I began having discharge from my penis and pain during urination on 1/24. I saw a doc via telehealth and he thought I had gonorrhea based on my symptoms. He decided to preemptively treat me while the labs he ordered came back. He gave me 800mg of cefixime(suprax) and 100mg of doxy 2x/day for 7 days that I began taking on 1/25. The discharge began improving within 24 hours. I read that you can contract gonorrhea in the throat as well and the girl I was with I performed oral sex on her. Concerned I decided to see my primary doc on 1/28. I was still experiencing pain during urinating at times and very very slight discharge at times and then other times none. He decided to give me a shot of rocephin as he felt it was a better treatment than the cefixime. It’s been a couple days since that shot and I still feel some slight pain during urinating and at times I feel like I’m still leaking some fluid out of my urethra.  The discharge is NO WHERE near where it was almost a week ago so I can say my symptoms have improved even tho I would say they are still lingering. My primary doc told me if things don’t get better then I would have to go see an infectious disease doc as my gonorrhea could be resistant. I also still have 2 days left a of doxy to finish. 

My concern should I still be experiencing these symptoms after all the meds I received?? After how long should I expect them to be gone or go see the infectious disease doc? Would you say my infection could be resistant?I’m concerned my gonorrhea could be resistant but I’m confused as my symptoms again aren’t as bad as they were day one. It is also my first time having it although I’ve had chlamydia in the past. 

Your symptoms indeed are typical for urethral gonorrhea -- and both the telehealth doctor and your primary physician appear to be knowledgeable and experienced in its management. The first recommended exactly the right treatment when ceftriazone (Rocephin) cannot be given; and the second understands that if injection treatment CAN be arranged, ceftriaxone is preferred -- and is more reliable than cefixime against pharyngeal (oral) gonorrhea. I'm not concerned that your urethral discharge and other symptoms haven't yet completely resolved; it takes a few days, and the fact that they are significantly improving is all you should expect at this time.

Keep taking the doxycycline -- your symptoms will continue to clear up. It is possible you have not only gonorrhea but also chlamydia (present in 20-30% of persons with gonorrhea) or other bacteria that cause nongonococcal urethritis (NGU):  in the presence of overt gonorrhea, it isn't possible to know if NGU also is present. (Chlamydia could have been detected if tesitng were done, but apparently testing wasn't done, which would have been ideal, but sometimes just can't be arranged without significantly delaying treatment. If so, NGU takes longer to clear than gonorrhea does; but doxycycline is exactly the right treatment.

It is unlikely your gonorrhea is unusually resistant to antibiotics; if it were, there would have been no improvement at all in your symptoms. Further, the improvement you are seeing probably would have occurred had you not had the additional ceftriaxone treatment; cefixime 800 mg is nearly 100% effective. However -- as noted above -- not for pharyngeal (oral) infection, and ceftriaxone was good in case you had acquired oral gonorrhea:  it is nearly 100% effective against oral infection, whereas cefixime is somewhat less reliable.

The bottom line is that your symptoms should continue to improve, but it could be a few more days before they are entirely gone. Stop doxycycline after 7 days. If symptoms are still present a week after that, return to your doctor for further testing. That would be a time to consider testing and perhaps treating for trichomonas and Mycoplasma genitalium. But not yet:  cross that bridge if you come to it. But no sex -- with anyone -- for at least another week and all symptoms are entirely gone.

You don't mention your partner. Presumably you have spoken with her and she is being treated (and, ideally, tested for both gonorrhea and chlamydia). And finally, you should be tested for HIV in a few weeks -- both are unlikely, but better safe than sorry. Syphilis is also a consideration, except that all your antibiotics (cefixime, ceftriaxone and doxycycline) are highly effective and would have aborted syphilis if you were exposed.

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

HHH, MD

Thanks for your reply. I did test for chlamydia, syphilis, MGen, and HIV. All came back negative 7 days post encounter minus the gonorrhea of course.. I was told the HIV 4th generation antigen test is effective within 2 weeks? It will be two weeks since my encounter tomorrow.I was planning to retest for that soon and was highly concerned I could have that although I don’t think I have any early symptoms. My partner claims she was tested and that she has gonorrhea in her throat not her vagina. I’m assuming her doc would have tested her for HIV etc as well so hopeful that was negative and she didn’t expose me to anything else.  The oddity is that she gave me oral sex twice with the first time being two weeks before the second. The only difference is that the second time we had unprotected vaginal sex which is where I believe I got it as symptoms showed up 6 days after that. I will continue to monitor. The rare chance symptoms due continue past another week are there any additional treatment options considering I’ve taken all of them it appears already?

Gonorrhea is transmitted by oral sex, but most STIs are not efficiently transmitted. For vaginal sex, if the female partner has gonorrhea, there's about a 50% chance of transmission for a single episode of vaginal sex. For oral exposure it's probably in the range of 10%. So it's not at all peculiar that you didn't catch it on the first exposure. It's also possible she had genital gonorrhea as well -- the test can miss occasional infections -- and isolated pharyngeal gonorrhea is uncommon. (That is, genital plus oral is common; oral alone is rare.) You'll never know sure which exposure infected you, but it really doesn't matter. 

I agree it is likely your partner was tested for HIV and she would be informed if it were positive. That's virtually 100% assurance you weren't exposed. You may wish to be tested anyway -- it's up to you. But you were misinformed about the performance of the antigen-antibody (AgAb, 4th generation) test. It detects no more than 80-90% of infections at 2 weeks, despite the marketing-based claim of the test center. A negative results is 98-99% conclusive at 4 weeks, but 6 weeks is needed for absolute certainty. That said, given that you were not exposed to HIV anyway, testing is optional.

Cross the bridge of continuing symptoms if it's still an issue 2 weeks after your initial treatment, i.e. a week after completing doxycycline. Probably they'll be gone, but if not, the standard approach would be to treat with a single dose of azithromycin 1 gram, and perhaps to test and treat you for trichomonas with a single dose of metronidazole 2 g.