[Question #11505] Anal Gonorrhea from Rimming?
14 months ago
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2 weeks ago today I went to an Asian massage.
I got condom protected oral. I did not give her oral and maybe 10 seconds of condom protected vag sex with 50% penetration. No vigorous tongue kissing occurred. She did give a vigorous rim job that lasted a few minutes. I am hetero. Never been with a man, never had anal other than this woman's tongue.
48-60 hours later started to feel a itchy in my butt with symptoms of hemorrhoids like sitting on a ball with mild burning, rectum feels swollen. Sitting is worse than standing. Not experiencing any anal discharge, no blood in stool, no chronic diarrhea and no constipation.
Concerned based on the timing I got anal gonorrhea from rimming though I have none of the classic symptoms and getting like this would be highly unusual.
5 days ago, I took 2 G Azithromycin. Not much symptom change. About 18 hours ago I took 800 MG Cefixime
How many unlikely things would have had to occur to get AG this way and to have both treatments fail?
Now what?
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H. Hunter Handsfield, MD
14 months ago
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Welcome. Thank you for your confidence in our services.
There has never been a reported case of rectal gonorrhea that was documented to be acquired by analingus (rimming). I am unaware of any anal gonorrhea ever being found in someone who had not had receptive anal sex (bottom). That doesn't mean the risk from analingus is zero, but obviously it's minuscule. In addition, the statistical likelihood a partner like yours has oral gonorrhea herself is under 1-2%. Given both those considerations, the chance you were infected was zero for all practical purposes. Conceivably your symptoms could be due to rectal gonorrhea, but as you already seem to know, they're also consistent with hemorrhoids and similar common causes of anal irritation. Finally, at this time there is no point in testing anyway: if you in fact had acquired gonorrhea, it was cured with the cefixime -- and azithromycin in a dose of 2 g is itself very reliable treatment for gonorrhea.
In terms of your closing question, I'd calculate the odds at something like this: that your partner had oral gonorrhea, let's say 1%; chance of transmission by analingus (rimming) if she had it, let's also estimate 1% (which probably is way too high); chance of failure to cure gonorrhea with cefixime 800 mg let's also estimate 1%; and failure with azithromycin 10%. That would make the likelihood you currently are infected 0.01 x 0.01 x 0.01 x 0.1 = 0.0000001. If I've correctly counted the decimal places, that's 1 in 10 million. Because these estimates are probably too high, the actual risk probably is still lower. I hope you'll agree it's zero for all practical purposes.
If somehow I were in your situation, I definitely would not be tested and would not be at all worried.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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