A man is treated for chlamydia, takes the antibiotics exactly as directed, and the symptoms clear. Six weeks later they are back. The conclusion he usually draws is that the treatment failed or that something new has happened, and the second conclusion in particular can cause a great deal of unnecessary trouble at home.
In most cases neither is what occurred. The antibiotics worked. What happened is that his partner was carrying the same infection, was never treated because she had no symptoms and no reason to suspect anything, and passed it back at the first opportunity. This is called reinfection, and it is the single most common reason a treated infection reappears.
How the Cycle Works
The mechanics are simple enough. Chlamydia and gonorrhoea frequently produce no symptoms in women — a majority of chlamydia infections in women are silent. A woman can therefore be infected, feel completely well, and have no indication that anything requires attention. If only the man is treated, the infection remains in the relationship and returns to him as soon as sexual contact resumes.
Timing plays a role too. Antibiotics do not clear an infection instantly. Resuming sex during or immediately after a course of treatment, before both people have finished and the recommended interval has passed, allows the infection to pass back and forth even when both are being treated. The standard advice is to avoid sexual contact until both partners have completed treatment and a specified period afterward has elapsed — a clinician will give the interval for the particular infection and regimen.
The consequences of leaving a partner untreated go well beyond the man’s own repeat infection. Untreated chlamydia and gonorrhoea in women are major causes of pelvic inflammatory disease, which can result in chronic pelvic pain, damage to the fallopian tubes, ectopic pregnancy and infertility. A woman may lose fertility from an infection she never knew she had. Telling a partner is not merely a courtesy in that light.
Telling a Partner
This is the part men find hardest, and it is worth separating the practical problem from the emotional one. The practical problem — making sure the other person gets tested and treated — has straightforward solutions. The emotional problem varies enormously depending on the relationship, and there is no version of the conversation that is comfortable.
A few things help. It is worth knowing before the conversation that the timing of infection is often impossible to determine. Chlamydia can be present for months or years without symptoms, so its appearance now does not establish when or from whom it was acquired, and a physician can confirm that plainly. Many arguments are built on an assumption about timing that the biology does not support.
For current partners, telling them directly is usually best. For previous partners, or where direct contact is not possible or safe, public health can carry out partner notification without identifying who provided the name. This service exists precisely because these conversations are difficult, and using it is unremarkable. In some circumstances a physician can also arrange treatment for a partner who is not able to attend, and it is worth asking whether that applies.
After Treatment
Certain infections warrant a repeat test after treatment to confirm clearance, and this is separate from a test of reinfection later on. Testing again a few months after treatment is often recommended, because reinfection within that period is common enough to be worth checking for even when everything appears fine.
It is also worth using the episode as a reason to test more broadly. An infection with one organism means exposure has occurred, and testing for syphilis and HIV alongside is standard practice for that reason.
Finally, a point that men rarely hear said out loud: a clinic treating this is interested in clearing the infection and preventing it coming back, not in the circumstances that produced it. The questions asked are about sites of exposure and timing because those determine testing and treatment. Nothing more is being inferred from the answers.
Dr. Raymond Nash provides STI testing and treatment at Grande Prairie Men’s Medical Clinic and can advise on partner notification and follow-up testing. To book, visit gpmm.clinic or call (587) 416-8296. This article provides general information and is not a substitute for individual medical care.