Will My Doctor Always Be Able to Tell if I Have Gonorrhea?

Throat examination
Throat examination. :webphotographeer/E+/Getty Images

One of the reasons that doctors screen for gonorrhea and other bacterial STDs is that they are often asymptomatic - people may not know they have them. However, the usual methods of screening for gonorrhea -- vaginal and urethral swabs or urine testing -- have a serious flaw. They will only detect cases of gonorrhea that occur in the vaginal area, including the cervix, or the penis. They will not detect cases of gonorrhea that occur in other locations, such as the throat or rectum.

Gonorrhea can be transmitted in a number of ways, not just through vaginal intercourse. In particular, it can be transmitted through both anal sex and oral sex. Although tests for rectal STDs are sometimes performed in men who have sex with men, they're rarely performed in other populations, even though gay men are far from the only people who have anal sex. Unfortunately, this means that many cases of rectal gonorrhea go undetected for long periods of time. Without regular testing, and without symptoms, it is easy for them to go undiagnosed.

The same is true for gonorrhea cases that are transmitted through oral sex. Although these cases can be detected through oral swabs, doing such swabs is rarely part of a doctor's exam unless there is a reason to suspect an oral infection. Some dentists perform oral STD checks on their patients, but those tests are primarily used to diagnose HPV -- as an oral HPV infection can be a precursor to oral cancer.

Despite the fact that doctors and scientists have serious questions about whether oral and rectal STD screening would be cost-effective in the population-at-large, there is no denying that such testing could have public health benefits. A large study published in the spring of 2015 found that almost 2.5 percent of heterosexual men and women had extragenital gonorrhea infections that would not be detected through standard STD tests, and that more than a third of all gonorrhea infections in women would not have been detected by vaginal screening.

That potentially represents an enormous reservoir of undiagnosed infection that could be spreading throughout the population.

Doctors may want to consider the possible benefits of taking a detailed sexual history from their patients. By expanding the repertoire of discussion past, "are you having sex?" and into a detailed discussion of the types of sex clients are having -- including the gender of their partners and whether barriers are used -- it may be possible to do a better job of identifying people who could benefit from oral and rectal STD screening. That could make implementing such screening significantly more cost effective.

Such a solution wouldn't be perfect, as people may not always be honest and barriers may not always be protective, but that doesn't mean it couldn't improve care. Not only would people at risk of oral and rectal STDs be more likely to get a diagnosis, but other clients would have the opportunity to have more in depth discussions of their sexual health. That could help improve not just diagnosis of STDs but also let doctors do a better job of addressing other issues that may effect sexual health and function.

Sources:

Trebach JD, Chaulk CP, Page KR, Tuddenham S, Ghanem KG. Neisseria gonorrhoeae and Chlamydia trachomatis Among Women Reporting Extragenital Exposures. Sex Transm Dis. 2015 May;42(5):233-9.

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