[Question #451] Pharyngeal Gonorrhea

94 months ago
I asked a series of questions several months ago, and you both were instrumental to my ability to overcome my anxiety about a regretted sexual encounter.  I've been doing great since then but have one final thing that is bugging me.

As a refresh, I tested positive for gonorrhea after receiving oral sex from a stripper in late September.  It never occurred to me that I also could have acquired pharyngeal gonorrhea as well.  There were two possible exposures:  (1) we engaged in significant, deep kissing; (2) several (3 or 4) days after the exposure, but before treatment, I swallowed some (but not a lot) of my own semen (don't ask).

I was subsequently treated, and have tested negative three times (urine) since.  Questions:

1.  Could I have contracted pharyngeal gonorrhea this way?

2.  Is there any possibility the combination of suprax and azithromycin that I received could have cured gonorrhea in my penis but failed to treat pharyngeal gonorrhea?

I really hope this is something I shouldn't be worried about.
H. Hunter Handsfield, MD
94 months ago
I think this is your 4th or even 5th question, all going back to this single exposure and treatment for urethral gonorrhea as a result. The rest of your concerns after the first couple of quesitons were unwarranted, and that's the case here as well. Why is pharyngeal gonorrhea even on your mind? Oral gonorrhea is not transmitted by kissing; and since your own urethral gonorreha was long gone, oral contact with your own semen of course carried no risk. As for treatment, it would have cured pharyngeal infection if present. 

So the direct answers to both these questions is no. Let's make this your last question on the forum unless and until you have a different STD exposure or event than the one that started all this. You've spent enough on us!

Regards--  HHH, MD

94 months ago
Yes, this is my fifth question, and I can assure you that it's more annoying/frustrating to me that I'm still here than you.  But, to be clear, the oral contact with my own semen occurred before I was treated, but after I was exposed (i.e. during the active infection).

Cutting to the chase, what I'm worried about here is whether I could possibly expose my wife to gonorrhea.  I was extremely careful not to engage in sexual contact with her until after I had tested negative for urethral gonorrhea twice.  Accordingly, the only possible path to infecting her would have been:

1.  Contracting pharyngeal gonorrhea through ingesting a small amount of my own semen while I had an active infection; and

2.  The pharyngeal infection (if it ever existed) persisting despite suprax and azithromycin treatment that cured the urethral infection; and 

3.  Infecting my wife by giving her cunninlingus (which also did not occur until approximately one month after treatment).

Your response suggests that there is no chance of #2, which would eliminate any risk of #3 (though further research suggests that the likelihood of even this is very low).  If I have this wrong, let me know.  I'm trying to decide whether I should have my throat tested. 

H. Hunter Handsfield, MD
94 months ago
Thanks for the clarification. The most important facts here are that if you had pharyngeal gonorrhea at the time, the treatment you received would have reliably cured i(as I replied above); and second, pharyngeal gonorrhea clears on its own without treatment, usually within 6 weeks and always (according to the single research study on the topica) within 3 months.

1) If I understand the scenario, there is no chance. It takes a couple of days for infection of the urethra to take hold and be transmissible. During the sexual event when you acquired your urethral gonorrhea, all you're really asking whether your own semen could carry enough of your partner's infected oral secretions to transmit gonorrhea to your pharynx. I cannot imagine that this would be possible. (In a slightly related vein, in the past I have had questions about people who said another man had sex with a women to whom he was then exposed, and the first guy had gonorrhea. Could he have been infectec by exposure to the other guy's infected semen in the vagina, before infection took hold in the woman? The answer was always no:  this was never known to have happened.

2) Apparently you didn't read, understand, or believe my initial reply above. I haven't changed my mind!

3) Even with active, untreated oral gonorrhea, the risk of transmission to femaile partners by cunnilingus is very low. In any case, it is impossible you had it and were infectious at the time.

It is time for you to stop obsessing about this business. Please move on. The incident is over and so should be any and all your concerns about it.