I’ve been having lower pelvic pain on my right side, and I thought normally was just ovulation but it persisted for over a week which is longer than it’s ever done for me. It’s very dull but I notice it. 

I had a small cyst back in July, but wondering if this is related to PID or an STD. For reference, the guy I was dating and I got a full std panel back on 12/30, all negative, HSV and HIV included. We last had sex 1/19, unprotected, we were always unprotected. No other symptoms from me. I don’t have a reason to believe he had sex with anyone else but I’ve been wrong before and had chlamydia last summer. 

Any advice/guidance is appreciated.

Unfortunately, I probably cannot help to the extent you're hoping. We take care to not create plausible impressions of practicing medicine from this distance. Despite that precaution, it's easier to judge some symptoms than others:  urethral symptoms in males usually are fairly straightforward, as are the possibilities for vaginal discharge, vulvar itching or irritation, and genital ulcers or other genital skin problems in either sex. However, low abdominal pain has so many possibilities (in medical terms, a broad differential diagnosis) that it's rarely possible to be confident about particular causes. A few considerations will follow, but the bottom line is that seeing a doctor in person is likely to be necessary, as well as lab tests and perhaps imaging.

You've clearly been at low risk for STDs, and your negative testing panel 2 months ago -- and only one partner since then -- makes PID unlikely. But it doesn't rule it out entirely; some PID cases aren't due to STD at all. Absence of fever also reduces the likelihood, but doen't rule it out. It's the same for abnormal vaginal discharge or strong vaginal odor; if present, they would elevate the chance of PID -- presumably you don't have or you would have said something about it, but this too is only a clue, and their absence doesn't exclude PID. Beyond those comments, I have no way to judge PID versus ovarian cyst versus numerous other possibilities like low grade appendicitis, diverticulitis, endometriosis, inflammatory bowel disease, idiopathic lymphadenitis, and more. A further hypothetical issue is that "ovarian cyst" can be a difficult diagnosis to confirm -- some apparent cysts are themselves actually due to PID.

So my advice is to see your gynecologist, ideally the one who diagnosed your ovarian cyst. I imagine that in additon to a detailed medical and sexual history, she probably will repeat tests for gonorrhe and chlamydia, and might suggest other lab studies like CBC, inflammatory markers (sed rate, CRP [you can google them for more information]) and, depending on what is found on pelvic exam, perhaps a pelvic ultrasound and/or CT scan.

I hope these comments are somewhat helpful. Let me know if anything isn't clear.

HHH, MD

Separately, I wanted to ask about something that is troubling me. This morning my anus was itching. When I took a mirror and looked inside my anus, I saw a bunch of red spots. They weren’t blistering or anything, only inside my anus, not on the outside. I have not had anal sex. Does this sound like herpes? These spots weren’t here two days ago. I only see them inside my anus when I spread the skin. Nothing on the outside. Is it possible my partner had sex with someone else and passed this to me? I’ve had an ongoing anal fissure but these are a bunch of dark circular dots. It doesn’t hurt to deficate, but I have had some lower pelvic pain as you know for a week and I’m wondering if these are herpes prodrome symptoms. 

Please help. I have STD OCD fears and I’m freaking out and can’t get an OBGYN appt until Friday.  

Your self described "STD OCD" needs to be taken into account, and much of what you described both yesterday and now could be overreaction to minor symptoms or even normal body sensations that, except for your OCD, might not be bothersome or even noticed. You're a better judge of this possibility than I can be, but to be maximally safe, seeing your ObG makes sense. I doubt serious harm will come by wating three days --- but if pain becomes severe (in either location) or if you develop other symptoms like fever, vaginal or anal discharge, or vaginal bleeding, your ObG probably would find a way to see you sooner -- or you might visit an urgent care clinic.

I'll be happy to comment one more time if you'd like to let me know the outcome of your gyn visit (or urgent care if necessary). But it is very unlikely I'll have any further useful advice until then, or in the event of more serious symptoms.

Beyond that, I don't see any new questions or need for clarification. As you seem to know, we're at the point that threads normally are closed (after two follow-up exchanges), but I'll leave this open so you can let me know if you need any furhter information or advice if you'd like to report the outcome of your visit with your doctor.

While I certainly do not want to raise your anxieties, it seems clear your doctor does not understand some aspects of some STDs. No genuine STD or herpes expert ever requests HSV IgM antibody; the result snever are helpful and often misleading. It's a terrible test, at least in adults. (It may have value in diagnosing herpes in newborns.) You also are correct that almost nobody with HSV affecting one body site acquires it elsewhere; your known HSV1 (presumably oral) makes GHSV1 almost impossible for your anal lesion. The test test for acute infection is a PCR test from a lesion. Anal fissures of various sorts are so common to be largely viewed as normal from time to time; they rarely are due to herpes or other STD.

To me, your low abdominal pain is the most important of your symptoms and the highest priority for evaluation, so I agree pelvic ultrasound is a good step. Also, you don't mention CBC (complete blood count) and inflammatory markers like ESR and CRP; they often are key in evaluating possible PID or pelvic abscess. If "full STD test" means gonorrhea, chlamydia, syphilis blood test, etc, those indeed make sense to me.

Keep working with your doctor. I suggest not returning to this forum until full evaluation, with any recommended follow-up tests and images, have been completed -- and not interim results as they come in piecemeal.

However, my bottom line guesstimate is that you have no active STD and nothing else likely to be serious. So stay mellow as the evaluation proceeds. Good luck.