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Chlamydia treatment effectiveness and NAAT accuracy

Questions:
- How effective are the antibiotics usually prescribed for the treatment of chlamydia – specifically, Azithromycin 1 Gram (Single Powdered Dose mixed with two (2) ounces of water) and Doxycycline Hyclate (100 Mg Capsules – Administered twice per day for seven (7) days)?
- How common is it that chlamydia symptoms persist during and after antibiotic treatment(s)? (Assume that both treatments were completed with strict adherence of clinical instruction).
- What are the treatment protocols when both Azithromycin and Doxycycline Hyclate fail?
- How accurate are Nucleic Acid Amplification Tests?
• Probability of False Positive?
• Probability of False Negative?
• Is there a difference in accuracy for NAATs performed on urine from Males or Females?
• Can age of urine specimen and/or fluctuated temperature storage of urine specimen diminish the accuracy of NAATs? (Example – If the urine specimen remained untested for a day or two) (Example – If the urine specimen was refrigerated then warmed for testing).

Background:
- November 5th, 6th, and 7th – Unprotected contact.
- November 12th – Symptoms began. Pinching sensation at tip of penis. No painful urination. No discharge. No abdominal pain. No testicular pain. No penis tissue inflammation or redness. No sores, lesions, or rashes.
- November 14th – Clinical assessment performed with Primary Care Provider and Tests ordered:
• Hepatitis Acute Panel (722967)
• Urinalysis Screen Dipstick (682790)
• HIV Ag&Ab 4t Generation (240402887)
• Chlamydia trachomatis/Neisseria gonorrhoeae RNA TMA (219039767)
- November 15th – Urine and Blood specimen collected.
- November 18th – Test results:
• Chlamydia trachomatis RNA TMA – NAAT – Detected – Flag A
• Neisseria gonorrhoeae RNA TMA – Not Detected
• Hep A IgM – Non Reactive
• Hep B Core  – Non Reactive
• Hep Bs Ag – (0.17) Negative
• Hep C Ab Index – (0.09) Negative
• HIV Ag/Ab Screen – (0.083) Nonreactive for antibodies to HIV-1 and HIV2 and p24 antigen
- November 18th – Patient Received Azithromycin 1 Gram Dose and mixed medication with two (2) ounces of water and consumed completely.
- November 22nd – Partner received Azithromycin 1 Gram Dose and mixed medication with two (2) ounces of water and consumed completely.
- December 5th – Patient continues to feel slight burning after urination and tingling sensation in penis 17 days following Azithromycin 1 Gram Dose and zero sexual contact of any kind. Patient provides a second urine and blood specimen for STD panel to include Syphilis. (Patient presents no sores, lesions, or rashes of any kind. Patient is not screened for Trichomoniasis.
- December 9th – Test Results:
• Chlamydia trachomatis RNA TMA – NAAT – Detected – Flag A
• All other tests are Normal/Negative/Non Reactive
- December 9th – Patient receives 14 Doxycycline Hyclate 100 Mg Capsules.
- December 9th through December 15th – Patient has taken Doxycycline Hyclate 100 Mg Capsules every day at exact 12 hour intervals for six (6) consecutive days with zero sexual contact of any kind. Patient continues to feel intense burning after urination and tingling sensation in penis.
- December 12th – Partner submits urine for Chlamydia trachomatis NAAT after 19 days since completing Azithromycin 1 Gram Dose treatment with no sexual contact of any kind.
- December 14th – Partner’s test reults:
• Chlamydia trachomatis NAAT – Negative
- December 16th – Patient’s symptoms continue with one day remaining (two (2) Doxycycline Hyclate 100 Mg Capsules) for treatment.

Final Concerns:

- What are the possible causes of continued symptoms considering the Patient has completed two (2) treatments of Azithromycin and Doxycycline Hyclate with strict adherence to clinical guidance.
- Is it realistic that the Partner's Negative result from the NAAT could have been false due to age of urine and/or fluctuated urine temperature.

Thank you for your time and consideration.
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