Chlamydia Test Results

[ECMB]

Hi - this is a two part question.

1. In July, I had a ThinPrep pap test as part of my first prenatal appointment.  A "Chlamydia, Nuc. Acid Amp" test was performed and it tested positive.  I have been married for 11 years with no other partners and have never tested positive (this is my third child), so I asked for a retest.  The next day I took a urine test - "Chlamydia trachomatis, NAA" and it came out negative.  Since I was pregnant and did get a positive result, I was treated.  

My husband has said he was tested via swab, and that his swab test was negative; he was still treated (b/c of me).

Since the results, my husband has admitted to physical affairs throughout the 11 years, but will only admit to receiving and giving oral sex.  He says his last 'time' was July 2011.  

Question - do you think I actually had Chlamydia?  My doctor is saying the "Nuc. Acid Amp" test result is more accurate than the urine and can be taken as good evidence that I had it. He said he had to treat me due to the positive, but even so he considers it accurate that I had it.

2. I had the normal pre-natal testing performed on July 6.  My husband has only had the Chlamydia and Gonococcus testing performed (although I never did see his test results).  We were both treated with antibiotics in July and he also received a shot (assuming for Gonorrhea).  

Question: Assuming he has been having sexual intercourse with others and I cannot confirm when his last exposure was, what are the tests we (both of us) should have and what should the frequency be for testing?  For example, I don't believe there has been activity since July, but there could have been activity up until discovery on July 13.  So based on the assumption that up until July 13 there were other sex partners, what testing should be done and how often should it be repeated?  (I will be retested for Chlamydia in the next 8 weeks for upcoming delivery)

Thank you

[Edward W Hook, MD]

I understand the difference however I would still have treated both you and your partner.  And yes, you could have cleared your infection is a week.  As for your husband and his statements, I believe that he had acknowledged having other partners and you had a positive test.  For him to argue is a bit silly.

Finally, with respect to the issue of infection, I think you are mis-interpreting what we mean when we write about risk for infection. The fact is, on a statistical basis, the risk of infection from any single exposure is rather low.  However, any person can be infected on any single exposure but the risk goes up with each exposure.  For example, if your are exposed to an infected partner, in statistical terms your risk of infection after one exposure is about 30%. After two exposures, the risk goes up to about 60%, to 90% after three exposures, etc.  

I hope this is helpful.  EWH

[ECMB]

One change from the last time I posted - they had told me over the phone that the lab said the urine test was positive.  So I thought I had two positive tests.  However, the lab had given the nurse incorrect information (over the phone) and the test was actually negative (when the report came back).  The tests were less than a week apart - could I have cleared the infection have cleared by then?

Guess what I am really getting at is - I can't get my husband to admit he exposed me to an STD.  He is using the negative test as "evidence" that I "didn't really have it."  

Also, I have read in other posts that you usually need to be exposed repeatedly to get the infection.  So would it be more likely than not that my husband was exposed many times to have actually contracted it?

[Edward W Hook, MD]

Welcome to the Forum.  I'll be pleased to comment.  Your first question is essentially an expansion of the questions you asked which were answered by Dr. Handsfield in July.  You can re-access those comments by clicking on your MedHelp pseudonym above.  I have probably done for evaluation of newer tests for chlamydia in recent years than any other investigator and my comments come from that perspective.  A great thing about the nucleic acid amplification tests (NAATs) for chlamydia (and gonorrhea) diagnosis is there versatility. They can be used with almost complete interchangeability on urine, swabs or specimens collected for PAP smears. The urine tests are SLIGHT (but only very slightly) lower than the other types of specimens.  You were tested twice and I agree with your doctor that the result warranted treatment of both you and your husband.  Your 2nd test may have been negative because of the slightly lower sensitivity of urine specimens for testing or because the infection had cleared by itself (this does happen about 20% of the time in women).  I agree with your doctor, you were probably infected and treatment of you and your husband was precisely the right thing to do.

As for re-testing, the CDC recommends (and we agree) that persons with chlamydia infection should be re-tested about 3-6 months after their  initial diagnosis.  After that, for women under age 25 or who are at risk (as you may be, depending apparently on your husband's behavior) on a yearly basis.

I hope these facts are helpful. EWH