[Question #7455] Gonorrhea

4 months ago
Dear doctors, thank you for this valuable service. 7 weeks ago(50 days) I received unprotected oral sex from a woman I did not really know that well. Frightened, I took 1 gram of Azithromycin roughly 6 hours after the event. I know, stupid. Prescription received from online doctor and sent to pharmacy. I now realize that dosage is useless against gonorrhea. My  question how likely would the meds suppress the infection and let it continue? I’ve had no discharge of pus and no painful urination. Any advice is greatly appreciated 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Welcome to the forum. Thanks for your confidence in our services.

Also thanks for your now accurate understanding that it wasn't a good idea to take azithromycin (even at the correct dose) in this situation -- you've saved me (and yourself) an online mini lecture!

There is no chance you have gonorrhea from the event described. First, the exposure was very low risk:  the chance any particular woman has pharyngeal (oral) gonorrhea is very low. Even among the most seuxally active women, at any time under 1-2% have gonorrhea; and of those, under 1-2% have pharyngeal (oral) infection. (Dr. Hook and I have personally done much of the research on this.) Second, even when pharyngeal gonorrhea is present, most oral sex events (fellatio) don't transmit it. Third, 95% of men with urethral (penile) gonorrhea develop obvious symptoms:  as you imply yourself, it's hard to miss pus dripping from the penis and painful urination, sometimes extremely painful.* Fourth, it isn't correct that 1 g azitrhomycin is "useless" against gonorrhea. It's not good enough for routine treatment, but it would cure 70-80% of infections. Fifth and finallly, it is a common misunderstanding that treatment of gonorrhea (or chlamydia, for that matter) can interfere with testing without curing the infection. Antibiotic treatment either cures the infection or it doesn't:  if a test is negative, the patient is not infected (either never infected or cured).

So as you can see, for you to have gonorrhea at this time, several very unlikely odds would have to have broken the wrong way. The statistics probably work out to under 1 chance in a billion you have gonorrhea. However, on this forum we understand that many users have more confidence in a negative test than in our expert opinion based on probabilities. (We don't take it personally!) If this applies to you, have a urine test. For the reasons discussed, you can expect a negative result.

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

HHH, MD

* Here's the footnote impled above. Historical factoid, from the book Band of Brothers (also a TV miniseries), the combat history of a company of the 101st Airborne Division during WWII. One of the soldiers, named Guarniere, gets gonorrhea. Illustrating how severe the symptoms can be, he descirbes the pain as "pissing razor blades". For the rest of the war, because of his name and hs infection, his buddies called him "Gonorrhea".
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4 months ago
Thank you doctor, I feel much better