Understanding the duration of tongue kissing among female sex workers for potential oropharyngeal-oropharyngeal gonorrhoea transmission

Duration of kissing in different intimate positions among men who have sex with men: A cross-sectional study

BackgroundDespite mounting evidence showing that kissing (tongue-kissing) may transmit gonorrhoea between men who have sex with men (MSM), little data exists on factors influencing the duration of kissing while they are above and/or lying underneath a partner for this population group.MethodsBetween May 2019 and March 2020, we invited MSM aged ≥18 years who attended the Melbourne Sexual Health Centre (MSHC) to participate in a survey about the duration of their kissing (minutes) and intimate position while kissing (i.e., kissing while above, or while lying underneath) their most recent partner. Univariable and multivariable negative binomial regressions were performed to examine the associations between the duration of kissing in different intimate positions, and demographic and behavioural characteristics (including age, region of birth, HIV status or PrEP use, and role in anal sex).ResultsOf the 965 men with a recent male kissing partner, 89.0% (n = 859) also had sex with that partner. Of the 166 men with a recent female kissing partner, 71.7% (n = 119) also had sex with that partner. Our adjusted analyses showed that, on average, men born in Asia (mean 8.52 vs 11.69 min, p < .001) and South America or the Caribbean (mean 8.61 vs 11.69 min, p = .022) spent less time kissing compared to men born in Oceania, and the same was also observed for kissing while above or lying underneath. Men who had only receptive anal sex spent less time kissing while above than those who only had insertive anal sex (mean 3.04 vs 5.86 min, p < .001).ConclusionOur study is the first to examine factors that influence duration of kissing in different intimate positions. These factors could be associated with oropharyngeal gonorrhoea if saliva transmitted gonorrhoea and if gravity played a role.

Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study

BACKGROUND

The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection.

OBJECTIVE

This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients.

METHODS

This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted.

RESULTS

In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30% of sex workers (192/664, 28.9%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients' lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam.

CONCLUSIONS

Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention.

STI pathogens in the oropharynx: update on screening and treatment

PURPOSE OF REVIEW

The rise in antimicrobial resistance in several STI pathogens such as Neisseria gonorrhoeae has become a public health threat as only one first-line treatment remains. Reducing screening interval for gonorrhoea and chlamydia in high-prevalence populations has been proposed to address antimicrobial stewardship, but this remains controversial. This review aimed to revisit the epidemiology of infections at the oropharynx and review the current screening recommendations and treatment guidelines in different populations.

RECENT FINDINGS

Emerging evidence suggests that the oropharynx is the primary anatomical site for gonorrhoea transmission but maybe not for chlamydia transmission. Most international guidelines recommend 3-monthly oropharyngeal gonorrhoea and chlamydia screening for high-prevalence populations (e.g. men who have sex with men) but not low-prevalence populations (e.g. heterosexuals) given the clinical and public health benefits of screening in low-prevalence populations are still unclear. Doxycycline remains the first-line treatment for oropharyngeal chlamydia in most guidelines. However, some countries have moved from dual therapy (ceftriaxone and azithromycin) to monotherapy (ceftriaxone) for oropharyngeal gonorrhoea treatment to address antimicrobial stewardship.

SUMMARY

The transmission of gonorrhoea and chlamydia is still not fully understood. Further work will be required to evaluate the benefits and harms of reducing screening in high-prevalence populations.