Today (Saturday), my throat started getting sore and now I have large white spots on my tonsils. I think that sometimes antibiotics can deplete natural bacteria and then candida/thrush can set in. But I also know that gonorrhea has issues with antibiotic resistance, and I'm concerned that not receiving the recommended panel of antibiotics means that the gonorrhea didn't go away and may have actually worsened. Are the white spots likely to be a complication of the gonorrhea itself not clearing up, or a reaction to the antibiotics? 

I wanted to ask in this forum before returning to the clinic, as it seemed the nurse wasn't very well versed in STD diagnosis and treatment. Even though I had specifically requested a throat swab on my visit, since my exposure was through oral sex, she initially tried to tell me that a urine test was all I needed and only agreed to a throat swab after leaving to consult other reference materials.

As you correctly understand, and the NP who treated you apparently does not, all gonorrhea should be treated with 2 antibiotics, i.e. ceftriaxone plus either azithromycin or doxycycline. That's the standard recommendation and the current advice of the CDC for gonorrhea treatment in the US. (Some providers mistakenly believe that this is done primarily to cover chlamydia, which is uncommon in the oral cavity. But the main reason is to give more assurance on effectiveness against gonorrhea and reduce the possibility of fostering the speard of antibiotic resistant gonorrhea. Here is a link to the CDC guidelines, which perhaps you might discuss with the NP; you can draw her attention to p. 63 in particular:  https://www.cdc.gov/mmwr/pdf/rr/rr6403.pdf

That said, ceftriaxone alone is highly reliable against pharyngeal gonorrhea, probably in the 95% range. So at this point it would be a reasonable option to either treat again with ceftriaxone + azithromycin (the two should be given together, so I would not take azithro alone at this point); or to do another culture as test of cure and, if negative, not worry about further treatment. But one of these definitely should be done. If you return to the same urgent care clinic, you could print out this discussion (and perhaps parts of the CDC document) as a framework for discussion with them.

And of course you are exactly right that urine testing can detect gonorrhea only at the genital tract. When the mouth or rectum are exposed, only testing by throat or rectal swab can detect infection.

As for your symptoms, almost certainly they are unrelated to any of this. As discussed in your previous thread, pharyngeal gonorrhea usually causes no symptoms, and would be especially unlikely to first cause a sore throat (or white patches) soon after treatment. White patches can show up in any pharyngeal infection, viral or bacterial -- so that doesn't mean anything one way or the other. Most likely you just have a coincidental garden variety viral pharyngitis.

I hope this is helpful. I look forward to follow-up comments as the rest of the story plays out.

HHH, MD