Trichomonas treatment

[unknownSpace]

Dear doctor,
   I am a male and was infected with Trichomonas. I only have mild discomfort. My doctor suggests me to take 3 weeks of Flagyl.
   However, when I check the CDC website, it said Flagyl needs to be taken for a week. why?

[H. Hunter Handsfield, M.D.]

Recheck with your doctor and make sure you understood correctly.  The standard treatments are either a single large dose (2 grams) all at once; or 7 days treatment, either with 250 mg 3 times a day or 500 mg twice a day.  Nobody needs 3 weeks treatment.

By the way, how do you know that what you have is trichomonas?  One way is when a female partner has it.  But most cases in men cause no symptoms, so your "mild discomfort" makes me concerned about other infections, such as chlamyida, NGU, or gonorrhea.

Good luck--   HHH, MD

[unknownSpace]

Dear doctor,
   Thanks for your answer a lot. I believe that you are a doctor who really concerns about patients and take care of their interest. I am pound of your contribution to this forum.

   This is my first exposure to sex worker, on Oct 10. I used condom during intercourse, but I gave the girl oral sex without protection. Since then, I am very scare about getting STD, mostly HIV. I did a STD screening 3 weeks after exposure, including Chlamydia, Gonorrhea, HSV2, Syphilis, HIV, all come back negative.

   Since i still had mild discomfort, and I did another STD screening 3 weeks later. This's time I was tested for Chlamydia, HSV, Syphilis, and Trich. I was diagnosed with Trich by urine test. The doctor said the urine test screens for something like Trich antigen, and it is more than 90% accurate. He gave me medication for that, 2 pills each time, 2 times per day, for totally 3 weeks.

   Doctor, I am really concerned about the following questions:
   1. How's my STD screening coverage? Do I need to do further testing because of testing sensitivity, or things like windows period?
   2. My HIV test was an antigen antibody combine test at 3 weeks, how accurate is it?
   3. After taken the trich pills for 11 days, there's still mild discomfort in my penis, what else should I be tested? or what should I do?

[H. Hunter Handsfield, M.D.]

I am unaware of any test for trichomonas like you describe.  If you call your doctor's office and ask for the name of the test (or find out what lab the doc uses and get the test information there), I will see what I can find.  But you definitely didn't catch trich or any other STD from the exposure you describe.  And the treatment you were given implies your doctor doesn't know much about trich.

To answer your specific questions:

1) If you had visited me, I probably wouldn't have done any of those tests, except perhaps HIV--not because I think you really risked catching HIV, but because it likely would have assured you that didn't catch anything deadly.  No, you don't need any more testing.

2) Modern HIV antibody tests become positive in 10-20 days after exposure.  Three weeks is cutting it a bit close, but the odds are so teeny you could have caught HIV, I would just relax and not worry about it.

3) You don't describe the "discomfort" in enough detail to know what might be going on.  But there is no way you could have caught any STD.  My guess is that your discomfort is psychogenic, i.e. related to your anxiety.  Stop taking the metronidazole (Flagyl) and sit tight (no pun intended).  Your symptoms likely will fade.

Good luck--   HHH, MD