[Question #6114] cervical gonorrhea

18 months ago

Backstory: I had sex with a heterosexual male (that I've known for quite some time) a few months ago. A few days after, I developed a yeast infection. I saw my GYN who diagnosed me with a yeast infection and did an STD screen which was negative--- took fluconazole pill and was resolved. I haven't had sex with him or anyone else until a couple of weeks ago when I had sex with him. A couple days later it looked like I was having another yeast infection which I decided to treat with over the counter medication. A few days post treatment, I was still having abnormal discharge so I went to see the doctor, thinking that I may have a strand of yeast not covered by over the counter medications. I also got an STD screen. I was called and told I tested positive for gonorrhea from the culture taken from the cervical discharge. Of course, I let my partner know, who is adamant that he also has not had sex (unprotected or otherwise) with anyone else during that time and his last screen (unknown date to me) was negative. He doesn't have any symptoms except that he developed a cold a couple days after I first had symptoms. I made sure I was treated and he said he will get checked with his doctor.

Could my partner have had it and not known? Could it lay dormant? Could the screen have been false negative? Could I have had a false positive? I see no other possibility than the fact that I got it from him since he is the only person I had sex with.

H. Hunter Handsfield, MD

18 months ago

Welcome to the forum and thanks for your confidence in our services.

Your situation is not rare: it's quite common for one person in a couple to have gonorrhea (or chlamydia) and the other partner to test negative. There are several possible explanations:

First, the tests miss sometimes miss it. For example, urine testing for gonorrhea in men misses up to 10% of infections. The test also misses a smaller proportion of infections in women, so it is conceivable you had gonorrhea going back several weeks or even months, that was missed (or not tested?) at the time of your first apparent yeast infection.

Second is the opposite problem, a false positive test result in an uninfected person. This is much more rare (1 chance in hundreds or thousands), but still occurs from time to time, i.e. perhaps you don't have gonorrhea despite your positive test result.

Third, gonorrhea is cleared by the immune system over time, even without treatment. This can occur qutie rapidly, especially in men. So your partner might have had it and transmitted it to you, then had a spontaneous cure.

Finally, of course there is always the possibility that someone isn't being truthful, either about their sexual partnerships or a known infection. Youu are of course in a much better position than I am to judge your partner's truthfulness on these issues.

If I had to judge the most likely scenario, it is that you indeed were infected by your partner, but perhaps not at the most recent exposures; and that he had a false negative test. He also could have had a longer infection that spontaneously cleared, but that doesn't fit well with his assertion of no other sex contacts recently. One thing to be considered, perhaps, is the very human tendency to not admit certain sexual exposures. As noted above, I cannot judge your partner in this regard; that has to be your judgment. (Of course for purposes of this discssion, I'm assuming your own sexual history is accurate.)

My guess is you're never going to have a clear answer, and in any case that's not hte most important issue. What is crucial is that both you and your partner need treatment. Don't let your partner or his doctor(s) get away with not treating him: all partners of confirmed gonorrhea cases always need treatment, regardless of their own test results, symptoms, etc. In addition to treatment, it would be reasonable for him to be tested again for gonorrhea.

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

HHH, MD

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