[APPLAUSE]

May 23, 2009 11:21 AM

I have some questions about Chlamydia and its extended effects... is anyone a doctor or nurse or medical professional [or just plain knows] who can give me some general information?

During her annual checkup a few weeks ago, my wife got tested; the results just came back, and she's tested positive for Chlamydia. They've put her on antibiotics right away, partially because she's very recently had an afternoon of some pelvic pain and because they feel that this indicates PID.

Unfortunately, the doctors haven't been as helpful as we'd like; she went back for a second exam, just to be sure, and the nurse who was taking her sample said that she didn't really know the answer to some of these questions. She's going in again next week (since you're supposed to get re-checked to make sure the antibiotics are working), so this isn't a situation where we're ignoring medicine; we're just somewhat concerned, and it'd help to have some answers to a few questions a little sooner than next week. Here's what we're wondering:

1. We know there isn't really a clinical test for PID (right?)--it's something that has to be clinically diagnosed. We also know that untreated PID can often cause infertility in women. This is what we're most worried about. However, no one's been able to tell us: is there any way to know how much damage PID has caused? She's on antibiotics, as I said above--are there any other treatments? What's the likelihood of infertility? She hasn't felt chronic pelvic pain--only once, really, although she's had bad digestion for some time.

2. How can Chlamydia be communicated? Everything we've read about it says that it can be sexually transmitted; we found one article that mentions that there is an avian version and a version most often found in children, but we don't know how far that goes.

3. The reason we ask that second question is: we've been together, and monogamous, for six years. We know each other well enough to know that neither of us has cheated. (No comments on the inevitability of betrayal, please; we just want answers.) I (male) have never seen so much as a single symptom of Chlamydia--no discharge, no pain, no swelling. I've had a very limited number of sexual partners (3 before her) and was very dilligent about using condoms; she had a few more partners than I, and has a latex allergy, and so she had more exposures. We're thinking it's likely we've had this, undetected, for six years. Our question: is this likely or even possible? Could Chlamydia really exist for six years without symptoms or detection?

4. Of course, there's a wrinkle even on this possibility. While I haven't been tested at all, she was tested five years ago, about a year after we got together, at a small clinic at our tiny (about 200 students) college. That test was negative. She doesn't really remember what kind of test it was, unfortunately. Is it possible that she had Chlamydia then, but the test didn't detect it? Otherwise, it's likely I had it before I met her; but then it seems strange that, a year after we'd started having sex, she hadn't contracted it.

So... what are the possibilities? Most of all, can someone fill us in on the detection of potential damage that's been done to her reproductive system and treatment of that damage?

I realize I haven't mentioned: I'm getting tested next week, so I'll know about myself soon.

posted by anonymous to health & fitness (17 comments total)

The CDC is a very reliable source for medical information.

There's also the National Institute of Allergy and Infections Diseases.

The National Library of Medicine has a lot of information.

Just scanning these, it seems pretty clear that Chlamydia is transmitted sexually and sometimes has no symptoms.
posted by jasper411 at 11:30 AM on May 23

(I don't have anything to offer, just a correction, OP. "The Clap" refers to gonorrhea, not chlamydia.)
posted by zerokey at 11:43 AM on May 23

About half of men infected with Chlamydia are asymptomatic.
posted by reflecked at 11:49 AM on May 23

Disclaimer: I am not a doctor. I am an undergrad in a biomedical field. All the information I'm going to give you is biological and from reliable websites.

Chlamydia is not only sexually transmitted, it can be transmitted if she's been in an infected pool. Has she been in a public swimming pool lately that hasn't been adequately chlorinated?

If symptoms occur, they occur within 1-3 weeks after exposure. Chlamydia is often a 'silent' disease. When was the first time you had sex that was unprotected enough to pass chlamydia? It may even be possible that her immune system could be weakened enough right now to allow symptoms to develop even if she was asymptomatic. It can linger for months or years before being discovered.

Chlamydia causes PID in about 50% of cases. An assessment of your wife's reproductive system will have to be done by her doctor. She'll be prescribed an antibiotic; I don't know what can be done about PID.
posted by kldickson at 11:51 AM on May 23

Chlamydia is an organism that can infect many different body systems (eyes, lungs, etc) and can be transmitted in various ways. If you have it in your uterus however, it most certainly got there through sexual transmission. Know though that it is quite common and also tends to stick around, failing to cause symptoms for a long time - so its not abnormal that she could be only having symptoms now from a long-ago infection.

It's also possible to have false negatives (and false positives) on any medical test. The likelihood depends on both the skill and experience of the care provider and on which type of test is being used. Chlamydia testing has changed recently, so perhaps a new test caught something an old test didn't. Also consider that she may not have actually been tested for chlamydia in that older checkup - a routine Pap smear does NOT "look for" chlamydia.

(It's very common that chlamydia is totally asymptomatic in men. Good to hear you'll be tested and treated so as not to reinfect her.)

There are various tests she could consider to evaluate possible "damage" to the tissues of her uterus and fallopian tubes, and you'd be best off approaching a gynecologist or infertility specialist about this, but if you're actually trying to get pregnant you may just want to see if you have any problems before embarking on expensive, invasive, and probably unnecessary testing.

I'm also curious to know which antibiotics she's on. Generally, the treatment for PID is a bit more aggressive than the treatment for an uncomplicated chlamydia infection. My understanding is that PID treatment assumes exposed to gonorrhea and treats for both organisms.

Good on you for not panicking and for seeking out more information. Do check out the links jasper411 highlighted above too, and good luck. I'm sure it will all work out soon.
posted by serazin at 11:53 AM on May 23 [1 favorite has favorites]

I have never heard of transmission through a pool mentioned above, and without seeing a reference in the medical literature, I am having trouble believing this is possible.
posted by serazin at 11:54 AM on May 23 [2 favorites has favorites]

Challenging situation, and I'm sorry the two of you are going through it. The unknowns with regards to fertility are, I'm sure, really difficult.

To answer your questions in order:

1) You're right, PID is diagnosed based on suspicion of it plus a work-up, but there's no quick test like there is for individual infections. It can be asymptomatic, which is what makes it all the more challenging. You can do exams where you look inside the uterus to assess damage, but that's not something that's typically done immediately. I think the best thing you can do is sit down with the doctor at the follow-up visit and discuss this. I'd put it out there as soon as he or she enters the room -- that in addition to the follow-up test for chlamydia, you want to have a discussion about the implications with regards to fertility.
To directly answer what you asked: No, there is no easy and immediate way to know if there is significant damage. As mentioned, there's a work-up you can do down the road, but immediately, no. Your doctor should be able to give both of you a better assessment of the odds of damage and where to go from here

2) It is easily communicable between males and females through sex. Once one partner tests positive, he or she should get treated and the partner should be tested immediately -- or perhaps even get treated empirically. A good rule of thumb: absolutely use a condom every time you have sex until both of you test negative.

3) Chlamydia can be asymptomatic in both of you. Thus why both of you need to be tested. You could never say who had it first, but whoever had it probably also gave it to the other. You need to get tested and/or treated now.

4) It would be possible to test negative when infected, yes. A quick search pulled up sensitivity (% of the time that the test does detect infection when infection is present) in the range of 80's-90's %. So it will catch most but not all cases in a single test. She could have been infected at the time. It also, however, gives some pause when testing you -- given that she has it and you likely have it, you might end up being treated even if you test negative, just to be sure.
By the way, the opposite case is also possible. She could, in fact, not have the infection but have had a false-positive. It is less likely, but still possible (~2% chance).


Anyways, hard, and I wish both of you the best of luck.
posted by davidnc at 11:57 AM on May 23

I used to work as a lab tech identifying chlamydia and other STDs. Also read papers on the topics, presented papers,/posters, blah blah blah (but i only did basic research0. Even though I am putting info here, please consult your physician above any of this.

Yes, it can be asymptomatic, in both males and females (more often asymptomatic in males).

There are areas in Africa where Chlamydia is spread 1) during birth and 2) in children with hgih contact, eye-to-eye. There are people in the states who do get STDs in their eye/facial regions, attributed to oral sex.

False negatives on a test -- absolutely. These tests are not accurate all the time, there are false positives and false negatives.

Good luck.
posted by Wolfster at 11:59 AM on May 23

How can Chlamydia be communicated? Everything we've read about it says that it can be sexually transmitted

Everything you have read is correct. Other avenues of infection (according to the fine folks here are possible but only in a theoretical sense. Particularly if the infection is vaginal/uterine.

So. Sorry. But according to the 'when you hear hoofbeats look for horses, not zebras' idea, one of you has not been monogamous. And given her negative test years back (yes, false negatives occur), that seems even more likely. I'm sorry.
posted by dirtynumbangelboy at 12:07 PM on May 23

I can't find the relevant article now, for all my googling, but I have read of chlamydia being spread through improper sterilization of instruments at gyn offices. (That this can happen has also been confirmed by a friend of mine who is a nurse. Obviously, since I can't provide you with any references, you may take this possibility with a grain of salt.)

Chlamydia can also live for awhile on sex toys. Also seconding that not only do routine pap smears not check for STDs, routine STD screening does not always include a test for chlamydia.
posted by desuetude at 12:16 PM on May 23

If her case of chlamydia is due to something besides sexual transmission you will never know. Mixed up sample, lab error, etc. Sure, all are possible. (Swimming pool? no fucking way). I think you make peace with the fact that it was detected and if you choose not to dwell on the more typical scenarios (and this is why your doctors are being evasive - who the hell wants to sit and spell it out for a grown adult and invoke that wrath, really?) you would best move on.
posted by docpops at 12:21 PM on May 23

I just went through this scare myself: no obvious symptoms and monogamous with my 4.5 year boyfriend, getting regular pelvics the entire time. Long story short, the retest was negative. My boyfriend went to his doctor and just got antibiotics (because the male test, at least the one his doctor had access to, was a painful urethra-scraping one), and I went through the unpleasant round of antibiotics myself. Here is what our doctors told us:
1) His doctor told him that it was unlikely he had had it for so long with absolutely no symptoms. Yes, this is contrary to what the internet says.
2) My doctor told me (before the second test results came back) that if I had had PID, I would know; it is "very painful" and people end up in the hospital from it. Again, contrary to the "silent infertility causer" that the internet portrays it as.
I think that chlamydia testing is a common part of routine paps after a certain age, but of course she should ask her doctor if they have been testing. I was freaking out after the positive because I feared I had never asked for it and therefore never gotten it but no, I had been getting them yearly with my exam. Maybe not every doctor does this but she should ask.
Personally, from what you've said and my recent experience, I think there's at least a chance it was a false positive. So try not to freak out too much. And make sure that whatever doctor you're going to can do the urine test and doesn't require an incredibly painful urethra-scraping one.
posted by ch1x0r at 12:48 PM on May 23

Chlamydia causes PID in about 50% of cases.

No, it doesn't. kldickson's answer and a lot of the other answers here are complete bunk, please disregard and consult a medical professional for answer's to your questions.
posted by tristeza at 12:49 PM on May 23

i believe its possible to acquire chlamydia from reptiles specifically turtles and lizards, as well as from sheep and goats, especially young sheep/goats. (i confirmed my memory from various reputable websites) any chance either of you has been around newborn sheep/goats or handled reptiles overly?
posted by chasles at 1:46 PM on May 23

IAND, but I am an epidemiologist who knows a bit about common STI infections.

From the CDC link above (for assessing damage):
"How is PID diagnosed?
...The health care provider may also order tests to identify the infection-causing organism (e.g., chlamydial or gonorrheal infection) or to distinguish between PID and other problems with similar symptoms. A pelvic ultrasound is a helpful procedure for diagnosing PID. An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether an abscess is present. In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a surgical procedure in which a thin, rigid tube with a lighted end and camera (laparoscope) is inserted through a small incision in the abdomen. This procedure enables the doctor to view the internal pelvic organs and to take specimens for laboratory studies, if needed."

2. You were sexually active young people, it's highly likely that is the source of the infection. Statistically much more likely than any other of the mentioned possible theories. If you look at the data, there is a huge peak for infection of those aged 15-25.

3. Yes, you can have it for 6 years undetected, that's one of the reasons why PID and eventual infertility are risks of chlamydia infection.

4. Either scenario is possible. No screening test is 100% accurate. The thing to remember is that chlamydia infection can be completely asymptomatic, so if you both end up testing positive, you'll likely never know had it initially. If possible, I suggest focusing on what's ahead and try to not spend too much time understanding how this happened, because you may never know. Like I mentioned, you were both sexually active young adults and chlamydia is a common sti in young adults that often goes untreated due to it being undetected.
posted by mandymanwasregistered at 1:56 PM on May 23

i believe its possible to acquire chlamydia from reptiles specifically turtles and lizards, as well as from sheep and goats, especially young sheep/goats. (i confirmed my memory from various reputable websites) any chance either of you has been around newborn sheep/goats or handled reptiles overly?

You need to find more reputable sources or do some better reading. There are 3 major species of chlamydia pathogenic in humans -- pneumoniae, psittaci, and trachomatis. The last of these is the only one relevant to the OP's questions.

Chlamydia is not only sexually transmitted, it can be transmitted if she's been in an infected pool.

Quite simply, no (short of case reports of conjunctivitis). And also...

Chlamydia causes PID in about 50% of cases.

No.

I'd like to strongly urge anyone and everyone to avoid spreading healthcare-related "information" unless they actually know what they are talking about. This is serious stuff in case you didn't know.

OP, these questions really are better served by a detailed conversation with your doctor, but briefly I will try to answer some of your questions.

1. Yes, PID is largely a clinical diagnosis in combination with laboratory tests for a causative pathogen. PID can lead to increased risk of infertility as well as ectopic pregnancy. The risk of developing these complications is most affected by the number of PID episodes, the severity of the disease, the exuberance of the immune response to the bug, and delays in or failure to seek proper care. In the best conducted and most often quoted study the risk of infertility was 16%. However it should be noted that that estimate applies to women with significant symptoms of acute PID severe enough to warrant laparoscopic surgery, and in your case (if this even is PID at all) the risk might be much smaller.

There are tests to assess for fertility problems related to PID but they range from uncomfortable to semi-invasive to full-on surgery and are neither perfect (both false positives and negatives) nor risk-free. Typically these are considered after failed attempts at conception (in the context of demonstrated infertility). There are ways to overcome potential infertility related to PID with the help of a fertility expert. With the caveat of some highly controversial, mixed, and limited data on the role of progestin-based contraceptives in reducing risk of complications, at this point there is probably little to do other than take the appropriate antibiotics and ensure that you are not passing the disease back and forth. Again, talk to your doctor or a fertility expert to better address these concerns, and in particular the role if any of additional tests (transvaginal ultrasound and others) in your specific case.

2. What you have read is essentially accurate. The other versions (species) are not relevant to your diagnosis of "chlamydia," and do not cause genitourinary disease.

3. Yes, undetected, asymptomatic chlamydia is very possible (as is newly contracted disease) though this phenomenon is somewhat poorly understood. The infection can be asymptomatic in both men and women. In one study of patients with infertility and surgical findings consistent with PID as the cause, less than a 1/3 of subjects reported ever having a prior diagnosis of PID. Look up "subclinical PID" for more on that.

4. False negatives are always a possibility.
posted by drpynchon at 3:23 PM on May 23 [7 favorites has favorites]

She doesn't really remember what kind of test it was, unfortunately. Is it possible that she had Chlamydia then, but the test didn't detect it?

Since it doesn't really seem to be spelled out above: Yeah, if she had a test for some sort of STD, it's possible the test didn't detect it because she did not get tested for chlamydia. People talk about "testing" as if it's always the same tests, but there are separate tests. She could have had it all along, untested for and undetected.
posted by yohko at 6:02 PM on May 24