[Question #2623] Gonorrhea and Oral Sex

42 months ago
I'm a bisexual male who has had sex with both men and women in the past few months. Earlier this week, a man that I have performed fellatio on told me that he had gonorrhea, so I feel pretty certain that I have gonorrhea of the throat. (I've had sore throat symptoms on and off for a couple of weeks, and I first noticed them about four days after an oral sex encounter with this man.)

I have to wait a couple of days before my doctor can see me to perform any tests, so I want to see the likelihood that I may have transferred the gonorrhea from my own throat to my penis. I usually use my own saliva as lube when I masturbate, so even though I haven't had genital contact with the man who has gonorrhea, I'm worried I may have transmitted it to myself through masturbation. 

How likely is it that I transferred the bacteria to myself from throat to penis this way? How likely is it that I then transmitted it to a female sexual partner? Finally, when I speak with my doctor, how do I make sure that I'm properly tested? I assume I need to ask for a urine test as well as a throat swab?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome back to the forum. Thanks for your question.

I agree there is a good likelihood you acquired pharyngeal (throat) gonorrhea. It may or may not explain your symptoms:  over 90% of pharyngeal gonorrhea cases are entirely asymptomatic.

There is no chance you have infected your own urethra. First, hand-genital contact never transmits gonorrhea or other STDs. Second, urethral gonorrhea (unlike pharyngeal) generally causes prominent symptoms that you wouldn't miss -- urethral discharge, usually in pretty large amount, and painful urination. Absence of those symptoms is strong evidence you don't have urethral gonorrhea. And therefore that you have not infected your female partner.

Based on the exposure described, the only test needed is a throat swab culture for gonorrhea. For completeness, perhaps your doctor will decide to test a urethral swab or urine as well. But it's optional.

You need to be treated without waiting for any test result. Indeed, you would need treatment for presumed gonorrhea even if your pharyngeal gonorrhea test is negative -- so no need to wait for the test result. Recommended treatment is 250 mg ceftriaxone by injection plus either single dose azithromycin or 7 days with doxycycline.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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42 months ago
Thank you Dr. Handsfield for your response. I think everything is clear, but I wanted to ask a few follow up questions.

Just to make sure I'm understanding correctly, even if I have gonorrhea in my throat, it couldn't be transferred by my saliva? You said hand-genital contact doesn't transmit it, so I just want to make sure that the presence of saliva doesn't make a difference.

Secondly, I've often read that "gonorrhea sometimes causes no symptoms" even in the urethra. But you're saying that in most cases, it would cause symptoms and those symptoms would be fairly obvious. Is that correct?

The only other question I have is just to expand on my original question. How concerned should I be about HIV along with exposure to gonorrhea? The sex partner who told me he tested positive for gonorrhea didn't mention any other STIs, so I believe that he had a full screening done and everything came back negative. But I do know that HIV sometimes takes a few months to give a positive result. How often do gonorrhea and HIV get contracted together?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Nobody can say that such transmission, e.g. by saliva, is impossible. But in the busiest STD clinics, we never see gonorrhea patients whose only exposure was hand-genital contact -- and as in your case, many of those events are lubricated with saliva. So any risk is so rare that we are unaware of any such cases.

It is true that urethral gonorrhea "sometimes" causes no symptoms. However, "sometimes" is in the 1-2% range. The vast majority of infected persons have obvious symptoms. (This is an area with which I am extremely familiar. Here is a link to the most extensive and important research study ever done on asymptomatic gonorrhea in men (note the senior author):  https://www.ncbi.nlm.nih.gov/pubmed/4202519

There has never been a proved case of HIV transmitted by oral sex, mouth to penis. Nobody can say the risk is zero, but CDC has estimated a risk of 1 in 20,000 if the oral partner has HIV. That's equivalent to giving BJs to infected men once daily for 55 years before transmission might be likely. Transmission could be more likely in the presence of pharyngeal gonorrhea, but probably not by much. And it sounds unlikely your partner has HIV. (Your "several months" statement is wrong. With the modern HIV tests, almost all infected people are positive by 4 weeks and for sure all by 6 weeks.)

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41 months ago
Thanks Dr. Handsfield for your help with this. Sorry for the delay in asking a follow up question, but I ended up being let go from my job and unfortunately my health insurance situation has made it difficult for me to actually get tested and treated. So I wanted to see how concerned I should be about the possibility of pharyngeal gonorrhea and any complications that might arise from it.

How easy is it to contract gonorrhea in the throat, and how likely is it to clear up on its own / lead to further problems (like additional infection in the body or becoming difficult to treat with antibiotics)? I trust based on your earlier responses that I have no reason to worry about urethral infection, but since I performed oral sex on a male who tested positive for gonorrhea I'm worried about that exposure still. It's my understanding that gonorrhea doesn't thrive very well in the throat, but I don't want to ignore the possibility for too long while I sort out my healthcare situation.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
I don't think I can answer your question about "how concerned" you should be about pharyngeal gonorrhea any better than I already have. Clearly you were exposed. We don't know the risk of acquiring it on a per-exposure basis, but it's probably fairly high, maybe a 50% chance? Most infections clear up on their own, but it can take a long time, at least a few weeks and often several months.

Your local or state health department may have an STD clinic, or other public health clinics, where you could be tested and treated at little or no cost. Please check it out. (Such clinics used to be nearly universally available in urban areas and even small towns -- not so much in the past few years, with changing fundiing of public health.) One way or another, you should do whatever is necessary to at least get treated and, ideally, have a throat swab to test for gonorrhea.

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