Dear Dr. Eva,

A friend says that he was treated for gonorrhea in the throat and was told he didn’t need a follow-up test to make sure it was gone. Does this make sense? Is there such a thing as gonorrhea in the throat? And if a person has an STD, don’t they always need to a follow-up test to make sure it’s gone?

Dubious

Dear Dubious,

Yes, there definitely is such a thing as gonorrhea infection of the throat. Throat gonorrhea is picked up when a person gives oral sex to a man who has gonorrhea of the penis. After being infected, a person can carry this infection for a long time without being aware of it. Nine out of ten cases of throat gonorrhea are totally silent – that is, the person doesn’t have any symptoms. No sore throat, no difficulty swallowing, no fever, no swollen neck lymph nodes (“glands”).

Throat gonorrhea is easy to diagnose: a throat swab for a test called NAAT (nucleic acid amplification test) will give the answer within a few days. Only the NAAT test can make this diagnosis; the tests and cultures used to diagnose strep throat do not test for gonorrhea. The NAAT test is available at many primary care doctors’ offices, all medical labs (with an order from your MD, nurse practitioner, or physician’s assistant), or at any sexually-transmitted disease clinic.

How is throat gonorrhea treated? Treatment is the same as for gonorrhea of the penis, anus, or vagina: an injection (shot) of the antibiotic ceftriaxone plus a dose of a second antibiotic, azithromycin, taken by mouth. The injection must be given in the deltoid muscle (upper arm), it does not absorb well enough if given in the butt muscles. The azithromycin is given for two reasons. First, it treats chlamydia, a second infection that is often picked up at the same time as gonorrhea. Second, taking a second antibiotic prevents the development of antibiotic-resistant strains of gonorrhea.

If throat gonorrhea is silent, how do I know when to get tested? People who have unprotected oral sex, especially with more than one partner, should be checked regularly. How often depends on the number of partners and the person’s past history of sexually transmitted infections. For most men who have sex with men, testing is recommended at least every six months and some experts recommend testing every three months.

What about testing for cure? Current (2015) guidelines from the CDC (Centers for Disease Control) do not recommend retesting if the standard treatment was given. Treatment is so effective that re-testing isn’t necessary. If a follow-up test shows infection, it means the person has been re-infected.

Eva Hersh is a Baltimore family physician. Send your comments and questions to her by email at dreva@baltimoreoutloud.com.

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