Chlamydia is a common sexually transmitted infection caused by the bacteria Chlamydia trachomatis. It can infect both men and women and often causes no symptoms. However, for some people chlamydia does not go away easily with treatment and seems to persist or keep coming back. There are several potential reasons why chlamydia may not go away:
You Were Re-Infected by an Untreated Partner
One of the most common reasons chlamydia persists is re-infection from an untreated partner. Chlamydia is passed between sexual partners through unprotected vaginal, anal, or oral sex. If your partner has chlamydia but was not also tested and treated, you can become re-infected even after taking antibiotics to treat your initial infection.
It is important that your partner(s) from the last 2-3 months also get tested and treated before resuming sexual activity. You should both avoid sex for 7 days after completing treatment and until any symptoms go away. Use condoms correctly every time you have sex in the future to help prevent re-infection.
The Infection Was Not Fully Treated
Chlamydia requires a full course of antibiotic treatment to be eliminated from the body. The recommended treatment is typically 1 gram of azithromycin taken as a single dose or 100 mg doxycycline twice per day for 7 days. Not finishing the full course of antibiotics can allow the infection to persist.
Make sure to take your medication exactly as prescribed and finish the entire course, even if symptoms improve sooner. Let your doctor know if you missed doses or did not complete treatment so they can prescribe a repeat course if needed. Taking antibiotics properly is key to curing chlamydia.
Your Partner(s) Were Not Treated
As mentioned above, chlamydia is passed between sexual partners. If your partner(s) were not properly tested and treated, you may have been re-exposed to chlamydia even after your own treatment.
It is crucial that any sexual partners from the prior 2-3 months get tested and treated before having sex again. Chlamydia can be asymptomatic, so your partner(s) may have unknowingly transmitted it back to you after your initial treatment.
Retesting and retreating you and your partner(s) at the same time is important when chlamydia infections persist. Your doctor can provide expedited partner therapy or assist with notifying partners if needed.
The Initial Antibiotic Did Not Work
While uncommon, it is possible for chlamydia bacteria to be resistant to certain antibiotics, including azithromycin and doxycycline. This could allow the infection to persist even after taking the medication as directed.
Let your doctor know if your symptoms continue or keep returning after antibiotic treatment. They may prescribe a different antibiotic or longer course to fully treat the resistant infection. Getting retested 2-3 weeks after finishing treatment can confirm whether it was effective.
You Have Another Infection Causing Similar Symptoms
Sometimes other sexually transmitted infections can cause symptoms or complications similar to chlamydia, including pain or discharge. Common examples are gonorrhea, trichomoniasis, bacterial vaginosis or pelvic inflammatory disease.
Testing for other STIs may be recommended if chlamydia symptoms persist after treatment. Your doctor can perform additional tests to determine if another infection is responsible for ongoing symptoms. Treating the underlying infection will be key to resolving your symptoms.
The Infection Spread to Other Sites in the Body
Although uncommon, untreated chlamydia can sometimes spread from the urethra, cervix or rectum to other areas of the reproductive system. In women this includes the fallopian tubes, uterus or ovaries, while in men it may spread to the epididymis.
These areas are more difficult for antibiotics taken orally to reach. An extended or injectable course of antibiotics may be needed to treat the infection if it has spread beyond the initial site of infection. Let your doctor know if pelvic pain persists after standard chlamydia treatment.
When to See Your Doctor
You should follow up with your doctor if:
- Chlamydia symptoms continue or return after treatment
- You had unprotected sex with a partner before you both finished treatment
- Your partners were not treated for chlamydia
- You did not take your antibiotics as prescribed
- You develop new pelvic pain, discharge or other concerning symptoms
Your doctor can perform a test of cure to see if chlamydia is still present. They may prescribe additional antibiotics or further evaluate other potential causes of persistent symptoms. Be sure to abstain from sex or use condoms in the meantime.
How Chlamydia is Diagnosed
If chlamydia persists after treatment, your doctor will start by performing a physical exam of the genitals and a rectal/cervical swab test. This nucleic acid amplification test (NAAT) is very accurate for diagnosing chlamydia and other STIs.
For women, a pelvic exam may also be done to check for signs of pelvic inflammatory disease which can be a complication of untreated chlamydia. Your doctor may test urine or do a swab of the throat/rectum depending on your sexual history and symptoms.
NAAT Urine or Swab Testing
This is the preferred test to diagnose chlamydia and check if infection persists after treatment. It detects chlamydia DNA to confirm whether the bacteria is still present. The test can be performed on a urine sample or by swabbing affected sites like the cervix, urethra, rectum or throat.
NAAT tests are highly accurate when properly collected. Urine tests may be less reliable for detecting rectal infections in both sexes or cervical infections in women. Swab samples directly from infected sites are considered the gold standard.
Culture Testing
Chlamydia culture was previously used to diagnose chlamydia. While very specific, it is less sensitive than NAAT testing and results take longer. Culture is no longer routinely recommended except when evaluating possible antibiotic resistance.
Your doctor may order a culture if NAAT results remain positive after repeat antibiotic treatment. Growing the bacteria in the lab allows sensitivity testing to identify effective antibiotics if resistance is suspected.
Treatments for Persistent Chlamydia
If you continue to test positive for chlamydia after initial standard antibiotic treatment, there are several options your doctor may consider:
Retreatment with Azithromycin or Doxycycline
The first step is often to retreat with the first-line antibiotics azithromycin or doxycycline. Taking the full 7-day course of doxycycline or ensuring the single 1 gram azithromycin dose was absorbed may be sufficient to cure the infection if initially treated inadequately.
Alternative Antibiotics
For persistent or recurrent chlamydia, your doctor may prescribe different antibiotics that are also effective, such as:
- Levofloxacin 500 mg daily for 7 days
- Ofloxacin 300 mg twice daily for 7 days
- Erythromycin base 500 mg four times daily for 7 days
This provides an alternative antibiotic class with activity against chlamydia in case of organisms resistant to first-line drugs.
Extended Azithromycin Regimen
Another option is to extend the azithromycin treatment duration and give 1 gram weekly for 3 weeks. This pulsed dosing approach achieves higher cumulative antibiotic levels which may improve effectiveness against persistent or resistant infections.
Combination Antibiotic Therapy
Using two antibiotics together is sometimes prescribed if standard single drug regimens fail. This combines different mechanisms of action to improve eradication of infection. Examples are:
- Azithromycin 1 gram plus doxycycline 100 mg twice daily for 10-14 days
- Azithromycin 1 gram once weekly for 3 weeks plus doxycycline 100 mg twice daily for 7 days
- Levofloxacin 500 mg daily plus metronidazole 500 mg twice daily for 10-14 days
Injectable Antibiotic Therapy
For severe or upper genital tract infections, an injectable antibiotic may be used either alone or combined with an oral antibiotic. Ceftriaxone, cefoxitin, and gentamicin are examples of injectable drugs sometimes used to treat persistent chlamydia.
Preventing Reinfection
The key steps to prevent getting re-infected with chlamydia include:
Abstain from Sex During Treatment
Avoid all sexual activity during the 7 days you are taking antibiotics or until a week after your partner(s) have been treated. This includes oral, anal and vaginal sex. Use condoms if abstinence is not possible.
Ensure Partner Treatment
Make absolutely sure any sexual partners from the prior 2-3 months get tested and treated for chlamydia before having sex again. Continue condom use for at least 7 days after retreatment if chlamydia persisted. Consider repeat testing after 3 months.
Use Condoms
Correctly use condoms every time you have sex in the future, especially with new partners whose STI status you do not know. This will help prevent acquiring or transmitting STIs.
Annual Screening
Get screened for chlamydia and other STIs at least once a year if you are sexually active and under age 25. Let partners know about positive results immediately so they can also get treated.
Complications of Untreated Chlamydia
Allowing chlamydia to persist untreated can lead to serious reproductive health consequences:
Pelvic Inflammatory Disease
Chlamydia can spread to the uterus and fallopian tubes causing pelvic inflammatory disease (PID). This may result in scarring, chronic pelvic pain, or ectopic pregnancy risk. PID is treated with antibiotics.
Infertility
Fallopian tube damage from PID can cause infertility or ectopic pregnancy. Untreated chlamydia is a common preventable cause of infertility.
Prostatitis
Chlamydia can infect the prostate gland in men, causing prostatitis. Symptoms may include pelvic pain and difficulty urinating. Antibiotics and pain relief are used in treatment.
Epididymitis
Infection of the epididymis, the coiled tube storing sperm, may occur. This can cause testicular pain, swelling, and fever. Antibiotics are needed to cure it.
Reactive Arthritis
A type of autoimmune arthritis that can develop weeks after chlamydia infection. It causes joint pain, eye inflammation, and urinary symptoms. Anti-inflammatories and antibiotics are used in treatment.
Conclusion
In summary, chlamydia may persist or keep recurring due to re-exposure from untreated partners, inadequate initial treatment, antibiotic resistance, or concurrent infections. See your doctor for retesting and possible retreatments, partner notification assistance, and evaluation of complications if chlamydia does not clear with standard therapy. Practicing safer sex by using condoms, annual screening, and prompt treatment are key to curing chlamydia and preventing serious reproductive health consequences.