persistent Chlamydia/phosphaturia?

[nick butt]

I’m 25.3years ago I had unprotected sex with girl.I started to have discharge from penis after 3 weeks.As I never had STD before in my life I didn’t know what to do.I went to my friend for advice.He said the matter is not serious and he was successfully treated for the same symptoms in past and had the drugs left.He offered his help and I took it.So I got two intramuscular injection of Retarpen (Benzathine benzylpenicillin).The discharge cleared away and only slight discomfort while passing urine was disturbing me.After 3months I admitted my urine had changed and looked cloudy.I started to worry and went to STD clinic.The swab from urethra,urine and a blood tests were taken.All results were-clear(chlamydia,gonorrhea,trihomona etc.) but the blood test showed the high level of Ch.trachomatis antibodies.So I was treated with azithromycin.After that I still had cloudy urine from time to time,slight feeling of fullness in the area behind penis and mild heaviness in epididymis.Control test in 3 weeks showed no infections.Urine wasn’t constantly cloudy.Sometimes I could have it for a week every day and then don’t have for a month.The only thing I could connect it with was stress.In about a year I decided to go to urologist for additional check up.All that time I didn’t have any sex so re-infection was not possible.The prostate secretion and blood test was taken for analysis.Prostate secretion showed the high level of leucocytes(18-20).All known infections–clear.Urologist said there's a need of treatment.So I took a 3 week course of doxy.After treatment the cloudy urine still stayed.Control tests in two month:prostate secretion (no infections,leucocytes 2-3,staph.aureus 100-1000/ml);Urethral swab (no infections);Urine – no abnormalities;Kidneys ultrasound–no abnormalities;biochemical blood test–no abnormalities;Possible diabetes was tested and excluded.Urologist said "there’s no need in further treatment,cloudy urine is explained by the presence of phosphates or high urine concentration (even though I’m drinking a lot liquid) or excessive prostate secretion".After another year symptoms didn’t go away.Sometimes I pass cloudy urine with feeling of discomfort in the prostate area.Urine extremely cloudy somedays and somedays it’s as clear as water.Always a powdery sediment will sink to the bottom.If you add some acid the urine becomes clear (phosphaturia?).There’s no severe pains or burning sensation while urinating.So I have the questions:1)I’ve been reading a lot about transformation of chlamydial infection to persistent form after using penicillin.After the treatment with azithromycin and doxy can I be sure that chlamydial infection was eradicated?2)Is there a chances I have persistent Chlamydia that didn’t show up during the tests?If so,what antibiotic would you suggest for treatment?3)Can phosphaturia be the cause of my symptoms or it was only triggered by urea-splitting bacterial infection?4)If phosphaturia is the cause,what treatment do you suggest?

[H. Hunter Handsfield, M.D.]

You have been evaluated extensively by several docs; I can't add anything.  As you probably realize, it was a mistake to get treated on your own for your initial symptoms, but it is unlikely that caused any problem.  Whatever you had to start, you don't have an active STD now.  "Phosphaturia" is a normal, physiologic occurrence; the presence of phosphate crystals in the urine, causing cloudiness, has nothing to do with any infection, and varies based on diet and the acidity of your urine.  I am not an expert in that area, by my understanding is that it means nothing. To answer your specific questions:

1 and 2) Chlamydia does not persist in the way you describe, and penicillin makes no difference.  I don't know what nonsense you have been reading.  After azithromycin and doxy, you can be sure you don't have chlamydia now, whether or not you ever did.

3 and 4) See above re phosphaturia.  To my knowledge it is not an abnormal condition and requires no treatment.

Good luck--  HHH, MD

[nick butt]

Thanks for your answers doc. Of course, now I realize how stupid it was to get treated on my own. But that time I didn’t think it was a big deal…
You have exactly repeated my urologist’s words. I have probably nothing to worry about. The reason I posted my question is the number of articles I’ve read about chlamydial persistence that were recently published
http://iai.asm.org/cgi/content/full/72/4/1843 (part about Antibiotic-induced persistence)
http://www.cacmid.ca/abstracts_05/p1.04.htm
http://home.swipnet.se/isop/Helsinki.ppt
This all made me thinking that it’s possible in my case to have latent chlamydial infection. So I wanted to clarify this possibility with a specialist.
I don’t think it’s such a nonsense about penicillin-induced Chlamydial persistence. But maybe it’s anxiety that makes me so suspicious.
Many thanks for dealing with my query doc anyway.

[H. Hunter Handsfield, M.D.]

The research you site is not relevant; the concept of latent genital chlamydial infection is a hypothetical one that has never been shown to actually occur; and if it occurs, to cause disease.  Anyway, no specialist will be able to help you find out; no regularly available test exists to detect "latent" infection when standard tests are negative.

And I would modify your quote from your urologist:  delete "probably".  This issue simply isn't worth the energy you are putting into it.

HHH, MD

[tetengi]

i tested positive for chlamydia 3 months ago. even though there is no pain now when i urinate, i still get discharge when i milk my penis. i have taken almost all the range of antibiotics without relieve. i have even done hiv tst which was negative. what potent drug is available to help stop this discharge. i have taken, doxycycline, zithromax, augmentin, ofloxacin all without effect on the discharge. i have also undergone vdrl test,fbc,esr, and all is normal. kindly help me.

mha

[jallens731]

A related discussion, persistant chlamydia? was started.