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An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study.
Sex Transm Infect. 2016 Mar; 92(2):155-60.ST

Abstract

BACKGROUND

Sexually transmitted infections (STIs) of the pharynx are common among men who have sex with men (MSM); the degree to which these infections are transmitted through oral sex is unknown.

METHODS

We conducted a case-control study of MSM attending Public Health-Seattle & King County STD Clinic between 2001 and 2013 to estimate the proportion of symptomatic urethritis cases attributable to oral sex using two methods. First, we categorised men into the following mutually exclusive behavioural categories based on their self-reported sexual history in the previous 60 days: (1) only received oral sex (IOS); (2) 100% condom usage with insertive anal sex plus oral sex (PIAI); (3) inconsistent condom usage with anal sex (UIAI); and (4) no sex. We then determined the proportion of cases in which men reported the oropharynx as their only urethral exposure (IOS and PIAI). Second, we calculated the population attributable risk per cent (PAR%) associated with oral sex using Mantel-Haenszel OR estimates.

RESULTS

Based on our behavioural categorisation method, men reported the oropharynx as their only urethral exposure in the past 60 days in 27.5% of gonococcal urethritis, 31.4% of chlamydial urethritis and 35.9% non-gonococcal, non-chlamydial urethritis (NGNCU) cases. The PAR%s for symptomatic gonococcal urethritis, chlamydial urethritis and NGNCU attributed to oropharyngeal exposure were 33.8%, 2.7% and 27.1%, respectively.

CONCLUSIONS

The pharynx is an important source of gonococcal transmission, and may be important in the transmission of chlamydia and other, unidentified pathogens that cause urethritis. Efforts to increase pharyngeal gonorrhoea screening among MSM could diminish STI transmission.

Authors+Show Affiliations

Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA Public Health, Seattle & King County HIV/STD Program.Department of Epidemiology, University of Washington, Seattle, Washington, USA.Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA Public Health, Seattle & King County HIV/STD Program.Department of Epidemiology, University of Washington, Seattle, Washington, USA Department of Global Health, University of Washington, Seattle, Washington, USA.Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA Public Health, Seattle & King County HIV/STD Program Department of Epidemiology, University of Washington, Seattle, Washington, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26297719

Citation

Barbee, Lindley A., et al. "An Estimate of the Proportion of Symptomatic Gonococcal, Chlamydial and Non-gonococcal Non-chlamydial Urethritis Attributable to Oral Sex Among Men Who Have Sex With Men: a Case-control Study." Sexually Transmitted Infections, vol. 92, no. 2, 2016, pp. 155-60.
Barbee LA, Khosropour CM, Dombrowski JC, et al. An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study. Sex Transm Infect. 2016;92(2):155-60.
Barbee, L. A., Khosropour, C. M., Dombrowski, J. C., Manhart, L. E., & Golden, M. R. (2016). An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study. Sexually Transmitted Infections, 92(2), 155-60. https://doi.org/10.1136/sextrans-2015-052214
Barbee LA, et al. An Estimate of the Proportion of Symptomatic Gonococcal, Chlamydial and Non-gonococcal Non-chlamydial Urethritis Attributable to Oral Sex Among Men Who Have Sex With Men: a Case-control Study. Sex Transm Infect. 2016;92(2):155-60. PubMed PMID: 26297719.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study. AU - Barbee,Lindley A, AU - Khosropour,Christine M, AU - Dombrowski,Julia C, AU - Manhart,Lisa E, AU - Golden,Matthew R, Y1 - 2015/08/21/ PY - 2015/06/15/received PY - 2015/08/04/accepted PY - 2017/03/01/pmc-release PY - 2015/8/23/entrez PY - 2015/8/25/pubmed PY - 2016/7/7/medline KW - CHLAMYDIA TRACHOMATIS KW - GONORRHOEA KW - SEXUAL BEHAVIOUR KW - URETHRITIS SP - 155 EP - 60 JF - Sexually transmitted infections JO - Sex Transm Infect VL - 92 IS - 2 N2 - BACKGROUND: Sexually transmitted infections (STIs) of the pharynx are common among men who have sex with men (MSM); the degree to which these infections are transmitted through oral sex is unknown. METHODS: We conducted a case-control study of MSM attending Public Health-Seattle & King County STD Clinic between 2001 and 2013 to estimate the proportion of symptomatic urethritis cases attributable to oral sex using two methods. First, we categorised men into the following mutually exclusive behavioural categories based on their self-reported sexual history in the previous 60 days: (1) only received oral sex (IOS); (2) 100% condom usage with insertive anal sex plus oral sex (PIAI); (3) inconsistent condom usage with anal sex (UIAI); and (4) no sex. We then determined the proportion of cases in which men reported the oropharynx as their only urethral exposure (IOS and PIAI). Second, we calculated the population attributable risk per cent (PAR%) associated with oral sex using Mantel-Haenszel OR estimates. RESULTS: Based on our behavioural categorisation method, men reported the oropharynx as their only urethral exposure in the past 60 days in 27.5% of gonococcal urethritis, 31.4% of chlamydial urethritis and 35.9% non-gonococcal, non-chlamydial urethritis (NGNCU) cases. The PAR%s for symptomatic gonococcal urethritis, chlamydial urethritis and NGNCU attributed to oropharyngeal exposure were 33.8%, 2.7% and 27.1%, respectively. CONCLUSIONS: The pharynx is an important source of gonococcal transmission, and may be important in the transmission of chlamydia and other, unidentified pathogens that cause urethritis. Efforts to increase pharyngeal gonorrhoea screening among MSM could diminish STI transmission. SN - 1472-3263 UR - https://www.unboundmedicine.com/medline/citation/26297719/An_estimate_of_the_proportion_of_symptomatic_gonococcal_chlamydial_and_non_gonococcal_non_chlamydial_urethritis_attributable_to_oral_sex_among_men_who_have_sex_with_men:_a_case_control_study_ L2 - https://sti.bmj.com/lookup/pmidlookup?view=long&pmid=26297719 DB - PRIME DP - Unbound Medicine ER -