STD Awareness: Gonorrhea of the Throat

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?

Gonococci can band together to attach themselves to a human cell. Image: Dustin Higashi, University of Arizona

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.

Click here to check out other installments of our monthly STD Awareness series!

17 thoughts on “STD Awareness: Gonorrhea of the Throat

  1. Pingback: STD Awareness: “Can I Get an STD from Oral Sex?” | Planned Parenthood Advocates of Arizona | Blog

  2. Good article. This weeks New Yorker has an article on the rise of drug-resistant gonorrhea, very detailed about how oral sex is a risk, but not as informative about prevention as this post.

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  8. “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.”

    Really? Really???? Right there, the author should be prohibited from ever writing about sexual anything ever again.

    • Do you care to elaborate? The medical literature supports the idea that sore throat is associated with a history of fellatio, with or without the presence of a pharyngeal infection with gonorrhea. Here is one source:

      Evaluation of pharyngeal symptoms is confounded, however, by the intriguing observation that among clients of STD clinics, sore throat and perhaps overt pharyngitis are correlated with a history of fellatio but not with isolation of N. gonorrhoeae or other sexually transmitted organisms. Cunnilingus has not been associated with pharyngeal symptoms. (Sexually Transmitted Diseases, 4th edition, by K.K. Holmes et al., page 633)

      The idea that cunnilingus might affect the throat differently than fellatio is not my own; I found it in several medical sources, where it is presented as a hypothesis — not a fact. I didn’t present it as a fact either. You are welcome to disagree, but sharing arguments supported by facts is preferred to personal attacks. In fact, personal attacks go against our commenting policy.

      • I do apologize for my snark. I do not object to the idea that pharyngeal gonorrhea is more likely to be spread during fellatio.

        This is the phrase I, um, choked on: “Perhaps there is something about fellatio that has the potential to irritate the throat, independently of a gonorrhea infection.”

        Yes. Yes, perhaps there is. Gee. Wonder what it could be?

        • Well, the point is that we can speculate about what it could be, but the scientists writing articles in medical journals are usually careful not to overstate their case. For example, we might hypothesize that semen could have a protein in it that irritates the throat, but to my knowledge this hasn’t actually been studied scientifically (I’d love to see the grant proposal for that study, though).

          Personally I thought the cautious language was amusing, but perhaps I am only amusing myself!

          • Lmao!!!!! Awesome reply Anna C. I just happened to come across this article by accident. It was very interesting and really puts things into perspective… As a young sexually active male. I definitely need to be more cautious with the different partners I choose and definitely use protection more frequently as I almost never had done so with any of my EXs/females I have had intercourse with. Thankfully I’ve yet to come across such a thing, and I look to steer clear of anything like this in the future (knocking on wood). So with this added awareness it was definitely an eye opener. Thanks.

          • This is extremely late to the game, but I believe the point that Juju was trying to make was that, well, it’s common sense that fellatio leads to more throat gc than cunnilingus. When most women perform fellatio, the penis goes inside the mouth, and touches the throat, for extended periods of time. With cunnilingus, there is a smaller contact area and, to the best of my knowledge and experience, no one puts the vagina inside of their mouth or touches it with their throat. So while you may have been wondering about sperm proteins, the sentence comes across as lacking knowledge about what fellatio and cunnilingus actually are, which is worrying for an article specifically about oral stds and sexual health. It seems extremely obvious that a penis on the throat has more infection potential for a throat std than a clit on the tongue.

          • Sure! I hesitate to present “common sense” as scientific fact, since it sometimes turns out to be wrong or incomplete. And the scientific articles I was reading about oral gonorrhea were themselves hesitant to put forth explanations that didn’t have a basis in experiments — so they, too, might be accused of not knowing about the mechanics of fellatio vs. cunnilingus. But I’ve been learning a lot over the years about bridging the communication gap between the cautious language of scientists and the everyday way laypeople use and understand language, and am always striving to do better.

  9. If a male has gonorrhea of the throat, can he transmit the infection from his penis to a woman’s vagina through his semen?

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