[Question #7487] Ticky Trich

2 months ago
Been with same partenr 5 years. No STd's Supposedly partner tested for STD's in 2019 at a physical. no symptoms. no positives.   Me, had BV  in 2019 which they at that time tested for STI's including Trich with a vag Naa test.  Trich Negative. only BV. Now  One year later the worst symptoms of frequent peeing a slight crotch redness/rash which seemed to go away but the worst was the frequent peeing. had a physical asked Dr. to check for UTI. took Azo.  but not antibiotics because small leuckytes  and Dr. said  no UTI so I avoided antibiotics.  Still peeing like crazy not a lot but often( thinking I am getting old) . and smelly discharge, try to treat as BV with boric acid does not work, got to Dr. test comes up BV and Trich.  So:
 1. Do men get rid of trich without treatment?  such weird info on the web about this. and of course my partner says he did not cheat, but I have grave doubts 
 2. how many years can Trich live in a man, its a parasite so its not like its dormant right? 
 3.  would it have been possible for me to have Trich and not have symptoms and months later breakout in symptoms?  I was under some other high stress when I started exhibiting the frequent peeing and symptoms.  also the peeing started mild and more like incontinence, then it was like going to the bathroom 14 times a day.  got progressively worse.
So I took a week of Flagyl and the chronic  peeing has finally stopped.  is it possible there is some residual parasites in me and this crap show will resurface?
Thanks in advance.
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Welcome to our forum. Thanks for your question. Trichomonas is a challenging STI. Until recently there was a little research on the organism and tests were not very good. The availability of NAATs for trichomonas diagnosis has provided powerful new tools for diagnosis and research.  That research has shown that for years we have been under treating trichomonas using a single 2 gram dose of metronidazole rather than a full week of therapy which gives better results.That said, there are many questions remaining, particularly when it comes to trichomonas in men.  We do know that most Trichomonas infections in men are asymptomatic. How long the infections persist in that asymptomatic state is unknown Although we certainly do know that over time most infections in men clear without treatment. How long that time period is on, average, and what the outer limits of persistence might be are unknown.  With that background, let me try to address your specific questions:

1.  I see above. Indeed men do clear the infection without treatment however how quickly that occurs is unknown. Unfortunately the fact that you had a negative test previously suggests that you were infection has been acquired since then.

2.  This too is unknown, particularly in men. We do not uncommonly find evidence that trichomonas has been present for years in women based on infections detected an elderly women who are not sexually active. Whether there is a male counterpart of this long term persistence is unknown.

3.  NAAT tests occasionally still miss the diagnosis of trichomoniasis. Certainly the infection can be present in asymptomatic state before it becomes symptomatic..

Seven days of metronidazole therapy is highly effective therapy although failures occur occasionally. To prevent recurrence of the infection it is particularly important that your partner be treated before you resume unprotected intercourse with him. 

I’m sorry I don’t have better answers for you on these issues. If there are further questions or anything I have said is unclear please feel free to use your up to two follow-up questions for clarification. EWH
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2 months ago
ok. that is pretty much confirms my conclusions. only clarification I would ask is your answer in #2. are you saying you commonly find trich in older women that are not sexually active? so the trich was there for years?

and once a week long dose of Flagyl works  the trich is gone?  or can it still be there if it (Rx) fails and just asymptomatic? so maybe the flagyl does not kill all the trich?

If I had a hysteroscopy DNC   for a polyp would the Dr have seen any any of this Trich if it was there or signs of it? does Trich cause any internal inflamation that can be seen?

Again thanks in advance
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Regarding number 2.  Correct, that’s one of the lingering questions the needs further study.  The observation is that from time to time trich is diagnosed in elderly, non sexually active women.  Presumably the organism has lingered there, asymptomatic for years, even possibly decades but the details and basis to these observations still warrants further research.

A week of metronidazole is highly effective for trich.

Signs of trich may not be present or detected at the time of hysteroscopy.  Trich does not always cause inflammation to signal its presence.

EWH 
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2 months ago
one last question: my partner was tested full panel  as well as urine and swab for trich.  he is negative. how on gods green earth did I get this?  the test I had urine dipstick: 
Glucose: negative Protein: negative Nitrite: negative Leukocytes: small.
 the wet mount: 
Hyphae/Candida: no Budding yeast: no Trich: yes Clue cells: yes (>=20%) WBCs: yes (many) Amine/Whiff test: positive pH: 7.5

I am just at a loss. so if I have trich ( which I thought I got from him but apparently did not) and I was with him wouldn't I have given it to him?   how could he be negative?
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Several comments. 
1.  You may never know where your infection came from.  Your partner may have been infected and cleared it, as occurs more commonly in men than women, his test may have missed his infection, or it may have been smoldering.  Irrespective, it is important mahatma even with a negative test that he be treated with metronidazole.

2.  Your tests show that you still have bacterial vaginosis.  If these results were from tests performed before you were treated, all’s well.  OTOH, if these results were from specimens collected after you were treated, if you have recurrent symptoms, you should be retreated.

Normally, this 3rd reply would complete this thread but I will keep it open for about 24 hours before closing it in case there is a final question.  EWH 
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2 months ago
So I’ll never know how when I got it?  Can one test positive if asymptomatic?   Meaning in 2019 I came up negative for trich poisiutve for BV took a week of flagyl  in 2020 recently positive for trich and BV took flagyl  again. Is it probable I got trich between 2019 and 2020  or could I have harbored trich for years before and it flared up under stress and low immunity in 2020?  
I find it weird my partners dr did not prescribe flagyl being we were together  and I tested positive and he is negative any advice other than he should take the Rx?
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Final thoughts/comments:

1.  Given your history of treatment for BV and prior negative tests it is quite likely that you infection was recently acquired.  ...even given his recent negative tests.
2.  Asymptomatic persons can certainly have positive tests.
3.  Your partner should absolutely be treated before you have unprotected sex again.

Sorry your having to go through this.

End of thread.  Take care. EWH 
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