paranoia or plausible?

[rookiepro]

I’m an early 30’s heterosexual male. About 6 months ago I received unprotected oral sex from a woman while intoxicated. After about 2 weeks with no symptoms of any kind, I forgot about it and resumed normal relations with my normal partner. A few weeks later I took a week or so of the antibiotic Septra for an unrelated problem. About a week and half after I finished taking Septra, I gave into a sense of nagging doubt and got tested for Chlamydia/gonorrhea, both came back negative. Instead of ending the matter, I somehow went into a downward spiral of “what if’s.” In your opinion, do I need more testing? My concern is that I could have an asymptomatic gonorrhea infection, have passed it to my girlfriend, tested negative due to the antibiotic I was on, and then required it. Is that even plausible, or I am just being ridiculous? Also, my girlfriend had a routine pelvic exam several months after we started having normal relations again. They didn’t test specifically for STDs (I kept this whole thing to myself), but would a bacterial STD have been apparent to her doctor if one had been present? As I said, it’s been nearly 6 months and no symptoms, but some sources make it seem like asymptomatic gonorrhea is common? I feel like all the misinformation out there compounds the anxiety. Do I need further testing, or is it time to take a few deep breaths and let this go. After reading several posts, I realize that the odds are in my favor, but I don’t want to take chances with someone else’s health.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

Well, I wouldn't characterise your fears as "ridiculous", but they are unjustified.  In general, oral sex is safe sex -- not totally risk free, but it is the rare oral sex encounter that results in any STD.  Chlamydia wasn't even possible, since it is rarely carried in the mouth/throat and therefore rarely if ever transmitted by oral sex; gonorrhea almost always would have caused obvious symptoms; if you had either one of these, it would have cleared up on its own by now; and sulfamethoxazole/trimethoprim (Septra) also would have likely cured either gonorrhea, chlamydia, or nongonococcal urethritis (NGU).  Other STDs aren't a realistic possibility without symptoms.

Your partner's pelvic exam probably wouldn't pick up STDs if specific tests were not done, but based on the situation you describe, this doesn't matter.  There was no risk anyway and she does not need testing.

In summary, you don't need further testing and it is indeed time for those deep breaths.  All is well.  If by chance any STD ever shows up in either of you, it won't be from your oral sex event 6 months ago.

Take care--  HHH, MD

[H. Hunter Handsfield, M.D.]

Cephalexin is not active against chlamydia, but that's not an issue, as I explained.  It would cure gonorrhea.  So this makes no difference in my opinion or advice.

Little is known about why some gonorrhea remains asymptomatic.  Part of the explanation, as you imply, is that some strains are less likely than others to cause symptoms.  In general, those strains are uncommon.  But that's only a partial explanation; other reasons are not known.  It isn't the individual immune system either.  The same person who has an asymptomatic infection one time usually gets symptoms the next.

[rookiepro]

One quick error I put in, got different medications I've been on mixed up. I doubt it will alter the spirit of your advice, but it was Cephalex, not Septra, I was on then . . . would it have been effective?

Also, just for the general knowledge of the forum, I was wondering if you could quickly say what causes some gonorrheah/chlamydia infections to be asymptomatic (I read one another post somewhere that it's your specialty I think?) Does it have to do with the strain of the bacteria, or with the strength of the individual immune system? Just curious. Thanks for your help Dr, you've been very helpful.