[Question #3588] PID Confusion

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88 months ago
Hello,

In PID caused by previously asymptomatic chlamydia or gonorrhea, what is the longest lead time between time of infection and the appearance of symptoms?

I've read that any sexual partners in the past 60 days would need to be tested/notified. Does this mean it's impossible for PID symptoms to show up in a longer amount of time than that? 

In other words, I read this as "if you're going to present with PID symptoms, it'll happen within 60 days." But what about the STI that sits without symptoms for longer than that?  Is a patient safe from experiencing PID?
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Edward W. Hook M.D.
88 months ago
Welcome to our Forum. You don't provide much detail so this reply may sound a bit textbook like.  PID occurs when bacteria from the lower genital tract move into the upper genital tract (uterus, Fallopian tubes).  PID can occur in Persons with symptomatic or asymptomatic lower genital tract infections.  Chlamydia, Gonorrhea, and the many bacteria which are normally present in the lower genital tract all can cause PID.  

In answer to your questions, asymptomatic chlamydial infections can persist in the lower genital tract for long periods of time, months or even years.  Typically over time, even without antibiotic treatment, the body fights off infection and infections "clear".  Thus, over time, more and more persons spontaneously clear their infections but, as long as infection is present, a woman with untreated chlamydial infection is at some risk for PID.

I hope this information is helpful.  EWH
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88 months ago
So why the guidance to contact only partners from the past 60 days? 

Sorry I was so vague. Here's more detail. 

-I am having a watery brown fishy-smelling discharge. No pain, fever or other symptoms (except for fatigue, but I've been working very hard and not getting a lot of sleep).  I have an appointment with my gyn this week but am getting very worried.
-My partner has been testing negative for chlamydia/gonorrhea since December 2016, but we've been together longer than that. He's never been diagnosed or treated for it, but from time to time has taken a zpack for other reasons (the 5-day dosing, not the 1g single dose).
-We have very infrequent sex (once every few months, if that). We don't use condoms but he always pulls out before ejaculating.



1, Could he have had chlamydia without knowing it more than 18 months ago, only to treat it unknowingly with a zpack?
2. If so, could I be infected from that long ago and have PID symptoms only appear now?
3. I've taken a number of 5-day zpacks in the past several years too, so wouldn't that have cleared me up if I had chlamydia?)
4. I know PID presents differently in every case, but is it common to have only the discharge and no other symptoms?

I know I should just wait for my doctor's appointment but I'm very nervous about this.  I'd love to hear your thoughts.

Thanks doctor.

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Edward W. Hook M.D.
88 months ago
Thank you for the additional information  I'll expand on my answers.

The 60 day guideline related to the assumption that PID is more likely to be related to recent (or new) sexual partners.  it is not absolute.  OTOH, from what you have told me, there is not a lot that you've said that suggests that you have PID.  The hallmark of PID is lower abdominal pain and pain on sexual intercourse, neither of which you mention.  Vaginal discharge can have many, many causes.   If your partner had had negative chlamydia tests, not to mention that you have both apparently taken azithromycin on several occasions in the past, I would look for other causes.  For instance, the discharge you have noticed could be bacterial vaginosis, the most common cause of vaginal discharge in women.  BV is not an STI in the traditional sense but is due to a disruption in the bacteria normally found in the vagina, has odor as one of its prominent symptoms and is treated with antibiotics other than azithromycin. 

In answer to your specific questions: 
1, Could he have had chlamydia without knowing it more than 18 months ago, only to treat it unknowingly with a zpack?
That is possible- chlamydial infections are often asymptomatic but I am not sure why you are assuming that your problem is an STI or that your BF has chlamydia.  Is there a trust issue here.  If so, the right thing for you to do is to see your own GYN and be evaluated.

2. If so, could I be infected from that long ago and have PID symptoms only appear now?
This can happen but really seems unlikely from what you have shared in your posts.

3. I've taken a number of 5-day zpacks in the past several years too, so wouldn't that have cleared me up if I had chlamydia?)
Yes, this is one of the reasons why chlamydia infection (and PID) seem to be unlikely as the source of your discharge.

4. I know PID presents differently in every case, but is it common to have only the discharge and no other symptoms?
No, this would be a most unusual way for PID to present.

I hope these comments are helpful.  Clearly the discharge is troubling you.  It could be due to many different causes and the best way to address this is to be evaluated.  Please don't be fearful of seeking evaluation, it does not chage what is present, but does give you information on a troublesome problem.  EWH

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88 months ago
Thanks for trying to set my mind at ease.

I think my concern starts from the color of the discharge. Everything I have read is that BV is usually clear to gray in color.  What I am seeing is brown. So is BV more variable than that?

And what is the most common presentation of PID?  Descriptions I've seen is that it's highly variable and can be very minor. But you say smelly discharge alone is unusual? I'm seeing my doctor later this week but I'm still pretty confused.


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Edward W. Hook M.D.
88 months ago
Vaginal discharge can have many appearances and an accurate diagnosis cannot be made based on color.  You are correct that BV discharge is usually white or grey but BV i also the vaginal discharge which most characteristically has an odor.  Seeing your doctor is the right thing to o.

The hallmark of clinical PID diagnosis is lower abdominal pain.  The vain can be variable but local pain and unusual tenderness are the most typical findings of PID.  Discharge by itself is not typical of PID.

Our Forum provides up to three replies to each client.  This thread will be closed later today and there will be no more replies from this side.  I hope the information I have provided has been helpful.  Take care.  EWH
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