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 Although the study involved only gay and bisexual men, the risk of
transmitting gonorrhea orally is likely also present for
heterosexuals and particularly sex workers, the study authors write
in the journal Sexually Transmitted Infections.
"It's important to understand that safe sex isn't a catch-all for
gonorrhea, which challenges previous sexual health practices," said
lead study author Eric Chow of the Melbourne Sexual Health Centre
and Monash University.
Public health messaging has focused on condom use because most
gonorrhea is thought to be transmitted during penile-anal sex among
men who have sex with men. However, recent studies have suggested
that sex accounts for only part of the documented cases, especially
when gonorrhea occurs in the throat.
"Kissing may be riskier than previously thought," Chow told Reuters
Health by email. "This may help people understand how the infection
was introduced, particularly if they haven't been sexually active."
Chow and colleagues surveyed 3,677 men who have sex with men between
March 2016 and February 2017 at the Melbourne Sexual Health Center,
which offers free walk-in service. The survey asked about the number
of male partners during the past three months in three separate
categories: kissing-only, sex-only and kissing-with-sex.
All of the men were tested for sexually transmitted diseases, and
229 men, about six percent, had throat gonorrhea infections. About
six percent had anorectal gonorrhea and three percent had urethral
gonorrhea. At an average age of 30, almost all of the men had
kissing-with-sex partners in the past three months, and 70 percent
had kissing-only partners, but just 38 percent had sex-only
partners. Less than a third of the men reported having all three
types of partner, but most had at least two of the types.
On average, the men had 4.3 kissing-only partners in the previous
three months, as well as 1.4 sex-only partners and 5
kissing-with-sex partners. Kissing-only and kissing-with-sex were
associated with throat gonorrhea but sex-only was not.
The odds of having throat gonorrhea nearly doubled for those with
four or more kissing-only or kissing-with-sex partners. In addition,
younger men had greater odds of having throat gonorrhea, which was
associated with younger men having more kissing-only partners, the
study team notes.
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"Gonorrhea rates continue to increase, and although some
interventions are bending the curve of the epidemic, we need to
continue to encourage screening," said Dr. Lindley Barbee of the
University of Washington in Seattle, who wasn't involved in the
study.
Future studies should investigate the different types of sex that
may be related to gonorrhea transmission as well, she added, such as
anal or oral sex. In addition, researchers should investigate
specific kissing behaviors, including the duration, number of times
or number of female partners kissed by bisexual men.
"This can be tough to study because people are not isolated and do
all of these behaviors in the same setting," Barbee told Reuters
Health by email. "It's hard to tease out which encounter or sexual
behavior transmitted the infection."
Chow and colleagues are now conducting a clinical trial that tests
whether daily mouthwash use could reduce the risk of infection with
the gonorrhea bacteria.
"We know it's unlikely that people will stop kissing," Chow said.
"If this works, it could be a simple and cheap intervention for
everyone."
In the meantime, Barbee recommends remaining aware and getting
tested. Throat gonorrhea can often be asymptomatic but may build
resistance to antibiotics, which can make the gonorrhea itself tough
to treat and potentially lead to more severe throat infections
later.
"Gonococcus is able to scavenge DNA from other bacteria and
interchange genetic material that can lead to antimicrobial
resistance," she added. "It's important to understand what's going
on in our throats and treat it."
SOURCE: https://bit.ly/2VF4WLr Sexually Transmitted Infections,
online May 9, 2019.
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