A new study concludes the throat is a major route of transmission of gonorrhea in gay and bisexual men.

The looked at 60 male couples in Melbourne, Australia, in which one partner had tested positive for gonorrhea. It found a high incidence of gonorrhea in the throat and anus of partners but not in their urethra.

This suggests gonorrhea transmission takes place through kissing and rimming. Transmission can also occur if saliva is used as a lubricant for anal sex.

‘Our key finding was that in the absence of urethral infection, when one man in a couple had throat gonorrhea, his partner commonly had throat gonorrhea (23%), and when one man in a couple had anal gonorrhea his partner commonly had throat gonorrhea (34%).’

They say this was a much higher incidence than pure chance would suggest. It also contradicts the previously held belief that urethra infection accounts for most incidences of gonorrhea transmission between men.

‘Instead, our data are consistent with a new paradigm of gonorrhea transmission in which the throat plays a central role in transmission to the partner’s throat, anus and urethra, presumably through infected saliva.’

Of the 120 men (60 couples) studied, 85 tested positive for gonorrhea. The most common site of infection was the throat (63), followed by the anus (48) and urethra (25). Some men had the infection in multiple sites.

In eleven couples (23%), both partners had gonorrhea in the throat but not elsewhere. This strongly suggests saliva as the route of transmission.

The authors want to see more men warned more about the risk of passing on gonorrhea via saliva. Most safe sex campaigns focuss largely on the use of condoms for anal sex.

Sexually-active gay and bi men should attend STI clinics for regular check-ups. Experts suggest at least once a year, even if men present with no symptoms, and every 3-6 months if they have multiple partners.

Gonorrhea infection in the urethra often prompts a pus-like discharge, but it can sometimes present with no symptoms. A gonorrhea throat infection can cause a sore throat, but again, can often present no symptoms. The same with an anal infection – potential discomfort but often no clear warning signs.

‘Our data support a new paradigm of gonorrhea transmission which suggests that the throat is a major source of gonorrhoea transmission between men,’ say the authors, before highlighting one potential method to reduce risk.

‘A novel gonorrhea prevention strategy is currently under investigation is the use of an antiseptic mouthwash to reduce the prevalence of throat gonorrhea.’

A 2016 for 1-minute daily with a commercial brand of mouthwash could help reduce gonorrhea infection in the throat. However, that study’s authors called for further research.

Gonorrhea transmission rates have in several countries in recent years, including the US, UK and Australia. Experts are also very concerned about the emergence of so-called ‘super gonorrhea’ : bacteria resistant to antibiotics. So far, there have only been a handful of such cases.

Matthew Hodson of HIV-information service NAM told GSN: ‘Earlier studies found high rates of gonorrhoea in the throat but this is the first study to find strong evidence of gonorrhea transmission via kissing, rimming or using saliva as a lubricant.

‘The study demonstrates once again that when it comes to STIs you can reduce risk but eliminating all risk will be impractical for most people who are sexually active. Gonorrhea in the throat is likely to have no noticeable symptoms so regular testing is recommended.’

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