[Question #3460] Gonarrhea Chlamidya HELP please (threesome)
89 months ago
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H. Hunter Handsfield, MD
89 months ago
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Welcome to the forum. Thanks for your question.
First, I will correct a misunderstanding reflected in your closing statement: gonorrhea is commonly transmitted by oral sex, especially fellatio (oral-penile), less so but still possible with cunnilingus (oral-vaginal). I think you have misinterpreted comments I have made about chlamydia, which is uncommonly transmitted by oral sex.
You tried to make it clear what sorts of contacts you had with the various partners in your threesome exposures, but I'm having trouble following it. Were there two separate threesomes in the relatively recent past? Anyway, it sounds like a lot of mixing and matching of sexually exposed sites. It sounds like gonorrhea is the main concern; that one person had chlamydia (or a partner with chlamydia) in the past doesn't necessarily mean a high risk of current infection or exposure. OTOH, chlamydia often goes along with gonorrhea, so much so that whenever gonorrhea is treated -- or if antibiotics are given to prevent gonorrhea -- the treatment always should cover the possibility of chlamydia in addition.
So the proper approach here is at least for all three persons in your recent threesome to be tested for both gonorrhea and chlamydia, as you and your main partner are planning to do. (If there was another threesome and it was fairly recent, i.e. within the past 1-2 months, those partner[s] also should be tested at this time.) If it seems likely that someone in all this mix indeed actually was infected recently with either gonorrhea or chlamydia, then everyone should be treated for both. The standard recommendation would be an injection of ceftriaxone (for gonorrhea) plus either single dose azithromycin or 7 days of doxycycline (for chlamydia).
Your personal information suggests you have a connection with Melbourne, Australia. In case you're not aware, Australia's federally supported sexual health centres comprise what probably is the world's very best network of STD/HIV/sexual health services -- and the Melbourne SHC is the best of the best. If you're not already under care of MSHC, I strongly recommend it as a world class source of the best advice in this situation.
I hope this information is helpful. Let me know if anything isn't clear.
HHH, MD
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89 months ago
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Thanks for the reply. So are you saying that all parties should be treated for Gonorrhea? Or do we wait till we are tested and then act on those results?
It was 2 threesomes with the same 2 woman, 2 seperate occasions over 2 weeks.
The new girl had Chlamidya, and found after the 3some.
I also just recently checked and my last urine test, after the 2 encounters, tested negative for Chlamidya and Gonorrhea oral and urine test.
However I did receive a quick 20 second oral sex from the girl, and my partner did give oral sex to the new girl After the new girl finished her antibiotics for Chlamidya.
It was a week after this 3rd encounter, that the new girl informed us she may have gonorrhea.
I will get retested again, however is it likely I would of gotten anything from the quick 20 second oral sex from the new girl? Which occured after the new girl finished her chlamidya anti biotics. But before she advised us that one of her partners had Gonorrhea?
Also are the urine test 100% accurate, is there any chance of a false negative?
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H. Hunter Handsfield, MD
89 months ago
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Thanks for the clarifications.
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Persons sexually exposed to untreated bacterial STDs (gonorrhea, chlamydia, syphilis) normally are treated even if their own tests are negative. However, chlamydia is rarely transmitted by oral sex, so a case could be made for not treating you, and for your regular partner to be treated without waiting for her own test result. HOWEVER, you also know your more recent threesome partner has been exposed to gonorrhea and may be infected with it -- and as noted above, people treated for gonorrhea should be automatically treated for chlamydia as well. On top of all that, the general policy is to have a low threshhold for treatment -- that is, if infection status and exposure are uncertain, it's best to err on the side of over treatment.
So if I correctly understand the situation, all three of you should be treated for both infections. It could be considered optional to do any additional testing (although I am unclear on whether your regular partner has been tested since the most recent threesome event). On the other hand, from what you say, apparently only urine or genital gonorrhea testing has been done, right? No throat swabs for oral gonorrhea? That's actually quite important, since standard treatment is slightly less reliable for oral than genital or rectal gonorrhea. Also, there indeed is a possility of false negative urine test results, which misses 5% of urethral gonorrhea in men and about 10% of genital gonorrhea in women; swab testing is best, especially in women.
Which brings me back to my closing suggestion above: Consider a visit to MSHC and put these decisions in their hands both for testing and treatment.