[Question #5308] Concerned about gonorrhea from unprotected oral and other STDs from sex.

22 months ago
Hi Doctors,

Me and my girlfriend use to have an open relationship but we decided against it about a year ago. However, the other day I had an extramarital sexual encounter with a women at a bar. This was the first night I met her the women. She gave me oral sex with no ejaculation. I applied a condom and she was on top for a short time, maybe a minute. I tried to switch positions and when I did I noticed the condom was not on. I believe it was pulled off when I tried to switch positions, but I'm hoping that it didn't fall off when she was  on top; I'm pretty sure this did NOT happen as my penis didn't leave her vagina, but I'm terrified I was in her unprotected. I I felt a rush of anxiety after this happened, due to my last STD and decided to stop.

I don't want to spread anything to my partner.. I feel terrible. My partner gave me brief oral sex the next morning and I'm scared I might have gave her oral gonorrhea. 

I know this is generally a low risk encounter, but I was tested for Gonorrhea and Chlamydia. I also want to be tested for Trich because I know it's very common. I know it is unlikely I got either and especially Chlamydia from this encounter, but I am very scared. My questions are: 

The encounter happened in the early morning, and I was tested about 2 and a half days after exposure. Is this enough time to detect Gonorrhea and Chlamydia with certainty? (I want to ask as it takes several days to get the results.)

What is the incubation period I need to wait for male Trich testing?

Finally, I think I am overreacting and being foolish but I took 1000 mg azithromycin that I had saved in my cabinet. I know this medication will effectively treat Chlamydia and NGU if present, but would it affect Gonorrhea results? I am going to be tested for final certainty 13-14 days after the encounter, and want to make sure I don't get a false negative/not completely treated Gonorrhea result because I took the Zithromax.

Thank you for you time.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome back to the forum and thanks for your continuing confidence in our services.

Almost any single sexual encounter, even entirely unprotected, can be considered low risk for gonorrhea and usually chlamydia as well:  at any point in time, the large majority of even the most sexually active straight men and women are not infected; and if either G or C is present, they are transmitted no more than half the time. So you can expect negative test results. That said, you may have been tested too early for reliable chlamydia results; it may take up to 5 days after exposure for infection to be detected. However, 2 days is fine for gonorrhea.

No experts recommend trichomonas testing in this setting, and there are no data on time to reliable test results. Based on what is known about the biology of trichomonas, it probably would be best to wait until at least a week after exposure. However, the chance of cacthing trich after any single vaginal sex exposure probably is under one in many thousand. I really wouldn't worry about it -- and if somehow I were in a situation like yours, I would not be tested at all and would continue unprotected sex with my wife once I new my gonorrhea and chlamydia tests were negative.

And indeed you overreacted by taking azithromycin in this situation. By doing so, you have ruined any chance of knowing whether you had chlamydia, so you can forget what I implied above about retesting. And assuming negative results on your current G/C test, it would be foolish to spend good money on yet another test after 13-14 days or any other time.

My final comment is that in looking back at both your two previous threads and this one, it would seem you are way over-concerned about STD risks. Your sexual lifestyle is not zero risk for these or other STDs, but it's certainly on the low side -- even though you had a documented chlamydial infection at one time. Rather than getting compulsively overtested (and overtreated) on account of this particular event or similar ones in the future, I would recommend that if you continue occasional sexual exposures outside your regular partnership, you have routine standard testing once a year (urine G/C, blood tests for syphilis and HIV -- no trich or other infections).

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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22 months ago
Hello again doctor Handsfield, and thank you for your normal thorough and educated helpful response. I want to say that this service, as well as studying the information provided by you and your peers, has made me a more aware and educated person when it comes to STD risks. I used to think I was at a great risk from HIV for getting occasional unprotected oral, now I know that the internet is full of misinformation that is unhelpful and anxiety producing. I believe that like you said, as long as my anal and vaginal intercourse is protected, I am low-risk (not zero risk)for STDs and will test yearly from this point on. 

I am confident I will receive a negative result on my G test, and once the zithro has cleared any potential infection, I will resume sex. But I won’t rush to take these in this situation in the future. That being said I’ll just use my follow up questions for my own fun and  education:

Is a single unprotected oral exposure to gonnorhea and NGU (assuming it IS indeed present in the throat less risk then a vaginal exposure? Or is it just less common in the throat hence the reduced risk? In other words, if one man is exposed to gonnorhea in the throat, and one is exposed to gonnorhea in the vagina, is the vaginal exposure more likely to produce an STD?

Why is gonnorhea detected more quickly? Is it a more sensitive bacteria?

Thank you as always to you and your peers for providing this great service. MWC
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Yes:  even if pharyngeal (throat) gonorrhea is present, transmission to a partner's penis is believed to be a lot less efficient, and therefore a lot less frequent, than transmission of genital gonorrhea. No data exist about NGU transmission, but almost certainly NGU follows oral sex less than one time in several thousand exposures.

Neisseria gonorrhoeae, the causative bacteria, grows more rapidly than Chlamydia trachomatis, and hence takes less time to reach levels detected by the standard tests.

Thanks for the thanks.
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21 months ago
Well doctor, I guess I have one more question, because my girlfriend has, unfortunately actually shown some symptoms of something, maybe not an std though.

I abstained from sex for 6 and a half days after taking the Zithromax. Negative G/C result.Then we had sex early in the day, and later in the day briefly. During the second time, I noticed that my girlfriend had an odd smell from her vaginal discharge. It’s been 3-4 days and the smell has persisted. It’s worth noting she was sick and not eating for a day or 2 before we had sex.

I was thinking that Trich would be the most likely cause because I don’t have any symptoms at all and I know symptoms are more common in women. We didn’t have sex in the days leading up to this, and I doubt symptoms would start for her in a few hours, however she did playfully jump on me in bed a few times during the week we abstained from sex and rub on me with her pelvis. She had thin underwear on. This interaction wouldn’t be enough to cause Trich would it? Should she be tested for that or Bacterial Vaginosis? Thanks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
The most common cause of strong (often fishy) vaginal odor is bacterial vaginosis, which is common in entirely healthy women. Trichomonas does the same, but is not carried in the oral cavity, hence never acquired by oral sex — so even if your partner has trich, it’s not from your recent oral sex event. She should get medical care for diagnosis and treatment. They’ll probably test her for common STDs, but if she has one, it won’t have anything to do with your outside sexual exposure.

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