We MUST Take Antibiotics With HSG!!

Please listen to me, ladies! This is such a serious topic. When it comes to our health, we have to be our own best advocate! This subject hurts my heart beyond words. But more so, quite frankly, it pisses me off!

So many women go for an HSG, but then quickly develop an infection...due to the HSG! This is a travesty that must be stopped! You ladies work too hard to heal yourselves to then be taken by uninformed, ignorant doctors who will not prescribe necessary antibiotics with HSGs. 

Why don't all doctors prescribe antibiotics with an HSG? 

For a long time, up until very recently, I was under the false presumption that all doctors do prescribe antibiotics with an HSG. Sadly, I've come to find out, many don't. I have spoken on the importance of antibiotics with HSG a few times, but today, I realized that it needs to be addressed in an article all on its own. This is NOT your fault, ladies. This is the fault of negligent, uninformed doctors.

So, why must we have antibiotics with an HSG?

First off, I am no friend of antibiotics. Let's get that out of the way. They can become very problematic for the human body. That said, you know that if I'm urging you to DEMAND antibiotics with your HSG, it's with very good reason! During an HSG, they open the cervix, which, by the way, is designed to be closed most of the time for the very reason of keeping out harmful bacteria and preventing infections from occurring in the womb.

This being the case, there is a moderate risk of developing pelvic inflammatory disease (PID) in dilated or distally blocked tubes following an HSG, if no antibiotics are used. There's also a risk of serious infection after HSG if there is a history suggestive of prior tubal infection or damage, which all of us dealing with blocked fallopian tubes have had. This type of infection may require hospitalization and an aggressive treatment with antibiotics, which may or may not be enough to protect our already fragile fallopian tubes from developing more scar tissue and inflammation. To minimize the likelihood of a pelvic infection, antibiotics should be prescribed.

Therefore, we MUST be ADAMANT about the use of antibiotics whenever we decide to go for a follow-up HSG. We are at a much higher risk of infection than someone with no previous tubal or uterine issues. Still, the doctors really have no way of knowing whether someone has had previous tubal or uterine issues, aside from asking them, and sometimes the woman doesn't even know herself if she's had an infection in the past. So, really, it should be standard practice to prescribe antibiotics with EVERY HSG. Period.

Take a look at these two studies that were done.

"While performing these procedures, the abdomen, upper vagina, and endocervix are breached, leading to the possibility of seeding pelvic structures with microorganisms. Antibiotic prophylaxis is therefore important to prevent or treat any procedure-related infections. After careful review of the published literature, it is evident that routine antibiotic prophylaxis is generally not recommended for the majority of ART-related procedures. For transcervical procedures such as HSG, SIS, hysteroscopy, ET, and chromotubation, patients at risk for pelvic infections should be screened and treated prior to the procedure. Patients with a history of pelvic inflammatory disease (PID) or dilated fallopian tubes are at high risk for postprocedural infections and should be given antibiotic prophylaxis during procedures such as HSG, SIS, or chromotubation. Antibiotic prophylaxis is recommended prior to oocyte retrieval in patients with a history of endometriosis, PID, ruptured appendicitis, or multiple prior pelvic surgeries."(1)

"A total of 150 women who had hysterosalpingography (HSG) for investigation of infertility, at the Kenyatta National Hospital over a five month period, were recruited into the study to determine the prevalence of pelvic infection following the procedure. 44.% of the total study group developed pelvic infection disease (PID) within the first week after the procedure. There were no obvious determining factors. It is possible that most women with infertility have quiescent genital tract infection, prior to HSG, with the latter only facilitating the entry of micro-organisms into the upper genital tract, thus causing pelvic infection or reactivating a pre-existing infections. Further studies should be conducted to determine the microbial patterns of the infection. There should be routine provision of prophylactic antimicrobial agent(s) to all women undergoing HSG in our unit to minimise the risk of developing pelvic infection and further damage to the uterine tubes which will worsen the prognosis. ....One week after hysterosalpingography, 44% developed acute PID, defined as having at least 2 of the following signs or symptoms: lower abdominal pain, rebound tenderness, cervical/adnexal tenderness, foul smelling vaginal discharge, adnexal mass(es), and fever of at least 38 degrees Celsius. The most frequent signs and symptoms were lower abdominal pain and tenderness."(2)

Completely preventable and unacceptable! How terribly irresponsible of these doctors to be so negligent with our healthcare!!

Demand antibiotics with your HSG!

So, ladies, I can't stress this enough! When you go for your follow-up HSG, demand your doctor to prescribe at least a 3 day round of antibiotics (day before HSG, day of, and day after HSG). If they say they don't do that, then tell them you will be finding a doctor that does. With that, they might go ahead and prescribe them. If they don't, you HAVE to go to another doctor. Or ask your Primary Care Physician if he or she will prescribe them to you. It doesn't hurt to ask. They likely will. If they don't, don't get the HSG until you find a doctor who will prescribe antibiotics with it. There's no getting around this one. Not for us. Our tubes have been through enough, without taking this unnecessary risk to further damage them. 

Take heed, ladies. Don't be a victim to an uninformed, negligent doctor. You have fought too hard for this. You deserve better.

Please feel free to share your experience with this in the comments below to further address this issue.

1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800103/

2: https://www.ncbi.nlm.nih.gov/pubmed/8181434

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