STDs Expert Forum
gonorrhea test accuracy, my risk assesment?
About This Forum:

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.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank Blank

gonorrhea test accuracy, my risk assesment?

65 days ago I received 30s- 1 minute of fellatio from co-worker woman I do not know well.  I'm VERY happily married and cut if off at that time, without orgasm.  I am an ordinary looking guy and was caught by surprise.  This has never happened to me before.

7 days after exposure, had mild burning, no discharge, normal looking urethra.

18 days after exposure, same thing, mild burning, no discharge, normal urethra.  Went to dedicated STD clinic, had blood, urine, urethral swab, and a full battery of tests.  All came back negative, same day, in his lab.  The doc mentioned that he sent the gonorrhea out for a "DNA" test or something, as an extra measure of assurance and to contact him in a couple of days for the confirmation.  I did.  It was still negative for gonorrhea.

He said I must have some infection from common mouth bacteria, and gave me 2G of azithromycin on the spot, and put me on 500mg cipro, 2x/day for 7 days as a wide net for whatever the infection might be.

10 days after treatment, 3 days after the cipro ran out, (and 30 days after the exposure), I had sex with my wife for the first time since the encounter.  That's when inflamed urethra started, with very mild pain from touching, and no discharge.  Now, 65 days after exposure, and 35 days after intercourse with my wife, I still have have lightly inflamed urethra, no discharge, and mild pain form touching it.  

1] I am deathly worried that somehow, the negative gonorrhea diagnosis was wrong.  How often are there false negatives, 18 days after exposure, and two DIFFERENT testing methods?  The doc's practice is ONLY STD's.  I think he is an expert, but still...

2] Can a woman with vaginal gonorrhea still transmit it from the mouth?

Regards,
Wurried1
Related Discussions
239123_tn?1267651214
Welcome to the STD forum.

I'm not certain you had anything at all from your non-marital oral sex exposure.  From your question on the herpes forum, I know you were worried about HSV, but your symptoms didn't really suggest it.  And although nongonococcal urethritis (NGU) can be acquired by oral sex, that usually causes discharge.  So does gonorrhea.  Uncomfortable urination without discharge could happen, but isn't usual.  In any case, your gonorrhea test was highly reliable; you can be sure you didn't have it.  Still, it was appropriately cautious for the STD clinic to treat you, just to be safe.  The combination of azithromycin and ciprofloxacin was highly reliable against either gonorrhea or NGU.  So all things considered, you can be sure you did not have gonorrhea.

With new symptoms after sex with your wife, it is possible you acquired a new infection entirely. However, you are a better judge than I am about whether your wife might otherwise be at risk for STDs.  If that isn't likely, then this may be a recurrence of NGU.  Herpes and gonorrhea both remain unlikely.  I recommend you return to the STD clinic and get re-checked.  If there is evidence of inflammation in your urethra, then it is possible your wife will require treatment. But cross that bridge when you come to it (and don't discuss it yet with your wife); maybe that won't be necessary.  However, the STD clinic/doctor may recommend that your wife be examined and tested.

Gonorrhea and other STDs do not travel through the body from one infected site to another.  You can't catch gonorrhea or any other STD by oral sex if a woman has only genital gonorrhea, only if an oral infection is present.

Going back to herpes, that's always a consideration when genital inflammation symptoms recur.  However, herpes rarely causes only urethral inflammation; usually there are skin blisters/sores as well.  And herpes of the urethra usually is extremely painful.  Still, you might mention this to your STD clinc/doctor when you return.

Good luck--  HHH, MD
17 Comments
Blank
Avatar_n_tn
Hi Doc, thanks for the reassurance re gonorrhea.  

Now, issue of recurrence:  First, I'm quite sure my wife did not go outside our marriage, (some things you just know), especially since the return of pain occurred during the act, not after an incubation period.  Second, I'm not sure it was a recurrence so much as, it never went away 100%... when I first had sex with my wife after treatment, the pain was immediate upon insertion, dull and mild, and associated with vasocongestion and the rigors of orgasm.  35 days later, (today, (which is 65 days after suspicious exposure)), it remains that way:  Discharge-free inflammation, Pain is mild, dull, (not burning), and only seems associated with friction from jogging, or manipulation, or vasocongestion. I'm still worried about herpes, except that the pain has never been more than mild, and the inflammation has not changed in 30 days, (don't herpes outbreaks go through a cycle of blister to ulcer to scab/crust?)

Interesting fact number 1:  On Feb 24th, I took another 2g of azithromycin I found around the house.  It had been prescribed to my wife for a UTI or something and she never took it because we were trying to become pregnant.  Hard to tell if it did any good.  On March 6th, I started on some Cipro, 500mg, 2x/day.  I have 10 days worth. The cipro, we had around for emergency use when we travel to Africa doing charity work. Hard to tell if it's done any good either, 5 days into this.

Interesting fact number 2: not long after my extramarital encounter, we both picked up a mild, "walking pneumonia", which still persists in a dry cough for both of us, 65 days later, today.

Number 3:  In late February, a few days after I took the second dose of Azithromycin, my wife performed oral sex on me, something she had not done in at least a year or two.  Could she have grown some mouth bacteria in that time, that I had no resistance to?  Could residual bacteria from her recovery stage of "walking pneumonia" be a factor?

I'm clinging to the hope that it's not herpes due to the duration of the 35 days of inflammation with no change, and the circumstances I brought up in my post on the herpes forum.

If I were to be purely objective, and not worried sick, I'd say that the biggest causative factor here is slow healing, exacerbated by friction, manipulation, and involuntary vasocongestion, (during sleep), though I don't know why it would take more than a month to heal.

regards,
wurried1
Blank
Avatar_n_tn
I'm starting to wonder if there's an anxiety component at work here.  I just looked at the head of my penis and the urethra and it was in the completely retracted, shrivelled up state and it looked pretty normal.  It's just that when blood flows to it, you can see the redness around the urethra.  Further, when "expanded" due to blood flow or manipulation, the normal sebacious texturing is reddened as well.  This has also been going of for about a month, not evolving through herpetic stages, along with the urethra.  I read the wiki article on CPPS.  I hope I don't have that.

regards,
wurried1
Blank
239123_tn?1267651214
Whenever a person suspects his or her own symptoms have a psychological origin, usually s/he is correct.  And your symptoms are not atypical for genitally focused anxiety.  But if in doubt, see a doctor or clinic.
Blank
Avatar_n_tn
OK, doctor, I'm getting your drift.  I have two last questions based on your first answer to my question, that I think the rest of the readers will find relevant and focused:

In your first response to me, you mentioned something about a recurrence of NGU.  The question then is, if NGU is a bacterial infection, which I think it is, and it is appropriately treated with azithromycin and ciprofloxacin, how does it recur without a subsequent re-exposure to the bacteria?

Second, also based on what you have said in other threads, NGU does not pose significant health risks to female partners.  Do I have that right?

Regards,
wurried1
Blank
239123_tn?1267651214
The specific bacteria that cause most cases of NGU are not known, and some may not be fully susceptible to various antibiotics -- so they are temporarily suppressed but not eradicated.  However, it also is not at all certain that all NGU is caused by bacteria.  Some may be due to non-infectious inflammation

Other than cases caused by chlamydia and perhaps Mycoplasma genitalium, NGU is not known to carry any health implications for men's female partners.  It may or may not; there has been little research on this.
Blank
Avatar_n_tn
Great answer, Doctor.  Thank you.  Golly, in some ways, it sounds like it's almost preferable to have gonorrhea or chlamydia, because at least those are known and treatable.  At the risk of being too far off topic for the title of this thread, is Mycoplasma Genitalium transmitted orally from female mouth to male penis?  Or is that one of the areas that is unknown?

Judging from the late night and weekend time stamping on your responses, you are very dedicated to your work on these forums.  Bravo.

Regards,
Wurried1
Blank
239123_tn?1267651214
Unknown.  Transmission of M. genitalium has not been carefully studied, and I am unaware of any studies that attempted to identify it in the oral cavity.  My guess is that it is transmitted infrequently by oral sex, but we really don't know.

Not all our responses are so quick.  But both Dr. Hook and I spend lots of time at our computers anyway, so it's easy to check the forum between other tasks.
Blank
Avatar_n_tn
Possible epilogue...

Well, my wife has become symptomatic.  This, despite the fact that after receiving 30s of extramarital oral sex I tested negative for all STD's, 17 days after exposure, AND was treated with 2g azithromycin and a 7 day course of ciprofloxacin, 500mg, 2x/day, AND waiting an extra 3 days after all antibiotics were completed before having sex with my wife.

Right now, she is convinced she has pinworms due to anal itching, (we have a very close, accountable relationship, so she does not suspect my extramarital encounter/mistake).  Plus, the itching seems to only be at night in bed, which is classic pinworms, and we have a 16 month old baby.  We have a joint appointment with our PCP for the day after tomorrow.  

Since this was not killed off by 2g azithromycin, single dose, I wonder if it's mycoplasma genitalium, based on this CDC paper?  The finding was to use moxifloxacin in cases where azithromycin fails.

http://www.cdc.gov/ncidod/eid/vol12no07/05-1558.htm

I'm still holding out hope for plausible deniability, as the PCP will test for trich, chlam, gonorrhea, and all will be negative.  Then I'm hoping she will put us both on antibiotics for some general infection.  These will have a suppressive effect, but will fail, (unless she starts us with moxifloxcacin, which would be non-standard), because I already know they failed in me.  When we return after the failure is it my place to suggest moxifloxacin or should I leave it up to her?

Or should I risk damage to our marriage as well as courtesy to the doctor's professionalism and tell the doctor that I already know I'm negative for the classic STD's and suspect mycoplasma genitalium right from the outset?

-Peter
Blank
Avatar_n_tn
Oh yes, for me, I still have only some urethral swelling and redness, pain only from vigorous touch or friction, and no (detectable) discharge, no pain while urinating.  I HAVE lost 15 lbs over the last 75 days due to stress induced lack of appetite, but I can't recommend extramarital encounters if you love your wife and baby as I do, even if you need to lose weight.

regards
wurried1
Blank
239123_tn?1267651214
You don't describe your wife's symptoms, but her belief she may have pinworms suggests she may have itching in the anal or perhaps vaginal area.  Itching is not a common STD symptom, and most likely her symptoms are unrelated to your brief extramarital exposure.  I can't comment on the pinworms possibility, but I will point out that the most common cause of genital or anal itching in women is yeast infection -- which is not sexually acquired.

Your wife should stop guessing about the cause of her symptoms and see a health care provider.  You need not say anything to her about your sexual indiscretion, which probably is not related to her symptoms.

As for your supposed continuing symptoms, they sound to me like nothing is really wrong.  As I already said, M. genitalium is not known to be acquired by oral sex and I see no need for you to take moxifloxacin.  If you are convinced your continuing symptoms are abnormal, get profeessionally evaluated -- but most likely nothing will be found on examination, in which case I doubt any more treatment is required.

Feel free to report the findings after you and/or your wife have been professionally evaluated.  Anything before then will be speculation, so I won't have any more to say until that time.

Blank
Avatar_n_tn
We're going to the PCP Wednesday, the day after tomorrow.  I'll report back.  Thanks for the info and advice thus far.

Regards,
wurried1
Blank
Avatar_n_tn
Oops, forgot to mention that I still have urethral inflammation, just no discharge or stricture or urgency or pain on urination.  But if the PCP takes a decent look at my penis, she WILL observe the redness on the "lips" of the opening, extending downward, and depending on it's state of vasocongenstion, some inflammation as well.

-Peter
Blank
239123_tn?1267651214
I continue to doubt you have urethritis.  Even with a "decent look", you should not expect your PCP to observe anything abnormal.  
Blank
Avatar_n_tn
on my wife, the PCP found a small hemorrhoid.  wife will be going for a pelvic exam sometime soon.

i am considering sneaking away to my local county public health department, or my local planned parenthood for a final evaluation of my inflamed urethra, [of which red inflammation is the only classic std symptom].  IF there is a bacterial infection that survived the 2g of azithromycin and week of cipro, how will they detect it?  swab and whitee cell count? i would hate for them to give me the same treatment AGAIN and have it be ineffective... again.  when i search planned parenthood's web site, there is not even a single result for mycoplasma genitalium.  should i still assume their docs know about it?  and of the measureable failure rate of azithromycin in treating it, [according to the 1996 CDC paper?

also doctor hhh, there was an ngu study, i think based in australia, that appears all over the web in many forms that talks of ngu symptoms that persist for "weeks to months", and there is a little commentary from you about it at the bottom.  do you recall that?  really? months for non-infeced inflammation to persist?  i can totally live with it as long as i know it's not infected.

my inflamed urethra [and red meatus] has persisted for 7 weeks, and began a few days after completion of the zithro/cipro regimen.  possible post-antibiotic,male yeast?

that's it for now, i'll report back resuts from my wife's pelvic and or my ngu exam i can sneak one in.
wurried1
Blank
Avatar_n_tn
My last post in this thread was over 10 days ago.  It has somehow worked it's way up near the top of the STD expert forum.  Has it been edited?  I only ask because I am not one who likes out of compliance with forum policies, so if I did something wrong, I'd like to know about it so I don't do it again.

In the interest of keeping this forum educational, I still plan to report back the results of my wife's pelvic exam, which should be sometime this month.  I'll be going to Planned Parenthood for a final look for white blood cells, and I'll report that back, too.  Still some meatus inflammation with no discharge and very mild pain that is not associated with urination.  It is now 12 weeks to the day, since exposure, [received oral sex only].

Regards,
wurried1
Blank
239123_tn?1267651214
You did nothing wrong.  Another user attempted to post a new question as a comment in this thread, and it was deleted.  When that happens, the thread bumps to the top despite deletion of the comment.

Your persistent urethral discomfort does not change my opinion or advice.
Blank
Continue discussion Blank
This Forum's Experts
239123_tn?1267651214
H. Hunter Handsfield, M.D.Blank
University of Washington
Seattle, WA
300980_tn?1194933000
Edward W Hook, MDBlank
University of Alabama at Birmingham
,
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
242532_tn?1269553979
Blank
Emotional Eating Control: How to St...
Aug 28 by Roger Gould, M.D.Blank
233488_tn?1310696703
Blank
New Cannabis Article from NORTH Mag...
Jul 20 by John C Hagan III, MD, FACS, FAAOBlank
242532_tn?1269553979
Blank
3 Reasons Why You are Still Binge E...
Jul 14 by Roger Gould, M.D.Blank