Hello, I recently had a risky encounter with another man. I am a male and received oral sex from another man that I am unfamiliar with for approximately 60 seconds and ejaculated in his mouth. I am in a committed relationship and immediately felt regretful and worried that I could potentially have been exposed to an STI. 24 hrs after the oral encounter I took Doxypep 200mg. I then took a home urine NAAT test on day 7 and while waiting for the results I took 800mg cefixime on day 8 to cover for the potential of gonorrhea not covered by doxypep. My day 7 test came back negative for GC/CT. I had vaginal sex with my female partner on day 12 post exposure. After the day 12 sex I had some intermittent urethral tingling, mild discomfort, and hypersensitivity that I attributed to anxiety. Urinating actually relieved the feeling and I never had discharge. I also took another home urine NAAT test on day 15 post exposure that was negative but was not a first void sample and I had urinated about 20 minutes prior. I’m worried that I could have potentially exposed my partner on day 12 and am worried about the possibility of a false negative on day 15 from antibiotics. What are the realistic chances I exposed her or could still have an asymptomatic STI? 

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Hello Dr Handsfield. I appreciate you taking the time to answer my question and alleviate some concerns. You were correct in assuming I’m in healthcare. I’m an emergency department RN. I wish I had found the forum sooner and had known that my antibiotic coverage was likely overkill. There’s a lot of misleading information out there about pharyngeal chlamydia prevalence and transmissibility. In regards to pharyngeal gonorrhea, in a world where I had been exposed and theoretically contracted from being the insert I’ve partner in oral sex. How effective is oral cefixime for urethral gonorrhea in the U.S.? I understand that drug resistance is the limiting factor for oral cefixime in the treatment of urethral gonorrhea but unsure of drug resistant gonorrhea prevalence in the U.S. or more specifically San Francisco. 

Also, I had a question regarding consuming alcohol while taking cefixime or doxycycline. Would consuming 2-3 alcohol drinks per day have any meaningful effect on either of these drugs? I understand that alcohol with most medications is not advised and that I likely didn’t need the antibiotics to begin with. Just a question for my future knowledge. Thank you for your consideration and feel free to close the post after this question 

Cefixime remains nearly 100% effective against genital or anal gonorrhea, although somewhat less effective than ceftriaxone for pharyngeal infection. The shift to routine ceftriaxone rather than cefixime for gonorrhea is precautionary in anticipation of rising antimicrobial resistance -- but so far this has not been a problem in the US or Western Europe.---

Thank you for the clarification. While I’ve got you for one more response i wanted to ask something else. Is the 7 day test I took considered conclusive and proves that I never contracted anything? I’ve seen some conflicting information about testing windows for GC/CT and when a urine test is considered definitive. I’m also wondering if my use of doxypep after the encounter could’ve rendered the test less accurate at 7 days