[Question #4602] Antibiotic suppressed symptoms?

28 months ago
45 y/o white male, uncircumcised 
In October I received unprotected oral from an Asian masseuse.  Immediately after, I took a single Bactrim 800/160.  I had no symptoms.  
5 days later I received unprotected oral twice and protected anal (as the insertive partner) with a 34 y/o w/f csw.  She claimed to be drug and disease free, but appeared to be from a lower socioeconomic situation, and she presented for anal without protection ( with me insisting on it), making me question her actual status.  She used antiseptic mouthwash immediately prior to these activities.  I took a single Bactrim immediately prior to this, and another about 14 hours later.  I also took 1 g of what I believe to be  amoxicillin (I can’t remember for sure, it was a common antibiotic that was left over in the medicine chest.)

I never had any symptoms, and after looking through these posts, believed that my encounters were low risk, as oral is not an efficient way to transmit infection, and that without any symptoms testing wasn’t warranted.  I continued unprotected sex with my wife.
About a month later my wife began complaining of vaginal pain and discharge.  She says the pain is internal, very severe burning, with inflamed genitalia, but not painful urination.  This began about 5 days after our last intercourse, and has continued despite OTC anti-fungal (thinking it might be a yeast infection.)
I got tested today for gonorrhea and chlamydia and dread receiving the news that I’ve destroyed my 20 year marriage.  Am I correct to believe that my irresponsible use of antibiotics lead to a gonorrhea infection that was asymptotic?  Is that known to happen when the wrong or insufficient antibiotics are taken (by panic-stricken, guilt ridden husbands hoping that it would prevent the infection from taking hold.). Am I correct that gonorrhea is the most likely cause of my wife’s pain, and I should prepare for that difficult conversation?  Are there any other concerns you have or things I should look out for?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
Welcome to the forum. Thanks for your question and your confidence in our services.

First, oral sex is generally considered safe sex. Even unprotected, the risk of any STD is low and it's virtuallly zero for some. However, unprotected anal sex obviously is high risk.

In general, it is unwise to take antibiotics after sexual exposures, even in fairly high risk situations. At times it's apprpriate, e.g. if travel or other considerations make exam and testing impractical. But the other problem is you are using exactly the wrong drugs. Neither Bactrim nor amoxicillin are recommended for any STD -- unreliable against all bacterial infections (gonorrhea, chlamydia, syphilis, and NGU). On top of that, you don't really know for sure what the second antibiotic was! (Presdumably the bottle is labeled; let me know.)

When an antibiotic works at all, it cures infections; they rarely suppress symptoms while allowing an infection to persist. So it seems unlikely you acquired any bacterial STD from the events described and probably did not put your wife at irsk.

Your wife's symptoms are not typical for gonorrhea. They are suggestive of either a more severe than usual yeast infection; or new genital herpes. I'm betting on herpes, which is almost certainly the cause if she has open sores in the affected area, and/or swollen and tender lymph nodes in the groin. Gonorrhea, chlmaydia, and syphilis all are unlikely with these symptoms. She needs to get medical care ASAP. Prompt diagnosis and treatment are crucial if it's herpes.

If she has herpes, it might have nothing to do with your extramarital sexual encounters. Have you ever had genital or oral herpes (cold sores)? Or recurrent symptoms of possible herpes outbreaks? When your wife is seen, make sure she has a PCR test from the genital area for herpes simplex virus (not culture, which misses some infections); and if positive for HSV, that the virus is typed to determine HSV1 (the usual cause of oral herpes) or HSV2 (mostly genital). (Some labs do this routinely, but others do not.) Beyond the implications for the source of her infection, ongoing treatment recommendations are different for the two types.

I suspect this reply has gone in directions you didn't anticipate. I'm happy to clarify anything as needed.

28 months ago
Thanks for the quick reply Dr.
To your questions -
I’m not sure if you misread, but the anal sex was protected at my request (I did not notice condom failure).
My wife was diagnosed with genital herpes before we met, although it’s been many years since she’s had an outbreak.
Unfortunately I threw the bottle away after taking the 2 pills (500 mg each).  I only remember that it was an antibiotic, a common one, that I read in an old (20+ years) medical journal online was a possible cure for some sti (I can’t even remember which ones, only that in 1 g dose it was a possible alternative for the 2 primary medicines).
I’m curious about male asymptotic gonorrhea, in that in this forum it’s said that virtually all men have symptoms, but online, (and even in a 1974 article by you!) it always says anywhere from 10-50% of men are asymptomatic.  Is that old data that is no longer true because of better studies, different strains of bacteria etc.?
Finally when you say my wife’s symptoms don’t appear to be gonorrhea, how would gonorrhea present differently?
She plans on seeing a doctor Friday if there is no improvement before then.  If my results do show gonorrhea +, of course I’ll tell her right away so she can get proper treatment, regardless of how difficult it will be.
Your response gives me some hope, perhaps I’ll sleep tonight, and I’ll let you know the results when I get them.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
I understood the anal exposure. That it was condom protected is the important aspect, not who proposed condom use.

Interesting about your wife's previous genital herpes. Recurrent herpes usually isn't as severe as it seems she is experiencing. But it's still a strong possibility. My advice about prompt exam, testing, and treatment isn't changed.

Amoxicillin was once recommended for some STDs, but not for 20+ years. It isn't reliable against any STD.

You flatter me by quoting the first important research I published. Thank you. Although we didn't know it at the time, certain strains of gonorrhea are much more likely than others to cause asymptomatic infection in men. As it happened, those strains were very common in some geographic areas, including Seattle, in the early 1970s. They are now rare. Currently less than 1% of urethral gonorrhea is without symptoms.

Gonorrhea doesn't cause external genital pain or inflammation in women. It is usually painless unless and until she develops pelvic inflammatory disease (PID, fallopian tube infection), which causes abdominal pain, not genital pain.

Your wife definitely should not wait until Friday to be seen. Waiting that long risks missing the diagnosis, especially if she has recurrent and not a new case of herpes. Also, if she is seen today or tomorrow and starts treatment (e.g. valacyclovir or acyclovir), that treatment will be much more effective than if she waits the extra days. Please do your best to convince her to be seen ASAP.