[Question #8488] Gonorrhea Question

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43 months ago
Hi doctor. I'm a male in my 40s. I had sex with a CSW on December 9.  The encounter lasted about an hour. It's the only sexual encounter I have had since early June of thiWe had unprotected fellatio and cunnilingus, followed by protected vaginal sex, properly using a condom.  On December 28, the CSW texted me to let me know she had just tested positive for gonorrhea that day.  She had no symptoms, but another client she had seen the previous Tuesday started having symptoms 2 or 3 days later and called to let her know.  For some reason, she doesn't think that guy gave it to her, so she's sure she had an active infection on December 9 when I saw her.

I've had no symptoms.  Certainly no discharge or irritation  around the urethra.  I started having a bit of a sore throat on the day she called me, but I would normally chalk this up to allergies.  (Also a bit of a cough, which I don't think is a symptom anyway.)

I went to a local lab on Wednesday for a test. They told me the results would normally be ready Friday, but  that's New Year's Eve so I'll have to wait until Monday.

I've been reading your answers to folks' questions and I have to say they are very helpful.   From what I gather, I had a small chance (probably 10% or less) of contracting gonorrhea in the urethra from receipt of fellatio.  On top of that, asymptomatic gonorrhea of the urethra in males happens less than 5% of the time. (I think I saw a post from Dr. Handsfield putting it at under 2%.  So I am pretty confident that I don't have gonorrhea at that site (.10 X .02=.002)

So here's my question. The lab where I went charged me a couple hundred bucks to do a "comprehensive STD panel." But it was only urine and blood.  When that (presumably) comes back negative on Monday, should I still be worried about an oral infection?   Do I need to go find a clinic that will do a swab, or is the probability of infection low enough that I need not bother? And even if I had a throat infection, would that clear up on its own?  
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Edward W. Hook M.D.
43 months ago
Welcome to our forum and thanks for your question. I’ll be glad to comment and offer some advice. I am pleased that your partner was so diligent in notifying you of your exposure. This will allow you to address any potential problems going forward.

You are correct that many oral gonorrhea infections are asymptomatic and will clear up spontaneously even without therapy. That said, based on a known exposure treatment, Even before test results are available,is recommended (see below).

How do you point out, the likelihood that you acquired gonorrhea, either of the urethra is the result of receiving oral sex, or, of your throat due to performing cunnilingus on her is quite low.  Your urine specimen will deal with the possibility that you acquired gonorrhea is a result of receiving oral sex although, as you point out, on the basis of the absence of symptoms, I anticipate your test will show that you are not infected at the penis.  If you wish to be entirely confident that you do not have pharyngeal Gonorrhea, a swab test from your throat would be needed. As I explain below however I do not think that is necessary.

As you have had a known exposure to an infected partner, Recommendations from the CDC as well as other expert groups, are that based on your known exposure to an infected partner, you should receive preventative therapy, preferably with an injection of ceftriaxone and a 1 g oral dose of azithromycin. These treatments would be expected to cure gonorrhea if present and I recommended irrespective of whether testing is performed or not.  If I were you I would see if I might be able to obtain this recommended, preventative therapy today and not bother with oral testing.

I hope you find this information and my suggestion helpful. If there are additional questions or further clarification is needed, please don’t hesitate do use your up to two follow-ups for clarification. EWH
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