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Gonorrhea is a common sexually transmitted infection (STI) that can affect the genital area, rectum, eye, and throat. This last type is also called pharyngeal or oropharyngeal gonorrhea. In approximately 90% of people, it does not cause any symptoms, and it is usually only detected by screening tests (Mayor, 2012). Oropharyngeal gonorrhea is seen in approximately 3%-7% of men who have sex with men (MSM), 0.4% of heterosexual men, and 0.1% of women (Lewis, 2015)). Oral gonorrhea can be spread by oral sex of any kind; recent studies have shown that tongue kissing (Chow, 2019) or using saliva as a lubricant during anal sex may contribute to its spread (Fairely, 2018).
The mouth and throat harbor many different types of bacteria. Having so many different neighbors allows the gonorrhea bacteria, Neisseria gonorrheae, to swap genetic material with other bacteria living in the mouth and throat and thereby become resistant to antibiotics. There are theories that oropharyngeal gonorrhea is contributing to the development of antibiotic-resistant gonorrhea worldwide, but it has not been definitively proven.
- Oral or oropharyngeal gonorrhea does not cause any symptoms in more than 90% of people.
- Men who have sex with men (MSM) are at higher risk of getting oropharyngeal gonorrhea.
- Oropharyngeal gonorrhea is both more difficult to detect and to treat than other types of gonorrhea infections.
- Any kind of sexual activity involving saliva increases the risk of transmission.
Oral gonorrhea vs. strep throat
Whenever someone has a sore throat, the first question often asked is, “Is it strep?”. It can be hard to differentiate oropharyngeal gonorrhea and strep throat without lab testing.
Although most people with oral gonorrhea don’t have symptoms, the most common symptoms when symptoms are present include:
- Throat soreness or redness (pharyngitis)
- Swollen lymph nodes in the neck (lymphadenopathy)
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These symptoms are similar to those seen in strep throat; people with strep throat typically experience the following symptoms:
- Fever (101˚F or higher)
- Swollen lymph nodes in the neck
- Throat soreness and redness with white patches
If you have been having oral sex and are experiencing these symptoms, you should tell your health care provider so that you can be tested for oral gonorrhea in addition to strep throat.
Testing for oropharyngeal gonorrhea (throat swabs)
If you get tested for gonorrhea, it is important to tell your healthcare provider if you have been having oral sex so that you can have your throat checked as well. Culture remains the “gold standard” for testing for oropharyngeal gonorrhea; the nucleic acid amplification test (NAAT) that is commonly used for genital gonorrhea has not been FDA approved for testing for the presence of oropharyngeal gonorrhea. To culture gonorrhea, a sterile swab is rubbed against the back of the throat and then onto a culture plate. Several days are needed for the bacterial colonies to grow enough so that they can be tested for N. gonorrhoeae. Anyone who tests positive for gonorrhea should also be tested for other STIs like chlamydia, syphilis, and HIV/AIDS.
Even though oropharyngeal gonorrhea does not usually cause any symptoms, it is still important that you get treated. Oropharyngeal gonorrhea can last for 3-4 months if left untreated, so people can unwittingly infect their sexual partners for months. Oropharyngeal gonorrhea is also a risk factor for developing urethral gonorrhea and can lead to disseminated gonococcal infection (DGI)–a serious and sometimes life-threatening complication.
Gonorrhea all over the world is becoming more and more resistant to antibiotics; fortunately, most types of gonorrhea are readily curable using dual therapy (two antibiotics to treat one infection). Oropharyngeal gonorrhea, however, is not cured as easily. Overall, gonorrhea has a cure rate of around 96% (Lewis, 2015). But looking at oropharyngeal gonorrhea specifically, the cure rate is approximately 80% for men and 83% for women (Lewis, 2015). The Centers for Disease Control and Prevention (CDC) currently recommend treating oropharyngeal gonorrhea with two antibiotics, ceftriaxone, and azithromycin, each given as a single dose (CDC, 2015). While this is the most effective treatment regimen to date, it is not as effective for oropharyngeal gonorrhea as it is for the other forms.
Studies are looking at the option of using mouthwash as a preventative measure to address the spread of gonorrhea during oral sex. The results are positive, but no treatment guidelines have been established (Fairley, 2018).
Gonorrhea is asymptomatic in many patients, especially the oropharyngeal type of infection. You should discuss any sexual practices involving saliva with your healthcare provider, especially if you are being tested for gonorrhea. Men who have sex with men are at higher risk and should be aware of this condition. You should always practice safe sex, regardless of the type of intercourse.