[Question #4185] Did my girlfriend's pelvic exam miss Pelvic Inflammatory Disease?

31 months ago
Hi doctors, Thank you for taking the time to answer my questions. Me and my girlfriend had a threesome in late January/early February. From this encounter, I received  chlamydia. We were both treated simultaneously for chlamydia on March 9th. However, recently my girlfriend told me that she was scared her medicine didn’t work, because she threw up less then an hour after taking it on March 9th. She did not see any pill residue in her vomit, so assumed that she would be OK. Now we did have lots of sex in the time after this, and I routinely retested. I received negative results for chlamydia twice in March and June, so it’s safe to say I believe it’s safe to say that the medicine worked. To ease her mind however, we took another dose of azithromycin in early August and waited 7 days to have sex.

My girlfriend suffers from endometriosis and already is infertile, has cramping, has somewhat erratic periods, and pain during sex. However, she recently complained about increased discharge before her period, so we decided to get her a pelvic exam to rule out the possibility of Pelvic Inflammatory Disease from the chlamydia.  The doctor did a wet mount and her antigen and antibody results were negative. However, the doctor did note that she had a “few”white blood cells on her wet mount. The exact language was “WBCs: Yes -few”She only did a wet mount to my knowledge, and not any other tests like an ultrasound. She said she did not think she has pelvic inflammatory disease.My question is, should the doctor have done more tests when they saw she had a “few” white blood cells? Is this just normal? If she had PID, would a cervical swab show more WBCs and a vaginal swab only show a couple?  I understand the doctor thought everything was alright and didn’t see the need for further testing, but I want to make sure she received proper treatment. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
Welcome back to the forum. I'll be answering your question this time, but I reviewed your discussion with Dr. Hook a few months ago.

The treatment you and your wife apparently both received, azithromycin in a single 1 gram dose, is around 95-98% effective in eradicating genital chlamydial infection. Although such a large dose can indeed cause nausea and vomiting, as your wife experienced, research has shown that if vomiting occurs more than 30-40 minutes after taking it, enough is retained so that treatment is effective. So your wife's vomiting doesn't concern me at all.

Even without vomiting, azithromycin is not quite 100% effective. In addition, you will understand that new infections are common -- many people with initial chlamydia (not necessarily you and your wife) are likely to be reexposed. Therefore, the standard recommendation from CDC and other public health agencies is that everyone treated for chlamydia should be retested 3-6 months later, to detect both the occasional treatment failure and occasional cases of reinfection. However, you and your wife did that -- you were retested and negative in June, right? And then despite those negative results, you both were retreated with azithromycin recently. I see no reason why that was done and I would have recommended against it. In any case, with both your negative test results in June plus re-treatment in August, there is simply no realistic chance either you or your wife currently have it. Finally, your wife's gyn is exactly right that "a few WBC" is entirely normal in healthy women and it definitely is not a reason for still more testing for chlamydia (or any other STD).

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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