Gonorrhea: Discharge and Symptoms in the Mouth

Gonorrhea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. While gonorrhea commonly affects the genital area, it can also infect other parts of the body, including the throat and mouth. Oral gonorrhea, or oropharyngeal gonorrhea, occurs when the bacteria infect the throat and mouth, usually through oral sexual contact with an infected partner. This article will explore the symptoms of gonorrhea in the mouth, including discharge and other notable signs, and provide guidance on diagnosis and treatment.

How is Oral Gonorrhea Transmitted?

Oral gonorrhea is primarily spread through oral-genital contact with an infected partner. The bacteria can enter the mouth and throat through contact with the genital fluids of an infected person, leading to infection. It’s important to note that oral gonorrhea can also spread to the genital area if an individual engages in both oral and genital sexual activities with an infected partner.

While oral gonorrhea is less common than genital gonorrhea, it is still a significant health concern because it can be asymptomatic, meaning many people may not realize they are infected and could unknowingly transmit the infection to others.

Symptoms of Oral Gonorrhea

Oral gonorrhea can often be asymptomatic, especially in its early stages. When symptoms do occur, they may include:

1. Sore Throat: A persistent sore throat is one of the most common symptoms of oral gonorrhea. Unlike typical sore throats caused by viral infections, this discomfort may persist longer without other typical cold symptoms.

2. Redness and Swelling in the Throat: The back of the throat may appear red and inflamed. Some people may notice swollen tonsils, which can also have a white or yellowish coating.

3. Discharge in the Mouth or Throat: In some cases, individuals with oral gonorrhea may experience thick, yellowish or greenish discharge in the back of the throat. This discharge can be accompanied by a bad taste in the mouth or bad breath.

4. Swollen Lymph Nodes: The lymph nodes in the neck may become swollen and tender as the immune system responds to the infection.

5. Difficulty Swallowing: Severe cases of oral gonorrhea can make swallowing painful due to throat inflammation, though this symptom is less common.

6. Bad Breath: The infection may lead to an unpleasant taste in the mouth and bad breath.

7. Fever: A low-grade fever is occasionally reported with oral gonorrhea, but it is not a common symptom.

How is Oral Gonorrhea Diagnosed?

Oral gonorrhea can be diagnosed through a combination of medical history, physical examination, and laboratory testing. The steps typically include:

1. Swab Test: A healthcare provider will take a swab from the back of the throat, which will be tested for the presence of Neisseria gonorrhoeae bacteria.

2. Nucleic Acid Amplification Test (NAAT): This is a highly accurate test used to detect gonorrhea. It is commonly used for genital infections and can also confirm oropharyngeal infections.

3. Culture Test: In some cases, a throat culture may be taken to identify the presence of gonorrhea bacteria, especially if antibiotic resistance is a concern.

4. Blood Tests (if needed): Blood tests may be done to rule out other infections if symptoms are unclear.

Treatment of Oral Gonorrhea

Oral gonorrhea is treated with antibiotics. The Centers for Disease Control and Prevention (CDC) currently recommends a single injection of ceftriaxone for treating gonorrhea, including oropharyngeal infections. In cases where ceftriaxone is not available or tolerated, an alternative regimen may be used.

1. Antibiotic Injection (Ceftriaxone): This is the primary treatment for gonorrhea, including oral gonorrhea, as it effectively targets Neisseria gonorrhoeae bacteria.

2. Azithromycin or Doxycycline (in some cases): These antibiotics may be used in conjunction with ceftriaxone if there is a risk of coinfection with Chlamydia trachomatis, as both infections can occur simultaneously.

It is crucial for individuals being treated for oral gonorrhea to abstain from sexual activity until the infection is fully cleared to prevent reinfection or transmission to others. Additionally, all recent sexual partners should be informed, tested, and treated as needed to prevent the spread of the infection.

Potential Complications of Untreated Oral Gonorrhea

If left untreated, oral gonorrhea can lead to complications, though these are less common than with genital gonorrhea. Potential complications include:

1. Spread of Infection: The bacteria can spread to other areas of the body, potentially leading to disseminated gonococcal infection (DGI), which can cause joint pain, skin sores, and other systemic issues.

2. Increased Risk of Transmission: Untreated oral gonorrhea can increase the risk of transmitting the infection to others, especially during oral-genital contact.

3. Coinfection Risk: Individuals with oral gonorrhea are at higher risk of contracting other STIs, including HIV, due to the open sores and inflammation in the mouth and throat.

4. Tonsillitis and Pharyngitis: Persistent inflammation can lead to chronic tonsillitis or pharyngitis, requiring further treatment or intervention.

Preventing Oral Gonorrhea

Preventing oral gonorrhea requires practicing safer sex and being aware of personal and partner health statuses. Here are some preventive measures:

• Use Condoms and Dental Dams: Using condoms and dental dams during oral sex can significantly reduce the risk of transmitting gonorrhea.

• Regular STI Testing: Routine STI screenings for sexually active individuals can help detect and treat infections early, even when symptoms are not present.

• Open Communication with Partners: Discussing STI testing and health status with sexual partners can reduce the risk of transmission.

• Avoid Sharing Eating Utensils or Mouth Contact: Although gonorrhea is rarely spread through casual contact, avoiding sharing utensils or direct contact when symptoms are present can further reduce the risk of transmission.

Conclusion

Oral gonorrhea is an STI caused by Neisseria gonorrhoeae that can affect the mouth and throat, often leading to symptoms like sore throat, discharge, and swollen lymph nodes. While the infection can sometimes be asymptomatic, prompt diagnosis and treatment are essential to prevent complications and reduce the risk of transmission. Antibiotic treatment with a single shot Ceftriaxone is effective. Regular STI screenings, especially for those at higher risk, play a vital role in detecting and managing gonorrhea and other STIs.

References

1. Centers for Disease Control and Prevention (CDC). (2021). Gonorrhea - CDC Fact Sheet. Available from: https://www.cdc.gov.

2. World Health Organization (WHO). (2020). Sexually Transmitted Infections. Available from: https://www.who.int.

3. Mayo Clinic. (2021). Gonorrhea Symptoms and Treatment. Available from: https://www.mayoclinic.org.

Author: Dr. Yesser Falk