[Question #7344] Treatment failure

6 months ago
Hi Doctors, I tested positive for oral gonorrhea two months ago had treatment and a test culture for antibiotics which tested suitable for the treatment prescribed along with a negative swab a week after treatment. 

My question is that I still have swallowen tonsils with white spots my tongue feels swallowen and I am now worried my negative test missed the infection as I've read that oral swabs can miss infections.

1. Is there a chance my negative test was wrong? And my treatment failed?

2. I know that this forum advises that oral gonorrhea rarely has symptoms but my initial symptoms of sore throat and tonsil pus lead me to seek testing. I am concerned this is a sign I am still infected.

What would you advise? 

Regards. 
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago

Welcome to the Forum.  Thanks for your question.  I fully understand how having the unhappy realization that you had pharyngeal gonorrhea could raise questions and lead you to worry that persistent symptoms could represent failure of the treatment you received.  I'm not sure what treatment you received for you infection.  Hopefully is was the recommended treatment- a shot of ceftriaxone and oral azithromycin pills.  If so, the combination of having received the recommended therapy which is close to 100% effective and the validation that your subsequent negative follow-up test (which was taken at a time which would give reliable results) are virtually absolute assurance that your infection has been successfully treated. 

I can't help but wonder whether the symptoms that cause you to be tested initially for gonorrhea might have been due to a second, co-existent infection and testing that lead to diagnosis of your oral gonorrhea.  As you point out, nearly all oral gonorrhea is asymptomatic and it would not be at all unusual for a co-existent viral pharyngitis to cause lingering symptoms.  Thus:

1. Is there a chance my negative test was wrong? And my treatment failed?
See above. This possibility is most unlikely.  Currently available tests for gonorrhea are very, very sensitive making it unlikely that a persistent, symptomatic infection was missed by re-testing. 

2. I know that this forum advises that oral gonorrhea rarely has symptoms but my initial symptoms of sore throat and tonsil pus lead me to seek testing. I am concerned this is a sign I am still infected.
Understood.  My guess is that you had both gonorrhea and some other cause of a sore throat simultaneously.  Hopefully at this time, you are improving, albeit not as rapidly as you would like or hope.   If you are improving, I would not worry and suggest giving yourself more time to improve.  OTOH, if you are not improving, I would suggest you return to see the clinician who diagnosed your initial infection for a follow-up examination to guide decision making. 

I hope this information and comment is helpful. EWH
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6 months ago
Thanks Doctor, yes treatment was as you described above 500mg into muscle and oral antibotics all at once very uncomfortable. I am feeling better but the persistent feeling of swelling and dryness is still present. I will seek examination and update on the result.
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
Thanks for the additional information.  It makes it all the more probably that your gonorrhea is cured and that this is either simply residual inflammation which will continue to improve, very possibly due to something other than your gonorrhea.  I look forward to hearing what you find out next week. EWH
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6 months ago
Thanks Doctor I will be seeing my original doctor should i request a retest or just a visual examination?
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago

I would request repeat examination as well as a test.  As you describe it, your concerns are fueled by continued symptoms.  I doubt that these are due to gonorrhea and think a repeat exam (unless your symptoms are entirely resolved at which time I'm not sure you need to be seen at all) will help to make sure there is not some other problem present. 

This is my 3rd response.  Thus, as per Forum Guidelines, there will be no further responses but I will try to keep the thread open in the hopes that you will report back what your doctor says.  EWH

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6 months ago
Hi Doctor,

I had another test for Oral Gonorrhea and a few other viral tests done all came back negative and since then I've had very little irritation my doctor feels it is most likely due to stress and allergies. 

Thanks