[Question #9647] Gonorrhea/PID concerns years after possible exposure

30 months ago

Hi, I am deeply frightened about how my history could impact my girlfriend's health/fertility.

In late 2018, I had sex with ~10 CSW (NOT "high end") in Colombia. I had protected vaginal sex each time, 1 instance of brief protected anal, received unprotected fellatio 2-3x, gave unprotected cunnilingus 2-3x and 1x brief anilingus.

A couple months afterwards I blood tested for HIV, syphilis & chlamydia (all neg) but stupidly not gonorrhea. The health worker expressed discomfort at administering a penile swab test and embarrassingly I didn't insist because I mistakenly thought there was v little risk from oral sex and I hadn't noticed any symptoms.

Since Jun 2019 I live with my GF in the UK and have unprotected sex (vaginal/oral/once or twice anal) with her on a semi-regular basis since then. No other sexual partners. I think upon returning to the UK I may have got a penile gonorrhea test that was negative but I'm not sure and there's no record.

As such, in Aug 2022 I suddenly had doubts about my testing history and researched gonorrhea, so I tested for oral gonorrhea + chlamydia (neg) and insisted my GF test for vaginal gonorrhea+chlamydia (neg). I consulted a doctor, who said if my GF contracted gonorrhea 3 years ago, the infection would not have persisted (and I assume the infection would not have bounced back & forth?)

However, after more reading I worry that I unknowingly infected my GF with gonorrhea that cleared in the vagina in the ~3y period before she got tested and she unknowingly developed PID. She's always had heavy & sometimes irregular periods (we assume due to physical & mental stress), but she also sometimes complains about vaginal tightness or post-sex discomfort the alst couple years. She is a vulnerable person who suffers from lifelong extreme full-body eczema.

She will get a pap smear/HPV test soon but is there anything else you recommend, especially in regards to any past/on-going gonocconal PID possibility?

Edward W. Hook M.D.

30 months ago

Welcome to the Forum. Thanks for your questions. I'll be glad to comment. MY sense is that your concerns at this time reflect guilt more than anything else. Your exposures were low risk (condom protected), you did not experience symptoms (which are common with gonorrhea), and you have both had negative tests. My guess is that you were not infected through your prior exposure and need not worry. My advice is to move forward without continuing concern. EWH---

30 months ago

Thank you for your prompt and helpful response, Dr. Hook.

I definitely feel guilty about this situation. I don't know how I would be able to live myself if something preventable like this caused harm to my girlfriend or took away her opportunity to have children.

That said, I am also just worried for her well-being. Does your assessment of my exposures as low-risk take into account the unprotected oral exposures? Is it not possible that gonorrhea symptoms are mild enough that they could be missed? Even if a vaginal swab is negative, is it possible for gonorrhea still to be present elsewhere in the reproductive system, causing PID?

If you consider my questions more anxiety-driven than productive, then may I at least ask whether there is some way to screen for potential PID for peace of mind?

Thank you so much.

Edward W. Hook M.D.

30 months ago

My assessment took into consideration all of the information you provided, including your oral exposures. Certainly gonorrhea can cause mild symptoms or even be asymptomatic however that the chances these occurred in your are miniscule. The chance that your prior exposure has impacted your partner's fertility are vanishingly low.

Testing for PID is typically based on symptoms which are not among the symptoms you report above. If it is to be pursued, that is something that she needs to discuss with her own doctor.

Please don't worry. Instead, I urge you to discuss your concerns, as well as the information I have provided with a trusted, confidential counselor. EWH

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