[Question #5044] Does having chlamydia symptoms actually mean you have PID?

77 months ago

I am a female who was diagnosed & treated for chlamydia over a year ago. The timing of my pos result from my last neg one meant i couldn’t have had it longer than 3 months at the latest (late sept. result was neg, early dec. result was pos). i was testing more often as I had multiple partners on and off at this time. Symptoms showed up a little over 3 wks from the last time I had had sex (vaginal discharge, burning/frequent urination, maybe a bit of lower ab pain). The symptoms all went away in about 3 days after treatment & my follow-up test 1 1/2 months later was neg, though i was diagnosed right before that with BV by a wet mount of my vaginal discharge. Since then, I have been monogamous with a guy who had never had any kind of sex before me, so I’m not worried about reinfection and haven’t tested since. my question is, does the fact that i had chlamydia symptoms at all mean it managed to cause PID that soon (between 3 weeks and 3 months)? If it was PID, did the azithromycin treat it too or could it still be present/doing damage silently? What are the odds of this affecting my fertility later on in life? I googled the chlamydia and PID link and it says PID can develop as soon as 2 days after infection! Can’t believe my doctor didn’t tell me that. I thought as long as I was treated I was good to go :(

Edward W. Hook M.D.

77 months ago

Welcome to the Forum. I'll do my best to help. You are asking good questions and your detailed history and timeline are also helpful. Even with all of this good information however, I cannot provide you with an absolute yes or no answer. Certainly chlamydia can and does cause PID and when it does it can damage the fallopian tubes, increasing the likelihood of infertility. Sophisticated research done over 30 years ago shows that about 10% of women who get PID due to chlamydia (or gonorrhea) will have bilateral tubal blockage and be infertile based on this. OTOH, this means that 90% of women will not be infertile.

Whether or not you had chlamydia is difficult to say. Although most chlamydial infections are asymptomatic, when women have symptoms they have the sort of symptoms that you describe - vaginal discharge, burning on urination. PID can occur soon after infection although the longer the infection is present, the more likely PID is to occur. Classical symptoms of PID include lower abdominal pain, unusual discomfort or pain during bimanual pelvic examinations (i.e. when the doctor puts their fingers not your vagina to feel your uterus), and pain of sexual intercourse. Thus whether your apparently mild abdominal pain represented PID is hard to say. The fact that your symptoms all improved and that your follow-up tests were negative indicate that your infection was cured.

Putting all f this together, the odds are good that you were not rendered infertile at the time of your chlamydial infection but you will not know for sure until you try to become pregnant.

I hope these comments are helpful. EWH

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77 months ago

Thank you very much for your input, Dr. Hook. I just want to clarify a few things!

1. Are you saying my symptoms could have just been from the chlamydia, but if it they were caused by PID the azithromycin cured that too as my symptoms all went away?

2. If not, could PID still have developed after my chlamydia infection cleared? Why didn't my doctor test me for PID when chlamydia was diagnosed?

3. Are my chances good that if I had progressed to PID and had my symptoms treated promptly that the damage done was minimal?

4. Are cases of infertility way more common with cases of chlamydia that were untreated for years rather than a couple weeks or months?

5. I've also read that BV can cause PID, but is this common? I had BV when I had chlamydia, or shortly after, and I think I may have it again now due to discharge and that makes me worry my risk for infertility rises due to that.

All in all, I just want to be reassured that my risk here is minimal. It's scary to think I won't know for sure til I try to get pregnant :( I thought I had managed to catch it somewhat early (between 3 wks-3 months of infection) but hearing that PID can develop within days is very unsettling indeed.

Edward W. Hook M.D.

77 months ago

1. Yes your symptoms could have been from chlamydial infection of the cervix (the primary site of infection) without being due to PID. Your infection was cured, as proven by both the resolution of your symptoms and the negative follow-up test you had.

2. PID is not a separate diagnosis. Chlamydia can be clinically present in a variety of ways, as asymptomatic infection of the cervix, as a symptomatic infection causing vaginal discharge, urinary frequency, etc., or as PID. Typically assessment for the presence or absence of PID is done in the context of diagnosis and management of chlamydial infection although clinicians typically would not even raise the issue of they did not thing PID was present.

3. I provided the statistics on this above. Prompt treatment and shorter duration of infection does help minimize and prevent damage by the infection.

4. Yes

5. PID can be caused by many different bacteria including PID, gonorrhea, and the bacteria that cause BV. PID is a subset of infections (a complication) that occurs when the bacteria go from the lower genital tract (the cervix of the uterus or the vagina) to the upper genital tract (i.e. the uterus and fallopian tubes). Most women with these infections do not develop PID and most women with PID do not become infertile. I urge you not to over think this. You had chlamydia, you were successfully treated. Continuing "what if" questions are not very helpful.

I hope these comments are helpful. The issue of who had PID and who suffers the consequences are complex. EWH

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