My questions are:

(1) Can candida and  gardnerella transmit orally then pass to my wife?

(2) Could this be other STI?

(3) I’m assuming whatever I caught initially have passed onto to her. If so what do you think this maybe? And why I never experience any more symptoms afterward?

(4) what advise do you have for us in this situation? 

Thanks in advance.

Your symptoms and their timing after your CSW exposure are typical for NGU acquired by oral sex. The exact cause from oral sex isn't well known, but probably it's usually the result of entirely normal oral bacteria. Improvement after doxycycline also fits. Because normal bacteria often are probably the cause, there is uncertainty about the need to treat exposed partners, but standard practice is for affected men's female partners to be evaluated and treated (usually with doxycycline). In other words, since you and your wife were having unprotected vaginal sex, she should have been evaluated and treated. It also would have been a good idea for you to be examined, tested for gonorrhea and chlamydia (even though both are unlikely -- but better safe than sorry). You also imply only a single dose of doxycycline, right? It's good your symptoms cleared up with only one dose, but 7 days treatment is the norm.

Your wife's situation is complex and uncertain. Her initial symptoms were typical for a yeast infection like Candida, but not BV -- which doesn't cause itchiness, genital irritation, or pain during sex. Candida is not sexually transmitted and not likely a result of your CSW events. On the other hand, sometimes is associated with oral sex, and although it has been uncertain whether it should be classified as an STI, recent research indicates that many or most cases do result from contact with an infected partner; and treatment of the male partners improves treatment outcome of women with BV. (Gardnerella vaginalis often is present during BV, but is not the cause; that idea was disproved decades ago.

Based on your description, your wife's current symptoms are most consistent with a yeast infection, and some vaginal yeasts are resistant to fluconazole and related drugs. She might require different treatment. If her doctor believes BV also is still present, she may need pretreatment for that, and you may need treatment for it yourself (with oral metronidazole plus penile clindamycin cream).

Those comments start to cover your specific questions, but to be explicit:

1. Candida no. BV (not gardnerella bacteria) might have been transmitted to your wife as a result of your oral exposure and NGU. It's impossible to know for sure, but the timing is right.

2. Probably no other STI is involved. Conceivably gonorrhea but very unlikely. Still, you should be tested for it, and your wife too. (Chlamydia is exceedingly unlikely in this situation, but chlamydia testing is automatic along with gonorrhea -- so you can expect that test to also be done.)

3. See discussion above. I agree this is likely, but most male partners of women with BV have no symptoms. How your NGU fits into all this also remains uncertain.

4. Your wife needs to return to her doctor. Ideally she and her doctor need to know your sexual history. Exactly what should be done clinically -- i.e. in terms of diagnostic tests and additional treatment -- will depend on the outcome of that evaluation. Having said that, the passage of 5 months also should be taken into account: if further evaluation indicates your wife's only current problem is recurrent candida, maybe nothing more need be done: most of these problems clear up on their own given enough time. All in all it's a complex situation; it would be best if you can find a doctor or clinic with substantial STI experience. If you'll tell me where you're located I may be able to have information about nearby resources for expert care.

I suspect you weren't hoping to hear some of this advice. But let me know if you have any questions about it.

HHH, MD

(2) For my wife’s treatment on yeast infection, fluconazole did seem to work, but puzzling part is it keeps coming back. So what you mentioned about allowing more time could very well be the case so we will give that a try and avoid sex for some time or use condom.

(3) I’m located around the Seattle area. So any resources or referral would be appreciated. 

2. Recurrent vaginal yeast isn't "puzzling" at all. I didn't go into detail above, but recurrent vulvovaginal candidiasis is a well recognized and fairly common problem that specifically is addressed in CDC guidelines -- i.e. recurrent symptoms just like your wife is experiencing. By definition, it is not due to resistance to the standard azole drugs. Usually there is no underlying health problem, although rare cases occur because of diabetes, immune deficiency, or other conditions. Prolonged azole treatment (e.g. 3-4 weeks) sometimes stops the problem; in other cases, weekly oral fluconazole is effective prevention. These issues should be discuss with your wife's doctor.

3. See below about sources of care.

4. There isn't any reason to have any concerns about your immune system.

5. RVVC is not due to aging, but might be somewhat more frequent in middle age and beyond.

6. Given your sexual lifestyle, you should be tested for common STIs from time to time (gonorrhea, chlamydia, HIV and syphilis -- and nothing more). Since you apparently haven't been tested recently, this seems a good time, while these issues are on your mind. I predict negative results.

The Seattle-King Count Public Health Sexual Health Clinic, located at Harborview Medical Center, is widely regarded as one of the most expert in the country. (I speak from intimate knowledge, as the SHC's director for 25 years.) Partly as a result of the clinic's local influence, many or most providers in the Seattle metropolitan area are pretty much on top of all the issues we have discussed. The UW Medicine clinic system is among the most reliable.