[Question #822] Oral transmission of gonnorhea

51 months ago

I realize you must all be sick of answering the same questions. I think I’ve read my exact question at least 10 times either here or at MedHelp. I’m wondering, though, if after years of practice, one of you will say, “I know I’ve been saying this for years, but I’m starting to change my mind …”

That being said …

I’m a male. A woman gave me unprotected oral sex about 1 week ago. It was brief (maybe 30 seconds?). After that we had protected vaginal sex and the condom stayed intact the whole time. I asked her about her STD status and she said she was negative and gets tested often.

This morning, I woke up with a burning sensation in my urethra. Not a searing pain, but a noticeable discomfort. And it hurts a little to urinate. I also masturbated and there was also a slight discomfort. There has not been any discharge, though.

I started thinking back to the oral sex. Here are my questions:

 ·         I know the woman told me she is tested, but does standard STD testing involve a throat culture for oral gonorrhea?

·         Transmission of gonorrhea via oral sex may be low, but if I did get it from this incident, what would symptom timeline be?

·         Is it possible to have gonorrhea without discharge?

 As always. Thanks. Your work is very much appreciated and needed.  

Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago
Welcome to the Forum.  I'll be pleased to answer your questions which are good ones.  I note that you are focused on gonorrhea.  As I explain  below however, the other possibility for you is non-gonococcal urethritis or (NGU).  The emerging concept is that NGU can be caused by a variety of different organisms, this includes chlamydia but many of these organisms may not be tested for in standard STD testing.  NGU is diagnosed by demonstrating the presence of white blood cells in urethral secretions. Most often this is done with a swab.

Now, going on to your questions:
1.   Unless the patient asks for it many clinicians will not do tests looking for gonorrhea in the throat.
2.  A week is slightly on the long side for the appearance of gonorrhea symptoms but would be quite a typical for NGU.  Further, while gonorrhea often causes an obvious discharge NGU may present with little or no discharge and simply irritation at the time of urination.  In my opinion your symptoms are more consistent with NGU then gonorrhea.
3.  Gonorrhea can certainly be present without a discharge. This is more common for NGU as mentioned above.

My suggestion is for you to seek evaluation by a knowledgeable clinician, either at an STD clinic or with your own doctor. I hope my comments are helpful to you.  EWH
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51 months ago
Dr. Hook, thanks for your reply. I made an appointment to see my doctor this week, but do have 2 clarifying questions. 

1. If I had gonorrhea or a NGU, how severe is the pain? Over the weekend, it seemed my symptoms have gone down and now I only feel a slight discomfort when I urinate. And it's not during the whole urination, it's usually just at the end while I'm finishing up. 
2. How long do NGU's last with treatment? Without treatment?

Again, thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

Good questions:

The pain of gonorrhea is not as severe as many think it will be and the discomfort of NGU can be quite mild, presenting as only mild discomfort on urination, particularly as you start.  I think that getting an evaluation is a fine idea.  As you do, please make every effort to have not voided for at least an hour before you are seen and if your doctor does a urine test, be sure it is collected as you begin to void, not at "mid-stream".

NGU should respond to treatment in a day or two, three at the most after treatment.  Hard to say about without treatment since when we find it we treat it.  I have seen patients with urethritis symptoms which have lasted weeks for sure.

Hope these further answers are helpful. EWH

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51 months ago
Thanks, Dr. Hook. My appointment is tomorrow. We'll see what the doctor says. 

As always, thanks for your help. This forum is a great service. 

Have a good day.
Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago
Glad we can help. Take care and please don't worry.  EWH
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