Trichomonas or other?

[rickyc1234]

In a drunken moment of stupidity, I had an encounter with a sex worker in S. America.  There was a lot of bump-grind fooling around, and some direct genital contact. Then, she gave me a hand-job using her saliva, no protection. A few days later, I had sex with my wife with no protection.  That same week, I started feeling discomfort in the scrotum, an urge to urinate and discomfort in my urethra (no discharge). I went to a local clinic. They tested for gonorrhea, and chlamydia and UTI (all neg). They gave me Cipro for 9 days. A week later, my wife began to have vaginal discharge and was diagnosed with Trichomonas. We had an honest talk and I let her know what had happened. She used the Metronidale gel for 5 days and her symptoms disappeared. I took Metronidazole 500 mg PO q12h x 7 days. I thought I started to feel better toward the 6th day, but still with some urge to urinate and discomfort. Then, about 3-4 days later, my discomfort was even worse then before. The urge to urinate was constant, discomfort in the urethra, and I felt as if my perineum hurt (swollen Prostate?), & scrotum burning.  The clinic prescribed Tinidazole 2g for 5 days as a follow-up. I also went to see a urologist. He said everything “looked” fine. Just in case, he put me on doxy for 7 days. His attempt to run a test for Trichomonas was botched. Labs are not prepared to test men. I finished that last round of Tinidazole and doxy3.5 weeks ago, and I am still having symptoms. My scrotum aches, I still have a constant slight urge to urinate, and discomfort of the urethra is still there.  According to the Johns Hopkins poc-it recommends a 28 day course of Tinidazole or Metronidazole for Trichomonas causing Prostatitis. Is this a good way to go?  Are there any other STDs to check?  I feel that I am beyond the realm of an average STD clinic and my suburban urologist. Do you know any STD specialist (non-HIV) in the Bay Area that can help me please?  

[Edward W Hook, MD]

The test for NGU is to look for white blood cells, either in a swab specimen from your penis or in the urine.  I'm sure the urologist did the test for white cells on your urine.

Ask if you can see Dr. Klausner or Joe Englemen at the clinic.  they are both excellent.  EWH

[rickyc1234]

Hi Doc,  I was tested for gonorrhea & chlamydia, and they came back negative. My urologist checked my urine and did a rectal exam. He said the urine looked fine, and the prostate only seemed a little mushy.  He says go away for a month and if you still feel bad, I'll scope you. What is the test for NGU?  He never mentioned it.

Ive been to the city clinic, twice. They test the basics (they lost my urine once), and they dont test for Trich in men, they just treat. Got any other specific infectious disease specialist to recommend? Please, I need help and I'm not finding it.

[Edward W Hook, MD]

Several comments:

First let's start with the trichomonas.  You are cured, almost sertainly.  Your treatments have exceeded recommendations for trichomonas far exceed what it recommended for this infection.  On the other hand, as far as your wife is concerned, metronidazole gel is not recommended for treatment because it has a higher failure rate that oral therapy with tinidazole or metronidazole.

You did not mention being tested for gonorrhea, chlamydia and NGU but I presume you were.  The cipro is marginally effective for some of these infections but the doxycycline is good therapy and would likely cure these if thy were present and contributing to your difficulties.  I do not see the need to check for other STDs.

As far as your prostate is concerned, did the urologist check your urine and do a rectal exam?  Both are usually performed in the evaluation of possible postatitis.  If you have prostatitis, it would be very unusual for it to be caused by trichomonas.   My advice is to work with your doctor to get this sorted out.  He/she needs to examine you and may wish to do some additonal tests.  In addition, in the Bay area there are a number of good infectious diseases specialists and the San Francisco City STD Clinic is world class.  They can likely be of assistance as well

EWH

Hope this helps.  EWH