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Conflicting Test Results
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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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Conflicting Test Results

Recently I had a positive chlamydia finding from a Pathologist associated with a "high end" fertility clinic in New York who did a urethral swab and in his own lab used a special European test (very expensive) using a "flourescent antibody" test using "visual reading" which also was described as a DFA test. He said it involves staining, where he read the results directly under the microscope to see what had turned a particular color.

At exactly the same time I had a standard PCR (I think that is the term) Urine test for Chlamydia and Gonorrhea which came back NEGATIVE from Bio Reference Labs (I believe a major national operation) and also a Semen test from another Bio Reference related lab used by a major NY hospital's Board Certified infectious disease specialist, which also came back NEGATIVE for Chlamydia.

The Pathologist says his test uses animal based antibodies which are more sensitive than the standard tests, and he believes Chlamydia can be antibiotic resistant for many years, which is why he recommends a more intensive injection of a mixture of antibiotics directly into the prostate over ten treatments.  You have previously suggested Chlamydia is highly treatable with Z-paks and/or Doxycycline

1.If you were faced with these conflicting results, what would you do?
2. Are you aware of strains of Chlamydia that are antibiotic resistant
3. Are you familiar with the efficacy or benefits of direct prostatic injections of concentrated antibiotics?
Tags: Chlamydia
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Welcome to the Forum. You don't say anything about why you were tested so I wonder what the story is here related to your testing.

Before PCR and other nucleic acid amplification tests became available direct fluorescent antibody tests of the sort your pathologist used were used in some settings for diagnosis of chlamydial infections.  They have been since almost completely replaced by the PCR and other nucleic acid amplification tests (NAATS) which have proven repeatedly to be more sensitive and have fewer false positive reactions that DFA tests.  Given your discordant results, my tendency would be to believe the PCR results, particularly if you were tested twice.

Treatment failure rates for chlamydia with 7 days of doxycycline or a single dose of azithromycin are very, very low and I am aware of only 1 well documented case of resistant chlamydia and that occurred a number of years ago.

In answer to your specific questions:

1.  I would believe the PCR unless there are some other extenuating circumstances.
2.  See above. Only 1 well documented case in the medical literature.
3.  I have never heard of injection of antibiotics directly into the prostate and would be quite doubtful about it.  

I think you at least need a second opinion.  EWH
Dr. Handsfield just alerted me that your question is similar to one he worked on last Spring ( see    ; ) which indeed does come to the same conclusion that I (perhaps more gently) suggested.  As I said, at the very least I would get a second opinion and would not be in favor of suggesting that antibiotics be injected directly into your prostate.  EWH
The testing is a result of failure to resolve findings of enterococcus faecalis in semen cultures after two 3 month courses of antibiotics, so the desire to explore the potential of prostate injections of concentrated antibiotics, with the chlamydia finding coming out of left field.

Did receive oral sex once in recent months, but all other tests (other than the one mentioned) came back NEGATIVE, and the two NEGATIVE tests were taken coincidentally with the urethral swap by the pathologist that came back POSITIVE

Still have mild itching, and slightly increased urinary urgency and frequency, which multiple drs insist relate to prostatitis (and perhaps the enterococcus finding). But the pathologist's findings of Chlamydia were a surprise.  He suggests Chlamydia often becomes antibiotic resistant and may have been present (in and out of some form of dormancy) for years, only activating periodically, and that he discounts the two other tests?  Since this is the exact opposite of your and other indications of highly effective treatment with Z Paks, 1 gram doses of Azythromycin, and Docycycline (all of which I have had), I am searching for avenues of inquiry.
Thanks for the clarification. What you tell me suggests even more that you would benefit from a second opinion.  Enterocicci are notoriuosly difficult infections to clear but they  have nothing to do with chlamydia.  I really think you need a seond opinion.  EWH  
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H. Hunter Handsfield, M.D.Blank
University of Washington
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