Trich - Risks

[brokenin2]

Hi Doctor,
Have been reading the threads on here to get as much info as possible but have some specific questions about Trich. 3 wks ago I had protected vaginal sex with a CSW in Europe. During the encounter my condom broke and was bare for was 30 secs. After, I was racked with guilt (I have SO), was checking the area lots (looking for discharge, lessions, etc.) and searching the web for possible things I might have picked up. I went to my local clinic on day 3 and was treated against all bacterial STDs (Penicillin, Azithromycin and Ceftriaxone). After 2 weeks I went for test of cure and came back neg across the panel. I have also done an HIV test - but not too worried as risk is low. I've had no lesions at 3 weeks - & not concerned about herpes based on low risk. However, I have had some symptoms that I'd like your opinion on: I have felt an increased urgency and frequency to urinate. Particularly more prominent when I am sitting down. When I am  driving my car at times I feel some urine coming out without control. I have inspected myself and it is definitely urine and not discharge. I have had no pain on urination or testicular pain. I have also been quite constipated - which I suppose could be a result of the high dose of antibiotics my body has been put through.
After googling Trich, I got quite concerned that this could be a risk that I hadn't been treated against. I have had sex once with my SO since my negative panel (not before as I didn't want to put her at risk) - however, didn't know at this time that Trich was a risk. Yesterday I was medicated with 2g metronidazole after pleading with doctor to treat.
- How likely a risk is Trich given brief exposure?
- Do you think Trich is the cause or the mind or something else?
- How successfully is Trich transmitted? (what's the chances of me having got it from 30 seconds with csw? And chances of passing it to SO in one encounter)
- How long am I infectious after meds?
- Is there anything else I might have?

[Edward W Hook, MD]

Fianl answer.  the sore throat would occur with oral herpes, with lesions, during an initial outbreak.  You have no reason to think that you have HSV.  Your red dots are not HSV lesions and 4 weeks would be too liate for a typical intial outbreak.

At 4 weeks following the onset of symptoms, about half of persons who have acquired HSV will have positve antibody tests

This completes this thread. Further answers will be deleted without comment. EWH

[brokenin2]

Hi doctor,

Am happy to re-pay to post another question (but have seen you comment elsewhere this reduces opportunity for others to post), have also tried to search on here for an answer to one final question, but had no joy - so I hope you'll accommodate a final question from a man very much in distress:

I have had a severe sore throat over the last couple of days and have just now noticed several red pin pricks on my penis head.

- I've read on here that sore throat can be a symptom of herpes (though is more likely to be attributable to a sore throat and just that) - can you please clarify whether this would be applicable for an initial genital herpes outbreak or only oral herpes that causes the sore throat?

- I've read that 4 weeks (I'm now at 30 days) is rather late for an initial outbreak - would it be possible that at 30 days I could be having a primary outbreak?

- If I were to test at 4-5 weeks, how accurate would a herpes test (blood test for hsv 1 and 2 antibodies) be? I already have a baseline test taken a couple of years ago with no new partners in between that was neg for both?

Many thanks for your response.

[Edward W Hook, MD]

This will need to be my final response.  We have limited time/space for follow-ups.  You have ruled out STIs in your repeated testing since the very low risk exposure you mentioned.  You need to give up on your concerns that you have an STI and focus on the guilt and resulting anxiety which you have already acknowledged.  

As for the "white sacks of pus" inside your return that you mention, I have no idea what these are (or how you have seen them if they are inside of your rectum) but I can assure you they are not related to the exposure that you have described.  

Finally, many of the continuing symptoms you are experiencing, while not commonly accepted as signs of STIs, are certainly signs which might result from anxiety.  I suspect this is your major problem.  EWH

[brokenin2]

Dear Dr. Hook,

Unfortunately despite my negative tests by PCR for Gon, Chlamydia, Ureaplasma, Mycoplasma, Trich and now negative results for HIV by DUO at 4 weeks, my symptoms have remained:

- frequent urination
- dribbling urine (uncontrolled when seated)
- feeling as though not fully voiding bladder
- I also have two white pus sacks inside my rectum and am having difficult bowel movements - I popped one of the sacks by mistake on examination which lead to the difficult bowel movements and made the urinary problems more pronounced
- I have also had some very minor pain in tip of penis when touched whilst seated
- my ejaculate is lower volume than usual and is dribbling rather than shooting

I know in light of two sets of negative STD results, this is unlikely to be of STD origin and I need to trust the results. However:

- is it possible an STD could have got to my prostate and caused an infection that was not detectable by urinalysis by PCR?
- Is it possible my semen / prostate could be infected and not my urine and therefore it wouldn't show on urinalysis by PCR?
- is there any NGU that would not have been covered by my tests and not treated by the medication I have already received?
- is there any perceivable risk to my partner given that I am symptomatic but have negative results?
- is it possible that a bacteria / virus etc., that I picked up in my penis could cause white sacks of pus in my rectum? I guess the question here is could I have got anything in my penis that transferred to my rectum? (Admittedly I have never checked my rectum before this week - so this is the first time I've seen these sacks)

Many many thanks in advance of your response.

[Edward W Hook, MD]

Glad to help.Take care. EWH

[brokenin2]

Hi Doctor,

Have just received my test results (PCR) for Trich, Ureaplasma and Mycoplasma Gen and all came back as 'Not Detected'.

Reading the forum, I understand that testing for Trich is a bit of a grey subject (although PCR does seem comparatively more accurate than Culture or Wet Mount) - however, I'm assuming that given this, non-typical symptoms for Trich (which really do seem to be a case of me dribbling some urine due to anxiety), and the already low risk to my partner - it's time to put this matter well and truly to bed.

This, combined with the negative panel I've already received for the bacterial infections (+ the fact I've been treated against them all) and the low risk for Herpes and HIV - make me 100% happy to continue a fulfilling relationship with my SO.

I'd like to thank you again for such a wonderful service - please know that the energy that you and Dr. HHH put into this service does not go unnoticed - although, I am firmly committed to this being my last visit!

[Edward W Hook, MD]

Anid I do think your estimates are on the high side.  EWH

[brokenin2]

Thanks Doctor,

That's very reassuring. I work that out at a 'worst case scenario' that my current partner has around a 2% chance of having been infected with Trich. That is assuming 50:50 chance the CSW had Trich in the first place (which is probably a very high estimate), a 20% chance I caught it after a 30 second exposure, and a 20% chance of me then infecting my partner on a single exposure.

[Edward W Hook, MD]

Directly to your questions:

The infection rates for gonorrhea and chlamydia following a single exposure is somewhere between 10 and 20%, IF the person was infected (and again, it is statistically unlikely that she was).  Your risk would be no greater than that.

Metronidazole would be curative within hours.

Urethral discharge is a spontaneous process. the Discharge is typically at least thicker than urine and would be cloudy, not clear like urine.  

Take care. EWH

[brokenin2]

Hi Dr. Hook,

Thank you so much for your speedy response and reassurance. I had suspected that this was more likely a case of mind over matter - it is amazing how the mind can trick (excuse the pun) into feeling such things.

If I can just ask 3 quick follow-up questions, I will then leave you to get back to your excellent forum:

1. [Can absolutely understand the lack of available data on trich and therefore it being difficult to give a definitive answer on transmission rate with infected partner.] If you were to take an 'expert guess', what transmission rate would you guess at for an infected vagina resulting in penile infection? Would this be the same for Penis to Vagina or would transmission be more difficult?

2. Assuming I did have Trich - how quick would the metronidazole render me non-contagious?

3. What is the difference between urine and discharge in terms of appearance and texture (I guess what I'm asking here is - if I had discharge could I confuse it with leaking urine or would it be absolutely noticeable? colour, texture, feeling etc.,)?

Keep up the fantastic work that you and Dr. HHH do on this service. Many thanks again.

[Edward W Hook, MD]

Who come to the Forum.  There is still much to be learned about trich in men.   The symptoms you describe however are not typical of any urethral STI, including trich.  (Typical symptoms would be a discharge of burning on urination.). Urinary frequency and urgency are common manifestations of anxiety however.

Analytically the risk of any single exposure is low.  Most women, even. Most commercial sex workers do not have any STI and most exposures to infected partners do not lead to infection.  If you did acquired trich, you are now treated and should not worry further.  

At this point, my advice is to try not to worry.  EWH