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Appreciate some guidance!
Hello Doctor,
First of all, thank you for your invaluable service. Second of all, I hope you can help shed some light on an issue I am experiencing:
I am a 22 year old female. I have had 3 partners in the past year, one being my boyfriend (Partner 1) who I just recently broke up with. Last October, I was told by a partner (Partner 2) that he had contracted Chlamydia. As I had had unprotected sex with him, I went in to get tested, probably 2 to 3 weeks after the potential exposure. During the pelvic exam, I was told that my cervix was inflamed, there was a lot of yellow/green discharge, and my WBC was very high; basically, I was told to expect a positive result, and was treated with Azithromycin. A week later, I received negative test results for both Chlamydia and Gonorrhea.
Now, a year later, I've experienced almost the exact same thing. Two weeks ago, I had sexual contact with a new partner (Partner 3). He fingered me, and there may have been some genital to genital contact, but no sexual intercourse. Regardless, I felt nervous and decided to get tested, a week after that contact. During the pelvic exam, I was told the exact same thing as a year ago: my cervix was inflamed, there was a lot of yellow/green discharge, and my WBC was very high. I was treated with Azithromycin. I've been worried that I picked something up from Partner 3, or that Partner 1 had been cheating on me during our relationship. I just got my results: Negative for Chlamydia and Gonorrhea.
So...
1.) Is there any way that I could have contracted Chlamydia from my contact two weeks ago? From what I understand, genital to genital apposition is low, possibly no risk.
2.) How accurate is testing for Chlamydia 6-7 days after a potential exposure? I had the test done at Planned Parenthood, if this matters.
3.) I've read a lot about "Mucopurulent cervicitis" causing recurrent symptoms very similar to what was seen by two different NPs during my pelvic exams. Any thoughts on this?
Thank you!
First of all, thank you for your invaluable service. Second of all, I hope you can help shed some light on an issue I am experiencing:
I am a 22 year old female. I have had 3 partners in the past year, one being my boyfriend (Partner 1) who I just recently broke up with. Last October, I was told by a partner (Partner 2) that he had contracted Chlamydia. As I had had unprotected sex with him, I went in to get tested, probably 2 to 3 weeks after the potential exposure. During the pelvic exam, I was told that my cervix was inflamed, there was a lot of yellow/green discharge, and my WBC was very high; basically, I was told to expect a positive result, and was treated with Azithromycin. A week later, I received negative test results for both Chlamydia and Gonorrhea.
Now, a year later, I've experienced almost the exact same thing. Two weeks ago, I had sexual contact with a new partner (Partner 3). He fingered me, and there may have been some genital to genital contact, but no sexual intercourse. Regardless, I felt nervous and decided to get tested, a week after that contact. During the pelvic exam, I was told the exact same thing as a year ago: my cervix was inflamed, there was a lot of yellow/green discharge, and my WBC was very high. I was treated with Azithromycin. I've been worried that I picked something up from Partner 3, or that Partner 1 had been cheating on me during our relationship. I just got my results: Negative for Chlamydia and Gonorrhea.
So...
1.) Is there any way that I could have contracted Chlamydia from my contact two weeks ago? From what I understand, genital to genital apposition is low, possibly no risk.
2.) How accurate is testing for Chlamydia 6-7 days after a potential exposure? I had the test done at Planned Parenthood, if this matters.
3.) I've read a lot about "Mucopurulent cervicitis" causing recurrent symptoms very similar to what was seen by two different NPs during my pelvic exams. Any thoughts on this?
Thank you!
Thank you so much, Doctor. I appreciate the input more than you know!
MEDICAL PROFESSIONAL
You may have misinterpreted "in most cases an organism cannot be isolated". That simply means that in most cases neither gonorrhea nor chlamydia is the cause.
You seem to have separated "high WBC" and "cervicitis" (or MPC) in your mind. MPC is defined primarily by high WBC in the cervix; they are one in the same thing.
As for other bacteria, I already addressed this. M. genitalium may be a cause of MPC; also trichomonas or BV (I think you hadn't seen my other follow-up comment when you were writing this one). Even these conditions don't account for all cases.
As for "this is slightly confusing", you're not alone! Everybody is confused by MPC, including STD experts and those doing research on it. It is hoped that someday we'll have better answers.
My comment on diagnosis of trichomoniasis was incomplete. I meant to write "Microscopic examination of vaginal fluid IS INSUFFICIENT; almost half of all trich in women is only detected by culture or a PCR test." Sorry for any confusion about it.
You seem to have separated "high WBC" and "cervicitis" (or MPC) in your mind. MPC is defined primarily by high WBC in the cervix; they are one in the same thing.
As for other bacteria, I already addressed this. M. genitalium may be a cause of MPC; also trichomonas or BV (I think you hadn't seen my other follow-up comment when you were writing this one). Even these conditions don't account for all cases.
As for "this is slightly confusing", you're not alone! Everybody is confused by MPC, including STD experts and those doing research on it. It is hoped that someday we'll have better answers.
My comment on diagnosis of trichomoniasis was incomplete. I meant to write "Microscopic examination of vaginal fluid IS INSUFFICIENT; almost half of all trich in women is only detected by culture or a PCR test." Sorry for any confusion about it.
Thank you so much for your prompt response, Dr. Handsfield, I truly appreciate it. I suppose after reading your response that my main concern would be the elevated WBC counts during both separate exams. I've read that Mucopurulent cervicitis can be caused by Chlamydia or Gonorrhea, but that in most cases an organism cannot be isolated. I've also read that elevated WBC counts can be associated with both Chlamydia and Gonorrhea, but that other organisms that aren't typically tested for, such as Mycoplasma genitalium, can also be associated with this elevation. To me, it seems that if elevated WBC counts are associated with Mucopurulent cervicitis due to organisms that can be isolated, like Chlamydia or Gonorrhea, it would make sense that elevated WBC counts would be associated with Mucopurulent cervicitis due to organisms that cannot be isolated as well. Therefore, I would think that elevated WBC counts would probably occur with MPC. Please correct me if I'm wrong!
Sorry if this is slightly confusing... I have spent many hours researching all of this and obviously would like to have that hard work validated by an expert. Thank you!
Sorry if this is slightly confusing... I have spent many hours researching all of this and obviously would like to have that hard work validated by an expert. Thank you!
MEDICAL PROFESSIONAL
I saw this before replying above. Yeast itself doesn't usually cause cervicitis.
Two more thoughts: First, you should be tested for trichomonas, if that hasn't been done. Microscopic examination of vaginal fluid; almost half of all trich in women is only detected by culture or a PCR test. Second, some cases of MPC are associated with bacterial vaginosis, i.e. bacterial overgrowth in the vagina. Make sure you have been evaluated for BV. If either BV or trich is present, your cervicitis may improve when they are treated treated.
Two more thoughts: First, you should be tested for trichomonas, if that hasn't been done. Microscopic examination of vaginal fluid; almost half of all trich in women is only detected by culture or a PCR test. Second, some cases of MPC are associated with bacterial vaginosis, i.e. bacterial overgrowth in the vagina. Make sure you have been evaluated for BV. If either BV or trich is present, your cervicitis may improve when they are treated treated.
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help.
Thanks for doing some research, whether on this forum or elsewhere, before asking your question. As you seem to realize, you describe typical symptoms of mucupurulent cervicitis, or MPC. MPC is a somewhat vague entity, without clear diagnostic criteria; in that way, it is similar to nongonoccal urethritis (NGU) in men. Many STD experts and clinicians simply refer simply to "cervicitis".
Chlamydia and gonorrhea are common causes of MPC, and your doctor was right to be concerned about both of them -- especially at your age (chlamydia is most frequent age 15-25) and in light of the diagnosis of chlamydia in someone in your sex partner network at the time. (As you might imagine, a partner "network" consists of partners, their partners, and so on.) However, the modern lab tests are quite accurate, so it is unlikely you had either of these STDs. But that's quite typical; more than half of all women with cervicitis have neither gonorrhea nor chlamydia. The cause in those cases is unknown, although the recently discovered bacteria called Mycoplasma genitalium may cause some cases.
Further, cervicitis often persists despite antibiotic treatment, or can recur after it first clears up. In fact, recurrence probably is most common when neither gonorrhea nor chlamnydia is present. Such recurrences do not necessarily require new sexual exposure, and the recent episode probably is just a coincidence with the recent new sexual exposure. Fingering is not known or suspected to cause cervicitis. So in this aspect as well, your case is quite typical.
By the way, I assume your "high" WBC count refers to elevated white blood cells in your cervix, or on a cervical swab. Elevated blood WBC counts are not known to occur with cervicitis/MPC.
The standard approach for MPC is to treat as if chlamydia and/or gonorrhea is present, without waiting for the test results. (Although you were not treated for gonorrhea, you needn't worry about it, since the test is now known to be negative.) Your regular partner should also be examined and should be tested again for gonorrhea and chlamydia -- but given your negative results, you can expect his tests to be negative as well. But better safe than sorry! However, there is no need for the more recent (fingering only) partner to be informed or treated.
To your specific questions: 1) Chlamydia is unlikely to be transmitted by fingering. 2) Testing for chlamydia (and gonorrhea) is accurate within 5-6 days of exposure; your negative result at 6-7 days is reliable. 3) See the discussion above.
I hope this helps. Best wishes-- HHH, MD
Thanks for doing some research, whether on this forum or elsewhere, before asking your question. As you seem to realize, you describe typical symptoms of mucupurulent cervicitis, or MPC. MPC is a somewhat vague entity, without clear diagnostic criteria; in that way, it is similar to nongonoccal urethritis (NGU) in men. Many STD experts and clinicians simply refer simply to "cervicitis".
Chlamydia and gonorrhea are common causes of MPC, and your doctor was right to be concerned about both of them -- especially at your age (chlamydia is most frequent age 15-25) and in light of the diagnosis of chlamydia in someone in your sex partner network at the time. (As you might imagine, a partner "network" consists of partners, their partners, and so on.) However, the modern lab tests are quite accurate, so it is unlikely you had either of these STDs. But that's quite typical; more than half of all women with cervicitis have neither gonorrhea nor chlamydia. The cause in those cases is unknown, although the recently discovered bacteria called Mycoplasma genitalium may cause some cases.
Further, cervicitis often persists despite antibiotic treatment, or can recur after it first clears up. In fact, recurrence probably is most common when neither gonorrhea nor chlamnydia is present. Such recurrences do not necessarily require new sexual exposure, and the recent episode probably is just a coincidence with the recent new sexual exposure. Fingering is not known or suspected to cause cervicitis. So in this aspect as well, your case is quite typical.
By the way, I assume your "high" WBC count refers to elevated white blood cells in your cervix, or on a cervical swab. Elevated blood WBC counts are not known to occur with cervicitis/MPC.
The standard approach for MPC is to treat as if chlamydia and/or gonorrhea is present, without waiting for the test results. (Although you were not treated for gonorrhea, you needn't worry about it, since the test is now known to be negative.) Your regular partner should also be examined and should be tested again for gonorrhea and chlamydia -- but given your negative results, you can expect his tests to be negative as well. But better safe than sorry! However, there is no need for the more recent (fingering only) partner to be informed or treated.
To your specific questions: 1) Chlamydia is unlikely to be transmitted by fingering. 2) Testing for chlamydia (and gonorrhea) is accurate within 5-6 days of exposure; your negative result at 6-7 days is reliable. 3) See the discussion above.
I hope this helps. Best wishes-- HHH, MD
Additionally... I had a bad yeast infection in January 2011, and was tested for Chla/Gon at that time, where both were negative as well. Thank you.
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