[Question #11117] gonorrhea

16 months ago

Hi I recently had a brief encounter with a sex worker. All that happened was she masturbated me then rubbed my anus with saliva on her fingers. I’m really concerned about gonorrhea, about 2 days later I developed a sore itchy anus, which is also red. I then took doxy 200 mg 48 hours later then took azithromycin and cefixme around 50 hours after the event. I took a full weeks worth of doxy . I’m just concerned that I’ve read that hat saliva can transmit gonorrhea? A day before this event I had a colonoscopy so I’m concerned that maybe this would make it easier for gonorrhea to enter my system.

Thank you in advance

H. Hunter Handsfield, MD

16 months ago

Welcome back to the forum. Thank you for your continued confidence in our services.

There was no risk for gonorrhea from this event, and anal irritation has many potential causes, and physical irritation or conceivably a yeast infection are most likely. it is not transmitted by hand-genital (or finger-anal) contact, and -- despite what you read somewhere -- infrequently by saliva. There is a bit of controversy about saliva and gonorrhea because of the results of research in Australia suggesting gonorrhea is more transmissible by kissing than previously believed and perhaps by analingus as well. However, some experts disagree with the conclusions of that research; and even the Australia investigators have found it to be a problem only among men who have sex with men.

In addition, anal gonorrhea doesn't cause redness or irritation of the outside of the anus. Gonorrhea is strictly an infection inside the rectum, usually with no symptoms; and when symptoms are present they mainly include discharge and bleeding, but not external irritation, itching or redness. These symptoms are equally likely a result of your colonoscopy the day before the fingering event.

As you may recall, some aspects of your current questions were addressed in your two previous threads a year ago. In any case, in the slight possibility that somehow your symptoms WERE due to gonorrhea, the antibiotics you took undoubtedly cured it. They also were 100% effective in the event that somehow you acquired syphilis or chlamydia.

If your symptoms are continuing, I would advise seeing a doctor -- ideally the doctor/clinic where the colonoscopy was done. If they have cleared up, nothing more need be done. There is no point in testing for any STD.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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16 months ago

So in the unlikely event 400 mg of cefixme and 2g of azithromycin would have cleared it? Or aborted it? What about drug resistance etc? I’m in the Uk and those 2 drugs are a second line treatment. Are second line treatments effective? May I have your take on saliva as a possible route of transmission of gonorrhea?

Many thanks

H. Hunter Handsfield, MD

16 months ago

My "take" on saliva is that there is no significant risk. And almost certainly cefixime + azithromycin would have cured or aborted a gonococcal infection if you had been exposed, which almost certainly you were not. Sufficient resistance of Neisseria gonorrhoeae to these drugs is almost never sufficient to prevent cure, especially in UK (or North America). The chance is higher in parts of Asia, but even there these drugs almost always should be effective. And as I said, your symptoms do not fit with rectal gonorrhea.

You have my reasoned, science based evaluation and advice. You do not need testing for gonorrhea or additional testing. Take or leave it, I don't care -- but this isn't a debate. There is nothing you will think of that has any chance of changing this assessment so please don't try.

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