[Question #9203] Oral gonorrhea treatment

35 months ago

Following up from today's question.

Went to a GP, prescribed ceftriaxone 1g IM daily FOR 5 DAYS! Is this excessive? Just got my 1st dose, but wondering if I should come back for more...

I would rather avoid if possible, but of course rather be cured so I'll take them if needed.

H. Hunter Handsfield, MD

35 months ago

This is appropriate to consider as a follow-up to our previous discussion. I will ask the moderator to refund your posting fee for this one and then close it. But if you think you need to ask still more, it will be open -- in which case do not expect the fee reversal.

Yes, definitely excessive, not to mention the discomfort of those larger injections. With one caveat: conceivably there is information about potentially ceftriaxone-resistant gonorrhea in your area of Mexico, something your doctor may know about but I do not. You might be able to check this out with regional or national public health authorities; or at least ask the doctor. This very high dose regimen is in use in parts of China, Japan and South Korea, where ceftriaxone resistant gonorrhea has been an occasional problem. (Even there, most cases probably don't need these whopping doses.) Even if no such gonorrhea strains are yet known in Mexico, perhaps your GP has a take-no-chances perspective. On the other hand, almost certainly it would be safe to not return for doses 2-5, but instead have a repeat throat swab for gonorrhea in a week, expecting a negative result.

HHH, MD

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35 months ago

Thanks doctor,

I will go ahead and use my follow ups. I appreciate the gesture.

My partner just got his results back today, (taken 7 days ago). As expected, his urethral swab was positive. He will seek treatment.

Given that it most likely it was this fellatio where I got oral infection, is frotting (the only other activity we engaged on) and mutual mastrubation worrisome for a potential urethral infection on my end? As I have said, I have had no symptoms at all, and of course I've been over vigilant on them.

Since that oral sex encounter, I have only engaged in non deep kissing and one condom protected vaginal encounter. On this encounter, penis was protected 100% of time, no oral, and not any kind of rubbing penis vagina, put condom on before getting close to vagina, removed after, no contact (again, I was hyper vigilant). Is this potentially risky for that party? Want to reiterate, I am 100% sure of no oral, kissing and no unprotected contact, also, no genital symptoms.

Yes, injection was super annoying, but I may come back for a couple more just for peace of mind. Are there any concerns if I do so?

H. Hunter Handsfield, MD

35 months ago

Urethral gonorrhea without symptoms (pus from penis, painful urination) is rare. Frottage probably carries little or no risk, but even if it did, you obviously didn't catch it. In the unlikely chance you have an asymptomatic infection, the ceftriaxone will take care of it. So at this point it doesn't matter.

You should inform your partner. The chance you infected her is low, but stranger things have happened. Put yourself in her position: someone with known gonorrhea at the time didn't tell you s/he had it. You wouldn't like that, and neither would she. Probably she doesn't need treatment, but might use this as an opportunity for routine STI screening (gonorrhea, chlamydia, HIV, syphilis).

If somehow I were in your situation, I would not have more ceftriaxone. It's BS and definite overkill without benefit -- again assuming there is no evidence of hyper-resistant gonorrhea in your community. It seems possible your GP is motivated mostly by profit.

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35 months ago

Hi Doctor,

I have several questions as a follow up.

I have been reading papers (some of them actually by Dr Hook) on time for NAAT negs (and false positive by non living bacterial genetic material) after treatment and how pharyngeal infection is harder to eradicate than genital. I am scared by this and have been having the full course of antibiotics that was prescribed (today was 4th shot).

I still feel this annoying itchy throat and even when you have said unrelated, I cannot get peace of mind after reading challenges of oral infection. If I somehow were symptomatic, and this was caused by infection, is it possible I still have an infection after 72 hrs of initial shot and 2 more? Is Monday (day 5 after 1st shot) a good time to get another PCR swab? Do you think I am still infectious after all these shots? Have been avoiding kissing and sex. Finally, can you speak about the efficiency of cefixine 800mg oral? Is that still a good treatment?

If I shared spoons when eating soup 48hrs after 1st shot, is that person okay?

Thanks

35 months ago

I am also worried that my partner tested positive in urethra two days into ciprofloxacine 500mg, do you think we may have a hyper resistant strain? Or is it expected that cipro failed too (or even worked but tested too soon). He also has taken ceftriaxone now and are waiting to retest.

H. Hunter Handsfield, MD

35 months ago

"pharyngeal infection is harder to eradicate than genital". True, but the important difference is not between various doses of ceftriaxone, but between ceftriaxone compared with other treatment options. In North America treatment failure is very rare for pharyngeal gonorrhea treated with single dose ceftriaxone 500 mg or higher. This is not a legitimate concern.

I remain confident your "itchy" throat is not due to gonorrhea. And I am confident you are not infectious. And gonorrhea has never been known to be transmitted by shared eating utensils. ONLY by sex, and maybe (as discussed above) by prolonged, open mouth kissing.

This gives the impression that you're hoping to have gonorrhea for the sake of argument, and a resistant strain at that. I don't get it: why is our reasoned, science-based reassurance so hard to believe and accept? In any case, that concludes this thread. Please note the forum policy against repeated questions on the same topic. This being your fourth related question in a month, it will have to be your last on oral sex risks, your current gonorrhea, its treatment, etc. Repeated questions are subject to being deleted without reply, and without refund of the posting fee. Thanks you for your understanding. I'm sorry the discussions have apparently not been as reassuring as intended. But you truly can move on without further worry about it. You're cured.

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