Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE

Only recent sexual partners contribute to oropharyngeal gonorrhoea positivity: the number of sexual partners over different time periods as an indicator of gonorrhoea and chlamydia infection duration among men who have sex with men

David Priest A , Tim R. H. Read A B , Marcus Y. Chen A B , Catriona S. Bradshaw A B , Christopher K. Fairley A B * and Eric P. F. Chow A B C *
+ Author Affiliations
- Author Affiliations

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

B Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia.

C Corresponding author. Email: Echow@mshc.org.au

Sexual Health 15(4) 342-349 https://doi.org/10.1071/SH17196
Submitted: 3 November 2017  Accepted: 5 April 2018   Published: 5 July 2018

Abstract

Background: Mathematical models have demonstrated that the majority of gonococcal transmission is from oropharynx to oropharynx (i.e. kissing) among men who have sex with men (MSM). The aim of this study is to investigate the association between the number of partners within specific time periods and gonorrhoea and chlamydia positivity. Methods: This was a retrospective data analysis of MSM attending the Melbourne Sexual Health Centre between 2007 and 2016. Univariable and multivariable logistic regression analyses, with generalised estimating equations (GEE), were performed to determine if the number of partners within specified time periods was associated with site-specific gonorrhoea and chlamydia positivity. Results: There were 45933 consultations which included 15197 MSM. Oropharyngeal gonorrhoea positivity was associated with the number of partners in the past 3 months, but not the number of partners 4–12 months ago; men who had ≥6 partners in the past 3 months had significantly higher odds of acquiring oropharyngeal gonorrhoea (aOR 1.93; 95% CI 1.61–2.31), but this was not the case for men who had ≥6 partners 4–12 months ago. Anorectal gonorrhoea and chlamydia and urethral chlamydia were associated with the number of partners in both time periods after adjusting for age and condom use. Conclusions: The association of oropharyngeal gonorrhoea with the number of recent partners, but not partners from an earlier period, unlike anorectal gonorrhoea and anorectal and urethral chlamydia, could be explained by a shorter duration of oropharyngeal gonococcal infection. Annual screening for gonorrhoea may be insufficient to materially reduce oropharyngeal prevalence.

Additional keywords: Chlamydia trachomatis, Neisseria gonorrhoeae, sexual behaviours.


References

[1]  The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2015. Sydney: The Kirby Institute, UNSW Australia; 2015. Available online at: https://kirby.unsw.edu.au/sites/default/files/kirby/report/SERP_2015-Annual-Surveillance-Report.pdf [verified 13 June 2018]

[2]  Savage EJ, Marsh K, Duffell S, Ison CA, Zaman A, Hughes G. Rapid increase in gonorrhoea and syphilis diagnoses in England in 2011. Euro surveillance 2012; 17 pii=20224.
Rapid increase in gonorrhoea and syphilis diagnoses in England in 2011.Crossref | GoogleScholarGoogle Scholar |

[3]  Chow EP, Tomnay J, Fehler G, Whiley D, Read TR, Denham I, Bradshaw CS, Chen MY, Fairley CK. 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 |

[4]  Jasek E, Chow EP, Ong JJ, Bradshaw CS, Chen MY, Hocking JS, Lee D, Phillips T, Phillips T, Temple-Smith M, Fehler G, Fairley CK. Sexually Transmitted Infections in Melbourne, Australia from 1918 to 2016: nearly a century of data. Commun Dis Intell Q Rep 2017; 41 E212–E222.

[5]  Peters RP, Verweij SP, Nijsten N, Ouburg S, Mutsaers J, Jansen CL, van Leeuwen AP, Morré SA. Evaluation of sexual history-based screening of anatomic sites for Chlamydia trachomatis and Neisseria gonorrhoeae infection in men having sex with men in routine practice. BMC Infect Dis 2011; 11
Evaluation of sexual history-based screening of anatomic sites for Chlamydia trachomatis and Neisseria gonorrhoeae infection in men having sex with men in routine practice.Crossref | GoogleScholarGoogle Scholar |

[6]  Fairley CK, Chow EP, Hocking JS. Early presentation of symptomatic individuals is critical in controlling sexually transmissible infections. Sex Health 2015; 12 181–2.
Early presentation of symptomatic individuals is critical in controlling sexually transmissible infections.Crossref | GoogleScholarGoogle Scholar |

[7]  Templeton DJ, Read P, Varma R, Bourne C. Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence. Sex Health 2014; 11 217–29.
Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence.Crossref | GoogleScholarGoogle Scholar |

[8]  Workowski KA, Bolan GA, Centers for Disease Control and Prevention Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2015; 64 1–137.

[9]  9 Lazaro N. Sexually transmitted infections in primary care (RCGP/BASHH). London: The RCGP Sex, Drugs, HIV and Viral Hepatitis Group, and the British Association for Sexual Health and HIV (BASHH); 2013. Available online at: http://www.rcgp.org.uk/-/media/Files/CIRC/RCGP-Sexually-Transmitted-Infections-in-Primary-Care-2013.ashx?la=en [verified 13 June 2018]

[10]  Chow EP, Camilleri S, Ward C, Huffam S, Chen MY, Bradshaw CS, Fairley CK. Duration of gonorrhoea and chlamydia infection at the pharynx and rectum among men who have sex with men: a systematic review. Sex Health 2016; 13 199–204.
Duration of gonorrhoea and chlamydia infection at the pharynx and rectum among men who have sex with men: a systematic review.Crossref | GoogleScholarGoogle Scholar |

[11]  Morris SR, Klausner JD, Buchbinder SP, Wheeler SL, Koblin B, Coates T, Chesney M, Colfax GN. Prevalence and incidence of pharyngeal gonorrhea in a longitudinal sample of men who have sex with men: the EXPLORE study. Clin Infect Dis 2006; 43 1284–9.
Prevalence and incidence of pharyngeal gonorrhea in a longitudinal sample of men who have sex with men: the EXPLORE study.Crossref | GoogleScholarGoogle Scholar |

[12]  Barbee LA, Khosropour CM, Dombrowski JC, Manhart LE, Golden MR. 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; 92 155–60.
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.Crossref | GoogleScholarGoogle Scholar |

[13]  Bernstein KT, Chesson H, Kirkcaldy RD, Marcus JL, Gift TL, Aral SO. Kiss and tell: limited empirical data on oropharyngeal Neisseria gonorrhoeae among men who have sex with men and implications for modeling. Sex Transm Dis 2017; 44 596–8.
Kiss and tell: limited empirical data on oropharyngeal Neisseria gonorrhoeae among men who have sex with men and implications for modeling.Crossref | GoogleScholarGoogle Scholar |

[14]  Wallin J, Siegel MS. Pharyngeal Neisseria gonorrhoeae: coloniser or pathogen? BMJ 1979; 1 1462–3.
Pharyngeal Neisseria gonorrhoeae: coloniser or pathogen?Crossref | GoogleScholarGoogle Scholar |

[15]  Rosenberger JG, Reece M, Schick V, Herbenick D, Novak DS, Van Der Pol B, Fortenberry JD. Sexual behaviors and situational characteristics of most recent male-partnered sexual event among gay and bisexually identified men in the United States. J Sex Med 2011; 8 3040–50.
Sexual behaviors and situational characteristics of most recent male-partnered sexual event among gay and bisexually identified men in the United States.Crossref | GoogleScholarGoogle Scholar |

[16]  Templeton DJ, Jin F, McNally LP, Imrie JC, Prestage GP, Donovan B, Cunningham PH, Kaldor JM, Kippax S, Grulich AE. Prevalence, incidence and risk factors for pharyngeal gonorrhoea in a community-based HIV-negative cohort of homosexual men in Sydney, Australia. Sex Transm Infect 2010; 86 90–6.
Prevalence, incidence and risk factors for pharyngeal gonorrhoea in a community-based HIV-negative cohort of homosexual men in Sydney, Australia.Crossref | GoogleScholarGoogle Scholar |

[17]  Cornelisse VJ, Walker S, Phillips T, Hocking JS, Bradshaw CS, Lewis DA, Prestage GP, Grulich AE, Fairley CK, Chow EPF. Risk factors for oro-pharyngeal gonorrhoea in men who have sex with men: an age-matched case-control study. Sex Transm Infect 2018;
Risk factors for oro-pharyngeal gonorrhoea in men who have sex with men: an age-matched case-control study.Crossref | GoogleScholarGoogle Scholar |

[18]  Zhang L, Regan DG, Chow EPF, Gambhir M, Cornelisse V, Grulich A, Ong J, Lewis DA, Hocking J, Fairley CK. Neisseria gonorrhoeae transmission among men who have sex with men: an anatomical site-specific mathematical model evaluating the potential preventive impact of mouthwash. Sex Transm Dis 2017; 44 586–92.
Neisseria gonorrhoeae transmission among men who have sex with men: an anatomical site-specific mathematical model evaluating the potential preventive impact of mouthwash.Crossref | GoogleScholarGoogle Scholar |

[19]  Fairley CK, Zhang L, Chow EPF. New thinking on gonorrhoea control in MSM: are antiseptic mouthwashes the answer? Curr Opin Infect Dis 2018; 31 45–9.
New thinking on gonorrhoea control in MSM: are antiseptic mouthwashes the answer?Crossref | GoogleScholarGoogle Scholar |

[20]  Fairley CK, Hocking JS, Zhang L, Chow EP. 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 |

[21]  Chow EPF, Walker S, Hocking JS, Bradshaw CS, Chen MY, Tabrizi SN, Howden BP, Law MG, Maddaford K, Read TRH, Lewis DA, Whiley DM, Zhang L, Grulich AE, Kaldor JM, Cornelisse VJ, Phillips S, Donovan B, McNulty AM, Templeton DJ, Roth N, Moore R, Fairley CK. 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 |

[22]  Chow EP, Fehler G, Chen MY, Bradshaw CS, Denham I, Law MG, Fairley CK. Testing commercial sex workers for sexually transmitted infections in Victoria, Australia: an evaluation of the impact of reducing the frequency of testing. PLoS One 2014; 9 e103081
Testing commercial sex workers for sexually transmitted infections in Victoria, Australia: an evaluation of the impact of reducing the frequency of testing.Crossref | GoogleScholarGoogle Scholar |

[23]  Ong JJ, Fethers K, Howden BP, Fairley CK, Chow EPF, Williamson DA, Petalotis I, Aung E, Kanhutu . Ong JJ, Fethers K, Howden BP, Fairley CK, Chow EPF, Williamson DA, Petalotis I, Aung E, Kanhutu . Asymptomatic and symptomatic urethral gonorrhoea in men who have sex with men attending a sexual health service. Clin Microbiol Infect 2017; 23 555–9.
Asymptomatic and symptomatic urethral gonorrhoea in men who have sex with men attending a sexual health service.Crossref | GoogleScholarGoogle Scholar |

[24]  Ong JJ, Chow EPF, De Petra V, Williamson D, Petalotis I, Howden B, Zhang L, Chen MY, Bradshaw CS, Hocking J, Fairley CK. Should asymptomatic men who have sex with men be screened for oropharyngeal chlamydia? Clinical outcomes from a cross-sectional study. Sex Transm Dis 2018; 45 103–106.
Should asymptomatic men who have sex with men be screened for oropharyngeal chlamydia? Clinical outcomes from a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |

[25]  Cornelisse VJ, Chow EP, Huffam S, Fairley CK, Bissessor M, De Petra V, Howden BP, Denham I, Bradshaw CS, Williamson D, Chen MY. Increased detection of pharyngeal and rectal gonorrhea in men who have sex with men after transition from culture to nucleic acid amplification testing. Sex Transm Dis 2017; 44 114–7.
Increased detection of pharyngeal and rectal gonorrhea in men who have sex with men after transition from culture to nucleic acid amplification testing.Crossref | GoogleScholarGoogle Scholar |

[26]  Chow EPF, Walker S, Read TRH, Chen MY, Bradshaw CS, Fairley CK. Self-reported use of mouthwash and pharyngeal gonorrhoea detection by nucleic acid amplification test. Sex Transm Dis 2017; 44 593–595.
Self-reported use of mouthwash and pharyngeal gonorrhoea detection by nucleic acid amplification test.Crossref | GoogleScholarGoogle Scholar |

[27]  Fairley CK, Chen S, Ugoni A, Tabrizi SN, Forbes A, Garland SM. Human papillomavirus infection and its relationship to recent and distant sexual partners. Obstet Gynecol 1994; 84 755–9.

[28]  Fairley CK, Chen MY, Bradshaw CS, Tabrizi SN. Is it time to move to nucleic acid amplification tests screening for pharyngeal and rectal gonorrhoea in men who have sex with men to improve gonorrhoea control? Sex Health 2011; 8 9–11.
Is it time to move to nucleic acid amplification tests screening for pharyngeal and rectal gonorrhoea in men who have sex with men to improve gonorrhoea control?Crossref | GoogleScholarGoogle Scholar |

[29]  Schachter J, Moncada J, Liska S, Shayevich C, Klausner JD. Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men. Sex Transm Dis 2008; 35 637–42.
Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men.Crossref | GoogleScholarGoogle Scholar |

[30]  Hutt DM, Judson FN. Epidemiology and treatment of oropharyngeal gonorrhea. Ann Intern Med 1986; 104 655–8.
Epidemiology and treatment of oropharyngeal gonorrhea.Crossref | GoogleScholarGoogle Scholar |

[31]  Chow EP, Lee D, Tabrizi SN, Phillips S, Snow A, Cook S, Howden BP, Petalotis I, Bradshaw CS, Chen MY, Fairley CK. Detection of Neisseria gonorrhoeae in the pharynx and saliva: implications for gonorrhoea transmission. Sex Transm Infect 2016; 92 347–9.
Detection of Neisseria gonorrhoeae in the pharynx and saliva: implications for gonorrhoea transmission.Crossref | GoogleScholarGoogle Scholar |

[32]  Geisler WM. Duration of untreated, uncomplicated Chlamydia trachomatis genital infection and factors associated with chlamydia resolution: a review of human studies. J Infect Dis 2010; 201 S104–13.
Duration of untreated, uncomplicated Chlamydia trachomatis genital infection and factors associated with chlamydia resolution: a review of human studies.Crossref | GoogleScholarGoogle Scholar |

[33]  Jenness SM, Weiss KM, Goodreau SM, Gift T, Chesson H, Hoover KW, Smith DK, Liu AY, Sullivan PS, Rosenberg ES. Incidence of Gonorrhea and Chlamydia Following HIV Preexposure Prophylaxis among Men Who Have Sex with Men: A Modeling Study. Clin Infect Dis 2017; 65 712–718.
Incidence of Gonorrhea and Chlamydia Following HIV Preexposure Prophylaxis among Men Who Have Sex with Men: A Modeling Study.Crossref | GoogleScholarGoogle Scholar |