[Question #1748] Ghonnorea and clarification

45 months ago
I have read over previous posts  that the general consensus on this forum with regard to ghonorrea in the context of receiving uprotected oral from female CSWs in the USA is to look for symptoms for a period of 1-2 weeks; in the absence of any, one can feel confident that there is no infection and one can resume normal unprotected sexual acitivities with one's partner.

I have also read responses from yourselves that the % chance that a male with this exposure was infected assymptomatically is around or less than 5%.

In connecting the dots, when advising us there is no need for testing or concern when no symptoms are present after a few weeks, does that mean there is still a 5% or less chance that there is an infection present?

Sorry about the confusion here; just looking for a FINAL bit of clarification.
45 months ago
Wow, that is a great response.

Thank you.

The question is mostly about the possibility of having infected a partner.

So, with chances of infection that low due to: type of exposure and lack of symptoms and let us assume I would have followed the 'watch for sypmptoms for two weeks before re-engaging in normal relations with wife' -- the calculus of her having been infected by me goes even lower?

I guess my question in two parts:

(1) 1 in 20000 chance maximum of infection is low enough for no medical need for testing?

and

(2) having used the 'watch for sypmptoms for two weeks before re-engaging in normal relations with wife' coupled with the low rates of infection, one can safely assume that she would not have been infected either?


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Here's a new version of my original reply -- corrected the typo and added some additional information.

Welcome to the forum. Thanks for your question, and for researching it by reading other discussions on the topic. I don't know if you're aware, but I can claim to literally be the nation's top expert on asymptomatic gonorrhea in men, having done the first research on it. Even though more than 40 years ago, the results remain valid:  https://www.ncbi.nlm.nih.gov/pubmed/4202519

Nice job "connecting the dots" -- except you might have forgotten one or two dots. The chance you caught gonorrhea is far less than 5% in the circumstances you have described. My analysis is:  chance any particular female CSW has oral gonorrhea, under 1% (but let's assume 1% for this cacluation); chance of transmission if she had it, let's say 10% (it may be lower); chance you would have no symptoms if infected, 5%. (This is a maximum figure -- more info below.) The chance you have gonorrhea then calculates as 0.01 x 0.1 x 0.05 = 0.00005. That's 5 in 100,000, or 1 in 20,000.

We can also factor in the time since your last such exposure. Gonorrhea is self cured by the immune system, usually over several weeks, maximum probably 6 months. If the last exposure was, say, 3 months ago, there's at least a 50% chance it's gone by now. That would further reduce the chance you arre currently infected to around 1 in 40,000.

Both these figures are maximum estimates. In particular, as implied above, probably fewer than 5% of urethral gonorrhea infections remain asymptomatic. That estimate comes from my own research cited above, plus others that followed. First, symptoms depend on personal awareness. Some of the men in our study had abnormal discharge on examination, but were not aware of it. (Dr. Hook was one of the authors of a study that expanded on this point, i.e. the distinction between truly asymptomatic versus infection with mild but unnoticed symptoms.) Exposed persons who are concerned would rarely fall in this category -- i.e. you would have noticed symptoms. Second, we now know -- which we did not at the time of my study -- that particular strains of gonorrhea are more likely than others to cause asymptomatic infection, and those strains were especially common in Seattle in the early 1970s. They are now much less common nationwide. My guess is that a more accurate estimate today would be that only 2% of urethral gonorrhea is completely asymptomatic. If so, it would drop your odds of having it to 1 in 50,000 (or 1 in 100K if last exposure was 3 months ago).

So should you be tested? From a strict risk assessment perspective, no. OTOH, since you were anxious enough to feel a need to ask, perhaps you would be more reassured by a negative test than by expert analysis based on probability and statistics. If so, go ahead and do it. If you do, obviously you can expect a negative result.

I hope this has been helpful. Best wishes and stay safe--  HHH, MD


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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
And in reply to your folow-up questions:  I agree with your analysis. The chance you had gonorrhea when you resumed sex with your wife was in the ballpark of 1 in 20,000 to 1 in 50,000. Low enough to not worry, and for her not to be tested for it. If somehow I were in your situation, I would not be concerned in the least.

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45 months ago
Thank you, that seems pretty clear.

And one last question, to be clear on my end: I was diligently checking during each exposure, 3 and 11 months ago, my urethra opening each time I would urinate, and also trying to be aware if urination was painful.  I did not once see anything abnormal and to my recollection urination was not painful.  Would symptoms have been abundantly obvious?  Really, really super obvious?

Wife had a pap smear last week so think this is on my mind.

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
You would notice painful urination or abnormal discharge due to gonorrhea without having to pay special attention. Also I strongly recommend against self examination for discharge. In other words, there is no need for "diligent checking". There is no way your wife is going to have any problem on her gyn exam that could have anything to do with your non-marital oral sex exposures. Don't worry about it.

That completes the two follow-up comments and replies included with each question, and so concludes this thread. You can move on without worry about gonorrhea or any other STD from those events.

Best wishes and stay safe!

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