[Question #1143] my PID symptoms

51 months ago

Hi, I’m a university student living in other country. I have a question about my symptoms. Please, refer to my previous post (“Why couldn’t I prevent PID?”)

 

Oct 18, 2013

After being diagnosed with PID, I took blood samples and was hospitalized. The doctor told me I was not very sick, but hospitalization is better when considering future pregnancy. I vomited right away when antibiotics were started to infuse.

I sometimes felt really sharp pain in lower quadrants while I was being infused. Strange feeling in flesh near pelvic bones area, and lower back pain didn’t go much.

 

Oct 21, 2013

The doctor told me results of PCR turned out all negative. He told me my blood test results were all normal. He told me I was completely cured, and I could discharge because my blood test results were normal. I couldn’t understand how he was able to know I was suddenly cured based on blood samples I took before the hospitalization. I was still having pains. The doctor told me blood test, especially ESR, is a definite test to tell full recovery from PID. So, I asked to re-take my blood samples, and results were normal again.

 

Oct 22, 2013

The doctor suggested me to have tests for syphilis, cystitis, N. gonorrhoeae and Herpese, and their results were normal.

 

Oct 23, 2013

The doctor told me I was having mucopurulent discharge, but it’s a symptom of vaginitis and his treatment for PID was completed. He told me my pains were not symptoms of PID and I was ok to rest at home. I discharged from the hospital.

 

Question) Since pain in LLQ began after few hours from the surgery, I had suffered really severe pain in LLQ & RLQ and bloating (I even had to draw up my knees whenever lying down) for about one month.

The doctor told me he was confused whether I was having acute PID, chronic PID, or no PID. He later told me I was having chronic PID because my pains didn’t go much after the treatment.

I would like to know whether my symptoms apply for PID. Thank you in advance!

Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

Thanks for the additional information, this clarifies your situation for me and will allow me to provide a more complete answer than I could from your earlier, more general questions.  Several pieces of the information you provide are relevant including that the events you describe occurred nearly three years ago, that all of your tests for STIs have been negative, and that you have repeatedly been treated with antibiotics for your problems.  The most important message I can provide to you is that this is not an STI-related problems, despite your previous boyfriends risky behaviors and that the most appropriate approach is to find a health care provider who you can meet with and work with to address your ongoing problems and concerns. 

PID is a "syndrome" meaning that it is a set of physical findings and symptoms that can be caused in a number of ways.   Sexually transmitted infections are one such way but other causes include other chronic non-STI infections related to surgery, endometriosis, other medical problems like appendicitis, or even other, non-STI infections such as tuberculosis.  No matter what the cause, pelvic infections can lead to scarring which in turn may lead to other chronic, non-infectious problems such as chronic pelvic pain.  The process and problems that you describe are not suggestive of STI-related PID (despite your boyfriend's high risk behaviors).  I do not doubt that you are having problems but I do not think they are related to STI.  My advice is the following:

1.  This is not a problem that can be handled over the internet.  You need to establish a relationship with a health care provider (perhaps a gynecologist or surgeon, perhaps another type of health care provider) and likely work on this with repeated visits. 

2.  I would urge you to not go from one health care provider to another since in doing so, each person would need to start again, adding to your frustration as well as cost and delaying what can ultimately be done.  These sorts of chronic problems are quite difficult to address.

I hope these comments are helpful.  I will accept one or two additional follow-up questions for purposes of clarification but will not be able to accept further questions on this topic after we close this thread and subsequent questions will be closed at your expense without further response.  I hope that you understand that this is not a dismissal of your difficulties but a statement that, at this point, your concerns and problems appear to be beyond the scope of this site.  EWH

---
51 months ago

Dear Dr. Hook,

 

Hi, I first appreciate for your general explanation and warm advices for me. I see that I left rooms for misunderstanding, and I really want to apologize for this.

Please, let me clarify my situation honestly and briefly, but entirely this time.

First, it is not true that I have been repeatedly treated with antibiotics. Five days of the hospitalization treatment in 2013 were my first and last antibiotics treatment.

Second, it is not also true that I have been suffering problems such as chronic pelvic pain.

It’s my fault that I didn’t provide enough information about me while asking general questions about PID. I again apologize.

I will not post any reply to my posts, so could you please read this for the last time? I’m begging you.. You will understand why I can’t go to a hospital. I was going to give up my life. ASHA is my last hope to live. I really need to ask a question to Dr. Handsfield..

 

To briefly explain my complicated situation…

I had some PCR tests during the hospitalization, and their results were all negative. After the hospital discharge, I still had abdominal pain, lower back pain, fever above 38C, and mucopurulent discharge. After few months, something painful was felt in flesh of lower back and hips. The burning pain spread to upper back thighs & front thighs, and the pain became really severe. I thought the pain is because of scar tissues, and I tried to endure the pain for the past 3 years.

Last month, I clearly realized the burning pain became really severe and is spreading to my calves and ankles. Lower back, hips, thighs, calves, and ankles, burning pain was everywhere and I realized I can’t live like this anymore.

I thought it’s time to give up my life, because a doctor told me before he couldn’t find reasons for my pain.

As I told you before, there is no public information about PID treatment in my country. I decided to try to find reasons for my pain before giving up. I searched information on the CDC, and tried to compare and understand my antibiotics regimen. It was totally different. At that time, I uploaded questions regarding my antibiotics regimen on somewhere else and I received answers from Dr. Handsfield.

“I’m not sure where you are, but in most of the world’s countries these drugs are not recommended and would not be used to treat PID.”

On the CDC, it also says “All regimens used to treat PID should also be effective against N. gonorrhoeae and Chlamydia because negative endocervical screening for these organisms does not rule out upper-reproductive-tract infection.”

However, antibiotics used to treat me were drugs which are not effective against Chlamydia or gonorrhoeae even though I had high possibility of having it.

The reason why I’m not going to a hospital, but instead uploading my questions here is I already went to several hospitals after finding out something might have been wrong with my treatment.

I visited the doctor who treated me, and he told me he had thought I was lying about having the surgery at an official hospital. He said he had thought I had the surgery at an illegal place. I told him that burning pain has occurred after the treatment, but he said he didn’t know why.

I visited other hospitals and showed my antibiotics regimen, but most of doctors were reluctant to say much about it. Some doctors showed me American gynecology textbooks, and they said they don’t see burning pain in PID section of the textbooks. They told me they don’t have a case for this rare situation.

I’m in a situation where I can’t expect to be treated today or tomorrow even though I’m suffering from the burning pain every second.

I sent Dr. Handsfiled an email asking for a help, and I was informed to visit ASHA.

The reason why I asked some general questions at first is because I wanted to understand proper regimen for PID since I’m scared of being treated with wrong antibiotics again and being treated by doctors who believe Metronidazole is effective against Chlamydia (Some doctors do so in my country).

I was going to upload my final question with new information about my inpatient regimen and symptoms after uploading these two threads about my sexual and medical history, because it was too long to write in one thread.

Dr. Hook, could you please allow me to ask a question?

I have a very important continuing question from previous Dr. Handsfield’s answers, and I desperately need to receive answers from him to get treated in my country. Could you please understand my situation?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
Greetings. Dr. Hook asked me to comment.

I agree with everything he wrote above and in your other threads. From the information above, I cannot tell whether or not your initial problem was acute PID. Association with mucopurulent discharge certainly is consistent with that, but you don't say whether that was also present at the beginning of your hospitalization and antibiotic treatment. Even if it started as acute PID, it wasn't necessarily due to gonorrhea, chlamydia, or any other STD. A substantial minority of PID cases have nothing to do with STD (which is really our only expertise on this forum). And maybe it wasn't PID at all.

Whatever you had then, you give no evidence to suggest active PID is the problem now. Neither PID nor any STD causes symptoms like "burning pain spread to upper back thighs & front thighs". Your chronic abdominal pain could result from past PID -- as well as endometriosis or any of several other pelvic or intra-abdominal problems. From your comment about "scarring", you seem to know that not all pain after these problems is due to active infection. The exact reasons for persisting pain after such conditions are not known well, even though often attributed to adhesions, scarring, etc. From one of your other threads, or perhaps from the questions you asked at HealthTap.com, I think I recall that you no longer have fever and have had normal inflammatory markers (ESR and perhaps C reactive protein (CRP), and maybe that your white blood cell count is normal. These results also favor a non-infectious, non-inflammatory cause of your symptoms. From much you have written both above and previously, I suspect a major component of the problem -- perhaps the only important part -- is psychological. While I am not a believer in emotion, depression, anxiety, etc creating symptoms out of thin air, for sure they can greatly magnify perceptions of discomfort, pain, and other symptoms. This may or may not apply in your case, but it is a reasonable possibility.

For those reasons, I agree that additional antibiotic treatment is not likely to be helpful. Whether or not you were treated with one of CDC's recommended regimens for PID really doesn't matter at this point. Those recommendations are clearly stated as guidelines, not requirements, and several other antibiotic regimens usually would work equally well. The PCR tests you had are highly reliable, essentially ruling out initial and/or continuing infection with gonorrhea or chlamydia. Also, both gonorrhea and chlamydia are cleared by the immune system, usually within a few weeks or months. So even if you had either of those STDs and the antibiotics in 2013 not fully active against them, you can be sure you are not infected now and they are not causing your current symptoms.

Moreover, I agree exactly with Dr. Hook's judgment that you are expecting too much from this forum. The answers to your concerns -- accurate diagnosis and appropriate treatment going forward -- will never come from this or any other forum, email, web information, or any other distant expert advice. Your situation is far too complex. The only rational approach is to find a single knowledgeable physician then follow his or her professional advice, which might include professional counseling if s/he agrees there may be a significant psychological component.

Finally, please note that this forum's policy is to reject repeated or anxiety-driven questions. I believe this is your fourth thread. It will have to be your last one. Any further new questions will be deleted without reply (and without refund of the posting fee). We have this policy first to protect users from themselves (spending money when the answers will not change) and because repeated questions have no educational value for other users, one of the important reasons for the forum.

If you have another BRIEF comment or question, post it below, after which this thread will be closed. Best wishes.

---