The unexpected text hit Robert Johnson like a bolt from the blue: “Hey… you have given me gonorrhea.”

Johnson, a 55-year-old father of one, was left dumbfounded as he read the message.

Having recently undergone a sexual health screening, Johnson had been assured he was in the clear.

He experienced no symptoms, felt completely healthy, and was confident he was managing his health responsibly.

The allegation, suddenly emerging from a woman he had been seeing for the past two years, seemed utterly implausible to him.

Feeling embarrassed and shaken, yet convinced of an error, Johnson promptly sent back evidence of his negative STI results. Surely, this would resolve the misunderstanding.

Instead, the reply that flashed back would turn his confidence upside down: ‘Did you get your throat swabbed?’

That single question exposed a blind spot in modern sexual health testing – one that doctors warn may be helping fuel America’s spiraling STI crisis. 

Robert Johnson, now 46, believes he passed on gonorrhea after he was not offered a throat swab

Because many people assume a negative STI result means they are entirely infection-free. 

But experts say testing should be based on what kind of sex someone has had – and the part of the body exposed may be the very place an infection is hiding.

If someone has had oral sex, they may need a throat swab. If they have had anal sex, they may need a rectal swab. If they have had penetrative sex, genital testing will be required.

Miss the site of infection, doctors warn, and the disease can be missed altogether.

The warning comes as the US battles what specialists describe as an epidemic of sexually transmitted infections.

More than 2.2 million cases of chlamydia, gonorrhea and syphilis were reported in 2024, the latest year available. 

While that was down nine percent on the year before, it remains more than 60 percent higher than levels seen three decades ago.

Experts say a rise in casual sex after Covid restrictions, reduced condom use, delayed testing and the spread of symptom-free infections have all helped drive the surge.

 The father-of-one had no symptoms, felt perfectly well and believed he was doing everything right

The above shows the test result he received in early December, which showed he was negative for gonorrhea

But just over a month later he would get an oral swab, which would reveal that he had a gonorrhea infection

Some also point to a more relaxed attitude toward sexual risk following the arrival of drugs that dramatically cut the risk of HIV transmission.

Dr Steven Goldberg, chief medical officer of HealthTrackRx, told the Daily Mail: ‘STIs are at epidemic levels in the US, and we are really trying to encourage people to get care.

‘One in 10 Americans are unaware that STIs can occur with no noticeable symptoms and, at least in the US, a meaningful number of people wait a while before coming forward for testing and treatment.’

For Johnson, the lesson came in the most humiliating way possible.

At the time, he was part of what he describes as ‘the consensual non-monogamy community’ – where people remain in committed relationships while agreeing that sexual or romantic relationships with others are permitted.

Johnson has been happily married for 20 years and said he did not pass the infection to his wife.

He had also been seeing another woman for around two years, and said the relationship seemed to be going well.

They would meet regularly at her home in suburban Chicago. He was optimistic about the future. Then came the text.

Doctors say that STI testing should be exposure led, and that if a patient has oral sex, they should also receive a throat swab

The woman told him she had slept with her husband, who was aware of the relationship, after seeing Johnson – and that her husband had suddenly developed dramatic symptoms.

The text message Johnson received continued: ‘I am symptom-free, but my husband has exploded with symptoms. All the signs point back to you.’

Johnson said: ‘I was surprised [by her text], because almost at that exact moment, I had just gotten an STI test… so, as far as I knew, I was negative,’ he said.

He immediately sent her the results of his recent screening. But the more he thought about it, the less comfortable he became.

What if he had infected somebody else? What if he had unknowingly put his wife at risk? What if the test had missed something?

That was when the woman asked about the throat swab. Had he had one during the STI screening? The answer was no.

On December 1 2020, Johnson had taken an STI test that only checked his genitals. That result came back negative for gonorrhea.

But no sample had been taken from his throat.

Shortly before seeing the woman, Johnson says he had oral sex with another partner and now believes that is how he contracted the infection.

Like many people, he had no idea gonorrhea could be sitting silently in the throat.

After the confrontation, Johnson said he saw three doctors before he found one willing to do the extra test.

Finally, on January 12 2021 – just over a month after being given the all-clear – the result came back positive for gonorrhea in his throat.

By then, the woman’s husband had also tested positive. Johnson said he was told the man had painful urination and discharge from the penis. The woman also tested positive.

Gonorrhea, commonly known as ‘the clap’, is the second most common STI in the US after chlamydia. It is spread through bodily fluids and can infect the genitals, rectum and throat.

The problem, doctors say, is that throat infections are notoriously easy to miss.

Around 90 percent cause no symptoms at all. Someone can feel completely healthy while still carrying the bacteria and passing it on through oral sex.

By contrast, infections in the genitals are more likely to trigger warning signs such as burning during urination, unusual discharge, bleeding between periods or pain during sex.

That mismatch means people often seek treatment only when the infection reaches a site more likely to cause misery.

Johnson said the real shock was realising how preventable it all 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 added: ‘I was humbled by not understanding oral swabs, that was embarrassing to me. I did a quick Google search, and was like, ‘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 into the backside, which cleared the infection.

But while the bacteria disappeared quickly, the embarrassment did not.

Johnson said he now always makes sure every exposure-linked area is tested, rather than relying on a single swab.

And the experience had such an impact on him that he decided to build a business around what he says is a glaring gap in the market.

He founded Shameless Care, an STI testing company based in Chicago that offers what he calls comprehensive screening.

For about $280, customers are sent kits including genital, throat and anal swabs, which are then processed in the firm’s lab. Results are returned within three days.

He refuses to offer cheaper $99 ‘quick check’ tests that only examine one 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 the more than 1,000 patients tested so far, he claims 86 percent of gonorrhea infections his company detects are found in the throat.

Whether or not that figure reflects the wider population, experts agree on one point: infections outside the genitals are frequently missed if they are not specifically looked for.