Chlamydia Infection: Prolonged Symptoms and Treatment Challenges

Chlamydia infection, not healed after more than a month of medication?

Hello Doctor, I have been experiencing abnormal discharge for nearly three months, which has caused me some panic.
I hope you can help clarify the following questions with your expertise!
I started noticing abnormal discharge in early September and, after using suppositories and taking medication intermittently, I was diagnosed with a Chlamydia infection in mid-October (during this time, I discovered I have an allergy to Doxycycline).
After taking antibiotics for two weeks and using suppositories, my condition improved, but later the discharge turned into a thick yellow-green color.
The clinic doctor mentioned that the bacteria might have developed resistance.

I then transferred to a hospital for further evaluation, where the doctor diagnosed me with pelvic inflammatory disease and prescribed Clindamycin, which I have been taking for three weeks.
The last week coincided with my menstrual period (and I continued taking the medication), but after my period ended, I noticed that the discharge has still been somewhat yellowish-white and mucus-like over the past two days.

During my follow-up appointment yesterday, the attending physician performed an internal examination and concluded that the pelvic inflammatory disease should be resolved, but there might be an infection or inflammation in the vagina, so they switched my medication to Cephalexin for one week.
I have also undergone other sexually transmitted infection tests, which showed no gonorrhea, syphilis, or HIV, and my Pap smear results were normal.
I am also following the doctor's advice to take probiotics (u-relax).
I would like to ask if the hospital physician's assessment of my current condition as a vaginal infection takes into account that the Chlamydia infection may not be fully resolved? Is Cephalexin appropriate for my current situation? Do you have any other recommendations? Is it normal for this to have dragged on for such a long time? Thank you very much for your response, Doctor!

nvhai, 20~29 year old female. Ask Date: 2019/11/28

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the following situations regarding vaginal discharge suggest that you should consult a physician: 1.
An abnormal increase in quantity that causes discomfort, even requiring the use of panty liners.
2.
Abnormal color and characteristics of the discharge.
3.
An unpleasant odor.
4.
Accompanied by other discomforting symptoms, such as itching or burning in the vulva or vagina, lower abdominal pain, which may indicate vaginitis or pelvic inflammatory disease.
The physician will arrange relevant examinations and treatments based on the symptoms.
The testing methods for Chlamydia include: 1.
Culture: Collecting the discharge and culturing it on the yolk sac of live embryonated chicken eggs or inoculating it into live cells for observation after staining; this method is more complex.
2.
Antigen testing: Directly swabbing the infected epithelial cells from the inner wall of the infected area and testing for the presence of the bacteria using reagents; this method has high sensitivity and specificity, but sampling can be inconvenient.
3.
Serological antibody testing: Testing for the presence of antibodies IgM, IgG, and IgA through blood samples to determine if there is an infection; this method is convenient as it only requires venous blood, and it also has high specificity.
However, individuals who have been previously infected and treated may still have IgG antibodies, but the antibody titer will not exceed 1:64, and those who are completely cured will not have IgM or IgA present.
There are various treatment options for Chlamydia, with commonly used medications including tetracycline, erythromycin, sulfonamides (effective only for trachoma), and rifampin.
Currently, there is no vaccine available to prevent Chlamydia infections.
After a Chlamydia infection, most individuals may be asymptomatic, leading to a lack of motivation for treatment or prevention, which contributes to its strong transmissibility.
Therefore, non-gonococcal urethritis caused by Chlamydia has become very common and should not be overlooked, as the incidence of infertility due to Chlamydia infection seems to be increasing.
It is recommended that once a patient is confirmed to have Chlamydia, their sexual partners should also be tested and treated simultaneously.
During sexual activity, it is advisable to use condoms consistently to prevent mutual reinfection and the potential development of drug resistance.
Since Chlamydia grows intracellularly and tends to grow deeper, treatment can be more prolonged and challenging than for typical bacteria, so patience is required during treatment, along with regular testing to avoid undetected drug resistance.
Based on the patient's test results, it is best to retest 10 to 14 days after starting medication to check for treatment effectiveness.
Subsequently, regular retesting every 10 to 14 days should be conducted to monitor for drug resistance until treatment is fully completed.
After treatment, it is advisable to test again 3 to 4 weeks later to check for recurrence, which is a safer and more prudent approach.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2019/11/28

More Info

Chlamydia infection, caused by the bacterium Chlamydia trachomatis, is a common sexually transmitted infection (STI) that can lead to various complications if left untreated. Your symptoms of abnormal discharge persisting for nearly three months, along with the diagnosis of pelvic inflammatory disease (PID), indicate a complex situation that requires careful management.

Firstly, it's important to understand that Chlamydia can sometimes be asymptomatic, meaning that individuals may not exhibit noticeable symptoms despite being infected. However, when symptoms do occur, they can include abnormal vaginal discharge, pelvic pain, and discomfort during intercourse. The yellow-green, thick discharge you described could be indicative of an ongoing infection or a secondary infection, especially if it has persisted despite treatment.

You mentioned that you experienced an allergic reaction to doxycycline, which is a common first-line treatment for Chlamydia. This allergy complicates treatment options, as it limits the antibiotics that can be safely used. The fact that you were switched to clindamycin (Lidacin) and are now on cephalexin suggests that your healthcare provider is trying to address both the Chlamydia infection and any potential secondary infections that may have developed.

The persistence of your symptoms raises concerns about antibiotic resistance, which can occur when bacteria adapt and become less susceptible to the effects of medications. This is particularly relevant in the context of prolonged infections and incomplete treatment courses. It is also possible that the initial treatment did not fully eradicate the Chlamydia infection, leading to ongoing symptoms.

Regarding your current treatment with cephalexin, it is primarily effective against certain types of bacterial infections, including some skin and respiratory infections, but it is not typically the first choice for treating Chlamydia. The standard treatment for Chlamydia usually involves azithromycin or doxycycline, unless contraindicated. Since you have a history of allergy to doxycycline, azithromycin might be a suitable alternative if you have not already been treated with it.

Your healthcare provider's assessment that the pelvic inflammatory disease may have resolved is a positive sign, but the ongoing symptoms suggest that further evaluation is necessary. It is crucial to ensure that the Chlamydia infection is fully treated, as untreated infections can lead to serious complications, including chronic pelvic pain, infertility, and ectopic pregnancy.

In light of your situation, I recommend the following steps:
1. Follow-Up Testing: Request follow-up testing to confirm whether the Chlamydia infection has been successfully treated. This may include a repeat test for Chlamydia and other STIs.

2. Consultation with a Specialist: If symptoms persist, consider consulting a gynecologist or an infectious disease specialist who can provide more targeted treatment options and further investigate any underlying issues.

3. Review of Antibiotic Options: Discuss with your healthcare provider the possibility of using azithromycin or another appropriate antibiotic that is effective against Chlamydia.

4. Monitor Symptoms: Keep track of any changes in your symptoms, including the nature of the discharge, any new symptoms, and overall health.

5. Consider Probiotics: Continuing with probiotics, as suggested, may help restore the natural flora of the vagina, especially after antibiotic treatment.

6. Safe Practices: Ensure that you and your partner(s) practice safe sex to prevent reinfection and transmission of STIs.

In conclusion, while it is not uncommon for Chlamydia infections to lead to prolonged symptoms, it is essential to address the situation promptly to avoid complications. Open communication with your healthcare provider and adherence to treatment recommendations will be key in resolving your symptoms and ensuring your reproductive health.

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