[Question #4791] "Super" or Drug-Resistant Gonorrhea

27 months ago
Hello, I always practice safe sex vaginally (and would do so anally if it came to that) but I don't like to use condoms or barriers for oral sex. I have seen that the consensus opinion on this forum is that oral sex is safe sex--not no risk, but little risk for some STIs and virtually no risk for others. I think I could handle these low odds, except for that wild card that is drug-resistant gonorrhea. My questions are 3: 1) Is super gonorrhea prevalent enough in the general US population to be worried about it realistically, or is it a very very rare occurrence? Any idea of how rare? 2) Can such gonorrhea be contracted through either orally pleasuring a woman or receiving a fellatio from her? Would this route or transmission be more, less, or equally likely as other routes? Finally, 3) if super gonorrhea were contracted for whatever reason, is this as damning a sentence as it sounds to be? No cure, constant pain in urinating, and worse effects down the road? I just want to be cautious. Thank you in advance for your replies. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Welcome back to the forum and thanks for this additional question. However, it has largely already been answered when you asked a similar question (in a follow-up comment) in another thread of yours almost a year ago. At that time Dr. Hook told you "Statements about drug resistant gonorrhea are a bit over stated.  Gonorrhea is becoming more resistant to antibiotics but it is still relatively uncommon in most of the world and even when drug resistant stains are encountered, there are alternate antibiotics that are highly effective.  So far there has never been a case of gonorrhea that could not be treated and this is unlikely to occur." That remains true. In addiition, perhaps you'll be interested in this online article, about 10 months ago, about a single case (the first) of failure or standard treatment to cure a case of gonorrhea. As you'll see, I was asked to comment on it:  https://www.everydayhealth.com/gonorrhea/standard-antibiotic-regimen-fails-cure-case-gonorrhea-uk/

To your specific questions:

1) " Is super gonorrhea prevalent enough in the general US population to be worried about it realistically....?" No. There have been no such cases in the United States, although it likely will be a problem someday, but not yet.

2) Antibiotic resistant gonorrhea is neither more nor any less transmissible than any other strain of gonorrhea.

3) "Super" gonorrhea is a non-scientific term never used by experts. Such strains are no more nor less virulent than others. And as stated by Dr. Hook in your previous thread, quoted above, there are effective treatments even for the most resistnat strains. Such gonorrhea strains may not be easily treated with the standard, recommended antibiotics. but other effective treatments are available. Probably there will never be a case of entirely untreatable gonorrhea, at least not for many years. And even without treatment, gonorrhea is cleared by the immune system within a few weeks or months. (In the pre-antibiotic era, the average duration of gonorrhea in men was about 2-3 months.)

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD


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27 months ago
This is very clear, thank you Doctor.  I do remember now that Dr. Hook addressed this question in a previous follow up, but I am grateful for the additional details and update.  I have no more follow ups at this time. Thanks again. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Thanks for the thanks. The thread will be open a while longer in case a clarifying question comes to mind. Best wishes and stay safe.---
27 months ago
If I could ask one follow-up, it would  be regarding whether there are any reliable statistics concerning the likelihood of contracting gonorrhea through oral sex. Something like, "For every 1,000 blowjobs, there are x cases of transmission." I understand that there may not be such statistics, but if there are, I am sure that you would be the right person to ask for them, either on the side of receiving a fellatio or giving cunnilingus. As someone who sticks with oral sex with regard to the unprotected part, it is mainly gonorrhea that concerns me, though if there are others I should be wary of do let me know about them also--keeping in mind, of course, that, as you and other doctors on the forum insist, std transmission through oral is not a common event in any case. Thanks again for the input.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Correct, such statistics do not exist. For vaginal sex, a rough estimate is that if a woman has vaginal infection, her male partner has roughtly 20-50% chance of infection from a single exposure, and there is evidence the risk is a lot lower than that for oral to penile transmission, probalby under 5% (1 chance in 20). Cunnilinugs is believed to be very low risk for gonorrhea for both the vaginal and penile partner.

But don't focus only on the risk of transmission. The more important consideration is the prevalence of oral gonorrhea in partners who might perform oral sex on you, and genital infection in women in whom you perform cunnilingus. On average, well under 1% of female sex workers have oral infection and at any time under 5% are likely to have genital infection. Even these are much too high for escorts, i.e. expensive female sex workers by appointment. For these reasons, the overall risk of acquiring gonorrhea from any single exposure of these types is probably in the range of one chance in several thousand.

That concludes this thread. I hope the discussion has been helpful.
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