Saliva use as a lubricant for anal sex is a risk factor for rectal gonorrhoea among men who have sex with men, a new public health message: a cross-sectional survey

Chow, Eric P F; Cornelisse, Vincent J; Read, Tim; Lee, David; Walker, Sandra; Hocking, Jane S; Chen, Marcus Y; Bradshaw, Catriona; Fairley, Christopher K.

doi:10.1136/sextrans-2015-052502

Cited by 55 publications

(49 citation statements)

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“…In addition, a substantial proportion of MSM (69%) use the partner's saliva as a lubricant for anal sex (6), suggesting that this might account for rectal gonorrheal infections in men who report condom use with receptive anal sex. This hypothesis is supported by a recent observational study showing that, after adjusting for potential confounders, including condom use for receptive anal sex, about 41% of the cases of rectal gonorrhea can be attributed to the use of a partner's saliva as a lubricant for anal sex (6).…”

Section: Discussionmentioning

confidence: 99%

“…Given that a substantial gonococcal bacterial DNA load is present in saliva, it is plausible that gonorrhea can be transmitted through saliva across all three anatomical sites, that is, from the pharynx to the rectum via rimming (19), from the rectum to the pharynx via rimming (7), from pharynx to pharynx via wet kissing (7), from the pharynx to the urethra via oral sex (19), and/or via saliva use as a lubricant for masturbation (6). In addition, a substantial proportion of MSM (69%) use the partner's saliva as a lubricant for anal sex (6), suggesting that this might account for rectal gonorrheal infections in men who report condom use with receptive anal sex. This hypothesis is supported by a recent observational study showing that, after adjusting for potential confounders, including condom use for receptive anal sex, about 41% of the cases of rectal gonorrhea can be attributed to the use of a partner's saliva as a lubricant for anal sex (6).…”

Section: Discussionmentioning

confidence: 99%

“…An Australian-based mathematical model conducted by Hui et al has shown that gonorrhea cannot be eliminated even if 100% condom use is practiced for anal sex among MSM (5), suggesting that gonorrhea has other routes of transmission other than penile-anal sex. Several observational studies have shown that kissing, oroanal (rimming) practices, oral-penile sex, and saliva use as a lubricant for anal sex are all associated with the detection of gonorrhea (6,7). All of these sexual activities involve the use and transfer of saliva, indicating that saliva could potentially act as a vehicle for the transmission of gonorrhea during sex.…”

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Neisseria gonorrhoeae Bacterial DNA Load in the Pharynges and Saliva of Men Who Have Sex with Men

et al. 2016

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e Neisseria gonorrhoeae can be cultured in the saliva of individuals with pharyngeal gonorrhea. The aim of this study was to quantify the gonococcal bacterial DNA loads in the pharynges and saliva among men who have sex with men (MSM) with untreated pharyngeal gonorrhea. Untreated MSM who tested positive for pharyngeal gonorrhea by culture and returned for antibiotic treatment within 14 days at the Melbourne Sexual Health Centre between October 2014 and March 2015 were eligible for this study. The gonococcal bacterial DNA load was measured using real-time quantitative PCR. The median gonococcal bacterial DNA loads in the pharynges and saliva were calculated and compared to culture positivity using the Mann-Whitney U test. A total of 33 men were included in this study. The median gonococcal bacterial DNA load did not differ between the pharynges in men who were culture positive (2.5 ؋ 10 5 copies/swab) and culture negative (2.9 ؋ 10 4 copies/swab) (P ‫؍‬ 0.166) and the saliva (culture positive, 2.2 ؋ 10 5 copies/ml; culture negative, 2.7 ؋ 10 5 copies/ml) (P ‫؍‬ 0.499). The bacterial DNA load in the pharynges (P ‫؍‬ 0.695) and saliva (P ‫؍‬ 0.969) did not differ between who men returned for treatment within 7 days and those who returned 8 to 14 days later. Substantial gonococcal bacterial DNA loads were detected in both saliva and pharynges among MSM with pharyngeal gonorrhea. These findings suggest that gonorrhea can be transmitted via sexual practices involving exposure to saliva, such as oroanal practices (rimming) and saliva use as a lubricant for anal sex.T he high prevalence of gonococcal infection among men who have sex with men (MSM) is a public health issue in many developed countries (1-4). It is important to understand how gonorrhea is transmitted in order to effectively reduce the burden of this epidemic. An Australian-based mathematical model conducted by Hui et al. has shown that gonorrhea cannot be eliminated even if 100% condom use is practiced for anal sex among MSM (5), suggesting that gonorrhea has other routes of transmission other than penile-anal sex. Several observational studies have shown that kissing, oroanal (rimming) practices, oral-penile sex, and saliva use as a lubricant for anal sex are all associated with the detection of gonorrhea (6, 7). All of these sexual activities involve the use and transfer of saliva, indicating that saliva could potentially act as a vehicle for the transmission of gonorrhea during sex. There have been three published studies showing that gonorrhea can be cultured from saliva samples (8-10); however, none of these studies examined the gonococcal bacterial DNA load in saliva. If saliva can act as a medium for gonorrhea transmission, it is important to understand the relative concentrations of bacteria at different anatomical sites to provide further understanding on gonorrhea transmission. The aim of this study was to quantify the gonococcal bacterial DNA loads in saliva and the pharynx. MATERIALS AND METHODSThis cross-sectional study was conducted at the M...

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confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Neisseria gonorrhoeae Bacterial DNA Load in the Pharynges and Saliva of Men Who Have Sex with Men

et al. 2016

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“…454 Early work has shown that antibacterial 1880 mouthwash might inhibit N. gonorrhoeae growth and studies of mouthwash for gonorrhoea 1881 prevention are underway. 439 We call on policy makers to fund research to better understand …”

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Sexually transmitted infections: challenges ahead

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Hocking

et al. 2017

The Lancet Infectious Diseases

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“…Most pharyngeal N. gonorrhoeae infections will remain undetected unless NAAT is used. Further, recent studies have reported that undetected pharyngeal gonorrhea can increase the risk of anal infection when saliva is used as a lubricant for anal sex (21).…”

Section: Discussionmentioning

confidence: 99%

Use of Nucleic Acid Amplification Testing for Diagnosis of Extragenital Sexually Transmitted Infections

et al. 2017

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Nucleic acid amplification testing (NAAT) is the preferred method to detect Chlamydia trachomatis and Neisseria gonorrhoeae, but no commercial tests are cleared by the U.S. Food and Drug Administration for use with extragenital swab samples. This study evaluated the performance of the Gen-Probe Aptima Combo2 assay (Aptima) and the Cepheid Xpert CT/NG assay (Xpert) to detect C. trachomatis and N. gonorrhoeae in rectal and pharyngeal samples from 224 men and 175 women reporting a history of anal receptive sexual intercourse. Discordant results between the NAATs were repeated using the assays APTIMA CT or APTIMA GC, which target alternate primers, as the confirmatory tests. C. trachomatis was detected from 59 rectal swabs and 8 pharyngeal samples, with 97.7% and 99.5% agreement between the two test systems, respectively. For C. trachomatis, Xpert was 95% sensitive (95% CI, 86 to 99%) and Aptima was 92% sensitive (95% CI, 81 to 97%) from rectal swabs, while both systems were 100% sensitive from pharyngeal samples. N. gonorrhoeae was detected from 30 rectal and 40 pharyngeal samples, with 99.5% and 97.5% agreement between the two test systems. The sensitivity of Xpert for N. gonorrhoeae from rectal swabs was 100% (95% CI, 88 to 100%) versus 93% (95% CI, 78 to 99%) for Aptima. From pharyngeal swab samples, Xpert was 98% sensitive (95% CI, 87 to 99.9%) versus 93% (95% CI, 80 to 98%) for Aptima. For C. trachomatis, neither system was Ͼ95% sensitive from the rectum, though both were Ͼ99.5% specific. For N. gonorrhoeae, Xpert had higher sensitivity than Aptima, but with more false positives from pharyngeal samples.

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Saliva use as a lubricant for anal sex is a risk factor for rectal gonorrhoea among men who have sex with men, a new public health message: a cross-sectional survey

Abstract: Saliva use as a lubricant for anal sex is a common sexual practice in MSM, and it may play an important role in gonorrhoea transmission. Almost half of rectal gonorrhoea cases may be eliminated if MSM stopped using partner's saliva for anal sex.

Cited by 55 publications

References 18 publications

Neisseria gonorrhoeae Bacterial DNA Load in the Pharynges and Saliva of Men Who Have Sex with Men

Neisseria gonorrhoeae Bacterial DNA Load in the Pharynges and Saliva of Men Who Have Sex with Men

Sexually transmitted infections: challenges ahead

Use of Nucleic Acid Amplification Testing for Diagnosis of Extragenital Sexually Transmitted Infections

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