Important Treatment Question

[helloitsme34]

I had sex with a woman two weeks ago. Within 2 days, I began to urinate differently. It wasn't painful but it wasn't coming out straight and I felt tingling. I made an appointment at a health center, and took all the different STD tests. At this point, I was sure I had chlamydia because I had crusting.

A week later, I received my results. Everything was negative, with the exception of chlamydia. The doctor at the health center gave me a perscription of one dose of Azithromycin. On Thursday, May 29th, at around 5:00 pm I took the perscribed dosage. At midnight that night, I had about a half glass of wine before remembering that I took the antibiotic. I didn't drink anything else.

It has been around 48hrs. The doctor at the health care clinic was not very helpful. She gave me no instructions about drinking or anything else. I wanted to know if what I drank would affect the effectiveness of the medication. Also, should I avoid drinking until I'm done with treatment? The doctor told me that it would take 7-10 days for the medicine to work. Is this accurate? When should I go back for retesting? Its been exactly two weeks since I had sex with that woman. I mention this because I did manage to identify and treat this rather early. I'm not sure if that will affect anything.

Thanks for your help.

[H. Hunter Handsfield, M.D.]

The doctor's advice about 7-10 days is correct.  No improvement at 48 hours is typical.  Symptoms might start to improve with 2-3 days, but typically take 7-10 days to resolve entirely.  There is a habit in STD clinics and among providers in general to warn patients to avoid alcohol during treatment, but there really are no data to suggest it matters.  The biggest risk probably is for people who are taking prolonged treatment (for a week), rather than single-dose azithromycin, because people who drink heavily might forget to take the drug, or might have sex before cured and risk transmission to new partners.  In any case, a little alcohol like you had will not affect the effectiveness of treatment.

Men infrequently have complications from chlamydia.  It's always better to be treated early rather than late, but probably no harm would have come to you if it had been more than a few days.  In fact, you might not have caught it when you think. Chlamydia symptoms generally don't start to appear until at least a week and often 10-14 days after exposure, and sometimes it takes quite a bit longer.  If you had sex with anyone else in the month before your symptoms began, that person is a more likely source of your infection than the contact only 2 days before onset.

Everybody with chlamydia should be retested 3-4 months later.  This is called "rescreening" and is designed to pick up new infections as well as the rare case of ones not cured by the orignal treatment.  On average, 10-20% of people with chlamydia have it again when retested at 3-4 months.

Bottom lines:  1) You can expect your symptoms to clear up in the next 7-10 days.  If not, return to the doc who treated you.  2) Make sure all sex partners in the past month get treatment, not just the woman from 2 weeks ago.  3) Get retested in 3-4 months.

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

Bottom lines:  

[helloitsme34]

Thank You, Dr. Handsfield. I think I have seen some improvement already.

There was one thing I wasn't clear about. Symptoms resolve in 7-10 days, but does that mean the chlamydia is cured? Would it make sense to retest after 2 weeks and then again in 3-4 months?

Finally, if I test negative in two weeks, would it be safe to say that this infection is gone and I can't spread it?  

[H. Hunter Handsfield, M.D.]

CDC and other authorities recommend against retesting until at least 4 weeks after treatment.  Before that, dead chlamydia can still give positve results on the lab test.  If you want to retest to assure cure, do it at least 4 weeks after treatment.  Even that isn't recommended, since the standard treatments are so reliable -- but feel free if you are anxious about it.

[helloitsme34]

Okay, thank you again for your help. I guess my biggest concern was the possiblity of spreading it.

[H. Hunter Handsfield, M.D.]

That's a responsible position and the correct one.  Men rarely get complications of chlamydia but women often do, so twhenever someone has chlamydia he most important consideration is to be sure that all women at risk are treated.  Good show and thank you -- I wish more infected men had that perspective.  In that spirit, see my comments above in regard to when you might have been infected -- i.e., be sure all partners in the month before onset of symptoms get treated.  Not that you haven't taken those steps; you just didn't say one way or the other.

[helloitsme34]

Thanks for all your help. I have notified my partners. How long should I wait before having sex again? Also, how effective are condoms against transmission of chlamydia?

[H. Hunter Handsfield, M.D.]

A week after treatment is the standard recommendation before resuming sex.  Proverly used condoms are close to 100% protective against chlamydia.

That's it for this thread.