Chlamydia and PID concerns

[limabean252]

Hello,

I posted a question here yesterday regarding my current chlamydia infection which was answered.
I have another question related to this as my ob/gyn has me very confused-

Basically my situation is that I was in a monogamous relationship for 18 months that ended four months ago. I know I was negative for chlamydia when entering the relationship. My ex does not know what his chlamydia status was when he entered the relationship (he was STD tested but turns out only for HIV, herpes).

At a routine ob/gyn visit this month I tested positive for bacterial vaginosis and chlamydia and was shocked.
My only symptom is that I had been spotting between periods the past two months. My doctor gave me a single dose of azithromycin yesterday. The past few days the spotting has actually become thick pink mucous that comes out occasionally.

My question is - does this mean my condition has progressed to PID?
I don't have pelvic pain. I don't know whether or not I have pain during intercourse because I have not been sexually active in 4 months.

My doctor said it's up to me whether or not I wanted to be treated for PID as I realize it would involve an injection, as well as doxycycline and metronidazole for two weeks. I just want to be sure all my bases are covered to ensure that any kind of bad bacteria affecting my reproductive organs is gone. The fact that I also had bacterial vaginosis makes me think I just go forward with this PID treatment.

Everything I read is so confusing. Chlamydia can be asymptomatic and so can PID so what's the threshold by which chlamydia turns to PID? Does my thick pink discharge indicate that my upper reproductive organs are now affected?

Thanks

[Edward W Hook, MD]

Great, I'm glad you were treated.  I wish there were a better answer to your questions but the test just do not accomplish this.  Take care. EWH

[limabean252]

Thank you, Dr. Hook. I was just hoping for some answers. It's unfortunate that they even offer these tests then if there's nothing to be gained by them.

And yes, I was treated with 1 g of azithromycin and have an appointment with my doc for f/u testing at the end of the month to make sure it's gone.

Thanks.

[Edward W Hook, MD]

Welcome back.  Several comments but first a question- I presume you were treated for chalmydial infection, correct?  If so, your care has been appropriate.  

As far as your subsequent tests, chalmydial antibody tests (IgG or IgM) are not recommended for clinical use.  Our lab has done much research on them and I can tell you for a fact that commerically available chlamdyial antibody tests are unreliable as evdience of past or current infection or for determining the timing of an infection.  As I told you, there is no way to tell how long you have had chalmydial infection from further testing.

Currently available chlamydia tests usig swabs are amongst the most reliable tests we have.  Your positive swab test is very, very stong evidence that you had an infection and it needed to be treated.  BV does not cause false postive chalmydial tests.

I hope these comments are helpful.  Please do not waste your time or money on further chlamydial blood tests- there is no useful information to be gained from them. EWH

[limabean252]

Hi Dr. Hook,

I wanted to follow up with you regarding the above situation. The original chlamydia test that came back positive in July was a vaginal swab test. My doctor sent me for bloodwork to check the chlammydia IgG and IgM antobody levels to see if it would indicate anything about timing of my infection.

Both came back negative. How can this be? Does this mean the vaginal swab last month was a false positive? I should note I also had BV at the time so could that have turned the chlamydia test false positive?

Thanks

[Edward W Hook, MD]

Welcome back to the Forum. I was following your earlier interaction with Dr. Handsfield and agree with him in all that he has already said.  All of the facts you mention are correct.  To repeat:
1.  You cannot be sure how long you have had chlamydia.
2. Chlamydial infections are often asymptomatic.
3. Symptomatic or asymptomatic chlamydial infection can spread from the primary site of infection, the cervix, into the uterus to cause the problem that we call PID.  The best estimates are that this occurs in about 10% of women with chlamydial infection.  
4.  Some (about 10-15%) of women with PID develop infertility as a result of their PID.
5. There is no clinical indication that you have PID and thus no reason to assume that you need treatment other than the azithromycin you have taken, as well as the metronidazole you'll need for the BV.  

That there has been a change in your discharge does not, by any means indicate that you have PID.  As Dr. Handsfield has told you, the odds that you have PID are quite low (see my statistics above).  I think the advice he's given, to get retested a few weeks from now to make sure you have been cured  is the right thing.  I see no indication for PID therapy.  

Try not to worry.  I hope my comments will be helpful to you. EWH