STDs Expert Forum
Persistent Chlamydia infection?
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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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Persistent Chlamydia infection?

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239123_tn?1267651214
It sounds like the big error here was that the woman you caught the infection from wasn't treated.  Did you contact her and let her know?  Everybody with a newly diagnosed STD has the responsibility to inform his or her partners.  And certainly you will agree it wasn't smart to have sex with her again, if she had not been treated. This isn't meant as a lecture; perhaps you tried.  (It's also the partner's responsibility to follow through and get treated, once informed.)  Almost certainly the first and third test results indicated true infection and reinfection, respectively.

To your questions:

1) Azithromycin is about 95% effective against chlamydia.  In addition, PCR detects the organism's DNA, which can persist for at least a couple of weeks after the organism is killed by antibiotics.  In your case, there is no way to know which explanation accounts for the positive test 13 days after treatment.  But either way, it's nothing special or unusual.

2) Doxycycline is the treatmet of choice for infection that persists after azithromycin.

3) Early retesting to verify cure is not routinely recommended at all, but if it is done, it should be dealyed to 3-4 weeks after treatment.  You are correct that delayed retesting (rescreening) after 3-4 months is routinely advised.  Rescreening detects both reinfection and treatment failures.

4) Urine testing is fine.  Despite the sequence of events in your case, I still do not recommend retesting until 3-4 months go by, especially since treatment failure probably never occurs with doxycycline (assuming the patients takes all the drug as recommended).

5) Both occur:  mild symptoms that are ignored and true asymptomatic infection both are common.

6) Complex question without a simple answer.  Part is behavioral; part is because past infections make people partly immune (i.e., many people over 25 have been infected before, whether they knew it or not); and young women may have normal physiologic changes in the cervix that increase susceptibility to chlamydia.

Good luck--  HHH, MD
4 Comments
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Avatar_m_tn
Why do most doc prescribe 1000mg of zithromax if Doxy is a more effective drug against chlamydia?
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239123_tn?1267651214
The difference between doxy and azithromycin is minor.  Both are more than 95% effective.  The knowledge that azithromycin might be slightly less effective than doxy is new.  And azithromcyin has the major advantage of single dose treatment.  All in all, treatment failures probably are more frequent with doxy because many people don't take all the drug reliably.
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Avatar_n_tn
Hello, I recently found this site and appreciate it very much.  
I dated someone from January to March 2006.  He is the last person I have had sex with (early March 2006).

In April 2006 I began noticing pain in urination, discharge and tenderness in the penis.  I saw my doctor in June for a routine physical exam which about 11 weeks after last sexual contact.  A chlamydia/gonorrhea test was ordered as well as blood test for Syph & HIV.  (Syph/HIV showed negative.)

Unfortunately the urine test sample was lost by the lab and since I moved out of state about a week after giving the specimen, I was unable to return to do so and my medical insurance did not cover me in the new state.  
The symptoms were not as noticeable and my former doctor told me by phone if I wanted to get tested here then I could but if I felt it was necessary.  Earlier this year, around March I would say I started noticing the same symptoms again so I decided to locate a low cost clinic (again I have had no sexual contact since March 2006).
The urinalysis showed positive for Chlamydia.  I received 1g Azithromycin which I took on 4/11/2007, which has been three weeks ago.

I noticed the urinary symptoms clear up within the first few days; however, now again it seems I am having some burning on urination and ejaculation, and tenderness in the penis.

I would like to know please how soon I can expect all symptoms of Chlamyida to clear up. Do you think the first treatment has not worked?  In reading this thread I am not sure if I should wait 3-4 months after Azithromycin or if that is only for Doxycycline.

Background info: I am a gay male. The person I was with was HIV positive and we had unprotected oral and anal sex 3-4 times (I am strictly top). I realize it was very stupid, I was very depressed at the time. He was the only HIV positive person I have been with in 20 years. Anyway, the HIV test done at 11 weeks came back negative. I will retest for HIV just to be sure. I notified him of the positive Chlamydia result and he got tested but had surgery recently and was on major post-op antibiotics which likely cleared it up (his Dr. said).

My main question here is for the Chlamydia. Thank you.
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