Researchers at the Melbourne Sexual Health Centre (MSHC) have discovered that gonorrhea, which is considered to be a sexually transmitted disease, may also be spread by oral sex and even kissing. The research, which was published in the latest issue of the journal Sexually Transmitted Infections is titled, “Kissing may be an important and neglected risk factor for oropharyngeal gonorrhoea: a cross-sectional study in men who have sex with men.”
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The study included 3677 homosexual and bisexual men and took place between March 2016 and February 2017. They were given a ‘Kissing Survey’ which asked questions about their sexual history.
Around 6.2 percent of the participants tested positive for oral or oropharyngeal gonorrhea, despite many of them not engaging in sexual intercourse during the three months prior. These participants engaged in oral sex or just kissed said the researchers.
We found that the more people an individual kissed also placed them at an increased risk of having throat gonorrhea, irrespective of whether sex occurred with the kissing. This data challenges the accepted traditional transmission routes of gonorrhea held for the past 100 years, where a partner’s penis was thought to be the source of throat infection.”
Eric Chow, Lead Author
He added, “We found after we controlled statistically for the number of men kissed, that ‘the number of men someone had sex with but did not kiss, was not associated with throat gonorrhea. Through our research, we have shown that gonorrhea can be passed on through kissing. This will help people understand how the infection was introduced — particularly if they have not have been sexually active.”
“We know it’s unlikely that people will stop kissing, and our team is already doing a clinical trial examining whether daily use of mouthwash could prevent gonorrhea. If it works, it could be a simple and cheap intervention for everyone.”
The authors of the study wrote that there was evidence that oropharyngeal gonorrhea could be transmitted via “oropharynx-to-oropharynx transmission (i.e., tongue-kissing)”. However, previous research into the link between tongue-kissing and gonorrhea is unclear.
A public health challenge
The research comes at a time when there has been a surge in cases of antibiotic-resistant infections of Neisseria gonorrhoeae. This is concerning, say the researchers, as public health messages focus on condom use to prevent sexually transmitted gonorrhea and do not consider the potential transmission of gonorrhea via the mouth.
The authors of the study write that “exchange of saliva between individuals may potentially transmit gonorrhea”. They also explain that “oro-anal contact” or using saliva as a lubricant for anal sex could be a way by which anorectal gonorrhea may spread.
The researchers discovered that younger men were more at risk of oropharyngeal gonorrhea than older men, which may be explained by kissing patterns in younger individuals. This was the first study to find a direct correlation between kissing and the transmission of gonorrhea.
The authors write, “It is clearly challenging to promote a public health message advocating MSM do not kiss to improve gonorrhea prevention and control.”
They add that kissing is common and is also one of the commonest sexual practices among homo and bisexual men. The team writes about a small randomized trial where they attempted to prevent the transmission of the infection by using an antiseptic mouthwash to inhibit the growth of N. gonorrhoeae among men who have sex with men.
Currently, a large Australian trial is being conducted to prove the efficacy of antiseptic mouth wash in the prevention of the spread of oral gonorrhea. Results of this trial are expected to be released at the end of this year.
‘The throat is a major source of gonorrhoea’
Another study, entitled “Evidence for a new paradigm of gonorrhoea transmission: cross-sectional analysis of Neisseria gonorrhoeae infections by anatomical site in both partners in 60 male couples,” found that the throat was the most common way that the disease was spread. This study supports the findings discussed above.
This was a smaller cross-sectional study where gonorrhea that was diagnosed using nucleic acid amplification tests among 60 male couples who attended Melbourne Sexual Health Centre between March 2015 and June 2017.
Among the 120 men included in the study, 32 men had anal gonorrhea and 34 percent had a partner who had oral gonorrhea. 23 percent of couples had both partners diagnosed with throat gonorrhea.
The observed gonorrhoea positivity when urethral infection is absent supports a new paradigm of gonorrhoea transmission, where the throat is a major source of gonorrhoea transmission between men, through tongue kissing, oro-anal sex and saliva use as anal lubricant.”
Public health messages need to look at the “risk of saliva exposure during sex”, they add.
Cornelisse VJ, Williamson D, Zhang L, et al. Evidence for a new paradigm of gonorrhea transmission: a cross-sectional analysis of Neisseria gonorrhoeae infections by anatomical site in both partners in 60 male couples Sex Transm Infect Published Online First: 17 April 2019. doi.org/10.1136/sextrans-2018-053896
Chow EPF, Cornelisse VJ, Williamson DA, et al. (2019). Kissing may be an important and neglected risk factor for oropharyngeal gonorrhoea: a cross-sectional study in men who have sex with men. Sex Transm Infect. doi.org/10.1136/sextrans-2018-053896.