[Question #522] Gonorrhea

36 months ago

First of all, thanks in advance to whomever answers this question. This service is very valuable.

I’m a white male and received unprotected oral sex from a white, female sex worker last week. She was British.  

About 4 days after our encounter, I started to feel some mild discomfort in my penis. The discomfort would mostly come right after I urinated.  The discomfort was never really painful, though. The pain wasn’t a sting and it didn’t hurt while urinating or ejaculating. I have not seen any white discharge, either. Right now, as I write this, I don’t feel any discomfort.

I started to wonder if this was gonorrhea. I’m wondering if symptoms could be this mild. Should I get checked out?

 I mentioned our demographics earlier in this post because after reading about gonorrhea on some Medhelp postings, it seems there are some demographic groups where gonorrhea is rare and some where it’s hardly prevalent at all. I looked up the STI stats for my county in my state. In 2012-2013 (the latest I could get) the rate per 100,000 of population was between 100-200 cases.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Welcome to the forum. Thanks for your confidence in our services. Thanks also for doing some useful research; it seems it reassured you somewhat, and appropriately so.

On one hand, gonorrhea indeed is a relatively uncommon STD, especially in comparison with HPV, herpes and chlamydia. OTOH, the overall statistics don't reflect very high rates in some population groups and virtually zero in others. (The other STDs just mentioned are common in all demographic groups.) The likelihood your partner had gonorrhea, in particular oral infection, depends on things you don't mention, such as social contex: such as in most settings a much lower chance in escorts (espensive female sex workers by appointment) than in street or brothel workers, bar pick-ups, etc. But even if she had oral gonorrhea, the chance of transmission from any single oral sex exposure is quite low, probably under 10%. Chlamydia is rarely transmitted by oral sex. Nongonococcal urethritis (NGU), which in this situation may often be due to entirely normal oral bacteria that don't "belong" in the urethra, is a possibility but still unlikely for any single exposure.

Your symptoms are against gonorrhea or any other urethral infection. Although minimally symptomatic or entirely asymptomatic urethral gonorrhea can occur, it is rare; the absence of overt pus dripping from your penis and absence of significant pain on urination (both usually starting within 2-3 days) are strongly against it. If you don't develop obvious discharge and/or painful urination doesn't appear within 10 days of the exposure, you can also be confident you don't have NGU (or chlamydia). As for your previous, transient symptoms, they could have been just minor physical irritation from the exposure, or perhaps anxiety magnifying normal body sensations or trivial discomfort that you otherwise might not have noticed at all.

Should you be tested? The chance you have anything is very low, and it will be even lower if you reach 10 days without more definite symptoms. Normally testing is not recommended after single oral sex exposures in the absence of symptoms. OTOH, if negative testing would give you additional confidence that all is well, there's no harm in it. If so, have a urine gonorrhea test. You needn't wait; testing is valid any time more than 2-3 days after exposure. (Chlamydia testing normally is combined with gonorrhea testing, but there is little chance of it, as noted above.)

I hope this has been helpful. Let me know if anything isn't clear. Best wishes and stay safe--   HHH, MD

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36 months ago
Dr. H,

Thanks a lot for the thorough reply. I'll wait for 10 days. If no symptoms appear after 10 days, I'll consider the matter behind me.

Good luck to you and everyone as ASHA.
34 months ago
I got a good answer from Dr. H. This can be "closed"
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
OK, glad all is well. Thanks for the thanks. Best regards-- HHH, MD

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