Back with questions

Doctors, I hate to say I’m embarrassed to be back on this forum but am.  Three years ago I had unprotected intercourse with a Las Vegas csw.  I was tested for everything and even issued doxycycline and Flagyl – and nothing ever came up.  However, I was just told yesterday that my significant other was diagnosed with Trich.  I was given a 4x500mg treatment of Flagyl, which I have started today, even though I was not tested or confirmed to have Trich.  I’m not sure how or why the Trich appeared after so long of an exposure, as I have felt completely normal over the past couple of years, maybe with the exception of dry skin at the base of my penis.

The problem now is that before I was told about my spouse’s infection, over the past week/weekend I had engaged in unprotected intercourse with two women, both said they were clean but not tested.  This is the first instance over other women aside from my wife from the incident three years ago.  Upon this stupid act, I have felt tingling sensations in my legs and waist area, had dizziness, and stiffness in my pelvic region.  No discharge as of yet, no lesions, and my penis feels normal.  I have not engaged in intercourse as of yet with my spouse and don’t plan to until at least my Flagyl treatment is complete.  So with having said all that, my questions are:

- I know that having Trich increases risk of contracting other STDs, including Herpes and HIV.  Do you know what those odds are?
- Should I get tested for both HSV and HIV, and if so, when can I get tested to feel confident enough everything is OK?
- Should I also get tested for Chlamydia and Gonorrhea given that I was prescribed Flagyl?  I did not know if being on that medication would skew the results of that test.
- Is my anxiety getting the best of me with the sensations I’ve feeling?

Thanks doctors, and I know I need to make some serious change re: my behavior.

[Edward W Hook, MD]

Welcome to the Forum.  Just to be clear, as I understand it, the encounter with the two partners outside of our wife occurred after your wife's diagnosis- is this correct?  If not, you may have acquired and transmitted trich to her.

Either way, I have my doubts that your wife's trich is related to your encounter three years ago.  i presume your wife has been checked prior to this and be negative and when trich infections do occur in men they tend to clear without therapy in just a few weeks.  In contrast, trich infections in women can arise for no obvious reason.

With regard to your specific questions:
I know that having Trich increases risk of contracting other STDs, including Herpes and HIV.  Do you know what those odds are?

The only STD this has been studied for is HIV and trich, like most STDs increases risk for infection by about 30%.  this of course is only the case if your partners happened to have STDs.

- Should I get tested for both HSV and HIV, and if so, when can I get tested to feel confident enough everything is OK?

In the absence of lesions or sores, we do not recommend blood tests for HSV- the tests are not good enough for this purpose and frequently give false positive results.  Following unprotected exposures to other partners however, screening for other STDs is a good idea. The most important tests are for chlamydia, NGU and gonorrhea and those test can be done at this time.  risk for HIV is low but testing is reasonable. Blood testing for HIV need not be done optimally at 8 weeks after your exposure for definitive results.

- Should I also get tested for Chlamydia and Gonorrhea given that I was prescribed Flagyl?  I did not know if being on that medication would skew the results of that test.
See above.   Your trich treatment will not skew your  test results for gonorrhea, chlamydia or NGU.

- Is my anxiety getting the best of me with the sensations I’ve feeling?
Only testing can resolve this question for sure but it would not surprise me if anxiety is a contributor.  When you test, let the test results guide you and believe them

I hope this helps.  EWH

[tryingtostaycalm290]

You are correct - the encounter with the two partners occurred after my wife's diagnosis of trich.

As an update, I was tested for both chlamydia and gonorrhea - both came back negative.  I have tried to find out where I can get tested for NGU, but haven't had much luck thus far (my city's STD clinic does not test for it).  I did visit my urologist and he ran a urinalysis and it came back fine.  My symptoms have pretty much died down, but the feeling I get is a little discomfort at the tip of my penis (which my urologist examined and said it looked fine) which admittedly does seem to go away if my mind is off of it.  I believe/hope my anxiety is getting the best of me and that nothing is wrong.  My urologist noted that this could be a factor, and recommended to not prescribe anything for NGU as of yet to see if sensations go away as they did 3 years ago in my similar circumstance.
My follow-up questions:

- Given limited symptoms (no discharge, no urethral pain) do you think NGU is still a realistic possibility?
- I thought I read that NGU can cure itself over time – is this true?
- Given no lesions or sores in the past 12-14 days, is HSV really not likely, hence why you say don’t test – meaning the chances of a false positive are greater than actually having HSV?
- In my case, would HIV chances after 4 weeks be about a 1 in 5 million shot (1 in 1000 of my partners having it, 1 in 1000 chances of contracting, multiplied by 2 (two partners) with a 90% certainty on the test)?  I would test at the definitive point but wanted an initial test as soon as numbers are fairly reliable.

Thanks again for your expertise.

[tryingtostaycalm290]

I should also add that I did receive oral sex in these two most recent acts.  I'm not sure how/if that changes any of your input, but I wanted to ensure I included that.  Thanks.

[tryingtostaycalm290]

Dr. Hook - just following up on my questions from Tuesday.  I know you're busy, I just wanted to make sure you saw them.  Please see above - thank you.

[Edward W Hook, MD]

Given limited symptoms (no discharge, no urethral pain) do you think NGU is still a realistic possibility?
No, I would not worry about NGU in your case.

I thought I read that NGU can cure itself over time – is this true?
All STDs, including NGU can ressolve over time without therapy.

- Given no lesions or sores in the past 12-14 days, is HSV really not likely, hence why you say don’t test – meaning the chances of a false positive are greater than actually having HSV?
No, HSV is not likely.  I do not recommend a blood test for herpes.

- In my case, would HIV chances after 4 weeks be about a 1 in 5 million shot (1 in 1000 of my partners having it, 1 in 1000 chances of contracting, multiplied by 2 (two partners) with a 90% certainty on the test)?  
Correct.

Your recipt of oral sex does not change things at all.

EWH

[tryingtostaycalm290]

Thanks doctor. Last questions and I'm done-would you recommend against precautionary antibiotic treatment? I do not want to spread this to my SO. Also, can the symptoms of herpes be confused with jock itch? I have what feels like jock itch on the skin around the base of my penis. Feels like jock itch, no lesions, just irritating of skin that comes and goes...

Thanks again.

[Edward W Hook, MD]

Your concerns about HSV are truly unwarranted.  Get over it.

As for "precautionary" treatment- since your partner has trich, you have been exposed and should both be treated at a time when neither of you has had sex in the interval between your two treatments. That however is not precautionary treatment.  In general treatment is the absence of proven infection in you or a partner only confuses matters and is not recommended.  EWH

[tryingtostaycalm290]

Thanks.  We have both been treated for Trich (2g dose of Flagyl) - I was referring to potential NGU - but it sounds as if you recommend against that given no discharge and no sign of bacteria in a urine sample.

[Edward W Hook, MD]

Correct- there is no evidence that you have NGU.  EWH

[tryingtostaycalm290]

Doctor, please let me know if I need to start a new thread - but last statement/questions:

- Tested negative for chlamydia, gonorrhea via urine, and clinic tested me negative for syphillis (syphilis) and HIV at 4 weeks (catching 90%) on blood test
- Receive trich treatment (1 dose of 2g of Flagyl)
- No evidence of NGU, but urologist did perscribe 10 days of 100mg doxycycline twice a day, as he said urinalysis isn't full proof for detecting NGU, even though urinalysis looked normal.
- Still having a little discomfort at tip of penis (mild sting at beginning of urination, and mild stinging after ejaculation (following the completed doxycycline treatment).

Does anything sound likely at all?  Could it be CPPS, which I read the recommended Wikipedia reading, and as I understand to not be harmful?  I just don't want to cause any harm to my spouse.

Thanks again for the service you provide.

[Edward W Hook, MD]

Your spouse is not in danger. No further testing or treatment is warranted.  I recommend that you not worry further and do your best to more forward, putting your dalliance long ago out of your mind.    EWH