[Question #9202] Ora gonorrhea
35 months ago
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Hi Doctors,
Following up from my previous question.
I went and had a throat swab and it was unfortunately positive for gonorrhea.
Some questions:
Is kissing safe? Rather not do it? Should I refrain for cunnilungus? For how much time from getting a ceftriaxone shot?
Also, is it possible to develop that itchy throat only 12 hrs after the fellatio experience? I have no urinary symptoms at all, do you think urethral swab is necessary? If not, is penetrative sex safe?
Finally, can it be a case of a false positive?
I was on amoxixiline/clavulanic acid for 5 days (2 no antibiotics) before test. Also have experienced cold symptoms 3 days after icht started, including sneezes and nasal secretion.
35 months ago
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Methodology lists:
qPCR
35 months ago
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qPCR Multiplex
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H. Hunter Handsfield, MD
35 months ago
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Welcome back. Interesting outcome, but should not be very worrisome. No harm will come from your pharyngeal (throat) gonorrhea infection and cure will be easy and quick. Details below.
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I reviewed your previous recent discussions and agree with all said both by Dr. Hook and myself: I haven't changed my mind or his! Your symptoms are of a viral cold, not the gonorrhea, which is not known to cause sneezing, nasal congestions or drip, etc. Gonorrhea almost certainly is not the cause of your "itchy throat", primarily because it started too soon after your exposure by fellatio -- which is probably the source of your infection. This assumes I correctly understand the timing, but I'm actually not sure of the detailed sequence of your exposure, testing, and symptoms. Feel free to summarize those on a day-by-day basis and perhaps I'll have more to say. Among other details, I would be interested to know if your positive throat swab was collected before or after you took the amoxicillin/clavulanate treatment. Anyway, kissing is a great source for catching colds, which you probably have.
Transmission of gonorrhea by kissing is controversial. Highly accomplished and respected investigators in Melbourne, Australia, have published several papers asserting that oral gonorrhea is commonly transmitted among MSM by kissing. Other equally qualified experts disagree with their conclusions -- not that it cannot be transmitted by kissing, but that this is infrequent and probably limited entirely to prolonged, vigorous kissing. Why it should be limited to men having sex with men is a mystery; even the Melbourne researchers cannot explain why it's apparently not an issue for kissing between males and females. At this point I have to acknowledge it is a possibility, but probably low risk for most kissing partners of persons with pharyngeal gonorrhea.
As Dr. Hook advised, amox/clav is not reliable treatment for pharyngeal gonorrhea. You need ceftriaxone 500 mg by injection. Do it even if you are retested with negative results: in this circumstance, you should not stop until you have had proper treatment. Ceftriaxone 500 mg is 100% reliable, at least in North America, including Mexico. Until treated, for sure you should not perform oral sex on partners, and to be completely safe on their behalf, avoid kissing as well. Finally, anyone on whom you have performed oral sex (and maybe kissing) should be informed, tested and treated for gonorrhea themselves, even if their own test results are negative.
Please let me know if anything isn't clear. And I look forward to hearing the details and sequence of your potential exposures, testing, and treatment. In the meantime, don't worry: after the ceftriaxone, this will be a done deal with no lasting harm.
HHH, MD
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35 months ago
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Itchy throat started 12 hrs after fellatio. 3 days (Saturday), 2 days later (Monday, I had amoxyciline), Wednesday sneeze and drip started. Friday I stopped taking it. Next Monday (3 days after stopping amoxyciline) I got oral swab.
No urination discomfort at all.
I have kissed people, but not deep kissed, ie. Only lip to lip as I have been very cautious an avoiding spreading anything I had. Not even wanting to breath close, being cautions of cold as well. Additionally, I have drank for very short periods from same glass. Are any of these a concern for other people?
When can I get back to kissing and oral sex after getting a shot?
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H. Hunter Handsfield, MD
35 months ago
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Thanks for the details. As Dr. Hook predicted, and I agree, the amoxicillin was not effective against your oral gonorrhea; if it were going to cure you, your swab test would have been negative. You definitely need the ceftriaxone.
For sure gonorrhea was not the cause of your itchy throat; 12 hr is much too soon. Probably that was the start of your cold symptoms, having been infected with a common respiratory virus a few days earlier. Of course you are NOT taking precautions against colds (or against COVID, which also is a possibility). Even casual, social kissing is very high risk for such infections; avoiding inhaling other persons breath doesn't help at all.
Standard practice and official advice is to avoid sex for a week after treatment for most bacterial STIs, including gonorrhea. However, that's a very conservative figure: you will be non-infectious for exposed partners within 2 days. Ideally you should wait a week, but if you must have sex before then, do wait at least 2-3 days.
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Don't forget to inform the guy to whom you gave fellatio; he should be tested and treated for gonorrhea. However, you need not say anything about gonorrhea to your kissing partners. Lip kissing is a likely source of colds and COVID, but not gonorrhea. And you might consider COVID testing as well. And also stay up to date on COVID vaccination.
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35 months ago
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Thanks doctor, can you confirm if the non deep kissing experience I mention and sharing glass is a problem?
Also, I am going to try to get treatment asap, but as I understand, ceftriaxone 500mg is a single dose? No need for azyhromicine? Chlamydia was negative.
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H. Hunter Handsfield, MD
35 months ago
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For sure no risk from sharing glasses, eating utensils. I hope you didn't think I might have changed my mind about no risk from non-deep kissing! Transmission by oral exposure is ONLY by performing oral sex and maybe sometimes by deep, prolonged (open mouth) kissing. Even deep kissing is questionable as a risk, as discussed above.
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A single 500 mg dose of ceftriaxone is all you need. Azithromycin is added only if chlamydia is present or suspected. In fact, in theory azithromycin might interfere with effectiveness of ceftriaxone against gonorrhea. Do not seek azithro treatment.
That completes the two follow-up comments and replies included with each question and so ends this thread. Best wishes and stay safe.
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