Oral sex requires a throat swab; negative results alone don't rule out infection.

Robert Johnson, a 55-year-old father from suburban Chicago, received a text message that shattered his confidence: "Hey... you have given me gonorrhea." Johnson had recently taken a sexual health test that returned negative results. He felt healthy, had no symptoms, and believed he was doing everything correctly. The accusation came from a woman he had been dating for two years, which made him certain a mistake had occurred.

He immediately replied with his negative test results, believing the matter was settled. However, the woman's response challenged his assumption: "Did you get your throat swabbed?" This single question highlighted a critical gap in modern testing protocols. Many individuals assume a negative result means they are entirely free of infection, but experts warn that testing must correspond to the specific type of sexual activity and the body parts involved. If a person has engaged in oral sex, they require a throat swab; for anal sex, a rectal swab is necessary; and for penetrative sex, genital testing is required. Missing the site of infection can lead to a complete oversight of the disease.

This warning comes as the United States confronts a significant rise in sexually transmitted infections. In 2024, more than 2.2 million cases of chlamydia, gonorrhea, and syphilis were reported. While this figure represents a nine percent decrease from the previous year, the numbers remain more than 60 percent higher than levels seen three decades ago. Specialists attribute this surge to increased casual sexual activity following pandemic restrictions, reduced condom use, delayed testing, and the spread of infections that often present without symptoms.

Dr. Steven Goldberg, chief medical officer of HealthTrackRx, emphasized the severity of the situation to the Daily Mail. "STIs are at epidemic levels in the US, and we are really trying to encourage people to get care," Goldberg stated. He noted that one in 10 Americans are unaware that STIs can occur without noticeable symptoms. Furthermore, many individuals in the United States wait too long before seeking testing and treatment.

Johnson, who identifies as part of the consensual non-monogamy community, explained that he had been happily married for 20 years and had not passed the infection to his wife. He had been seeing another woman for about two years, and their relationship appeared stable. The crisis unfolded after the woman reported that she had slept with her husband, who was aware of her relationship with Johnson, and that her husband subsequently developed dramatic symptoms. She told Johnson, "I am symptom-free, but my husband has exploded with symptoms."

Johnson's case illustrates how regulations or the lack thereof in medical screening can have severe consequences for individuals. The lesson learned is that relying on a single test result without considering the full scope of one's sexual history can lead to dangerous false negatives. Public health officials are urging a shift toward exposure-led testing, ensuring that patients receive the specific swabs needed for the types of sexual contact they have had. This approach is essential to curbing the rising tide of infections and protecting the public from unknowingly spreading diseases.

All the signs pointed back to me."

That was the chilling realization for Johnson, who found himself in the midst of a sudden health crisis. The catalyst arrived via a text message, but the moment it appeared on his screen, he was already grappling with a personal dilemma. "I was surprised [by her text]," Johnson explained, "because almost at that exact moment, I had just gotten an STI test... so, as far as I knew, I was negative."

Acting quickly on that confidence, he immediately forwarded the results of his recent screening to the woman. However, the initial relief gave way to a growing unease as he allowed the facts to sink in. If his test was negative, how could he be the source of her distress? The anxiety escalated into a series of terrifying questions: What if he had unknowingly infected someone else? What if he had put his wife at risk? What if the test had failed to detect something lurking undetected?

The investigation led back to a specific detail: a throat swab. Had he undergone one during his screening? The answer was a definitive no. On December 1, 2020, Johnson had taken a standard STI test that examined only his genitals. The result came back negative for gonorrhea. Yet, no sample had been taken from his throat.

Shortly before his confrontation with the woman, Johnson realized he had engaged in oral sex with another partner, a connection he now believed was the vector for the infection. Like many others, he had no conception that gonorrhea could sit silently in the throat.

Following the confrontation, Johnson sought medical help, visiting three doctors before finally finding one willing to administer the crucial extra test. It was not until January 12, 2021—just over a month after receiving his all-clear—that the results came back positive for gonorrhea in his throat. By that time, the woman's husband had also tested positive, suffering from painful urination and penile discharge, and the woman herself had tested positive as well.

Gonorrhea, frequently referred to as 'the clap,' remains the second most common sexually transmitted infection in the United States, trailing only chlamydia. Spread through bodily fluids, the bacteria can infect the genitals, rectum, and throat. Medical experts warn that throat infections are notoriously difficult to detect. Approximately 90 percent of these cases produce no symptoms whatsoever. A person can feel entirely healthy while harboring the bacteria and unknowingly transmitting it through oral contact.

In stark contrast, infections in the genital area are far more likely to trigger warning signs such as burning during urination, unusual discharge, bleeding between periods, or pain during intercourse. This disparity creates a dangerous scenario where individuals often seek treatment only after the infection has reached a site capable of causing significant misery.

Johnson admitted that the true shock lay in realizing how entirely preventable the situation was. "I felt bamboozled, and I felt like I infected somebody else when it was completely preventable. That's the part that upset me," he stated. He described feeling humbled by his lack of knowledge regarding oral swabs, noting that a quick Google search revealed, "Oh, that is a thing, and Robert, you didn't even know about that."

"I was the culprit in this situation. I didn't even feel sick. I got an injection and I was cured."

He was treated with antibiotic injections administered into the buttocks, which successfully cleared the infection. While the bacteria vanished quickly, the associated embarrassment lingered. Johnson now ensures that every area linked to potential exposure is tested, refusing to rely on a single swab.

The experience was so transformative that he decided to build a business around what he views as a glaring gap in the market. He founded Shameless Care, an STI testing company based in Chicago that offers what he terms comprehensive screening. For approximately $280, customers receive kits containing genital, throat, and anal swabs, which are processed at the firm's laboratory with results returned within three days.

He explicitly refuses to offer cheaper $99 "quick check" tests that examine only a single site. "I consider those unethical," he said. "They are telling people they are not infected when they have not done the testing properly. That means they could pass on the disease to others."

Out of more than 1,000 patients tested to date, he claims that 86 percent of the gonorrhea infections his company detects are found in the throat. Whether this figure mirrors the wider population or not, experts agree on a fundamental truth: infections outside the genitals are frequently missed if they are not specifically sought.