Gonorrhea Question

[PeterPaul3535]

I am a male and recently had an oral encounter (I was the insertive partner) with some one who is not my regular partner in which I am worried about the possibility of contracting Gonorrhea and possibly passing it on to my partner (male). I received treatment by way of shot (ceferxiatrone?) 18 hours after the encounter and had sex with my partner a 3.5 days after that.  I have read comments relating to the time it takes to clear the bacteria on other threads and have also read two scientific studies relating to the subject.  One used culture as the test of cure and found all would be cured by 24 hours and the other used NAT (Duration of Persistence of Gonococcal DNA Detected by Ligase Chain Reaction in Men and Women following Recommended Therapy for Uncomplicated Gonorrhea). I am not in the medical field and did not totally understand the outcome of the study.  Im sure either Dr. Hook (who is see was a part of the study) or Dr. HHH can clear this up my confusion with the answers to the following questions

1) Did all the patients clear the virus 24 hours after testing and have false positives afterwards?  

2) Did these patients have the ability to pass Gonorrhea after their first negative test?

3) What is your opinion on the time it takes to clear Gonorrhea after being treated?

Im sure either Dr. Hook (who is see was a part of the study) or Dr. HHH can clear this up for me

.

http://jcm.asm.org/cgi/content/short/40/10/3596

[Edward W Hook, MD]

This will be the final answer.  Further anxiety driven questions will be deleted without comment.  

DNA from dead organisims can persist after the bacteria are no longer alive. As a result cultures will be negative but the NAATs can be positve.  This was explained to you before.  

The urine sample is positve in such cases becasue that is typically where the infection starts.  

The proper tests to request are NAATs tests fro sites of sexual exposure.  Testing in your case will be a waste of time as the ceftiriaxone you recieved will have killed any gonorrhea, had they been there.  

The threqad is over.EWH

[PeterPaul3535]

Im sorry, I know I said I would not ask any more questions, but things have changed a bit in my situation. As a follow up I went to a orthopedist who diagnosed me with tendonitis in my foot which and in addition I do have some skin abnormalities (they are probably bug bites) but one has what appears to be a scab that looks similar some of the skin lesions of DGI I have seen ( no others bite mark that I have look like that)  It is on the same foot that is suffering from tendonitis.From everything that I read it says in DGI, standard tests from the urogenital tract (cultures) will more then likely be negative. Why will a DNA (NAAT) test be positive? Is a urine sample really meaningful once Gonorrhea has disseminated? If yes, how? I ask because tomorrow I am going to my doctor and want to ask for the correct test.  I am not sure how skilled and knowledgeable he is in this field.

Thank you so much in advance, I know from your long sigh in you previous post that this is annoying.  I really have no defense for myself other then this is a situation I have never had to deal with and as crazy as it seems, this is my way of covering my bases.

[Edward W Hook, MD]

Sigh..............  the answer to both questions is yes.   EWH

[PeterPaul3535]

I'm not sure what you responded Yes to (the first question or the second)

1)Would DNA testing (LCR) be positive in cases or Disseminated Gonorrhea?

2)Would early treatment that I received prevent DGI?

I know the odds so much in favor that I did not contract gonorrhea but I really want piece of mind if it is obtainable in this circumstance.  I'm sure you deal with that all the time.  In other life choices I am certainly more judicious with other people's time and certainly my money but I feel an uneasiness about this which is crippling.  If you could answer the two questions I promise to ask no more.

Thanks

[Edward W Hook, MD]

Yes it would.   Your tendon pain is not a sign of disseminated gonococcal infection but is a sign of the same sort of unwarranted anxiety that lead you to treatment in the first place.  Testing would be a waste of time and money.  EWH

[PeterPaul3535]

Would DNA testing (LCR) be positive in cases or Disseminated Gonorrhea? I know it seems outlandish especially with the treatment that I received but I have had some very bad tendon pain in my ankle and foot and want to make sure it is not related. I have read that Gonorrhea can quickly enter your blood stream.  The timing lines up, the pain came about 3 weeks after the encounter.  Would early treatment that I received prevent DGI. What is the correct test to take in order to rule this out? Thanks again

[Edward W Hook, MD]

Just being conservative and to make sure that infected partners have time to be treated. EWH

[PeterPaul3535]

Thanks for the response.  I understand completely and really appreciate your expertise on the matter.  In my research I noticed that most agencies suggest seven days before resuming sex again, in light of this research why are these still the guidelines?

[Edward W Hook, MD]

Welcome to the Forum.  The shot of ceftriaxone that you received following your exposure (which is not recommended since your likelihood of infection following the encounter you describe is low, statistically less than 1%)  would have cured an infection in the unlikely circumstance that you had become infected in less than 8 hours, making transmission of infection to your regular partner not a concern.  

There is a difference between killing the bacterium, which takes just a few hours (less than 8 for sure) and the presence of residual fragments of DNA from dead bacteria.  In the study which I directed, the testing was done with Ligase Chain Reaction which detects gonococcal DNA which can persist long after the bacterium has been killed by therapy.  

As I said, your most probably did not need the ceftriaxone but if you had been infected, the injection would have cured you. Your partner was not at risk.  EWH