First I apologize and likely deserve to be scolded but my anxiety is getting the best of me. When I had the oral encounter (both ways MSM unprotected) I had taken 1g of amoxicillin an hour or two afterwards and continued to take it for 5 days. Then today out of fear and stupidity I took 1.5grams of zithromiacin. I know this was far from ideal. Would any of this cure gononorhea or NGU had I caught it? I was going to just bite the bullet and test but couldn’t get in before the holiday. Dr. Hook mentioned this was low risk and he wouldn’t recommend testing and I was safe to resume unprotected see with wife. I took the meds out of an abundance of caution. I appreciate your insights and know that I must accept risk if I’m going to do immoral things. 

Also - I have had no typical symptoms of an STD. But have had congestion, achy body and very tired. I haven’t slept much the last week though. I have had no discharge except a few dribbles after urinating (all clear). No issues ejaculating. No pain.  

By the way I misspelled the medicine. 1.5g of azithromyacin. (Z pack). 

As Dr. Hook advised, this was a low risk exposure, with the risk even further reduced by taking amoxicicllin. You are correct that we and other experts would not have recommended the azithromycin either, but it wasn't harmful and further reduced the chance of any bacterial STI from the exposure described. Would it prevent ALL cases of gonorrhea? No. But considering the statistical possibility either of your partners had it, the probability of transmission if gonorrhea was present, and the effectiveness of amoxicillin and/or azithromycin, the chance you caught gonorrhea is under one in hundreds of thousands. It's zero for all practical pruposes. NGU probably even lower risk (and mostly harmless for infected persons' sex partners). You really should not be at all worried.---

Dr. H - Thank you very much. Haven't read several posts, I am familiar where you quote the statistics of death in an auto accident (1 in 1750'ish).  So under 1 in a over 100,000 seems like odds anyone would take. I must say where you and Dr. Hook discuss being hyper attentive to any sensations you are spot, I've noticed every little sensation.  I started to become concerned that I had acquired HSV due to back and leg pain, but this resulted after a long flight. The antibiotics certainly have not been kind to the stomach and seem to have made my skin a bit sensitive (all over). The part that increased my anxiety was that one of the partners stopped responding to me after the encounter, but that could be a myriad of reasons (hook up culture, etc.).  Would you say that the majority of men who become infected with gonorrhea would develop systems within 5-6 days?  Given all of this information, I assume no testing is necessary.

One final questions, more of a curiosity.  I read that 1g is what is usually given (along with an infection) for treatment, was taking 1.5G too much or is it completely irrelevant  and I would have been fine with 1G instead of 1.5G. It was 6 pills. 

"I started to become concerned that I had acquired HSV due to back and leg pain...."  HSV never causes such symptoms. Ignore such claims you can find online.---

Dr. Handsfield - Thank you very much. I hope you had a good holiday. I know this will be my final response - I was curious - what are your thoughts on "Doxy Prep" - I have been reading about that and have heard about it from a couple of friends. 

Excellent question -- thanks for the opportunity to address it. Pre-exposure prophylaxis with doxycycline (doxy PrEP) to prevent syphilis still is under study to determine its benefits vs risks. Preliminary evidence is favorable, and almost certainly it would prevent syphilis, the main intended benefit, and chlamydial infection. However, widespread use likely would promote increasing resistance of gonorrhea and Mycoplasma genitalium to doxycycline and other antibiotics. It also might affect antibiotic resistance and risk treatment failure for intestinal infections, another "occupational" risk among men having sex with men. The bottom line is that the jury is still out, and I would advise holding off until and unless the well controlled studies demonstrate benefit that appears to outweigh the downsides. For sure it will never be recommended outside populations with especially high rates of syphilis, such as men who have sex with men. I doubt it will ever be much recommended in anyone else, at least not in the Americas and Western Europe.---