Gonorrhea / conjunctivitis question

[madesomebadchoices]

A brief history:

Early March, I had unprotected oral sex from a SW.  

I had 3 days worth of Levaquin 500mg in the subsequent 72 hours.

In mid April I noticed mild burning while urinating and some "fullness" in my rectum.  I have had prostatitis before, and it felt similar.  No discharge, no extreme pain while urinating.

Then 1 week ago while on business, I had protected oral and protected vaginal with a massage parlor worker.  No condom slippage etc.

Yesterday (less than 12 hours after the first time we have had sex in many weeks), my wife developed what appears to be bacterial conjunctivitis.  This morning it had spread to the second eye.

After hearing this from my wife, I got very concerned and went to the local std clinic.  On exam, they diagnosed NGU (white cells in the urine, but no "drip") and gave me doxy. My results will be in tomorrow or Friday.

My questions:

* some gonorrhea is asymptomatic in males.  Does that present as mild symptoms or no symptoms at all?
* could I have contracted gonorrhea that was resistant to the levaquin (I live in California), and passed it to my wife's eyes, either through the first episode or the second?
* Gonococcal conjunctivitis seems very aggressive and can potentially lead to blindness if not treated.  Do I need to tell my wife about this possibility, or can I wait for my test results?
* Lastly, are all NGUs sexually transmitted?  Does my wife need testing?

Thank you.

[H. Hunter Handsfield, M.D.]

The chance of acquring any STD from the exposures you describe is very low.  Asymptomatic gonorrhea of the urethra (penis) is very rare; and if you had it, the Levaquin probably would have cleared it up.  (Yes, resistance is growing.  But in heterosexual men and women in California, >90% of gonorrhea strains remain susceptible to the fluoroquinolones, like Levaquin.)

The NGU is a more uncertain issue.  Perhaps it reflects recurrent prostatitis, i.e. not sexually acquired at all.  Given protected vaginal but unprotected oral, it's also possible you acquired NGU due to normal oral bacteria--in which case there may be no risk to your wife.  On the other hand, an incubation period of 2 months is too long; I doubt you acquired the NGU back in March.

Of all cases of conjunctivitis, I'll bet no more than 1 in 10,000 is due to gonorrhea.  The large majority are due to viruses.  It is possible you and your wife are sharing a non-sexually transmitted adenovirus infection.  Some types of adenovirus are acquired by oral sex, can cause NGU, and also cause conjunctivitis (often with other cold symptoms).  So it's possible you and your wife are sharing an adenovirus infection, which she might have acquired as a common cold then transmitted to you by oral sex, if that is among your sexual practices together.

Having said all that, I can only speculate.  There is at least some chance your wife is at risk, and certainly the common medical practice and recommendations are that the female partners of men with NGU should be treated.  Might you and she get away without her being examined and treated, without threatening her health.  Yes, that is possible.  But I will not take the responsibility for that hope.  If you were my patient, I would insist that she be examined and treated as an NGU contact.  But I wouldn't worry much about the conjunctivitis, which probably will clear up on its own and most likely has nothing to do with your sexual adventures.

Good luck--  HHH, MD

[madesomebadchoices]

One quick follow-up question: if my test comes back as negative for gonorrhea and chlamydia, that only leaves non "dangerous" NGUs, correct, meaning my wife would not be at risk?  I will certainly need to have her tested if I come back positive for either of those, but if negative?

[H. Hunter Handsfield, M.D.]

There are other potentially dangerous causes of NGU, including the newly discovered Mycoplasma genitalium, which tends to be resistant to doxycycline and can cause pelvic inflammatory disease in women.  There is no test for M. genitalium except specialized research tests.

Further, the potential health threats to women for the other causes--that is the majority of NGU cases in men--simply are not known.  There is no clear research to show that such women are in danger; but neither is there research to show there is no danger.  That's why the routine recommendation is for treatment of all female partners of men with NGU.

Without chlamydia or gonorrhea, your wife's risks are low, but nobody can say they are zero.

[madesomebadchoices]

Got it thank you.

Oral sex actually is a very regular part of my wife and my sexual life -- so is mycoplasma genitalium a "normal" oral bacterium or only one that could be acquired through oral contact with another infected partner?