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Questions about chlamydia
I had unprotected sex over 4 years ago with a boyfriend. He had only one partner before me and with whom he only had sex once, 5.5 to 6 years before he had sex with me. We are now both 28. I went for STD testing recently. Nothing specific prompted the testing, just the fact that I had never been tested before. Everything came back negative. The test for chlamydia/gonorrhoea was the BD Probe-Tec DNA assay. Unfortunately, I didn't wait until after my period and got tested on the very first day of medium/heavy bleeding. The nurse said it was fine to test on my period, that it happens to women all the time, and yet the manufacturer BD said that blood > 5% in urine has been shown to cause false negative results and that blood in swabs MAY cause false negatives.
My questions:
1. I have seen Dr HHH say many times that chlamydia eventually resolves itself without treatment. He has also said that it probably resolves faster in men than women. On what evidence does he base the statement that men clear the infection faster than women? I've always heard that men's immune systems are actually not as good as women's. And how likely is it that I could have caught chlamydia from my ex-boyfriend (assuming he had it) if he caught it 5-6 years before having sex with me?
2. Why might it take some people as long as 3-4 years to clear a chlamydia infection without treatment? Generally speaking, is it to do with the person's health, immune system, genetics and/or some other factor(s)?
3. What is your opinion of women getting a chlamydia swab while on their period and how often does it happen in your clinics?
4. If the study (http://www.ncbi.nlm.nih.gov/pubmed/6386694) is true that 9 out of 19 people got rid of their chlamydia after taking trimethoprim, is it likely that the antibiotic I took might have gotten rid of a hypothetical infection in me? I took trimethoprim about 3 months ago for a UTI. 2x 200mg dose per day for a week.
My questions:
1. I have seen Dr HHH say many times that chlamydia eventually resolves itself without treatment. He has also said that it probably resolves faster in men than women. On what evidence does he base the statement that men clear the infection faster than women? I've always heard that men's immune systems are actually not as good as women's. And how likely is it that I could have caught chlamydia from my ex-boyfriend (assuming he had it) if he caught it 5-6 years before having sex with me?
2. Why might it take some people as long as 3-4 years to clear a chlamydia infection without treatment? Generally speaking, is it to do with the person's health, immune system, genetics and/or some other factor(s)?
3. What is your opinion of women getting a chlamydia swab while on their period and how often does it happen in your clinics?
4. If the study (http://www.ncbi.nlm.nih.gov/pubmed/6386694) is true that 9 out of 19 people got rid of their chlamydia after taking trimethoprim, is it likely that the antibiotic I took might have gotten rid of a hypothetical infection in me? I took trimethoprim about 3 months ago for a UTI. 2x 200mg dose per day for a week.
That takes care of all my queries. Yes, they weren't really relevant to me, but you often get misleading or conflicting information about STDs, especially on the internet, so I wanted to get all the facts straight. I have gone from knowing almost nothing about chlamydia/gonorrhea to knowing a lot more in just under two weeks. Your advice is appreciated. Thank you.
MEDICAL PROFESSIONAL
These questions seem irrelevant to your situation, since all evidence is that neither your nor your partner has chlamydia. This horse is dead: why do you continue to beat it?
1) I can't tell whether you're asking about transmission from or to a previously infected person. Partial immunity frequently appears to occur, i.e. reduced risk of infection in people who previously had chlamydia.
2) It is quite common to see chlamydia in one member of a couple, with the other partner not becoming infected even after repeated unprotected sex. At least some of the time, this probably is because of prior infection with partial immunity, as just discussed.
3) "how is it possible that so many women have complained of testing positive for chlamydia while having been married for years, and swear that both they and their husband were faithful?" I disagree with the premise; this is not a common situation. When couples make such claims, usually it turns out that, in fact, one member of the couple has had other partners, despite claims to the contrary. Have I ever seen long-term couples in this situation? Sure. But mostly it quickly became clear that one or the other partner had been unfaithful. What they tell their partners and what they tell their doctors, when promised confidentiality, often are different!
That should end this thread. Take care.
1) I can't tell whether you're asking about transmission from or to a previously infected person. Partial immunity frequently appears to occur, i.e. reduced risk of infection in people who previously had chlamydia.
2) It is quite common to see chlamydia in one member of a couple, with the other partner not becoming infected even after repeated unprotected sex. At least some of the time, this probably is because of prior infection with partial immunity, as just discussed.
3) "how is it possible that so many women have complained of testing positive for chlamydia while having been married for years, and swear that both they and their husband were faithful?" I disagree with the premise; this is not a common situation. When couples make such claims, usually it turns out that, in fact, one member of the couple has had other partners, despite claims to the contrary. Have I ever seen long-term couples in this situation? Sure. But mostly it quickly became clear that one or the other partner had been unfaithful. What they tell their partners and what they tell their doctors, when promised confidentiality, often are different!
That should end this thread. Take care.
Thank you Dr HHH, this is very helpful. I have two more questions if you don't mind. These thoughts came up as I discussed with a friend earlier, who referred me to an article about chlamydia reinfection. I forgot the source but I think the main topic was studying protective immunity.
1. If someone already had chlamydia before and it was treated, would the transmission rate of 26-40% still apply to him/her or would it be slightly lower? Would a prior infection decrease the risk of reinfection in any way?
2. Since chlamydia is very infectious, there is practically no chance a person can have unprotected sex with an infected partner for, say, one month straight and not have contracted it, is there?
I have no personal reason to ask, I'm just curious to get the facts straight. I was always under the impression that having had chlamydia before doesn't make a person "immune" to reinfection.
Also, when you said "it is rare to see women with chlamydia whose only potential source of infection was a male partner who appeared to have been infected more than a few months", how is it possible that so many women have complained of testing positive for chlamydia while having been married for years, and swear that both they and their husband were faithful? Have you come across married couples with this problem in your career?
Thanks for your insight.
1. If someone already had chlamydia before and it was treated, would the transmission rate of 26-40% still apply to him/her or would it be slightly lower? Would a prior infection decrease the risk of reinfection in any way?
2. Since chlamydia is very infectious, there is practically no chance a person can have unprotected sex with an infected partner for, say, one month straight and not have contracted it, is there?
I have no personal reason to ask, I'm just curious to get the facts straight. I was always under the impression that having had chlamydia before doesn't make a person "immune" to reinfection.
Also, when you said "it is rare to see women with chlamydia whose only potential source of infection was a male partner who appeared to have been infected more than a few months", how is it possible that so many women have complained of testing positive for chlamydia while having been married for years, and swear that both they and their husband were faithful? Have you come across married couples with this problem in your career?
Thanks for your insight.
MEDICAL PROFESSIONAL
Welcome to the forum. I'll go directly to your specific questions.
1) There have been no systematic studies of duration of chlamydial infection in men. That most infections resolve fairly rapidly, probably more quickly than in women, is based on the collective clinical experience of STD specialists and chlamydia experts. For example, it is rare to see women with chlamydia whose only potential source of infection was a male partner who appeared to have been infected more than a few months. Also, it's fairly common to test people, get a positive result, but for the patient to fail to call or return for his or her test results -- and finally to return say 3-6 months later. For many (most?) women in this situation, a follow-up test is usually positive. For men, it is often negative.
"how likely is it that I could have caught chlamydia from my ex-boyfriend (assuming he had it) if he caught it 5-6 years before having sex with me?" Extremely unlikely. I've never encountered anything like this.
2) The reasons that chlamydia may be carried longer in women than men doesn't necessarily have anything to do with the "strength" of the immune system. Other factors, such as differences in genital anatomy, may be more important. In any case, I do not accept the premise: I am unaware of any definitive data, or of a consensus among immunologists, that either males or females have "stronger" immune systems.
3) I agree with your doctor. To my knowledge, most or all STD clinics and expert physicians test women for chlamydia during their menstrual periods. That's what we do in my clinic.
4) There are other studies showing trimethoprim to be less effective than the study you cite. Note that the study is 30 years old -- and most important, used culture to detect chlamydia, not the more modern and more accurate nucleic acid amplification tests. That study probably missed some infections that persisted after treatment. If you had chlamydia at the time you took trimethoprim, you should not assume it would have been cured.
My main advice is this: In view of your and your partner's sexual histories and your negative test results, you can be confident that neither of you is currently infected with chlamydia. I suggest no further testing and that you enjoy your sexual relationship without worries about chlamydia.
Best wishes-- HHH, MD
1) There have been no systematic studies of duration of chlamydial infection in men. That most infections resolve fairly rapidly, probably more quickly than in women, is based on the collective clinical experience of STD specialists and chlamydia experts. For example, it is rare to see women with chlamydia whose only potential source of infection was a male partner who appeared to have been infected more than a few months. Also, it's fairly common to test people, get a positive result, but for the patient to fail to call or return for his or her test results -- and finally to return say 3-6 months later. For many (most?) women in this situation, a follow-up test is usually positive. For men, it is often negative.
"how likely is it that I could have caught chlamydia from my ex-boyfriend (assuming he had it) if he caught it 5-6 years before having sex with me?" Extremely unlikely. I've never encountered anything like this.
2) The reasons that chlamydia may be carried longer in women than men doesn't necessarily have anything to do with the "strength" of the immune system. Other factors, such as differences in genital anatomy, may be more important. In any case, I do not accept the premise: I am unaware of any definitive data, or of a consensus among immunologists, that either males or females have "stronger" immune systems.
3) I agree with your doctor. To my knowledge, most or all STD clinics and expert physicians test women for chlamydia during their menstrual periods. That's what we do in my clinic.
4) There are other studies showing trimethoprim to be less effective than the study you cite. Note that the study is 30 years old -- and most important, used culture to detect chlamydia, not the more modern and more accurate nucleic acid amplification tests. That study probably missed some infections that persisted after treatment. If you had chlamydia at the time you took trimethoprim, you should not assume it would have been cured.
My main advice is this: In view of your and your partner's sexual histories and your negative test results, you can be confident that neither of you is currently infected with chlamydia. I suggest no further testing and that you enjoy your sexual relationship without worries about chlamydia.
Best wishes-- HHH, MD
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