Positive for chlamydia, question about gonorrhea

[BronxChuck]

Hello Doctors:

A little background:

I recently had protected vaginal sex with a woman, and performed unprotected oral sex on her, and she performed unprotected oral sex on me; then, a short while later, I also performed unprotected oral sex on a man, and he ejaculated in my mouth (I am a man). Other than these two incidences, I have not had any other sexual contact for months.

I immediately started to worry that I had an STD, but didn't really have many symptoms. I did have a little redness/irritation/discomfort around the head of my penis (the main reason I thought I might have an STD), but no other sores. No real burning while urinating, and some discharge, but it was white, not yellow, and not every time. I have experienced this type of discharge most of my life, and it has never been STD related. Nevertheless, I went and got tested for several STDs.

I came back positive for chlamydia and HSV-1. I was given Zithromax (1g) which I have taken. My question is this:

I was not tested for gonorrhea; given that it seems it is very difficult to get chlamydia just through oral sex, should I get tested for gonorrhea as well? Should I get the test immediately, or wait a week or so and get tested, and then re-tested for chlamydia at the same time (to make sure the treatment worked)?

I have had no other symptoms other than those described above. Thanks for any advice you can give!

[Edward W Hook, MD]

Personally I think you are worrying needlessly.  That said, I understand your desire for testing.  Even if they do not do it, your health department should be able to tell you where you can have a swab test for  both gonorrhea and chlamydial infection of the throat (they are typically done off the same swab)  As you point out testing your urine (penis) for a throat infection makes no sense.

Azithromycin (Zithromax could cure both gonorrhea as well as chlamydia but the recommended doe for gonorrhea is higher than for chlamydia.  2.0 grams as a single dose rather than just 1 gram.  EWH

[Edward W Hook, MD]

Welcome to our Forum and thanks for your detailed descriptions  I have several comments and a recommendation.

Your exposures of concern include active and receptive oral sex.  Your protected vaginal sex is not a major concern- condom protected sex is safe sex.  

You do not say what sort of testing was performed to make your diagnosis.  I presume your urine or a swab from your penis was the specimen tested for chlamydia. If your urine or swab test was positive for chlamydia it would be quite unusual for the same specimen to have not been tested for gonorrhea at the same time.  Thus one of the first things I would suggest is for you to call your doctor’s office and see if perhaps you were tested for gonorrhea.  If so and the test was negative, you have nothing further to worry about.  If not, I suppose testing for gonorrhea would be a good idea.  The azithromycin at the dose you took would have cured many but not all gonorrhea infections of the penis.  

As you have mentioned, oral chlamydial infections are very, very rare (almost unheard of), as is transmission of chlamydia from a person's mouth to another person.  If you had penile chlamydia the infection may have been present for some time as an asymptomatic infection or it may have been transmitted to you. either way, the 1.0 gram dose of azithromycin should be curative.  There is no recommended need for follow-up chlamydial testing.  

If you were not tested for gonorrhea, testing is a good idea.  Given your exposures however, I would emphasize the need to have your throat tested at the time of testing.

I hope this information is helpful.  I look forward to hearing more from you about what sorts of test specimens were collected.  EWH

[BronxChuck]

Thank you!

[BronxChuck]

Sorry to ask yet another question, but I am having a hard time finding any place that uses an oral swab to test for oral gonorrhea-- almost every place just uses urine tests, which I don't think I need (as I have never had unprotected vaginal/anal sex). My concern is that since I did have unprotected oral sex, and did test positive for chlamydia (even though it was on an unreliable blood test) that I possibly might have contracted oral gonorrhea. Am I just needlessly worrying? I am entering what I hope to be a monogamous, long-term relationship, and I want to be able to do so worry- and disease-free. Why is it so hard to find anyone who tests for oral gonorrhea, since that is the most common STD you can get from oral sex? If I did have it, would the Zithromax likely take care of it as well?

Sorry for the barrage of questions, but just trying to get a little more clarity, so I can know how to proceed.

Thanks!

[Edward W Hook, MD]

Gald to help. Take care.  EWH

[BronxChuck]

Thanks Dr. Hook! I likely will get the oral gonorrhea test, just to put my mind at ease, but your responses were so helpful! I don't think I'll get re-tested for chlamydia; I have faith in the Zithromax. This has been really helpful!

[Edward W Hook, MD]

Thanks for the clarification.  Blood tests for chlamydia and notoriously unreliable.  Given the circumstances of your testing. I would guess that you did not have chlamydia.  

At this time, if I were you I would not worry further.  If however you want to geo get tested, as I said swab or, for the penis, urine, tests are the way to go.  EWH

[BronxChuck]

The chlamydia test was done using a blood sample-- was that sufficient? That's why I was not tested for gonnorhea. How long could I possibly have had asymptomatic chlamydia? I had a battery of (negative) tests done 15 years ago, but since that time (until the two recent instances I related above) I have not had unprotected sex (oral or penatrative) with anyone outside of  a long term monogamous relationship (9 years).