[Question #2288] Pelvic Inflammatory Disease

44 months ago
Hi this is a second question for me and thank you for your help. I began sleeping with my ex unprotected in February in March I had symptoms of  an ear infection, I was prescribed Augmentin on March 13th BID for 7 days, I took the full dose. On April 17th I had a STD test which I was positive for Chlamydia. I took the full treatment on April 19th 1G of Azithromycin. My partner took his dose on April 26th and hours later he had vomiting and continued to have vomiting for a couple days that actually put him in the ED on May 2nd. He told the doctor he had taken 4 250mg tablet of Azithromycin and the ED doctor did not retreat him. A week later we began having oral and brief (5-10) seconds of penetration, no ejaculation. On June 1st I had some abdominal discomfort with 1 episode of discharge.  I went to an urgent care and was swabbed, my test came back positive for chlamydia again. My dr now has me on 100mg BID of doxycycline for 7 days, I am on day 6. My MD said I do not have PID on Friday June 9th, after I began treatment. My question is, is it possible that I had PID prior to beginning treatment with doxy? I had pelvic pain, bloating, and 1 episode of yellowish discharge, no copious amounts. Also my menstrual cycle before was 2 weeks late.  Am I receiving the proper treatment? I am now on my menstrual cycle and cramps feel more like a burning sensation, but go away. Also how soon can chlamydia be detected in males for urine? And how long does it take PID to effect fertility in women? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Welcome back to the forum. However, these are the identical questions to which Dr. Hook replies in your previous thread. I agree with all he said and will only add a few minor points of clarification.

Azithromycin fails to cure 2-5% of chlamydial infections. The chance it failed in your partner probably is a little higher than this, given his vomiting. However, vomiting any more than an hour after taking it is not believed to reduce its effectiveness against chlamydia. In any case, it is impossible to judge whether your repeat positive test was because azithromycin failed in you or in him, i.e. whether you had a persistent infection (treatment failure) or reinfection after resuming sex with your partner. In any case, this really doesn't matter.

Diagnosing PID is imprecise. However, only transient pain is against it; you don't mention severe tenderness internally during pelvic exam; and your doctor said you didn't have it. You give no evidence to suggest he is wrong, and 7 days doxycycline always is sufficient against chlamydia. (Longer treatment is recommended for PID, not because of chlamydia per se, but because PID usually involves additional bacteria in addition to chlamydia or gonorrhea. I doubt your fertility will be affected. 

In both men and women, the standard chlamydia test (a nucleic acid amplification test, or NAAT -- a test for chlamydial DNA) generally is positive within 2-3 days (and for sure within a week) after catching the infection.

Does that help?   HHH, MD

---
44 months ago
It does, thank you. Does the 98% effectiveness of Doxycycline still hold for this situation?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
I'm not sure where you learned that doxycycline is 98% reliable against chlamydia. It's probably truly 100%, or very close to it -- certainly over 99%. Just about all apparent exceptions in various treatment studies were generally attributable to failure of the patient to take the drug as directed, or to reinfection in people who did not admit to reexposure. You can be sure you'll be cured if you take doxycycline as directed and complete the 7 days course.

---
44 months ago
I took the doxycycline twice a day, at exact intervals, sometimes with food as directed by my physician as it can cause nausea. Although I've read you should only take on an empty stomach. And I realized I've had at least 2 yogurts during the week, and I've read you should avoid calcium. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
The effect of calcium or other foods on doxycycline absorption and effectiveness is theoretical; the actual effect is small and we generally do not give such instructions to our many STD clinic chlamydia patients treated with doxy, and I recall no instances of documented treatment failure. Indeed, shorter courses of doxy (e.g. only 4 days) or lower doses (100 mg once daily instead of twice) usually would be effective. You took the drug more carefully than many patients do and really needn't worry about its effectiveness.

That completes the two follow-up comments and replies included with each question and so concludes this thread. Please note the forum does not permit repeated questions on the same topic or exposure. This being your second, it will have to be the last; any further questions about this exposure, testing, and your concerns about chlamydia or PID will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.

I hope both of your forum discussions have been helpful. Best wishes and stay safe! 

---