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RESEARCH ARTICLE (Open Access)

Age, ethnic and travel-related disparities in kissing and sexual practices among heterosexual men in Melbourne, Australia

Finley J. Charleson A B E , Christopher K. Fairley A C , Jane S. Hocking D , Lenka A. Vodstrcil A C , Catriona S. Bradshaw A C and Eric P. F. Chow https://orcid.org/0000-0003-1766-0657 A C D E
+ Author Affiliations
- Author Affiliations

A Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia.

B Melbourne Medical School, The University of Melbourne, Corner Grattan Street and Royal Parade, Parkville, Vic. 3010, Australia.

C Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia.

D Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia.

E Corresponding authors. Emails: finleycharleson@gmail.com; eric.chow@monash.edu.

Sexual Health 17(3) 279-287 https://doi.org/10.1071/SH19230
Submitted: 13 December 2019  Accepted: 6 April 2020   Published: 23 June 2020

Journal compilation © CSIRO 2020 Open Access CC BY-NC-ND

Abstract

Background: The kissing practices of heterosexual men are not well understood, despite the potential of kissing to be a significant risk factor for gonorrhoea transmission. This study aimed to explore kissing and sex practices among heterosexual men. Methods: A cross-sectional survey among heterosexual men attending the Melbourne Sexual Health Centre in 2016–2017 was conducted. Men were asked to report their number of kissing-only (in the absence of sex), sex-only (in the absence of kissing) and kissing-with-sex partners in the last 3 months. The mean number of each partner type was calculated, and multivariable negative binomial regression was used to investigate associations between the number of different types of partners and demographic characteristics. Results: Of the 2351 heterosexual men, men reported a mean of 2.98 kissing-only, 0.54 sex-only and 2.64 kissing-with-sex partners in the last 3 months. Younger men had a mean higher number of kissing-only partners than older men (4.52 partners among men aged ≤24 years compared with 1.75 partners among men ≥35 years, P < 0.001). Men born in Europe had the most kissing-only partners (mean: 5.16 partners) and men born in Asia had the fewest kissing-only partners (mean: 1.61 partners). Men recently arrived in Australia, including travellers from overseas, had significantly more kissing-only partners (adjusted incidence rate ratio (aIRR): 1.53; 95% CI: 1.31–1.80) than local men. Conclusions: This study provides novel data about kissing practices of heterosexual men. Studies assessing oropharyngeal gonorrhoea should include measurements of kissing until studies can clarify its contribution to transmission risk.

Additional keywords: behaviour, gonorrhoea, kiss, sex, sexually transmissible infections, tongue kiss.


References

[1]  Chow EPF, Cornelisse VJ, Williamson DA, Priest D, Hocking JS, Bradshaw CS, et al. 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; 95 516–21.
Kissing may be an important and neglected risk factor for oropharyngeal gonorrhoea: a cross-sectional study in men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 31073095PubMed |

[2]  Chow EP, Fairley CK. The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission. J Int AIDS Soc 2019; 22 e25354
The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission.Crossref | GoogleScholarGoogle Scholar | 31468730PubMed |

[3]  Herbenick D, Fu TCJ, Owens C, Bartelt E, Dodge B, Reece M, et al. Kissing, cuddling, and massage at most recent sexual event: findings from a U.S. nationally representative probability sample. J Sex Marital Ther 2019; 45 159–72.
Kissing, cuddling, and massage at most recent sexual event: findings from a U.S. nationally representative probability sample.Crossref | GoogleScholarGoogle Scholar | 30040548PubMed |

[4]  Chow EP, Tomnay J, Fehler G, Whiley D, Read TR, Denham I, et al. 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 | 25585066PubMed |

[5]  Mohammed H, Blomquist P, Ogaz D, Duffell S, Furegato M, Checchi M, et al. 100 years of STIs in the UK: a review of national surveillance data. Sex Transm Infect 2018; 94 553–8.
100 years of STIs in the UK: a review of national surveillance data.Crossref | GoogleScholarGoogle Scholar | 29654061PubMed |

[6]  Town K, Furegato M, Field N, Hughes G. Estimating gonorrhoea prevalence in young heterosexual men and women attending community-based sexual health services to inform decisions on gonorrhoea testing. Epidemiol Infect 2017; 145 1682–7.
Estimating gonorrhoea prevalence in young heterosexual men and women attending community-based sexual health services to inform decisions on gonorrhoea testing.Crossref | GoogleScholarGoogle Scholar | 28253939PubMed |

[7]  Chow EPF, Grulich AE, Fairley CK. Epidemiology and prevention of sexually transmitted infections in men who have sex with men at risk of HIV. Lancet HIV 2019; 6 e396–405.
Epidemiology and prevention of sexually transmitted infections in men who have sex with men at risk of HIV.Crossref | GoogleScholarGoogle Scholar | 31006612PubMed |

[8]  Misson J, Chow EPF, Chen MY, Read TRH, Bradshaw CS, Fairley CK. Trends in gonorrhoea infection and overseas sexual contacts among females attending a sexual health centre in Melbourne, Australia, 2008–2015. Commun Dis Intell 2018; 42 S2209-6051(18)00024-6

[9]  Phillips TR, Fairley CK, Chen MY, Bradshaw CS, Chow EPF. Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia: 2007–2017. Sex Health 2019; 16 508–513.
Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia: 2007–2017.Crossref | GoogleScholarGoogle Scholar | 31203836PubMed |

[10]  Callander D, McManus H, Guy R, Hellard M, O’Connor CC, Fairley CK, et al. Rising chlamydia and gonorrhoea incidence and associated risk factors among female sex workers in Australia: a retrospective cohort study. Sex Transm Dis 2018; 45 199–206.
Rising chlamydia and gonorrhoea incidence and associated risk factors among female sex workers in Australia: a retrospective cohort study.Crossref | GoogleScholarGoogle Scholar | 29420449PubMed |

[11]  The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2018. Sydney: Kirby Institute, UNSW Sydney; 2018.

[12]  Lusk MJ, Uddin RN, Lahra MM, Garden FL, Kundu RL, Konecny P. Pharyngeal gonorrhoea in women: an important reservoir for increasing Neisseria gonorrhoea prevalence in urban Australian heterosexuals? J Sex Transm Dis 2013; 2013 967471
Pharyngeal gonorrhoea in women: an important reservoir for increasing Neisseria gonorrhoea prevalence in urban Australian heterosexuals?Crossref | GoogleScholarGoogle Scholar | 26316970PubMed |

[13]  Chow EP, Williamson DA, Fortune R, Bradshaw CS, Chen MY, Fehler G, et al. Prevalence of genital and oropharyngeal chlamydia and gonorrhoea among female sex workers in Melbourne, Australia, 2015–2017: need for oropharyngeal testing. Sex Transm Infect 2019; 95 398–401.
Prevalence of genital and oropharyngeal chlamydia and gonorrhoea among female sex workers in Melbourne, Australia, 2015–2017: need for oropharyngeal testing.Crossref | GoogleScholarGoogle Scholar | 31113904PubMed |

[14]  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 | 27983487PubMed |

[15]  Cornelisse VJ, Bradshaw CS, Chow EPF, Williamson DA, Fairley CK. Oropharyngeal gonorrhea in absence of urogenital gonorrhea in sexual network of male and female participants, Australia, 2018. Emerg Infect Dis 2019; 25 1373–6.
Oropharyngeal gonorrhea in absence of urogenital gonorrhea in sexual network of male and female participants, Australia, 2018.Crossref | GoogleScholarGoogle Scholar | 31211673PubMed |

[16]  Fairley CK, Cornelisse VJ, Hocking JS, Chow EPF. Models of gonorrhoea transmission from the mouth and saliva. Lancet Infect Dis 2019; 19 e360–6.
Models of gonorrhoea transmission from the mouth and saliva.Crossref | GoogleScholarGoogle Scholar | 31324517PubMed |

[17]  Chow EPF, Carlin JB, Read TRH, Chen MY, Bradshaw CS, Sze JK, et al. Factors associated with declining to report the number of sexual partners using computer-assisted self-interviewing: a cross-sectional study among individuals attending a sexual health centre in Melbourne, Australia. Sex Health 2018; 15 350–7.
Factors associated with declining to report the number of sexual partners using computer-assisted self-interviewing: a cross-sectional study among individuals attending a sexual health centre in Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar | 29966584PubMed |

[18]  Vodstrcil LA. Computer assisted self interviewing in a sexual health clinic as part of routine clinical care; impact on service and patient and clinician views. PLoS ONE 2011; 6 e18456
Computer assisted self interviewing in a sexual health clinic as part of routine clinical care; impact on service and patient and clinician views.Crossref | GoogleScholarGoogle Scholar | 21483799PubMed |

[19]  Guy RJ, Wand H, Franklin N, Fairley CK, Chen MY, O’Connor CC, et al. Chlamydia trends in men who have sex with men attending sexual health services in Australia, 2004–2008. Sex Transm Dis 2011; 38 339–46.
Chlamydia trends in men who have sex with men attending sexual health services in Australia, 2004–2008.Crossref | GoogleScholarGoogle Scholar | 21217421PubMed |

[20]  Micallef L, Rodgers P. eulerAPE: drawing area-proportional 3-Venn diagrams using ellipses. PLoS One 2014; 9 e101717
eulerAPE: drawing area-proportional 3-Venn diagrams using ellipses.Crossref | GoogleScholarGoogle Scholar | 25032825PubMed |

[21]  Tully J, Viner RM, Coen PG, Stuart JM, Zambon M, Peckham C, et al. Risk and protective factors for meningococcal disease in adolescents: matched cohort study. BMJ 2006; 332 445–50.
Risk and protective factors for meningococcal disease in adolescents: matched cohort study.Crossref | GoogleScholarGoogle Scholar | 16473859PubMed |

[22]  O’Sullivan LF, Cheng MM, Harris KM, Brooks-Gunn J. I wanna hold your hand: the progression of social, romantic and sexual events in adolescent relationships. Perspect Sex Reprod Health 2007; 39 100–7.
I wanna hold your hand: the progression of social, romantic and sexual events in adolescent relationships.Crossref | GoogleScholarGoogle Scholar | 17565623PubMed |

[23]  Lefkowitz ES, Wesche R, Leavitt CE. Never been kissed: correlates of lifetime kissing status in U.S. university students. Arch Sex Behav 2018; 47 1283–93.
Never been kissed: correlates of lifetime kissing status in U.S. university students.Crossref | GoogleScholarGoogle Scholar | 29464454PubMed |

[24]  Arnett JJ. Emerging adulthood: a theory of development from the late teens through the twenties. Am Psychol 2000; 55 469–80.
Emerging adulthood: a theory of development from the late teens through the twenties.Crossref | GoogleScholarGoogle Scholar | 10842426PubMed |

[25]  Welsh DP, Haugen PT, Widman L, Darling N, Grello CM. Kissing is good: a developmental investigation of sexuality in adolescent romantic couples. Sex Res Soc Policy 2005; 2 32–41.
Kissing is good: a developmental investigation of sexuality in adolescent romantic couples.Crossref | GoogleScholarGoogle Scholar |

[26]  Moore EA, Kulibert D, Thompson AE. Is a kiss just a kiss?: predicting variations in motives for romantic kissing. Journal of Relationships Research 2017; 8 e3
Is a kiss just a kiss?: predicting variations in motives for romantic kissing.Crossref | GoogleScholarGoogle Scholar |

[27]  Regan PC, Durvasula R, Howell L, Ureño O, Rea M. Gender, ethnicity, and the developmental timing of first sexual and romantic experiences. Soc Behav Personal 2004; 32 667–76.
Gender, ethnicity, and the developmental timing of first sexual and romantic experiences.Crossref | GoogleScholarGoogle Scholar |

[28]  Wayal S, Hughes G, Sonnenberg P, Mohammed H, Copas AJ, Gerressu M, et al. Ethnic variations in sexual behaviours and sexual health markers: findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet Public Health 2017; 2 e458–72.
Ethnic variations in sexual behaviours and sexual health markers: findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3).Crossref | GoogleScholarGoogle Scholar | 29057382PubMed |

[29]  Matteelli A, Capone S. The Holy Grail of prevention of sexually transmitted infections in travellers. Sex Transm Infect 2016; 92 405–6.
The Holy Grail of prevention of sexually transmitted infections in travellers.Crossref | GoogleScholarGoogle Scholar | 27272531PubMed |

[30]  Sundbeck M, Emmelin A, Mannheimer L, Miorner H, Agardh A. Sexual risk-taking during travel abroad – a cross-sectional survey among youth in Sweden. Travel Med Infect Dis 2016; 14 233–41.
Sexual risk-taking during travel abroad – a cross-sectional survey among youth in Sweden.Crossref | GoogleScholarGoogle Scholar | 27083687PubMed |

[31]  Aung ET, Chow EP, Fairley CK, Hocking JS, Bradshaw CS, Williamson DA, et al. International travel as risk factor for Chlamydia trachomatis infections among young heterosexuals attending a sexual health clinic in Melbourne, Australia, 2007 to 2017. Euro Surveill 2019; 24 1900219
International travel as risk factor for Chlamydia trachomatis infections among young heterosexuals attending a sexual health clinic in Melbourne, Australia, 2007 to 2017.Crossref | GoogleScholarGoogle Scholar | 31690365PubMed |

[32]  Hughes K, Downing J, Bellis MA, Dillon P, Copeland J. The sexual behaviour of British backpackers in Australia. Sex Transm Infect 2009; 85 477–82.
The sexual behaviour of British backpackers in Australia.Crossref | GoogleScholarGoogle Scholar | 19826066PubMed |

[33]  McNulty AM, Egan C, Wand H, Donovan B. The behaviour and sexual health of young international travellers (backpackers) in Australia. Sex Transm Infect 2010; 86 247–50.
The behaviour and sexual health of young international travellers (backpackers) in Australia.Crossref | GoogleScholarGoogle Scholar | 20237395PubMed |

[34]  Australian Government Department of Education, Skills and Employment. 2019 International student data summary: end of year summary of international student data 2019. Canberra: Department of Education, Skills and Employment; 2019. Available online at: https://internationaleducation.gov.au/research/International-Student-Data/Documents/MONTHLY%20SUMMARIES/2019/December%202019%20End%20of%20year%20summary.pdf [verified 30 March 2020].

[35]  Priest D, Chow EPF. Kissing while high on ecstasy: lessons from a gay dance party attendee. Sex Transm Infect 2018; 94 143
Kissing while high on ecstasy: lessons from a gay dance party attendee.Crossref | GoogleScholarGoogle Scholar | 29463767PubMed |

[36]  Cornelisse VJ, Priest D, Fairley CK, Walker S, Bradshaw CS, Phillips T, et al. The frequency of kissing as part of sexual activity differs depending on how men meet their male casual sexual partners. Int J STD AIDS 2018; 29 598–602.
The frequency of kissing as part of sexual activity differs depending on how men meet their male casual sexual partners.Crossref | GoogleScholarGoogle Scholar | 29256822PubMed |

[37]  Chow EP, Ong JJ, Vodstrcil LA, Fairley CK. Drug use and the influence on kissing among men who have sex with men in Melbourne, Australia. Int J STD AIDS 2020; 31 16–21.
Drug use and the influence on kissing among men who have sex with men in Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar | 31793387PubMed |

[38]  Chan PA, Robinette A, Montgomery M, Almonte A, Cu-Uvin S, Lonks JR, et al. Extragenital infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae: a review of the literature. Infect Dis Obstet Gynecol 2016; 2016 5758387
Extragenital infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae: a review of the literature.Crossref | GoogleScholarGoogle Scholar | 27366021PubMed |

[39]  Chow EPF, Chen MY, Williamson DA, Bradshaw CS, Vodstrcil LA, Trumpour S, et al. Oropharyngeal and genital gonorrhea infections among women and heterosexual men reporting sexual contact with partners with gonorrhea: implication for oropharyngeal testing of heterosexual gonorrhea contacts. Sex Transm Dis 2019; 46 743–7.
Oropharyngeal and genital gonorrhea infections among women and heterosexual men reporting sexual contact with partners with gonorrhea: implication for oropharyngeal testing of heterosexual gonorrhea contacts.Crossref | GoogleScholarGoogle Scholar | 31517767PubMed |

[40]  Thomson-Glover R, Brown R, Edirisinghe DN. Isolated pharyngeal Neisseria gonorrhoeae in heterosexual male contacts. Int J STD AIDS 2013; 24 983–5.
Isolated pharyngeal Neisseria gonorrhoeae in heterosexual male contacts.Crossref | GoogleScholarGoogle Scholar | 23970625PubMed |

[41]  Chow EPF, Walker S, Hocking JS, Bradshaw CS, Chen MY, Tabrizi SN, 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 | 28659133PubMed |

[42]  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 2019; 16 433–441.
Translating mouthwash use for gonorrhoea prevention into a public health campaign: identifying current knowledge and research gaps.Crossref | GoogleScholarGoogle Scholar | 31099331PubMed |