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

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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.

Original languageEnglish
Article number053803
Number of pages6
JournalSexually Transmitted Infections
DOIs
Publication statusAccepted/In press - Apr 2019

Keywords

  • gay men
  • neisseria gonorrhoea
  • oral sex
  • transmission dynamics

Cite this

@article{0671e4029e734b4db8387a337483c9ac,
title = "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",
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.",
keywords = "gay men, neisseria gonorrhoea, oral sex, transmission dynamics",
author = "Cornelisse, {Vincent Jasper} and Deborah Williamson and Lei Zhang and Chen, {Marcus Y} and Catriona Bradshaw and Hocking, {Jane S.} and Jennifer Hoy and Howden, {Benjamin P.} and Chow, {Eric P F} and Fairley, {Christopher K}",
year = "2019",
month = "4",
doi = "10.1136/sextrans-2018-053803",
language = "English",
journal = "Sexually Transmitted Infections",
issn = "1368-4973",
publisher = "BMJ Group",

}

TY - JOUR

T1 - Evidence for a new paradigm of gonorrhoea transmission

T2 - 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

PY - 2019/4

Y1 - 2019/4

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.

AB - 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.

KW - gay men

KW - neisseria gonorrhoea

KW - oral sex

KW - transmission dynamics

UR - http://www.scopus.com/inward/record.url?scp=85064522093&partnerID=8YFLogxK

U2 - 10.1136/sextrans-2018-053803

DO - 10.1136/sextrans-2018-053803

M3 - Article

JO - Sexually Transmitted Infections

JF - Sexually Transmitted Infections

SN - 1368-4973

M1 - 053803

ER -