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Pictured above: Gonococci can band together to attach themselves to a human cell. From: Dustin Higashi, University of Arizona http://uanews.org/node/33150

Editor’s note: For more information on oral gonorrhea, please see our post Why Should You Care About Oral Gonorrhea? For more information on whether a gonorrhea infection can go away without treatment, please see our post Will STDs Go Away on Their Own?

My fellow Generation Xers might remember an episode of Chicago Hope in which a very young Jessica Alba portrays a teenage girl with a gonorrhea infection in her throat — also called pharyngeal gonorrhea. The actress later reported being shunned by members of her church, disillusioning her from the religion she grew up with. It is a testament to the power of taboo that even a fictional association with a sexually transmitted disease (STD) can elicit such negative reactions.

Taboos can affect the ways we relate to one another sexually, as well. Many of us conceptualize of disease as “dirty,” and the flip side to that is to think of people without disease as “clean.” This kind of stigmatizing language can be found in phrases like “She looked clean” and “Don’t worry, I’m clean” — all to describe people who are perceived to be or who claim to be free of STDs. With all the baggage we put on STD status, it can be difficult to ask a partner to use a condom or dental dam during oral sex. Some people might think we don’t trust them or are underhandedly questioning their “cleanliness.” These sorts of fears can cloud our judgment when it comes to protecting our health, but there is nothing wrong with asking your partner to use protection during oral sex — especially if you don’t know one another’s STD status. There are many good reasons to use barrier methods when engaging in oral sex, and pharyngeal gonorrhea is just one of them.

Unprotected oral contact with a penis puts you at the most risk of acquiring pharyngeal gonorrhea.

Gonorrhea is most famous as an infection of the cervix or the urethra. But gonococci, the bacteria that cause gonorrhea, can thrive in other warm, moist areas of your body — not just the reproductive tract, but also the mouth, throat, eyes, and anus. Gonococci can be transmitted to your mouth or throat via oral sex — most likely via unprotected oral sex. Symptoms might include a sore throat, but 90 percent of the time there are no symptoms at all.

If you were to put everyone with gonorrhea into one giant room, you would be able to find gonococci in the throats of about:

  • 3 to 7 percent of heterosexual men
  • 10 to 20 percent of heterosexual women
  • 10 to 25 percent of men who have sex with men (MSM)

As shown by the above numbers, people who perform fellatio (oral contact with a penis) are much more likely to wind up with pharyngeal gonorrhea than are those whose oral-sex repertoire includes only cunnilingus (oral contact with a vagina, clitoris, etc.). Interestingly, performing fellatio seems to be associated with symptoms of pharyngeal gonorrhea while performing cunnilingus does not. Perhaps there is something about fellatio that has the potential to irritate the throat, independently of a gonorrhea infection.

Although gonorrhea can be spread via cervical and vaginal secretions, the frequency of transmission by this route has not been well studied among women who have sex with women (WSW). Documentation of pharyngeal gonorrhea among exclusively lesbian populations is rare, although it certainly exists!

While transmission of gonorrhea from a penis to a mouth has been well documented, researchers aren’t quite sure how easy it is to transmit gonorrhea from a mouth to a urethra, vagina, or anus. Despite an unknown transmission rate, the fact remains that this mode of transmission is possible — therefore, during the time you have a pharyngeal gonorrhea infection, you can transmit the infection to your partner(s).

The good news about pharyngeal gonorrhea is that gonococci don’t seem very well suited to living in throats — they are much better adapted to the anus and genitals. A flurry of research on pharyngeal gonorrhea was performed in the 1970s and 1980s, when it was demonstrated that gonorrhea infections in the throat can clear up without medical intervention within three months — with possibly half of infections going away after just a week.

This shouldn’t lull you into complacency, however — during the time you have a pharyngeal gonorrhea infection, you have the potential to infect others, and some experts fear that these symptom-free, under-the-radar infections might perpetuate strains of antibiotic-resistant gonorrhea. Furthermore, depending on your other sexual activities you might have gonorrhea in your genital or anal area as well, and infections in those sites are often asymptomatic. Additionally (and rarely), someone with untreated gonorrhea can develop a form of infective arthritis called disseminated gonococcal infection (DGI), which can cause joint pain, rashes, lesions, or fever. It seems likely that someone with a pharyngeal gonorrhea infection might also be at increased risk for DGI, despite the ability of a throat infection to clear up on its own. DGI can be treated, but if it is ignored for too long it can cause permanent joint damage.

It’s unfortunate that so many people are under the impression that barrier methods aren’t necessary during oral sex (at least when we don’t know our partners’ STD status) — this leaves them more vulnerable to preventable infections. Furthermore, pharyngeal gonorrhea is more difficult to treat than gonorrhea in the genital or anal areas. Throat infections are treated most effectively with a single shot of ceftriaxone and an oral antibiotic. While genital and anal gonorrhea infections are usually treated this way as well, they can also be treated with a wider range of antibiotics — but these other antibiotics aren’t as effective against pharyngeal infections. And, since there are strains of antibiotic-resistant gonorrhea out there, you don’t want your choice of antibiotics to be further limited.

Pharyngeal gonorrhea is diagnosed by taking a swab of the throat. You can receive testing and treatment at a Planned Parenthood health center, as well as other clinics, health departments, and private health care providers. Infected individuals should also make sure their sexual partners receive treatment to ensure that they won’t be reinfected.

Tags: sexual health, oral sex, condom, sexually transmitted infections, STI, safer sex, gonorrhea, STD Awareness

About Anna C.

Anna first volunteered for Planned Parenthood as a high school student in the 1990s. Since then, she has received a bachelor’s degree from UC Berkeley and a master's degree in epidemiology from the University of Arizona. As an ode to her fascination with microbes, she writes the monthly STD Awareness series, as well as other pieces focusing on health and medicine.