trying to decide course of action

[truenice]

Dear Dr,



Thanks for the nice work.sorry for the long post, but it is definitely related to possible STD so had to explain. this is just another opinion I am seeking as it is unclear after many tests/doc visits.



I am male , 29, straight,



have seen many docs (urology, ID) before.



Problem is



symptoms started sometime in 2002.



Had trichomonas vaginalis culture positive in 2003. Treated with flagyl 3 weeks 500mg  times a day, subsequent cultures of EPS/semen negative for trich.



also showed other coliforms that time ( E-coli/enterococcus,staph )



not able to trace when, and where i got the trich ( very minimal sexual activity ).



Not sexually active since then, trying to clear off whatever it is. REINFECTION with Trichomonas not possible at all.



symptoms continue (burning on ejac, mild pain above right testicle) for years together. so in 2006,



decided to do some PCRs for Trich - 1 lab ran 2 assays - one was weak positive, one was negative ), 2 other labs infact same sample of (EPS/semen) calls negative.



cultures with in-pouch, diamond medium for trich all negative -many times. some antibodies tests in semen OSOM, DFA for trich also negative.



also been on 10 days of tinidazole ( 2g each) in april 2006.



the pcrs repeated with the same set of labs, still showing the same results, weak band in one lab in one of the assays, negative in other labs.



not able to decide if it is still an active infection/ resolved old infection.



lab cultues now show Klebsiella  / e-coli, but not able to decide exactly what is causing the symptoms.



WHAT IS THE BEST POSSIBLE TREATMENT FOR TRICH IN MEN. ?

is this curable in men ?



Is tinidazole for 3-6 months indicated. ? prostatic injections with tinidazole can help ?



Also, wanted to rule out Klebsiella Granulomatis ( donavanosis )

cuz one lab calls klebsiella pnemonia, other oxytoca.



worried if they are getting the subtype right. Not able to remember any flagrant lesions at any point in my life thou.



just trying to rule out this condition because of the chronicity of the infections.



local doctors in florida are not able to know where and what tests are available to test for Klebsiella granulomatis.



any references in the above 2 areas will be very helpful.



other than this, plan is to try IV antibiotics for the coliforms that are showing up.



No other urological abnormality(cystoscopy,MRI,TRUS)



All other infectoions negative( hiv, hsv1/2,chlam,gona,RPR,myco/ureaplasma )



might enter marriage in the next few months  - so a little tensed.

[H. Hunter Handsfield, M.D.]

Sorry, but I really cannot help.  I disagree with the premise; your probabem is not "definitely STD related".  You clearly have no STD at all, and there is no reason to suspect persistent trichomoniasis.  On top of that, no online source can come up with a clear answer for undiagnosed health problems when personal evaluation by several providers has not been successful.  Based on the cultures for E. coli and Klebsiella, you might have prostatitis with one or both of those organisms.  Klebsiella granulomatis does not cause urinary infections, and K. oxytoca cannot be confused with it--because K. granulomatis has never been grown in the laboratory.  (That is, any positve culture for Klebsiella cannot be K. granulomatis.)



Follow up with your own health care providers.  In the meantime, you can be certain you have nothing that will ever seriously harm your health or that of a sex partner.



Good luck--  HHH, MD

[truenice]

Dear Dr,



Thanks for your comments.



My EPS/semen cultures many many times have turned out negative for the trich.



In the most unfortunate event of the weak band in one of the trichomonal PCR assays, is actually some low count active infection, as opposed to DNA fragments of the resolved infection, what does it mean to the health of my partner long term.



Is it still a manageable / curable thing at that point.



I am trying to get over this, and think in terms of marriage and kids.