[Question #8310] Chlamydia/ Gonorrhea/ Syphilis

46 months ago

Hello Doctors:

I went to a massage parlor in Cabo San Lucas Mexico 17 days ago and received unprotected oral sex from a masseuse. It lasted 5 minutes and included French kissing. 11 days after, I started having uncomfortable urination and 15 days after cloudy penile discharge in my underwear. I’m thinking this is either gonorrhea or chlamydia. I went to an urgent care clinic yesterday and received a 500 mg Rocephin shot in my glute and one oral dose of 1g azithromycin. I also had bloodwork done for syphilis and HIV and a urine sample for Chlamydia, Gonorrhea, Hep B+C and herpes.

At this point, I understand that due to the symptoms and timeframe of exposure, I likely have either gonorrhea or chlamydia.

A few questions:

1. What are my chances of also catching syphilis during this encounter?

2. Will the rocephin cure gonorrhea? I understand that there may be antibiotic resistant strains.

3. My last sexual encounter ended 23 days ago with my ex girlfriend (unprotected oral and vaginal sex). That was a year and a half relationship in which I am positive she was only with me during that time. Toward the end of that relationship, I was with another masseuse in Cabo San Lucas (3 months ago; unprotected oral) but I didn’t have any symptoms in the months after. Assuming I have chlamydia and/ or gonorrhea, is it a moral obligation to tell my ex about the infection? In all likelihood, I caught the bacteria from the massage parlor 2.5 weeks ago after the relationship with my ex ended.

H. Hunter Handsfield, MD

46 months ago

Welcome back to the forum. (I scanned your past discussion with Terri about HSV1.) Thanks for your continued confidence in our services.

It seems clear you acquired urethritis from the oral sex event. Almost certainly it is nongonococcal urethritis, but probably neither gonorrhea nor chlamydia. NGU from oral sex is believed to result primarily from normal oral bacteria and not traditional STIs. Gonorrhea is possible but very unlikely: the onset was too late (gonorrhea almost always within a week) and the symptoms too mild (versus overt pus and painful urination). And chlamydia is unlikely because it so rarely infects the oral cavity and thus rarely transmitted by oral sex. So I expect your urine gonorrhea/chlamydia tests to be negative. Hepatitis B and C are not known to be transmitted by oral sex (testing was unnecessary), and herpes is almost impossible based both on your symptoms and your prior HSV1 infection, for the reasons discussed with Terri in your previous thread.

To your numbered questions:

1) The large majority of syphilis in the US is currently occurring in men having sex with men, so the risk of exposure was low. In the off chance syphilis was acquired and incubating, it would have been aborted by the ceftriaxone, so for sure no worries about syphilis.

2) To date there have been a total of 10 documented ceftriaxone treatment failures for gonorrhea world wide, and all of those cases were pharyngeal (oral) gonorrhea. As noted above, it is very unlikely you had gonorrhea, but if you did, you can be sure the ceftriaxone+azithromycin will cure it.

3) This raises the possibility that the source of your infection was your ex girlfriend. I'm not sure I understand exactly when you last had sex with your gf (23 days ago now, or 23 days before onset of symptoms?). As relationships are winding down and one partner begins having other sexual partnerships, often the other has also done so. It's still most likely that you were infected by the oral sex event 11 days before onset of symptoms. But if your gonorrhea or chlamydia test is positive, you'll definitely need to inform her. If not, it may not be necessary.

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

HHH, MD

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