Minomycin: adequate treatment?

Thank you for your information and assistance.

I am a 24 year old female previously diagnosed with low-grade hpv. I should note that I am living in a rural area of Japan and    the language barrier is considerable. Also, I have been in a (supposedly) monogamous relationship for the past 10 months. He was tested in 11/05 for hiv/syph/hep (-).

Two months ago I began having symptoms including white vaginal discharge, lower abdominal pain (bloated feeling), lower back pain and frequent urination. I went to a local ob-gyn first, who tested me for candida (-) and sent me home without treatment after writing off my abdominal pain. Next I went to a city ob-gyn. I was tested for candida, uti and chlamydia. All were negative. The doctor's non-specific diagnosis was that I had a bacterial infection. I was treated with Cravit 100mg twice daily for five days. Symptoms began approx. 3/17 and improved rapidly after I started the antibiotics on 3/28.

As of 5/6, the same symptoms returned, however this time the lower abdominal and back pain is much worse. The pain seems to be focused on my left side. I was seen by a urologist who diagnosed me with an acute cystitis in March leading to pyleonephritis of the left kidney. I was also seen by another ob-gyn, and tested for uti (-), gonorrhea (-), and chlamydia. This time, the chlamydia was positive. I was told this was a culture test, but I don't know what specific type. The urologist prescribed Minomycin 100mg twice daily for 13 days and the ob-gyn stated that this dosage would treat the chlamydia.

7 days into treatment, the lower abdominal and back pain is still severe.

My primary concern is for pelvic inflammatory disease. As I had no bleeding or fever, the 3rd ob-gyn ruled this out, but I'm still worried.

Questions:

1. Is the dosage of Minomycin sufficient to treat chlamydia? And if so, shouldn't this pain be easing by now? I have a prescription for Cipro 500mg and am considering taking it. Should I?

2. As my symptoms now are the same as they were in March, if I had chlamydia all along, can I assume my first test was false-negative? Or that I was partially cured in March only to be reinfected by my partner?

3. Do you think my concerns for pid are warranted? And if so, what should I do to seek out further treatment?  I am returning to the US in July, but I am afraid to wait that long.

Thank you again for your time.

[H. Hunter Handsfield, M.D.]

I'll try to help.  But you have seen at least 4 different doctors; if they cannot make a clear diagnosis, I cannot do so by online description. But since you were tested and negative for the common causes of PID, and do not seem to be at risk (no other partners, and your partner says he doesn't either), PID seems unlikely.  By the way, I don't know what Cravit is; presumably the Japan trade name for an antibiotic (?).

1) You probably mean minocycline, not minomycin.  Minocycline is chemically similar to doxycycline and is active against chlamydia.  But probably you don't have chlamydia anyway.  My guess is that your symptoms are not due to an infection at all, and the cipro won't make any difference.  But it's best to follow your doctor's advice.

2,3) As I said above, I doubt you have chlamydia; if you did, the antibiotics would have cleared it up. Something other than PID most likely explains your pain.

Good luck-- HHH, MD

[kodansha]

Thanks for the quick response. To clarify, I tested positive for chlamydia during my last visit to the ob-gyn. Are you saying that 7  days of antibiotics should've cleared up a chlamydia infection? Should I consider the possibility of a false-positive test?

[H. Hunter Handsfield, M.D.]

Please accept my apology; I missed the positive chlamydia test.  You don't say whether your have been sexually active during all this.  If so, you could have become infected during the course of the events you describe; and in that case, your partner needs to be tested (or retested).  But you can be confident you didn't have it previously; and that if you really were infected in may, minocycline would clear it up.  If you haven't been sexually active, you can be certain you had a false positive chlamydia test result.  

Apologies again for the error.  Best wishes--

HHH, MD

[kodansha]

Hello again, Doctor. I wanted to follow-up that I had been sexually active in both March and May.

However, my partner received the results of his chlamydia test today...negative.
So for my tests,
March: (-)
April: no symptoms
May: (+)

For my partner(who had no symptoms)
May: (-)(his test was taken the same day I was diagnosed)

My follow-up question: If he infected me in March and most recently in May, could his chlamydia clear up in under 2 weeks without treatment?

I'm not looking for sugar-coated proof of faithfulness, I just don't know how to logically approach these conflicting test results... Thank you again.

[H. Hunter Handsfield, M.D.]

It seems most likely that your May test was falsely positive.  But the unknown factor (to me) is your judgment of your partner's fidelity.  Given the conflicting medical tests, that is going to have to be the basis of your judgment; I'm not going to be able to help further.

HHH, MD