STDs Expert Forum
Lots of Chlamydia confusion
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Lots of Chlamydia confusion

I'll briefly give you some background info about this issue:
Attempted to have protected sex with an ex-boyfriend back in Nov '09.  I say attempted because somehow the condom fell off inside of me during intercourse.  He failed to tell me until the next day!  Started experiencing some symptoms (vaginal discharge) early December.  Went to my gyno and was diagnosed with BV.  I did a basic STD panel (no blood-work) to be safe (this included tric & ghono). Went home with some metrodonizole (excuse my spelling) to take twice a day for five days.  Turned out I had Chlamydia as well.  Was prescribed azithromycin to take in one dose totaling 1 gram.  Took both medications exactly as prescribed.  Finished them ALL.

The problem I had been having during and after treatment was the pelvic pain.  Waited approx two weeks to go back to the doctor to be tested again.  I mentioned to the doctor that I had been still having symptoms and he informed me not to worry about it at this time.

Here's the whammy...tests results came back positive again.  There is no way I have been re-infected because I have not had sex since my last encounter in November.  When I mentioned this to the nurse calling today I got the feeling that she brushed me off and didn't believe that I have been abstaining.  I would not compromise my treatment by having sex nor would I lie about my sexual activity.  I'm pretty confused about how this could happen.

As for today the pelvic pain is pretty bad.  I have been prescribed 1gram of azithromycin again, which I just took.  

Can you give me any guidance on what is going on?  How could I be positive still when azithromycin is so effective?  I'm not getting any clues from my doctors and I'm worried about PID and the implication of it-specifically infertility.  Your expertise is greatly appreciated.
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Welcome to the STD clinic.  I'll try to help.  I have seen your follow-up note below, i.e. initial diagnosis November last year.

I don't think there is anything mysterious here.  Azithromycin is highly reliable against chlamydia, but not perfect.  The cure rate probably is around 95-98%, i.e. 1 in 20 to 1 in 50 treated patients will have persistent infection.  There is a slight possibility your follow-up chlamydia test is false; the lab tests for chlamydia are not perfect.  But treatment failure is more likely.  The standard recommendation in this situaiton is to be treated with doxyxycline (not single dose, requires 7 days treatment) which always works if azithromycin fails.

As for your pelvic pain, however, I agree with your concern about PID, and I'm a little surprised your doctor seems to have blown this off.  Perhaps s/he is unaware that azithromycin sometimes fails to cure chlamydia.  You need to return immediately for reevaluation -- or if your own doctor still isn't responsive, find someone else.  One way or the other, please do not delay; with the weekend upon us, you may need to visit an urgent care clinic.

Please return with a follow-up comment to let me know how this shakes out.

Regards--  HHH, MD
4 Comments
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Sorry doc I gave you a wrong date...Nov '10.  Got my years mixed up there!
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With you advice, I went to an urgent care office.  Thank you for your advice, you helped me realize what I had felt was real and serious despite what I had been told.

The doctor seemed pretty surprised that my gyno blew off the pelvic pain as well.  He was concerned that I had PID.  He was also confused as to why they prescribed me azithromycin again since the first treatment obviously didn't work.  He thought that they probably didn't believe I wasn't sexually active (frustrating!).   One of his thoughts on the pelvic pain was that I possibly had gonorrhea in my fallopian tubes that wasn't detectable with the STD testing my doctors used.  I was prescribed doxyxycline 2x day for ten days.  They also gave me a shot of Rocephin, 1 gram.  Whew, was that painful.  

I will be going back to my gyno around the week of Feb 7th and I'll be sure to give them all this information.  Hopefully permanent damage hasn't been done.  With all of this going on for weeks now, what kind of outcome should I expect with this diagnosis?  What kind of tests would be done to determine PID if any?

Thanks again for your help!
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I'm glad to hear things are now on the right track.  You seem to have found a wise provider in the urgent care clinic -- although I doubt gonorrhea is the problem.

There are no definitive tests for PID.  Sometimes a pelvic untrasound examination or CT scan are done, but usually the diagnosis is made on clinical grounds -- symptoms, pevlic exam, etc.  There also are no routine tests to look for PID outcomes, unless there are later problems with fertility.  Most patients do fine after treatment of PID, with no long term side effects.  
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