[Question #9171] Oral STIs window period

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35 months ago
Hi Doctors, 
I am back with some additional questions regarding oral STIs, specially g/c as those are less obvious than say syphilis or herpes. 
Following up on my last interaction, my sore throat was caused by strep, so definitely had something going on there (although no STI as you predicted). 

I want to know what symptoms can I see (if any) for oral gonorrhea and their timeline so I can be less worried about this. 

A couple of day ago I met my regular male partner again. He just tested neg for hiv, syphilis and hep (our agreement involves testing for peace of mind) but as I also mentioned last time, g/c throat test is not available in Mexico. I performed fellatio on him, and just 12 hrs later I developed a scratchy throat (not as sore as last time). You mentioned itchy throat is no sign of STI, even if it were, would I develop symptoms so fast? What about any other bacterial infection from fellatio/kissing? Is it too soon? Is trauma a potential cause? 

For the record, I saw nothing obvious on his penis (no discharge) and he was upfront saying he has not experienced discharge nor painful urination when asked about it. He was also on a course of trimetropin + sulfametazol (sorry for Spanish name) for a stomach bug a month ago or so, and said he experienced burning urination a single day, which doctor attributed to really strong meds, but also antibiotics would Kell UTI if any. He was clear it was a single day and has not had any symptoms or uncommonality at all, I do believe him. Finally, can oral G be spread by kissing and cunnilingus (mouth to vagina?) 

Thanks 

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Edward W. Hook M.D.
35 months ago
Welcome back to our forum. Let me offer my continuing congratulations for the care with which you approach your sexual encounters. Were you and your partner to test on a regular basis will do much to keep you both safe.

I cannot offer you information on the symptoms of oral gonorrhea because the vast majority of oral gonorrhea infections are asymptomatic. I can however tell you that any symptoms that you developed within 12 to 36 hours or probably within two days of a sexual encounter are almost certainly not due to an STI acquired in the preceding interval. It typically takes two or more days for symptoms to develop even at genital sites. Thus I would am comfortable in telling you that it is most unlikely that the symptoms you experienced beginning 12 hours after your most recent encounter are not due to gonorrhea.  The fact that your partner denied any recent discomfort on urination and there was no apparent urethral discharge makes it still more than likely that the exposure you described involve transmission of gonorrhea. Finally, even if your partner had gonorrhea however most single exposures do not leave the transmission.

In response to your final questions, gonorrhea is most efficiently and effectively transmitted during genital or anogenital sexual contact. Infections are only rarely transmitted through oral sex and the risk of acquiring gonorrhea from cunnilingus with an infected partner is lower than the risk from performing fellatio. There are rare instances in which deep kissing has been associated with gonorrhea transmission however this appears to be very, very uncommon. 

I hope this information is helpful. Thanks again for your question. EWH
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35 months ago
Thanks for your prompt response.

I assume you answer intended to say "lack of urethral discharge makes it even more unlikely" instead of "more than likely". 

Yes, irritation started just when I woke up (maybe earlier) and encounter was before going to bed. So definitely soon. Would any other bacterial or viral infection act that fast? Or is the mouth lining so thin that friction alone can irritate it for now more than 24 hrs? For the record, this started yesterday morning, as of today I still feel a little itch, but it is also not getting worse by any means (last time my strep throat got worse as days passed). 

Finally, on my question on cunnilingus, I was referring mouth to vagiba, not the other way around. This is only for self education, if I had gonorrhea on the mouth, could it be passed to a female partner? Most of these questions come exactly due to the fact that oral infection is mostly assymptomatic as you mention. 
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35 months ago
Forgot to add.. I guess then you wouldn't recommend refraining from performing any kind of oral sex or kissing with my current symptoms. 
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Edward W. Hook M.D.
35 months ago
Apologies for the typo.  You are correct, the phrase should have read “…makes it even more unlikely.”

The chance of transmitting oral Gonorrhea is close to, but not quite zero.

EWH 
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35 months ago
Hi doctor, 

I am getting really nervous and anxious here. 

Saturday I went to a GP, he examined my throat and said it was in fact irritated although he didn't see signs of infection. He prescribed ibuprofen + paracetamol and bicarbonate gargle, however when I told him I had already taken naproxen for a couple of days with no change, he prescribed amoxicillin + clavulanic acid (825mg/125mg 12 hrs/7days).
My first dose I took two tablets (1.75g/250mg), second I took 8hrs later instead of 12 as I was going to bed. Felt some improvement, but irritation remains today, I am getting anxious now. I read that while not ideal, amoxicillin + clavulanic acid can work for gonorrhea, but dose is 2-3 g. I took 1.75 +. 875 8 hrs later. Would that have killed gonorrhea if I had it? Also, my partner has gone and taken an urethral swab for my peace of mind, but his doctor already prescribed him ciprofloxacin 500mg 12hr which he had been taking for 2 days by swab time (prescribed him on my symptoms, not him, as I said, he claims no issue at all and doctor prescribed just out of caution). I am worried a neg can be because of it already cured him by lab time, is this feasible? 
I am so sorry there is no throat swab in Mexico, I would just do it if available, but I cannot get peace of mind with this. 
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Edward W. Hook M.D.
35 months ago
As you know, we provide up to three responses to each client's questions.  This will be my final response after which the thread will be closes without further responses.

Your partner's urethral swab will be unreliable if he has already taken two days of ciprofloxacin before he was tested.

As I've already told you. most gonorrhea is asymptomatic and does not show the irritation you report.  Irritation of the sort you report is most likely due to a virus or strep, neither of which are STIs.  The amoxicillin/clavulanic acid you mention is good treatment for strep throat but would be expected to cure only about half of cases of gonorrhea.  Your rapid improvement is consistent with a strep throat. 

EWH

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