Chlamydia signs, not the symptoms

I would like to ask you a question about chlamydial signs for the gynecologist, not the symptoms. I did a search in the archive and did not find any reply to this question.
First question: If most of chlamydial infections do not present any infections or its symptoms were not reported to the gyneco, what are the signs that would induce the gyneco to make a test for chlamydia, or make him think that maybe it is a chlamydia?

My concern is: during many years I had painful intercourse and recurrent low abdominal pain and burning on urination (I cannot tell if it comes from the urethra- I guess it was cystitis in general). Now I am afraid that my gyneco never tested me for chlamydia, although I had every 6 months a control visit with her.
I met a suspicious guy 10 years ago, and I am afraid I contrated chlamydia from him since I have very recurrent cystitis and pain with sexual intercourse. I tested twice for HIV and both were negative.
Second question: Considering the symptoms that I have and the unprotected sex with that suspicious man, would it be possible that I have chlamydia? Would it possible that chlamydia is the cause for my recurrent cystitis?
I would be so grateful if you could give a detailed reply, as you are the only forum, that I have found, which give so competent and detailed replies. THANK YOU IN ADVANCE. And sorry for my English, I am French.

[H. Hunter Handsfield, M.D.]

The clinical signs that would (or should) make a women's health care provider suspicious about chlamydia primarily are those of cervicitis:  abnormal appearing mucus or discharge from the cervic, edematous (swollen) cervical ectopy (a reddened, beefy appearance to the cervicx), and induced bleeding (a swab in the cervix, or collecting a pap specieman, causes bleeding).  Also, clinical evidence of pelvic inflammatory disease, with pelvic tenderness on examinatio; or evidence suggesting a urinary tract infection, but with negative culture tests for common UTI bacteria.  However, all these are poorly predictive except in younger women.  Any of these signs (or all of them together) do not suggest particularly high risk for chlamydia in a 40 year old women, but would be highly suggestive in a 20-year-old.

To answer your second question, it probably is extremely rare for chlamydia to persist 10 years.  The best research follwed women for 4-5 years, and only a very few who didn't receive treatment still were infected 4 years after the initial diagnosis.  Also, longstanding chlamydia is an unlikely explantion for recurrent cystitis.  Among other things, it is likely your health care providers treated most of your cystitis episodes with antibiotics.  Most such antibiotics also would have cured chlamydia, if it were present.

Thanks for your thanks about the STD Forum.  I hope this information is helpful.

HHH, MD

[MadameInquiete]

YES, this was very helpful. This is very reassuring to have a precise and competent reply. Thank you very much Doctor Hunter Handsfield.

[H. Hunter Handsfield, M.D.]

You're welcome.

HHH, MD