[Question #7401] Uti or trich

4 months ago
Good day doctors - I have a couple of questions below based on years of anxiety - wife was diagnosed with uti - had urine culture and came back positive with E. coli.   Was given 5 days of 100 mg of nitrofurantoin and she is now stating that she still has symptoms - it has been 3 days since completing the medication.  The lab report for the culture only had e coli over 100,000.  And nothing else - my questions below

1 - can this be something else like trich?

2 - would the urine culture have picked up any bacterial std during the test?

3 - would the urine culture detected trich?

4 - is it normal for the antibiotic in this case not work and they try another?

5 - can it be possible to have trich for over 10 years in females and now show symptoms - is this possible or rare or common?

I have had a outside of my marriage oral a few years back and worries I am the cause of this.

Can my past be part of this issue with the uti that is not clearing up?

Is it rare to have this antibiotic not treat the uti?

I’m concerned it might be the uti and something else - would that be possible if not found on urine culture?

Sorry for all the questions and thank you in advance for the help! 
4 months ago
I forgot to mention her symptoms 
Burning urine -fishy smell - seems like that’s gone - from what I understand the fishy smell is usually not a symptom of uti - is that correct?  She also had a heavy period same time as the the uti. From what I read this is more trick than uti - I’m worried that the uti caused the trick to act up after years.  Is this realistic or am I overreacting? 
4 months ago
Sorry last but of info for you -

She is in her 40’s if that helps and for the last 3-4 years she has been complaining about painful sex and really heavy periods - I have read these are symptoms as well - we just assumed it’s part of pre menopause as early menopause runs in family - hope this helps with your thoughts - thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Welcome to the forum. Thanks for your confidence in our services.

First some general comments then to your specific questions. First, UTIs are very common in women; almost all women experience one or more UTIs during their lives. Although some STDs can cause UTI-like symptoms, usually they do not; and the vast majority are truly UTIs, not STDs masquerading as UTI. Second, your wife's UTI is confirmed by her urine culture. Lack of response to nitrofurantoin is quite common -- many E. coli strains are resistant to it. She needs to contact her doctor to discuss alternate treatments.

Fishy vaginal odor is a nonspecific symptom. Sometimes it points to bacterial vaginosis, an overgrowth of mostly normal bacteria; and even to trichomonas or other STDs. However, since that symptoms has cleared up, I wouldn't worry about it. Painful vaginal sex, vaginal burning, etc become very common as women approach menopause, due to reduced estrogen, which helps maintain vaginal health. Reduced estrogen also riases the risk of UTI. The overall picture here is not one that raises concern about trichomonas or any other STD. Your wife should be speaking with her physician about all this, including the possibility of estrogen vaginal inserts or creams. They work wonders for many couples in your situation.

You say nothing about potential STD risks. Have you had extramarital partners, especially any with known STD or at risk? Have you had symptoms? My remaining comments assume not, but do let me know if such risks exist.

Those comments laregely address your specific questions, but to be explicit:

1) There is no reason to suspect trichomonas or any other STD. Having said that, trich is often sexually acquired by women when young but doesn't cause symptoms or otherwise show up until decades later. If your wife follows through with a gyn visit as suggested above, that likely will automatically include testing for trich, but I would expect negative results.

2,3) No. Urine culture is strictly for UTI bacteria. Gonorrhea, chlamydia, and trichomonas require their own tests.

4) Quite common with nitrofurantoin. Your wife has a proved E. coli UTI, and this situation does not elevate concerns about STD.

5) See comments above. It's common for trich to remain silent for years. However, your wife's symptoms and oerall situation do not suggest trich or any STD.

I hope these comments help resolve your worries. Let me know if anything isn't clear, and especially if there are STD risks you haven't mentioned.

HHH, MD
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4 months ago
Thank you the prompt response - I appreciate it.  My only concern was oral received briefly for about 10 sec unprotected back about 2-3 years ago. This is my main concern - also if it is trick that it was from me from that encounter - also I thought that a urine culture grows all bacteria including the ghonorhea and chlymidia.  Is that not true?  What about those then as a result of these symptoms and results - so based on all of this info - would you be concerned if you were me?  Thank you again!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Thanks for the exposure information. Trichomonas doesn't infect the oral cavity -- it's strictly genital -- and therefore cannot be acquired by receiving oral sex. And oral sex in general is low risk for other STDs as well; and the other possibilities, like gonorrhea or chlamydia, are naturally cleared by the immune system within weeks or months. Absence of symptoms is further assurance you have no STD from that event. Don't give it another thought.

As I said before, labs generally do not run STD tests unless specifically requested by the clinicial requsting the test. An order for "urine culture" almost always is interpreted by the lab as exclusively for bacteria that can cause UTI. In fact, different kinds of urine specimens are required: standard culture requires a midstream specimen, whereas STD testing is done on the first 1-2 ounces of voided urine.

If I were you, I would not be even remontely concerned about any STD either in myself or my wife, and would not seek STD testing of any kind in either of us. As i suggested above, it would be wise for your wife to discuss her vaginal itching, painful intercourse, and any other genitourinary symptoms with her gynecologist -- with an expectation that naturally declining estrogen levels may be worthy of evaluation.
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4 months ago
Thank you doctor for the response.  I learned a few things with your service today.  I’m also surprised to hear about women carrying trich for possibly decades without symptoms - this must cause quite a few issues in marriages.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Actually, the trich issue you raise doesn't come up all that often. But all gyns (those most likely to diagnose trich in older women) know these facts and typically are able to reassure infected women and thier partners. This comes up less frequently than other STDs, especially herpes.

That completes the two follow-up exchanges includd with each question and so ends this thread. Thanks for the thanks -- I'm glad to have helped!
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