[Question #11959] Oral Gonorrhea test results

11 months ago

December 2023 i did a routine STI screening. I purchased a 3 site gonorrhea and chlamydia test from the online provider mylabbox. results were normal except my throat was positive for gonorrhea. I received a 500mg dose ceftriaxone. I returned for a test of cure 7 days later that was performed by labcorp came back negative. July 2024, I ordered the same test from mylabbox since it is recommended to retest after three months. This test also came back positive for oral gonorrhea. I went to urgent care where they did a confirmatory test before treating with labcorp. the oral swab and urine came back negative. Despite the negative tests i was anxious and returned to urgent care for another test done by labcorp came back negative. I was anxious and got retested at a different urgent care who used Vikor scientific. This test came back positive and I was treated with 500mg ceftriaxone. I returned for my confirmatory test with Vikor scientific at 2 weeks which came back positive. I was given 1000mg ceftriaxone. I returned two weeks later for a test of cure that came back negative. I decided to test again at 3 months. This most recent test from Vikor scientific came back as positive. The doctor said he was confused by my results but did not thing I had it. He suggested that I could consult an infectious disease specialist. I am just not really sure what to do at this point and really just questioning the validity of my results. The vikor scientific test included resistance testing and indicated that my infection should be susceptible to ceftriaxone. I did not engage with the infected partner after my initial positive test.

11 months ago

for clarification I informed my previous partners of the initial diagnosis but they never informed if they were tested or what their results were

Edward W. Hook M.D.

11 months ago

Welcome to our Forum and thanks for your questions. I'll be glad to comment and have some suggestions. You do not mention sexual activity in the interval between your 1rst positive throat testing in December 2023 and the present time but my sense is that you have continued to be sexual activity (and I do not fault you for this following treatment). While i cannot comment on the relative likelihood of one scenario over another, there are several important facts to share with you:

1. OF all potential sites of gonorrhea infection, throat infections are most challenging. They are the sites most likely to fail therapy.

2. Most gonorrhea throat infections are asymptomatic making them hard to detect without testing. You did right with your follow-up testing- good job!

3. The reason that repeat testing at 3 months is suggested is because persons who have gonorrhea once are statistically more likely to become re-infected. The 3 month recommendation is not to detect treatment failures. (see comment 6 below)

4. Following successful treatment, dead gonorrhea may be present and detected in the throat at a site of successfully treated infection for two weeks, perhaps longer with the positivity rates falling over time as the dead bacterial are cleared from the site of infection.

5. Following treatment failure, most clinicians would suggest use of 1.0 gram of ceftriaxone. While 500 mg is adequate for other sites, higher doses are often needed to treat infections which fail initial therapy.

6. Unfortunately., person with asymptomatic gonorrhea may not seek therapy, even when notified that a partner is infected

I do not know which of these factors may have contributed to your repeated positive tests. Perhaps several. I do not know where you are located geographically and am not trying to cast aspersions on your regular doctors but ceftriaxone antibiotic resistance and treatment failure is a matter of great public health concern. I would urge you to see your local health department to tell them your situation in the detail provided here and to get their help in sorting this out

I hope this information is helpful. You need to see an infectious diseases specialist or Health Department clinician about this. If they wish to speak with me directly about this, they should be able to reach me fairly easily. EWH

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11 months ago

I have not been with anyone since before my july 2024 test. The labcorp test is a TMA while the vikor scientific and test by mylabbox is a PCR so im not sure if that has anything to do with it? They also seem to use the same assay i believe quant studio while labcorp uses Aptima. My main confusion is with my most recent positive test i was negative two weeks after the 1000mg of ceftriaxone. but then positive about 2 months after when I have not had any further exposure. I know it is not even possible to be reinfected from water bottles, toothbrushes, retainers, etc... but I even made an effort to switch those out every two days waiting for my results. I live in the US.

11 months ago

Sorry if I am coming off rude. I was nervous about hitting the character limit again. I truly appreciate your insight and compassion in this situation. I just am questioning the validity I guess of the at home test i had as well as the vikor scientific. I read that pcr tests can mistake commensal Neisseria for gonnorhea.

11 months ago

I also wanted to mention I went to the initial urgent care that performed the labcorp test just now where they performed another oral test for chlamydia and gonnorhhea along with a throat culture and urine sample.

Edward W. Hook M.D.

11 months ago

Thanks for your initial information. Several additional comments.

I am not familiar with MyLabBox. I went there website and it appears that the basis if their gonorrhea test is not and FDA approved test or perhaps an FDA approved test used in a non-approved manner. Maybe even a “ home brew” PCR test. Like you, without more detail, this makes me nervous. In the past, other such home tests have had performance issues. On the other hand, the Altima TMA test has been rigorously evaluated ( I have used it myself in many studies as well as for routine clinical evaluations) and when used as directed, is a superb test.

Going forward, as much as I like the concept, I would avoid home tests. Particularly those which don’t used F.D.A. approved assays.

This remains a conundrum. I would still consult your local health department and seek their assistance. This is something they should have great interest in and pursue vigorously. EWH

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11 months ago

Thank you for your insight. The doctor who performed the vikor scientific test did not seem very knowledgable or confident in the test . do you have any insights on the vikor test? It was the urine-id extended panel they did on me. My main concern is that it said it was a urine swab sample and then they just put in the notes it was from my throat. I would love to update you on the TMA test I did today if possible. If it is negative would you recommend still consulting an infectious disease specialist?

11 months ago

I also acknowledge that I do not have the skill set to properly analyze a medical text but I found it interesting in relation to my situation. I'm not sure if you have insights on it. thank you again ! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2668347/

Edward W. Hook M.D.

11 months ago

I'm sorry, I am not familiar with Vikor and as I'm traveling at the moment I have limited access to their web site. When I looked I saw tests for common infections but unless I missed them, did not see tests for STIs. For testing I would urge you to stick with Nationally known, proven labs using proven assays such as the Aptima tests.

Regarding the reference you found, LOL, I wrote it :). In that study we used commercially available tests such as those make by Hologic (Aptima), Roche or Becton-Dickinson. The conclusion basically reinforce what I've said above.

I'll leave the thread open. I want to hear your TMA result. EWH

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11 months ago

Hi again!

I did notice that after I sent it haha! I received a negative TMA test from the urgent care. I also took your advice and went to my local sti center where they performed another test as well as a culture. All three tests came back negative. Am I in the clear? I am just having a hard time understanding how I could get so many false positives. I obviously feel a lot better with all the negative results I have received but I am just wondering if I ever even had it in the first place. I just felt like I was doing the right thing by getting tested so I guess that’s why I am a little frusturated.

Edward W. Hook M.D.

11 months ago

Thanks for the additional information. These data, obtain using carefully studied, highly reliable tests for gonorrhea prove that you are not infected. You are in the clear.

Of course I do not have a definitive answer for the reason for your multiple falsely positive tests, and I do believe that they were falsely positive, but my best guess is that the tests which revealed falsely positive results had not been rigorously evaluate for the potential for false positives. In the phalanx there are other species of Neisseria bacteria which closely mimic gonorrhea and have been a source of falsely positive test results, in some studies. As I said above, I cannot be entirely sure that this is the case, but I believe, a strong possibility.

Going forward, it is my advice for you to test for gonorrhea using only proven tests at well established laboratories. I understand that it may be difficult to determine whether the test being used are going to be reliable or not. As I believe I mentioned above, tests made by Hologic, Roche, and Becton Dickinson are highly reliable and are the test that’s are typically used by well establish laboratories such as Lab Corp or health departments.

I hope this perspective is helpful to you. I will be closing the thread shortly and wish you the best. I hope the information I have provided has been useful. EWH.

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11 months ago

I cannot thank you enough for easing my anxiety. This has been going on for almost a year now and I just felt like something was off. I feel like I can move on from all of this now. Thank you for this forum and hope you have a great rest of your day (:

Edward W. Hook M.D.

11 months ago

I hope the information I’ve provided has been helpful. EWH---