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STD: Chlamydia and Gonorrhea
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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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STD: Chlamydia and Gonorrhea

I have 3 questions re: Chlamydia and Gonorrhea .  It is possible I have been exposed to either or both of chlamydia and gonorrhea in southeast Asia.  A girl I had vaginal sex with (I did use a condom, although I briefly touched her genitals with my penis before I put the condom on) called to tell me I needed to be checked for both of these diseases.  

(1) Avelox question on Chlamydia.   I am just starting Avelox for a sinus infection.    From other research / articles I have seen it appears Avelox may cover Chlamydia.  Will Avelox cover Chlamydia, and if so, how many days would  be prudent to take it?   For my sinus infection I will be on it for 10 days (400 mg 1x per day).   Should this be effective for Chlamydia?    

(2) Avelox question on gonorrhea.  I will be getting a Rocephin gonorrhea shot regardless, but am curious to know the following:  Does Avelox have any efficacy against gonorrhea?

(3)  Regardless of the Avelox above, I have a question about doxycycline versus Zithromax.  I have previously been exposed to Chlamydia, took 1g of Zithromax, and had treatment failure.  I then took doxycycline for a month (2x / day) and had cure.  Doxycycline makes me very sensitive to the sun and I much prefer Zithromax if possible.  So my question is, if my only choices for Chlamydia were doxycycline vs. Zithromax and I preferred Zithromax over a longer period of time (since for me 1g didn't work); what would be the proper dosage for what period of time?  Would it be 500 mg for 10 days (I have seen something like this before)?
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Welcome to the Forum.  I'll answer your questions and comment on your situation.  Few persons, including the majority of commercial sex workers have STDs. Further, when they do, the risk of infection following a single totally unprotected penetrative exposure is not greater than 1 in five for men.  Condom protected sex is safe sex and STDs are not transmitted in such situation, nor are they transmitted by touching or the contact that tends to occur during foreplay.  thus your risk for infection is quite low, particularly since you used a condom however, since you have been notified by a partner that you may have been exposed, preventative therapy is warranted.   I'll comment on your medication choices below.  


1) Avelox question on Chlamydia.   I am just starting Avelox for a sinus infection.    From other research / articles I have seen it appears Avelox may cover Chlamydia.  Will Avelox cover Chlamydia, and if so, how many days would  be prudent to take it?   For my sinus infection I will be on it for 10 days (400 mg 1x per day).   Should this be effective for Chlamydia?  

Avelox (moxifloxacin) has not been well studied for treatment of chlamydial infection and is not recommended for gonorrhea therapy.  It may well be effective for either or both infections but there are not sufficient data to provide a confident answer.  If you were taking moxifloxacin when you were exposed, it would substantially reduce your risk for infection (infections are easier to prevent than to cure once established).  I would not count on moxifloxacin for therapy of gonorrhea or chlamydial infection  there are better drugs.    

(2) Avelox question on gonorrhea.  I will be getting a Rocephin gonorrhea shot regardless, but am curious to know the following:  Does Avelox have any efficacy against gonorrhea?
See above.  Ceftriaxone (Rocephin) is the recommended therapy for gonorrhea treatment.  Moxifloxacin might work but there is also substantial resistance to the quinolone group of antibiotics of which moxifloxacin is a member, particularly in the Far East.  

(3)  Regardless of the Avelox above, I have a question about doxycycline versus Zithromax.  I have previously been exposed to Chlamydia, took 1g of Zithromax, and had treatment failure.  I then took doxycycline for a month (2x / day) and had cure.  Doxycycline makes me very sensitive to the sun and I much prefer Zithromax if possible.  So my question is, if my only choices for Chlamydia were doxycycline vs. Zithromax and I preferred Zithromax over a longer period of time (since for me 1g didn't work); what would be the proper dosage for what period of time?  Would it be 500 mg for 10 days (I have seen something like this before)?

That you failed once does not assure that you would fail again. Azithromycin and doxycycline are recommended as equals by the CDC for chlamydia treatment although there is a recent paper which suggests that there may be a somewhat increased failure rate with azithromycin.  There are no data that taking azithromycin longer or in increased dose helps reduce failures when they occur- if you are worried, I'd suggest sticking with the doxycycline.

I hope these comments are helpful,. EWH
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