Oral Sex Chlamydia worry

[sillybilly37]

Dear Dr HHH,

I'm male, live in England and I'm married. I had an unprotected oral encounter back in June last year with a white woman (I believe she was a mum) that I met in a bar. The oral sex probably lasted no more than a minute and I didn't ejaculate.

I had a urine test for both chlam and gonn at the local NHS GUM clinic at approx 11/11.5 days after the encounter which came back negative for peace of mind. I'd had no symptoms whatsoever i.e. discharge or penile sores etc.

I went back this week (Wednesday) to the NHS GUM clinc for peace of mind  (tests taken were chlam, gonn, syphillis and HIV).

During the session that doctor stated that really you should wait 14 days for a valid chlamydia/gonn test which freaked me out a bit - the health advisors at the cliinc had previously said 10 days should be sufficient. So now I'm starting to think that the test I had back in july may not have been valid. Also, on the day before my appointment at the clinc I'd just finished a week course of clarithromycin for a chest infection. The doctor said that this drug could have cleared up a chlamydia infection if I'd had one.

So, as you can imagine I'm now freaking out thinking that the original chlam/gonn test taken back in the summer may be invalid and that I could have given my wife chlamydia and that because I was on clarithromycin  up until Tuesday of this week the tests which I took on the Wednesday (the next day) could show a negative result even though I did have chlamydia a week before. The doctor did suggest this scenario.

So, to sum up  -

1. I can't get it out of my head that I should tell my wife about this and get her to go and get tested for chlamydia to be on the safe side. Do I need to do this? I know from your various posts that you say it's rare to get chlamydia from oral sex (throat to penile).

2. Are my original urine chlam/gonn tests reliable at 11/12 days? Am I unnecassarily freaking out about these results?

Many thanks

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.  I'll go straight to your questions:

1.  Whomever you spoke with about test reliability was being overly conservative.  Tests for gonorrhea and chlamydia reliably detect infect 3-4 days following acquisition which lead to infection.  Furthermore, just to put things in context, I would point out that oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not.  If you had gotten gonorrhea or NGU you would have also most likely developed symptoms of urethritis (penile infection).  Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection.  In your case, your exposure was brief; I would urge you not to worry.  

2.  This is the same question.  Yes, your test results are reliable.  You have no reason to worry.  EWH

[sillybilly37]

Dr Hook,

Many thanks for your help.

[Edward W Hook, MD]

I see no need to repeat myself.  Your summary is correct.  It is now time for you to move on from these concerns.  EWH

[sillybilly37]

Dr Hook,

Thanks again for your responses.

So, to sum up then -

1. You see no reason to doubt my original chlam/gonn urine test taken at 11.5 days post oral sex exposure.

2. There really is no need to worry about contracting chlamydia via oral sex because it basically doesn't happen because chlamydia throat/month infection is very very rare and therefore highly unlikely that there is chlamydia bacteria to transmit.

Many thanks for your help. You both do a great job on the forum.

[Edward W Hook, MD]

Straight to your questions:

I am sure the urine tests for gonorrhea and chlamyida performed at the GUM Clinics are the standard tests and can be relied upon.  The are currently consiered as the test of choice for diagnosis of these infections in most situations, including yours.  

Yes, the clarithromycin would be expected to cure chalmydial infection.  


I agree, the ache you describe is unlikely to be due to STD.

Try to move on.  EWH

[sillybilly37]

Dr Hook,

Thanks for your response and reassurances.

As you can tell chlamydia is the infection I've got hung up on. I see that you (and Dr HHH) say chlamydia cannot be transmitted via oral sex. I suggested this to the doctor I saw at the clinic and they said it was unlikey but not impossible. Probably covering all her bases, maybe.

I did see on the NHS website in this country that throat infection by chlamidya is very rare and if so then you should be able to conclude that infection via oral sex would be very rare i.e.  you would very unlucky to meet somebody that had a throat chlamydia infection.

I'm just having problems (guilt, I know) getting rid of the notion that I should get my wife tested for chlamydia. The doctor did suggest once I got the lastest test results back (negative, hopefully) I could carry on having sex with my wife and then go back and be tested again to see if my wife and reinfected me for peace of mind. I'm not sure I could deal with that.

I know you don't like follow up questions so this will be my only ones.

1. Are the urine test used to test for gonn/chlam in GUM clincs standard tests? I would assume NHS (English) GUM clinics would use the latest/most reliable test available and be the same as the test you use?

2. Would a week course of clarithromycin get rid of chlamydia?. My wife also actually had a half week course of clarithromycin.

3. I've been noticing a dull ache in my testicles now again recently but I've been putting this down to anxiety - I doubt this on it's own would be a symptom of an STD?

Thanks once again