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Lyu H, Tang H, Feng Y, Hu S, Wang Y, Zhou L, Huang S, Li J, Zhu H, He X, Tang W, Zhou Y, Zhang L. Incidence and spontaneous clearance of gonorrhea and chlamydia infections among men who have sex with men: a prospective cohort study in Zhuhai, China. Front Public Health 2024; 12:1348686. [PMID: 38770362 PMCID: PMC11102956 DOI: 10.3389/fpubh.2024.1348686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
Background Men who have sex with men (MSM) face significant risks of Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG) infection. Nevertheless, only limited studies have looked into the site-specific infection and clearance of CT/NG. In order to prevent transmission, it is essential to understand the underlying factors that drive infection and spontaneous clearance. Methods A 12-week cohort study examined the association between CT/NG infection, self-clearance, and sexual behaviors among MSM. The Willingness Service recruited participants who completed weekly questionnaires and provided urine, throat, and rectal swab samples. Results The study involved 151 men, in which 51 (33.8%) were diagnosed with CT/NG infection during the study period. HIV (OR = 11.31), kissing (OR = 1.59), receptive oral sex (OR = 36.64), and insertive anal sex (OR = 19.73) constituted significant risk factors. 100% condom use (OR = 5.78) and antibiotic (OR = 7.53) were more likely to cause spontaneous clearance. Discussion MSM may engage in riskier sexual behaviors due to insufficient knowledge and awareness of STI prevention, leading to increased susceptibility to NG/CT. It is crucial to concentrate on enhancing health education for MSM. Conclusion This study found that the rectum was the most prevalent site of CT/NG and sexual behavior can influence the infection. Additionally, the appropriate use of antibiotics and consistent condom use may contribute to clear spontaneously.
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Affiliation(s)
- Hang Lyu
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Haotong Tang
- Jieyang Center for Disease Control and Prevention, Jieyang, China
| | - Yunlong Feng
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Shuyan Hu
- Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China
| | - Yuyu Wang
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Lanlan Zhou
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Shanzi Huang
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Jiarun Li
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Huamei Zhu
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Yi Zhou
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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King AJ, Bilardi JE, Maddaford K, Fairley CK, Chow EP, Phillips TR. Sexual health clinic attendees' views on antibiotic post-exposure prophylaxis and vaccinations for sexually transmitted infections prevention: A qualitative study. Prev Med Rep 2024; 38:102628. [PMID: 38375181 PMCID: PMC10874840 DOI: 10.1016/j.pmedr.2024.102628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/19/2023] [Accepted: 01/20/2024] [Indexed: 02/21/2024] Open
Abstract
Background The rising prevalence of bacterial sexually transmitted infections (STIs) is cause for concern in the context of antimicrobial resistance and the potential health outcomes of untreated infections. Objective The Community Awareness and Surveillance of Transmission (CAST) study sought sexual health service users' views on reducing the prevalence of STIs. Methods Semi-structured interviews were conducted with sexual health clinic attendees who had received a diagnosis of chlamydia, gonorrhea or syphilis in the previous six months. Participant comments relating to antibiotic post-exposure prophylaxis (APEP) and vaccination were inductively coded, then compared using comparative qualitative data analysis methods described by Miles and Huberman. Findings Twenty-one participants with differing genders, ages, nationalities and sexual orientations, were interviewed. Participants across informant groups expressed concerns about APEP for STI prevention because of potential antimicrobial resistance and personal health impacts. Vaccination against bacterial STIs was more acceptable. Common factors mentioned in relation to both interventions included perception of individual STI risk over time, safety, effectiveness and accessibility. Conclusions The views of sexual health service users support efforts to find alternatives to more frequent use of antibiotics, such as vaccinations against bacterial STIs, to reduce STI incidence and support antimicrobial stewardship.
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Affiliation(s)
- Alicia J. King
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Jade E. Bilardi
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Maddaford
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Eric P.F. Chow
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Tiffany R. Phillips
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
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King AJ, Bilardi JE, Fairley CK, Maddaford K, Chow EPF, Phillips TR. Australian Sexual Health Service Users' Perspectives on Reducing the Oral Transmission of Bacterial STIs: A Qualitative Study. JOURNAL OF SEX RESEARCH 2023:1-12. [PMID: 38016028 DOI: 10.1080/00224499.2023.2278528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Growing rates of bacterial sexually transmitted infections (STIs) demand new approaches to STI prevention. Sexual practices involving saliva or direct contact with the mouth increase the risk of STI transmission, but community awareness remains largely unexplored in the literature. The Community Awareness and Surveillance of STI Transmission study sought to explore sexual health clinic attendees' awareness of oral STIs; experiences when seeking testing and treatment; and acceptable educational and clinical interventions. Twenty-one semi-structured interviews were conducted with a diverse group of Melbourne Sexual Health Center attendees'. Reflective thematic analysis was undertaken, revealing key themes across people of different genders, sexual identities, ages, and nationalities. All participants emphasized the importance of understanding how their sexual practices might put them at risk of an oral STI. They also sought care from specialist sexual health services with the expectation that health-care providers (HCPs) in these settings had more understanding of diverse sexual practices. Participants' decisions to protect themselves against oral STIs were primarily driven by the effect the decision had on pleasure and intimacy. Comfort during the health-care encounter and trust in HCPs facilitated better understanding of individual STI risk. Differences in awareness and risk reduction strategies were noted based on past experience with oral testing and STIs. These findings highlight the importance of HCPs and public health interventions providing solutions that recognize the central role of pleasure and intimacy in our sexual lives.
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Affiliation(s)
- Alicia J King
- Central Clinical School, Monash University
- Melbourne Sexual Health Centre, Alfred Health
| | - Jade E Bilardi
- Central Clinical School, Monash University
- Melbourne Sexual Health Centre, Alfred Health
| | - Christopher K Fairley
- Central Clinical School, Monash University
- Melbourne Sexual Health Centre, Alfred Health
| | - Kate Maddaford
- Central Clinical School, Monash University
- Melbourne Sexual Health Centre, Alfred Health
| | - Eric P F Chow
- Central Clinical School, Monash University
- Melbourne Sexual Health Centre, Alfred Health
| | - Tiffany R Phillips
- Central Clinical School, Monash University
- Melbourne Sexual Health Centre, Alfred Health
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MacGibbon J, Cornelisse VJ, Smith AKJ, Broady TR, Hammoud MA, Bavinton BR, Heath-Paynter D, Vaughan M, Wright EJ, Holt M. Mpox (monkeypox) knowledge, concern, willingness to change behaviour, and seek vaccination: results of a national cross-sectional survey. Sex Health 2023; 20:403-410. [PMID: 37611539 DOI: 10.1071/sh23047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND In mid-2022, a global mpox (formerly 'monkeypox') outbreak affecting predominantly gay and bisexual men emerged in non-endemic countries. Australia had never previously recorded mpox cases and there was no prior research on knowledge or attitudes to mpox among gay and bisexual men across Australia. METHODS We conducted a national, online cross-sectional survey between August 2022 and September 2022. Participants were recruited through community organisation promotions, online advertising, and direct email invitations. Eligible participants were gay, bisexual or queer; identified as male (cisgender or transgender) or non-binary; aged 16years or older; and lived in Australia. The main outcome measures were: knowledge and concern about mpox; recognition of mpox symptoms and transmission routes; vaccination history; acceptability of behavioural changes to reduce mpox risk, and willingness to be vaccinated. RESULTS Of 2287 participants, most participants were male (2189/2287; 95.7%) and gay (1894/2287; 82.8%). Nearly all had heard about mpox (2255/2287; 98.6%), and the majority were concerned about acquiring it (1461/2287; 64.4%). Most of the 2268 participants not previously diagnosed with mpox correctly identified skin lesions (2087; 92%), rash (1977; 87.2%), and fever (1647; 72.6%) as potential symptoms, and prolonged and brief skin-to-skin contact as potential ways to acquire mpox (2124, 93.7%; and 1860, 82%, respectively). The most acceptable behavioural changes were reducing or avoiding attendance at sex parties (1494; 65.9%) and sex-on-premises venues (1503; 66.4%), and having fewer sexual partners (1466; 64.6%). Most unvaccinated and undiagnosed participants were willing to be vaccinated (1457/1733; 84.1%). CONCLUSIONS People at risk of mpox should be supported to adopt acceptable risk reduction strategies during outbreaks and to seek vaccination.
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Affiliation(s)
- James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Vincent J Cornelisse
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and NSW Health, Sydney, NSW, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | | | | | | | - Edwina J Wright
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Vic., Australia; and Burnet Institute, Melbourne, Vic., Australia; and The Peter Doherty Institute of Infection and Immunity, Melbourne, Vic., Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
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Charleson F, Tran J, Kolobaric A, Case R, Fairley CK, Hocking JS, Chow EP. A Systematic Review of Kissing as a Risk Factor for Oropharyngeal Gonorrhea or Chlamydia. Sex Transm Dis 2023; 50:395-401. [PMID: 36735907 PMCID: PMC10259206 DOI: 10.1097/olq.0000000000001777] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Tongue kissing is a poorly studied risk factor for sexually transmitted infections (STIs). We undertook the first systematic review to assess whether kissing is a risk factor for gonorrhea or chlamydia of the oropharynx. METHODS Online databases (MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane) and reference lists were searched until September 30, 2022. The eligibility criteria for studies included: any peer-reviewed study design in the English language; gonorrhea or chlamydia diagnosed by nucleic acid amplification test, or an infection self-reported by a patient; tongue kissing or its equivalent measured as an exposure. Studies were appraised using a quality scoring tool and qualitatively synthesized. RESULTS Of 8248 studies screened, 6 were eligible for review. All were conducted among men who have sex with men in Australia, including 3 prospective cohort studies, 2 cross-sectional studies, and 1 age-matched case-control study. In summary, all 5 studies examining gonorrhea found an unadjusted association between kissing and oropharyngeal gonorrhea. Two cross-sectional studies found that tongue kissing was an independent risk factor for oropharyngeal gonorrhea after adjusting for other confounders, such as participant demographic characteristics and other sexual practices. In contrast, a single eligible prospective cohort study found no association between kissing and oropharyngeal chlamydia. CONCLUSIONS This systematic review summarized the existing evidence that suggests that tongue kissing may be a risk factor for oropharyngeal gonorrhea but not chlamydia. Reinforcing the message that oropharyngeal gonorrhea could be transmitted through kissing may inform the development of novel approaches to prevent and treat gonorrhea.
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Affiliation(s)
- Finley Charleson
- From the Melbourne Sexual Health Centre, Alfred Health
- Melbourne School of Population and Global Health, The University of Melbourne
| | - Julien Tran
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Adam Kolobaric
- School of Science, RMIT University, Melbourne, Victoria, Australia
| | - Richard Case
- From the Melbourne Sexual Health Centre, Alfred Health
| | - Christopher K. Fairley
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Jane S. Hocking
- Melbourne School of Population and Global Health, The University of Melbourne
| | - Eric P.F. Chow
- From the Melbourne Sexual Health Centre, Alfred Health
- Melbourne School of Population and Global Health, The University of Melbourne
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
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6
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Tran J, Ong JJ, Bradshaw CS, Chen MY, Kong FY, Hocking JS, Aung ET, Maddaford K, Fairley CK, Chow EP. Kissing, fellatio, and analingus as risk factors for oropharyngeal gonorrhoea in men who have sex with men: A cross-sectional study. EClinicalMedicine 2022; 51:101557. [PMID: 35865738 PMCID: PMC9294476 DOI: 10.1016/j.eclinm.2022.101557] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Our aim was to determine whether exposure to the anatomical sites (oropharynx, penis, or anus) of male partners of men who have sex with men (MSM) were independent risk factors for oropharyngeal gonorrhoea after adjusting for exposures to these sites. METHODS In this cross-sectional study, we invited MSM who attended the Melbourne Sexual Health Centre (MSHC) in Victoria, Australia between 26-November 2018 and 31-December 2020 to complete a survey of their sexual practices in the past three months. We collected data on the number of male partners with whom men engaged in sexual activities that exposed their oropharynx to their partners' oropharynx (kissing), penis (fellatio), and anus (rimming or analingus). Only men who were aged ≥16 years, tested for oropharyngeal gonorrhoea and did not have indeterminate or invalid results were included in the final analysis. We conducted univariable and multivariable logistic regression analyses to investigate associations between oropharyngeal gonorrhoea and the three exposures to the oropharynx. FINDINGS The median age of the 2,322 men who completed the survey was 31 years (IQR: 26-40), and 5·2% (n = 120) were diagnosed with oropharyngeal gonorrhoea. Our univariate analysis showed that oropharyngeal gonorrhoea was significantly associated with increasing number of kissing (p trend<0·0001), rimming (p trend<0·0001) and fellatio (p trend<0·0001) partners. After adjusting for all three exposures, oropharyngeal gonorrhoea was associated with increasing number of kissing (p trend =0·014) and rimming partners (p trend = 0·037) but not fellatio (p trend = 0·61). INTERPRETATION Our data suggest kissing and rimming are important practices in oropharyngeal gonorrhoea transmission in MSM Novel interventions which target the oropharynx are required for gonorrohoea prevention. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Julien Tran
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
- Corresponding authors at: Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, VIC 3053, Australia.
| | - Jason J. Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Catriona S. Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y. Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Fabian Y.S. Kong
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane S. Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ei T. Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Eric P.F. Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Corresponding authors at: Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, VIC 3053, Australia.
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Xu X, Chow EPF, Shen M, Zou Z, Wang C, Ong JJ, Fairley CK, Zhang L. Potential effect of antiseptic mouthwash on the incidence of Neisseria gonorrhoeae among men who have sex with men: a mathematical modelling study. BMJ Open 2021; 11:e052823. [PMID: 34620667 PMCID: PMC8499270 DOI: 10.1136/bmjopen-2021-052823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The incidence of Neisseria gonorrhoeae and its antimicrobial resistance is increasing in many countries. Antibacterial mouthwash may reduce gonorrhoea transmission without using antibiotics. We modelled the effect that antiseptic mouthwash may have on the incidence of gonorrhoea. DESIGN We developed a mathematical model of the transmission of gonorrhoea between each anatomical site (oropharynx, urethra and anorectum) in men who have sex with men (MSM). We constructed four scenarios: (1) mouthwash had no effect; (2) mouthwash increased the susceptibility of the oropharynx; (3) mouthwash reduced the transmissibility from the oropharynx; (4) the combined effect of mouthwash from scenarios 2 and 3. SETTING We used data at three anatomical sites from 4873 MSM attending Melbourne Sexual Health Centre in 2018 and 2019 to calibrate our models and data from the USA, Netherlands and Thailand for sensitivity analyses. PARTICIPANTS Published available data on MSM with multisite infections of gonorrhoea. PRIMARY AND SECONDARY OUTCOME MEASURES Incidence of gonorrhoea. RESULTS The overall incidence of gonorrhoea was 44 (95% CI 37 to 50)/100 person-years (PY) in scenario 1. Under scenario 2 (20%-80% mouthwash coverage), the total incidence increased (47-60/100 PY) and at all three anatomical sites by between 7.4% (5.9%-60.8%) and 136.6% (108.1%-177.5%). Under scenario 3, with the same coverage, the total incidence decreased (20-39/100 PY) and at all anatomical sites by between 11.6% (10.2%-13.5%) and 99.8% (99.2%-100%). Under scenario 4, changes in the incidence depended on the efficacy of mouthwash on the susceptibility or transmissibility. The effect on the total incidence varied (22-55/100 PY), and at all anatomical sites, there were increases of nearly 130% and large declines of almost 100%. CONCLUSIONS The effect of mouthwash on gonorrhoea incidence is largely predictable depending on whether it increases susceptibility to or reduces the transmissibility of gonorrhoea.
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Affiliation(s)
- Xianglong Xu
- China-Australia Joint Research Center for Infectious Diseases,School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi an, Shanxi, People's Republic of China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mingwang Shen
- China-Australia Joint Research Center for Infectious Diseases,School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi an, Shanxi, People's Republic of China
| | - Zhuoru Zou
- China-Australia Joint Research Center for Infectious Diseases,School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi an, Shanxi, People's Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jason J Ong
- China-Australia Joint Research Center for Infectious Diseases,School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi an, Shanxi, People's Republic of China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- China-Australia Joint Research Center for Infectious Diseases,School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi an, Shanxi, People's Republic of China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases,School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi an, Shanxi, People's Republic of China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
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8
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Sansone A, Limoncin E, Colonnello E, Mollaioli D, Ciocca G, Corona G, Jannini EA. Harm Reduction in Sexual Medicine. Sex Med Rev 2021; 10:3-22. [DOI: 10.1016/j.sxmr.2021.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 12/22/2022]
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Phillips TR, Fairley C, Maddaford K, Trumpour S, Wigan R, Bradshaw C, Hocking JS, Chow EPF. Duration of gargling and rinsing among frequent mouthwash users: a cross-sectional study. BMJ Open 2020; 10:e040754. [PMID: 32994261 PMCID: PMC7526318 DOI: 10.1136/bmjopen-2020-040754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To examine the rinsing and gargling mouthwash practices among frequent mouthwash users to determine if there are differences in use between gender, sexual orientation and sex work status. DESIGN Cross-sectional study. SETTING Data obtained from patients attending a sexual health centre located in Melbourne, Australia. PARTICIPANTS 200 frequent mouthwash users (four or more times per week), 50 for each of the following patient groups: men who have sex with men (MSM), female sex workers (FSW), females who are not sex workers and men who have sex with women only (MSW). Participants were observed and audio recorded using mouthwash. PRIMARY AND SECONDARY OUTCOME MEASURES Descriptive analyses were conducted to calculate the median age, time rinsing and gargling, amount of mouthwash used and proportion of participants who rinsed, gargled or both, as determined from the audio files. Kruskal-Wallis H test and χ2 test were used to examine differences between the patient groups. RESULTS Median age was 28 years (IQR: 24-33). During the study, most (n=127; 63.5%) rinsed and gargled, but 70 (35.0%) rinsed only and three (1.5%) gargled only. Median time rinsing was 13.5 s (IQR: 8.5-22.0 s), gargling was 4.0 s (IQR: 2.5-6.0 s) and the median total duration was 17.0 s (IQR: 11.5-25.8 s). Median duration of mouthwash did not differ significantly between the groups (females not sex workers: 18.8 s (IQR: 12.5-24.5 s); FSW: 14.0 s (9.0-22.0 s); MSM: 22.3 s (13.0-26.5 s); MSW: 15.8 s (12.0-25.0 s); p=0.070) but males used mouthwash longer than females (median 20.3 s compared with 15.5 s; p=0.034). The median volume of mouthwash used was 20 mL (IQR: 15-27 mL). And most (n=198; 99.0%) did not dilute mouthwash with water. CONCLUSION Over a quarter of frequent users do not gargle mouthwash at all (35%) and used it for a substantially shorter period of time than it was used in the randomised trial (1 min) where it was shown to be effective at inhibiting Neisseria gonorrhoeae growth. Our findings suggest that many frequent mouthwash users do not follow the manufacturer instructions for using mouthwash and may not use mouthwash in a way that was shown to reduce the growth of oropharyngeal gonorrhoea.
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Affiliation(s)
- Tiffany Renee Phillips
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Carlton, Victoria, Australia
| | - Christopher Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Carlton, Victoria, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Sabrina Trumpour
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Carlton, Victoria, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Carlton, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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10
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Chow EPF, Maddaford K, Trumpour S, Fairley CK. Translating mouthwash use for gonorrhoea prevention into a public health campaign: identifying current knowledge and research gaps. Sex Health 2020; 16:433-441. [PMID: 31099331 DOI: 10.1071/sh18237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/13/2019] [Indexed: 11/23/2022]
Abstract
The gonorrhoea rate among gay and bisexual men who have sex with men (MSM) has been increasing rapidly in many Western countries. Furthermore, gonorrhoea is becoming increasingly resistant to antibiotics and only limited options remain for treatment. Recent evidence suggests that the oropharynx may play an important role in gonorrhoea transmission. It is hypothesised that reducing the prevalence of oropharyngeal gonorrhoea will also reduce the population incidence of gonorrhoea. Mouthwash has been proposed as a novel non-antibiotic intervention to prevent oropharyngeal gonorrhoea; hence, reducing the probability of antibiotic resistance developing. However, its efficacy is yet to be confirmed by a randomised controlled trial - the findings of which will be available in 2019. If the trial shows mouthwash is effective in preventing gonorrhoea, this finding could potentially be translated into a public health campaign to increase the mouthwash use in the MSM population. This article summarises the current evidence of the effectiveness of mouthwash against gonorrhoea and discusses the potential literature gaps before implementing the mouthwash intervention at a population level.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and Corresponding author.
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Sabrina Trumpour
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
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Recent Developments in Biomedical Issues in Sexually Transmitted Infections: Implications for Behavioral Parameters of Interest. Sex Transm Dis 2020; 46:e65-e67. [PMID: 30601376 DOI: 10.1097/olq.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chow EPF, Vodstrcil LA, Fairley CK. Seasonal variations in kissing and sexual activities among men who have sex with men in Melbourne, Australia: implications for seasonal sexually transmissible infection preventions and interventions. Sex Health 2020; 17:149-154. [PMID: 32135076 DOI: 10.1071/sh19046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 11/15/2019] [Indexed: 12/25/2022]
Abstract
Background Previous studies have shown that there is a peak in sexually transmissible infection (STI) cases and sexual activities around summer, but there has been no study examining whether kissing also follows a similar seasonal pattern. The aim of this study was to examine the seasonal patterns of kissing and sex partners among gay, bisexual and other men who have sex with men (MSM). METHODS A short cross-sectional study was conducted among MSM attending the Melbourne Sexual Health Centre between March 2016 and February 2017. Participants were asked to report the number of kissing-only, sex-only and kissing-with-sex male partners in the last 3 months. The mean number of male partners was calculated and stratified by Australia's seasons. The seasonal trend in the number of partners was assessed by negative binomial regression models. RESULTS In total, 4391 MSM were included in the analysis. The number of kissing-only and sex-only partners increased significantly from autumn to summer among MSM in Melbourne (Ptrend <0.001). MSM reported the highest number of male partners for kissing-only (mean: 4.91; 95% confidence intervals (CI): 4.78-5.04) and sex-only (mean: 1.91; 95% CI: 1.83-1.99) around summer compared with other seasons. However, the number of kissing-with-sex partners remained stable across seasons. CONCLUSIONS The study data suggest that there is a peak in kissing-only and sex-only partners among MSM around summer and holiday seasons.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and Corresponding author.
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
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Maddaford K, Fairley CK, Trumpour S, Chung M, Chow EPF. Sites in the oropharynx reached by different methods of using mouthwash: clinical implication for oropharyngeal gonorrhoea prevention. Sex Transm Infect 2019; 96:358-360. [PMID: 31628249 DOI: 10.1136/sextrans-2019-054158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/24/2019] [Accepted: 10/06/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Oropharyngeal gonorrhoea is increasing among men who have sex with men and is commonly found in the tonsils and at the posterior pharyngeal wall. To address this rise, investigators are currently trialling mouthwash to prevent oropharyngeal gonorrhoea. We aimed to determine which parts of the oropharynx were reached by different methods of mouthwash use (oral rinse, oral gargle and oral spray). METHODS Twenty staff at Melbourne Sexual Health Centre participated in the study from March to May 2018. Participants were asked to use mouthwash mixed with food dye, by three application methods on three separate days: oral rinse (15 s and 60 s), oral gargle (15 s and 60 s) and oral spray (10 and 20 times). Photographs were taken after using each method. Three authors assessed the photographs of seven anatomical areas (tongue base, soft palate, uvula, anterior tonsillar pillar, posterior tonsillar pillar, tonsil, posterior pharyngeal wall) independently and scored the dye coverage from 0% to 100%. Scores were then averaged. RESULTS The mean coverage at the sites ranged from 2 to 100. At the posterior pharyngeal wall, spraying 10 times had the highest mean coverage (29%) and was higher than a 15 s rinse (2%, p=0.001) or a 15 s gargle (8%, p=0.016). At the tonsils, there was no difference in mean coverage between spray and gargle at any dosage, but spraying 20 times had a higher mean coverage than a 15 s rinse (42% vs 12%, p=0.012). CONCLUSION Overall, spray is more effective at reaching the tonsils and posterior pharyngeal wall compared with rinse and gargle. If mouthwash is effective in preventing oropharyngeal gonorrhoea, application methods that have greater coverage may be more efficacious.
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Affiliation(s)
- Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sabrina Trumpour
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Mark Chung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia .,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Abstract
PURPOSE OF REVIEW The rate of gonorrhoea is rising and is much higher in men who have sex with men (MSM) than heterosexuals. The purpose of this review was to describe research supporting a new paradigm of transmission of gonorrhoea in MSM and interventions that may result from this. RECENT FINDINGS Evidence is accumulating that gonorrhoea in MSM is transmitted differently than previously thought and that asymptomatic sites of infection may play a major role in the persistent of gonorrhoea at a population level. Saliva commonly contains gonorrhoea, and saliva is commonly used during sexual acts. Both in-vitro, in-vivo studies have suggested that antibacterial mouthwash may reduce gonorrhoea at the oropharynx. A recently published mathematical model also suggests that if mouthwash were effective, it would result in considerable declines in the community prevalence in MSM. SUMMARY A newly suggested paradigm for the transmission of gonorrhoea in MSM could potentially offer a simple condom-free control strategy. But considerable more research is required before it could be recommended even if it were shown to be effective in a clinical trial.
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Williamson DA, Chow EPF, Lee D, Maddaford K, Sait M, Easton M, Ingle D, Wigan R, De Petra V, Howden BP, Fairley CK, Chen MY. Risk Factors for Asymptomatic Enteric Pathogen Detection Among Men Who Have Sex With Men. Open Forum Infect Dis 2019; 6:ofz326. [PMID: 31660405 PMCID: PMC6798250 DOI: 10.1093/ofid/ofz326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/09/2019] [Indexed: 11/15/2022] Open
Abstract
Improved knowledge of factors that promote outbreaks of enteric pathogens among men who have sex with men (MSM) could enable targeted public health interventions. We detected enteric pathogens in 57 of 519 (11%) asymptomatic MSM, and we found that enteric pathogen detection was associated with both oroanal sex (rimming) and group sex.
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Affiliation(s)
- Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Darren Lee
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Michelle Sait
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Australia
| | - Marion Easton
- Victorian Department of Health and Human Services, Melbourne, Australia
| | - Danielle Ingle
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Vesna De Petra
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Australia
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Chow EPF, Cornelisse VJ, Williamson DA, Priest D, Hocking JS, Bradshaw CS, Read TRH, Chen MY, Howden BP, Fairley CK. 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 2019; 95:516-521. [PMID: 31073095 DOI: 10.1136/sextrans-2018-053896] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/03/2019] [Accepted: 03/24/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES A mathematical model suggested that a significant proportion of oropharyngeal gonorrhoea cases are acquired via oropharynx-to-oropharynx transmission (ie, tongue-kissing), but to date, no empirical study has investigated this. This study aimed to examine the association between kissing and oropharyngeal gonorrhoea among gay and bisexual men who have sex with men (MSM). METHODS MSM attending a public sexual health centre in Melbourne, Australia, between March 2016 and February 2017 were invited to participate in a brief survey that collected data on their number of male partners in the last 3 months, in three distinct categories: kissing-only (ie, no sex including no oral and/or anal sex), sex-only (ie, any sex without kissing), and kissing-with-sex (ie, kissing with any sex). Univariable and multivariable logistic regression analyses were performed to examine associations between oropharyngeal gonorrhoea positivity by nucleic acid amplification tests and the three distinct partner categories. RESULTS A total of 3677 men completed the survey and were tested for oropharyngeal gonorrhoea. Their median age was 30 (IQR 25-37) and 6.2% (n=229) had oropharyngeal gonorrhoea. Men had a mean number of 4.3 kissing-only, 1.4 sex-only, and 5.0 kissing-with-sex partners in the last 3 months. Kissing-only and kissing-with-sex were associated with oropharyngeal gonorrhoea, but sex-only was not. The adjusted odds for having oropharyngeal gonorrhoea were 1.46-fold (95% CI 1.04 to 2.06) for men with ≥4 kissing-only partners and 1.81-fold (95% CI 1.17 to 2.79) for men with ≥4 kissing-with-sex partners. CONCLUSIONS These data suggest that kissing may be associated with transmission of oropharyngeal gonorrhoea in MSM, irrespective of whether sex also occurs.
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Affiliation(s)
- Eric P F Chow
- Central Clinical School, Monash University, Melbourne, Victoria, Australia .,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Vincent J Cornelisse
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - David Priest
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Catriona S Bradshaw
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Tim R H Read
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Marcus Y Chen
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
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Brisson J, Ravitsky V, Williams-Jones B. Towards an Integration of PrEP into a Safe Sex Ethics Framework for Men Who Have Sex with Men. Public Health Ethics 2018; 12:54-63. [PMID: 30936942 DOI: 10.1093/phe/phy018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The ethics of safe sex in the gay community has, for many years, been focused on debates surrounding the responsibility (or lack thereof) regarding the use of condoms to prevent HIV transmission, once the only tool available. With the development of Truvada as a pre-exposure prophylaxis (PrEP) for HIV, for the first time in the history of the HIV/AIDS epidemic there is the potential to significantly reduce the risk of HIV transmission during sex without the use of condoms (without taking into consideration 'treatment as prevention' with HIV-positive people). The introduction of PrEP necessitates a renewed discussion about the politics and ethics of safe sex for men who have sex with men (MSM). We present the arguments of authors who hold radically opposite positions with regard to the ethics of condom use by gay men, but who currently both criticize the use of PrEP. We offer a critique of their arguments and advance the position that the use of PrEP, even without condoms, can be acceptable and part of a safe sex ethics framework for MSM.
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Cornelisse VJ, Priest D, Fairley CK, Walker S, Bradshaw CS, Phillips T, Chow EP. The frequency of kissing as part of sexual activity differs depending on how men meet their male casual sexual partners. Int J STD AIDS 2017; 29:598-602. [PMID: 29256822 DOI: 10.1177/0956462417748717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies have shown that men who have sex with men (MSM) who use smartphone dating applications (apps) are at higher risk of gonorrhoea, but not HIV. We have hypothesised that kissing may be a risk factor for oropharyngeal gonorrhoea. We measured differences in kissing practices among MSM who use different methods to find male casual sexual partners (CSPs). If MSM who use apps kiss more CSPs, then this may help to explain why these men are at increased risk of gonorrhoea but not HIV. This was a cross-sectional questionnaire-based study of MSM attending Melbourne Sexual Health Centre, Australia, between March and September 2015. We measured differences in kissing practices among MSM who use different methods to find male casual sexual partners (CSPs). The questionnaire included questions about numbers of CSPs, numbers of CSPs kissed, and how men found CSPs. We surveyed 753 MSM with a median age of 29 years (interquartile range 25-36). Six hundred and one men (79.8%) reported using apps to find CSPs in the last three months. Users of apps had a higher number of CSPs than non-users (5.0 vs. 3.2; p < 0.001). Users of apps kissed a higher number (4.6 vs. 2.2; p < 0.001), and a higher proportion (90.4% vs. 71.0%; p < 0.001) of CSPs compared to non-users. We are currently investigating whether kissing is a significant mode of transmission of gonorrhoea, and if this proves correct then this study suggests that users of apps would particularly benefit from health promotion that addresses this mode of transmission.
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Affiliation(s)
- Vincent J Cornelisse
- 1 198098 Melbourne Sexual Health Centre , Alfred Health, Melbourne, Australia.,2 Central Clinical School, 22457 Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Australia
| | - David Priest
- 1 198098 Melbourne Sexual Health Centre , Alfred Health, Melbourne, Australia.,2 Central Clinical School, 22457 Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Australia
| | - Christopher K Fairley
- 1 198098 Melbourne Sexual Health Centre , Alfred Health, Melbourne, Australia.,2 Central Clinical School, 22457 Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Australia
| | - Sandra Walker
- 1 198098 Melbourne Sexual Health Centre , Alfred Health, Melbourne, Australia.,2 Central Clinical School, 22457 Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Australia
| | - Catriona S Bradshaw
- 1 198098 Melbourne Sexual Health Centre , Alfred Health, Melbourne, Australia.,2 Central Clinical School, 22457 Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Australia
| | - Tiffany Phillips
- 1 198098 Melbourne Sexual Health Centre , Alfred Health, Melbourne, Australia
| | - Eric Pf Chow
- 1 198098 Melbourne Sexual Health Centre , Alfred Health, Melbourne, Australia.,2 Central Clinical School, 22457 Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Australia
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