Welcome to the forum. Thanks for an interesting question -- which happens to be right up my alley. My earliest days of STD research were on DGI and asymptomatic gonorrhea in men; and a few years after that, in the 1980s, we learned the two syndromies are closely related:  the same strains of gonorrhea that thend to disseminate also are especially likely to cause asymptomatic urethral gonorrhea in men, which also might have been an issue in your situation.

https://www.ncbi.nlm.nih.gov/pubmed/4633690

https://www.ncbi.nlm.nih.gov/pubmed/804363

https://www.ncbi.nlm.nih.gov/pubmed/4202519

Your history is typical of DGI and I suspect the diagnosis was correct. Certainly you were at risk, based on your seuxal history and your symptoms were classical:  I could use your story to teach medical students about DGI. Up to 20% of persons with DGI have negative test results for gonorrhea at all exposed sites, and it's often difficult to identify it in sex partners as well. That said, I would have expected at least one of these -- your urethral or throat test results, or or perhaps a test in one of your other partners to be positive. OTOH, it sounds like weeks or months might have passed before they were tested, which is plenty of time for self cure of gonorrhea by the immune system. (But more about your wife below.)

It sounds like you were treated more than adequately for DGI -- in fact, most STD experts would advise that you were seriously overtreated. During my research days caring for >100 patients with DGI, a person like you would have received 2-3 days of IV antibiotic, then another few days of oral.

However, there are other conditions that mimic DGI. For example, you could have had essentially the same syndrome caused by Neisseria meningitidis (the meningococcus, i.e. one of the main causes of bacterial meningitis.) (My forum colleague Dr. Hook was the lead researcher on a past report about meningococcal infection mimicking DGI.) Certain viral infections and immunologic conditions also could cause similar symptoms and exam findings. The improvement on the antibiotics you received suggests it was an infectious problem of some sort, however, and my money is still on DGI, with meningococcal infection a pretty good second bet. Unfortunately, there are no tests for past epiosdes of either gonorrhea or meningococcal infection, so probably you'll never know for sure.

To your specific, numbered questions:

1) It was a mistake, in my opinion, for your wife not to have been informed. She should have been tested for gonorrhea and she still should be. Gonorrhea can be carried without symptoms for a long time -- and as noted, some strains that disseminate are especially likely to cause asymptomatic infection. Even with all the time that has passed, I recommend she be informed, tested, and treated for possible gonorrhea. You also should be retested (throat swab and either urethral swab or urine).

2) This depends partly on exactly what test was done. A nucleic acid amplification test (NAAT, i.e. DNA test) usually would still be positive, but not always. However, a culture test would usually be negative within 48 hr or even faster.

3) NAAT, which is the only test done on urine, didn't exist back in the day when almost all DGI research was done. Probably it would pick up most infections, but it is difficult to be certain.

4) Gonorrhea usually would be transmitted within the first few episodes of unprotected vaginal sex. But for the reasons above, absence of symptoms does not mean that either or both of you is not currently infected. Hence my recommendation for both you and your wife to be tested/retested at this time.

I'm curious where all this took place. If you feel free to share it, are you in the US? What city? 

These are complex issues, an I'm sure some of my advice is not what you were hoping to hear.  But let me know if anything isn't clear.

Best wishes--  HHH, MD

THX!

You had nucleic acid (DNA) testing. The initial test results still could have been affected if you had antibiotic before being tested. For sure it's no surprise that all tests remained negative after high dose IV antibiotics were started.

If your wife is infected, most likely she will not develop DGI, but it could happen. Similarly, if she is infected and you were to be reinfected, you probably would not get DGI. Whether you would have symptoms from a genital infection isn't known. There have been no reports of reinfection with the kinds of gonorrhea strains that cause asymptomatic gonorrhea and DGI, so we really don't know what to expect in the event of reinfection.

Of course I am well aware of the fact that STDs are "complicated" (i.e. inconvenient in relationships, stigma, and all the rest). And after 4+ decades in this business, I also undersand the emotions you are going through, including "hoping to be lucky". But the bottom line is that you do not have a right, morallly, to take risks with another person's health, especially that of a person close to you and who trusts you. Be clear:  my bet is that your gonorrhea is entirely gone, and your wife's too (if she ever had it). But neither I, you, nor your doctors can know this with certainty. Don't act solely on my advice; it would be wise to discuss all this with your doctor(s), perhaps especially the ID specialist, if you have one. But once you have all the available information, and within the next few days, you have an obligation to do what's right. I think you know what that is.

Good luck with it all.