[Question #34] Gonorrhea time of transmission

40 months ago
Dear ASHA Expert,

I recently went to the emergency room (ER) because I was having symptoms of miscarriage (severe cramps and bleeding at 6 weeks of pregnancy). I was discharged within hours. The sonogram results suggested risk of miscarriage (no heart bit detected) and I was asked to have another sonogram within 2-3 days. I had a confirmed miscarriage the next day. However, I was called to go back to the ER to get treatment for Gonorrhea. I was puzzled and I am still confused. Other than the miscarriage symptoms, I haven't had any other symptoms. I have had only one partner for the past 7 years (my current partner), except for the last 5 months were I had unprotected sex with another man. Specifically, I had unprotected sex with another man 114-121 days before experiencing the miscarriage symptoms. However, he had a medical check up, which included STD testing for "gonorrhoeae by probe" and "chlamydia by probe" 5 days after having unprotected sex with me; results were negative for both.  Then, could I had contracted gonorrhea from him even though his results were negative OR should he be re-tested in case I had transmitted the infection to him, assuming that I have had the infection for a long time without knowing it? He has no symptoms after more than 125 days.

Since then, I had unprotected sex with my current partner, exactly 96-103 days and 34-42 days before experiencing the miscarriage symptoms. My partner denied having sexual intercourse with another person.  After reading numerous posts and information on Gonorrhea, I am assuming that I was infected with gonorrhea and got pregnant around 34-42 days before experiencing the miscarriage symptoms? Is this the most accurate estimation of transmission time given the information provided? Also, is it possible that my current partner may not be infected even though I am positive and we have had multiple unprotected sexual intercourse (96-103 and 34-42 days and many more years) before?

Lastly, I was given medication for both gonorrhea and chlamydia, and cramps, but not bleeding, was gone within 48 hours after medication. Bleeding was gradually reduced, lasting 5 days after medication. Since the cramps (lower abdominal pain) was gone relatively soon after medication, I am assuming that it is not possible that I had a false positive testing result for gonorrhea or given medication when in fact I was not infected with gonorrhea....

Thanks in advance for reviewing and addressing my question promptly.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcom to Ask the Expert. I'll try to help.

First, you can be very sure you in fact had gonorrhea. The modern tests miss infections once in a while (more about that below), but false positive results are extremely rare. So your positive test is conclusive.

Second, I can't say whether gonorrhea might have contributed to your miscarriage or to the cramps and other symptoms you had at the time. Interference with early pregnancy isn't a recognized gonorrhea complication, and of course miscarriages are very common in the absence of obvious triggers. So most likely gonorrhea wasn't a direct cause.

Third and most important are your concerns about when and from whom you were infected. Clearly you were infected by one of your two sex partners. Without treatment, gonorrhea in women persists for a few months (rarely up to a year), so it wasn't necessarily the more recent partner (5-6 weeks before miscarriage). False negative tests occur 5-10% of the time in infected men, especially on urine testing. In other words, the infection can be missed in some men with negative urine tests. The "probe test" is more likely to miss infection than a nucleic acid amplification test (NAAT), so maybe that gives a soft clue, if your more recent partner was tested by NAAT. Of course it's also possible that one or the other partner wasn't completely honest -- wan't really tested, had taken an antibiotic (either for gonorrhea or some other infection) within a few days before being tested, was positive but didn't inform you, had another partner with known gonorrhea, etc, etc; you can imagine the possibilities as well as I can. And you can judge their personalities and probabilities better than I can; you know them and I don't!

Finally, you don't say whether your partners have been retested since you were diagnosed. That is essential. And they both should be treated for gonorrhea (and presumed chlamydia, as is automatic for all persons with gonorrhea), even if repeat testing is negative (or if not retested at all). The usual approach is to collect specimens for testing and then treat, without waiting for the test result. But even negative tests will not exonerate them as the source of your infection. Urethral gonorrhea in men clears spontaneously in a few weeks, so one of them could have been infected previously but not now, even without treatment.

Unless one of those repeat tests is positive, probably you'll never know for sure when and from which partner you were infected. But there is no doubt that at least one of them had gonorrhea and infected you; and hence that at least one of them also was having sex with at least one other partner. And I'll repeat that both should be treated for possible gonorrhea.

I hope this has been helpful. Best wishes--  HHH, MD
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
One other thing to consider. In the US, gonorrhea is 10-20 times more common in gay men than in straight men and women, even more so in some urban areas. Whenever a woman has gonorrhea, it is legitimate to consider whether her male partner might be gay or bisexual. And given how deep and dark the closet can be for some men who have sex with men, it's a situation that often leads to denial, falsification of test results, etc. Of course it isn't necessarily the case; there are plenty of truly straight men with gonorrhea! Still, it's something to consider in discussing the situation with your partners. It's an important thing to know, since this would also markedly elevate the chance ofexposure to other serious STDs, especially syphilis and HIV -- not to mention the potential relationship implications.---