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Non specific cervicitis and flue-like symptoms
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Non specific cervicitis and flue-like symptoms

I've had instances of unprotected sex with two different people the past several months (I'm a 33 yr old hetero female).  The first guy was in late March or first week of April.  We had vaginal unprotected sex for about 10-15 minutes with no ejaculation.  Then the last 2 weeks of May I had protected vaginal sex with him but we both performed non-protected oral sex on each other and I swallowed his ejaculate one time.  We probably had unprotected oral sex on each other about a total of 3-4 times and only once did i swallow.  Later I found out that he's had sex w/prostitutes in his past, group sex and has been a drug user (although doubtfully intravenous).

Then the first week of August I had sex with another male - once vaginally unprotected and he ejaculated in his hand. I performed oral sex on him once and swallowed his ejaculate which was about a teaspoon full.  He performed oral sex on me once I believe.  Also when I had sex with him I bled some and it showed on the condom.  I believe I have bled in between periods after having sex w/the first guy but before the second guy.

On 8/23 I went to the health dept for testing but had no symptoms or so i thought.  But the lady said I had some discharge. She told me I had cervicitis and prescribed doxycycline which i took religiously until it ran out.  While on the meds I started developing weird symptoms: back pain, malaise, tiredness for no reason, some anal itching/redness both around anus and in that area btween vaginal and anus, sore throat.  I also notice red bumps on my tongue in the very back.  I've also felt like a had a fever but once I checked it and my temp was normal.  I've also noticed mild dull pain in abdomin (abdomen) at times that are not near my period but it is gone right now.

On 8/30 i got my test results for Chlamydia, gonorria, HIV, trich, syphillis (syphilis) and they came back negative. I didn't have a herpes test and have no genital sores, no tingling, no itching, no nerve pain in legs or groin yet my discharge is still there and i've had a sore throat for about a week.

Questions:

1)  Could this be herpes? I read that non specific cervicitis can be caused by HSV and since i've tested neg for Chlamydia, etc what else could it be? Could my sore throat be herpes from oral sex and swallowing?

2) Is 14 days enough time to wait before being tested for chlamydia, syphillis (syphilis), gonorrhea, trich?  Should I be retested?  I was tested on 8/23 and the last time i've had sex was 8/9.

3) Obviously I need to go the either the health dept or my gyno to find out why I still have a discharge. What testing should i have them do, knowing that i've already had one round of antibiotics and tested neg for those above?

4) Could this in any way be related to HPV? I had a bad pap about 16 years ago and had cryo.  I've had normal paps since then though. But i've had some ovarian cysts, etc.
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Cervicitis not due to either gonorrhea or chlamydia is a pretty big mystery.  Several causes have been proposed but either research disproved them or high-quality studies have not been done.  Happily, such cases are not known to cause any serious health outcome, i.e. no pelvic infection, infertility, etc as can follow gonorrhea or chlamydia, so most likely there is no major health threat to you.

Herpes clearly causes some cases but only a small minority. Most but not all cases of herpetic cervicitis are accompanied by typical external genital lesions.

1) Herpes is possible, and is slightly favored by the simultaneous occurrence of systemic symptoms (malaise, etc).  Initial herpes sometimes is accompanied by sore throat.  My guess is that herpes doesn't explain any of this; but if it does, the symptoms will resolve soon.  In other words, chronic/persistent symptoms beyond 3-4 weeks would be strong evidence against HSV.   But if no other explanation becomes apparent, diagnostic tests for HSV would be reasonable.  (Search the the forum for "herpes diagnosis", "genital herpes", and "HerpeSelect test" for many discussions about herpes diagnosis.)

2) Yes, 14 days is plenty of time.  Tests for gonorrhea and chlamydia generally are positive within a couple days of exposure.

3) Yes, follow up on the vaginal discharge.  Recent research suggests some cases of cervicitis may accompany bacterial vaginosis, i.e. overgrowth of otherwise normal vaginal bacteria.  Sometimes an additional course of another antibiotic (e.g., azithromycin) is worth a try; or metronidazole if you have BV.

4) This probably isn't related to HPV.  However--and not to frighten you, just to suggest you have another pap smear and raise this with your doc--some cases of cervical dysplasia or more advance pre-cancerous disease may mimic cervicitis.  This should be checked out, just to be safe.

Finally, the other rational approach here wopuld be to contact your partners and suggest they get checked, perhaps at a local STD clinic.  Diagnostic tests aren't perfect in women, and sometimes a problem shows up in a partner that isn't recognized in the patient herself.

Best wishes--  HHH, MD
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I went to my gyno and had the discharge checked out.  She looked at it during my office visit and said she sees a little extra yeast and a little extra bacteria but that the amounts are so minute that it is probably my normal discharge.  (I was on my last day of my period at this time.  Could this change what she sees under the microscope this day?)

I explained everything to her and she did a HerpeSelect test and I'm awaiting results.  

Meanwhile.....I still have a sore throat but no other symptoms.  It's been nearly 6 weeks since I last had sex and it's been 19 days of off and on sore throat.  It may be a week before I get the HerpeSelect results.  I should have had my gyno do a throat culture for strep but she didn't and I was already on antibiotics when all this started anyway (Doxicycline).

So.....should I wait for my herpes results or see someone now about this sore throat?  Is it dangerous to wait a month before seeing someone about a sore throat?
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