Before we begin, here is a quick word on words and language in this piece. We’ve tested many ways of communicating sensitive, sexual information to you. Many organizations have tried using standard medical jargon, but this hasn’t worked well. (40 years + of HIV/AIDS, and 50,000 new infections every year, over 87% due to gay male sex. Something has to change.)
We at GMJ decided to speak to you as adults about sex because it is an adult activity, and frank, real talk works best with most in our community. It’s not our intention to offend, but rather to educate on a standard level, speaking to you, how you speak, and how you speak to others.
So, yes, we sometimes use “bad and naughty words” instead of medical ones, but you do, too. We want to meet you where you live and help provide facts and research-based information so that you can make life decisions that work well for you and your partners.
It usually starts with a tingling or burning sensation when you take a piss and then can take a nasty turn towards a yellowish, milky discharge from your dick or even anus (depending on how you get down). But either way, these are the tell-tell signs that you’ve been infected with gonorrhea. It’s also known as “the clap” because, legend says, that’s the sound your hand makes against your forehead once you realize that you have contracted an STD.
Either way, gonorrhea is a prevalent sexually transmitted disease, along with its sister, chlamydia. They often travel in pairs, making detection and treatment a bit more complicated, but we’ll deal with that later. For the vast majority of people, gonorrhea is a very treatable illness and (almost always) can be cured.
Yes, there’s been lots of fear being spread about the new super gonorrhea and its resistance to medication. But resistance doesn’t mean it cannot be cured. Instead, it might take a different set of drugs or for a more extended period. This is not the time to panic. Keep calm and get your learn on!
WHAT IS GONORRHEA?
Caused by the Neisseria gonorrhoeae bacterium, gonococcal infection is transmitted via some form of unprotected sexual intercourse or contact. The effects vary: the infection may take hold in your mouth, throat, urethra, or anus, with symptoms appearing between 2-10 days after infection, with some studies suggesting a possible more extended incubation period lasting up to 30 days.
Oral sex is known to produce more minor symptoms in the . . . let’s say, “dick suckers” throat, associated more with soreness for the estimated 10% of the population that will produce symptoms at all. These symptoms may be mistaken or misdiagnosed without proper medical testing, such as a cold, allergies, or a basic sore throat. But this also means 90% of dudes infected with an oral clap infection are essentially asymptomatic. So proper and consistent testing is key! If you are sexually active, testing for gonorrhea, as well as syphilis, chlamydia, herpes, and HIV, should be conducted at least three times a year (yes, 3) whether you think you need it or not.
The two main reasons why gonorrhea is so common are:
1. carriers may be asymptomatic no matter where they were infected
2. it is a skin-to-skin contact infection
No amount of bodily fluid transfer is needed to contract this illness. This might account for the estimated 7,000 new cases each year. So proper hand washing (for the duration of the “Happy Birthday” song) is a great first line of defense. Washing your cock wouldn’t hurt either.
Like some other STDs, gonorrhea is a major traveler and likes to get around. Sucking an infected guy’s dick can give you oral gonorrhea. And putting your cock inside of an infected mouth can give you a penile infection. This also goes for anal sex, so when your doctor tests you, make sure that he/she is testing every portion of your body that is sexually active. Better safe than sorry, as the long-term effects of not being treated are pretty gross. These include inflammation of the pelvis, joint and heart valve disorders, painful, swollen nuts, and even sterility.
SALIVA AS A MODE OF TRANSMISSION
A report from May 2019, published on AIDSMAP, shed new light on the possibility of saliva (spit) being a mode of transmitting gonorrhea. The report is very clear. “The throat is a major source of gonorrhea transmission among men who have sex with men (MSM), according to Australian research published in Sexually Transmitted Infections. The study involved 60 male couples and showed a high prevalence of gonorrhea infection in the throat and/or anus in the absence of urethral infection. The investigators suggest that transmission is occurring due to kissing, oral sex, rimming, or the use of saliva as a lubricant for anal sex”.
They add: “Our data are not consistent with the conventional paradigm of gonorrhea transmission between men, in which most gonorrhea transmission is from the urethra to the throat and anus, and vice versa. Instead, our data are consistent with a new paradigm of gonorrhea transmission in which the throat plays a central role in transmission to the partner’s throat, anus, and urethra, presumably through infected saliva”.
The investigators also highlight that when one man in a couple had throat gonorrhea, there was a high chance that both men in the couple would have the infection at this site. They, therefore, suggest that transmission was occurring directly from throat to throat via kissing.
A second study from the same research group provides further evidence to support the hypothesis. A total of 3677 MSM attending the Melbourne clinic completed surveys, reporting on numbers of sexual partners in the past three months:
- mean 4.3 partners who they had kissed but not had oral or anal sex with
- mean 5.0 partners they had kissed and had sex with
- mean 1.4 partners they had had oral or anal sex with but not kissed.
Kissing-only and kissing-with-sex were associated with gonorrhea in the throat, but sex-only was not. The adjusted odds for gonorrhea in the throat were 1.46-fold for men with more than four kissing-only partners and 1.81-fold for men with more than four kissing-with-sex partners.
WHAT DOES THIS MEAN?
Gay male sex is complex, but unfortunately, it is not studied as a complete series of contacts and actions. Instead, our sex is researched around one singular activity at a time. This creates difficulties in finding out which activity causes some infections versus others.
For the grown folks, here is an example regarding saliva.
- Joe and Dale meet to have sex. Joe is a total top, and Dale is a vers/bottom. Joe and Dale begin with kissing and progress to touching and exploring each other’s naked bodies. At some point, Joe starts to rim Dale, who, in turn, performs oral sex on Joe. Joe returns the favor before inserting his condom-covered penis inside Dale’s rectum.
Traditionally, the above activities would be considered very safe. But now, think of the large amounts of saliva and bare physical contact Joe and Dale had. This is how oral, penile, and rectal gonorrhea is spread.
- Saliva is a major mode of gonorrhea infection. Spit, when used during rimming, as lubrication for anal sex, exchanged during kissing, and even during oral sex, is the most likely way oral, anal, and penile infections occur.
- Condoms will not stop the spread of gonorrhea if kissing, rimming and oral sex are involved.
- Condoms should decrease the risk of infection if the only contact is anal sex and the condom(s) are used each time and correctly.
- Kissing is not a new risk factor for gonorrhea infection…IT ALWAYS HAS BEEN A RISK FACTOR; we just didn’t know it.
- Regular testing and treatment for gonorrhea and all STDs are paramount.
- It is time we change the conversation around safer sex to include risk factors associated with saliva.
- PrEP should not be blamed for increases in gonorrhea infections.
SYMPTOMS
As gay dudes, we have a lot of options when it comes to our sexual activities, which is super impressive. But this also creates a larger breeding ground for contracting and passing on sexually transmitted diseases. Since gonorrhea is so easy to contract and enjoys moving around the body, we’re going to examine the symptoms for each sexual body part separately, but keep in mind some guys don’t exhibit any symptoms at all and that some symptoms can be caused by non-gonococcal agents (so-called non-gonococcal urethritis in the case of penile discharge). You need to get tested in any case.
ORAL:
sore throat
swollen glands
no symptoms at all
DICK:
yellow/green/milky discharge
greater need to piss than normal fluid intake
burning sensation when urinating
ANUS:
yellow/green/milky discharge
soreness around the rectum
butt itch
mucus in stool
WHY WORRY?
First off, never worry, but be aware. Gonorrhea, even though treatable, is no joke. Along with syphilis, it is one of the fastest-growing sexually transmitted diseases in our community. And because guys are not being tested, treated early, nor completing the medication routine, gonorrhea is becoming highly resistant to treatment. The CDC thinks that one day, these new resistant strains will take away the first line of defense of treatment options. So, goodbye to one-shot-in-the-butt and pill-based solutions. Also, as we stated above, its close relationship with chlamydia and the dudes that are co-infected creates a low clearance rate of the bacteria.
ANY GOOD NEWS?
Even as the United States has been seeing a “progressive development” of drug-resistant gonorrhea cases, which require higher dosages of traditional antibacterial medications for a cure, more and better medications are being developed to combat this ever-tricky bug. “At this time, no drug-immune cases have been identified in the United States,” says Sarah Kidd, a medical epidemiologist at the CDC. The clap is still very treatable, but some strains may require higher dosages, combination therapies, and longer cure times. Luckily, for now, gonorrhea is still curable.
As we stated above, the rate of gonorrhea in the gay male population around the world is seeing an alarming rise. But this is good news because these facts are being reported in the news, and there is a global response from guys and the medical field. Even these so-called resistant strains are being treated in America and Europe through campaigns and multi-governmental strategies. In our community, we need to follow the advice, get tested, and not let fear force us to make poor decisions.
HOW DO I PROTECT MYSELF FROM GONORRHEA?
We want you to dig a little deeper into this one and use this STD as a basis for how you approach all sexually transmitted illnesses. It’s very simple to say “wrap it up,” but condoms aren’t always effective in stopping any of these illnesses. We, as gay men, must stop believing that a thin piece of rubber is our most excellent protector. It is this mindset—and its failure—which keeps biting us in the ass, literally. Condoms are the most effective way to prevent anal-sex gonorrhea infections but they do nothing for cock suckers.
We hate to use preachy “non-profit speak,” but this is an opportunity to think about what is in your STD-prevention toolbox. The very first tool should be your brain. Think first, then act. Not re-act or act out. So how about we use our big head in this case? Even though you should remain aware of the symptoms of gonorrhea, most guys don’t show them. Because of this, you have actually to do some work. This includes talking to your potential sex partners about possible gonorrhea infection—when was the last time they were tested—and stop believing the only STD you need to think about is HIV. Pissing out fire or green goo dripping from your asshole is not cute.
Communication is vital, but so is regular testing and hand washing. But, if you contract the clap, at least for now, there is a good chance it will be curable. Relax, see a medical professional if you believe you have been exposed, take the medication (an antibiotic) fully (no leftover pills) as directed, and try to remember how you were infected so that you may be more aware the next time.
NOTE: Some people seem to attract this STD like flies to… well, you know. If you find that you are contracting gonorrhea over and over again, then maybe you should not only think about some lifestyle changes but check with your doctor to see if you are one of those “special magnets”. It seems that a previous history of STDs may make you more likely to contract the clap.
PREVENTION OPTIONS
We are pleased to share information from a new study regarding the medication doxycycline and its ability to prevent STI infections BEFORE and AFTER exposure (PEP). Condoms are still the most recommended method for preventing all STDs, but medications to prevent infections are increasingly being prescribed.
Doxycycline used as post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) are tools that can prevent infection.
When taken before or after coming into contact with a pathogen (like a virus or bacteria), they can decrease a person’s chances of developing infection.
In our context, PEP involves taking medication after sex where we might come into contact with STIs.
PrEP involves taking medication regularly so it is already in our system when we come into contact with STIs.
Recent research showed that Doxy PEP reduced bacterial STIs overall by 66% (among people on PrEP), and 62% (among people living with HIV). Doxy PEP was effective in preventing chlamydia, gonorrhea, and syphilis.
How to use it
- 200 mg of doxycycline taken within 24 hours (no later than 72 hours) after condomless oral or anal sex.
- If you have sex again, take another dose 24 hours after your last dose.
- You can take Doxy PEP as often as every day but don’t take more than 200 mg every 24 hours.
- Take doxycycline with plenty of water. If you get an upset stomach, try taking it with food.
TREATMENT OPTIONS
If you live in the United States of America, your treatment options are pretty good. Even though the Centers for Disease Control reports that “antibiotics have treated gonorrhea successfully for several decades, now the bacteria have become resistant to nearly every drug used for treatment,” this is not a cause to freak out. Nearly is not all. Be aware that the CDC has issued new guidelines and recommendations for doctors to treat these new, resistant strains. So, talk to your doctor about your options and which medications may suit you.
As usual, we highly recommend you keep it in your pants while you’re being treated, as you’re still contagious until your doctor gives you the all-clear sign. This includes sex with condoms. As stated above, gonorrhea loves to travel, and you can still pass it on orally or through some other form of physical contact.
PARTNER NOTIFICATION
Remember that part earlier about communication? Well, here is one of the more complex parts. Talking to your prior and current sexual partners about your gonorrhea infection is a huge step in reducing the infection incidence rate and also a great way to slow down the progress of this bacteria through our community.
Since most guys don’t show symptoms, if you are the one who got tested or did show symptoms, you can be the “bigger man” and raise the bar for others. Yes, this may seem scary and humiliating, but we both know it is the right thing to do. Not to shame-blame him (or them… all of them), but rather to notify and help someone else out and keep them from spreading this illness. Who knows, if you think you cannot get it again, the ass (and dick and throat) you save may be your own.
