[Question #706] PID

103 months ago

Dear Doctor,

I was diagnosed with chlamydia towards the end of February and treated with a 7 day course of doxycycline. (I have been proven to be resistant to azithromyicin) I was given a test of cure (swab) on March 28th and the results came back negative for Chlamydia. My symptoms have gone away for the most part. My discharge is no longer a dark yellow color (It never smelled foul). However, I still feel like I am having an excessive amount of discharge. It ranges from a clear to milky color and occasionally leaves a light yellow stain on my panty liner. At this point, I don't know if I'm just paranoid (I have always felt the need to wear panty liners because of discharge) or if I might still be at risk for PID. I know for certain that I have not been re-infected with chlamydia because I have not had sex since I was treated. The last couple of days, I've had on and off cramp like pains and my lower abdomen feels slightly tender when pushed around on. If the chlamydia was successfully treated, could I still have developed PID? My doctor did not test me for PID even though we discussed it. Any information would be helpful. Thank you so much!

Carrie

H. Hunter Handsfield, MD

103 months ago

Welcome to the forum and thanks for your question, which came while I was logged in to the forum. Other users should not expect nearly real-time replies!

First and perhaps most important, doxycycline virtually never fails to cure chlamydia; and your follow-up test confirms your infection was eradicated. Second, as you have noticed yourself, the amount of vaginal discharge or moisture that is "normal" can be difficult to sort out. Larger amount, color, and associated symptoms like itching or irritation are more important indicators that something is wrong than are mild variations in the amount. Clear to milky is normal, as is scant staining. However, if you remain concerned that your vaginal discharge is not normal for you, the safest thing is to be examined professionally to make sure nothing is wrong.

As for PID, that might be a risk if your chlamydia had not been successfully treated; and there are many PID cases not associated with traditional STDs like chlamydia or gonorrhea. But there is nothing in your medical history of symptoms that suggest you are risk for PID at this time. As you may have experienced, on and off mild cramps are pretty common. Finally, your doctor has reassured you about it. (There is no lab test for PID. Generally it is a diagnosis based on risk, lab tests for chlamydia or gonorrhea, and physical examination.)

So at this juncture, I am quite confident you don't have PID and are not at significant risk for it. For sure chlamydia can't be causing PID at this time. If your cramps and/or possibly abnormal discharge continue or get worse, I would suggest reevaluation by your doctor. The most important prevention strategy at this point is to avoid future chlamydial infections or other STDs. You shouldn't be having sex with any partners from last February who haven't been treated, and of course should otherwise follow standard safe sex practices in terms of partner selection, condoms for new or unsafe partners, etc.

By the way, you are not "resistant to azithromycin". Antibiotics work or not based on whether it is active against the particular cause of an infection, not because the antibiotic doesn't work in that person. People can have strains of bacteria resistant to azithro, but if the bug is susceptible, treatment is generally effective. Azithromycin isn't quite as reliable against chlamydia as doxycycline is (98% instead of 100% reliability), but that's not because somehow you would be resistant to it. In other words, if you have another chlamydial infection someday, azithromycin would work well.

I hope these comments have been helpful, but let me know if anything isn't clear.

Best wishes-- HHH, MD

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103 months ago

Good morning!

I would like to give you more information regarding my experience with chlamydia. It's been a complete nightmare. I was first diagnosed with chlamydia in July 2015 by my doctor. I was treated with azithromycin and went about my everyday life because I was told a test for cure was not necessary. My symptoms seemed to ease up, but I was still worried. A couple of months later, I could tell something was still wrong. I went to the health department because it's only $20 opposed to the $160 (even w/ United Health Care). I tested positive again and treated with azithro. Long story short, I have been going back and forth between my doctor and health department from July 2015 - March 2016. It seemed that we could not get anything sorted out until this last treatment with doxy. My next question is, if PID had already developed at the time of my last treatment, would the treatment have treated both chlamydia and PID? I don't know if that makes any sense, but I am losing my mind and feel like I have been caught in a hamster wheel. I have even lost confidence in my doctor because I have become so paranoid. Is it likely that PID could have developed over those 8 months? How long does it normally take? I don't feel comfortable just waiting to see if my symptoms get worse to know answers. I've been reading that by the time symptoms of PID occur, the damage has already been done. Side note: Each time I was treated, I waited the 7 days to have sex, and my partner was also treated (but his doctor prescribed him doxy from the get-go). I still feel strongly that my subsequent chlamydia was due to treatment failure and not re-infection by intercourse. I am no longer in that relationship (essentially because of this). Because of all the confusion, my doctor suggests I re-test towards the end of June, 3 months from my last negative results. Thank you for listening.

Carrie

H. Hunter Handsfield, MD

103 months ago

Thanks for the additional information. Chlamydia somtimes is carried long-term in the intestinal tract, and recent research suggests that azithromycin does not work well against chlamydia in the intestines. Re-colonization from the rectal area to the genital tract -- for obvious reasons, given their anatomic locations -- may explain some cases of treatment failure with azithromycin, as well as some infections that show up in truly monogamous couples. Perhaps these factors explain your apparently recurrent chlamydial infections and/or azithromycin treatment failures. I'm very sorry to hear your relationship apparently ended partly because of these events. Had you or your partner asked my advice at that time, I would have explained these things as well as other reasons you could have chlamydia without any implication that either you was sexually unfaithful to the other. In the large majority of couples in whom some STDs show up (e.g. chlamydia, HSV, and HPV), there are reasonable explanations other than having other sex partners.

Silent PID can occur. However, the vast majority of chlamydial infections do not lead to PID. And although PID (including silent infections) can result in tubal damage and later infertility, this does not happen in most cases, even following prolonged or recurrent infections. Still, you could ask your doctor whether testing such as a pelvic ultrasound study or other methods might tell whether there appears to be residual fallopian tube damage.

Finally, given the fact that doxycline for 7 days virtually never fails to cure chlamydia (including infections carried in the GI tract), you don't actually need another test in 3 months. However, given your special circumstances, I agree with your doctor that retestig after 3 months makes sense, if only for reassurance. You definitely can expect it to be negative.

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103 months ago

This is great information! Thank you.

My last question is about antibiotics causing my recent discharge. I saw a dermatologist last Wednesday about an irritation around my nose and was diagnosed with Perioral dermatitis. I began taking Minocycline 100mg once per day. It seems that I began noticing the excessive milky discharge after that. Could the antibiotics be causing this discharge? Thanks again!

H. Hunter Handsfield, MD

103 months ago

The main infection triggered by antibiotics is yeast, which usually causes itching and irritation more than discharge. However, this is a complex issue and the exact cause of your discharge (if anything is abnormal at all) would require expert professional evaluation.

That concludes the two follow-up questions and replies included with each thread. Best wishes and stay safe!

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