Gonorrhea Treatment Effectiveness and Reinfection: LOTS of Questions

[catluver080]

I had a positive gonorrhea test. My doctor gave me an injection of ceftriaxone (rocephine) in my hip and they prescribed me four 250 mg tablets of Azithromycin to take in one dose. My steady sex partner got treated that same day, but he wasn't given the rocephin injection. He was prescribed 400 mg of cefixime (Suprax) and two 500 mg tablets of Azithromycin to take all at once. He took them that same night. We both had this treatment on Thursday, February 24. But I have several questions.

1. My health care provider told me the only cure for gonorrhea was the rocephine injection and that the pill form doesn't work, but yet my partner was still prescribed the Suprax anyway. Is his treatment going to be sufficient?

2. Even though we both received different treatments, will we both be able to engage in intimacy again in a week?

3. My partner took the medication even though he was having no symptoms. How soon after exposure does the treatment actually work?

4. Is it possible to reinfect each other through hand to genital contact if we were both careful to wash our hands after touching the other? Or through dry humping through his nightclothes and my panties? This happened early this morning, February 27. Could we have reinfected ourselves this way?  

6. I had the treatment Thursday afternoon. It's now Sunday, but I'm still really itchy around my vulva and my skin is irritated a little bit. Could this be a yeast infection from the antibiotics or still gonorrhea?

7. How soon could I get retested and get an accurate negative or positive result?

8. When should I clean all my sex toys to make sure I don't reinfect myself with them?

8. And lastly, my partner is about to relocate for his job, so we want to be intimate this weekend and engage in our normal oral sex and intercourse. If we were both treated on Thursday, February 24th, if we were to have normal sexual intercourse without a condom anytime starting on Friday, March 4th, would we be okay?

[Clerkgirl]

A related discussion, Concern was started.

[bonbon89]

A related discussion, possible test results messed up was started.

[DAEjavu]

A related discussion, How will you know where GONORRHEA came from? was started.

[H. Hunter Handsfield, M.D.]

Many people with STDs have new partners within the next few months and others cannot be certain about a partner's fidelity.  If when the time comes you are convinced there has been no possibility of reinfection, you can skip the 3-6 month test.

That will end this thread.  Take care.

[catluver080]

Well, with your advice, I did go ahead and get retested. My tests came back negative. Negative for everything they tested for anyway, which was chlamydia, gonorrhea, yeast, BV, and trich (I think that's what it was called). So since I had a negative test of cure, should I go ahead and retest again in another few months? I don't want to be in that 10-15% who catch it again. And I know my partner is negative as well, because we started having intercourse again starting eight days after receiving gonorrhea treatments. So basically what I'm asking is, if we stay faithful to each other, is it necessary to retest again in a few months? I'm guessing probably not, but I thought I would make sure. And thank you for all of the help you've been giving me! Your advice has helped more than any of the doctors I've talked to here.

[H. Hunter Handsfield, M.D.]

Sorry if I used confusing terminology.  STD exerpts and other professionals know that "reinfection" means a new infection due to sex with an infected person.  Your question concerns persistent infection, i.e. failure of the antibiotic to cure you -- which is a different issue.

[catluver080]

How are people more easily reinfected within 3-6 months? Gonorrhea bacteria doesn't grow back within that time does it? Also, if I was to have a negative test result this time, should I still retest at the recommended time to make sure it's completely gone? My partner still hasn't had symptoms, and I keep getting itchy and being diagnosed with yeast infections. I'm afraid I may have reinfected myself with a sex toy, even though I cleaned all of them with anti-bacterial soap and antiseptic.

[H. Hunter Handsfield, M.D.]

The test result will be accurate.  The reason for testing at 3-6 months isn't because it takes that long for accurate testing, and not because treatment is likely to fail.  It is because 10-15% of people with gonorrhea or chlamydia are reinfected within that time.  Therefore, retesting is a common sense precaution.  But it isn't necessary if you don't have sex between now and then.

[catluver080]

Hello Dr, I have one more thing I would like to ask you, but I'm not sure if I will get an answer since it's been so long. But I'll try.

I decided to go back to my normal gynecologist today because of all the wrong information my student health clinic kept giving me, and they decided to do a test of cure on me today for the gonorrhea, but it has only been a month. Today is March 30, and I was treated February 24. Was that too soon to be tested again, because I know you said 3-6 months. I'm afraid I might not get an accurate result.

[H. Hunter Handsfield, M.D.]

I have no further comments or advice.  Try to put this event behind you.  It's over, except for the yeast -- which should clear up within 2-3 days of taking the fluconazole.

[catluver080]

It is good to know your expertise on the subject, otherwise I would still be very worried about him receiving Suprax rather than Rocephin. I am happy that forums such as this one exist, as you have answered more of my questions than either mine or my partner's doctors.

Today I was prescribed fluconazole to take in case I had a yeast infection, so I took that just now, and I am hoping it will take care of the itching and the skin irritation I have. My skin is just kind of red in places, but otherwise I look normal and I haven't noticed much discharge, if any. However, I was told if symptoms don't go away by Thursday, I will go back in for further evaluation.

But I am hoping everything will be okay, that my partner and I were both suffiently treated and that we will be safe to resume our normal sexual activity either this Friday or Saturday evening. With or without a condom, I'm not sure about yet, as we never used them before except in the beginning of our relationship, then we learned that we were both clean and that I am on birth control pills and quit using them. But since this gonorrhea stuff, I'm not sure anymore. I will heed your advice that we may still need condoms, even though we're not new to each other. By then it will have been eight or nine days since receiving and/or taking gonorrhea treatments.

If you have any further comments or advice on the condom use, by all means, tell me. But if you are done with this thread, I fully understand that too. If that's the case, then I thank you again for being such a wonderful help on this topic!

[H. Hunter Handsfield, M.D.]

I agree with your analysis about duration of infection and your partner's lack of symptoms.  He may or may not have been infected, but as I said, you'll never know.

You are wise to rely on my advice about gonorrhea treatment standards over that of your student health clinic.  Not to put too fine a point on it, but Dr. Hook and I would be on any STD expert's list of the world's top 10 experts on gonorrhea treatment.  I was the lead on the first research (many years ago) on both ceftriaxone and cefixime as treatments for gonorrhea.

[catluver080]

Thank you for your advice doctor. I kept getting mixed answers from other people, and my school health clinic confused me when they said my partner's treatment would have to be an injection, not a pill. But you cleared it up for me, thank you.

I don't believe either of us were infected very long, because the day right before the bad sexual encounter, I had my annual PAP smear and STD testing done, and it all came back okay. I got retested after the encounter and I came up positive for gonorrhea. So if my calculations are correct, I was only infected for about a week and my partner might have only been infected for a few days before he was treated. That might be why he never got symptoms. But I guess the treatment works no matter how long it has been since exposure, right?

I am going to be treated for a possible yeast infection as well, starting today, and if it doesn't clear up by this Thursday, I'm supposed to go back in.

Thank you again for your advice! I guess I'll just see what happens from here and learn from my mistake!

[H. Hunter Handsfield, M.D.]

Without symptoms, the odds are good your partner had not yet been infected -- or was, but enough time had not passed to develop symptoms.  Usually it takes 3-5 days before symptoms start, but it is normal to treat all sex partners of infected persons, without waiting for symptoms or positive tests.  If he wasn't tested, you'll never know for sure whether or not he actually was infected -- but at this point it really doesn't matter.

I agree it would be a good idea to avoid sex with your yeast symptoms, assuming yeast is indeed the cause.

The treatments you and your partner received are sufficiently foolproof that retesting is not nomally recommended or necessary.  However, I do recommend "rescreening", which is retesting after 3-6 months.  The purpose is not primarily to detect treatment failure, but reinfection. Of all persons with gonorrhea, 10-15% catch it again in that time.

[catluver080]

I was going to mention that I brought the gonorrhea into the relationship after a risky sexual encounter at a party, but I ran out of room in my initial post, so I only put in the necessary information. That person has been notified. Whether he has been treated or not is unknown to me.

I am usually monogamous to this one partner who I infected with gonorrhea, and I take the full responsibility for it. I have been clean up until the encounter with this stranger, so I know my partner was clean before it too. That's why we normally never used condoms. I am afraid of resuming sex with him this weekend because of the yeast infection-like symptoms I keep having though. I don't want to reinfect him before he moves.

My partner was not actually tested for the diseases, but rather just given the treatment for them because of exposure. Does that mean he may not have been infected?

And I mean no disrespect, but you skipped a question. How long would I have to wait before getting retested to see if I am cured of gonorrhea?

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I'll go directly to your questions.

1) Your doctor is wrong, or you misunderstood his position.  Ceftriaxone (with azithromycin) indeed is the first chose therapy as currently recommended by CDC, but cefixime (also with azithromycin) is also highly recommended.  When given with azithromcyin, either treatment is equally effective.

2) It is not uncommon for mutually infected partners to receive somewhat different treatment.  As long as the treatments are both effective, it makes no difference.  Assuming any symptoms (in either of you) have cleared up in about a week, at that time it is safe for you to resume intercourse.

3) The infection typically is cured within a day or so, but it is still recommended to allow a margin of safety, i.e. a week before resuming sex.  However, I have a comment below about your partner's lack of symptoms.

4) Hand-genital transmission or sexual activity without actual intercourse (or oral sex) carries no significant risk.

6)  A yeast infection is more likely than continued gonorrhea symptoms, and yeast infections often are triggered by antibiotics.  You should return to the doctor or clinic who treated you to confirm the diagnosis and prescribe treatment.

7) I would clean them now.  Why would you wait?

8) Probably no harm will come.  However, as discussed above, it isn't recommended.  If you decide to have sex that soon, please use condoms.

You don't mention other partners.  Obviously you or your partner had to bring the gonorrhea into your relationship, i.e. acquired from another sex partner.  Make sure any such partners also are tested and treated.

Finally, gonorrhea can occur without symptoms in men, but it is rare.  Was your partner actually tested with a positive result?  If not, perhaps he isn't (yet) infected.

Regards--  HHH, MD