It is possible for one partner in a sexual relationship to test positive for gonorrhea while the other partner tests negative. Gonorrhea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It is spread through unprotected vaginal, anal, or oral sex with an infected partner. However, there are several reasons why one partner may test positive while the other tests negative, including:
- One partner was infected before the current relationship and never properly treated. Gonorrhea can persist for months or years if left untreated.
- One partner had gonorrhea in the past, was treated, but then got re-infected from a different partner outside the current relationship.
- The partners have not had sex in the last 1-2 weeks, and the recently infected partner has not yet developed a positive test.
- One partner received oral sex from an infected person outside the relationship and developed a gonorrhea infection in the throat only.
- The infected partner has gonorrhea in the rectum or throat only, and the testing method for the negative partner did not include those sites.
- One partner’s immune system was able to clear the infection, while the other partner remained infected.
- The negative test result was a false negative.
Proper testing and treatment of both partners is important whenever gonorrhea is suspected or diagnosed. Continue reading for more details on these potential reasons for differing test results between partners.
Detailed Explanations
Untreated Gonorrhea from a Previous Partner
One possible reason that one partner tests positive for gonorrhea while the other tests negative is that the positive partner contracted gonorrhea in a previous relationship but was never properly treated. Gonorrhea can persist for months or even years if left untreated. The Centers for Disease Control and Prevention (CDC) estimates that about 80% of gonorrheal infections in women and 50% in men show no symptoms.
- Without symptoms, an infected person may be unaware they have gonorrhea and unknowingly transmit it to new partners.
- Some people do not follow through with the full course of medication once symptoms resolve, allowing gonorrhea to return.
- Improperly treated gonorrhea can lead to antibiotic resistance, making infections harder to cure.
If one partner had gonorrhea prior to the current relationship, even years earlier, the infection could still be present and produce a positive test result. The current negative partner may have initially contracted gonorrhea as well but cleared the infection naturally or with incomplete treatment. Re-testing of both partners is recommended when a positive gonorrhea test occurs to determine if both harbor infections.
Re-infection from Outside Partnership
Another explanation is that one partner had gonorrhea earlier in the relationship, was properly treated and cured, but then contracted gonorrhea again from a more recent encounter outside the relationship. Gonorrhea re-infection from new partners is common since it does not provide long-lasting immunity.
- Up to 20% of people treated for gonorrhea get re-infected within several months.
- Those engaging in high risk behaviors such as inconsistent condom use or multiple partners are at greatest risk of re-infection.
- Re-infection allows for transmission back into an existing relationship and differing test results between monogamous partners.
Partners should communicate openly about sexual contact outside the relationship and possible exposure risks. Both partners should get re-tested for gonorrhea and other STIs after potential re-infection events.
Recent Infection
Differing gonorrhea test results may also stem from one partner being exposed and infected very recently while the other partner’s test is still negative. It can take up to two weeks after exposure for gonorrhea infections to become detectable on common tests.
- Nucleic acid amplification tests (NAAT) for gonorrhea can provide results within 1-3 days but may not turn positive for 1-2 weeks.
- Culture tests directly detect gonorrhea bacteria but also require time for the infection to develop.
- If a partner engages in sex outside the relationship and acquires gonorrhea, their test may initially be negative.
- After an incubation period, they can then transmit gonorrhea to the main partner whose test is still negative.
Partners who engage in unprotected sex with new partners should wait 2-3 weeks and get re-tested before resuming sex with main partners. This allows time for infections like gonorrhea to become detectable.
Oral Gonorrhea Infection
Gonorrhea can infect multiple sites, including the urethra, rectum, and pharynx (throat). If testing only looks for urethral or cervical gonorrhea, oral infections may be missed.
- Performing oral sex on an infected partner can lead to pharyngeal gonorrhea.
- Symptoms of oral gonorrhea tend to be mild or non-existent.
- Traditional gonorrhea tests use urine samples and will miss oral infections.
- One partner could have an undetected oral gonorrhea infection while the other tests negative.
Testing for gonorrhea should include a pharyngeal swab in people engaging in oral sex, especially if one partner tests positive while the other is negative. Treating oral infections is important for providing a cure and preventing transmission back to the genitals or rectum.
Rectal Gonorrhea Infection
As with oral infections, rectal gonorrhea may go undiagnosed if testing only evaluates urethral or cervical sites.
- Receptive anal sex can transmit gonorrhea to the rectum.
- Signs and symptoms of rectal gonorrhea tend to be absent.
- Using urine or genital samples will miss rectal gonorrhea present in one partner.
Performing a rectal swab is necessary to check for rectal gonorrhea, especially if one partner engages in receptive anal sex. Treating rectal infections along with other sites is important for a complete cure.
Differences in Immune Response
There is some evidence that specific immune responses may allow one infected person to clear gonorrhea infections while another infected person remains symptomatic.
- Blood tests looking for gonorrhea antibodies can sometimes be positive in people without current detectable infections.
- Higher levels of complement system proteins involved in immune function may correlate with faster clearance of gonorrhea.
- Genetic factors that influence immune responses could explain why one partner eliminates the infection while the other does not.
More research is needed to fully understand variable immune responses to gonorrhea between different individuals. But it provides one possible explanation for differing test results between monogamous partners.
False Negative Test Result
In a small percentage of cases, differing gonorrhea test results between partners may be explained by a false negative result in the partner testing negative. No laboratory test is 100% accurate at all times.
- False negative results occur in up to 5% of gonorrhea nucleic acid tests.
- Improper sample collection or laboratory processing can lead to inaccurate results.
- Missing an active infection allows for continued transmission to partners.
If a partner tests positive for gonorrhea, the other partner should be re-tested even if an initial test was negative. This can identify potential false negative results. If gonorrhea exposure seems likely based on symptoms or high-risk behavior, a negative test may need to be confirmed with additional testing.
Key Takeaways
It is possible for one partner to have a gonorrhea infection while the other partner tests negative, even with an exclusive sexual relationship. Some key points to keep in mind include:
- Treat all prior gonorrhea infections fully – incomplete treatment can allow infections to persist.
- Limit unprotected sexual contact outside relationships – this raises the risk of re-infection.
- Wait 2 weeks after new partners to get re-tested before sex with main partners.
- Test for oral, rectal, and pharyngeal gonorrhea if applicable based on sexual exposure.
- Retest both partners when a positive gonorrhea result occurs in one.
With appropriate testing and treatment, cases where one partner tests positive while the other is negative can be managed. Open communication between partners is also key to ensure STI risks are minimized.
Frequently Asked Questions
Can a man test positive for gonorrhea with no symptoms?
Yes, men often have no symptoms with gonorrhea infections. The CDC estimates up to 50% of men with gonorrhea infections do not have symptoms. Lack of symptoms is one reason why infections go undiagnosed and can be passed between partners.
Does gonorrhea always have symptoms?
No, the majority of gonorrhea cases in women and up to half in men have no symptoms. When present, symptoms of gonorrhea may include a burning sensation when urinating, yellow or green discharge from the penis or vagina, rectal bleeding or itching, and painful or swollen testicles. However, infected people can still transmit the bacteria even without symptoms.
Can a man have gonorrhea without discharge?
Yes, gonorrhea can occur in men without penile discharge. Again, up to 50% of men with gonorrhea have no symptoms at all. Even when there are symptoms, some men may experience painful urination or testicular pain without visible urethral discharge. Lack of discharge does not rule out possible gonorrhea infection.
Can gonorrhea be dormant?
Gonorrhea does not truly become dormant or go into a latent phase. However, the symptoms may resolve even though an infection still persists. Without proper diagnosis and treatment, gonorrhea infections can linger for months or years. People remain contagious even after symptoms disappear until appropriate treatment is given.
How accurate are gonorrhea tests?
Nucleic acid amplification tests (NAAT) detect gonorrhea with 95-98% accuracy from urine samples. However, throat and rectal samples are less accurate. False negatives happen in about 5% of NAAT tests, so repeat testing may be needed to rule out infection.
What is the window period for gonorrhea testing?
The window period for gonorrhea testing is 1-14 days, but typically tests become positive within 1-3 days after infection. Nucleic acid tests can provide results in 1-2 days but may initially miss very recent infections. Retesting 2 weeks after potential exposure will detect almost all gonorrhea infections.
Can I pass gonorrhea without penetration?
Yes, gonorrhea can be transmitted through intimate contact without penetration leading to orgasm. Mucus and pre-ejaculate fluid carry gonorrhea bacteria that can spread through skin contact. However, the risk is lower than with penetration and ejaculation.
Conclusion
Partners in a sexual relationship may have differing test results for gonorrhea, with one testing positive and the other negative. There are a variety of reasons this can occur, including untreated infections in one partner, re-infections from outside contact, time delays in recent infections becoming detectable, infections in the throat or rectum that go undetected, immune response differences, and false negative test results.
Careful diagnosis with comprehensive testing, proper treatment of infected partners, risk reduction between partners, and retesting after potential exposures are keys to managing these situations. While challenging, differing gonorrhea test results between partners do not necessarily indicate infidelity or transmission within the relationship. However, open communication is very important in establishing the reason one partner tested positive and the other negative.