STDs Expert Forum
Oral gonorrhea
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Oral gonorrhea

Ok...here's the situation,

I had oral sex with two guys, on different days about 3/25.  One of them developed symptoms of a gonorrhea infection on about 3/30.  The other has been asymptomatic.  About that same time (3/25) I developed a mild sore throat and very stuffy nose.  The sore throat lasted about a week, but the stuffy nose never went away.  A few days later, and feeling better, I had oral sex again with the asymptomatic guy on 4/6.  He had a physical with a complete STD screen on 4/8 that was negative for any std's.  I finally got tired of the stuffy nose (sore throat had subsided) on 4/9 and went to the doctor.  Doctor looked and wasn't certain that I had any type of infection.  He said he could see that I had some drainage but nothing looked especially irritated.  Because I had been previously diagnosed (and treated with 1000mg  Amoxicillin three times daily) with a sinus and left ear infection about a month earlier he suspected that I could possibly have some type of resistant sinusitus and prescribed Augmentin XR (1000 mg) 2 pills twice a day.  I had oral sex again with the asymptomatic guy again on 4/11.  I was informed by the guy who developed gonorrhea of all this yesterday, 4/14, and have not had sex with him since before his symptoms began.

So my questions:

Typically what are the symptoms of oral gonorrhea?  If someone were to develop oral gonorrhea, how quickly would those symptoms (typically) manifest?

Could my sore throat one month ago be oral gonorrhea and resistant to the antibiotics?  Could I have passed it to the guy who developed symptoms, even though one month prior I had undergone such a strong course of amoxicillin?  Are these bugs resistant to amoxicillin?

If the guy who is asymptomatic hasn't developed symptoms at this point, and has been tested negative, how likely is it that he may have gonorrhea, assuming I was the initial carrier?

Now that I'm taking the Augmentin, would it be advisable that I get tested?
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"Oral" gonorrhea is actually infection of the pharynx (throat), not the mouth itself.  You may or may not have had pharyngeal gonorrhea, which you could have acquired from the guy who developed gonorrhea symptoms a few days after your exposure. In view of your antibiotic treatment, most likely you'll know.  To the specific questions:

Most pharyngeal gonorrhea causes no symptoms at all.  When it does, sore throat is the main one; stuffy nose is not.  A cold is a more likely explanation of your symptoms than gonorrhea.  Timing of symptoms hasn't been studied well, but when symptoms occur, probably they usually start within few days.

You might have been the source of his infection.  However, pharyngeal gonorrhea is less easily transmitted than genital or rectal gonorrhea.  I'm more concerned that you could have caught it from the partner who developed gonorrhea symptoms, not the other way around.  

Most gonorrhea responds to the penicillin-class drugs, including amoxicillin, especially in the doses you had.  But 10-15% are resistant.  Augmentin is active against even the resistant strains.  Augmentin has not been studied for its effect against pharyngeal gonorrhea, but in the doses used for strep throat and respiratory infections, it probably would cure it.

Asymptomatic urethral gonorrhea is uncommon in men, and testing is reliable.  The asymptomatic person can be sure he doesn't have it.

There is no point in you being tested while taking augmentin.  You could be tested a week or so after you finish the drug, to be sure that it is gone (if you had it at all).

I hope this helps. Best wishes--  HHH, MD
4 Comments
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239123_tn?1267651214
The statement in the opening paragraph is supposed to be "Most likely you'll never know."
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Doc

Thanks so much.  You cleared up some of my confusion.  I guess my only real concern is that the guy who did show symptoms of urethral gonorrhea stated that he was 99% sure it was me, that he'd only been with me and his wife in the past 6 months.  I suppose it could be possible that I picked up pharyngeal gonorrhea after I took the first course of antibiotics, and not had symptoms?  There's also the possibility that he's not being honest?

All that said, I think you're right, because of the timings of the antibiotics and the dosages, we'll probably never know if I am the carrier.   My primary concern was for the guy who is asymptomatic, and I'll take your advice that there is no point in him getting tested (again) a week later when he's never had any symptoms from exposure to me prior to the antibiotic, and we were together after I'd been on the augmentin for 2 days.  I am also more convinced that my symptoms were due to a cold and not pharyngeal gonorrhea.  I did run to the health clinic this morning and at their recommendation did have my throat cultured (even though I'm on the antibiotic).  I suspect that this test will come back negative.

Would you advise that I get another culture after I get the results of the most recent culture and have completed my course of antibiotics, or just drop it and not worry about it?

Thank you so much for your advice and time.  
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239123_tn?1267651214
It's always a judgment call, and often a difficult one, to figure out who transmitted an STD to whom, and when it happened.  Certainly the timing is right for you as the source of one partner's gonorrhea.  If his sexual history is accurate, then that's the best bet.  That you didn't have symptoms at the time makes no difference, since more than 90% of pharyngeal gonorrhea cases are entirely asymptomatic.

As for your other partner, with both no symptoms plus negative tes, it svirtually impossible that he caught it from you.  According to standard recommendations, he should have been treated anyway.  It is routine to treat all partners of persons with gonorrhea, without waiting for test results.  However, once the test results are available and negative, most people don't need treatment.

Your buddy's wife also needs testing and, without awaiting her test results, treatment.  That should happen even if he didn't have sex with her after his symptoms appeared.  Since it isn't absolutely certain when he was infected (as you said, maybe he also has sex with other guys and didn't tell you), it is safest to assume she is at risk.  And gonorrhea in women is much more serious than in men.

To answer the last question, yes, I definitely recommend you be tested.  Although augmentin probably would be effective, it hasn't actually been studied and its actual efficacy isn't known.  CDC and other experts recommend test-of-cure whenever a non-standard treatment regimen is used.

And by the way, it is uncommon for someone to have gonorrhoea only of the throat.  Most men with pharyngeal gonorrhea also have urethral and/or rectal infection.  Of course this can vary, depending on one's sexual practices.  But if you have had any rectal or penile exposures to other people in the past couple of months, you should have a throat culture plus testing at whatever other sites might have been exposed.  You can expect negative results, but it's best to be sure.

Finally, HIV hasn't been mentioned here.  This sounds like a pretty high risk situation, even though HIV isn't commonly transmitted by oral sex.  Everybody concerned should be HIV tested if they haven't tested negative in the past few months.  And syphilis as well.
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