DRHOOK-Trich-y business: Pesky STD can have serious effects

the handsome doctor John Hong

Trick or Treat! Smell my feet. Give me something good to eat. (Ah, to be a kid again!) Thinking about it, isn't it coercion to threaten to toilet-paper people's houses or soap their windows if they don't fork over some candy?

"Give me candy or you can Hershey Kiss this place goodbye."

I must admit I haven't given out candy for Halloween in years because our house used to be at the very end of the neighborhood, and no one wanted to walk that far. But now we're buying a new house, and I guess I better get the goods for this Halloween. 

No one likes to be tricked– and does that include having Trich (pronounced trick)? Trichomonas vaginalis is a bug– really a protozoan with a flagella that whips around so this critter can swim like Olympian Dana Torres. 

In women, it infects the vagina but also the glands in the vulva, the urethra, the cervix, and– in worst-case scenarios– goes up the pelvis and can cause infertility. 

In men, it lives in the urethra as well, but it can also infect the head of the penis, the prostate, and epididymitis (which can cause infertility). 

There are probably 3-5 million cases of trichomoniasis a year in this country. In a typical doctor's office, 4-35 percent of vaginitis symptoms are from trichomonas, depending on the physician's client population. 

Some women don't have any symptoms, and most men don't have symptoms. For women who develop symptoms, they can range from severe inflammation that causes vaginal itch to pelvic pain. 

For carriers, we don't know how long a woman can have trichomonas without symptoms. For those who present to the doctor with symptoms, most of them have purulent, smelly thick discharge– sometimes frothy green. Pain with intercourse and bleeding afterwards occurs from the inflammation, and, in fact, the cervix can look like a strawberry from all the small hemorrhages. 

Burning, frequency, and stinging with peeing can mimic a bladder infection, but it isn't due to bacteria. So calling the doctor for a prescription to treat a Urinary Tract Infection without being seen and testing is like driving to the hardware store for milk: wrong! 

Trichomonas in pregnancy can cause preterm labor, and to make things worse, infect the newborn to cause fever, breathing problems, and bladder and vaginal infections. 

Women who get a hysterectomy can get a bad infection of the skin afterwards due to trichomonas. Also menstruation can make "that time of the month" into "the worse time ever." 

Virtually all cases of trichomoniasis are from sex. You can't catch it from an animal or anything else because humans are the only home for trichomonas. Women can transmit it to other women, but rarely men give it to other men. 

Therefore, use of a condom as well as nonoxynol-9 can reduce the risk of transmission. Diagnoses can be "trichy" because it is only seen about 60 percent the time under the microscope. 

Urine testing can be done in the lab, although that's still no guarantee. Treatment requires both sexual partners to take an anti-parasitic medication. But, unfortunately, many partners do not get treated at the same time and do not abstain from sex for a week to allow this parasite to be destroyed. Like ping-pong, they keep giving the bug back and forth to each other. 

Also, some guys who don't want to be treated because they don't have any symptoms. 

"Uh, uh. I'm clean as Dial soap bar! I'm not seeing a doctor for this!"

STDs can be a tricky issue to deal with. So if someone comes on to you and says, "Trich or Treat!" ask them to take an antibiotic and get back to you in a week.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.