Oral or throat gonorrhoea

Being diagnosed with oral gonorrhoea comes as a surprise to many people who think that sexually transmitted infections or diseases are limited to genital to gential contact.

In fact, gonorrhoeal infection of the throat is common and often does not produce any symptoms at all. It is estimated that 9 out of 10 cases have no symptoms. Diagnosis until recently has been rather difficult due to the poor pick up rate of traditional swabs and the fragility of the gonorrhoea bacteria. Recent PCR testing has increased diagnostic pickups very considerably.

A recent paper in the International Journal of STD and Aids 2010: 21; 138-140 by Manavi and co workers looked at the rate of co-infection with other STD's, susceptibility of the gonorrhoea detected to antibiotics and the treatment outcome.

The authors make the interesting observation that in conjunction with gonorrhoeal infection of the throat there was a high rate of chlamyidal, HIV, hepatitis B and gonorrhoeal infections of the anus and or genitals in the study group.

They found that the rate of antibiotic resistant gonorrhoea infections was high with as many as 27% of gonorrheao infections in the UK in 2007 being resistant to ciprofloxacin whereas none of the patients studied was resistant to the antibiotic cefixime. It should be noted that in the UK the antibiotic ceftriaxone by injection is the preferred treatment for oral gonorrhoea although the use of an injection may be offputting for some patients.

The majority of the patients in the study were taken from a busy urban genitourinary medicine clinic in the UK. Most were of white ethnicity, were males who had sex with other males, were aged less than 4 years and had other infections.

What this means in practical terms is that it is well worth performing full STD screens, screening for all the above, when patients appear for testing. In addition of course, taking the opportunity to immunise as many people as possible against Hepatitis A and B would be of great benefit.

Using modern screening methods such as DNA PCR swabs is likely to increase the diagnosis.