tests - false +ve, carriage duration of infection

[blah99]

My partner has been tested twice in the last week for chlamydia.
1. Swab test - result negative
2. blood test - result positive

I have been blood tested but don't have the result back.

How likely is it for a false positive in this kind of test? She was tested in September 07 (blood test) and it was -ve.

There are 2 issues in that we are worried about potential side effects (getting pregnant), and also inevitably about fidelity in the relationship.

We are together 5 years, and there have been struggles, she having serious trust issues. In the early stages of our relationship we were apart for large amounts of time and so trust was a major issue. She developed persistent problems with Thrush/yeast infections. Arguments ensued and I was tested for STDs, results were negative. This was approx 4 years ago.

Around the same time frame she was given medication to deal with some of her problems, I was told I had to take the same medication. My doctor wanted to know why she was taking it as it was used only to treat Chlamydia. Unfortunately I don't remember what the antibiotics were. I had her blood test results with me and the Chlamydia test was negative. I took the treatment in any case.

She has had regular tests since then, always negative. My last previous sexual partner was 5 months prior to having intercourse with my current partner. I have had no sexual encounters with anyone else since then. As described above we've both tested -ve and been treated with "anti-chlamydia" antibiotics since then.

Is there any reasonable explanation how either of us could have carried it for so long undetected? Her ObG told her there was a tiny chance that it could be carried in cysts on my prostate that could have recently released the infection. My doctor says he can't say. A physical exam which showed nothing, and he prescribed antibiotics and a blood test. She denies having any other partners since we've been together.

[H. Hunter Handsfield, M.D.]

Stopping after the opening line: There are no valid blood tests that diagnose a current chlamydial infection.  The swab test is reliable.  The blood test only indicates she might have been infected in the past, but even that isn't very reliable.

There are only 2 recommended uses of chlamydia blood tests in routine (non-research) health care:  evaluating women who are infertile, bec ause some infertility experts believe that if the test is positive, it is worthwhile treating for possible chlamydia; and to diagnose the rare chlamydial infection called lymphogranuloma venereum (LGV).  Otherwise there is no valid reason to ever have a chlamydia blood test.

In the off chance that your partner actually was infected despite the negative swab test, you both have been treated, so no further worries about chlamydia.  I have no other thoughts about your partner's symptoms.  For that she will need to continue to speak with her provider.  But you can put chlamydia aside.

I hope this helps.  Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

I just realized your own test was on blood.  Whether your result is positive or negative will make no difference.  Only swab or urine testing is worthwhile.  But since you have been treated, there is no point in testing again.

[blah99]

Thanks for the quick response.
I'm mystified then as to why I was blood tested, and why her ObG put such emphasis on the blood result and not the swab. His inference to her was that I had been playing away from home, which is obviously unhelpful to any relationship.

We're in France, which you americans love to mock but they've a notably efficient health system so its difficult to understand why inappropriate tests are being taken. The tests were also ordered by 2 different doctors.

[H. Hunter Handsfield, M.D.]

Certainly there are differences in attitudes and beliefs about health care in general and STD in particular from one country to another.  Maybe chlamydia blood testing is done commonly in France.  If so, perhaps there are data I don't know about.  But I doubt it; STD researchers internationally are a small community and most of us know each other and are pretty much aware of the important research.  Maybe it's just a clinical habit in France.  It isn't meant as a criticism of France your your doctors, but I stand by my original reply.  (But I do disagree with any doctor in any country who interjects his or her own moral beliefs into health care advice, especially in regard to STD.)

For what it's worth, I don't think there is so much mocking of France in my country.  Certainly not in the health arena.  And when it comes to international politics, I and most of the people I know -- both professional and personal -- agree more with France than my government.  That probably will change in a year -- I hope!

[blah99]

As an FYI on the testing, if its of any interest:
The bloods were for a multitude of things, in an ongoing effort to work out why she has so many problems.
The chlamydia results were positive for IgG and negative for IgA for C. Trachomatis. The lab described it as an acute infection.
The results for C. Pneumonia were positive for IgG, negative for IgA, with the lab conclusion being a historic infection.

On the morality issue, as this type of case has severe implications for a relationship I would think the doctor should make an effort to explain the circumstances as clearly as possible. In this case one passed moral judgement, and the other washed his hands, explaining professionally how it all works but studiously avoiding "getting involved". I have sympathy with the doctors but at the same time...

Regarding the politics, my partner is berating me for baiting a political debate in a medical forum ;)
I'm not French so no danger of offence. Things, as they say, can only get better. Although the Dems seem set on cannabilism. Romney's speech imploring that electing a Dem was leading the US on the rocky road to becoming "the France of the 21st century" was one of the funniest lines in years. And now I'll leave the politics to the more appropriate forum...

[H. Hunter Handsfield, M.D.]

The formal organism name is Chlamydia trachomatis; those results are not for 2 separate tests.  But I still am sure you don't have a current chlamydial infection.  But if you did, you were treated so the issue is moot.