[Question #3184] Gonorrhea

40 months ago
Doctors:

In December Dr. Handsfield was able to ease my concerns on an issue.  Well unfortunately I continue to feel anxiety about sexual events from several years ago and would appreciate your comments on my questions.  It is not lost on me that something is driving this anxiety and am going to see an counselor but thankful for your reply in the meantime.  I am male and 2000 - 2010 I engaged in sex with different men.  I routinely was checked for STD's but for whatever dumb reason never tested for throat or rectal  infection with gonorrhea or chlamydia.  Most of the time I was the top but did bottom on several occasions and to the best of my recollection always used condoms for anal sex but not oral.  2006-2011 I had a lot of issues with prostatitis and urologist did prescribe antibiotics; 4 weeks or so of cipro and I do recall a round of 2 weeks cipro, 2 weeks doxycycline and 2 weeks augmenting.  I have been celibate since 2010 and tested for STD's except in throat and rectum.  my specific questions: 1) I have read that gonorrhea and chlamydia clear by immune system on own when not treated in urethra, does this also include that they would clear in throat and rectum?  2) I know the doxy would of been effective against chlamydia if infected in those areas but would a gonorrhea strain from gay community been effective with those treatments? 3) Could gonorrhea or chlamydia have infected the prostate, is there research/studies showing that it can travel from rectum to infect prostate? 4) if prostate was infected would immune clearance be the same within the prostate?  concerned harbored in prostate and undetected could still be in there and need post prostate massage and urine test?  Does gonorrhea cause long term side effects in men if not detected such as DGI later on if infections continues in throat, rectum or prostate?  worried given did not have these tests back then.....thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
40 months ago
Welcome back to the Forum.  On this occasion I happened to pick up your question.  I am disappointed to hear that you are still worrying about the encounters that took place so long ago.  I read your earlier interaction with Dr. Handsfield and agree with all that he said.  Reading between the lines, I also worry that you are spending time looking for information regarding your isk on the internet- bad idea.  If you are doing that, please, for your own sake, stop.  Statements there will often be misleading

With respect to your current questions:
1) I have read that gonorrhea and chlamydia clear by immune system on own when not treated in urethra, does this also include that they would clear in throat and rectum?  
this is correct, both infections are regularly cleared over time without therapy.  While there is less data, this appears to occur at all possible sites of infection.  In your own case, the multiple cases of antibiotics you have taken would also likely have cured these infections, if present.

2) I know the doxy would of been effective against chlamydia if infected in those areas but would a gonorrhea strain from gay community been effective with those treatments?
either the doxycycline or the ciprofloxacin you took would have likely been effective, if you happened to be infected.

3) Could gonorrhea or chlamydia have infected the prostate, is there research/studies showing that it can travel from rectum to infect prostate?
Neither gonorrhea nor chlamydia are meaningful causes of prostate infections.  This has been studied and while it is perhaps surprising that it is not the case, the fact is that multiple studies have shown that neither gonorrhea nor chlamydia is an important cause of prostatitis. 

4) if prostate was infected would immune clearance be the same within the prostate?  concerned harbored in prostate and undetected could still be in there and need post prostate massage and urine test?  Does gonorrhea cause long term side effects in men if not detected such as DGI later on if infections continues in throat, rectum or prostate?  worried given did not have these tests back then.
See above.  I am confident that your tests will come back negative and prove that you are not infected with either gonorrhea or chlamydia at any site. 

I urge you to do your best to stop worrying about your exposures in the distant past.  Your multiple courses of antibiotics, as well as your own immune system would clear any infection that might have been present.  More likely however is that you were never infected at all.  I hope my comments will be helpful to you.  EWH
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40 months ago
Thank you, Dr. Hook
 Appreciate the response and it does help me start to move past.  If I may just some clarification...

1) from a pharmacology standpoint even if a drug like cipro if not as effective it can still clear if given enough volume...generally speaking. Thus your response of effectiveness?
2) from what I understand gonorrhea and chlamydia are not long term latent infections like syphilis where it can be dormant for years and then reactivate to cause infections and symptoms? I know may be asymptomatic when infected before clearance. But does not come back 8-10 years later.
3) I recall having a rash and fever in mid '00 which obviously can be caused by lots of things but it last a few days and then gone, if that had been gono  infection then immune clearance and cannot come back?

If this is the case and confident of clearance then any testing at this point in your opinion is not necessary?

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
40 months ago
1.  Cipro is effective for most strains of Gonorrhea as a single dose.  You took many doses.  Likewise doxycycline is also active against many Gonorrhea strains.  You would have been cured.
2.  Correct.j
3.  No, a rash is non-specific.  The rash you suggest does not suggest sn STI of any sort.

Once again, no additional testing is needed

EWH 
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40 months ago
Thank you Dr. Hook I think one of the items that is most reassuring from your response and helps me move on is that regardless if gonorrhea had some resistant strains or becoming resistant that based on the amount of cipro I was taking for prostatitis at the time it would of cured a potential infection.  Apprentice your time!
Edward W. Hook M.D.
Edward W. Hook M.D.
40 months ago
Glad to comment.  Take care. EWH
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39 months ago
Hi Dr Hook,

Well I just couldn't get 100% past it so I figured since never had a throat/rectal test it would be easy enough to get one done.  Throat was easy enough with nurse but clinic required that I collect my own rectal. She provided little instruction but I had done some research before going.  After getting back home I had a couple of questions on the rectal swab test (if I may) it was a NAAT.  1) instructions are a little all over the board but it appears inserting 2.5 -3.5cm is sufficient into anal canal? 2) on the tip of the cotton swab there was a little bit of fecal matter, a little brown.  All instructions say to do your best to avoid fecal contamination (which is hard to do) and they specifically say if 'grossly' contaminated to throw out and start over. I did not ask the nurse when departing but later realized that typically 'gross' in medical terms means visible., that's a low threshold. Would this mess up the test or do they mean significant amounts? Your counsel on this would be appreciated with these sensitive tests and whether I contaminated the sample from getting an accurate result.  Thank you 
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Thanks for your questions.  Instructions for collecting rectal swabs are all over the place.  The good news however is that this is OK because the NAAT tests are so very sensitive that it is hard to do them wrong.  Anything inserted in the range of 2-4 cm into the anal canal will provide an adequate rectal specimen for testing.  In addition, stool contamination, as you have noted is hard to avoid but should not negatively effect the accuracy of your tests (which I am confident will be negative).

Please have confidence in your tests.  When the tests are negative, please don't hesitate to move forward without concern 

As you know, this is my 3rd response to your questions.  Thus, as per Forum guidelines, this thread will be closed in a few hours.  Take care.  EWH
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