What could this be???

[the_edge]

last month i had an irregular menstrual period (blood only came out while i was on the toilet, not on my sanitary napkin, cramps were worse than normal).  i had sex with my boyfriend on the last day of my period. two days later, he was masturbating & ejaculated and felt a sharp intense pain in his right testicle.  as the week progressed, he had a nagging discomfort in his left testicle.  He went to the doctor, who prescribed him doxy for epididymitis.  he had this nagging discomfort in his testicle earlier last year & the doxy was able to get rid of the discomfort. However, this time the doxy did not help.  so he saw another doctor who prescribed him cipro; this doctor said that doxy is close to 45 yrs old & is not effective at killing anaerobic bacteria.in the meantime, i developed intermittent pain in my lower left pelvic area & frequent urination without pain or burning.  i went to urgent care & they did a pelvic exam & tested for chlamydia and gonnorhea along.  she also did a dipstick urine test. all tests came back neg.  i wasn't satisfied, so i went to visit my primary care physician, she said it was a uti & prescribed me cipro for 3 days. she did a urine test & sent out for a urinalysis, both came back normal. the cipro didn't help.  i then went to urgent care again the next week complaining of the ongoing pelvic pain and frequent urination.they did another pelvic exam & said that i may have vaginitis/pid. he took some vaginal/cervical swabs and some blood to run tests for stds (including herpes).all these tests came back negative & the bacterial culture was found to only have normal vaginal flora.  he had given me an antibiotic shot and put me on doxy for ten days. the doxy did not work,i went back to my pcp - she totally ruled out pid because of all the test results. during this office visit, i had a fever of 101. she said it wasn't related to the other symptoms.  what could this possibly be? an anaerobic bacteria? m.genitalium or hominis maybe?

[H. Hunter Handsfield, M.D.]

I would like to help but cannot.  Some of the symptoms you describe indeed could be due to PID, but I can neither confirm nor refute that diagnosis.  No distant online expert can provide more accurate information than a provider who has personally examined someone.  Clearly you don't have chlamydia or gonorrhea, and probably never did; and if the tests missed one of those infections, the treatments you were given would have eradicated them.  It is impossible to speculate accurately about Mycoplasma genitalium.  M. hominis is not sexually transmitted and is not known to cause the sorts of problems you describe.  In any case, the symptoms of PID are pretty much identical to various non-infectious gynecologic conditions, but I cannot speculate about non STD issues.

The best I can suggest is that you follow up with your personal provider(s); or if not satisfied they are completely on top of things, ask for referral to someone else.

Sorry I can't be more helpful.  Best wishes--  HHH, MD

[the_edge_]

thank you for the response doc.

are any of our symptoms consistent with those caused by m. genitalium? if so, how do doctors test for it? is m. genitalium part of a women's natural vaginal flora? would it have been found in my bacterial culture?

lastly, are our symptoms suggestive of herpes or genital warts?

thank you for you time. happy new year.

thanks again.

[H. Hunter Handsfield, M.D.]

The symptoms of Mycoplasma genitalium are no different than those of any other vaginal or cervical infection; same as chlamydia, gonorrhea, etc.  Whether it causes PID or not isn't clear; some research suggests yes, other studies say no.  In any case, the treatments you have had probably would have eradicated it and M. gen is unlikely to be responsible for your continuing symptoms.  And you describe nothing that suggests herpes or HPV.

If you ever had an STD, that part of the problem almost certainly is now long gone.  Whether you even have infection at all is uncertain; maybe just residual symptoms.

Thanks for the thanks, but please don't rely on distant advice like this.  The only route to clear answers is direct care by a knowledgeable health care provider.