Can a Treated STD Come Back?

Young woman sitting in bed, man sitting on edge of bed in background
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There are effective treatments available for a number of STDs. Chlamydia, gonorrhea, syphilis, and trichomoniasis can all be treated and cured reasonably easily with antibiotics. However, having your STD treated is not a guarantee that it will never come back. There are several reasons why simply finding treatment for an STD isn't enough. You also have to be careful about your future behavior.

Some reasons that a treated STD can come back include: 

  1. Taking Your Medication Incorrectly/Taking The Incorrect Medication
    If your doctor prescribes you antibiotics, it's incredibly important to take the whole prescription. That's true even if you feel better before you're done. Failing to finish your antibiotics might not only keep your STD from being cured. It might also make it far more difficult to treat your STD when your doctor tries to do so next time -- because of antibiotic resistance. This is a serious concern, particularly with certain infections.


    Another reason that treatment can fail is that you're taking the wrong medication. That might happen either because your doctor prescribed the wrong drugs or because you found a way to acquire drugs on your own and chose the wrong ones. Not all STDs are caused by the same pathogens. Different illnesses require different treatments. That's why it's so important for your doctor to correctly identify what's causing your infection before she prescribes antibiotics. That's also why you can't just take any random antibiotic and hope that it's going to work.

  1. Forgetting to Make Sure Your Partner Gets Treated
    If you have a regular sexual partner, it's important to tell them about your infection. That way they can get get treatment too. Once you've both gotten treated, you have to wait until the treatment has had time to work before you once again start having sex. At minimum, you have to wait before you go back to having unprotected sex. If both of you don't get treated, or you don't wait for the treatment to work, it can cause real problems. In particular, you might end up passing the STD back and forth between you indefinitely.
  1. Being Exposed to a New STD
    This is a big one. Being successfully treated for chlamydia, gonorrhea, or another STD does not mean that you can't get it again. In fact, many people become infected with STDs over and over again. Why? Because they continue to have unprotected sex with partners who have untreated STDs. That's why, if you've been treated for an STD and don't want to get another one, the best thing that you can do is change your behaviors to decrease your risk. That means both consistently practicing safe sex  always talking to new partners about risk before having sex.

Chlamydia Treatment Issues

It is well known that in a significant fraction of people who have been diagnosed with and treated for chlamydia, chlamydia will come back after treatment. For a long time it was thought that they were simply becoming exposed again or that treatment was failing. However, recently research has suggested there may be an additional explanation. Animal models suggests that chlamydia may be able to hide out in the gut and re-emerge. This probably doesn't happen all that frequently. Still, it is another reason why chlamydia can come back after treatment. 

Problems with Gonorrhea Treatment

In theory, gonorrhea is easily treatable with antibiotics.

However, antibiotic-resistant gonorrhea has grown so common that it is starting to become a public health crisis. Over time, it has become more difficult to find affordable antibiotics that can consistently, effectively treat gonorrhea. That means people seeking treatment may need to be treated with more expensive antibiotics. They also may need to have their infection tested for susceptibility to treatment or come back after treatment to see if it worked. Either way can lead to substantial costs -- in terms of both time and effort. 

Syphilis Treatment Failures

As with the other bacterial STDs, syphilis can be treated effectively.

However, a variety of factors have been shown to effect how well treatment works. These include the stage of syphilis that people are in, how often they use condoms, and whether or not they have HIV. In general, it is easiest to treat syphilis when it is caught early, and when people have a health immune system. Fortunately, even in other groups, treatment failure is relatively rare. 

Problems with Treating Trichomoniasis

Around the world, trichomoniasis is the most common curable STD. However, with the standard single dose treatment, repeat infections occur somewhat frequently. Fortunately, research has shown that recurrence occurs around half as frequently multi dose treatments for trichomoniasis. Multi dose trichomoniasis treatment is now the standard regimen for women with HIV. However, it is available for HIV negative women as well. 

The other issue with treating trichomoniasis, is that men are generally not tested for the disease. Therefore, it can be difficult to both get them treatment and see if treatment has been effective. While infections are generally less serious in men, they do need to be treated to keep them from re-infecting their female partners. 

A Word from Verywell: Learn From Your Diagnosis

If you've been diagnosed with an STD, and you're wondering if it can come back after treatment, it's presumably because the experience was unpleasant and you don't want to go through it again. Fortunately, most of the STDs that are curable with antibiotics are also preventable by practicing safe sex. Using condoms, dental dams, and other barriers to make your sex life safer is a very effective way to prevent bacterial STDs. However, it's important to use them consistently, and not just for vaginal and anal intercourse. You also have to use them for oral sex.

That said, if you've made a mistake once, don't throw the baby out with the bathwater. You can do better the next time. STDs aren't necessarily transmitted every time you have sex, so it's never too late to start doing things more safely.

Sources:

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Seña AC, Zhang XH, Li T, Zheng HP, Yang B, Yang LG, Salazar JC, Cohen MS, Moody MA, Radolf JD, Tucker JD. A systematic review of syphilis serological treatment outcomes in HIV-infected and HIV-uninfected persons: rethinking the significance of serological non-responsiveness and the serofast state after therapy. BMC Infect Dis. 2015 Oct 28;15:479. doi: 10.1186/s12879-015-1209-0.

van der Helm JJ, Koekenbier RH, van Rooijen MS, Schim van der Loeff MF, de Vries HJC. What Is the Optimal Time to Retest Patients With a Urogenital Chlamydia Infection? A Randomized Controlled Trial. Sex Transm Dis. 2018 Feb;45(2):132-137. doi: 10.1097/OLQ.0000000000000706. 

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