Gonnorhea and other STSs

Doctor(s)

I recently had two encounters with CSWs in the Middle East.

The first time I had brief unprotected oral followed by condom protected vaginal intercourse. I am sure the condom didnt break but afterwards she removed the condom and then gave me a handjob to completion with the same hand. From the way she took it off im sure there was secretions on her hand from the condom.

The second encounter (20 days later) consisted of unprotected oral followed by condom protected sex (this time I took the condom off myself carefully and I am sure it was intact) and then unprotected oral again to completion. The oral sex was prolonged and quite rough.

2 days after the second encounter I developed a white discharge from my penis and within 24 hours I was in a lot of pain. I went to the doctor and was diagnosed with gonnorhea (Gonorrhea). I got a jab in the butt which cleared things up very quickly. I also got some doxycycline to take for a week.

My question refers to the increased risk of being infected with other STDs because of this gon diagnosis. In your opinion do I need testing for anything else now? (syphlis, herpes etc) I am especially worried about HIV as I know it increases the risk with vaginal sex. Is the same tue for oral sex? The gon diagnosis has me feeling a bit shocked so im questioning whether i was being safe or not.

Thanks for the sevice

[H. Hunter Handsfield, M.D.]

You probably acquired the gonorrhea from the oral exposure.  Gonorrhea is one of the few STDs that is readily transmitted from mouth to genitals (along with herpes due to HSV type 1 and nongonococcal urethritis that may be due to oral bacteria).  Although acquiring gonorrhea or other STDs enhances the risk of HIV if one's partner is infected, oral sex is such low risk for HIV transmission that it is not a serious concern in this event.  Regardless of how your partner removed the condom during the first episode, that getting some sexual secretions on the penis by that route probably does not measurably increase the risk of any STD.

Nonetheless, as a general principle, anyone who acquires any STD ought to be tested and/or treated for other common ones.  Gonorrhea treatment routinely covers chlamydia, which is why your doc gave you doxycycline; the injection (probably ceftriaxone, but perhaps something else) was the gonorrhea treatment.  In your case, chlamydial co-infection was unlikely (not transmitted orally), but still a reasonable thing to do.  By the same token, you should have an HIV test in a few weeks; 6 weeks is sufficient, but some experts would recommend waiting until 3 months.  Ask your own doctor about it and follow his or her advice.  In any case, the odds you caught HIV are near zero and you can expect a negative result, so don't lose sleep over this in the meantime.

Good luck--  HHH, MD

[Bigtin]

Thanks Doctor

Im an engineer and I work well with numbers. Ive seen some other posts where you calculate the risk someone aquired an std/hiv. Is it possible to do that in this circumstance regarding hiv?

Last post - I promise

[H. Hunter Handsfield, M.D.]

The risk of HIV through fellatio by an infected partner has been estimated at 1 in 20,000.  Even if catching gonorrhea increases that risk 2-3 fold, the odds remain overwhelmingly in your favor.  To that miniscule number, you have to factor in the risk that one of your partners had HIV, which probably is no higher than 10%.  All in all, the risk probably is much lower than the chance you'll die in the next week of some unanticipated event--perhaps especially in the Middle East, depending of course on what brings you there.

[Bigtin]

Thanks, I will get the test regardless and expect a negative result. I certainly will be using condoms for oral sex in the future...lesson learned.

[Bigtin]

Hello Doctor,

I know I promised not to post again but there have been developments. I have been lucky enough to find the girl that I had the second encounter with. We went to a clinic together where she got tested for HIV. The result was negative. I also informed her afterwards that I probably contracted gon from oral sex with her. (thought it was better to tell her after in case she was too embarassed to go for testing with that knowledge.  I knew that if I asked her to take test for gon in her throat that would have scared her away.)

It is reasonable to assume that the gon came from her and not the previous encounter 20 days before due to the timeline of symptoms?

In light of this do I still need testing after 6 weeks in your opinion?

[Bigtin]

By the way, the doctor didnt test me for anything when I got treated for gonnorhea (Gonorrhea). He just listened to my account of the two exposures and gave me the medication. Is it possible that I may have actually got clamidiya from the first encounter and the symptoms didnt show up for 3 weeks?

[H. Hunter Handsfield, M.D.]

People don't get chlamydia from oral sex.  For more information see the thread earlier today (http://www.medhelp.org/posts/show/367977).  But since you weren't tested for gonorrhea, it is possible you had nongonococcal urethritis (NGU), which can be acquired by fellatio.  The incubation period for NGU typically is 1-3 weeks.  However, NGU usually is painless, so my bet remains with gonorrhea acquired from the more recent partner.  But the bottom line is that you'll never know for sure. (Shame on your doc for not testing you for gonorrhea!)  Both your partners should be treated for both possibilities, just as you were.  They should be treated even if they are tested for STD and all tests are negative.

[Bigtin]

Doctor,

Since the treatment for gon and clamidiya I seem to have retained a slight clear/cloudy discharge from my penis. Its barely noticible except for some fluff from my underwear that sticks to it sometimes.  Some days it feels like a very slow drip. Is this normal after treatment?

[H. Hunter Handsfield, M.D.]

NGU sometimes persists despite recommended treatment, but I cannot tell from your description whether anything abnormal is going on or not.  Best to follow-up with the provider who treated you; an online source can't substitute for direct clinical evaluation.

This thread is over.  I won't have any further comments.

[Bigtin]

For the sake of completness guys heres the ending: Today I went to an outpatient clinic at a local hospital because I am still having a discharge in the morning and now also pain in my testicles. The doctor was excellent and after listening to my story immediatly ordered a urine analysis and a hiv DUO test (5.5 weeks after the first exposure, the girl from the second exposure tested negative). We had the results back in 40 mins. HIV negative (Phew!)... but I still have a prettty bad urinary infection. The doc then took a swab to figure out what antibiotics I need to cure the UTI. I have to go back in a couple of days for the results and for the meds.

On a personal note, Dr H, thank you for helping me through a tough few weeks. Much appreciated.

[H. Hunter Handsfield, M.D.]

I'm glad you followed up with your doc.  No surprise your HIV test is negative, but congratulations.

UTI does not generally cause discharge and UTIs are rare in healthy younger men, unless there is an underlying anatomic abnormality of the urinary tract.  It is more likely you have nongonococcal urethritis (NGU).  (When NGU follows gonorrhea, it is often called postgonococcal urethritis, or PGU.)  It could be UTI, but it would be the rare exception in your case.  Your treatment should include either azithromycin or a repeat course of doxycycline, and should also include a drug active against trichomonas, i.e. either metronidazole (Flagyl) or tinidazole (Tindamax).

This isn't meant as critical of your doc.  Most likely he also collected a urine specimen for culture; if so, my bet is that no typical UTI bacteria will be isolated.  But if such an organism is isolated, treatment based on that finding would of course be reasonable.  But whatever else is done, I recommend the trichomonas treatment be included.

Feel free to show this message to your doc for his comment.

[Bigtin]

Thanks doc. You are right, he did mention NGU and he did take both a urine sample and a swab.

Very sorry for the confusion because 'UTI' were my words, I thought this term covered all infections. I realise my error now.

So it looks like all should be well soon.

Best wishes

[H. Hunter Handsfield, M.D.]

In literal usage, UTI should encompass NGU and other STDs.  But in common usage, UTIs are not sexually transmitted and are due to an entirely different spectrum of bacteria.