Pelvic infection is a not infrequent condition encountered in the patients attending the outpatient clinic. Our standard management protocol is to treat it with doxycycline and metronidazole. Microbiologic study on the patient’s cervical discharge is helpful in deciding the choice of antibiotic in some cases. But often the results are so weird and inappropriate, that we do not perform the test as a routine.
Some patients have a partial response after a week, and they are advised to complete the course of another week. Some have no response. A curious phenomenon seen in some patients. They claim that they are free of pelvic pain while they are on antibiotic therapy. But there is a recurrence of the pain if they miss a dose or two. It is my opinion that these patients have a placebo action of the antibiotic. They feel that the medication has a symptomatic action as well, and hence the relief from pain with medication and a recurrence of pain when they miss out a dose due to any reason. These patients invariably have a recurrence of symptoms on completing antibiotic therapy, and require a laparoscopy for evaluation of chronic pelvic pain. They do not have any disease in the pelvis, and are diagnosed to have somatoform pain. They do well with treatment by a psychiatrist.
This should serve as a useful test for predicting early which patients will prove to have somatoform pain mimicking pelvic infection.
