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P066 Transmission of Neisseria Gonorrhoeae among men who have sex with men: an anatomical site-specific mathematical model and impact of mouthwash
  1. Lei Zhang1,2,
  2. David Regan3,
  3. Eric Chow1,2,
  4. Vincent Cornelisse1,2,
  5. Manoj Gambhir5,
  6. Jane Hocking1,2,
  7. Christopher Fairley1
  1. 1Melbourne Sexual Health Centre, Melbourne, Australia
  2. 2Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia
  3. 3Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
  4. 4Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
  5. 5School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia

Abstract

Background/introduction Epidemiological data suggest that kissing may play a significant role in gonorrhoea transmission.

Aim(s)/objectives We developed a transmission model to explain anatomical site-specific prevalence of gonorrhoea among Australian men who have sex with men (MSM) and evaluate the population-level impacts of screening and the use of mouthwash as interventions in reducing its transmission.

Methods We constructed a gonorrhoea transmission model to estimate the per-act transmission probability. Using Monte-Carlo simulations, we constructed hypothetical scenarios to evaluate its population-level impacts.

Results We have previously reported the prevalence of pharyngeal, anal and urethral gonorrhoea as being 10.6% (95%CI 8.1–12.2%), 8.6% (6.7–10.4%) and 0.17% (0.02–0.24%), respectively, in Australian MSM. Calibrated to these data, the model-estimated per-act transmission probability for gonorrhoea was high for transmission from urethra-to-anus (46.0% [41.7–52.6%]) and from-urethra to-pharynx (49.6% [46.7–53.8%]). Although pharynx-to-pharynx transmission through kissing has only a transmission probability of 17.4% (16.0–21.0%), it accounts for nearly three quarters of the annual incident cases (74.6% [70.0–82.4%]). A substantial increase in gonorrhoea screening from the current 40% to 100% may only halve gonorrhoea prevalence in MSM. In contrast, the use of mouthwash with moderate efficacy (extra 1% bacterial load reduction/use) would further reduce the corresponding site prevalence to 2.4% (1.8%–3.7%), 2.2% (1.6–3.2%) and 0.02% (0.01–0.03%), whereas a high efficacy (extra 1.5% reduction/use) may achieve a scenario of close to elimination.

Discussion/conclusion Our results suggests that kissing may be the key driver of community prevalence. If antibacterial mouthwash is effective and widely used, it may contribute to controlling the gonorrhoea epidemic.

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