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Evidence for a new paradigm of gonorrhoea transmission: cross-sectional analysis of Neisseria gonorrhoeae infections by anatomical site in both partners in 60 male couples.
Sex Transm Infect. 2019 09; 95(6):437-442.ST

Abstract

OBJECTIVE

Gonorrhoea transmission between men is currently thought to occur primarily to and from the urethra. Transmission without urethral involvement, from throat-to-throat and throat-to-anus, is considered to be uncommon. Using gonorrhoea results from male couples, we aimed to investigate the transmission dynamics of gonorrhoea. If current medical consensus is correct, then most throat and anal infections should be explained by the partner's urethral infection.

METHODS

This is a cross-sectional analysis of gonorrhoea diagnosed by nucleic acid amplification tests in both partners in male couples who attended Melbourne Sexual Health Centre together between March 2015 and June 2017. Isolates obtained from culture-positive infections underwent whole genome sequencing to assess phylogenetic relatedness between partners.

RESULTS

In all 60 couples (120 men) at least one partner had gonorrhoea, and isolates had very high phylogenetic relatedness between partners. After excluding men with urethral gonorrhoea, among 32 men with anal gonorrhoea, 34% (95% CI 19% to 53 %) had a partner with throat gonorrhoea. After excluding couples where either man had urethral gonorrhoea, among 48 couples in which at least one man had throat gonorrhoea, in 23% (95% CI 12% to 37 %) of couples both men had throat gonorrhoea.

CONCLUSIONS

The observed gonorrhoea positivity when urethral infection is absent supports a new paradigm of gonorrhoea transmission, where the throat is a major source of gonorrhoea transmission between men, through tongue kissing, oroanal sex and saliva use as anal lubricant. Public health messages may need to address the risk of saliva exposure during sex.

Authors+Show Affiliations

Melbourne Sexual Health Centre, Carlton, Victoria, Australia vcornelisse@mshc.org.au. Prahran Market Clinic, Prahran, Victoria, Australia. Central Clinical School, Monash University, Prahran, Victoria, Australia. Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.Melbourne Diagnostic Unit Public Health Laboratory, Peter Doherty Institute, University of Melbourne, Melbourne, Sydney, Australia.Melbourne Sexual Health Centre, Carlton, Victoria, Australia. Central Clinical School, Monash University, Prahran, Victoria, Australia. The Kirby Institute, UNSW Australia, Kensington, New South Wales, Australia.Melbourne Sexual Health Centre, Carlton, Victoria, Australia. Central Clinical School, Monash University, Prahran, Victoria, Australia.Melbourne Sexual Health Centre, Carlton, Victoria, Australia. Central Clinical School, Monash University, Prahran, Victoria, Australia.Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia.Central Clinical School, Monash University, Prahran, Victoria, Australia. Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.Melbourne Diagnostic Unit Public Health Laboratory, Peter Doherty Institute, University of Melbourne, Melbourne, Sydney, Australia. Doherty Applied Microbial Genomics, Peter Doherty Institute, Department of Microbiology and Immunology, University of Melbourne, Melbourne, Sydney, Australia.Melbourne Sexual Health Centre, Carlton, Victoria, Australia. Central Clinical School, Monash University, Prahran, Victoria, Australia.Melbourne Sexual Health Centre, Carlton, Victoria, Australia. Central Clinical School, Monash University, Prahran, Victoria, Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30996106

Citation

Cornelisse, Vincent Jasper, et al. "Evidence for a New Paradigm of Gonorrhoea Transmission: Cross-sectional Analysis of Neisseria Gonorrhoeae Infections By Anatomical Site in Both Partners in 60 Male Couples." Sexually Transmitted Infections, vol. 95, no. 6, 2019, pp. 437-442.
Cornelisse VJ, Williamson D, Zhang L, et al. Evidence for a new paradigm of gonorrhoea transmission: cross-sectional analysis of Neisseria gonorrhoeae infections by anatomical site in both partners in 60 male couples. Sex Transm Infect. 2019;95(6):437-442.
Cornelisse, V. J., Williamson, D., Zhang, L., Chen, M. Y., Bradshaw, C., Hocking, J. S., Hoy, J., Howden, B. P., Chow, E. P. F., & Fairley, C. K. (2019). Evidence for a new paradigm of gonorrhoea transmission: cross-sectional analysis of Neisseria gonorrhoeae infections by anatomical site in both partners in 60 male couples. Sexually Transmitted Infections, 95(6), 437-442. https://doi.org/10.1136/sextrans-2018-053803
Cornelisse VJ, et al. Evidence for a New Paradigm of Gonorrhoea Transmission: Cross-sectional Analysis of Neisseria Gonorrhoeae Infections By Anatomical Site in Both Partners in 60 Male Couples. Sex Transm Infect. 2019;95(6):437-442. PubMed PMID: 30996106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evidence for a new paradigm of gonorrhoea transmission: cross-sectional analysis of Neisseria gonorrhoeae infections by anatomical site in both partners in 60 male couples. AU - Cornelisse,Vincent Jasper, AU - Williamson,Deborah, AU - Zhang,Lei, AU - Chen,Marcus Y, AU - Bradshaw,Catriona, AU - Hocking,Jane S, AU - Hoy,Jennifer, AU - Howden,Benjamin P, AU - Chow,Eric P F, AU - Fairley,Christopher K, Y1 - 2019/04/17/ PY - 2018/08/12/received PY - 2019/02/12/revised PY - 2019/03/03/accepted PY - 2019/4/19/pubmed PY - 2020/2/6/medline PY - 2019/4/19/entrez KW - gay men KW - neisseria gonorrhoea KW - oral sex KW - transmission dynamics SP - 437 EP - 442 JF - Sexually transmitted infections JO - Sex Transm Infect VL - 95 IS - 6 N2 - OBJECTIVE: Gonorrhoea transmission between men is currently thought to occur primarily to and from the urethra. Transmission without urethral involvement, from throat-to-throat and throat-to-anus, is considered to be uncommon. Using gonorrhoea results from male couples, we aimed to investigate the transmission dynamics of gonorrhoea. If current medical consensus is correct, then most throat and anal infections should be explained by the partner's urethral infection. METHODS: This is a cross-sectional analysis of gonorrhoea diagnosed by nucleic acid amplification tests in both partners in male couples who attended Melbourne Sexual Health Centre together between March 2015 and June 2017. Isolates obtained from culture-positive infections underwent whole genome sequencing to assess phylogenetic relatedness between partners. RESULTS: In all 60 couples (120 men) at least one partner had gonorrhoea, and isolates had very high phylogenetic relatedness between partners. After excluding men with urethral gonorrhoea, among 32 men with anal gonorrhoea, 34% (95% CI 19% to 53 %) had a partner with throat gonorrhoea. After excluding couples where either man had urethral gonorrhoea, among 48 couples in which at least one man had throat gonorrhoea, in 23% (95% CI 12% to 37 %) of couples both men had throat gonorrhoea. CONCLUSIONS: The observed gonorrhoea positivity when urethral infection is absent supports a new paradigm of gonorrhoea transmission, where the throat is a major source of gonorrhoea transmission between men, through tongue kissing, oroanal sex and saliva use as anal lubricant. Public health messages may need to address the risk of saliva exposure during sex. SN - 1472-3263 UR - https://www.unboundmedicine.com/medline/citation/30996106/Evidence_for_a_new_paradigm_of_gonorrhoea_transmission:_cross_sectional_analysis_of_Neisseria_gonorrhoeae_infections_by_anatomical_site_in_both_partners_in_60_male_couples_ L2 - https://sti.bmj.com/lookup/pmidlookup?view=long&pmid=30996106 DB - PRIME DP - Unbound Medicine ER -