Oral Gonorrhea May Be Spread Through Kissing in MSM

Oropharyngeal gonorrhea may be spread via French kissing, according to a new study out of Australia that looked at oropharynx-to-oropharynx transmission of the sexually transmitted infection (STI).

Investigators in Melbourne recruited more than 3000 gay and bisexual men who have sex with men (MSM) to participate in the study, which relied on a survey to create a mathematical model of gonorrhea transmission. Their findings were published in the journal Sexually Transmitted Infections.

Participants, who had visited a sexual health clinic in Melbourne between March 2016 and February 2017, were stratified into 3 categories of relationships: 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).

The median age of participants was 30 years [interquartile range (IQR): 25—37] and 6.2% (n = 229) had oropharyngeal gonorrhea. The average number of kissing-only partners in the last 3 months was 4.3, sex-only partners 1.4, and kissing-with-sex partners 5.0. Sex-only was not affiliated with oropharyngeal gonorrhea but kissing-only and kissing-with-sex were.

“The adjusted odds for having oropharyngeal gonorrhea were 1.46-fold [95% confidence interval (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,” investigators reported.

The research team concluded that kissing appears to be associated with the transmission of oropharyngeal gonorrhea regardless of whether sex also occurs.

“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,” lead author Eric P. F. Chow, PhD, MPH, BSc, associate professor at Monash University, told Contagion®. “A key strength of this study is that we measured ‘kissing-only partners’ for the first time. This has not been done before. 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.”

Chow and his team hope that their study demonstrates that safe sex isn’t necessarily a catch-all.

“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 been sexually active,” Chow told Contagion®. “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.”