Drs:

I am a mid-30s married male. I travel frequently for work. About three months ago, I had unprotected oral and vaginal sex with a young woman advertising “escort” services on a local classifieds website. I got the impression she was not a professional and relatively new at this. She insisted she was clean.

Three days later I returned home and had one instance of unprotected vaginal intercourse with my wife. I left the next day on another trip. 3-4 days into the trip, I began experiencing mild testicular soreness and discomfort while urinating. There was no discharge of any kind. I visited an urgent care center and told the doctor about my symptoms and the timeline. He suspected chlamydia or gonorrhea, but since I didn't have any discharge and my symptoms were mild, he suggested it was likely chlamydia and prescribed a single dose of azithromycin. I declined STD testing on his advice; he felt relatively confident of his diagnosis. I took the medication immediately. Seven days later, with my symptoms not completely abated, I returned home and had unprotected sex with my wife.

Shortly after the diagnosis, I texted the escort to tell her I caught something from her and she should get tested. A few weeks later, she thanked me for letting her know, as she had tested positive and been treated for gonorrhea. I have no idea how many other men she may have slept with, unprotected, before or after my encounter with her and prior to her positive STD test.

My wife texted me during my latest trip – nearly three months after my possible exposure – that she had been battling what she described as a “UTI, pelvic soreness, and fatigue.” She attributed it to her age and some roughness during our last intercourse. She is mid-30s, very petite, and has a history of occasional UTIs and vaginal soreness/bleeding during our marriage. But I am concerned her symptoms might indicate that I transmitted something to her. My own symptoms (primarily the soreness in my groin area) never completely went away, but it could be my own anxiety over the issue.

Questions:

1. How likely is it that I actually had gonorrhea and it did not respond to the azithromycin treatment? Would I still be carrying it at this point?

2. Might I have transmitted gonorrhea (or chlamydia) to my wife during the first encounter, been treated effectively on the following trip, only to re-contract it when I returned home and had sex with her?

3. If I undergo testing for STDs and the results are negative, would that be sufficient evidence to conclude that my wife does not have anything either? We have regular sex (2-3 times per week), always unprotected, when I am home.

Thank you in advance.

Welcome to our Forum.  I'll try to help.  From what you say there is a reasonable probability that you acquired gonorrhea from your CSW partner and that you transmitted it to your wife.  Nothing here is absolute but with tests, the story is sufficiently strong that at the least I would suggest further testing for you and your wife.  The urgent care doctor who saw you did not do you any favors by not testing and compounded them with his choice of treatment for you.  Let me start by giving you the statistics which are behind my concnern:

You know your partner had gonorrhea.  Following a single unprotected sex act your risk of infection is about 20%.  That you had symptoms, although somewhat atypical, raises the likelihood that you were infected.  If you were infected, with unprotected sex your likelihood of transmitting your infection to your wife is estimated to be about 40% per act of intercourse.  After you first had unprotected sex with your wife you went to urgent care where the doctor gave you azithromycin which, at best has about a 70% chance of curing your infection.  Your wife's symptoms are compatible with infection which could be causing the symptoms you describe (pelvic inflammatory disease).  at this point, a negative test would not be sufficient to assure you that you were not infected and transmitting infection to her when you had sex before being seen at urgent care.  

Now, on to your specific questions:

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Dr. Hook,

Thank you for your prompt reply.  Obviously I had hoped for better news, but I think I already knew what you were going to say.  I will have the difficult conversation and make sure we are both treated.

Assuming the worst case, that she caught it from me at the earliest exposure and has had it for close to three months... do you believe there is a significant possibility of irreversible damage to my wife's fertility?

Thank you again.

There is no way to know:

a.) If her current symptoms represent PID

b.) If she has PID, what its effect on her fertility might be.

As difficult as it will be, I applaud your willingness to have the difficult discussion with your wife.  This can lead to testing and provide you with some data as to her current infection status and that is better off than your current situation.  Further, having this discussion with your wife, as difficult as it will be will be an indication of your concern for her and her well being.  EWH

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