PID

[aurora327]

About 3 weeks ago I was drugged at a party.  When I went to the ER (after I had figured out what had happened), my urine tests came back negative, although they concluded I had been drugged.  The doctors and I did not think there was any sexual assault because I was on my period and when I woke up there was I still had a tampon in.  

   Since this incident, I have been diagnosed with PID.  I've never had a STD before so I am very concerned.  I have also only had 2 partners in the past 5 years.  One was a relationship for 6 years and the other is just recently (in the last 4 months).  Over the first 4 years, I was tested frequently and never had a positive result.  However I haven't been tested (until a couple of days ago) in almost 2 years (but at the time I was only having sex with one person and just recently had sex with another person).  My recent partner has only had 1 sex partner (other than myself) in his entire life and she was a virgin.  

   My question is that is it more likely I got chlamydia from my long relationship & its just showing up now, from the recent relationship (even though he's only had one sex partner and the other partner was close to 4 years ago), or is it more likely I was sexually assualted a couple of weeks ago?

[H. Hunter Handsfield, M.D.]

The first question is the accuracy of the PID diagnosis.  Expert recommendation, including CDC's guidelines, is to treat for presumptive PID in any younger woman with unexplained low abdominal or pelvic pain.  But many women with apparent PID in fact do not have it; it is hard to be sure unless the pelvic organs are visualized by laparoscopy, pelvic ultrasound, MRI, etc.  Does your last sentence mean your recent chlamydia test was positive? Or are you just making an assumption?  The combination of pelvic pain plus a positive test for chlamydia is good evidence for PID even without laparoscopy etc.



Although most cases of PID are triggered by chlamydia or gonorrhea, some cases are not.  And not all PID is sexually acquired.  For example, women with past PID are more susceptible to non-sexually-acquired PID.



Carrying chlamydia for 2+ years is possible but somewhat unlikely.  It would be very rare to carry gonorrhea that long.  So if you have sexually acquired PID due to chlamydia or gonorrhea, you probably acquired it from your recent partner, but perhaps were infected the night you were drugged.  If it is from your partner, that would raise questions about the truth of his past sexual exposures.  I am not accusing him; I can't judge that possibility nearly as well as you can.  But since things are in doubt, he should be tested for gonorrhea and chlamydial infection.



Best wishes--  HHH, MD