Hello Dr Hook answered my last questioned titled "is this any type of std?" I was concerned about trichomonas. Over the last three years I been worried about having trich. I tested negative for trich in march of 2015. Every doctor I have seen or spoken with say it's not a std. My symptoms were itching on the shaft of penis and on the inside. I have never had discharge or anything.  I don't want to repeat my same question but yesterday I took the single dose of metronidazole and it seems like my symptoms are going away.  How is this if I tested negative for trich with naa test?  I live in georgia.

What you are doing is repeating your question with a challenge, implying that the fact that you feel better proves that you had trichomoniasis.  While I'm pleased to hear that you symptoms have improved with metronidazole, this does not however prove that you had trichomoniasis.  You were tested with the most sensitive test for trichomoniasis there is and the tests were negative.   Certainly health care providers do make mistakes but you were seen by multiple health care providers and tested on more than one occasion making it most unlikely that everyone and multiple tests were wrong. In science we do believe the tests.  Perhaps the metronidazole has influenced an anaerobic infection of some sort or has relieved your anxiety to a point at which you can stop worrying about something that there is no evidence that you had.  My advice is for you to be glad that you are improved and do your best to move forward without further concern.  I will continue to manage patients and advise clients on this forum based on current science.  EWH
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Thanks again Doc. Trying to get better understanding of the testing.  With NAA being one of the best test there is,  would the volume of urine submitted play a part in results being negative or positive?

For NAA tests, urine is supposed to be collected at the beginning of urination and the first few ounces of urine are supposed to be collected however studies with other STDs suggest that this variable does not appear to change the accuracy of the tests much.  EWH
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Ok. This has really been bothering me for some time now.  I've only tested for trich once. I was scared to do so because I was afraid of what the results would be. As a patient coming to your office and I say Doc after a brief unprotected sexual encounter I began to itch on the shaft of my penis and sometimes on the inside of my penis. I have never had discharge or burn on urine.  If a patient decibels these symptoms. You would tell them that this isn't any type of std? I'm just trying to wrap my head around this.  I have a counseling session this Thursday. I'm glad my symptoms have subsided,but I'm confused and scared at the same time.  As professionals I know you trust and believe in science and I want to get to that point of trust as well. It was just hard to believe what doctors were saying in spite of my symptoms. 

As you know, this will be the final response to your question(s).  I will summarize (once again) why it is unlikely that you had trichomoniasis.  I suggest that you show this to your counselor as well and explore the possibility that your prolonged symptoms may have been a manifestation of guilt and/or anxiety on your part:

 

1.  The statistics make it unlikely you were infected.  The encounter that worries you occurred three years ago and, by your account, lasted only 20 seconds.  Most people do not have STIs and, on average, only one in five exposures lead to infection.

2.  You had three years of the symptoms you describe without overt signs of infection.  Most STIs resolve even without treatment in just  a few months. 

3.  The symptoms you describe are not typical of trichomoniasis.  Trichomonas infects the urethra, not the external skin yet your symptoms included itching on the outside of the penis.  This is not a symptom of trichomonas infection.

4.  You mention two subsequent sexual relationships and apparently stayed on contact with these women, noting that they developed UTI symptoms several weeks after sex with you.  In getting evaluated for their symptoms, they should have been evaluated for trich yet there is no mention of them having trich.  If they were treated for UTIs and improved, this would not have cured trich as trichomoniasis requires different antibiotics than UTIs.

4.  You were tested with the most sensitive test we have for detection of trich on men or women and that test was negative.

5.  Your symptoms (itching) are typical of the symptoms that we regularly see when concerned persons focus on there genitals or other parts of the body looking for symptoms.

If you came to see me with these complaints I would explain each of the facts that I have listed above, inform you that it is unlikely that you had trichomoniasis and that, like the three health care providers that you had seen in the past, there is no indication to treat you. I would then offer you testing (which you had).  If the test was negative as yours was, I would repeat the massages above and inform you that there is no reason to be concerned about trich or other STIs (which you indicate you have already been tested for). 

I applaud your going for counseling related to these issues.  I hope you will find it helpful.   Einstein (yesterday was his birthday) once said (paraphrased) the one definition of insanity is to keep doing the same thing again and again and to expect different results.  It is (past) time for you to move forward on this issue.  I will not respond to further questions.  I also hope my explanations have been helpful although it appears that is not the case.  EWH

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