Chlamydia is a widespread sexually transmitted infection (STI) caused by the bacterium Chlamydia trachomatis. It is one of the most frequently reported bacterial infectious diseases in the United States, with prevalence highest among individuals aged 24 years and younger. Many people with chlamydia do not experience symptoms, allowing the infection to spread unknowingly. While treatable with antibiotics, a common concern arises about whether chlamydia can “come back” after successful treatment.
Understanding “Recurrence”
When an individual experiences chlamydia symptoms again after treatment, it is almost always due to a new infection, rather than the original infection returning. True treatment failure, where the antibiotics do not eliminate the initial infection despite correct adherence, is uncommon. Treatment for urogenital chlamydia typically has a success rate of 95% or more with appropriate antibiotics.
The main reason for a “recurrence” of chlamydia is re-infection, meaning a person contracts the infection again. This occurs after successful treatment of the initial infection, but subsequent exposure to the bacterium. Studies show that repeat infections are common, affecting as many as one in five individuals treated for chlamydia within a few months. Re-infection rates can be as high as 10-20% within 12 months after treatment, and up to 24.4% of women experience a repeat infection within three years or less.
Reasons for Re-infection
Re-infection typically happens due to specific scenarios involving sexual contact after successful treatment. The most common cause is sexual activity with a partner who has an untreated chlamydia infection. This can be a previous partner who was not treated, or a new partner who unknowingly carries the bacterium.
Another contributing factor is a sexual partner not completing their prescribed course of treatment, leading to persistent infection in that individual. Resuming sexual activity too soon after treatment, before both the infected individual and their partners have completed their full course of antibiotics and are cleared of the infection, also poses a risk. This creates a cycle where the infection can be passed back and forth.
Identifying Re-infection
If symptoms reappear after chlamydia treatment, or if there is a concern about re-exposure, it is important to seek medical attention. Re-infection symptoms are often similar to the initial infection, though many chlamydia infections remain asymptomatic. Therefore, re-testing is recommended even without symptoms.
The Centers for Disease Control and Prevention (CDC) advises retesting for chlamydia approximately three months after treatment, regardless of whether sexual partners were treated. This helps detect repeat infections early, which is particularly important for women due to the increased risk of complications like pelvic inflammatory disease if re-infections go untreated. If retesting at three months is not possible, individuals should be retested whenever they next seek medical care within 12 months of initial treatment.
Steps to Prevent Future Infections
Preventing future chlamydia infections involves a combination of safe sexual practices and diligent follow-up. Consistent and correct use of barrier methods, such as condoms, during all sexual activity can significantly reduce the risk of transmission. It is also important to ensure that all sexual partners are tested and treated for chlamydia. Partners from the last 60 days should be evaluated, tested, and presumptively treated.
Individuals should abstain from sexual intercourse for seven days after single-dose therapy or until completion of a seven-day regimen and resolution of any symptoms. Additionally, it is advised to wait until all sexual partners have also completed their treatment and are no longer infectious. Regular screening for chlamydia is also important, especially for sexually active women under 25 years old and older women with risk factors, even in the absence of symptoms.