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It has been hypothesised that the oropharynx plays a major role in overall gonorrhoea transmission among gay, bisexual and other men who have sex with men (MSM) and this has been recently proven by a mathematical model suggesting that 75% of incident gonorrhoea cases would have to be acquired via the oropharynx-to-oropharynx pathway, that is, kissing.1 However, there have been very limited studies examining kissing among MSM.
The author remembers going out to a gay dance party with a friend, where this friend consumed the party drug ecstasy (3,4-methylenedioxymethamphetamine, also known as MDMA). The author subsequently watched his friend kiss more than 15 different partners over the course of just a few hours at that gay dance party, without having sex with any of them. This friend explained that ecstasy is an empathogen, and as such it made him feel closer and more emotionally connected to those around him, and that it would not be unusual for ecstasy users to kiss multiple people with whom they do not have sex at such gay dance parties.
Evidence has shown that younger MSM are more likely to attend gay dance parties and have a higher number of kissing partners as compared with older men.2 There has been an increase in using ecstasy in the MSM population and in particular in gay dance parties. Anecdotally, ecstasy use is linked to erectile dysfunction, so kissing may be the only practice these men can partake in. If this is true, this may explain the current rise in gonorrhoea cases in MSM. However, there is currently no study examining the associations between age and ecstasy use, and between oropharyngeal gonorrhoea and ecstasy use. Thus, further epidemiological evidence is required.
Handling editor Jackie A Cassell
Contributors DP drafted and wrote the letter. EPFC aided with editing and approved the final version.
Funding EPFC is supported by the Australian National Health and Medical Research Council (NHMRC) Early Career Fellowships (1091226).
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.