A male age 18 years came in for a screening and was positive for chlamydia. He and his 17-year-old girlfriend were treated elsewhere and had unprotected intercourse four days later. The couple returned to my clinic for retreatment two weeks later. I treated both with azithromycin (Zithromax) 1 g and instructed them to abstain from intercourse for two weeks. After having oral sex the next day, they called requesting retreatment. I told them that this would not be necessary (since they had just been treated) and cautioned them against any sexual activity until the medicine had been in their systems for one week. Finally, I encouraged retesting in eight weeks. Can chlamydia be transmitted orally?—JACKIE AGENBROAD, WHCNP-BC, Litchfield Park, Ariz.

Chlamydia can be transmitted through oral sex (penis to mouth), but this scenario is not likely because the bacteria prefer the genital area rather than the throat. According to the American Social Health Association, chlamydia is not known to be transmitted from vagina to mouth or anus to mouth. The treatment and recommendations given to this couple are in accordance with the CDC guidelines (MMWR Recomm Rep. 2006;55[RR-11]:1-94).—Julee B. Waldrop, MS, PNP (138-7)

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