STD Awareness: Why Should You Care About Oral Gonorrhea?

Image: CDC

An illustration of Neisseria gonorrhoeae, the bacteria that cause gonorrhea. Image: CDC

When I say “gonorrhea,” you might think of genitals that feel as though they have been set ablaze, or perhaps a viscous fluid oozing from the urethra. But gonococci, the bacteria that cause gonorrhea, can also set up camp in the pharynx after being transmitted into a mouth and down a throat when its new host gave oral sex to its old host. Indeed, performing oral sex on multiple partners has been found to increase risk for an oral gonorrhea infection (more properly called pharyngeal gonorrhea).

If you read our September 2012 article on gonorrhea of the throat, you might remember these fun facts: Oral gonorrhea goes away within three months, even without treatment! Plus, these infections rarely have symptoms. Why, then, should you care about a gonorrhea infection in your throat? You’re not likely to notice it’s there, and it’ll go away on its own anyway.


Many researchers believe that the throat is an incubator for antibiotic-resistant gonorrhea.


Well, aside from the possibility of transmitting a gonorrhea infection from your throat to someone’s genitals, there’s one other thing to care about: the development of antibiotic resistance.

The emergence of antibiotic-resistant gonorrhea is considered one of the most pressing problems in infectious disease — just two years ago, the Centers for Disease Control and Prevention named it an “urgent threat,” and indeed, gonorrhea seems to be evolving resistance to drugs at quite a rapid clip. If gonorrhea evolves complete resistance to the drugs we use to cure it, we could find ourselves sent back in time, to the days when gonorrhea was untreatable — and responsible for infertility, blindness, and chronic pain. While scientists figure out how to address this emerging threat, you can do your part by avoiding gonorrhea in the first place — and that includes using condoms and dental dams to prevent oral gonorrhea infections.

So, while it sounds like a blessing that gonorrhea of the throat rarely has symptoms, there’s actually a drawback: An oral gonorrhea infection probably won’t be effectively treated — or even identified in the first place. And these hidden throat infections are likely to be helping to drive the development of antibiotic resistance. Continue reading

STD Awareness: An Update on Antibiotic-Resistant Gonorrhea

Last year, we shared the fascinating and frightening story of the emergence of increasingly antibiotic-resistant gonorrhea, an STD caused by the gonococci bacteria. The sexually transmitted scourge, which we only so recently reined in with the development of antibiotics, has been performing some genetic gymnastics to defeat almost every drug we’ve thrown at it. We douse it with certain drugs, and the bacterium literally spits them back out at us, and it inactivates other drugs by snapping the active molecules in half. Sulfa drugs, penicillins, tetracyclines, fluoroquinolones — they all make a gonococcus heave a bored sigh. Luckily, cephalosporins were still an effective treatment, but recently there have been reports of stubborn gonorrhea infections caused by the latest and greatest (and some might say most hated) strain of gonococci.


The bacteria that cause gonorrhea continue to evolve, right under our noses!


Well, the story isn’t over — just like the bacteria that cause gonorrhea, the tale is rapidly evolving. The latest class of antibiotics that the gonococci are chipping away at is the cephalosporin family, which includes several chemically related drugs that work in similar ways — and that can likewise be defeated by microbes in similar ways. Cephalosporin-resistant gonorrhea was first reported in Japan and documented in a few European countries. The Japanese case that inspired the New England Journal of Medicine to declare last year that it was “time to sound the alarm” was an oral gonorrhea infection that was resistant to one member of the cephalosporin family: ceftriaxone.

Earlier this month, the prestigious medical journal JAMA reported the first North American sightings of gonorrhea that failed treatment with another cephalosporin: cefixime. Yeah, I know, you’d rather hear about Big Foot or UFO sightings, not evidence that something as real and unmythical as Gonorrhea 5.0 has landed in your back yard. Luckily, there’s plenty you can do to protect yourself from it, and we’ll tell you all about it toward the end of this article. (Spoiler alert: It involves using condoms!) Continue reading

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. Continue reading