[Question #5596] Did I give my wife chlamydial pid

21 months ago

Dr HHH,

I contracted chlamydia on a work trip and upon my return home awaiting the results of the test, I had insertive vagina intercourse with my wife with a condom. since I had one time protected sex, I wouldn’t  risk my relationship because the effectiveness of condoms stated on your site.  I was treated with anzythromycin upon the positive test and followed the doctors instructions and did not have sex until 2 weeks later, where we had unprotective vaginal sex. Later that day, she then started having some symptoms of burning and itching on her vagina, and we both underwent treatment of doxy for 7 days. The symptoms of burning and itching went away. However, a month or two later, she started composing of stomach pain after she ate certain foods, and her stomach would bloat immensely, and have diarrhea and constipation. I started to become worried that she had indeed contracted chlamydia, and had manifested to PID. . In addition, she went off her birth control at this time and started to complain of extremely painful periods, and a dull ache on her right ovary. She claimed she always thought she had endometriosis from a young age / and symptoms of a cyst on her ovary. 

    Now, extremely worried I got a test for chlamydia again and came out negative. Upon further continued syptoms and more worrying, I got another NAT test which also came out negative . Starting from the treatment of doxy initially, we had multiple unprotected intercourse. 

  1. With one time protected sex while positive, doxy treatment for both of us, and my subsequent CT tests being negative, what are the odds that she has Chlamydial PID?  

2.Would only 7 days of doxy  have a high change of clearing PID if it had manifested?

3.Does the fact that we had unprotected sex numerous times, and my subsequent negative test prove that she does not have PID? Will a STI negative test on her end mean she doesn’t have PID? 

Your response is appreciated.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Welcome to the forum. Thanks for your very articulate and insightful question.

1) Since the single episode of sex after your diagnosis, but before treatment, was condom-protected, the chance you infected your wife was very low, but not zero. Since you both subsequently took doxycycline (and you were also treated with azithromycin), there is no realistic chance either of you has chlamydia now, or that she had PID caused by chlamydia. In any case, the symptoms you describe for your wife don't sound suspicious for PID, which doesn't cause bloating, diarrhea, constipation, food intolerance, or genital itching/gurning. And your most recent negatiive chlamydia tests are reliable.

2) Doxy for 7 days migh or migh tnot cure PID, but it's unlikely she had PID. For sure that dose always cures chlamydia. 

3) The negative tests prove she doesn't have chlamydia. PID is a clincial diagnosis, i.e. based on symptoms and examination; it't not a diagnosis made by any single lab test. But all things considered, I am confident your wife does not have PID and never did. I think you can go on with no worries of your wife having any medical consequences of your sexual indiscretion or chlamydia.

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

HHH, MD
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21 months ago
Thanks for the reply. This answers reassures me and I have no real further questions, but it just seems like the gastro problems, as well as the thought that she has endometriosis, (which has similar symptoms to PID) came far to much  during the same time to be coincidence. Along with symptoms associated with endometriosis,she has also been complaining of a burning sensation in her stomach, as well as the dull ache on her right ovary, (which I think is adrexnal tenderness). Just some follow up questions out of curiosity. 

1. Could PID  cause gastro problems? 
2. Are there statistics on single episode chlamydial transmission from male to female and vice versa? ( research seems to say around 60% which seems low)
3. Are CRP and ESR blood tests that show a “normal” range sensitive enough disclude PID. One stat I show was a sensitivity of 91%. 

Thanks you for your thoughts. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
I'm glad the comments were reassuring. Indeed endometriosis can cause symptoms similar to PID. So can a substantial number of other conditions. If she isn't seeing a physician about her symptoms, she should do so. But you can be sure it isn't PID.

1) Already abnswered above -- PID is not a likely cause of gastrointestinal symptoms. 2) There are rough estimates of transmission efficiency for chlamydia, and yourm 0.6 (60%) chance is about right for any single epsiode of unprotected vaginal sex -- maybe around 50% female to male and 80% M to F. 3) There are no data on CRP, but ESR probably is indeed roughly 90% sensitive for PID. For the reasons already discussed, there was already little chance (virtually zero) your wife has PID; with normal CRP and PID, virtually no chance.

Really, try not to overthink all this. The science is very strongly on your side, i.e. no PID time for you to move on and stop worrying about it. 
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