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Dear doc

7 months ago I received unprotected oral sex ( I am a man) from a csw.  I didn’t think much of it till recently (last week) I began to have knee issues.  My knee became inflamed and stiff to the point where I could hardly walk. Over the last week it has been getting progressively better I went to the doctor who believes it is a tendon or ligament issue
but ran some tests all were normal except my ESR and CRP which were both elevated.  My questions have to do with DGI given that I was at risk for a Gonorrhea.

1)      Is it possible for DGI to present 7 months after exposure? Or is that something that happens very shortly after exposure?

2)      Does the fact that my sedimentation rate and C-reactive protein levels were very elevated hint at DGI?

I did not mention the exposure to the doctor.  He overall seemed to think it was not a septic joint.  I am hoping your response will put my mind at ease.
6 Responses
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239123 tn?1267647614
MEDICAL PROFESSIONAL
You're misreading my comments and opinion.  I have given you strong reasons why your problem is not at all related to chlamydia or any other STD, and I do not believe you have (or had) it. Please re-read my comments carefully.

That will be all for the "yes but" or "what if" questions.  Feel free to report your rheumatologist's opinion or advice, but nothing more 'til then.
Helpful - 0
Avatar universal
I will explore RA with a rheumatologist, but to be honest the whole idea that it can be due to chlamydia has me nervous.  I thought between the medicine I took and the fact that the exposure was oral sex that I would not be at risk for chalmydia.  I tested negative for gonorrhea but did not test for chlamydia since I didnt think it was necessary. The only other partner I have had is my gf who is monogamous (so exploring another exposure as you described in your previous response would not be possible and I know for a fact that she has been faithful). Did I put her at risk for chlamydia?....I'm confused
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Correct about azithromycin and chlamydia, but wrong about gonorrhea.  Although a 1 gram dose of AZM isn't recommended for gonorrhea, it would cure or prevent the large majority of cases (90% or more).

Even AZM isn't perfect for chlamydia (about 95% effective), so you could talk to your doctor about testing for it, especially if s/he believes reactive arthritis is a possibility.  However, if the result were to be positive, you would have to look to other sexual exposures as the source.  As noted above, chlamydia is rarely if ever acquired by oral sex.  (That's because the organism doesn't take hold well in the mouth or throat -- so it is very unlikely your partner had an oral chlamydial infection.)

All things considered, reactive arthritis due to chlamydia seems unlikely.  But that doesn't exclude the diagnosis.  As I said above, some cases of RA are induced by other infections; and others have no obvious trigger at all.

My final advice essentially repeats what I suggested above:  You should not be trying to figure this out by online exploration, either on this forum or anywhere else, and should not be arranging your own testing for chlamydia or anything else.  Please follow your doctor's or a rheumatologist's advice.  If professional, in-person evaluation ultimately comes up with a clear diagnosis (especially if you in fact have reactive arthritis), I would be interested in knowing it.  Other than that, I will have no further comments or advice.
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Avatar universal
RA from Chlamydia seems like a far stretch based on two reasons. The first being I self medicated with 1 gm of azthromycin the day after the exposure ( I know that was stupid but at the time I was panicking, I would of self medicated for gonorrehea but I didn't have the right drugs.). The other being that from this forum and your previous post I have learned that chlamydia is not really transferred through oral sex.

In light of this do you think it would make sense to test for chlamydia just to be sure or can I rule out RA due to chlamydia all together based on these two facts?
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
By "mention 'it' to your doctor" I meant your sexual exposure, and any other potential STD exposures in the past year or so.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum.  I'll try to help.

Disseminated gonococcal infection (DGI) doesn't behave at all like you describe.  It is an acute complication of gonorrhea, usually starting within days of catching it and certainly within a few weeks.  And DGI doesn't generally start simply with a single painful joint.  Although asymptomatic gonorrhea can occur in men and can be acquired by oral sex, both of these are rare.  Finally, gonorrhea in men generally resolves on its own, without treatment, within a few weeks -- so even in the unlikely chance you acquired urethral gonorrhea 7 month ago, almost certainly the infection is long gone.  As for the elevated CRP and ESR, that is expected with any inflammatory condition; in and of themselves, these test results don't hint at DGI.

So all things considered, DGI is not a serious consideration.  However, there is one other potential STD-related concern, namely reactive arthritis (formerly called Reiter's syndrome).  Reactive arthritis can present with a single inflamed joint, and the knee is commonly involved, the CRP and ESR usually are elevated, and this can be a delayed complication of chlamydial infection.  On the other hand, chlamydia is rarely if ever acquired by oral sex, and reactive arthritis is also triggered by certain non-STD intestinal infections.  And there are a number of other conditions that are potential causes of new arthritis of the knee.  Still, it would be wise to mention it to your doctor and to ask about reactive arthritis, as well as other possibilities.

If uncertainty about the diagnosis continues, you should consider asking for referral to a rheumatologist for expert consultation. But in the meantime, I doubt this is related in any way to the oral sexual exposure.

Regards--  HHH, MD
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