Hello and thank you for this service.  My wife went to the OBGYN yesterday after a week of increasing discomfort with her cervix.  They took cultures for Gono/Chlamydia and prescribed her Augmentin for 10 days.  She has been on it for 2 days (4 doses I believe) with symptoms staying the same or worse which include shooting pains into her pelvis from her vagina, stomach pain and severe discomfort (she is currently menstruating so its hard to tell if her discharge is abnormal).  The doctor did tell her that she was going to prescribe something for Gono/Chlamydia but changed her mind and prescribed Augmentin because my wife told the her we are monogamous and the examination of the discharge didn't look like Gono/Chlamydia.  However, I am terrified that I caused this since 24 days ago I visited a massage parlor and received unprotected oral to completion (probably 7-10 minutes).  My wife and I had sex a few days (3-5) after my exposure that included analingus (me on her), cunnilingus, sharing a vibrator with some anal play but no insertion for either and vaginal sex (I believe she had just finished or was close.  To this day since my massage parlor exposure however I have had zero symptoms of an STI (no puss, discharge, discomfort, etc) but went and got a urine test for Gono/Chlamydia/Trich anyways (I should have the results in 1-2 days).  On a side note, I was diagnosed with HSV1 over 10 years ago and my wife was diagnosed with HSV2 during that same period.  I have no idea if my HSV1 is genital or not because I've never had a breakout (she has the occasional mild breakout that's effectively treated with Valtrex).   

Questions: 1. I'm wondering what the chances are that I caused her PID?  2. I realize unprotected fellatio is relatively safe, but isn't the timing of all this too coincidental? 3. Could I have an anal STI and passed it to her with the vibrator (I received analingus about three months ago from another massage parlor exposure but nothing else unprotected)? 4. 

This is a somewhat challenging situation. The only STD likely to be acquired by oral sex that is also a potential cause of PID is gonorrhea. But gonorrhea almost always causes prominent symptoms in men, with painful urination and pus dripping from the penis, generally starting within 5 days of exposure. So although I cannot say for sure you were not the source of your wife's apparent PID, it seems unlikely. That said, the timing certainly remains suspicious. Presumably your wife's gonorrhea and chlamydia tests were negative, right? (If not done, if no more than a few days have passed, it still may be worthwhile; it takes a few days of treatment for the standard DNA tests to become negative.)

I'm a bit puzzled by her doctor's treatment advice. The recommended treatment of PID does not depend on whether or not it is suspected to have been acquired sexually or due to STD. Some PID is not related to sex at all, and can be caused by bacteria that indeed would respond well to augmentin (I'm thinking of Haemophilis influenzae in particular, but there are others as well). However, this and other non-STD causes would also resond to the standard recommended treatment, i.e. an initial dose of ceftriaxone (by injection) followed by 10 days of doxycycline (often also with metronidazole). She might do well on augmentin, but her doctor will need to follow her carefully.

Another factor for you to keep in mind is that when one member of a couple finds a need for outside sexual experiences, the feeling often is mutual. Of course you're a much better judge than I can be about whether this is likely for your partner.

Those comments pretty well cover your specific questions, but to be explicit:  1) Possible but the likelihood seems low, although (2) i agree the timing is suspicious. 3) This probably has nothing to do with the vibrator business. Anal/rectal STDs from analingus are rare.

A final aspect you don't mention:  All sex partners of women with PID should be treated as if they have gonorrhea and/or chlamyida, regardless of the woman's test results and the apparent source of her infection. You should be treated with ceftriaxone plus either azithromycin or doxycycline. Discuss it with your doctor or hers.

Sorry that clear answers aren't possible, but I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

Almost certainly this isn't a herpes problem. HSV doesn't cause PID or abdominal pain.

There are no symptoms to be on the lookout for, other than discharge and painful urination. No STDs cause altered urinary frequency, urine odor, or obvious change in appearnce of urine. 

Each forum question includes two follow-up questions and replies. At this point, there's nothing more I can advise. I look forward to learning in a few days how your wife has done and the results of her gonorrhea/chlamydia tests.

No other comments or advice until you have the results. OK?