Chronic Chlamydia

[ayudame007]

Hello Doctor. I am a resident in Pediatrics and am having a very hard time finding the answers to my questions. Please help.
iam a 30 yo female. I had unprotected sex with my boyfriend for the first time (never had any sexual intercourse with anyone prior) in (2002). He was tested and stated that he was negative for all STD's *(I didnt see the test results myself). We had unprotected sex until 2004 and then we broke up.
I had a pap smear this year 2003 that i assume was negative (unfortunately did not ask for the results to be sent to me) and in 2008 that was positive for chlamydia. I have not had any sexual with relations since 2004 to now.
I have never had vaginal discharge that i noticed to be abnormal, i have not had any abdominal pain/cramping/no pain with menstruation. Since 2004 when i stopped taking OCP's i have noticed that my periods are abnormal, i have a period every month but the flow is dark, dark brown in the begining, with 1 das of nl bleeding and then cessation. My questions are:
1. Why did i not clear an infection that i got likely 4 or maybe even 6 years ago? Is something very wrong with my fpr not being able to do that?
2.Are there certain types of chlamydia that last in the body for longer? Does that cause more damage?
3. I obviously wasnt treated until this year (doxycycline) and now am scared that i have PID...does the lenght of time i have had chlamydia and not been treated increase my risk of infertility and PID?
4. Does all chlamydia ascend up the uterus to infect the fallopian tubes?

Please help, i'm sorry for being so wordy, but am just frustrated that i cant get the answers from my ob/gyn
Thank You
ayudame

[Edward W Hook, MD]

You are asking good questions, some of which do not have good answers.  Here are my thoughts:
1.  No one knows why CT persists in some persons and not others.  Clearly is has something to do with ow your body responds to infection but it is unknown.  Sorry.
2.  Doxy is recommended for 7 days and, if you take all the meds, has a >97% cure rate (nothing has a 100% cure rate in clinical trials).  For you to be taking a two week course is twice what's recommended.  There is no better therapy.
3.  The therapy is so good that test of cure evaluations are not recommended.  Given your unusual circumstances, you may want to be rechecked 2-4 weeks following completion of therapy but that's your call.  
4.  Depends on how you define asymptomatic PID.  some studies suggest that about 15% of women with CT but without CT symptoms have endometrial infection as well.  Whether or not this is related to infertility is unknown and logically, should be lower risk than for women with symptomatic PID.  I would expect it to be lower and in your case, would add that there is not particular reason to think that you are in that situation.

Hope this helps.  EWH

[Edward W Hook, MD]

Just a comment.  You do not need a pap, just a PCR-type test for chlamydia.  EWH

[Edward W Hook, MD]

Thanks for the clarification.  This does indicate that you had chlamydia at the time you were tested and, if you had not had sex for the preceeding four years, that it had persisted for that period.  As mentioned above, it does not mean that you had PID or that you will have consequences.  EWH

[ayudame007]

Thank you for all your help! This website is such a lifesaver.

[Edward W Hook, MD]

This is at least the second time you have asked this question and the answer will not change.  There is no reason to think that the infection will be more difficult to treat because you carried it for a longer period of time. EWH

[ayudame007]

Dr Hook, i cant thank ou enough during this stressful period! ! I realize there may not be an answer to this question.  I read the past forum q and a's.  It was mentioned that a study showed that women can carry chlamydia for upto 4 years, i  belong in this category. There was an answer stating that if you have had it for longer, it is harder to treat and it has to be treated for longer. Is that true? any info on the treatment duration and response in prolonged duration cases? Im taking doxy for 2 weeks.
Ok thats it, im just trying  my best to do the right thing.

many, many thanks for your time

[Edward W Hook, MD]

No a stupid question given the unusual circumstances.  The answer is that it would be highly unusual, even unlikely.  I wish I could say this never happens but it's like trying to define how close is too close.  It could of happened that way.  Either scenario is unlikely but we know you have chlamydia, thus I would guess it is most likely you acquired the infection in the distant past and it has persisted, not that you acquired it more recently without penetration.  EWH

[ayudame007]

Ok, ill get that in 1-2 months. Since ive tested positive for chlamydia after 5 years, i started thinking. I have one last possibly stupid question: Sorry for being so graphic, but can i get chlamydia without penetration? My last boyfriend's penis rubbed outside of my vagina for about 2-5 minutes - no discharge, no penetration. This occurred 1 year ago. Once again sorry for the graphic question...im just so stressed, and cant believe ive had this for so long :(
Thanks again!!!

[ayudame007]

Thank you so much! I will get follow a follow up pap in a few weeks.

[ayudame007]

Thank you so much for  your time and consideration, and sorry, but i have  4 last questions:
1. Why did i not clear it, or what makes it persist?
2. I am on a 2 week course of doxy. Should I be treated for longer or with another agent in this case?
3. Will it be cured with antibiotics? Or recur (assuming no sexual contact)
4. How common is asymptomatic PID, and is it still the 20% chance of infertitlity?
Thank you again for your help!

[ayudame007]

The test was done by PCR. And is definitely positive. Does this mean poersistent chlamydia?

[Edward W Hook, MD]

Before I answer your question, let me comment on the diagnosis of chlamydia by pap smear. Unless the test done was a PCR-like test, there is a reasonable possibility that your result was false positive.  In fact, i would say the chances of that are relatively high.   As for your questions:

1.  Most but not all chlamydia infections either clear spontaneously or go on to cause symptomatic PID.  Neither happened to you, making me wonder about the diagnosis.  That said, there are plenty of documented cases of persistent chlamydial infection without adverse effects. if you were infected, persistence does not mean you are abnormal in any way.
2.  No
3.  You do not have clinical PID.  So called symptomatic PID does occur but there is no way to determine if you had it, or if you did, that there will be consequences.
4.  No

I hope these answers are helpful.  My guess is that all is OK.  EWH