[Question #4060] Oral Gonorrhea

33 months ago
I am a bisexual male.  Several days ago, I had unprotected oral sex with a man of unknown STD status.  He ejaculated a small amount of semen into my mouth.  Until doing some research, I was under the mistaken notion that oral sex is safe.  I have learned since that it is not, and that it creates the risk of chlamydia or gonorrhea.  Can you give me some solid information on the transmission risk for both of these infections?  The information I have seen so far is mixed.  BTW, I took double the recommended dose for chlamydia a few days after.  Today, I have some tenderness in a lymph node on the side of my neck and a post-nasal drip.    
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Welcome to the Forum and thanks for your confidence in us.  I'll be glad to provide some information. Virtually any mucosal site of direct sexual exposure can be infected with gonorrhea and chlamydia.  Oral infections due to gonorrhea and chlamydia certainly occur but they appear to be a bit less common than genital infections, in part because for reasons that are unclear, the oral pharynx is a less "hospitable" environment for infection than genital or rectal mucosal sites.  This also appears to be more true for chlamydia than for gonorrhea (i.e. pharyngeal chlamydia is rarer than pharyngeal gonorrhea).   In the case of both infections they are even more often asymptomatic than infections occurring at genital sites.  Thus based on the exposure you describe, you are at some risk for acquisition of gonorrhea and/or chlamydia.  The only way to really know is to have tested and now that you have taken antibiotics you may never know.  Nonetheless, because we also have reliably found that oral infections by either organism are more difficult to treat than infections at other sites, testing is probably a good idea.

Having said all of this, statistically, your somewhat tender lymph node is more likely to be due to something other than an STI such as one of the pesky viruses that we all get from time to time.  Post-nasal drip is not a sign of oral STI.

I hope this information is helpful to you.  EWH
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33 months ago
Thanks for your response and insight.   A few questions.  

1.  Are their statistics (as with HIV) that quantify risk of transmission from oral sex and, if so, can you share them?   
2.  Would kissing create a risk of my transmitting oral gonorrhea (assuming I had it)?  
3.  Would genital sex create a transmission risk, or would an infection be localized?  
4.  When you say I “may never know,” does that mean the azithromycin could have knocked out both chlamydia and gonorrhea?   Any way to quantify that likelihood?  My understanding is that azythromycin was not effective for gonorrhea by itself.  
5.  Is it true that most cases of oral  gonorrhea self-cure?  If so, do you have statistics.

Thanks again.  
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
1.  Are their statistics (as with HIV) that quantify risk of transmission from oral sex and, if so, can you share them?   
Receipt of oral sex from and infected person- there has NEVER been a proven case.  Performing oral sex on an infected person, risk is less than 1 in 10,000 (i.e. like performing oral sex on an infected person daily for more than 27 years)/

2.  Would kissing create a risk of my transmitting oral gonorrhea (assuming I had it)?  
This topic has been in the news and is being debated.  If there is any risk, it is extraordinarily no.  Cannot provide a more precise number. 

3.  Would genital sex create a transmission risk, or would an infection be localized?
Infections stay where they occur.  Genital sex leads to genital infection, etc.
 
4.  When you say I “may never know,” does that mean the azithromycin could have knocked out both chlamydia and gonorrhea?   Any way to quantify that likelihood?  My understanding is that azythromycin was not effective for gonorrhea by itself.  
Yes, azithro could have knocked out gonorrhea an chlamydia, if present with a more than 90% probability. 

5.  Is it true that most cases of oral  gonorrhea self-cure?  If so, do you have statistics
No precise data but the answer is yes, most gonorrhea would self cure with time.
EWH
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33 months ago
Thanks again Dr. Hook.  My final questions are  as follows.

1.  I think there was a misunderstanding with respect to my first question.  What I was trying to ascertain is whether there are any statistical indicators regarding the risk of gonorrhea  as a result of the fellatio I performed as receiver (that resulted in a small amount of ejaculate in my mouth).   If so, can you share the data?

2.   notice you mentioned the risk of HIV infection may be less than 10,000 to one, which would seem to be borderline safe sex.  I am wondering, since oral sex often is not performed in isolation from other sexual activities, how is it possible to segregate oral sex as the exclusive factor?  Does the “less” than 10,000 to 1” mean that the “10,000” or “1” is the higher number?

3.  I may be mistaken but think I read in a previous post by Dr. Handsfield that the risk of an HIV infection via oral sex is 20,000 to one.   Is there a variance in your thinking on this point and, if so, why?  

4.  Should I avoid performing cunnilingus at least until I receive test results for oral gonorrhea?

5.  If there is a >90% likelihood that the 2g of  azithromycin I took would knock out both chlamydia and gonorrhea, and most pharyngeal gonorrhea cures on its own, would it make sense to avoid further treatment to minimize the risk of building immunity to antibiotics?   Do you know what percentage of cases self-cure and how long it takes?

In closing, thanks again.

 

Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
1. There are no good studies to answer the question.  The risk for infection, if your partner was infected however is likely to be less than 1 in 10.
2.  Borderline is a matter of personal perception.  To put this in context, your risk for getting HIV from performing oral sex on an untreated infected partner (less than 1 infection in 10,000 exposures) is less than your lifetime risk of being struck by lightening (1 in 1000)
3.  You are splitting hairs. Estimates vary in  the range of 1 in 10,000 and 1 in 20,000 depend one which source you use.  As I mentioned, performing sex on an infected partner once a day, it would take you over 27 years to have performed sex on him more than 10,000 times. 
4.  This risk of transmitting gonorrhea through cunnilingus is estimated to be less than the risk for fellatio.  In your situation, I certainly would not be worried.
5.  The data on self cure and the rates are still evolving.  In your situation, given the nature of your exposure and the antibiotics you took, were I you I would not be worried.  You'll have to make up your own mind.  My sense however is that you are more worried than is really needed.

this ends this thread.  EWH
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