PID

[ebro]

Doctor, I was the one who wrote to you a few days ago about the epididymitis. My girlfriend has since taken a gram of zithromax as a precaution without being tested. I am concerned about PID.  She was treated probably about three months after (possible) exposure and has has had no symptoms. Is this too late? I know silent PID can occur. A few questions, if you don't mind.

1.Are people treated presumptively for PID if they have no symptoms but have an STD?

2.What % of women get PID from Chlamydia and when would it occur? She has always had abdominal cramping during her period and there has been nothing out of the ordinary recently.

3.Do you think she should be treated for PID as a precaution? Is Levaquin taken for two weeks effective against PID?

4. I still seem to have some swelling in my testicles after completing treatment but have had a negative urine test. Does it seem likely then that my past epididymitis was not caused by an STD? How accurate was my first swab test? I think It was a culture, but am unsure. They made a preliminary diagnosis of negativity after 30 minutes and microscopic examanation, and I got final results 2 weeks later. Do you know what kind of tests the NYC DOH uses?

Thank you very much and I appreciate your input

[H. Hunter Handsfield, M.D.]

1. No, presumptive treatment without even testing is not proper care.  However, it probably would have prevented PID.



2. Up to 10-20% of women with chlamydia get PID.



3. Since she wasn't having unusual abdominal or pelvic pain, the zithromax would treat chlamydia adequately, if it was there.



4. Pain swelling can take a long time to clear up entirely after epididymitis treatment.  I can't speak to what tests are used by the NYC DOH STD clinics.  But since you were treated, you can be sure you don't have persistent infection.



Good luck-- HHH, MD

[ebro]

So without abdominal pain is it safe to assume that she does not have PID? Would PID produce pain soon after it had set in or would it take a long period of time? How soon would PID likely develop after chlamydial infection?

Thank you again for all of your input and time

[H. Hunter Handsfield, M.D.]

It's a question of terminology.  In most women with chlamydia, the infection spreads up the genital tract to involve the uterus, and in many (most) all they way up into the fallopian tubes.  Biologically, that is pelvic inflammatory disease (PID).  However, most such infections are asymptomatic, and in general use the term PID is restricted to people with painful infections of the fallopian tubes.



Looked at another way:  Biologically, half or more of all women with chlamydia have PID.  Clinically, no more than 10-20% do.  But in the absence of pain, you can be pretty confident your partner is going to have no important health consequence, even if she was infected.  In any case, there is no way to know, so it isn't worth losing sleep over.



Good luck--  HHH, MD