[Question #2145] STD question

90 months ago

First of all, thank you very much for giving me the opportunity of asking to experts like you. I am a man, 43 years old. I’ve been with my wife since 2002. Between 2005 and 2008 I was involved in some CSW’s relations which I now strongly regret. They were always condom protected for vaginal and oral, but only once unprotected oral. From 2008 to 2013, I had some erotic massages, but no penetrative sex with CSW’s. In all these years I had periods of unprotected sex with my wife.

Since 2009 I have been strongly worried about having got some STD. I started to feel some symptoms which did not include discharge or painful urination. The most relevant was a wet feeling at the tip of penis, which, however, was not accompanied of discharge. I went to an analyst who is specialized in STD and my obsession has taken me to have up to 9 or 10 analyses along all these years. Everything was always negative. Trich exam was microscope observation, which is not reliable. A pair of times WBCs were high, and then the culture revealed E coli.

After some years of having protected sex for pregnancy control, my wife and I returned to unprotected sex in 2014. After the first times, she developed itching and some discharge that were treated as yeast (but not analyzed). At the same time, I also developed red dots and itching on my foreskin that I thought were yeast too. For some weeks this situation was going worst and better until it resolved completely. However, from time to time she complains of some itching after her period and lower abdominal pain.

In 2014 I started with some very slight pain at the beginning of urination (up to now). However, the analysis continued being negative and no discharge was detected. This pain typically appeared when I was urinating at a sitting position and not when standing up. For some days the pain disappeared and then came back. I have found that the previous symptom of wet feeling is strongly related to constipation. If I have it and I go to the toilet, it’s gone.

I got obsessed about trich, so I could manage to have tinidazole. This was about one week ago and short after having it (a pair of hours) I felt that my symptoms had gone. I am not sure if now they are coming back or it is that I wish they do it, so that I could blame something else, as CPPS.

I would like to have your opinion about the possibility of trich. Thank you very much in advance.

Edward W. Hook M.D.

90 months ago

Welcome to the Forum and thanks for the detailed history. it is quite helpful. Clearly there are some things that are better done in person than on-line and I suspect that this is one of them as I suspect hat you would benefit from an ongoing relationship with a clinician who can periodically examine you and test as needed. Your post suggests that guilt plays a role here and that related to this you are quite attendant to urogenital symptoms in both yourself and your wife. We see this rather commonly among our clients, both in practice and on this Forum and have learned that any time a person starts to look for possible symptoms, they are likely to detect sensations and variations in the appearance of their genitals which were previously unnoticed. To illustrate this, let me point out that our minds "edit out" sensations related to the touch of clothing or jewelry on our skin on a day-to-day basis but if we focus on how our watch feels on our writ or how a shirt collar or cuff feels on our skin it is often perceived as an "itch". I suspect that this is at least a portion of what goes on here.

Now for a comment on trichamoniasis. Our knowledge and understanding of trich has grown greatly over the past decade as more sensitive NAAT tests have become available bu there is still much to be learned, particularly about trich in men. Current knowledge suggests that when present in men, trich infections are most often asymptomatic and will resolve without treatment over a period of days or weeks. When symptoms are present, the most common symptoms are burning on urination or a slight urethral discharge. The sorts of transient spots you describe or positional discomfort on urination are not suggestive of trich. If you wish to rule out this possibility however, my advice would be to seek a urine NAAT test for trich performed on urine collected just as you begin to void after not voiding for an hour or two. If such a test is negative, I would not be worried about trich.

I hope these comments are helpful. In the interim, I might ask if you are still working with your analyst? CPPS may be contributing here but this diagnosis is a rather large "umbrella diagnosis" to which I suspect your own guilt may be contributing. EWH

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90 months ago

Thank you very much for your answer, Dr. Hook. I am still in contact with my analyst, but she only does microscope observation for trich diagnosis. The NAAT is not available in my city (I have asked in the best laboratories). In any case, I already had tinidazole so that probably would give a negative result. Actually, the intention when having the medication was to have a kind of test. I expected that my symptoms continued as always, but they have fade, although I feel a bit of the sharp but slight pain at the beggining of urination that scared me as a trich symptom. The option would be to tell my wife to be analysed, but this would surely have consecuencies in my life.
I have read about complications on infertility and others from trich, and this really makes me feel even more worried.

Edward W. Hook M.D.

90 months ago

Not sure what city you are located in- most countries now have NAAT tests for trich available. When you spoke of an "analyst" I presumed you were speaking of a mental health professional who could provide you with psychological support which I sense would be helpful to you. Further, I would discount concerns about infertility or serious complications related to trich- I doubt that you have it and do not believe it causes the sorts of complications you mention. EWH
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90 months ago

Thanks again, Dr. Hook. Sorry, maybe it has been a wrong translation from my language. As "Analyst", I was meaning the person who has carried out most of my clinical tests for STDs (I also had a PCR test for Chlamydia and Gonorrhea that was negative). Please let me ask one last question: could I blame something else than trich the fact that my symptoms seem to have gone after taking tinidazole?
Thanks a lot for your help and the rest of the medical board. I have read a lot of your and Dr. Handsfield previous posts.

Edward W. Hook M.D.

90 months ago

As I mentioned to you earlier, from what you have told me, there is little reason for you to worry that you have an STI of any sort. My opinion, based on what you have said, is that your symptoms reflected heightened awareness and anxiety over the possibility of infection. now that you have received tinidazole, your anxiety is better and therefore your concern about possible symptoms is also less.

As you probably know, now that this is my 3rd reply to your questions, this thread will be closed later today without further replies. If you have additional questions you will have to pay again and start a new question. I really don't think that should be necessary however. EWH

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