[Question #13752] Clarifying risk of gonorrhea from oral sex

26 days ago

In September 2024, I had a brief episode of unprotected oral sex with a sex worker. Within 48 hours, I took cefixime 800 mg and doxycycline 200 mg daily for 7 days.

I had a urine NAAT for gonorrhea/chlamydia 2–3 days after exposure (possibly too early to be definitive) and have had no urethral symptoms since (no persistent discharge or painful urination).

I later had unprotected intercourse with my wife prior to developing any symptoms.

I’ve read on your platform and in other expert sources that acquiring gonorrhea from receiving oral sex is considered unlikely, but I’ve also seen a small number of anecdotal cases on here where this appears to have occurred.

My questions are:
• How should anecdotal cases be interpreted in the context of overall risk estimates?
• How likely is asymptomatic urethral gonorrhea after receiving oral sex, particularly with early cefixime treatment?
• How likely would transmission to a female partner be shortly after exposure in this scenario?
• Based on this timeline and lack of symptoms, is there any medical reason for ongoing concern, or would reassurance alone be appropriate?

Edward W. Hook M.D.

26 days ago

Welcome back to the Forum. This appears to be the same, very low risk encounter that we interacted about 16 months ago. I'm not sure why you felt the need to return with these questions. My assessment has not changed. Despite the low risk nature of the encounter and the absence of symptoms you opted to self-medicate with cefixime and azithromycin which, in the unlikely event that you have been exposed would have prevented/cured gonorrhea, chlamydia and syphilis. Your test results provided further evidence that you did not have gonorrhea or chlamydia.. Apparently you continue to worry and continue to search the internet for additional information and apparently that continues to fuel your unwarranted concerned. In response to your questions:

1. Anecdotes are solitary events which if anything, tend to confirm the low risk of the encounter you described. Anecdotes are sometimes useful to scientists to raise questions as to how common situations described in the anecdote occur. Any questions regarding the frequency of gonorrhea following receipt of oral sex have since been answered. Studies have since confirmed that receipt of oral sex rarely results in gonorrhea.

2. After your antibiotics the possibility of having asymptomatic gonorrhea is virtually zero.

3. There would be no meaningful risk of you having given gonorrhea to a female partner.

4. You should feel reassured that you do not have gonorrhea and have not transmitted you your partner. There is no need for continued concern or testing related to the encounter you described.

EWH

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23 days ago

Thank you for the reassurance! Yes, this is the same encounter about 16 months ago. My anxiety has gotten the best of me lately, but I needed to hear this again for my own sake.

Edward W. Hook M.D.

23 days ago

Please don't worry. EWH---