Hello Doctors,  Thank you again for providing this service.  In May, I wrote to you regarding an unprotected mutual oral encounter I had with a Trans CSW.   All recommended STD tests performed in July at an urgent care clinic with negative results. However, oral gonorrhea test was not performed since the nurse said they only perform oral STD swabs if there are lesions or sores present.  I had no symptoms including no sore throat.  I attempted to do the oral test myself via a mail order kit but it has been a frustrating process so I gave up on it.  Here are my questions then:   1)  At this point, should I get tested for oral gonorrhea?  I have not had any symptoms and it is my understanding that it can clear on its own.  Also, WBC count from last 2 GP visits were normal.  2) How common are gonorrhea infections of the bloodstream?  I ask because over the past 6 months I have been experiencing random hives on various parts of my body.  One of the possible causes that came up is gonorrhea.  A gonorrhea rash is the result of when the bacteria has spread to the bloodstream but since this is rare and there are usually other symptoms, e.g., joint pain, etc. associated with it which I do not have, I ruled it out.  The normal WBC results also helped me reach this conclusion.  Turns out I have chronic hives which is currently being treated with strong doses of antihistamines. Thanks again for your assistance. 

1.  You don’t know that your partner had gonorrhea or if he did that it was transmitted.  Most oral exposures to infected partners do not result in infection.  Further, had oral infection occurred, it would have most likely spontaneously resolved in the 3-4 weeks following infection.

2.  Very rare.  Further hives are not characteristic of disseminated gonorrhea.

My advice is to not worry further about the encounter you had about 8 months ago.  I see no medical or scientific reason for further testing or for concern of any sort.  EWH

I have a general follow-up question regarding oral gonorrhea, if you don't mind.  How does oral gonorrhea resolve on its own?  A few medical websites acknowledged that oral gonorrhea does self-resolve (while most STD sites do not) and the few sites that do also opined that self-resolution of the bacteria can lead to further antibiotic resistance.  I found this information comforting for my own situation but also disturbing for the long term treatment of gonorrhea since I've read it is becoming more antibiotic resistant in certain parts of the world.  Appreciate your thoughts.  I look forward to your response (no rush) and thanks again for providing this much needed service.         

I know of no data that suggests that resolution of infection without treatment leads to development of antibiotic resistance and don’t see why it would.  EWH