Gonorrhea Testing

[manischewitz]

Dear Doctor,

First of all thanks for providing such a great service, there is so much misinformation out there.

Here is my situation:  10 weeks ago I had unprotected oral from a CSW (receiving, I am a man).  Since then I have had no symptoms of any STD, other than a slight itching on the head of my penis (not inside the urethra, at the end, no discharge, no burning, nothing).  I got tested for chlamydia, HIV, syphilis, but the people at the lab said that as a man if I didn't have any symptoms I didn't need to get tested.  I don't have any white blood cells in my urine.

2 weeks after the encounter I took a Makrolide antibiotic in use in Britain for an unrelated illness.  I can't remember the brand name, but the medication was Josamycin.  Do you know anything about this regarding the hypothetical situation that I might have had it?

Now I'm wondering, since it's the only one I didn't test for, do I need to even think about it?  I know that you are going to say that if I'm worried, I might as well get tested.  But if you were to say "If you came into my clinic, I would advise against it," I wouldn't worry.

Please let me know, and thanks in advance for your time.

A not-too-worried Brit needing assurance.

[Edward W Hook, MD]

I agree that there is not a lot to worry about.  At the same time, there is some mis-information you have been given.  Specifically, about 10% of all gonorrhea in men can be asymptomatic and among those with symptoms they can be mild. Thus, screening for gonorrhea was not an unreasonable thing to seek.  

On the other hand, your risk of gonorrhea is low.  The infection can be spread to others through oral sex.  This is a very uncommon occurrence but it does happen.  the absence of white blood cells in your urine makes the probability that you have gonorrhea even lower than if you were in this situation but had no testing at all.

Regarding your current status, the macrolide antibiotic you took would be expected to have some activity against gonorrhea but, at the same time it is not recommended because cure rates are not greater than the 95% cure rate standard we use for recommending gonorrhea therapy.

Putting all of this together, I doubt that you have gonorrhea and based on the information you have provided, I really don’t think there is much to be gained by testing at this time.  there is a tiny chance that you might have infection but given how small that chance is, I don't think it warrants testing.  On the other hand, if nothing short ofo complete reassurance will set your mind at rest, then there are enough reasons to seek testing for you to go on and do so.  Hope this helps.  EWH

[Edward W Hook, MD]

Last answer.  If had been exposed to syphilis, one of two things would have happened, the antibiotic would have prevented the infection or, if you got syphilis, your test would have been positive. There is nothing to be gained for you to have futher testing.  

No, syphilis is best tested with tests for syphilis.  Other tests such as white blood cell counts very well might not pick it up.  It is time for you to stop worrying about syphilis.  EWH

[manischewitz]

Dear Doc,

I hope I'm not crossing any boundaries by adding this information, but another question:  if one were infected with syphilis, and there were extensive blood tests done to check for, among other things, white blood cell activity in the blood, would alarms go off there?

thanks and cheers, my last post

[manischewitz]

Dear Doc,

I don't know if I am allowed to post here again, but I will try--a follow up question:  if I was tested for syphilis 5 weeks post-exposure, and now it has been 3 months with no symptoms of anything, do I need to test again?  Also, if I had been exposed, would the antibiotic have taken care of it?

cheers
a still not-too-worried Brit needing assurance