[Question #3342] Follow up to 3260

37 months ago
Following up to question 3260.  Without any noticeable symptoms other than pain and discomfort,  I let my anxiety get the best of me and I took a 10 panel test at the 4 week mark.  All test came back negative.  I am still feeling discomfort in the genital area.  One STI I have not been tested for is Trich.  I have had no discharge or and noticeable pain during urination, however I have had discomfort in pain in the penis/urethra.  It is intermittent and seems to get worse after workouts/exercise.    Do you think it is possible I contracted this disease and should I be tested for it?  Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Welcome back to the forum, but I'm sorry you found it necessary.

The chance of trichomonas is very low for a condom protected exposure, and it is not acquired by oral sex (because trich rarely if ever infects the oral cavity). Given the possible condom failure, I cannot say the risk was zero, but it was a lot lower than for gonorrhea or chlamydia -- so those negative results are at least partially reassuring about trichomonas. And for sure trich is not a likely cause of the symptoms you describe.

That said, since it's on your mind and accurate testing is available, it makes sense for you to be tested. Don't get me wrong -- I really don't think testing is medically necessary, and if somehow I were in your situation I would not feel a need for testing. But since it's on your mind and you're obviously anxious about the exposure, testing makes sense for the anticipated reassurance value of a negative result. Look for a lab that offers a urine nucleic acid amplification test (NAAT, e.g. PCR) for trichomonas.

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

HHH, MD
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37 months ago
Thank you for your quick reply doctor.

If you don’t mind me asking, why wouldn’t an irritation in the penis be a symptom of trich?  Is it because of the absence of other symptoms?   Everywhere you look on the internet it says this is a symptom.  Don’t get me wrong, I trust your advice and that’s why I am here, I would just like your comment on that as it would make me get past this pain.  

Also, when I was at the lab I was not informed to stop urinating in the cup after the first catch.   The first test I had after 3.5 days I filled up the cup.  The second time after 4 weeks I stopped halfway.  How does this affect the sensitivity of the testing?  Is four weeks long enough to wait for the 10 panel for accurate results?  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
I think you are not understanding the websites you have found about trichomonas symptoms. If it causes symptoms at all in men, usually it's exactly the same as in any NGU, regardless of cause:  primarily discharge and sometimes irritation or pain on urination. Urethral or penile pain, without discharge or painful urination, is not a symptom of any STD. If these replies don't resolve your concerns about trich, see my advice above about testing.

Although it is ideal to collect the first part of urine for gonorrhea/chlamydia testing (i.e. a washout of the urethra), it actually makes little or no difference in test reliability.

All blood tests for STDs requires 6 weeks to reach full sensitivity, and for HSV it's 3-4 months. Your negative results probably are 90-95% reliable for most or all infections. This does not mean there is a 5-10% chance you have any of these infections. If your pre-test probability of an infection was, say, 1 chance in 10,000, then after a 90% reliable test, the odds you are infected drop to 1 in a hundred thousand. So I do not recommend you have any further tests except maybe for trichomonas.


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37 months ago
Doctor HHH

You have been a tremendous help.  Your replies have relieved most of my worries.  Hopefully I can finally move on from what has no doubt been the worst 1.5 months of my life.  The trich answer makes me feel much more comfortable, and yes, I had been interpreting those websites incorrectly.   I have not had one drop of discharge since the event.  

If you don’t mind, since I more than likely do not have an sti, do you know what could be the root cause of the irritation? 

Once again,  thanks for the quick replies and you have been a great help. 
37 months ago
Full disclosure ...I actually had the trich test done yesterday.  I wanted to approach this question as I hadn’t so when I get the results I could feel better about them not being a false negative  if they were in fact negative.  I just received the results and they were negative.  This comes as a great relief.   In your professional opinion, would you say I am in fact STI free and can put this behind me?  Thanks again doc.  This website is a great resource and service.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Thanks for the thanks. My best guess for your discomfort is genitally focused anxiety. Not that anxiety is painful, and I'm not saying you don't have real pain or discomfort.  Just as tension headaches are real pain triggered by stress etc, so can pain anywhere in the body be greatly magnified by anxiety. When people are concerned about a sexual decision they regret, such discomfort is often perceived in the genital area. In other words, most likely it's anxiety magnifying a minor symptom or even normal body sensations that otherwise would be ignored or not even noticed.

That completes the two follow-up comments and replies included with each question and so ends this thread. Let's make it the last one in relation to this exposure and symptoms, OK?

I hope the discussion has been helpful.
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