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Lingering Chlamydia Symptoms

6/13- Notice symptoms (some discomfort after urination, slight clear discharge)
6/17- Doctor prescribes doxycycline (2x day for 7 days)
6/18- Lab for tests (Gonorrhea= neg, HSV I & II= neg, Chlamydia= positive via Aptima NAAT); start meds after test
7/5- Lab retest (suspecting false positive)
7/7- Another round of meds after still experiencing some symptoms (1g azithromycin)
7/13- Repeat test comes back positive for Chlamydia again
7/26- Another round of meds after still experiencing symptoms (5 day course of azithromycin)
8/13- Repeat test; comes back negative (Aptima Combo2 NAAT)

Summary: three rounds of antibiotics (one doxycycline, then two aziothromycin), three rounds of tests (two positive, then one negative)

Other notes: my girlfriend tested positive via pap smear twice (she tested positive, took a round of azithromycin, tested positive again, took another round of azithromycin, and then finally tested negative).

I am still experiencing some symptoms even after all this. I occasionally still have slight discomfort in the middle/bottom of my urethra (not at the tip) after urination, and at the conclusion of urination I get a slight clear sticky discharge (like pre-ejaculate), which leads to a tiny bit of dribbling after. I have also noticed that recently during sexual activity I get a substantial amount of clear pre-ejaculate fluid, and there are a lot of air bubbles in it. Occasionally I have noticed the end of my urethra stuck closed when I go to urinate as well.

1. How reliable is the negative test result I received? Is there anything that could cause a false negative (e.g. not giving enough urine, having had a couple of drinks the night before, etc)?
2. Any idea what this could be if it is in fact not Chlamydia anymore?
3. Should I see a urologist or an infectious disease specialist at this point? Any specific tests I should ask for (really hoping I don’t have to get a scope…)? Should I get yet another retest?

Thanks very much!
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239123 tn?1267651214
Welcome back.  Sorry I never responded to your closing comment on your previous thread, when you reported the positive chlamydia result.

I don't understand the timing of the second positive chlamydia test.  Was that the test on July 5, i.e. after the first round of treatment?  If so, it doesn't necessarily imply treatment failure.  NAAT can remain positive for up to 3 weeks after treatment; these tests detect chamydial DNA, which can persist for a while even though the chlamydia organisms themselves have been killed.

Nongonococcal urethritis (NGU), whether due to chlamydia or other causes, often persists or recurs after treatment.  This is most common for nonchlamydial cases, but isn't rare after chlamydia treatment either.  The important thing is that your test result became negative.  The modern chlamydia tests, including the Aptima NAAT, are highly reliable, much more so than symptoms.  And you had 3 rounds of treatment with antibiotic regimens that are virtually 100% reliable in curing chlamydia.  So you can be confident your chlamydial infection was eradicated.

However, it seems likely you nevertheless have persistent urethritis or perhaps prostatitis, either of which could cause intermittent discharge, mild urinary discomfort, and the sticky secretions that partially obstruce the urethral opening from time to time.  The most usuaal aspect is your report that there are bubbles in pre-ejaculate fluid and/or other urethral discharge fluid.  If true, this could indicate a rather unusual bacterial infection, or perhaps trichomonas.

Those comments answer questions 1 and 2.  And I indeed recommend you see a urologist or ID specialist.  While you should not insist on any particular test -- rely on the doc's judgment -- you could consider printing out this thread as a starting point for discussion.  Tests for trichomonas and for urinary tract infection bacteria might be warranted.  And perhaps an imaging study of your prostate (e.g. ultrasound) might not be a bad idea -- but that is getting outside my expertise.

I'll be interested to hear how this shakes out after you have seen a urologist or ID specialst.  But in the meantime, don't be worried.  None of the likely possibilities is especially dangerous either for affected men or their sex partners.

Regards--  HHH, MD
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