Whenever I disclose the diagnosis of trichomonas to a patient, I explain many things, like the symptoms and the type of bug that it is. But the main piece of information that ends up sticking in the patient’s head is that it is a sexually transmitted infection. I can see them processing in their head and thinking about all of the things that they are going to do and say to their partner as soon as they see them. Whether they are someone in a casual fling, a newlywed, or going 20 years strong with their partner, the gut punch is similar when they consider themselves a victim of someone who has been sleeping around. But should this be the initial knee-jerk reflex? Could it be that nobody was truly ‘stepping out’?
Trichomonas, a parasite of the genitourinary tract, is the most common non-viral sexually transmitted infection in the world. Most of the time, it does not cause any symptoms, but when it does, the most common ones in women are vaginal itching, discharge, and pain during sexual intercourse. Men can get discharge or burning with urination or intercourse. We care about diagnosing and treating this infection because it has been linked to pelvic inflammatory disease, cervical cancer, infertility, preterm delivery, increased risk of HIV infection, cervical cancer, and prostate cancer.
Screening for trichomonas is generally recommended for all women (definitely for those who are HIV-positive) but it is not recommended for men. The issue with this is that most of the woman with a trichomonas infection got it from a man through sexual intercourse. As a result, whenever a woman is diagnosed, they assume that their male partner was cheating if they know that they have not had any other partners. Conversely, a man may accuse their female partner of cheating if he knows that he has not been active with anyone else. I have experienced this diagnosis cause a lot of angst in relationships and potentially even break some of them up. However, it doesn’t necessarily need to.
Like I mentioned previously, most people with trichomonas infection do not have any symptoms and even though infection is thought to come and go by itself in men lasting for only a few days, many men can carry it for several months just like women. Imagine a scenario in which a man was sexually active with a woman and got infected, never developing any symptoms and losing contact with that woman. He can then have sexual relations with another woman unaware that he is infected (because remember, screening is not recommended in guys) and infect them. When this woman goes to get screened by her doctor and ends up being positive, she is likely to accuse him of foul play, even though there was none involved. The man can also accuse the woman of cheating while under the impression that he was not infected before he met her, when in reality he was.
I like to watch dramas in movies and on television, but in real life I really feel for all parties involved when these situations play out (yes, yes I’m aware that in some cases somebody probably was cheating). Personally, I think that it would be reasonable to routinely start screening men for trichomonas, and recommend that men discuss this with their doctor when getting screened for sexually transmitted infections. That way, we can get diagnosed and treated if needed before entering a situation and decrease the likelihood for spreading the infection. The best tests are by urine or urethral swab looking for either growth of the parasite or DNA. Testing could lower the rates from a public health standpoint and avoid adding any confusion to the typical relationship, which if we’re being honest, is complicated enough anyway.
Ladies and gentleman, I’m speaking independently, as no major organizations really advocate for trichomonas screening in men, and therefore there is no guarantee that the cost of the test will be reimbursed by insurance. Plus, when I order the test for self-pay/uninsured patients, it can be pretty expensive (90 bucks at the lab contracted with my clinic). As a result, the decision to listen to me may be made for you. However, I have identified and cured countless cases in men since I started screening for it about a year ago, and would like to believe that I am simultaneously protecting women, giving men a clean slate, and getting ahead of the firestorm to come when a woman is confronted with her positive results from her RECOMMENDED screening. Oops, did I capitalize that out loud?