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Is it possible my Chlamydia was not fully treated three years ago?

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bri_t03 asks:

My boyfriend and I have been together for 4 years and we have 2 children together. When I found out I was pregnant with our first child I also found out I had Chlamydia. I got treated and so did he. Just last week I got my yearly check up and I have Chlamydia again! I have been completely faithful to my boyfriend and he said he has been completely faithful to me. I do believe him! Is it possible either my boyfriend or I was not fully treated three years ago? How could I have gotten infected again?

Red replies:

Before I answer your questions, I’d like to commend you for even getting yourself to the doctor for your yearly check up (a chore that many of us seem to avoid!) I’m also glad that your gynecologist tested you for Chlamydia because the CDC (Centers for Disease Control) recommends yearly Chlamydia testing for all sexually active women under 25.

Now to your questions. First, the possibility of your treatment “failing”- meaning that the Chlamydia bacteria was resistant to your antibiotics- is very small. There are currently several effective antibiotic treatments for Chlamydia and while there are a few scattered reports in the medical literature about Chlamydia strains that do not respond to the current antibiotic therapy, these reports are rare. If you, as a woman, did happen to be infected with one of these strains, the chances of you “failing” treatment and then not having some sort of symptoms is possible. Because of our anatomy, if we let bugs like Chlamydia, Gonorrhea and even E. coli hang out in our vaginal canals for too long, these bugs will slowly move up our vaginas, through our cervixes, into our uteruses and eventually make their way to our fallopian tubes. This results in a condition known as Pelvic Inflammatory Disease (PID). PID can be asymptomatic or can cause symptoms like a low-grade fever, lower abdominal pain, vaginal discharge or bleeding. The inflammation in PID can lead to scarring of your fallopian tubes and can make it difficult for an egg to travel from your ovary, through your fallopian tube and into your uterus. This can lead to infertility or to an ectopic pregnancy.

So, again, it is possible that you “failed” treatment and then went on to develop asymptomatic PID. However, the fact that you went through another pregnancy after your initial bout of Chlamydia leads me to believe that you were fully treated the first time around. Pregnant women are usually screened for sexually transmitted infections like Chlamydia at the beginning of prenatal care. Doctors routinely do this screening because a Chlamydia infection in the mom may lead to an early delivery as well as pneumonia and/or pink eye in the new baby. If you had “failed” treatment and had somehow managed not to get PID or if you had PID with no symptoms, you still would have had a positive Chlamydia test during your prenatal care.

What about your boyfriend? Again, it is possible that he “failed” treatment. However, a study that was published a few years ago found that men who “fail” antibiotic treatment either somehow manage to kill the bug by themselves or go on to develop symptoms. These symptoms can include the regular symptoms of Chlamydia in guys- painful peeing, penile discharge- or symptoms of a Chlamydia infection gone crazy- in guys the infection can end up at the top of the testicle in the epididymis. This results in a very swollen and painful testicle that has to be treated with even stronger antibiotics. So, the reality of your boyfriend failing treatment and then having absolutely no symptoms for three years while still harboring the bacteria is slim to none.

How could you have gotten infected again? (AGAIN being the important word here.) You got infected the way everyone does - through sex.

Chlamydia can be passed from one partner to another during oral, vaginal or anal sex. The bacteria that causes Chlamydia, Chlamydia trachomatis, is known as an “obligate intracellular parasite” which means that it must take up residence within our cells to sustain life. This means that the Chlamydia bacteria does not survive very long outside of our bodies and explains why you can’t get Chlamydia from sitting on a toilet seat. So, unless either you or your boyfriend “failed” treatment (rare but possible) and had absolutely no symptoms for the next three years (highly unlikely) and your doctor didn’t screen you for chlamydia during your prenatal care for your second pregnancy (extremely unlikely) and you have been completely faithful to your boyfriend, your boyfriend re-infected you.

What now?

1. Please have your boyfriend see a doctor and be tested and treated appropriately.

2. ABstain from sex (oral, vaginal or anal) until both of you have completed treatment and are symptom free. After you complete treatment and are symptom free, have protected sex until you get retested and get a clean bill of health (see #3 below).

3. Please make sure that you get retested for Chlamydia three to four months after finishing your treatment. You might be wondering why you need to get retested if I just told you that Chlamydia is rarely resistant to antibiotics. The CDC encourages all women to get retested, especially if they are not sure that their partner was appropriately treated. It’s been shown that there is a high rate of Chlamydia infection among younger folks who receive treatment for Chlamydia and then come back to the doc in six months. However, the vast majority of these cases are RE-infections, not treatment resistant infections. As you know, a Chlamydial infection can be silent, but these infections are important to diagnose and treat! Repeated infections with Chlamydia can increase your chances of developing infertility caused by scarring of your fallopian tubes.

4. To maintain your sexual health, continue to see your gynecologist on a yearly basis (or more often if necessary!). Continue to get screened for sexually transmitted infections yearly.

5. To maintain your emotional health and the health of your relationship, I recommend that you and your boyfriend sit down and have a chat. Try to find a quiet time and place to sit down and discuss the situation. Lay out the facts as you know them and give him a chance to respond. Personally, I am a huge fan of believing that all people are honest and good, BUT I also believe that it’s dangerous to argue with science! As much as anyone hates to believe that a partner has cheated, it unfortunately seems like that is a significant possibility in this situation.

Good luck and good health to you.

For more info, check out the links below:

written 30 May 2008 . updated 21 Nov 2012

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