Worried about PID/STDs

[Sallylove]

Last year I was hospitalized for PID. My symptoms were severe itching and green discharge. they put a bunch of antibiotic IVs, did an ultrasound that revealed a cyst and a vaginal culture came back positive for chlamydia.

Ever since the PID I've had a dull ache where the cyst was in my ovaries it sometimes hurts when i cough or lie on my stomach. I don't know if I would describe it as pain or just discomfort and a feeling of something being in my lower right abdomen. Is this normal?

I had protected sex a month ago and 2 weeks after my genital area started itching and burning, at times when i pee it would also burn. bearable and from time to time. I took 2 difulcans 4 days apart hoping its a yeast infection and the symptoms are still there. Theres no discharge but a weird smell down there. I bought an at home kit to test for BV or Trich or yeast infections and according to those tests it is a yeast infection. I dont think this is true because if it was a yeast infection, why didn't the difulcan work?

Ive been feeling a pain come and go in my pelvic area where the cyst was and I am worried i did in fact catch an STD and it already escalated to PID.

This is stressing me out and I think i might also be giving myself symptoms. I read that lower back pain is a symptom of PID and a few minutes later i felt lower back pain (that went away in a matter of minutes).

I cant even see a doctor for the next month and I certainly don't want to be infertile (if I'm not already) so I took 1g of Zithromax yesterday to treat chlamydia if that is what i have, but the itching is still there. Could i have gonorrhoea that lead to PID? I only have access to oral antibiotics so I am thinking of taking levofloxacin 500 mg for 14 days with metronidazole 500 mg twice daily for 14 days. Is this a better alternative to one dose of 400 mg of cefixime with metronidazole?

[Edward W Hook, MD]

I probably would have done the same thing that your doctor did.  In complex situations such as yours, provision of antibiotics at times when the diagnosis is unclear can complicate assessessment.  This Forum is full of patients who either took antibiotics themselves or were given antibiotics by doctors who did not know what they were treating who then went on to long confused courses with complications from unwarranted therapy.  

That said, if you did have acute PID again, the therapy your doctor gave is roughly equivalent to the therapy you received a year ago.  Cefixime is similar to ceftriaxone which is the injection you probably received and azithromycin is a long acting antibiotic with many of the same actions as the doxycycline which was most probably the medication you received before.  

It sounds like you have a better than average doctor.  I would stick with her.  EWH

[Sallylove]

Reason I have my doubts is because last year i was treated with an IM antibiotic at the doctors office and a 14 day course of antibiotics

[Sallylove]

Thank you Dr Hook, your answers have been very helpful thus far. I have one last question to ask. My pelvic pain got worse and i went back to the doctor. Im appalled she refused to treat or test me at first despite the fact that i have vaginal itching, burning, burning when urinating and worsened pelvic pain. I finally managed to convince her to treat me for PID just in case. She prescribed me with 400 mg cefixime single dose with 1g azithromycin one dose twice two weeks apart. Is this adequate treatment? needless to say i have lost credibility with this doctor and would appreciate your feedback.
Thanks in advance

[Edward W Hook, MD]

Stright to your questions and comments:

Actually, the pelvic examination is crucial for the diagnosis of PID and, in fact, it would be unsual to make this diagnosis without a pelvic.  Similally, visual appearance is often a clue to yeast infections.   What you were told by your doctor actually sounds logical to me.  

Yeast infections may or may not smell.

As I mentioned above, following PID there can be chrnic pelvic pain which may come and go.  This is a diagnosis of exclusion and sometimes is quite frustrating for patients.

I'm not sure what you mean by PCOS, polycystic ovary syndrome or something else?

Finally, it does sound to me like your doctor is acting logically and has made decisions that, based on your note, sound logical. Chronic pelvic discomfort is a challenging problem for doctors and sometimes takes some trial and errorr to sort out. Each time a person changes doctors, the doctor often has to start over.  Thus, unless there is a reason not to, you may have a doctor who is on the right tract. All too often on this forum we find doctors who either do not exam their patients or do not explain their thinking to them. To her credit, it sounds like your doctor is doing both.  EWH

[Sallylove]

Thank you for your prompt response. I managed to go to a doctor. She didn't want to do a culture because my symptoms sounded like ovulation issues (its the middle of my cycle) and also because i took zithromax so bacteria wouldn't show up on the test. She just did a manual pelvic exam and she said everything felt fine. there was no pain except a burning pressure pain when she pressed on the bladder area because i really needed to pee. She also said I have a yeast infection by just looking at the skin down there and that the pain could just be gas.
Im don't know how convinced i am with this diagnosis. Can you tell someone has PID or if they need further testing for an STD just by a manual exam?
Do yeast infections usually smell?
Also does PID cause a constant pain in the pelvic area or is it a sharp pain that comes and goes?
One last thing, I told her I was diagnosed with PCOS after i had an ultrasound done, she said that an ultrasound wouldn't diagnose PCOS and that it is usually diagnosed with a blood test. Is this true?

[Edward W Hook, MD]

Welcome to the Forum.  Your post raises several issues which I'll try to comment on.  Most importantly, I think you should not wait until next month to sex your doctor and should not be guessing/self-medicating for your symptoms.  There are so very many possible causes of the symptoms you describe that self-medication is likely to be wrong most of the time and will just confuse things.  You could have a urinary tract infection, bacterial vaginosis, some sort of STI, or none of the above.  If you cannot see your doctor expeditiously, you should see someone else.  Your local health department is likely to provide high quality, confidential services on a walk in basis.

As for your chronic pelvic discomfort, 15-20% of women who have PID are then troubled with residual pelvic pain. The origins of this discomfort are not completely known but are thought to be related to scarring which occurs as a result of PID.  If the pain comes and goes as seems to be the case for you, it is not likely to be an ongoing infection.

I hope these comments are helpful.  Please see a health care professional who can examine you, perform tests if need be, and help determine what is causing your current symptoms.  EWH

[Sallylove]

lower back pain is also present

[Sallylove]

EDIT

Just now I discovered some discharge.. white and slightly yellow and clumpy.