[Question #3249] Trichomoniasis testing

37 months ago
I cheated on my wife approximately 6months ago. This week, she had some signs of trich like green discharge. I went and got tested for everything including trich. Everything came back negative. 

My question is how accurate is the test for trich in asymptotic males?  What are the chances I gave her anything?  The test is an Aptima TV Assay TMA RNA. It is a type of NAAT test. I provided a first-catch urine sample filled exactly to the line on the cup at Quest. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Welcome back to the forum and thanks for your confidence in our services.

As you likely know, there are many potential causes of increased vaginal discharge in women, and colored discharge (e.g. yellow, green, brown, etc) often is due to infection. However, it's not particularly indicative of trichomonas, and it also isn't necessarily related to your extramarital sexual exposure 6 months ago. Indeed, that's an unlikely explanation, given a) your negative tests at the time and b) your apparent absence of symptoms yourself (assuming you would have said if you have been experiencing urethral discharge or other symptoms).

That said, to answer your specific question, you had the most accurate test available for trichomonas. The test was developed primarily to test women and precise data do not exist on its performance in men. However, the consensus among experts is that it is highly sensitive in men, i.e. that a negative result is highly reliable. You can be confident you don't have it.

Presumably your wife will be seeing her doctor about her discharge, right? Any new, abnormal, or unexplained vaginal discharge should be professionally evaluated. I would recommend you not say anything to her about your extramarital event, at least not yet. Of course if she is diagnosed with trichomonas or any other STD, you'll have to discuss it with her then, but that probably won't happen. And of course even if she has an STD, you may not be implicated:  some infections (including trichomonas) are carried for years, i.e. from distant past partners, and only cause late symptoms for unknown reasons. And as you probably understand, when one member of a couple seeks outside sexual experiences, quite frequently the other has done so as well. (You're a much better judge of this than I am; of course I have no way of knowing. But it's just common sense, as well as my and other experts' common observation among our patients.) 

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

PS:  Note to all potential future forum users:  This is the third time in two days that a question was posted with username Brian. It is recommended that potential questioners choose more unique usernames than simply their own (or someone's) common first name. The three Brians have different email addresses and quite varied exposures and other aspects of their situations. Still, it helps the moderators when we don't have to do extra searching to make sure that the same person isn't asking repeated anxiety driven questions. Thanks to all!
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37 months ago
Thank you for your quick reply.  I see that this test is nearly perfect for females. Is there any reason why it would be significantly different in men?  Or if men’s urine wouldn’t contain the organisms?  Yes, I am asymptomatic. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Urine probably detects most but not all make trichomonas infections in men, probably for exactly the reason you imply. The anatomic location of trich in the male urogenital tract has not been carefully studied, but some infections probably are isolated to the prostate or perhaps seminal vesicles and might not be detected by urine testing. So a negative urine test in men is less secure proof against infection than vaginal swab testing in women.

At the same time, this doesn't imply a high chance you have it. The likelihood of acquiring trich from any single sexual exposure is quite low, even if the female partner is infected. Still, I cannot say with certainty you don't have it or that trichomonas isn't the cause of your wife's vaginal discharge. But my advice is unchnaged:  she should be evaluated, and let that outcome determine what additonal tests or treatment you might need. But stay relaxed in the meantime. Even if she turns out to have trich, there will be no reason for anyone to assume a recent new sexual partnership on either your part or hers, because so many cases of trich are chronic, carried for years in both ment and women.

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37 months ago
Thanks again Doc.  One more question.  In reading online, everything says the only cause of green discharge is Trich.  Have you ever seen or known anyone with a green discharge and it not be trich?  Can trich lay dormant for years and present symptoms later?

Also, can you remove my name from your first reply?  I registered with a screen name, but it is putting my real name in the responses.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
I can't imagine any knowledgeable, professional websites or other resources that would say trich is the only likely cause of green discharge. First, color of discharge is highly subjective -- one person's "green" could be another's gray, yellow, tan, light brown, etc. Second, any of these colors suggests an infection of some sort, more likely bacterial or trichomonal, yeast less likely but still possible; bacterial vaginosis; or non-infectious cervicitis; also foreign bodies, e.g. forgotten tampon.

It is time for you to stop speculating and to cease online research on this. I can't say she won't turn out to have trichomonas or, for that matter, gonorrhea or chlamydia. But for all the reasons already discussed, I think it is unlikely, and therefore it is probable that your wife's problem is unrelated to your sexual indiscrtion 6 months ago. But you're never going to know for sure unless and until your wife has been professionally evaluated.

That concludes the two follow-up comments and replies included with each thread, but I'm going to leave this open (for a maximum of 10 days) so that you can report the outcome after your wife has been professionally evaluated. However, I will have no other comments of any kind until then, and will close the thread in 10 days if you don't post that information. In the meantime, I do hope the discussion so far has been useful.

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