Recurring Positive

[perplexed30]

Doctors, your advice on this matter is greatly appreciated.
My significant other and myself both tested positive for chlamydia.  We also tested for all other STD's and both had negative results for everything else.  My doctor gave me a single dose zithromax and when I went back three weeks later my pcr was now negative.  Doctor's office said this was not a false negative and reasurred me.  

My boyfriend's doctor started him with a cycle of doxy, retested about 10 days later and he still came back positive.  He then took zithromax and again came back positive for chlamydia in the culture but this time negative in the urine test.  Was given another cycle of zithromax, this time a little more and tested for prostate infections.  Prostate came back negative, chlamydia still positive.  He was retested for the chlamydia again about thirteen days after the third cycle of antibiotics and it was still positive.  He is also still feeling symptoms.  We have not had any sexual contact since we were both diagnosed back in January.  Can you please give us insight on why his test keeps coming back positive and the systems are presisting?

[Edward W Hook, MD]

I'm sorry, there is a limit to what can be done through this medium.  I think that going to an infectious diseases specialist would be the best approach.  He/she may have access to more specialized testing to help sort things out.  EWH

[perplexed30]

Thanks again, it is comforting knowing I have a place to voice these concerns.  Do you have any sugestions as to what he should do next, his Urologist hasn't given him any options except saying its not possible my boyfriend still has the infection and that it is dead cells showing up in the test.  
I guess one thing worth mentioning is that he does start to feel better when he takes the antibiotics but when he's done with them the symptoms come back.

[Edward W Hook, MD]

Very unlikely. EWH

[perplexed30]

Could it be resistant in him and not in me since mine cleared with my first dose of zithromax.

[Edward W Hook, MD]

There have been very rare reports of antibiotic resistant chlammydia in individual patients (two that I am aware of).  to evaluate this possiblity would require input of an STD specialist and perhaps the help of a research chlamydia laboratory.  Unless your ID specialist has an explanation for repeated postive chlamydia tests despite the fact taht both of you have been treated and don't have other partners, perhaps he/she can contact one on your behalf.  EWH

[perplexed30]

It has been over a month since my last post, however, my boyfriend and I are still worried.  His urologist had consulted with three infectious disease Drs and they all said there was no way he still had chlamydia but his last test just came back positive and he is still having symptoms (sensitivity around tip, testical discomfort, drip after urination, and occasional itch)  We have had no sexual interaction since January.  He took his first dose of doxy on Feb. 1 and has since taken two cycles of zithromax and two other antibiotics.  I don't think his Dr. wants to give him anymore antibiotics. It has been over two months now, is there any other possible explanation for this repeated positive and recurring symptoms?  

[Edward W Hook, MD]

10 days following completion of recommended therapy, the DNA detected by nucleic acid amplification tests could still be positive.  A culture would not- cultures only detect living organisms.  (Caution, some doctors call the nucleic acid amplification tests "cultures" which is not totally true as noted above).  EWH

[perplexed30]

I understand and respect your stand on the patient doctor thing.  I do have one more question though, could the fact that they retested my BF only about 10 days after his cycle of antibiotics effected the results?  Don't know if it is a female thing but my doctor made me wait at least three weeks.

[Edward W Hook, MD]

Thanks for the clarification.  Different medications vary from person to person in terms of how they are metabolized.  Whether this is contributing to your BF's problems, I cannot say.  While I agree with you that the azithromycin is likely to work in both persons, strange things do happen.  In addition, MedHelp specifically asks us not to get into debates between patients and their doctors, something that I think is a good idea.  He needs to work this out with his doctor (the preferred approach) or get another doctor.  EWH

[perplexed30]

Sorry I am one of those paranoid types.  My boyfriend starts to feel better while on the zithro but as soon as he stops them he feels worse again.  I know this sounds gross but after his last culture, his doctor told him there was no pus this time which is a good thing.  My boyfriend feels he needs the zithromax in a stronger or longer dose since it seems to be helping.  His Dr. does not agree and thinks the antibiotic dose is not the problem and that the strain of chlamydia my boyfriend has is not responsive to zithro.  I don't agree because I would assume we had the same strain (monogamous relationship, figured out one of us had it before our current relationship) and the zithro worked with me?

[perplexed30]

My pcr was negative after first treatment

[perplexed30]

Sorry, I may have not articulated that well.  Only he had the persistent positive.  And he has had a culture with each test.

[Edward W Hook, MD]

The situation you describe is rather unusual, not in that you each had persistently positive tests following treatment but that it has taken so long for your BF.  the nature of most chlamydia tests currently used (PCR, ProbeTec, Aptima) is that they do not detect living organisms but there DNA.  The DNA can hang around following effective treatment for a number of weeks, leading to repeat positive.  In addition, while rare, there are occasional false positive tests.

The effectiveness of both azithromycin as a single dose and doxycycline take for 7 or more days exceeds 97%.  For those rare treatment failures, re-treatment with either the same medication or the alternative is almost always effective.

My advice, given your abstinence since diagnosis and repeated treatment of your BF, I would be quite surprised if he (or you) were still infected and would look for an alternate explanation. Retesting with an alternate test or, even better, a culture would be an appropriate next step.  Hope this helps.  EWH