[Question #3380] Bacterial Pharyngitis

38 months ago
I performed cunnilingus on and had condom protected vaginal sex with a masseuse about 20 days ago.  I asked my partner her status and she said negative and she gets tested regularly. 

About 3 days ago I developed a sore throat and today I noticed my throat was red with some exudate, so I thought this may be bacterial. I do not have any other symptoms. I went to a walk in clinic today. The NP did an exam and agreed my throat looked swollen, erythematous with some exudate, noting worse on the R side, favoring bacterial. She did a rapid strep test which was negative. She sampled for strep culture, results still pending. The clinic did not have the capacity to do oral gonococcal/chlamydia test. The NP prescribed me Azithromycin 500 mg once a day for 3 days. 

1) Does this sound like STD, strep or something else? Should I seek out further testing or medical care?

2) Will the Azithromycin 500 mg qday x3 days be adequate if this is strep, gonorrhea or chlamydia?

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum and thanks for your question. Love your username -- how true!

Everything points strongly away from any STD as the cause of this problem. I'm sure it has nothing to do with the sexual exposure described. First, too many days have passed:  the only STD that could do this is gonorrhea, and it would cause symptoms within 3-5 days. Second, even these symptoms are rare with gonorrhea:  pharyngeal (throat) infection almost always is entirely asymptomatic. Third, cunnilingus is extremely low risk for gonorrhea. Fourth, this was also low risk for chlamydia, and in any case oral chlamydia has never been reported to cause sore throat or other symptoms.

The large majority of acute pharyngitis, including cases with overt exudate, are viral, not bacterial. So I'm not surprised the rapid strep test was negative and expect the throat culture will be negative as well.

It makes no sense that a clinic (and the lab they use) that can do a culture for strep throat cannot also do a pharyngeal culture for gonorrhea. The specimen is the same and the lab methods almost identical as well; and if the lab is able to do urine or swab testing for a DNA test for gonorrhea, they could also do it on a throat swab. However, it is true that testing for oral chlamydia is not widely available -- but for the reasons noted above, this really doesn't matter anyway.

Those comment address question 1:  no need for any further STD testing. Azithromycin in that dose is fine for strep. This particular regimen has not specifically been studied for gonorrhea or chlamydia, but almost certainly it would be effective against either one.

Bottom lines:  Probably a garden variety respiratory virus; slight possibility of strep throat; no realistic chance of any STD; and in any case, your treatment was adequate for all three of these.

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