Gonorrhea -- Cervical vs. Throat

How reliable is a cervical gram stain (or a cervical culture) for Gonorrhea, if the primary contact is oral sex?

Everyone involved is asymptomatic for STDs. My recent cervical swab culture was Gonorrhea + last week. I was treated with Ceftriaxone 250 mg IM & Zithromax 1 gram.

My male partner & I were tested last year. He is my only sex contact (oral/genital). My partner has contact with 2 other females:

1. A -- Past couple of months-unbarriered oral sex (giving/receiving), condomed genital sex. She & her other male partner were tested last year, same contact.

2. B -- Past month or so-unbarriered oral sex (giving and receiving), rare unprotected genital sex. She and her male partner were tested 6 months ago, same contact.

B had a cervical swab and gram stain done, which was negative for Chlyamydia and Gonorrhea that same day. A had a cervical swab sent out. My partner got swabbed. Everyone is waiting for his results & had bloodwork drawn for full screening.

If for some reason the other tests come back negative and they decide not to get treatment, what are the chances for my re-infection if I continue to interact with my partner (barriered or not?) Would A's cervical swab be reliable since a condom is used for genital sex?

[H. Hunter Handsfield, M.D.]

I'll try to help, but I think you are over-analyzing the situation.  Your positive cervical test probably was a culture, or it might have been a DNA test.  I doubt it was a Gram stain only--but if it was, the diagnosis is in question.  It's a very unreliable test on a cervical swab.

Oral sex is not known to transmit gonorrhea to women--that is, the source of your gonorrhea has to be a male urethra.  Whether and how your partner caught it is immaterial, and I cannot speculate.  It could have been by receiving oral sex, or perhaps the condom wasn't properly used.  But perhaps he was infected from one of the episodes of 'rare' unprotected vaginal sex.

The other persons' test results won't change any of this.  There can be false negative results with any test (slightly more often with culture than DNA test); and there also is spontaneous cure (i.e., your partner or either of the other women could have had gonorrhea but now have negative tests).

Bottom line:  don't worry about which exact exposure infected you or your partner; you'll probably never know for sure.  The important thing is that everybody involved needs to be treated, regardless of their test results.  It would be a serious mistake for any of you to 'decide not to get treatment'.

Good luck--  HHH, MD