[Question #13840] Testing Confusion.
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3 hours ago
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Confused regarding an encounter some weeks ago. Traditionally heterosexual and monogamous, with no known prior exposure or positive tests for gonorrhea. 30 year old male - however, I received unprotected oral from a transsexual three weeks ago. No ejaculation for either party. Felt burning and urinary pain two weeks after; took 1.5mg Z-Pack without testing.
Wife and I had sex five days after Z-Pack, unprotected and with ejaculation. Had not had sex since above incident. Both of us took 800mg Cefixime prophylactically same day as we both apparently had similar urinary symptoms. She was then tested for STDs 72 hours later, and tested positive for gonorrhea.
1. Given the azithromycin and cefixime doses and timing, could the positive gonorrhea test have occurred from the oral sex encounter?
2. Would gonorrhea show up that quickly on a lab (three days)?
3. Would gonorrhea show up 72 hours later even with same-day cefixime?
4. Could gonorrhea have been latent for months or even years for us, and be completely unrelated?
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Edward W. Hook M.D.
2 hours ago
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Welcome to our Forum. thanks for your questions. I'll be glad to provide some information nor cefixime are first line therapies for gonorrhea and failures of both are relatively more common at the oropharynx than genital sites. In the absence of testing when your symptoms occurred, as well as the fact that the amount of azithromycin you took is less than is recommended for any STI, it's hard to know what is going on here. I should add that about 5% of urethral gonorrhea is asymptomatic and that asymptomatic infections can persist for relatively long periods of time although how long such infections persist (the infections do often resolve themselves, without treatment over time) is not well studies. So it is possible that you'd acquired gonorrhea from receipt of oral sex, as well as the medications you took may not have cured gonorrhea. Here are the answers to your specific questions:
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1. Given the azithromycin and cefixime doses and timing, could the positive gonorrhea test have occurred from the oral sex encounter?
Yes. You do not provide any test results for yourself so we can't know whether or not you had gonorrhea. If you did, you may have transmitted it to your wife and her test may have reflected either a treatment failure or residual, dead gonorrhea detected when she was tested.
2. Would gonorrhea show up that quickly on a lab (three days)?
Yes, tests for gonorrhea are highly reliable any time more than 3-5 days after an exposure which leads to infection.
3. Would gonorrhea show up 72 hours later even with same-day cefixime?
Yes, current tests do no require living gonorrhea to be positive. A test several days after recent successful treatment can still be positive
4. Could gonorrhea have been latent for months or even years for us, and be completely unrelated?
Asymptomatic gonorrhea can persist for long periods of time but it is unusual.
At this time, things are confused and may not be answerable. I would suggest that both you and your wife get tested for gonorrhea at this time. Should one or both of you be positive, you should be re-treated with recommended doses of ceftriaxone. EWH