Sexually transmitted disease tests need interpretation


DEAR DR. DONOHUE: Recently my wife had her annual Pap smear. The doctor told her she has trichomoniasis, a sexually transmitted disease. Of course she asked me about this. I told her that the last time I was with another woman was more than 30 years ago. I am very certain that she has been faithful. We have both taken medicine for this. Can you explain this to us? We are in our 60s. – B.T.

Trichomonas (TRICK-oh-MOAN-us) is a one-celled organism, like an amoeba. It is spread mostly through sex and is a common sexually transmitted infection. However, it can survive for several hours in a moist environment and can, therefore, potentially be spread in other ways. Being spread in nonsexual ways is rare, though.

Trichomonas can persist for a long time and not cause a single symptom, especially in men. A man can be a silent carrier, as can a woman.

Most females do have symptoms – a yellow-green, frothy and often malodorous vaginal discharge. The primary sign of male infection, when it occurs, is a penile discharge.

Your wife’s infection was discovered on a Pap smear. Pap smears frequently can be labeled mistakenly as being positive for trichomonas when there is no infection – a false positive. Your wife is a woman at low risk for infection. You and she have been faithful to each other. Neither has had any symptoms. In this case, the Pap smear should not be used as definite proof of infection. Another test should be performed before declaring the woman infected. Two such tests are the RNA probe test and the nucleic acid amplification tests. There are others.

I don’t believe your wife ever had an infection. This situation pops up constantly and is a source of great domestic discord.

The booklet on vaginal infections includes material on trichomonas infection. Readers can order a copy by writing: Dr. Donohue – No. 1203, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Please explain what happens in the digestive tract after taking antibiotics, which I did. I developed a stomachache, much gas and diarrhea. After several weeks, those symptoms have subsided, but now my elimination is sluggish. – J.R.

Antibiotics kill bacteria. The digestive tract is full of bacteria. They’re, for the most part, good guys that help in food assimilation. Some have very important chores, such as the production of vitamin K. Antibiotics kill bacteria indiscriminately – the good and the bad. If the digestive tract’s good bacteria are eliminated, then symptoms like yours can happen.

In some instances, a rogue bacterium, Clostridium difficile, begins to multiply in the tract. Previously it was held in check by the normal bacteria. Without them, it can experience a population explosion. It makes a poison, a toxin that brings on severe diarrhea.

Most of the time, simply stopping the antibiotic straightens matters out.

Your current “sluggish elimination” might need a jump-start with fiber or a stool softener such as Colace.

DEAR DR. DONOHUE: Nowadays there is such a to-do about gluten sensitivity and celiac disease. Which comes first? – F.G.

Gluten sensitivity and celiac disease are different names for the same condition. Gluten is a protein found in wheat, barley and rye. People with a sensitivity to gluten develop an inability to absorb nutrients, causing diarrhea and weight loss. Gluten acts like a poison to their digestive tracts.

Treatment is avoidance of those grains and gluten.

You can call the illness celiac disease, gluten sensitivity, gluten enteropathy or sprue – whichever strikes your fancy.

DEAR DR. DONOHUE: When a person has cancer, does the cancer spread rapidly if the body is opened for surgery? – P.G.

Opening the body for surgery doesn’t spread cancer cells, but jostling and cutting of the cancer might cause cancer cells to break loose and find their way into the blood. Surgeons go to great lengths to prevent that from happening.

DEAR DR. DONOHUE: I have experienced extreme diarrhea several times after visiting a local restaurant where I enjoy the sugar-free, calorie-free raspberry iced tea. It’s delicious. I ask the waitress to include a generous portion of the raspberry syrup in my tea. I am enclosing the list of ingredients in it. Is one the cause of my diarrhea? – M.W.

My money is on erythritol. It’s a sugar alcohol – which is a misleading name, since it’s neither a sugar nor an alcohol. It supplies sweetness without supplying many calories and is used as a sugar substitute. Sugar alcohols, in large amounts, can cause diarrhea. Drink less of the tea or tell the waitress to cut back on the raspberry syrup.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from