[Question #8357] Trichomonas, STI or something else

45 months ago

Hi Doctors,

Thanks for everything that you do. Im a conflicted married male Recently I’ve been stepping out of my marriage with another man. I thought I was being safe. We were both tested and continue to be tested every 3 months. I’m in Canada and the standard STI panels are negative. However trichomiasis testing is not available to men here. My friend and engage in mutual masterbation, frottage, condom protected oral(both giving and receiving) and last week I started toping him using a condom. I am certain my wife is faithful to me.

Since this has started I’ve had minor symptoms like a tightness at the head of my penis, urgent and frequent need to urinate, and what appears to be a slightly swollen penis head.

About three weeks after our first encounter in January 2021 my wife had what appeared to be yeast infection which cleared up with over the counter meds, fast forwards 3 months yet another yeast infection and she continues to Complains of dryness and can no longer use tampons due to them causing pain and spotting and now she has yet another yeast infection. I’m very concerned that I have infected her with something.

I was tested last week for gone, clam, syphilis,HIV, etc. Is this trich? I’ve read on planned parenthood that mutual masterbation can spread it and elsewhere that condoms are not necessarily effective against trich. Some sites even say it’s spread skin to skin. What are the stats on MSM trich transmission. I’m just very confused and worried.

Edward W. Hook M.D.

45 months ago

Welcome to our forum and thanks for your question. Thanks as well for your commitment the safe, condom protected sex. It will do much to keep you safe and prevent acquisition of STI’s. I also fully endorse your plan for periodic testing on the part of both you and your partner. Regarding your specific questions:

1. Tightness of the head of the penis is not a typical sign or symptom of any STI. Tightness of the sort you describe could possibly represent swelling but what might be causing the swelling remains unknown. Urinary frequency and urgency are also not signs associated with STI’s. These symptoms are suggests sometimes correlated with urinary tract infection or inflammation of the prostate gland.

2. Condoms are highly effective for prevention of trichomoniasis and trichamonas is rarely, if ever transmitted amongst men with other male sexual partners. I doubt that trichomonas or any other STI is the cause of the symptoms you are experiencing. The suggestion that trichomonas is transmitted through masturbation is incorrect.

3. Vaginal dryness or recurrent yeast infections are not suggestive of any STI. Some yeast infections require stronger medication than can be obtained over-the-counter. Vaginal dryness can occur because of aging or other processes and is something best evaluate it by her gynecologist.

I hope these perspectives are helpful. If any part of my response is unclear or there are additional questions please feel free to use your opted to follow ups for clarification. EWH

---

45 months ago

Thank you for your response Dr Hook since I have your ear so to speak i would like to ask for clarification. I understand the internet is both a blessing and a curse. That’s why I find myself here for you expert advice. Planned parenthood makes it sound like if any part of your penis even comes near someone infected with trich you will get it. Is it spread via fluids, skin to skin contact or both? Do frottage and apposition or like pre-cum on your hand during mutual-maturation pose a transmission risk. My apologies if this is repetitive I just want to make sure I understand.

As trich is one of the most common STI why is rarely transmitted amongst msm?

I’m keep telling myself I will stop my behaviour yet I keep finding myself going back. Keeping in mind that Canada has a universal healthcare system and I’m not out of pocket for testing are there other tests I should be asking for? During routine testing I do get a throat swab for chlamydia and gonorrhea. I’m not bottoming but should I be having anal swab done? What should my testing frequency be? Is every 3 months adequate?

Are there any additional steps I should be taking in order to avoid acquiring an STI? If god forbid I experience condom failure should I run to my Doctor for preventative antibiotics and pep? Or should I consider prep as an additional measure?

Edward W. Hook M.D.

45 months ago

Thanks for your additional questions. I believe that the information you obtained from the Internet, perhaps at the Planned Parenthood site, overstated the risk for acquiring trichomoniasis. Research on trichomoniasis is limited and thus, it is not clear whether the infection is transmitted by fluids or direct contact. My guess would be fluids. Thus there is a theoretical risk of transmission through introduction of genital secretions in the course of mutual masturbation however, this process would, for a number of complex reasons, would be far less likely to lead to transmission when compared to direct penetrated sexual activity. Once again, let me emphasize, the trichomoniasis is not a concern for men having sex with other men.

Trichamonas infections do occasionally occur in men however, they are far less common than in women. The reasons for this are unclear. Most men with trichamonas however are asymptomatic or, at worse have very mild symptoms of burning on urination or small amounts of urethral discharge.

As far as testing for gonorrhea and chlamydia is concerned, when you go for testing, I would urge you to seek testing at any potentially expose sites. This oral sex would lead to a throat swab, receipt of oral sex or topping a partner would lead to a urethral swab or urine test and rectal swab’s would only be needed if one was receiving rectal intercourse.

I hope this helps. EWH

---