Hello, I have a question that has been on my mind for a long time. As far as I know, chlamydia and gonorrhea are mucosal bacteria. Based on this, I would like to ask the following: if someone is infected with these bacteria, is it possible to transfer them from one part of their own body to another in daily life, in other words, is there a mechanism of autoinoculation?

For example, if the infection is present only in the pharynx, could it be transferred to the urethra through saliva during a shower, or by spitting in the toilet and saliva coming into contact with the urethra or rectum? Could it be transferred to the urethra through saliva during masturbation? In general, can autoinoculation occur from one anatomical site to another?

Do Chlamydia trachomatis and Neisseria gonorrhoeae have such autoinoculation mechanisms? I am asking this for all sites, for example: transfer from the rectum to the urethra (penis) after defecation, such as wiping the anus with toilet paper and then touching the penis; transfer from the urethra to the rectum via urine, wiping, etc.; transfer from the pharynx to the urethra or from the pharynx to the rectum via saliva (for example, saliva exposure during showering or in the toilet), including masturbation using saliva.

In short, if one or two of these three sites (pharynx, urethra, rectum) are infected with these bacteria, can autoinoculation occur between these sites and the other site(s) during daily-life activities?

Welcome back to the Forum.  These are questions we addressed in part when you were last on the Forum 7 months ago.  Spread of STIs through transfer of infectious material (secretions/ blood) from one site on the body, while theoretically possible in the same way it is possible that you'll be struck by lightening today, does not occur with meaningful frequency.  The reasons for this are several and most importantly include that upon exposure to the environment (room temperature, drying) organisms quickly become less infectious and well as dilution.  When materials are transferred, only a portion of the organisms present are transferred.  In the laboratory under optimal conditions (unlike what would happen elsewhere) each transfer results in an approximately 100-fold reduction in the numbers of organisms transferred.  Since transmission of infection is related to the numbers of organisms transferred and their viability, both which would be markedly reduced through transfer of materials from one part of the body to another.  The same principal is behind the assessment by the WHO, the CDC and virtually all experts that transfer of genital secretions from person to person through mutual masturbation is a safe, no risk activity.  ---

That was very informative, thank you sir. With your permission, I have a few additional questions:

1. Can saliva transmit chlamydia or gonorrhea?

2. Is autoinoculation of CT/NG through saliva during daily-life activities considered a realistic mechanism of transmission or an indication for testing?

3. Does contact of saliva with the urethral meatus (outside of oral sex) pose any risk of urethral infection?

4. For someone whose only exposure was pharyngeal, is contact of saliva with the urethral meatus during routine daily activities (such as showering or toileting) considered a realistic route of CT/NG transmission or an indication for testing?

5. Is STI testing recommended only for anatomical sites that were directly involved through mucosal-to-mucosal contact?

1.  No to a meaningful degree---

Thanks for your answers. It seems that autoinoculation is not a well-defined or clinically significant concept for chlamydia and gonorrhea. Is that correct, and is this something I need to worry about?

I have one final question: If a person’s only risk for CT/NG is in the pharynx, would urethral testing be indicated if they masturbated using their saliva on the penis?

You are correct, ,auto inoculation is not a meaningful problem for persons with Gonorrhea, chlamydia or other STIs.---