[Question #13279] Anal Gonorrhea

25 days ago

Hi Doctors,

This has me perplexed and maybe a good explanation.

Day 1 - I was rimmed by a person

Day 4 - I was fingered by an another person and mutual masterbation. There was some rubbing of his penis on my anus but no penetration.

Day 6 - I was fingered by another person. I started to have anal mucus (yellow/green) that evening and took two pills of Doxycycline

Day 7 - I went to the doctor who tested me for anal gonorrhea/Chlamydia and treated me with a shot and 7 days of Doxycycline.

The tests from Day 7 came back negative. On Day 13, I had my regular checkup (as on Prep) and was tested for gonorrhea, chlamydia and mycoplasma for throat, penis and anus. All Tests were negative except the anal gonorrhea was positive.

Questions:

1. Would it be fair to say that I probably tested too soon at Day 7 for the test to pick up Gonorrhea?

2. I had treatment (shot and 7 days doxy) but then tested positive. How long would it take for the test to no longer detect Gonorrhea?

3. I am trying to determine if I should be treated again or how long I should wait to get tested. I have read mixed reviews about tests can pick up the infection for some time after being treated even though you no longer have it.

Thanks

24 days ago

Couple points I forgot to mention. I was surprised the first test was negative as I had mucus symptoms. I assume I got this from Day 4 exposure due to timing of symptoms (2.5 days). The test done by the clinic was a PCR test. Also - could I transfer the infection from my anus if I fingered my ass and masterbated?

Edward W. Hook M.D.

24 days ago

Welcome back to the forum. Thank you for your continuing confidence in our service. I agree with you that several elements of this situation are perplexing as you have been told in previous interactions on the forum. As you have been told in the past, STI‘s are rarely transferred to person from person to person through a fingering, although I know that your clinic suggests that they have seen this in the past. Second analingus is likewise a very, very low risk event. I agree with you that your encounter on day four that involved rubbing of the penis around your anus is the likely source of infection.

The symptoms that you began to experience on day, six are consistent, both in terms of your description and time-wise, with gonorrhea or another STI acquired at the day 4 encounter. The doxycycline you took at that time may have cured gonorrhea if present or suppressed the infection in such a way that your test on day seven was negative but the infection persisted and was then detected at your next clinic visit. Either way, the therapy that you received on day seven should’ve cured gonorrhea if present in response to your specific questions:

1. Testing for STI such as gonorrhea or chlamydia seven days after an encounter should be accurate unless your results were impacted by the doxycycline that you took earlier. As a generalization test for gonorrhea and chlamydia, provide reliable, conclusive results anytime more than 3 to 5 days following an exposure

2. Treatment for gonorrhea eliminates living and therefore transmissible bacteria within 24 hours of receipt of treatment. Dead bacteria, however, may still be present and can yield positive tests following successful treatment for a week or more.

3. The treatment you received is the recommended treatment and I would anticipate that it was successful. A “ test of cure.” specimen collected anytime more than 10 days following treatment will provide reliable results.

I hope that the information I have provided is helpful. If any part of my responses unclear or there are additional questions, please feel free to use the up the two follow up questions aloud for clarification. EWH.

---

24 days ago

Dr. Hook - kindly thank you for the response below. A couple clarifications and last questions and I think that should do it.

1. The test I took on day 7 was almost 3 days from the incident on day 4. I did take a doxypep dose (2 100 MG) on the evening of day 6 (2.5 days after anal frottage/nudging)about 15 hours before the test. the test and treatment was at a private clinic and I was asked to swab myself. Maybe it just hadn't been long enough as there was plenty of mucus the night before.

2. The doctor at the private clinic (he is not near as well versed on STIs) prescribed me to take the doxycyclineine for 10 days to prevent any syphilis infection. Do you agree with this? Or should it be 14 days?

3. I will need to go to my public sexual health clinic where they are experts in this. If they want to treat me again, can it do any damage? I did still have minor mucus on the stool (think whitish strand) 5 days after treatment. I do another appear to have mucus anymore just some constipation which could be antibiotic. In the past they have given me the shot plus azithromycin which is a little bit different than what the private doctor did. If they want to treat me again, can it do any damage?

4. It should as I would not be able to transfer the infection to my penis through masterbation even if I had rubbed my anus with fingers and should not worry about this per your comment. Agreed?

5. Two doses of prep on Day 0 and 1 pill each day through day 11 (7 days post nudging.frottate). No HIV Concerns?

24 days ago

Dr. - I apologize as I just read your response more carefully. You state: "2. Treatment for gonorrhea eliminates living and therefore transmissible bacteria within 24 hours of receipt of treatment. Dead bacteria, however, may still be present and can yield positive tests following successful treatment for a week or more."

Sounds like even if I did masterbate my anus and then my penis that it wouldn't be transmissible anyways. Is that correct?

Do most sites say not sex for 7 days in case the treatment is not successful? I no longer have any mucus in my stool so anticipate it eradicated the infection. I will get a TOC PCR test this Friday which will be 10 days and expect it to be negative.

Thanks for all your help. I know some of my previous questions for kind of stupid but this one occurrence was very strange.

Edward W. Hook M.D.

24 days ago

3. Retreatment is probably not needed but is unlikely to do any harm.

4. Correct

5. Not sure why you’re taking a none recommended dose but no concern

The no sex for 7 days is a conservative, unstudied recommendation which allows time to notify and treat partners, breaking the chain of transmission.

Agree with your plans for TOC.

One follow up remaining. EWH

---

24 days ago

Hi Doctor - thank you so much for your response. These are my last questions based on your answers.

2. The doctor in the private clinic was overly cons and perhaps unfamiliar with DoxyPep. You did not need 10 days of doxycycline. And if you were being treated for syphilis the recommended duration of therapy is 14 days. My doctor did not prescribe 10 days of Doxy for DoxyPep but 7 days for treatment and another 3 to ensure I would not get syphilis from these encounters.

5. Not sure why you’re taking a none recommended dose but no concern. This is because I generally do Prep On Demand as my encounters for a time period are always well defined. I start with two pills per recommendation and take daily until last potential encounter (the day 4) and take for 7 days after per a recommendation I read from you in the past. Do you have a different recommendation for me?

Edward W. Hook M.D.

24 days ago

Final responses:

2. I’m sorry if my response was unclear. No matter how you slice it, your doctor prescribed more doxycycline than you needed to prevent syphilis.

3. Thanks for the clarification. I do not have an alternative recommendation but find myself wondering why you don’t just take PrEP daily rather than on demand. This is a personal decision and between you and your health care providers.

End of thread. EWH

---