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(PID) - Pelvic Inflammatory Disease

Hello, I'm 24 years old. I have a Mirena IUD. I have not had a period in over a year, but last week I started spotting and having severe cramps. I called my Gyno and the nurse said that it is pretty normal for this to happen with the IUD, and they prescribed me Mefenamic Acid (Ponstel) 250mg every 6 hours as needed for cramps. This had helped somewhat with the cramps (made them tolerable), until yesterday. By the time the cramps had gotten to the point where they were the worse I have ever felt, and the medicine was not even touching the pain. I called my doctor and she had gone for the day.

With the pain so bad I went into the ER, thinking that my IUD was possibly accidently pulled and misplaced (this has happened in the past with my first IUD). The ER doctor did a pelvic exam and took some cultures, along with a manual exam. During the manual exam my cervix was very tender when pressed. The doctor told me that it shouldn't be and that usually indicated an infection. She took blood and urine labs as well.

Labs showed I had slightly elevated Liver Enzymes (I have lived with Chronic RUQ Abdominal Pain since 2007 and the elevated enzymes are nothing new). My WBC was normal which didn't point to an infection and all other labs were normal. They said I most likely have Pelvic Inflammatory Disease (PID) and gave me an antibiotic injection as well as started me on another antibiotic, Doxycycline 100mg 2x daily for the next 2 weeks.

I called my gynocologist first thing this morning and made an appointment for Thursday (she wants to wait to see if the antibiotics work). The doctor told me that the antibiotics should start helping in 24-48 hours. As of right now I am not noticing any changes in my symptoms besides occasionally the pain radiates to the LLQ of my abdomen and my lower back on the left side.

I also should state that my last Pap came back abnormal with HPV positive (ACSUS), but with no other STD findings. I do not have a history of any other STDs (however I did have a scare once of possible Clamydia but it came back negative). In the past I have had several sexual partners. However, have been in a mutual monogomous sexual relationship with my boyfriend for over 2 years.

I have done a little bit of research on PID, but still feel quite confused and increasingly worried as the serious complications that can arise from it (infertility, etc). And having the pain starting to radiate is not making my anxiety any better. What happens if the antibiotics don't work? How do I know if I need to be seen again before my next appointment? Did my IUD and/or HPV cause this? or something else?

As you can see I am just very concerned. Any information, suggestions, and/or comments would be much appreciated. Thank you!
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replied December 13th, 2012
Hello, and thanks for your medical question on eHealth forum!

If you have had multiple partners then STD panel should be done. PID can be due to STD as well. IUD itself can also be a source of infection. Cramps can also be due to threatened abortion, quite likely with IUD failure. So, please take a pregnancy test and see. Also, the vaginal swab should be cultured. Since a confirmed diagnosis cannot be given on net please consult your gynecologist regarding this. Hope this helps. Take care!

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