Neisseria gonorrhoeae Transmission among Men Who Have Sex with Men: An Anatomical Site-Specific Mathematical Model Evaluating the Potential Preventive Impact of Mouthwash

Lei Zhang, David G. Regan, Eric P.F. Chow, Manoj Gambhir, Vincent Cornelisse, Andrew Grulich, Jason Ong, David A. Lewis, Jane Hocking, Christopher K. Fairley

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background Gonorrhoea notifications are rapidly rising in men who have sex with men (MSM). We developed a model to assess mouthwash as a novel intervention for gonorrhoea control. Methods We developed a model of Neisseria gonorrhoeae (NG) transmission to explain anatomic site-specific prevalence of gonorrhoea among MSM. The model was calibrated to available epidemiological and behavioral data. We estimated the contribution of various sexual acts to gonorrhoea incidence and evaluate the potential impacts of screening scale-up and utilization of mouthwash on the gonorrhoea epidemic. Results We calibrated the model to prevalence of oropharyngeal, anal, and urethral gonorrhoea of 8.6% (7.7-9.5%), 8.3% (7.4-9.1%), and 0.20% (0.04-0.35%), respectively, among MSM. Oropharynx to oropharynx transmission through kissing is estimated to account for nearly three quarters of all incident cases (71.6% [64.4-80.5%]) of gonorrhoea in MSM. Substantially increasing annual oropharynx screening for gonorrhoea from the current 40% to 100% may only halve the prevalence of gonorrhoea in MSM. In contrast, the use of mouthwash with moderate efficacy (additional 1% clearance per daily use) would further reduce the corresponding prevalence rates to 3.1% (2.2-4.4%), 3.8% (2.3-4.9%), and 0.10% (0.06-0.11%), and a high-efficacy mouthwash (additional 1.5% clearance per daily use) may further halve the gonorrhoea prevalence. Without oropharynx to oropharynx transmission, we could not replicate current prevalence data. Conclusions Despite a dearth of empirical data, our model suggests that kissing could potentially play an important role in NG transmission among MSM. Control through sexually transmitted infection screening alone is unlikely to have a substantial impact on the gonorrhoea epidemic in MSM.

Original languageEnglish
Pages (from-to)586-592
Number of pages7
JournalSexually Transmitted Diseases
Volume44
Issue number10
DOIs
Publication statusPublished - 1 Oct 2017

Keywords

  • 10

Cite this

@article{a34427d22c9f4b5b918ae52567b5e00b,
title = "Neisseria gonorrhoeae Transmission among Men Who Have Sex with Men: An Anatomical Site-Specific Mathematical Model Evaluating the Potential Preventive Impact of Mouthwash",
abstract = "Background Gonorrhoea notifications are rapidly rising in men who have sex with men (MSM). We developed a model to assess mouthwash as a novel intervention for gonorrhoea control. Methods We developed a model of Neisseria gonorrhoeae (NG) transmission to explain anatomic site-specific prevalence of gonorrhoea among MSM. The model was calibrated to available epidemiological and behavioral data. We estimated the contribution of various sexual acts to gonorrhoea incidence and evaluate the potential impacts of screening scale-up and utilization of mouthwash on the gonorrhoea epidemic. Results We calibrated the model to prevalence of oropharyngeal, anal, and urethral gonorrhoea of 8.6{\%} (7.7-9.5{\%}), 8.3{\%} (7.4-9.1{\%}), and 0.20{\%} (0.04-0.35{\%}), respectively, among MSM. Oropharynx to oropharynx transmission through kissing is estimated to account for nearly three quarters of all incident cases (71.6{\%} [64.4-80.5{\%}]) of gonorrhoea in MSM. Substantially increasing annual oropharynx screening for gonorrhoea from the current 40{\%} to 100{\%} may only halve the prevalence of gonorrhoea in MSM. In contrast, the use of mouthwash with moderate efficacy (additional 1{\%} clearance per daily use) would further reduce the corresponding prevalence rates to 3.1{\%} (2.2-4.4{\%}), 3.8{\%} (2.3-4.9{\%}), and 0.10{\%} (0.06-0.11{\%}), and a high-efficacy mouthwash (additional 1.5{\%} clearance per daily use) may further halve the gonorrhoea prevalence. Without oropharynx to oropharynx transmission, we could not replicate current prevalence data. Conclusions Despite a dearth of empirical data, our model suggests that kissing could potentially play an important role in NG transmission among MSM. Control through sexually transmitted infection screening alone is unlikely to have a substantial impact on the gonorrhoea epidemic in MSM.",
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author = "Lei Zhang and Regan, {David G.} and Chow, {Eric P.F.} and Manoj Gambhir and Vincent Cornelisse and Andrew Grulich and Jason Ong and Lewis, {David A.} and Jane Hocking and Fairley, {Christopher K.}",
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Neisseria gonorrhoeae Transmission among Men Who Have Sex with Men : An Anatomical Site-Specific Mathematical Model Evaluating the Potential Preventive Impact of Mouthwash. / Zhang, Lei; Regan, David G.; Chow, Eric P.F.; Gambhir, Manoj; Cornelisse, Vincent; Grulich, Andrew; Ong, Jason; Lewis, David A.; Hocking, Jane; Fairley, Christopher K.

In: Sexually Transmitted Diseases, Vol. 44, No. 10, 01.10.2017, p. 586-592.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Neisseria gonorrhoeae Transmission among Men Who Have Sex with Men

T2 - An Anatomical Site-Specific Mathematical Model Evaluating the Potential Preventive Impact of Mouthwash

AU - Zhang, Lei

AU - Regan, David G.

AU - Chow, Eric P.F.

AU - Gambhir, Manoj

AU - Cornelisse, Vincent

AU - Grulich, Andrew

AU - Ong, Jason

AU - Lewis, David A.

AU - Hocking, Jane

AU - Fairley, Christopher K.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background Gonorrhoea notifications are rapidly rising in men who have sex with men (MSM). We developed a model to assess mouthwash as a novel intervention for gonorrhoea control. Methods We developed a model of Neisseria gonorrhoeae (NG) transmission to explain anatomic site-specific prevalence of gonorrhoea among MSM. The model was calibrated to available epidemiological and behavioral data. We estimated the contribution of various sexual acts to gonorrhoea incidence and evaluate the potential impacts of screening scale-up and utilization of mouthwash on the gonorrhoea epidemic. Results We calibrated the model to prevalence of oropharyngeal, anal, and urethral gonorrhoea of 8.6% (7.7-9.5%), 8.3% (7.4-9.1%), and 0.20% (0.04-0.35%), respectively, among MSM. Oropharynx to oropharynx transmission through kissing is estimated to account for nearly three quarters of all incident cases (71.6% [64.4-80.5%]) of gonorrhoea in MSM. Substantially increasing annual oropharynx screening for gonorrhoea from the current 40% to 100% may only halve the prevalence of gonorrhoea in MSM. In contrast, the use of mouthwash with moderate efficacy (additional 1% clearance per daily use) would further reduce the corresponding prevalence rates to 3.1% (2.2-4.4%), 3.8% (2.3-4.9%), and 0.10% (0.06-0.11%), and a high-efficacy mouthwash (additional 1.5% clearance per daily use) may further halve the gonorrhoea prevalence. Without oropharynx to oropharynx transmission, we could not replicate current prevalence data. Conclusions Despite a dearth of empirical data, our model suggests that kissing could potentially play an important role in NG transmission among MSM. Control through sexually transmitted infection screening alone is unlikely to have a substantial impact on the gonorrhoea epidemic in MSM.

AB - Background Gonorrhoea notifications are rapidly rising in men who have sex with men (MSM). We developed a model to assess mouthwash as a novel intervention for gonorrhoea control. Methods We developed a model of Neisseria gonorrhoeae (NG) transmission to explain anatomic site-specific prevalence of gonorrhoea among MSM. The model was calibrated to available epidemiological and behavioral data. We estimated the contribution of various sexual acts to gonorrhoea incidence and evaluate the potential impacts of screening scale-up and utilization of mouthwash on the gonorrhoea epidemic. Results We calibrated the model to prevalence of oropharyngeal, anal, and urethral gonorrhoea of 8.6% (7.7-9.5%), 8.3% (7.4-9.1%), and 0.20% (0.04-0.35%), respectively, among MSM. Oropharynx to oropharynx transmission through kissing is estimated to account for nearly three quarters of all incident cases (71.6% [64.4-80.5%]) of gonorrhoea in MSM. Substantially increasing annual oropharynx screening for gonorrhoea from the current 40% to 100% may only halve the prevalence of gonorrhoea in MSM. In contrast, the use of mouthwash with moderate efficacy (additional 1% clearance per daily use) would further reduce the corresponding prevalence rates to 3.1% (2.2-4.4%), 3.8% (2.3-4.9%), and 0.10% (0.06-0.11%), and a high-efficacy mouthwash (additional 1.5% clearance per daily use) may further halve the gonorrhoea prevalence. Without oropharynx to oropharynx transmission, we could not replicate current prevalence data. Conclusions Despite a dearth of empirical data, our model suggests that kissing could potentially play an important role in NG transmission among MSM. Control through sexually transmitted infection screening alone is unlikely to have a substantial impact on the gonorrhoea epidemic in MSM.

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