Oral Gonorrhea Symptoms

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Many people, especially young teens, consider oral sex to be "safe" sex. "Safe sex" by many people is defined as having sexual gratification by means that reduces or eliminates the chance of producing a fetus (pregnancy). However, many people include in the meaning of "safe sex," sex practices that prevent or significantly reduce the possibility of getting a disease from a sex partner (for example, HIV, chlamydia, syphilis, or gonorrhea). Most doctors, me included, do not consider oral (and other) sexual practices "safe" unless precautions are taken to prevent or substantially reduce disease transmission between partners, or if the sex partners are uninfected. Consequently, oral sex (any male or female oral contact with a partner's genitalia; most clinicians also include genital/oral contact with any other body orifice such as the anus or rectum in the definition) is not, without precautions, considered inherently "safe sex" because sexually transmitted diseases (STD's) may be transferred by these practices.

Specifically, oral gonorrhea (also termed pharyngeal gonorrhea) is defined as an STD infection of the pharynx with Gram-negative coccal-shaped (round) bacteria named Neisseria gonorrhoeae. Infection is acquired from direct contact with white/yellowish pus-like fluid containing N. gonorrhoeae (also termed discharge or exudates) in one sex partner. This discharge is caused by N. gonorrhoeae. It mixes with a person's vaginal fluids, seminal fluids, or mucus membranes near the anus and rectum that come in contact with another person's oral mucus membranes. The bacterial infection then establishes itself in the pharynx and may be asymptomatic (cause no symptoms), but can cause symptoms of sore throat and discomfort when swallowing food. The affected throat resembles a strep throat with redness and occasionally may have some white spots or whitish/yellow discharge.

Picture of the throat in a person with oral gonorrhea

Picture of a person with oral gonorrhea
(photo courtesy of CDC)

These symptoms of oral gonorrhea are the same for men or women and usually occur a few days after oral contact with a partner's genitals or anal area when the partner is infected with N. gonorrhoeae. People with oral gonorrhea usually do not transmit the disease to others, but it can occur in some instances. Most investigators state that kissing does not transmit the disease as the bacteria apparently do not infect the tongue or mouth. However, it is possible to transmit the disease if the bacteria in the pharynx are transmitted to other objects by direct contact (for example, fingers, penis, or sex toys) and then the objects touch other body areas such as genitals, anal/rectal areas, or the eyes. This type of oral transfer of bacteria occurs infrequently.

Definitive diagnosis usually depends on isolating N. gonorrhoeae from the throat; however, most doctors consider a positive rapid throat swab, designed to detect N. gonorrhoeae, a good presumptive diagnosis of the disease. Doctors usually will treat the patient with antibiotics that are effective on the locally occurring N. gonorrhoeae strains.

On the bright side of this disease, many people that develop oral gonorrhea never develop symptoms and spontaneously clear the infection without antibiotics. Those individuals that develop symptoms may also clear the infection, but many are treated with antibiotics. Because a large number of N. gonorrhoeae bacterial strains are resistant to some antibiotics, the treating health care practitioner usually will choose one or more antibiotics that are known to be effective against the strains that are predominant in the patient's local geographic region.

On the darker side of this oral infection, is the rare instance in an immune depressed individual when the person could develop systemic (throughout the body) spread of the disease.

Prevention of oral gonorrhea is tricky. The presence of the bacteria on mucus membranes or in discharges in seminal or vaginal fluids facilitates transfer of N. gonorrhoeae bacteria, so preventing contact with these will prevent disease transfer. Condoms, although not 100% effective, afford significant protection from these secretions. This is true for both male and female condoms. The use of condoms during oral sex is not to allow the mouth to come in contact with these secretions, only with the condom material. If you are new to these situations, do not be hesitant to ask for help or instructions from reliable sources (for example, doctors or sex educators) because the information may help protect your health.