I need some help with possible PID infection

[jessy442]

I am a married (6 yrs) 31yo F with 2 children born via C/S 8/04 and 5/07.On 7/30 had unprotected intercourse with another person.  Very brief and no ejaculation.
On 8/21 had sex with my husband lt. vag bleeding found by touching cervix.  Took an ovulation kit (on BCP and BF) (+)  called PCP did an HCG = 0 she gave Plan B.
8/25 - slight burning/urgency to urinate no burning while urinating or reduced flow
8/26 - Menustration cycle begins lasts long normal after B
8/27 - unilateral pain in back PCP prescribes Zmax for UTI
8/29 - PCP urine dip (-). Gives Cipro 500/5D Call back that PM slight pelvic pain says BV w/ poss. PID adds Metro 2/D 7D.did pelvic no motion tenderness,no disch.cervix looks pink,clean healthy.
9/2 - Back PCP insist having tests does DNA probe for G & C.
9/9 - Sex with husband 1st 8/21
9/10 - Probes (-) for infection
9/11 - OB/GYN does pelvic healthy, small WBC on slide & yeast also states that R ovary sl. big. Diflucan yeast.Blood CBC, ESR and C prot.
9/15 - All normal tests
9/24 - pain starts never goes away int. chages.OB/GYN have U/S which shows slightly enlarged pelvic vein (mentions pelvic cong. Then 2 dots in my ut. adenmyosis? remind US tech of two C/S it could be scar sl enlarged R ovary but all is within normal limits. OB sees me after US and feels that I have pelvic floor weakness (after pushing in certain areas) and sends me to PT which I start 10/3.
9/26 - Menustration begins & pain radiates from pelvic region to include over the right hip and a weird feeling near R rib cage (had this during last period on 8/26 also).  Intensity varies but it never really goes away.
9/28 - Menustration ends and pain is still persistant.

What do you think of tests and the antib.?what is the likelihood that this is an STD  DNA probe is accurate & blood normal don't worry. Had greenish disc 2-3 times before anti. not out vagina on finger after inser but gone quite normal now

Only give 2000 characters sorry 4 poor eng.and abbreviations.

[H. Hunter Handsfield, M.D.]

Yes, you correctly understand me.  The normal ESR and C-reactive protein results tend to support a conclusion that you have no currently active infection and no PID.  Beyond that, I have no opinion about the cause of your pain, the ultrasound, or other test results.  These are issues for a gynecologist, not an STD expert.  This forum really cannot help any further.  Sorry.

[jessy442]

So if I am understanding you...most likely I do not have STD and if I did, it should have been cleared up by the antibiotics I was given correct?  If this is the case, do you have any insight into what could be causing the pain I described.  I have kept a very accurate journal of the pain and am planning on sharing it with another OB/GYN shortly but I don't understand why all tests are negative and I am still having symptoms.  I am sure my husband has not been unfaithful...there are certain things that I would doubt about him but his character and honesty is never one mine is another story.  So if the antibiotics cured the infection it could not have developed into PID correct?  What do you feel about the U/S findings (pelvic congestion or ademyosis)? and the ESR and C-protein results?

[H. Hunter Handsfield, M.D.]

It is clear you are in pain and also probably emotionally distressed by the situation, and I truly would like to help.  I'll provide some information about sexually acquired PID (below).  However, I cannot solve the mystery of the cause of your continuing symptoms.  Direct examination by a gynecologist, including such diagnostic tests as pelvic ultrasound, is far more reliable than anything any distant expert can conclude based on your description.  Since the ObG apparently believes PID does not explain your symptoms, that also is my opinion.

Having said that, your story has elements that make an initial STD seem a fair possibility, including your exposure to a new partner, followed a few weeks later by a possible infection of your cervix, since post-intercourse bleeding is one of the common symptoms of sexually acquried cervicitis.  However, there are many other (non-STD) potential causes of the same problem.

Apparently you were treated with azithromycin (Zmax) before being tested for gonorrhea and/or chlamydia.  That could have cured either infection, and the later antibiotic therapy (cipro plus metronidazole) would have also cleared up any plausible STD that might have started your problem.  Therefore, the negative DNA tests don't help one way or the other. (I would have agreed with your ObG that there was no point in doing those tests at that time.)

You don't say whether your husband or your recent new partner have been examined and tested for STDs.  Both should be tested.  If you had an STD, perhaps it didn't come from your casual partner.  When one member of an outwardly monogamous couple is having other partners, often the other is doing so as well.  Of course I have no way of knowing whether this is likely in your case; you are the only one who can judge that possibility.

However things startd out, at this point you can trust your ObG's conclusion that PID does not explain your symptoms.  Further, I am inclined to believe there never was any STD and that your new sexual partnership has nothing to do with it.  But at this point, it is unlikely you will ever know for sure, unless an STD shows up in either your husband or other partner.

If you remain uncertain about your ObG's expertise or would just like a second opinion, don't hesitate to request it.  In that case,consider requesting referral to another ObG, perhaps one who specializes in infectious diseases.  ObG/ID specialists usually can be found near major medical centers.

Best wishes--  HHH, MD