Associations between oral sex practices and frequent mouthwash use in men who have sex with men: implications for gonorrhoea prevention
Tiffany Phillips
A C , Christopher K. Fairley A B , Sandra Walker A and Eric P. F. Chow A B
+ Author Affiliations
- Author Affiliations
A Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia.
B Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia.
C Corresponding author. Email: tphillips@mshc.org.au
Sexual Health 16(5) 473-478 https://doi.org/10.1071/SH18131
Submitted: 18 July 2018 Accepted: 30 August 2018 Published: 18 December 2018
Journal Compilation © CSIRO 2019 Open Access CC BY-NC-ND
Abstract
Background: Rates of gonorrhoea continue to rise among men who have sex with men (MSM) in Australia and worldwide. Recently, it has been proposed that oropharyngeal gonorrhoea may play a role in its onward transmission and that mouthwash use may be an effective intervention for gonorrhoea prevention and control. The objective of this study was to determine the association between specific oral sex practices and frequency of mouthwash use. Methods: A questionnaire-based study was conducted among MSM attending the Melbourne Sexual Health Centre in Australia from March to September 2015. Logistic regression was performed to examine the association between frequent mouthwash use (i.e. daily or weekly mouthwash use) and four oral sex practices (tongue kissing, receptive fellatio with or without ejaculation, and insertive rimming) among MSM. Results: Of the 918 MSM included in the final analysis, 490 men (53.4%) were frequent mouthwash users. Participants aged 24–34 years were 2.13-fold (95% CI 1.52–2.98) and those ≥35 years were 2.64-fold (95% CI 1.83–3.83) more likely to use mouthwash frequently than those aged ≤24 years. The most common oral sex practice was tongue kissing (n = 874; 95.2%), followed by receptive fellatio without ejaculation (n = 839; 91.4%), receptive fellatio with ejaculation (n = 610; 66.5%), then insertive rimming (n = 356; 38.8%). No significant association was found between frequent mouthwash use and tongue kissing, receptive fellatio with or without ejaculation, or insertive rimming with regular or casual male partners in the previous 3 months. Conclusions: Younger MSM are less likely to use mouthwash. There is no association between engaging in oral sex practices and frequent mouthwash use among MSM.
Additional keywords: homosexuality, Neisseria gonorrhoeae, sexual practices, sexually transmissible infection.
References
[1] Chow EPF, Tomnay J, Fehler G, Whiley D, Read TRH, Denham I, Bradshaw CS, Chen MY, Fairley CK. Substantial increases in chlamydia and gonorrhea positivity unexplained by changes in individual-level sexual behaviors among men who have sex with men in an Australian sexual health service from 2007 to 2013. Sex Transm Dis 2015; 42 81–7.| Substantial increases in chlamydia and gonorrhea positivity unexplained by changes in individual-level sexual behaviors among men who have sex with men in an Australian sexual health service from 2007 to 2013.Crossref | GoogleScholarGoogle Scholar |
[2] Weston EJ, Kirkcaldy RD, Stenger M, Llata E, Hoots B, Torrone EA. Narrative review: assessment of Neisseria gonorrhoeae infections among men who have sex with men in national and sentinel surveillance systems in the United States. Sex Transm Dis 2018; 45 243–9.
[3] Public Health England. Sexually transmitted infections and screening for chlamydia in England, 2017 – Health Protection Report, Volume 12 Number 20, 8 June 2018. London, UK: Public Health England; 2018. Available online at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/713962/hpr2018_AA-STIs_v5.pdf [verified 13 December 2018].
[4] Wi T, Lahra MM, Ndowa F, Bala M, Dillon J-AE, Ramon-Pardo P, Eremin SR, Bolan G, Unemo M. Antimicrobial resistance in Neisseria gonorrhoeae: global surveillance and a call for international collaborative action. PLoS Med 2017; 14 e1002344
| Antimicrobial resistance in Neisseria gonorrhoeae: global surveillance and a call for international collaborative action.Crossref | GoogleScholarGoogle Scholar |
[5] Fairley CK, Hocking JS, Zhang L, Chow EPF. Frequent transmission of gonorrhea in men who have sex with men. Emerg Infect Dis 2017; 23 102–4.
| Frequent transmission of gonorrhea in men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[6] Fairley CK, Zhang L, Chow EPF. New thinking on gonorrhoea control in MSM: are antiseptic mouthwashes the answer? Curr Opin Infect Dis 2018; 31 45–9.
| New thinking on gonorrhoea control in MSM: are antiseptic mouthwashes the answer?Crossref | GoogleScholarGoogle Scholar |
[7] Hutt DM, Judson FN. Epidemiology and treatment of oropharyngeal gonorrhea. Ann Intern Med 1986; 104 655–8.
| Epidemiology and treatment of oropharyngeal gonorrhea.Crossref | GoogleScholarGoogle Scholar |
[8] Chow EPF, Lee D, Tabrizi SN, Phillips S, Snow A, Cook S, Howden BP, Petalotis I, Bradshaw CS, Chen MY, Fairley CK. Detection of Neisseria gonorrhoeae in the pharynx and saliva: implications for gonorrhoea transmission. Sex Transm Infect 2016; 92 347–9.
| Detection of Neisseria gonorrhoeae in the pharynx and saliva: implications for gonorrhoea transmission.Crossref | GoogleScholarGoogle Scholar |
[9] Hallqvist L, Lindgren S. Gonorrhoea of the throat at a venereological clinic. Incidence and results of treatment. Br J Vener Dis 1975; 51 395–7.
[10] Chow EPF, Cornelisse VJ, Read TRH, Lee D, Walker S, Hocking JS, Chen MY, Bradshaw CS, Fairley CK. 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. Sex Transm Infect 2016; 92 532–6.
| 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.Crossref | GoogleScholarGoogle Scholar |
[11] Chow EPF, Howden BP, Walker S, Lee D, Bradshaw CS, Chen MY, Snow A, Cook S, Fehler G, Fairley CK. Antiseptic mouthwash against pharyngeal Neisseria gonorrhoeae: a randomised controlled trial and an in vitro study. Sex Transm Infect 2017; 93 88–93.
| Antiseptic mouthwash against pharyngeal Neisseria gonorrhoeae: a randomised controlled trial and an in vitro study.Crossref | GoogleScholarGoogle Scholar |
[12] Chow EPF, Walker S, Hocking JS, Bradshaw CS, Chen MY, Tabrizi SN, Howden BP, Law MG, Maddaford K, Read TRH, Lewis DA, Whiley DM, Zhang L, Grulich AE, Kaldor JM, Cornelisse VJ, Phillips S, Donovan B, McNulty AM, Templeton DJ, et al A multicentre double-blind randomised controlled trial evaluating the efficacy of daily use of antibacterial mouthwash against oropharyngeal gonorrhoea among men who have sex with men: the OMEGA (Oral Mouthwash use to Eradicate GonorrhoeA) study protocol. BMC Infect Dis 2017; 17 456
| A multicentre double-blind randomised controlled trial evaluating the efficacy of daily use of antibacterial mouthwash against oropharyngeal gonorrhoea among men who have sex with men: the OMEGA (Oral Mouthwash use to Eradicate GonorrhoeA) study protocol.Crossref | GoogleScholarGoogle Scholar |
[13] Walker S, Bellhouse C, Fairley CK, Bilardi JE, Chow EPF. Pharyngeal gonorrhoea: the willingness of Australian men who have sex with men to change current sexual practices to reduce their risk of transmission - a qualitative study. PLoS One 2016; 11 e0164033
| Pharyngeal gonorrhoea: the willingness of Australian men who have sex with men to change current sexual practices to reduce their risk of transmission - a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[14] Needleman R, Chow EP, Towns JM, Cornelisse VJ, Yang TZT, Chen MY, Bradshaw CS, Fortune R, Fairley CK. Access to sexual health services after the rapid roll out of the launch of pre-exposure prophylaxis for HIV in Melbourne, Australia: a retrospective cross-sectional analysis. Sex Health 2018; 15 528–32.
| Access to sexual health services after the rapid roll out of the launch of pre-exposure prophylaxis for HIV in Melbourne, Australia: a retrospective cross-sectional analysis.Crossref | GoogleScholarGoogle Scholar |
[15] Cornelisse VJ, Walker S, Phillips T, Hocking JS, Bradshaw CS, Lewis DA, Prestage GP, Grulich AE, Fairley CK, Chow EPF. Risk factors for oropharyngeal gonorrhoea in men who have sex with men: an age-matched case-control study. Sex Transm Infect 2018; 94 359–64.
| Risk factors for oropharyngeal gonorrhoea in men who have sex with men: an age-matched case-control study.Crossref | GoogleScholarGoogle Scholar |
[16] Chow EPF, Walker S, Read TRH, Chen MY, Bradshaw CS, Fairley CK. Self-reported use of mouthwash and pharyngeal gonorrhoea detection by nucleic acid amplification test. Sex Transm Dis 2017; 44 593–5.
| Self-reported use of mouthwash and pharyngeal gonorrhoea detection by nucleic acid amplification test.Crossref | GoogleScholarGoogle Scholar |
[17] Hunt AJ, Weatherburn P, Hickson FCI, Davies PM, McManus TJ, Coxon APM. Changes in condom use by gay men. AIDS Care 1993; 5 439–48.
| Changes in condom use by gay men.Crossref | GoogleScholarGoogle Scholar |
[18] Bernstein KT, Chesson H, Kirkcaldy RD, Marcus JL, Gift TL, Aral SO. Kiss and tell: limited empirical data on oropharyngeal Neisseria gonorrhoeae among men who have sex with men and implications for modeling. Sex Transm Dis 2017; 44 596–8.
| Kiss and tell: limited empirical data on oropharyngeal Neisseria gonorrhoeae among men who have sex with men and implications for modeling.Crossref | GoogleScholarGoogle Scholar |
[19] Cornelisse VJ, Zhang L, Law M, Chen MY, Bradshaw CS, Bellhouse C, Fairley CK, Chow EPF. Concordance of gonorrhoea of the rectum, pharynx and urethra in same-sex male partnerships attending a sexual health service in Melbourne, Australia. BMC Infect Dis 2018; 18 95
| Concordance of gonorrhoea of the rectum, pharynx and urethra in same-sex male partnerships attending a sexual health service in Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar |
[20] Chow EPF, Priest D, Cornelisse V, Read TRH, Bradshaw CS, Chen MY, Fairley CK. Kissing but not sex is the strongest risk factor for oropharyngeal gonorrhoea in men who have sex with men: a cross-sectional survey. [Poster abstract P103] In: Gazzard B, Lundgren J, editors. HIV Medicine, 2018, 19(Suppl 2). Abstracts of the 4th Joint Conference of the British HIV Association (BHIVA) with the British Association for Sexual Health and HIV (BASHH); 17–20 April 2018; Edinburgh, UK. Oxford: John Wiley & Sons; 2018.
[21] Kinghorn G. Pharyngeal gonorrhoea: a silent cause for concern. Sex Transm Infect 2010; 86 413–4.
| Pharyngeal gonorrhoea: a silent cause for concern.Crossref | GoogleScholarGoogle Scholar |
[22] Chow EPF, Camilleri S, Ward C, Huffam S, Chen MY, Bradshaw CS, Fairley CK. Duration of gonorrhoea and chlamydia infection at the pharynx and rectum among men who have sex with men: a systematic review. Sex Health 2016; 13 199–204.
[23] Jenness SM, Weiss KM, Goodreau SM, Gift T, Chesson H, Hoover KW, Smith DK, Liu AY, Sullivan PS, Rosenberg ES. Incidence of gonorrhea and chlamydia following human immunodeficiency virus preexposure prophylaxis among men who have sex with men: a modeling study. Clin Infect Dis 2017; 65 712–8.
| Incidence of gonorrhea and chlamydia following human immunodeficiency virus preexposure prophylaxis among men who have sex with men: a modeling study.Crossref | GoogleScholarGoogle Scholar |
[24] Zhang L, Regan DG, Chow EPF, Gambhir M, Cornelisse V, Grulich A, Ong J, Lewis DA, Hocking J, Fairley CK. Neisseria gonorrhoeae transmission among men who have sex with men: an anatomical site-specific mathematical model evaluating the potential preventive impact of mouthwash. Sex Transm Dis 2017; 44 586–92.
| Neisseria gonorrhoeae transmission among men who have sex with men: an anatomical site-specific mathematical model evaluating the potential preventive impact of mouthwash.Crossref | GoogleScholarGoogle Scholar |
[25] Lin CTS, Raman R. Comparison of the efficacy between oral rinse, oral gargle, and oral spray. J Prim Care Community Health 2012; 3 80–2.
| Comparison of the efficacy between oral rinse, oral gargle, and oral spray.Crossref | GoogleScholarGoogle Scholar |
[26] Chow EPF, Fairley CK. Could antiseptic mouthwash inhibit pharyngeal Neisseria gonorrhoeae? Further research is required. Sex Transm Infect 2017; 93 403
| Could antiseptic mouthwash inhibit pharyngeal Neisseria gonorrhoeae? Further research is required.Crossref | GoogleScholarGoogle Scholar |
