[Question #110] Time Frame for Transmitting Gonorrhea after Antibiotic Treatment

96 months ago

Dear Dr.

I was having a very difficult time with my wife, and I made a very bad decision while experiencing a lot of stress.

I received unprotected oral sex from a very high risk prostitute. Unfortunately this included the anatomical point of contact, a term I have since read about. - The back of her throat did make quite a bit of contact with my penis.

20 hours later I went to the Emergency Room. They treated me pre-emptively (presumptively), with the CDC's recommended antibiotic treatment. I had the intramuscular injection of ceftriaxone in my bicep and the Azithromycin drink.

5 full days after receiving the treatment and going to the ER, I had unprotected vaginal and oral intercourse with my wife.

Should I be concerned that I could have given her gonorrhea?

I have tested negative for gonorrhea and chlamydia at the ER, seven days after exposure, nine days after exposure, and 17 and 20 days after exposure.

The thing is Dr., I could have given it to my wife since I only waited 5 full days before having unprotected sex with her ? Or do you think it would have been killed by then?

I haven't told my wife about this, and I'm hoping that I don't have to. But her safety is paramount to absolutely everything. Also - my wife mentions during vaginal sex that it hurts. She has definitely said this many times in the past, even many times a year ago and way before this exposure, but it makes me nervous.

Could I have given her something ? The prostitute who performed unprotected oral was 22 years old, lower income, money for sex, African-American, inner city, and a marijuana user. Due to inequality, those are all high risk criteria according to the CDC.

So you can see why I'm very, very concerned.

Thank you very much for your compassion, knowledge, expertise, and help.

H. Hunter Handsfield, MD
96 months ago
Welcome to the forum. Thanks for your question.

Bottom line: There is no chance you infected your wife. All is well.

The details: First, you don't know that your commercial sex partner had oral gonorrhea. Statistically, it is unlikely. Even among the highest risk sex workers, at any point in time probably no more than 10% have gonorrhea, and only 10% of those have an oral/throat infection. That translates to a guesstimate of only 1 chance in a hundred she had it.  Second, oral gonorrhea probably is transmitted under 10% of the time for any single exposure, regardless of contact with the back of the throat. (I'm not sure where you read that. It's not a known fact. Some educational or online sources might have assumed it based on common sense, but it there are no data at all on this.) So now we're down to something like one chance in a thousand you acquired gonorrhea. Third, there is virtually no chance that the combination of cetriaxone and azithromycin would fail to cure gonorrhea. Fourth, cure is very fast. Within hours of treatment, and for sure within a day, you would no longer be infectious. Fifth, urethral gonorrhea almost always (at least 99%) causes obvious symptoms, i.e. pus dripping from the penis and usually painful urination. While symptoms could have been delayed if somehow treatment failed, that would only be for a day or two; by a week later you would have know you were infected. And finally, the standard gonorrhea tests are highly reliable. Your negative tests (way too many of them!) prove you didn't have gonorrhea 7, 9, 17, and 20 days after the sexual exposure.

The only remaining issue is whether you might have acquired any other STD. However, oral sex is safe sex, with low risk of all STDs and zero risk for some. There is little or no risk of chlamydia from oral sex, and azithromycin would have covered it anyway. No nongonococcal urethritis (NGU), which would have caused symptoms by now, and also treated by azithro. No herpes, same reason (no symptoms by now). Syphils rare, and prevented by ceftriaxone and probably azithro as well. HIV and viral hepatitis are not transmitted by oral sex. That leaves HPV, which is rare by oral sex and with which we all are infected anyway.

So all is well, no further worries. You should continue normal sexual realations with your wife (and work on the relationship) and stop getting tested for gonorrhea or any other STDs.

I hope that helps, but let me know if anything isn't clear.

Best wishes--  HHH, MD

H. Hunter Handsfield, MD
95 months ago
Do you have a follow-up question? Your new thread (#158) was deleted and your credit card reimbursed, and this thread (#110) reopened so you could re-post your concerns here. Please do so in the next day or two, after which this thread will be closed once and for all. Thanks.


95 months ago
You mentioned NGU. I do not have gonorrhea or chlamydia. Can the bacteria / microorganisms that comprise NGU, other than chlamydia, also cause PID in my wife? Or can NGU cause PID only if it is chlamydia related?

About 10 days or 2 weeks ago my wife had several 101 degree fevers, severe chills, and sore throat. Her only other symptoms were more pronounced than usual painful intercourse and some stomach aches. Her strepthroat test was negative and so was the urine culture her primary gave her. I presume the urine culture tested for yeast infection. Would it also test in any way for an STD, such as NGU?

My wife will return for a follow up in 2 weeks. I'm going to insist that she goes. She is doing better on a wide spectrum antibiotic her primary gave her. 

I've never had symptoms of an STD before. However, the symptoms for NGU are basically silent. It seems like a pretty symptomless infection, so should I get tested? I wonder how likely it is I contracted NGU from the exposure I described in my initial post?, because my wife's health is paramount to everything. 

Thank you very much for your expertise Dr. Handsfield. It's much appreciated. 
H. Hunter Handsfield, MD
95 months ago
Nonchlamydial NGU has never been shown to cause PID or other serious problems in men's sex partners. Mycoplasma genitalium could do it, but M. genitalium is not carried orally and therefore is not transmitted by oral sex.

STDs rarely cause fever without other symptoms typical of STDs. That her PMD did a urine culture (almost certainly not for yeast) suggests she suspected a UTI, and her improvement with antibiotic is consistent with a UTI. Standard urine cultures don't test for STD.

It isn't true that "the symptoms for NGU are basically silent". Asymptomatic infections can occur, but most cases cause symptoms, especially urethral discharge. In any case, the chance of NGU from any single episode of oral sex is low (as an educated guess, probably no higher than one chance in thousand); orally acquired NGU is not known to cause symptoms or any problems in sex partners; and azithromycin is the drug of choice, so you were treated for it anyway. There are no standardized tests for asymptomatic NGU in men. You should drop this line of thinking. There is simply no realistic chance of it.

Truly, you needn't be at all worried. I care as much about my wife's health and welfare as much as you do, but if somehow I had been in your circumstance, I can guarantee you that I would not have sought STD testing or treatment, and I would have continued unprotected sex with my wife without worry. 

Thanks for the thanks. I hope this discussion has been helpful. 

95 months ago

Thank you Dr. Handsfield! This discussion has been very helpful and educational. I feel great and have nothing to worry about. Being committed to one's monogamous relationship are the only way to go in my opinion, the anxiety is not worth it. I have learned a great deal and thank you very much for your expertise and help.

If I were a wealthy donor or just had more money I would donate to U. Washington and ASHA. I'll spread the word, thank you for this outstanding service. It's been worth every penny.

H. Hunter Handsfield, MD
95 months ago
ASHA and I are glad to be of service. Thanks again for your kind comments about it.