[Question #9147] oral gonorrhea and ngu

35 months ago

Hello Dr.s, first of all i wanted to thank you for everything you do.

-I’m a circumcised 32 years old man, On 3/05/2022 i had an unprotected cunnilingus performed on a escort in a spain night club ( Venezuelan origin) for about 5 minutes then we had vaginal protected condom sex. It's my first time and my relationship was always monogamous.

-4 days after i had a mild sore throat, with some white spots. No fever. I took 1.85 grams of azytromicn, not 2 grams because a started to feel very nauseous after takin 1.5 g. The white spot disappered after 3 days.

-24 hours after taking azythromycin I had unprotected vaginal sex with my wife and after a week a started also having unprotected oral sex

-After 30 days tested negative for HIV - After 45 days my wife started having episode of bleeding durind defecation. She already had before , and was diagnosed with ulcerative proctitis. But , in any case I started get paranoid that i could pass gonorrhea or clamydia after giver her anilungus (just once). So i started to examine my self quite compulsively for 2/3 weeks. I never notice discharge, pain during urination or stain in underwear. The only sympton i had was an increased frequency to urinate, sometimes when opening my meatus i could see some filaments ( this happened just twice), and my meatus was dry but not inflamed. In the meantime a cortisone treatment was given to my wife and her symptons has improved.

-After 75 days I ve been tested for clamidia and not for gonorrea because there was no discharge. Urine test show negative result. My symptons improved and no more urge to urination, no filaments and just still with dry meatus ( like hard dry skin). Stop examinate my self.

-After 90 days i got Covid with severe sore throat and white spot. I got augmentin and the white spot dissapeared in 3 days. But i started again being very axious and examinate my self. I could not see discharge but just sometimes( just twice in 10 days of examination) some filaments when opening meatus and hard dry skin around it.

-After 100 days i started getting very paronoid that my treatment with azythromycin hadn’t worked so I got a shot of rochefin(500mg) and 1 gr od azytromicin. I don’t know if is coincidence but after 1 day the skin around my meatus was softer and could not see any filaments.

Could be that the first azithromycin treatment was no effective against oral gonorrhea, and I may transmitted to my wife through cunnilingus?

Could be possible that I have asymptomatic gonorrea ?

Could be possible that I had oral NGU and trasmitted to my wife through cunnilingus and then she transmitted to me by vaginal sex ?

I have read many of your articles about cunnilingus, and I know that the risk in very very low but it’s been 4 month that anxiety is destroying me for my sense of guilty.

Thank you.

H. Hunter Handsfield, MD

35 months ago

Welcome to the forum. I'm happy to help.

I'm sorry to hear you are so concerned after this sexual experience. Apparently "first time" means your first sexual experience outside your marriage, which is mutually monogamous. Is that right? (Your opening sentences are a bit confusing -- please clarify if I do not understand correctly.) For now, I will assume you are concerned about risks only from the events a few months ago. The bottom lines are that you were at little or no risk for any STI, you were not infected with anything, you do not need any additional testing, and you can safely continue unprotected sex with your wife.

You correctly understand that cunnilingus is very safe, with very rare STI transmission. Even if your partner had an active genital/vaginal STI, you were not at risk. The condom protected vaginal sex actually was risker than unprotected cunnlingus -- but of course also very low risk. You did not need the azithromycin treatment. None of the symptoms you describe fits with any active STI -- mostly they seem most consistent with anxiety, which can magnify minor symptoms or even normal body sensations that otherwise would not bother you, or you might not even notice. The occurrence of acute proctitis undoubtedly was a coincidence, unrelated to the sexual exposure.

I am surprised you were tested for chlamydia, but not gonorrhea; usually both tests are done whenever either one is requested. But there is no chance you have (or had) gonorrhea anyway. Anyway, you had not symptoms that suggest either one. Although you did not need the azithromycin 4 days after the sexual event, it would have cured either gonorrhea or chlamydia if you had been exposed. (1.85 g undoubtedly is equally effective as 2g against gonorrhea, and only 1g is required for chlamydia or NGU.) And the later treatments with ceftriaxone (Rocephin) and azithromycin also would have been infected if somehow you were infected at that time.

Those comments pretty well cover your specific questions, but to be explicit:

It is not possible you had gonorrhea, oral or genital; or if you did that it persisted despite the first azithromycin treatment. Even if somehow you had it, cunnilingus with your wife did not put her at significant risk.

There is no possibility you currently have asymptomatic gonorrhea.

There is no such thing as "oral NGU". This scenario is impossible, and anyway you give no evidence you have (or have had) NGU yourself.

I hope these comments help relieve your anxiety and fears. Do your best to separate your STI fears from the guilt or shame you obviously are experiencing from a sexual decision you regret. They are not the same, and you need not worry about any infection. Let me know if anything isn't clear.

HHH, MD

---

35 months ago

Yes , you understand correctly. this was my first sexual experience outside my marriage, which is absolutely mutually monogamous.

Everything it's so clear that i don't need other question. Thank you so much Doctor Handsfield for helping.

H. Hunter Handsfield, MD

35 months ago

Thanks for the thanks. I'm glad to have helped. I'll leave the thread open for a few days in case you think of anything that needs clarification.---

35 months ago

Doctor, you were right I need further clarification.

what do you mean condom-protected sex is more at risk than cunnilingus? because I have a doubt about this aspect. during sex with the escort the condom slipped twice without uncovering the urethra (as far as I remember). I always proceeded to put a new condom.

I just wanted to better describe the symptoms I had starting 2 months later: Urgency to urinate, slight loss of urine after urinating, opening the meatus sometimes I noticed some (1 or 2) filaments (maybe mucus). No underwear stain or discharge, no pain during urination. Maybe just one morning, 5 minutes after urinating I noticed a slightly sticky clear liquid but never seen again. Symptoms improved after chlamydia negative results and reappeared with the covid after taking augmenting. Then I do not know if it is a coincidence but after the shot of rochefin and azithromycin they improved again, but after 3 days the urge to urinate returned with no discharge.

If there is any chance I had contract NGU with partially protected vaginal sex, would I have put my wife in danger by having unprotected vaginal sex 36 hours after taking azithromycin?
If yes, it could be possible she reinfected me and this could explain why my symptoms appears after 2 month, even if they don’t fits exactly with NGU symptoms ?
Do you remain of the idea that i don't need any testing ?

Thank you so much

H. Hunter Handsfield, MD

35 months ago

It means just what it says: the risk of STI is higher from condom protected sex than from unprotected cunnilingus. That's because 1) some STIs are transmitted skin to skin, above the condom range; and 2) people often make mistakes in condom use.

I fully understood your symptoms. They are not typical STI symptoms at all. It sounds like you may be seeing normal mucus in your urethra.

First bullet: No, if you had NGU, you would not be able to transmit it 36 hr after taking azithromycin.

Second bullet: Irrelevant because of the answer to the first.

Third bullet: Yes. You can be sure you have no STI. And there aren't any tests to be done anyway. (There are no lab tests for NGU, for example.)

Just move on with your life without worry about all this!

That concludes this thread. Best wishes and stay safe.

---