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Risk factors for oropharyngeal gonorrhoea in men who have sex with men: an age-matched case–control study
  1. Vincent J Cornelisse1,2,
  2. Sandra Walker1,2,
  3. Tiffany Phillips1,
  4. Jane S Hocking3,
  5. Catriona S Bradshaw1,2,
  6. David A Lewis4,5,
  7. Garrett Paul Prestage6,
  8. Andrew E Grulich6,
  9. Christopher K Fairley1,2,
  10. Eric P F Chow1,2
  1. 1 Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
  2. 2 Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  3. 3 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Western Sydney Sexual Health Centre, Western Sydney Local Health District, North Parramatta, New South Wales, Australia
  5. 5 Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney Medical School, The University of Sydney, Westmead, New South Wales, Australia
  6. 6 The Kirby Institute, UNSW Australia, Kensington, New South Wales, Australia
  1. Correspondence to Dr Vincent J Cornelisse, Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC 3053, Australia; vcornelisse{at}


Objectives Oropharyngeal gonorrhoea is common among men who have sex with men (MSM). We aimed to clarify which oral sex practices were independent risk factors for oropharyngeal gonorrhoea: tongue kissing, receptive oro-penile sex (fellatio) or insertive oro-anal sex (rimming), and whether daily use of mouthwash and recent antibiotic use was protective.

Methods In 2015, we conducted an age-matched case–control study of MSM who attended the Melbourne Sexual Health Centre. Cases had tested positive for oropharyngeal gonorrhoea by nucleic acid amplification testing, and controls had tested negative. Questionnaire items included tongue kissing, oral sex practices, condom use, recent antibiotic use, mouthwash use and alcohol consumption.

Results We identified 177 cases, age matched to 354 controls. In univariable analyses, cases were 1.90 times (95% CI 1.13 to 3.20) more likely than controls to have had casual sexual partners (CSP) in the preceding 3 months, were 2.17 times (95% CI 1.31 to 3.59) more likely to have kissed CSP and were 2.04 times (95% CI 1.26 to 3.30) more likely to have had receptive oro-penile sex with CSP. Oropharyngeal gonorrhoea was not associated with insertive oro-anal sex or mouthwash use. The number of CSP for tongue kissing and receptive oral sex and total CSP were highly correlated, and in multivariable analysis neither kissing nor receptive oro-penile sex was significantly associated with having oropharyngeal gonorrhoea, after adjusting for total number of CSP.

Conclusions The finding that oropharyngeal gonorrhoea was associated with a higher number of sexual partners but not specific sexual practices highlights the need for further research in the area of gonorrhoea transmission to define the probability of transmission from specific sex acts.

  • neisseria gonorrhoea
  • gay men
  • oral sex
  • homosexuality

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  • CKF and EPFC contributed equally.

  • Handling editor Nigel Field

  • Contributors EPFC and CKF designed the study. VJC conducted the data analysis and wrote the first draft of the manuscript. SW and TP were involved in data collection and management. All authors contributed to the interpretation of the study findings, revised the manuscript critically for important intellectual content and approved the final version of the manuscript.

  • Funding This work was supported by the National Health and Medical Research Council (NHMRC) programme grant (number 568971). EPFC is supported by the Australian NHMRC Early Career Fellowship (number 1091226). VJC is supported by a stipend from the Research Training Program of the Australian Government’s Department of Education and Training.

  • Competing interests DAL’s organisation receives funding for External Consultancy work for GlaxoSmithKline. The other authors have no conflict of interest to declare.

  • Ethics approval Ethical approval was obtained from the Alfred Hospital Ethics Committee (544/14).

  • Provenance and peer review Not commissioned; externally peer reviewed.