Expert: Mark Behar - 2/22/2007

Question
I have recently been diagnosed with Chlamydia. This was a strong episode whereby I also had concurrent urethritis. However, this was not the first time I faced Chlamydia having had a first infection some 4 years ago. I took then a Vibramycin treatment for 2 weeks (just as I did now) and final tests (scrub plus urine) came out OK. I always assumed I was cured.

So, as concerns the most recent incident, none of my sexual partners had ever had Chlamydia. Moreover, their partners seem also to be clean of this trouble. In the meantime, after reading the information available in the internet and some discussions with my GP, I realise that I may have had a mild case of prostatitis since my first bout of Chlamydia. I recognize now that for the last few years I have indeed felt, sometimes, a slight pain after ejaculation (which would increase whenever several ejaculations took place within a short period of time, say 3 in one day). Apart from this a little sting, in the region located between the anus and the testicles, was also felt every so often. I never made much case of these symptoms until now. In brief, this makes me wonder whether I have had a mild case of prostatitis over the years and just did not realise it.

In view of what was said above, I wanted to launch the following hypothetical question:

Chlamydia can, as far as I understand, only be transmitted sexually. On the other hand, Prostatitis is far from being well understood as to causes and ways to treating it. As such, could there be a chance that after my first Chlamydia episode, the bacteria found somehow refuge in the prostate (which is notoriously resilient to antibacterial treatment) and thereby becoming latent but still potentially infectious?  

Answer
Hi Pablo,
Thanks for your thoughtful question! I'm not sure about a few things. When you have chlamydia trachomatis (C. trachomatis), it infects whatever body part it is attaches to: the epithelium of the anorectum, the urethra, the throat, the cervix, the conjunctiva of the eye. It probably can infect the prostate as well, but what the significance of this is, is unclear.

If you took vibramycin (also known as doxycycline) 100mg twice daily for 7-14 days, this was effective in eliminating the acute infection. You were cured.

You stated that you had tests-- "scrub plus urine"-- I have no idea what that is. The traditional urine test is a Gen-Probe test that uses a DNA amplification technique to identify chlamydia. It is very good. Don't know that the "scrub" part is!  Please advise.

You stated that none of your past partners had chlamydia; or is it that none of them admitted it to you? Or, that they never had appropriate diagnostic testing? I cannot answer this.

Some of the symptoms you describe are in fact suggestive of prostatitis. You might have a heavy and nonspecific discomfort in your scrotum or testicles, or in the perineum (the area between anus and scrotum).  You may have nonspecific urinary & ejaculatory complaints as well-- increased urinary frequency, hesitancy, change in forcefulness of outflow, nonspecific ejaculatory discomfort (such as a sting). You may have had a vague chronic prostatitis for awhile, however I do not know how long such a chronic prostate infection can persist.

You are correct that prostate infections can be tough to cure, and that they can be resistant to antibiotics. Effective treatments include antibiotics that are suitable for the particular infection-- chlamydia is best treated with a tetracycline or erythromycin derivative. In addition, one way to enhance antibiotic penetration of prostate infections is daily-- yes DAILY-- ejaculations! Not necessarily sex with someone, however.  Ejaculations partially empty prostatic fluids stored in the prostate, and the cells of the gland must call upon increased blood supply to nourish the cells so that they may produce more prostatic fluid. If this blood has antibiotic in it, then this antibiotic is correctly delivered to the cells of the prostate that are infected with E. coli (the most common germ causing prostate infections), and sometimes, less frequently, germs like chlamydia.

The question about chronic prostate infections caused by chlamydia, and whether this can be transmitted... I cannot answer. It is not latent, but it may not be infectious during this chronic state; i.e., it may not be shed during ejaculations.

Hope this helps answer your question.

--mark