Hello doctors thanks for having this resource and for sharing your expertise. I’m a bisexual male, earlier this year I met with a gentleman for 2 oral encounters, me performing unprotected fellatio on him only, no anal or any contact made with my penis. Since those encounters I started a new relationship with a female, but I have since learned about oral gonorrhea and I’m concerned I may have put my new female partner at risk. Here’s a timeline of events:

Early Feb: gave unprotected oral to male

Late March/early April: Fell ill to respiratory infection, was prescribed doxy for 1 week which worked rapidly. 

April 7th: Had some anxiety regarding illness, and tested for HIV/syphilis both negative. 

April 27th: Met same man, gave oral. This time took 200mg doxy 3 hours post encounter. 

In May started dating female partner.

June 6th: got IgG HSV test done, negative. 

July 27th: follow up IgG test negative, also tested for HIV/syphilis as this was 90 days from my last MSM encounter. Included urine screen for G/C. All tests negative. 

My concern is that since my tests did not include throat swabs is that I was asymptomatically infected with oral G and passed it. 

Your question reveals some basic misunderstandings. First, although oral gonorrhea can occur through oral genital contact, if your February partner was outwardly well and you didn't observe pus dripping from his penis, almost certainly he didn't have it. (Non-symptomatic gonorrhea can occur but is rare -- and especially rare in men who have sex with other men.) Second, if you were infected, it has gone by now; oral gonorrhea is cleared by the immune system, typically within a few weeks. Third, oral gonorrhea is rarely if ever transmitted to female partners either by kissing or oral sex. (The same considerations apply to the April encounter, except that it occurred only a month later -- but still the other reasons make it almost impossible you had it or that you infected your female partner. In addition, the doxycycline further reduced the very small risk of infection.)

Your urine G/C test of course was negative. Urine testing only can detect genital infection:  it says nothing about your oral exposures.

I'm not sure why you raise the HSV blood test results, which of course are irrelevant to the gonorrhea issue. I'm glad that test result was negative, but I would encourage you to not have any further HSV IgG (or IgM) blood tests in absence of symptoms that suggest you have genital herpes. Falsely positive results are a major problem.

For these reasons, the possibility that you have oral gonorrhea now (or ever had it) is zero for all practical purposes. However, if you remain nervous, of course you could arrange for a throat swab test. If you do so, you can count on a negative result.

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

HHH, MD

I mentioned my test history including HSV tests, as I was wondering if there was anything else I may have overlooked that wasn’t covered by the tests I had. Should I test for anything else? I was mildly concerned about getting oral HSV from giving fellatio but have had no symptoms.

My thinking with the G/C urine screen on 7/27 was that on the off chance I did pass it to her via cunnilingus, that I would have very likely picked up gonorrhea genitally after several instances of unprotected intercourse with her. I understand this cannot be taken as conclusive evidence in place of testing but does this logic track? 

My concern with oral G mainly arose due to a yeast infection my female partner had in July, her symptoms were mostly itching and pain during intercourse but it sent me down the Google rabbit hole and I worried gonorrhea was the reason for her symptoms. If she was infected genitally, does genital gonorrhea naturally clear the same way that oral gonorrhea does? 

It is true that my male partner did not have any visible symptoms during either encounter, both took place at his home and was well lit. I do know that he has other male partners that give him oral so I worried that made this all the more riskier. But from your response it sounds like I can move forward with my female partner without fear, and even if I was infected it is clear by now.  The anxiety has been eating me up last few weeks so I greatly appreciate your help! 

Vaginal yeast and gonorrhea symptoms in women are not at all similar:  itching/irritation for yeast, vaginal discharge (without itching) for gonorrhea. And yes, the immune system clears all gonorrhea within a few weeks in men, somewhat longer (months) for genital infection in women.

And yes:  if you had transmitted gonorrhea to your female partner, after several episodes of unprotected sex you would have been infected yourself, with obvious penile symptoms.

Finally, oral herpes from cunnilingus is extremely rare. I believe Ms. Warren, our herpes expert, has seen few if any cases over the years, and I don't recall any myself.

Since I do have this last follow up question I was just curious about the last point you addressed. Is giving fellatio any higher risk for getting oral herpes than giving cunnilingus or are they about the same? 

Thank you! 

In general, you're going about your contacts with other men with great safety. However, you might want to consider condoms. You're definitely taking a small but real risk of gonorrhea and syphilis -- quite a bit higher than HIV, herpes, or others. Of course this depends on how and where you meet your partners -- but venues the favor anonymous contacts (bath houses, saunas, bookstores, etc) are the worst, as they tend to attract men with many partnerships, including (probably) many infected men.

That concludes this thread. Thanks for the thanks; I'm glad to have helped.