Dr. Handsfield:

Thank you for your thorough response. I'm quite certain that whatever I have is triggered by oral sex. The first threesome, which caused the chlamydia, involved a variety of activities; but since then my partner and I have been fastidious about using protection with the exception of oral sex, in which I am the insertive partner.

I have one quick follow up question. Two years ago I went to the doctor (at a university student health facility) with testicular discomfort and somewhat similar symptoms of urinary dribble and incomplete bladder evacuation. I can't remember if they tested me for STDs, but they definitely found white blood cells and put me on a two-week regimen of cipro out of anxiety over epididymitis. They also did a culture, but it came out inconclusive (or indeterminate, I can't remember the word). So perhaps what I'm having now is a repeat of this earlier incident? I'm just really worried that if I go back to the clinic, they're going to put me on a powerful antibiotic, which will, like that Cipro before, do a number on my stomach.

So am I okay--given my currently mild symptoms--to wait a little while to see if the symptoms improve in the absence of sexual activity? I'm just a little confused by your saying that I should abstain for 2 or 3 weeks but return to the doctor is symptoms don't improve in "a few days."  
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239123_tn?1267651214
Even though condom are not as high a priority for oral as for anal sex, when you resume sex after laying off a while you might try oral with condoms and see if it makes a difference in your post-exposure symptoms.

By the way, chlamydia is almost never acquired by oral sex.  Assuming the lab test was accurate, the initial infection likely was acquired by anal exposure, whether during the threesome event or earlier.

And yes, I believe your current symptoms could be related to the previous event 2 years ago, which sounds like prostatitis or the chronic pelvic pain syndrome (which are not STDs).  For a wealth of information, google CPPS (spell it out) and/or chronic prostatitis.  The Wikipedia article (which will be near the top of the google hit list) is very good; you can also look for information from the Stanford University Dept of Urology, where much of the research on these syndromes has been done.

If you have actual urethral discharge, I suggest you be reexamined right away.  Without obvious discharge, most likely it is safe to wait a couple of weeks and see how your symptoms evolve.
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Avatar_m_tn
Thank you, Dr. Handsfield. I will keep you updated. You need to know, as I'm certain you do, that the popularity of your forum owes in part to the inability of many health care providers to offer clear answers to patients like me. The doctor I saw last time was convinced, beyond the shadow of a doubt, that I had re-contracted chlamydia via oral sex in 48 hours. Now, I'm not suggesting this is impossible; but it's incredibly unlikely. And believe it or not, I also had to explain to the doctor--after she suggested my partner might want to come in for a urine test--that if the chlamydia infection is in his mouth or anus, a urine test won't suffice. It's difficult to feel reassured and properly cared for as a patient when the doctor appears to know so little, particularly regarding sex between men. I should also add that after the initial infection, the doctor would not provide expedited partner therapy despite its being legal in my state. My partner had to go in separately. I'm not saying this adds up to incompetence, but it's certainly not the best care for nervous and uncertain patients. The service you provide here is invaluable, and yet I can't help regretting that it is necessary.
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Avatar_m_tn
Dear Dr.

One final question. Is there an easy way to distinguish discharge from dribbles of urine?
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239123_tn?1267651214
Sure. Dribbles of urine look like urine, smell like urine, and stain the underwear in the same way.  Discharge is much thicker, mucus like, generally cloudy or overt pus (yellow or creamy).  In other words, abnormal urethral discharge is like nasal discharge during a cold.
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Avatar_m_tn
I just wanted to provide the update--a month later--that I subsequently tested negative for gonorrhea, chlamydia, and NGU. I took your advice and laid off receiving oral sex, and sure enough the symptoms disappeared, including frequent urination, burning, dribble, etc. I really don't believe it was psychological, although anxiety might have amplified the symptoms. I think, as you speculated, that there was some kind of residual sensitivity or inflammation following the initial chlamydia infection. But I guess I will never know. In any case, thanks again for your advice; you saved me what would no doubt have been expensive and time-consuming visits to specialists, which appeared to be the next step given my impatience and my doctor's frustration.
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239123_tn?1267651214
Glad to hear things are going well.  Take care.
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H. Hunter Handsfield, M.D.Blank
University of Washington
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