Dr.Gian on Chlamydia - Page 4

Dr.Gian on Chlamydia - Page 4

**Ask Dr. Gian ....but read this first**
HERPES	SYPHILIS	HPV	FUNGUS
HIV	HEPATITIS	MOLLUSCUM	VAGINITIS
GONORRHEA	CHLAMYDIA	FOLLICULITIS	MISCELLANEA

CHLAMYDIA

From:
Sent:
To: drgian
Subject: Urgent Inquiry

Dr. Gian,

I work in the Quality Assurance Department of a residential care facility for the mentally retarded. One of our female residents has just tested positive for Chlamydia during her routine annual gynecological exam. She is 51 years old, profoundly retarded, and non-verbal. She requires assistance in all areas of personal hygiene. She has lived in our residence for 8 years, and came to us from another facility. She has tested negative at her previous annuals since being in our care. She lives in an all female wing of our residence, where all of the direct care staff are female. While there are male employees in other areas of the building (administrative, professional, and maintenance staff), she is under constant supervision by the female direct care staff during her waking hours, and she is checked on every 20-30 minutes throughout the night. The above mentioned male staff would have no reason to be in that wing during the overnight shift, and it would be extremely difficult for them to do so without being noticed. We are having her re-tested at another laboratory, to make certain that there has been no mistake. But assuming the results are accurate, here is my question for you: If a female staff person has chlamydia, and suppose she didn't wash her own hands after going to the bathroom, and then assisted this woman with her personal hygiene after toileting without wearing gloves, is it at all POSSIBLE that she could have contracted Chlamydia that way? Can the organisms survive on a person's hands for any length of time? Have there been any such known cases in residential care or otherwise? I would appreciate having your professional opinion on this matter as soon as possible. In our circumstances, it is hard for us to imagine how any of our male staff would have had the opportunity or the privacy that would be required to abuse her.

Thank you.

Hi,

Non sexual Chlamydia infection is possible but rare. Chlamydia usually resides in the genitals and a genital oral, anal or vaginal contact is required. However Chlamydia can be auto inoculated in other mucosal cell like the situation of Chlamydia conjunctivitis, an infection which occur by touching one's eye after touching infected genitals. Transmission by sharing bedding, towels and clothes has been studied and it is considered almost non existent since the virus does not survive long without mucosal cells. Consider, among other possibilities, also a false positive and/or a false negative test.

I hope this helps.

Dr. Gian

From:
Sent:
To: drgian
Subject: nucleic acid amplification Should I get retested?

Thank you Dr. Gian, I hope you can help me. Very worried. Made a big mistake but learned a valuable lesson about what is important to me. Don't want to hurt my wife. Should I get retested for Chlamydia and Gonorrhea?

Background History:

51 year old male with history of a few gout symptoms (big toe pain). Never tested for Uric acid levels. What I figured to be typical urinary problems of a guy in his 50's, low volume stream, sometimes slow to start, slight dribble. Monogamous relationship for 27 years. One time mistake, drunk and had exposure to unprotected sex w/coworker 7 mo. ago.

2 mo. ago, (5 mo. after unprotected encounter) sudden tingle, irritation in penis, frequent urge to urinate, little volume, slight burning in head of penis. Volume seemed to increased during this time, could be due to increase in water intake. Self treated with cranberry pills and D-mannose but UTI has not cleared. Within the week full STD panel through Labsafe .com, LabCorp collection point, negative results for all tests. Chlamydia and Gonorrhea urine test (nucleic acid amplification), however because of my urgency to urinate after holding urine for 4 hrs. the sample used was actually a midstream catch. First oz or two went in the toilet. I ended up providing 3 or 4 oz sample. I have since read that with this type of testing, first catch is required. What are the chances I would have a false negative. After all, I have had minimal exposure. One time.

Question:

1. Is it likely that a false negative would happen given the midstream catch I supplied?

2. I have not gone to the Dr. (family friend) for fear I have STD. Self treated with 500MG of Cephalexin 12hr. for 5days now. Penis irritation and urgency has gone away but back pain is still there. I know that Cephalexin can be effective against Gonorrhea but not Chlamydia. I want to discontinue self medication and see my doctor but want to be reasonably sure that I don't have an STD. My wife does not have any symptoms, the co-worker I was exposed to does not have any symptoms. What is the possibilities that both would be symptom free, and my symptoms without discharge, would show up 5 mo. after one time exposure? Does my symptoms sound more like a UTI either from obstruction Kidney stones, etc.?

Thank you for any help you can provide.

Hi,

the first urine catch is the proper way to collect urine for a Chlamydia and Gonorrhea amplification test. This is done after withholding urination for at least three hours to obtain the maximum concentration of DNA particles of the infective agent. So a mid stream catch may reduce the test sensitivity.

Your history suggests however a garden variety urinary tract infection ( E. coli, etc.) and this is best treated with Bactrim (Trimethoprim-sulfamethoxazole) a Sulfa medication. Bacterial cells produce folic acid, a chemical necessary for their growth. Sulfamethoxazole kills the bacterium by interfering with the enzyme that helps form folic acid. The combination of a sulfamethoxazole with trimethoprim is effective because high levels of the drugs are achieved in the urinary tract and urine, which kills bacteria directly at the site of the infection.

If it gives you peace of mind you may want to retest for Chlamydia

Be well.

Dr. Gian

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