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Chlamydia and epididymitis

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Hi, I got chlamydia back in may 2013 and got treated five months later in October, I have had 2 retests one 3 weeks after starting the the antibiotics (Zithromax 4 pills at once) and then got tested on the 2nd of January. The tests were both negative (all clear) but on the 10th of January I started feeling hot and cold one night and had a bad nights sleep and my left testicle started feeling uncomfortable. I had a stomach upset for about 4 days and then since then my testicle has been uncomfortable, but not unbearable. I went to see a doctor today and he thought it was epididymitis. He thought that it may be linked with the chlamydia infection, so have me doxycycline to take 2 times a day for a week. Is there much chance of is being a chlamydial infection?? And should I be worried about the possible chance of infertility?? I did have sex with a girl I have started seeing with contraception but got tested for chlamydia 3 weeks later on January 2nd 2014 and am all clear


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Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello,

Thank you for choosing DoctorSpring

I understand your concern and I will my best to help you out here. I will require some additional information from you so that I can provide my best and learned opinion.

1. During this current episode of testicular pain , did you get tested for any STD ?
2. Do you have pain while urination ?
3. Is there any warmth over the testes ?
4. Is there any pain on palpation / or touching of the testes ?
5. And finally do you have this discomfort in both the testes or one ?

You can reply as a followup
Thank you


Patient replied :

I understand your concern and I will my best to help you out here. I will require some additional information from you so that I can provide my best and learned opinion.

1. During this current episode of testicular pain , did you get tested for any STD ? No, I had a test on the 2nd of January and then the pain started on about the 8th of January
2. Do you have pain while urination ? No, no pain atall during urination
3. Is there any warmth over the testes ? Yes a slight warmth over the left testicle, but the right one seems to be normal
4. Is there any pain on palpation / or touching of the testes ? Slight pain when touching the top and bottom end of left testicle, right one is fine
5. And finally do you have this discomfort in both the testes or one ? Just the left one. Please note, I didn't have any pain from the time I contracted chlamydia in may until treatment in October, There wasn't any difference I noticed at all across the whole of my body to suggest I had chlamydia, apart from a very small amount of pus one morning when I woke up in august, but iit was a very very small amount


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello,

Thank you for the additional information.

The pain the testes most likely to be from Epididymitis as your Doctor rightly suspected. The cause could be Chalmydia itself. But I would also consider Gonorrhoea in your case. (even though the initial testes were negative ) First of all let me assure you there is nothing much to worry about. The good thing about bacterial infection is the they can be well treated with antibiotics.

This will not result in infertility. Doxucycline is a good medication to start with. But it is better to reasses after a week . If the symptoms persists it is better to consider addition of another antibiotics like Ceftriaxone. Epididymitis usually have more sever symptoms. So it seems your's is a minor infection. After one week if the pain persists repeat resting, urine culture, syphillis testing also to be considered . Meanwhile take care not to touch or manipulate the testes.

Hope this helps
Feel free to ask followups
Thank you


Patient replied :

Ok thanks, for your answer.
I do want to ask how likely it would actually be of it being chlamydia if it has defiantly not come from my new partner as I did take the course of antibiotics and then had two clear tests, surely chlamydia would show signs of being in my system after earlier than 3 months after the treatment? And those tests would have picked something up.
Also what is the likely hood of gonorrhoea not being picked up in the first test? As once again I'm 99.9% sure my new partner will not have this.
Is there any chance of this being an anomaly , I have got verukas on my feet, could that be linked at all?
I though gonorrhoea was mainly spread through anal sex, I have never had anal sex in my life. And the girl who have my chlamydia informed me she had it and didn't say anything about gonorrhoea so the chance of having it is minimal I would think.
Finally should I mention anything to my new partner, I mean I made sure I was completely STI free before doing anything with her and then this random pain comes along..we have worn condoms every time we have had sex, that has only been three times and none have split, I really would prefer not to tell her if you don't think there is a risk!!


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Hello,

First of all the diagnosis of Epididymitis is only one possibility. You do not have the typical symptoms, still it is possible. The cause if Chalmydia could be the old infection (from the first encounter ) or a new. It is really impossible to say. This is because the infection could have been there not fully treated by the antibiotics (resistant infection ). Gonococci can also cause Epidiymitis and yes can spread via means other than anal sex.

At this pint it will really difficult to indentify your source. Whatever conclusion we come up to, there is a 40-50% chance of error. So there is no point in deducting the sources. Another fact is that all tests are not 100% accurate especially when it comes to epididymtis. Ordinary STD tests can miss those.

For now I would recommend this :

1. The diagnosis now would be Testicular pain for evaluation ( ? Epididymitis)
2. Take the medications, consider repeat testing if the symptoms persist.

You can choose not to tell / to tell . You can wait till the diagnosis is confirmed. Moreover Epidiymitis can occur via non sexual means also. Meanwhile do use condoms.

Thank you


Patient replied :

One last question, if the antibiotics do not cure the discomfort then does this mean it won't have been an STI that caused it? And if it does stop the pain then will this show that it has been chlamydia or another STI? Is there any chance of it being a varicose problem?


Expert:  Dr. Deepu Sebin Sebastian replied 1 Day.

If the antibiotics does not cure it can mean either it is a

(1) non infectious (not STD ) problem or
(2) an infection that has not responded to an antibiotics.


If it does stop the pain, it is likely to be Chalmydia. Varicose vein and other non infectious causes can cause similar symptom, but it need to be considered only if there is no response to the antibiotics

Thank you


Dr. Deepu Sebin Sebastian
Category: Select Speciality
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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