[Question #4961] Questions

26 months ago

Hello Doctors, I am currently looking through past medical records and am curious about a previous case of undiagnosed cervicitis.  My symptoms were as follows:"Urinary Symptoms, Description: Onset: 1 week ago. There is no radiation. Location is suprapubic. The patient describes it as burning. It occurs occasionally. The problem is with no change. Context: post-coital and new partner. Denies aggravating factors. Denies relieving factors. Additional information: no history of interstitial cystitis, no history of irritable bowel, no history of pyelonephritis, no history of stones, no history of UTIs, sexually active and LMP: 07/13/2017. Pelvic Pain (chief complaint). Description: Onset 1 week ago. There was no radiation. Location is left, right and midline. The patient describes it as aching, sharp and Notes white d/c. It occurs constantly. The problem is unchanged. Context: after intercourse, increased STD risk and with intercourse. Symptom is aggravated by intercourse. Denies relieving factors. Associated symptoms include dysuria and dyspareunia. Pertinent negatives include amenorrhea, bloating, constipation, diarrhea, dysmenorrhea, fatigue, fever, hematuria, nausea, rectal bleeding, urinary frequency, vaginal bleeding, vaginal discharge and Denies odor or itching."I tested negative for chalmydia and gonnorhea and the following procedures were performed: Amines, vaginal fluid, qualitative, Assay, body fluid acidity, Smear, stain & interpret, wet."  I was prescribed Zithromax 500 mg tablet.  The symptoms went away after a few days.  When I asked the doctor what the cause was she was not certain and did not report any bv, trich, or yeast infection.  Based on the procedures performed, am I to assume I was not diagnosed with BV, yeast, or trich?  The diagnosis on the chart were as follows: "Inflammatory disease of cervix uteri; Acute vaginitis; Dyspareunia; Dysuria; High risk heterosexual behavior." Is it possible this wasn’t an STI? Should I have had partners treated?

Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Welcome back to the Forum.  The material you describe in your question appears to have been generated by one the the modern electronic medical record programs which provide clinicians with limited options for reporting what they see.  Such programs are great for billing but sometimes make understanding what is going on difficult.  As I read the report you were evaluated for lower abdominal oand/or pelvic pain and perhaps burning on urination.  You were tested for Gonorrhea, Chlamydia, trichamonas and perhaps BV and yeast.  All tests were negative and you were treated with azithro in which, by your report, lead to improvement over the next few days.

FYI. there may be a separate section of your medical record in which your laboratory tests are directly and specifically reported.

From what I see here, it is hard to know what was going on.   You MAY have had a syndrome called pelvic inflammatory disease which is sometimes but not always related to STIs.  Because your tests were apparently negative for STIs, there is no clear indication that your sex partners needed treatment.

I hope this helps.  EWH
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26 months ago

What makes you say that I was tested for trich?  Is there a reason why the Planned Parenthood reports do not report the results for trich, and other possible infections? Is there a chance that the test missed the trich and the azithro cleared up the trich? What would the more definitive lab results report?  And, based on my symptoms, should I have been told to notify my current partner at the time? Is there any benefit to notifying them now or is it more likely than not that I did not have an STI, even though my symptoms were relieved with the azithro? Could this possibly be a herpes infection? No lesions were reported and the antibiotics helped. 

26 months ago
Additionally, is it common to have acute vaginitis and cervicitis and urethral pain that is treated successfully with an antibiotic that is not due to an STI? Is it highly unlikely this was not caused by an undiagnosed STI? How many cases of acute cervicitis are not caused by STIs?  Would you recommend against notifying this past partner and letting him know to get tested?
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Your record mentions "vaginal fluid, qualitative....wer".  The,wet preparation is the most widely used test for trichamoniasis. M these tests are typically done at the time a client is sen at PPH- is that where you were seen?  Did you ask them if they tested for trich?  Most PPH clinics typically do.

Trich is sometimes missed by the wet preparation but azithromycin is of no,proven value for treatment of trich.

Your question about partner notification was answered above.  If your tests were negative there is no reason to treat partners unless there is a clinical diagnosis of an STI problem such as pelvic inflammatory disease.

Nothing in your record indicates a reason to suspect herpes.

 Having answered your questions I must ask a question or two of my own.    This is your third question to Dr. Handsfield or myself in the last few weeks.  Each of the events. CIN and this apparent episode of abdominal/pelvic pain, that you describe occurred over a year and a half ago.  You seem to be reviewing old medical records. The context in which you are asking these questions is difficult for me to follow. While I respect your concern for your partners, if you explained more of your circumstance I could be more helpful to you.   EWH
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26 months ago
Thank you for your help and subsequent questions. 

Yes, I was tested at the Planned Parenthood. 

Considering there was a physical exam, would I have been notified if I had PID? How is PID diagnosed? I did not receive positive tests for anything as far as I am concerned. They said the cause of my cervicitis was inconclusive and did not administer further testing. 

If the test did not report trich, and the medication prescribed treated my symptoms and i had no further inflammation or the painful, at times almost bloody urination I experienced as well as pelvic pain after the antibiotic, is it safe to say I was negative for the STIs that could have led to the cervicitis and that all my symptoms could have been the cause of some other bacteria (not bv or yeast)?  I have also just heard of m. genitalium.  Is it likely that I had it and why was not told to disclose to partners or tested for it?  Could the genitalium have extreme adverse consequences for that partner if left untreated?

And, I really do apologize for my neurosis.  I am coming from a place of confusion about the lack of communication I experienced with practitioners and how this may have affected my partners and where my responsibility began and ended in regards to partner notification, especially in this case of the mysterious cause of the cervicitis.  I have not always practiced safe sex and feel like I have put people at risk. 
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
I suspect you are overthinking this, and perhaps do not have a high level of trust in the providers who saw you at PPH.  Trust is critical here.  Providers train for years to be able to integrate the observations they may in taking a history, doing s physical examination, and performing both in-clinic and send-out laboratory testing to put all this information together to guide their patients forward.  It sounds to me as though your providers did things properly.  If you were not comfortable with what they were doing, it is your right o ask them for clarification.

Cervicitis is a term which refers to inflammation of the uterine cervix - STIs can cause cervicitis but for most women with clinical findings of cervicitis, STIs are not the cause and no microbial cause is immediately apparent.  In a minority of women with cervical STIs infection may go up into the genital tract to cause pelvic inflammatory disease. Your tests for the most common causes of PID, gonorrhea and chlamydia, were negative (trich does not cause PID).  Thus the provider you saw gave you appropriate therapy for non-specific cervicitis (azithromycin) and it sounds as though you improved.  There was not a clear indication for partner therapy here.

The role of M. genitalium as an STI is unclear at present and even when present, azithromycin would have been expected to cure it.

My sincere advice:
1.  Try to stop worrying.  Part of this should include staying of the internet which will mislead you more often than not.
2.  Trust your providers going forward.  If you have questions ask.
3.  Put the past behind you and do not upset yourself with "what if" questions, particularly as it related to partner notification and therapy.  The past is past.

This is my 3rd reply to your questions which are beginning to be redundant.  I am not sure we have much more to offer you att this time on this site.  This thread will be closed, as per Forum guidelines shortly.  Take care.  EWH
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