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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6703
Experience:  14 years as clinician in the field of Family Practice
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Dr bray what are symptoms of pid

Customer Question

Dr bray what are symptoms of pid
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray MD : Hello again!
Customer: Sorry for being bothersome
Anthony Bray MD : symptoms of PID usually would include a vaginall purulent ( infected appearing/ yellowish discharge)
Anthony Bray MD : you would usually expect pelvic pain and it is a classic sign if it hurts to stand up....
Anthony Bray MD : sexual intercourse would be very painful....
Anthony Bray MD : you may or may not have fever depending on the severity of the infection... Severe PID would have fever....
Customer: I went to my dr a week ago yesterday with green thick discharge. Ge did a wet prep was negative for everything but an overabundance of WBCs. He did a gc/chlamydia urine test which was negative. Over that weekend i experienced intense pain down there and itching. On monday i saw the dr on call who started me i
Anthony Bray MD : you should have an elevated WBC on your CBC with neutrophils subtype predominant....
Customer: on 1gm azithromycin becsuse i was having symptoms and my fiance cheated on me
Anthony Bray MD : nausea is a possible sign but not near 100%....
Customer: The azithromycin didnt help so on wednesdsy he rxed me metronidazole gel. So far that hasnt helped. I have intense pain to just even wipe down there
Anthony Bray MD : Aziithromycin regimen may typically take care of GC and chlamydia but would not be strong enough to take care of advanced PID...
Anthony Bray MD : GC / and chlamydia are the most common causes of PID but other infections and even non STDs are possible....
Anthony Bray MD : Use of tampons can increase risk of toxic shock syndrome....
Anthony Bray MD : Advanced PID MAY need IV antibiotic course to bring it under control IF this is what you have....
Anthony Bray MD : on exam I would expect that a pelvic exam would make this diagnosis clear....
Anthony Bray MD : blood count should show elevated WBC by now if this is a bacterial infection....
Anthony Bray MD : PID would NOT be viral ....
Customer: I cant see anything you wrote after i typed what i typed
Anthony Bray MD : I hope this helps! Let me know if you have further questions! Let me know how your progress is. I hope that you feel better soon.
Anthony Bray MD : Take care!
Anthony Bray MD : Anthony Bray MD
Customer: Cant see anything you wrote
Anthony Bray MD : Ok I will switch to Q and A format....
Expert:  Anthony Bray, MD replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Customer: replied 1 year ago.
I have crampy pain in my pelvic area, still have discharge and quite a bit of pain. Im 5 days late for my period
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

It does sound that you have symptoms consistent with possible PID a pelvic exam should be done to help confirm the diagnosis. ALSO CRITICALLY IMPORTANT TO RULE OUT ECTOPIC PRENANCY!!

You still are in need of follow up evaluation and ongoing treatment.

I hope this helps! Let me know if you have further questions!

Best Regards!!

Anthony Bray MD
Customer: replied 1 year ago.
Ive had 3 pregancy tests in the last week all negative. Wouldnt an ectopic pregnancy turn a pregnancy test positive? Wouldnt it have shown up on a ct? Btw i talked to my dr and he said to just keep trying to push fluids
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Yes a pregnancy test would be positive with an ectopic pregnancy so this should rule out this potential problem.

Your doctor has the advantage of knowing you and having examined you. That being said I can't help but to stick to my opinion that you need further evaluation and treatment. Ultimately use your best judgment and common sense! My point of view is limited to what you tell me but I remain concerned with several aspects of your illness. Has your urine cleared up? That would be reassuring to an extent. Less pelvic pain would be a step on the right direction. The reduction of fever would be a positive sign. The better you tolerate oral fluids would be reassuring--- you can follow your weight to help judge short term fluid changes.

I hope this helps! Let me know if you have further questions! I will be happy to get back with you!

Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
Everythings about the same. Cept my weight is really down 8#
Expert:  Anthony Bray, MD replied 1 year ago.
Hi again,

Well I guess I am on the cautious and conservative side but I recommend follow up. You are becoming significantly dehydrated . I take it as a few positive signs that you have not worsened in terms if pain And fever however. I think it is easier to get on top of problems to be aggressive early however... Say if you had PID the azithromycin may help but 1.0 gram IV Rocephin tonight and a few days of IM Rocephin may really help to knock it out. ( this is just an example scenario of course and not any specific recommendation for your treatment)

I hope this helps! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
How would the er test for pid. I think i need iv fluids. I just had a bout of very watery diarrhea
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Main thing would be the pelvic exam. This determines if uterus/ Fallopian tubes/ ovaries are tender consistent with infection.

Cultures of the cervix is typical.

CBC : with differential of white cell types would be typical.

Sometimes imaging studies are done to check for presence of abscess but with the studies you have had done them this would probably be unnecessary.

PID vs other intra-abdominal or pelvic infections would be critical as some infections would demand surgical intervention ( example would be appendicitis)

I hope this helps. Let me know if you have further questions!

Best Regards,

Anthony Bray MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6703
Experience: 14 years as clinician in the field of Family Practice
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Customer: replied 1 year ago.
Would an infection show up on a ct scan?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

No not necessarily but at times it does. A large abscess would show up. The CT scan shows structural abnormalities of a certain size primarily. There can be differences in tissue difference especially in certain tissues that show infection. This is especially helpful to show pneumonia of the lung tissues for example. On the other hand the CT scan is not sensitive enough to detect infection in all places or tissues. It may be a helpful tool but this would have to be considered in light of its limitations.

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Do you think this still sounds like it could be viral
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I doubt viral infection really but it could be possible. My bet is that repeat CBC will show higher white cell count with predominance of neutrophils which would be pattern of bacterial infection. Now a pattern if predominate lymphocytes would be more suggestive of a viral infection. Your pattern so far has seemed more of a pattern if PID and this is not a viral infection.

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I dont want to look dumb going back to the er when i just saw my dr today
Expert:  Anthony Bray, MD replied 1 year ago.
Hi again,


You would not look dumb!! You have legitimate concerns!! There is nothing wrong with getting these problems checked out. Please if you go do ASK. Both about your dehydration , possible PID, fever, abnormal appearing urine and nausea. They won't investigate what they do not know about!!!

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I
Told them all this stuff wednesday night
Expert:  Anthony Bray, MD replied 1 year ago.
Hi again,

I see but you are still having problems such as tolerating fluids and the 8 pound weight loss! You have ongoing concerns! You still have pelvic pain , right?? How long ago was recent fever? I take it that you are still nauseated??

If you are well then don't go to the ER! It sounds to me that whoever saw you must have been too careless to send you out with such a low BP ( 85/50 as I recall??) you did not have stable vitals and this technically would be malpractice to discharge you with unstable vital signs...

So if you go I hope that you get good thorough care! I know that this is not always the case...

Best regards ,

Anthony Bray MD
Customer: replied 1 year ago.
My pelvic area feels crampy like a period. But my discharge is blood tinged now. I dont think my vagina should hirt this bad. I had a fever this am but have been taking tylenol as often as i can. Right now temp is 99.6. I am still nausous. I am very lightheaded. My lips are dry and peeling. Can they do a culture and stuff if im using the metronidazole vaginal gel
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well the fever is at least controlled with the Tylenol.

I'm not sure if your pelvic pain/ discomfort would be considered medically more of moderate or severe category. Again a pelvic exam by the doctor provides a lot of helpful information here. If you press gently over pelvis and let go quickly ( while laying down) does the letting go hurt??

The hydration can proceed orally IF you are not too severely dehydrated and IF you are able to take in adequate oral fluids. You should be able to take in 8 ounces of Gatorade every hour while awake to attempt to rehydrate. If you can do this then you could wait and see.

Also has your urine cleared? If still brownish or tea colored then that would be of concern.

Are you light headed?? Do you feel like you might pass out?? This would be a major factor in determining if you need to go or not.

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
It doesnt feel any different when i let go. I cant take in that much fluid. How do i know if im severly dehydrated? My urines about the same. I am very dizzy. Seeing spots. I have pain down my lft side kinda by my hip bone
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

The dizziness / light headed feeling would be suggestive of your blood pressure remaining too low and this is probably due to dehydration. Your sudden 8 pound weight loss would also suggest dehydration. Low urine output is consistent with dehydration. Skin turgid--- this is the flexibility of your skin --- if the back of your forearm is lightly pinched then it should bounce right back to normal-- if it lingers in a tented state then that is consistent with dehydration. If you have dry mouth and intense thirst then these would be signs consistent with dehydration. A weight loss of more than 5 percent is serious and more than 10 percent is critical.

The urine may be very concentrated and infrequent with dehydration. If it is still tea colored then you may have even more of a problem.

If you can check your BP then 90/ 60 to 135/ 85 is normal resting...

Normal resting pulse is 60 to 100...

I hope this information helps you to self asses where you are and what you need to do.

Best Regards,

Anthony Bray MD


Customer: replied 1 year ago.
Just tell me if i should go to the er or not
Expert:  Anthony Bray, MD replied 1 year ago.
Yep --- you should!!

Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Will you be here when i get back
Expert:  Anthony Bray, MD replied 1 year ago.
Yes I will be online until late and the majority of the time. On tomorrow as well!

Good luck-- I hope that you get good help and feel better soon!!

Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Is it normal to be this sore to even wipe
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

No that is normal either. This isn't the most serous of your symptoms but it is not normal.

Take care,

Anthony Bray MD
Customer: replied 1 year ago.
The most serious thing is dehydration
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes the dehydration would be the most serious. The infection?? PID IS ALSO SERIOUS. The abnormal color urine ?? Tea colored urine meaning possible blood in the urine also concerns me...

I hope this is helpful for you.

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Talked to my mom. She says to wait until tomorrow
Expert:  Anthony Bray, MD replied 1 year ago.
Well good luck--- I hope that you feel better tomorrow!

Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
Its been 49 hours with very little fluid. Im very lightheaded, nauseous have a headache and feel like im going to puke. Is this normal? Will it go away
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

No of course your symptoms are not normal. As I have advised I think that the sooner you get treatment this will help you to feel better.

Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
How many liters?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello! I would guess that you would need 2.0 liters of IV and that this would help you to feel better.

I hope this helps! Take care,

Anthony Bray MD
Customer: replied 1 year ago.
People dont die in this short of time do they
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

No not usually. I have seen horror stories that you would not wish to know about however. If you are not urinating normally and with normal color then I would advise that you go ahead to ER. If your weight loss has not improved any from the 8 pound drop then I would advise that you go.

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
What could happen?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well of course hopefully and probably neither if these complications will happen to you--- but with a bacterial infection there can be risk of sepsis( infection to the blood) and this is frequently fatal in less than 24 hours.

With the kidneys I worry about the brownish color which may mean blood. This may mean injury of the kidneys and this could progress to renal failure requiring dialysis. Again hopefully and probably this will not be the case.

I hope this information is helpful to you. Get well soon. Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
Im on my way
Expert:  Anthony Bray, MD replied 1 year ago.
Ok well I hope that you get good treatment and that you will feel better soon!!

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Can i let you know how it goes
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

Yes please do! I am interested in how you are doing!

Take care,

Anthony Bray MD
Customer: replied 1 year ago.
They gave me a liter of fluid. Had me switch from the flagyl gel to the oral flagyl
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

OK -- that is good How are you feeling??

I hope that you feeling better! I suppose that your kidneys are OK then?? They checked your urine too right?

Glad to hear you got treated for your dehydration

Best Regards,

Anthony Bray MD!
Customer: replied 1 year ago.
I feel like a bus hit me. Im exhausted They didnt do a urine
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,Well I'm sure that you are exhausted with the illness that you have been dealing with. Remember to have your doctor to check the urine and BUN and creatinine on Monday if possible! Let me know if you have further questions! Best regards,Anthony Bray MD
Customer: replied 1 year ago.
Thanks for spending so much time helping me and caring. Have a good Easter
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

You are most welcome! Happy Easter to you too!

Take Care!!

Anthony Bray MD
Customer: replied 1 year ago.
Was in the er again tonight. With what they assumed was a ruptured cyst. They did lab and a urine. They gabr me a shot of toradol and 4 mg of morphine. They said urine showed i was still dehydrated so i got more fluids. I assume my BUN was fine. Just wanted to let you know that I think my kidneys are fine
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

I'm glad to hear that your kidneys seem OK!

Sorry that you had to make yet another trip to ER. I hope that you have nothing but recovery from this point forward!

Take Care,

Anthony Bray MD
Customer: replied 1 year ago.
Ive personally never had strep before. This am i wake up with a sore throat and it hurts to swallow. And my voice is hoarse. Could i have picked something up? How long do ruptured ovarian cyst hurt?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Well strep would account for high fever and a first episode if strep would make you very ill!! It is unusual not to have had several cases of strep by adulthood however.

A ruptured cyst may hurt for several days to a week most typically.

I hope that this helps. Let me know if you have further questions.

Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
I had a quick strep done friday. Was negative. I feel worse today than i did Wednesday when it all started
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

If the rapid strep was negative then you probably do not have strep---since symptoms appeared later then it might be considered to be repeated. The test in general is about 90% sensitive to pick it up ...

I hope this helps! Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
How can they tell if a cyst has ruptured vs just leaking if they didnt do any imaging
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!!

It is a common phenomenon for a follicular cyst to rupture monthly as part if the reproductive cycle. On general there is no need for any imaging to be done. Sometimes a very large cyst may be monitored. They bleed internally but this is generally limited. This bleeding into the pelvis may cause some discomfort however. This would not be expected to cause fever however.

I hope this helps! Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
I will give you another positve rating for all your help. Why am i so exhausted? The morphine couldnt still be causing it.
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

I suspect that it is the toll fro your illness that makes you feel exhausted. The dehydration and whatever infection that caused the high fever( maybe PID or other??? )

The morphine will make you tired but this effect depends on the deliver form... Can vary 4 plus hours to 24 plus hours depending on the form of it...

I hope this Helps let me know if you have further questions!

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
It was administered via iv
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Then this form if morphine would be short acting--- more along 2 to 4 hours in side effects -- not long lasting with this delivery. So other factors of our illness probably account for your fatigue.

Best regards!

Anthony Bray MD
Customer: replied 1 year ago.
I know you cant predict this. But would you guess id feel better tomorrow so i can go to work
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

My best guess from what you have told me would be return to to work by Tuesday probable but I doubt tomorrow..

I hope this helps! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Ok. Thank you so much.
Expert:  Anthony Bray, MD replied 1 year ago.
You are very welcome!

Take care and I hope that you feel much better very soon!

Best regards,

Anthony Bray MD
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

This is Dr. Bray from Justanswer.com. I was interested to know hoe you are doing ( you may have been in contact as I am sending this message on3/30). I hope that you have recovered from your nausea and dehydration. I hope that your fever has been properly diagnosed and treated. Was the source definitely identified? Finally are your kidneys ok? I hope that you are doing well as this message is received!!


Best Regards!!

Anthony Bray MD
Customer: replied 1 year ago.
No source ever identified. Everything is fine other than im pretty sure i got a sinus infection
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well a lack of a certain diagnosis is not the worst outcome BY FAR!! So don't get too frustrated with that!

I hope you recover soon from your sinus infection!

Take care,

Anthony Bray MD

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