About 8 weeks ago I was the involved in an oral sex with a Korean CSW at a massage parlor in the U.S.(I was sucked). She did not have a condom so instead used plastic wrap which at the time I really didn’t think much of it. I am a nervous person by nature so 24 (actually 26) hours later after processing it I went to a clinic and was given a shot 250mg of ceftriaxone and 1g of azthromycin, at that point I was tested negative for gonorrhea and chlamydia by culture ( Im not sure why not NAAT was not given) . I realize this testing was too soon to be considered a useful diagnostic. After the recommended amount of time I again had sex with my wife. Three weeks later I had a serious bout of tendonitis in my foot which over a 2 week span was treated three times with injectiable corticosteroids which was eventually successful in relieving the pain. I have had similar tendon problems in my ankle/ foot before. During this time I also had some small lesions and scabs on my ankle which I was fairly sure were due to mosquito bites. A dermatologist confirmed they were bites I had irritated by scratching. Over the last two days I have had some ankle pain, as well as dull shooting pains in both my knees. I have of course been thinking about the possibility disseminated gonorrhea infection (dgi). My wife is pregnant which of course makes more nervous about this possibility. I want to test again to be sure I am not infected. From what I have read in older literature that mucosal cultures are positive 80% of the time when people have DGI? Is this true?
My questions are:
Is it possible for Gonorrhea to disseminate into the blood stream in 24 hours?
If I did in fact have DGI and were to test with a urine sample NAAT for gonorrhea , would it be positive given how sensitive it or has that ship sailed (it would no longer be useful as a diagnostic)?
Would the early dose of ceftriaxone that I have prevent dissemination? Is it medically possible for me to have dgi? (given that therapy failure with ceftriaxone is almost unheard of)?
This has been a difficult time for me, my doctor and the dermatologist I consulted have suggested that guilt is really the cause of this and while I admit that I do have those feelings my symptoms are real and would really like to put this behind with some kind of peace of mind.
Hello,
Thank you for your post and welcome to our forum.
It would highly unlikely and virtually impossible for you to have developed disseminated gonorrhoea after only 24 hours. In any case you were treated with the correct antibiotic treatment very early on, which would have cleared gonorrhoea completely in the event that you had been infected in the first place. Therefore you could not have developed disseminated gonorrhoea and I do not believe that your symptoms of tendonitis have anything to do with it. Doing any tests now will not be useful as you have already been treated and results will be negative. I am totally confident that you do not have disseminated gonococcal infection.
Best wishes,
José
Thank you so much for your asessment. One of the major reasons I was so worried is when my doctor gave me the diagnosis for tendinitis, he said it could also be tenosynovitis which is clearly listed as a main component of DGI. Although your response has calmed me down, just for peace of mind and at this point to end my academic search ( I have read through a number of academic papers trying to find the answer).
Will a urine NAAT test with someone ( i guess not me) with DGI be positive? or because of dissemination that type of test is not valuable as a diagnostic? If the answer is yes, what is the medical logic behind it?I think mentally it will help me to test, collect my negative and move on.
On another note, do you think the plastic wrap would of served as sufficient barrier in the contact? I know there is no data on the issue but I have some sources say it is the next best thing to a condom and other say it serves almost no protection
That test is certainly of value to confirm the diagnosis and place of entry of infection, provided that the patient has not been treated before the test is performed. Obviosuly if the patient has already been treated correctly is highly unlikely that disseminated gonorrhoea would develop. Another diagnostic tool is to perform a NAAT (PCR) test on joint fluid from an aspirate. I do not beleive that this is required in your case.
I cannot really comment on the plastic wrap; I doubt that it would have been an effective barrier.
Best wishes,
José
Difficult question
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