odds of chlamydia

[punkybear]

Hello Dr. H. I just want to say that you do a great job both putting people's minds at ease and giving knowledgeable advice. This forums is a wonderful service. Anyway, on with my question: I am a female and I plan on trying to conceive in a few months and I can't stop worrying about what I consider a promiscuous period of my life about five years ago. I had unprotected sex with three men in a year one of them being very questionable and I can't shake the fear that I could have contracted chlamydia at that time and now I am infertile. I know you can't help me with my anxiety but my question is this: I always get tested with my yearly pap for chlamydia and gonorrhea and my tests have always been negative. It is a good bet with my yearly testing that I never had Chlamydia at that time? How likely is it that I could have caught it and it gotten rid of it in a couple months and never tested positive? I know there is no possible way for you to know this but statistically speaking, can I safely assume that I never contracted it? And if I did, how likely is it that I have tubal damage because of it, statistically speaking? I know this is a sort of odd question, I am just so worried and kicking myself for this period in my life. I wish I had a time machine. Thank you in advance for your response.

[H. Hunter Handsfield, M.D.]

I'm happy to try to help.  Your question reflects the single most important STD risk for sexually active women.  Despite all the discussion in recent years about herpes, HPV, and HIV, and the dominance of questions on this forum on those topics, from a real risk standpoint and the perspective of public health impact, chlamydia remains the Big One.  It is so precisely because it is a major cause of infertility due to tubal damage.  (Almost none of the many popular media stories about in vitro fertilization mention the fact that past STD, especially chlamydia, probably is the single most important reason for IVF.)

So your concerns are valid.  However, your risk still is pretty low.  With consistently negative tests, it is unlikely you were infected.  But you are correct, it certainly would be possible to acquire chlamydia and spontaneously resolve it over several months, between annual exams.  There simply are no data to calculate the numerical odds.  However, the majority of chlamydial infections do not result in signficant tubal damage or impaired fertility.  Taken together, these facts suggest you are at low risk for that outcome.

The standard advice is to not medically evaluate a couple for infertility until they fail to conceive after a year of attempting to do so.  However, in some circumstances, an ObG specializing in infertility might recommend diagnostic tests without that waiting period.  But the work-up is expensive (and likely not covered by insurance until infertility is documented), and some are painful or might carry their own risk of adverse effects.  This isn't my area of expertise, though.

Bottom line:  Most likely you don't have anything to worry about.  But if you remain concerned, seek out an infertility specialist and follow his/her advice.

Best wishes--  HHH, MD

[punkybear]

I will add that the "questionable" man and I had sex for about eight months. If rumors are correct, he was not faithful.