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Ask Dr. Arun Phophalia Your Own Question

Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29565
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have been dealing with chronic PID. I have tested negative

Customer Question

I have been dealing with chronic PID. I have tested negative to all STDs and the only thing I have been showing posive for is group B strep. I am not pregnant and I have only been sexually active once in the past two months. I was recently given doxycycline for the cervicitis that was caused by my PID after a hospital visit and eventually I was prescribed Flagyl for 14 days. I have contacted my doctor about the horrible side effects (throat swelling, horrible urinary pain, back pain, vaginal burning) associated with the pill and was advised to tough it out. I stopped taking the flagyl due to the horrible side effects. The vaginal burning has become unbearable and now my PID (pelvic burning in uterus and ovaries) are beginning to flare up again.
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello,
I am Dr. Arun and will be helping you today.

Do you have vaginal discharge?
What did your ultrasound show?
Customer: replied 1 year ago.
The sonogram showed a small 1cm cyst on my right ovary and a small incidental fibroid. I do not have a discharge
Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello Bria,

Since how long are is your PID?

Did your doctor do following work up;

1) erythrocyte sedimentation rate (ESR)

2) C-reactive protein (CRP) level
3) urethral swab

Were following investigations considered; laparoscopy, MRI, endometrial biopsy?

Thank you for using Just Answer.

Customer: replied 1 year ago.
In March 2012, I was diagnosed with Chlamydia. Prior to the pelvic exam, I only had vaginal irritation but immediately after my pap things went downhill and my ovaries began to burn. I returned to the doctor twice and was advised to wait for the results. Eventually I was advised I tested positive for chlamydia and was given Zithromax. I returned for the retest a month later still in pain and was advised to keep up on the pain meds. During 2012 I had repeated yeast infections and eventually BV. I practiced safe sex. In March 2013, my new partner tested negative for chlamydia and I tested positive. The pid returned for a little. A month later after testing negative my partner and I had unprotected sex and the PID returned. My partner was treated. I have tested negative to all STDs since yet I keep getting cervicitis and pelvic burning even after multiple antibiotics (flagyl, Zithromax, amoxicillin). Last week my doctor diagnosed me with PID and turned me away once I returned saying the PID returned. I had my urine drawn at yr hospital and my blood was taken recently at the doctor to test my white blood cells. I have not been tested for anything you have mentioned
Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello Bria,

The investigations we discussed are the next step to confirm the diagnosis. Meanwhile an empiric therapy for PID may be considered. PID empiric therapy is warranted if one or more of the following are present on pelvic examination:
1) cervical motion tenderness,
2) uterine tenderness,
3) adnexal tenderness.
4) lower abdominal pain and pelvic tenderness.

Since you have taken oral antibiotics without the complete eradication of the PID; injectable regime may be considered with the following antibiotics (these are efficacious for group B strept and do not have resistance);

1) Linezolid
2) Vancomycin.

Both the above antibiotics are available in oral form too and no harm in trying that also, if you are not comfortable with the injectables.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

 

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Expert:  Dr. Arun Phophalia replied 1 year ago.
Bria,

A concomitant chronic yeast infection also should be considered for your symptoms. Some women experience chronic recurrent vulvovaginitis, which often require long-term or prophylactic oral azole therapy for control. So for that, the recommended regimen is fluconazole 150 mg every other day for 3 doses, followed by weekly fluconazole 150-200 mg for 6 months. This regimen abate the symptoms and prevents further recurrence in majority of women.

 

Boric acid wash for vagina can be used in resistant cases, as an alternative measure with the consultation of your physician. A specific culture; Nickerson or Sabouraud mediums should be performed for candidiasis to confirm the infection. So you can talk to your doctor to get this culture before you start the treatment.

 

Women who do not improve with above can use, clotrimazole 500 mg vaginal suppositories administered once per week for six months which is also effective.

 

Also avoid (if you do) following;

 

1) panty liners,

2) pantyhose,

3) sexual lubricants


It is privilege assisting you.

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