Chlamydia

Dear Dr. HHH,
I have now visited quite a few web sites on the topic of Chlamydia and oral sex.  Almost all the sites list oral sex (male as the recipient) as a possible way of transmitting Chlamydia, but your responses claim that there is zero risk in it being transmitted this way.  I have a few questions:
1.  Can you explain why there is a difference of opinion here?  2.  Do other sites (i.e. CDC) represent unprotected oral sex as a way of transmission to try and minimize this activity?
3.  If a women were experiencing symptoms of Chlamydia, what would be the most typical of the symptoms (if there were one)? Would they normally experience more than just one of typical symptoms listed?

Thanks again for your response.  

[H. Hunter Handsfield, M.D.]

Thanks for those questions:  my favorite kind of questions are those asking for general information that all forum users will learn something from.

1) Sites that list oral sex as a chlamydia risk typically are going by "common sense", based on the similarities between gonorrhea and chlamydia--but there are no data in support of it. Since gonorrhea can be transmitted throat-to-urethra, and because other forms of NGU can be acquired by oral sex, people make assumptions about chlamydia.  But CDC carefully reviewed the data a few months ago, in preparation for new national guidelines for STD diagnosis and treatment, to be released later this year.  The new guidelines will specifically recommend against even testing for chlamydia in the mouth or throat, partly because there is no evidence that it occurs with any significant frequency (and also because no readily available tests have been shown to work in the throat); and if chlamydia isn't in the mouth or throat, it cannot be transmitted by oral sex.  Further, there has never been a reported case of chlamydia being isolated from the urethra in which oral sex was the only possible source of exposure.  It is possible that future research will prove me (and CDC) to be wrong in this area, but the best available data suggest that such transmission occurs rarely, if ever.

2) There has been political pressure on CDC with respect to HPV, i.e. overstating the risks of STD in general and HPV in particular, and in understating the protection provided by condoms, from the religious right and other political conservatives.  It is hard to find fingerprints from the Administration itself, but clearly some people in the Administration agree with the conservative perspective on HPV--and there are some legislators (e.g., Senator Coburn, a rightist ObG doc) who have tried to lean on CDC.  By and large, the people at CDC actually responsible for making prevention recommendations have found ways around the politics; with minor exceptions, the effect of that political pressure has been small.  The main effect has been heavier emphasis on abstinence and reduced emphasis on condoms in the public education message.  However, I do not believe there has been much pressure on CDC about oral sex in particular.  All the oral sex-related advice I have seen from CDC has been solidly based on the avaiable epidemiological data.  (But mine is only one person's perspective.  Some reasonable people may believe differently, on either side of the political fence, or might know facts about political pressure that I do not.)

3) Most women with chlamydia (probably 60-70%) have no symptoms, and most of the rest have only mild symptoms.  The most common ones are increased vaginal discharge, uncomfortable urination, and minor vaginal bleeding, often just spotting after sex.  More serious but less common symptoms are pain in the lower abdomen, fever, and other symptoms of pevlic inflammatory disease (tubal infection, PID).

Best wishes--  HHH, MD

[Nonstopaxiety]

Thanks Dr. H,

Just one further question:

Are there many other non-std related causes of vaginal spotting assuming that I have not contracted anything and my wife has been faithful to me?

Thanks.

[H. Hunter Handsfield, M.D.]

There are many non-STD causes of vaginal spotting.  But STD or not, it is a symptom that needs to be evaluated.  Your wife should see her health care provider about it, if she hasn't done so.

HHH, MD

[Nonstopaxiety]

Thanks Dr.,

She has an appointment in a couple of weeks and that is probably what is bringing on this unwanted anxiety I'm experiencing.  I don't know how I'm going to get through the next couple of weeks.

[lolin769]

A related discussion, Contracting Clamidia was started.