[Question #2326] Dr. HH: Gonorrhea treatment was reversed, effectiveness and contagiousness.

45 months ago
Hello Drs, (Preferably Hansfield), 
About 18 days ago, I made the ill-decision of a one-night encounter abroad in HongKong, between myself female (23) and unknown Male, a Belgian living in China. There was oral sex performed on myself (mouth to vagina) and unprotected sex.  The day after, I felt itchy, frequent urination, symptoms mirroring a UTI. I let the anxiety get the best of me and fear STD since I had unprotected sex with a complete stranger and country. I sought medical help 6 days after encounter, she said my vagina was irritated and seemed to be a lot of yeast, to put my mind to ease she prescribed 7 days of doxy, twice a day. While on doxy, I felt that I was frequently urinating but no burn. Researching online about Gonorrhea co-infection , I went back and they administered the rocephin shot on the LAST day (7) I was on doxy. 
Approx. 50 hours after the shot and finishing the last of the doxy, I had sex with my steady and clean sex partner (I read that could no longer be contagious after 48 hours).  Maybe 20 hours after the sex, he started to complain of testicular pain in one side but then it subsided and he has not complained since. Is it possible that I could have infected my steady partner that soon and he show a symptom? And is it possible I re-infected myself (Gonorrhea) after 7 days of doxy and the shot on the last day?
I am currently waiting my STD results and was told conflicting things by the clinician and OBGYN: Clinician said even if I was treated it could still show positive so I can know if I even had the STD to begin with, OB says due to the antibiotics we cannot know if I even had it to begin with. Also, my OB in California says the 7 days of doxy could have wiped the gonorrhea to begin with but I have read time after time that doxcy cannot get rid of gonorrhea. Can you help clear some of this up about doxcycline? Should I trust that if I get a positive result, I had it in the beginning and a negative I never had to begin with?

Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Welcome to the Forum.  As you probably know clients on this site are not permitted to request who responds to their questions.  All questions regarding herpes go to Ms. Warren and Dr. Handsfield and I split all other questions.  As it happened, today I happened to pick up your question.  As an FYI, having worked closely for more than 35 years, Dr. Handsfield and I never disagree on the content of our replies although our verbal styles vary.  I will be addressing this question.

Your story disappoints me in that it indicates that the health care professionals who cared from you provided such conflicting and confusing answers.  I'll provide comments and facts in the order that I read about them:

1.  It is hard to know of your risk for STI from this single encounter but it is, statistically speaking, rather low.  Most people do not have STIs and even when they do, a single episode of unprotected vaginal sex usually does not result in infection (and oral sex is even less likely to transmit STI).  Further and importantly, the onset of your symptoms a day after sex is in no way suggestive of any STI as it typically takes at least 3 and usually more days for STIs to cause symptoms. 

2.  I'm perplexed that someone would give you doxycycline when yeast was present. This would tend to make yeast worse, not better.  On the other hand, doxycycline would treat about 90% of gonorrhea and virtually all chlamydia which is even more common than gonorrhea.

3.  The shot of ceftriaxone (rocephin) you received is the global standard for gonorrhea therapy with over 99% effectiveness.  There is no realistic chance that you infected your regular partner by having sex 50 hours after the ceftriaxone and completion of doxycycline.  His transient symptoms are not suggestive of an STI.  I would not worry at all about re-infecting yourself.

4.  Your providers' comments about tests were not too clear.  The fact is that after successful treatment of STIs, currently used tests which detect the DNA or RNA of the organisms being tested for can detect DNA or RNA from dead bacteria for about two (VERY rarely up to three) weeks after the bacteria are killed by successful treatment.  Thus tests can remain positive after successful therapy for up to three weeks although this is rare and tests taken two weeks after therapy are usually quite reliable.  I'm not completely clear on precisely how long it has been since your encounter in Hong Kong but if it has been more than 2 weeks testing will not provide reliable information as to whether or not you were infected.  Having said that, odds are that you were not infected.

I hope this information is helpful to you.  EWH


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45 months ago
Hi Dr. Hook, 

Thanks for your prompt advice and help! If the doxyc wiped about 90% of the possible gonorrhea, How long would it take the rocephin I took after to kill the remaining 10% of the bacteria?  Does rocephin work quickly? Within the 48 Hours after the shot?

I was researching further about my partners minor symptom of testicular pain,  only thing it points to is epididymitis, main causes include gonorrhea. It seems that his pain was a "twinge" in one testicle that happened while urinating but went away after an hour or so.  My main concern was the timing of his pain following my possible status.   Is it possible for him to receive the testicular pain so quickly (24 hours) after sex for it to even be epididymitis caused my gonorrhea?  Does epididymitis show early symptoms such as the pain coming and going? or would it be a single, continuous pain that would not go away? I would like to hear anything you know about epididymitis in relation to  my case/concern.

I will save my last follow up after my test results incase there is anything. 
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Gonorrhea can no longer be cultured (and thus, by extension, transmitted to others) in less than 8 hours after an injection.   You would not be infectious to a sex partner at 48 hours if you had gonorrhea. 

My sense is that you looked on the internet for the cause of your partner's testicular pain.  This is often misleading.  What you described in NO WAY sounds like epididymitis.  Epididymitis does not go away without therapy. Further there are a large number of alternative possibilities for transient testicular pain.   The pain of epididymitis is continuous until it is treated.

I look forward to hearing your test results.   I am confident they will be negative.  EWH
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45 months ago
I have not received my test results back yet, should know for sure by Monday. This might be good news indicating no infection since they are taking the full week to get back to me. I will purchase another question if necessary. 

However,  4 days after the brief testicular pain my partner has complained of a mild pain/discomfort in his lower abdomen/above the pelvic region that has been there for 3 days so far.  He does not know about my encounter so it would not be psychologically brought on and he shakes it off as a reaction to a bad food. I read from articles such as this: http://www.livestrong.com/article/178060-causes-of-lower-abdominal-testicular-pain/ 

That epidymitis symptoms could be gradual and start to develop over time. Does this sound like an onset of symptoms? Testicular pain and then moving to abdominal pain? 

Since we can rule out chlymadia/gonorrhea per your previous advice, Is there a possibility he could have contracted any other bacteria/sti from me that could cause this? The lower abdominal discomfort is about 4 days after having unprotected sex with me. 
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Sorry for the delay in responding.  your follow-up question slipped by me.

I would presume that your partner's abdominal pain is not due to an STI.  I looked at the web site you mentioned and would dispute it's link between abdominal pain and epididymitis in men.  While this may happen VERY rarely,  I have never seen a case of epididymitis in which the predominant symptom was not continuous testicular discomfort.  As I said before, I really would not  worry about your having an STI or, even if you did, transmitting it to your BF.  I would look for another cause of his abdominal pain.

this is my third reply to this series of questions.  We will respond to your other question shortly and this thread will be closed later today.  EWH

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