Risk of STD's through oral sex

[male05101979]

Hi, I am a 31 year old male who had sex with a prostitute in Malaysia 2 weeks ago. I used protection except when she finished by giving my oral sex and I made a point not to ejaculate in her mouth. Less than 10 days later I notice discharge and went to the clinic to be screened. The results showed I had gonorrhoea and NGU. I was given antibiotics and told not to have sex for 7 days.

Now I am concerned about the risk to my girlfriend and would really appreciate your help on the following;

1) My understanding is that the incubation period is 2-14 days and so I can be sure that it was this incident that infected me since I had not had sex for up to a month before. Is this correct?

2) What other STI’s am I at risk to that would take longer than 10 days to show up? i.e. HIV takes upto 12 weeks right?

3) Can you catch both gonorrhoea and NGU in the same exposure?

3) Should I go back to be screened after 7 days to ensure the bacteria has gone?

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

I'm a bit confused by your diagnosis, since it is not possible to diagnose gonorrhea and NGU at the same time.  The very name nongonococcal urethritis means infection not caused by gonorrhea.  If a person presents with urethritis and gonorrhea is present, then by definition the patient does not have NGU.  However, treatment against urethritis of any kind typically is designed to cover both gonorrhea and NGU (and chlamydia, a common cause of NGU, but rarely acquired by oral sex).  Perhaps that's where the confusion comes from -- i.e. you were treated for both and there was some miscommunication about the diagnosis.  Exactly what treatment(s) were you given?

1) The incubation period for gonorrhea typically is 2-5 days, but sometimes a week; for NGU it's usually 7-14 days, maybe up to 3 weeks or so.  It is very unlikely your infection dates back to your last contact a month earlier.

2) All STDs that could be transmitted by oral sex would show up with symptoms within 2-3 weeks.  Syphilis is unlikely, but its blood test takes 6 weeks to be reliable.  Herpes and HIV are too rare in this situation to be worthy of testing, if this is your only potential exposure.

3) See my opening comments.  Certainly they can be acquired together, but it isn't possible to diagnose both NGU and gonorrhea simultaneously.

4) The standard treatments are sufficiently reliable that re-testing to check for cure is not usually necessary.  If your penile discharge clears up, there is no need -- but if in doubt about this, check with the clinic where you were treated.

Feel free to return with a follow-up comment if you can clarify the diagnosis and/or the treatment(s) you received.  But if your symptoms clear up and do not return within 1-2 weeks, you can put this incident behind you.

Regards--  HHH, MD

[male05101979]

Thanks for your help!

[H. Hunter Handsfield, M.D.]

I stand by my reply about simultaneous diagnosis of NGU (yes, it's the same as NSU, short for "nonspecific" urethritis).  My interpretation is that you had gonorrhea and there is no way they could know you had simultaneous NGU/NSU.  If you need further clarity, you will have to contact the clinic.

Your treatment sounds typical; single dose treatment ("all in one go") is the norm.  The 2 tablets probably were cefixime (400 mg total) or a related drug for gonorrhea, and the 4 tablets azithromycin (1.0 g total) for NGU and chlamydia.  

[male05101979]

Hello, thanks for the quick reply. The clinic definitely told me I had both gonorrhoea and NSU (Non Specific Urethritis) which I understood is the same as NGU. Do you think it could be that they detected another form of bacteria they they could not identify as Chlamydia or Gonorrhoea?

I don't remember the exact antibiotics they gave me but it was 2 tables of one and 4 of another, all taken there and then in one go (which surprised me?).

Thanks again.