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Original article
Kissing may be an important and neglected risk factor for oropharyngeal gonorrhoea: a cross-sectional study in men who have sex with men
  1. Eric P F Chow1,2,
  2. Vincent J Cornelisse1,2,
  3. Deborah A Williamson3,
  4. David Priest2,
  5. Jane S Hocking4,
  6. Catriona S Bradshaw1,2,
  7. Tim R H Read1,2,
  8. Marcus Y Chen1,2,
  9. Benjamin P Howden3,
  10. Christopher K Fairley1,2
  1. 1 Central Clinical School, Monash University, Melbourne, Victoria, Australia
  2. 2 Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
  3. 3 Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
  4. 4 Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
  1. Correspondence to Associate Professor Eric P F Chow, Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC 3053, Australia; eric.chow{at}


Objectives A mathematical model suggested that a significant proportion of oropharyngeal gonorrhoea cases are acquired via oropharynx-to-oropharynx transmission (ie, tongue-kissing), but to date, no empirical study has investigated this. This study aimed to examine the association between kissing and oropharyngeal gonorrhoea among gay and bisexual men who have sex with men (MSM).

Methods MSM attending a public sexual health centre in Melbourne, Australia, between March 2016 and February 2017 were invited to participate in a brief survey that collected data on their number of male partners in the last 3 months, in three distinct categories: kissing-only (ie, no sex including no oral and/or anal sex), sex-only (ie, any sex without kissing), and kissing-with-sex (ie, kissing with any sex). Univariable and multivariable logistic regression analyses were performed to examine associations between oropharyngeal gonorrhoea positivity by nucleic acid amplification tests and the three distinct partner categories.

Results A total of 3677 men completed the survey and were tested for oropharyngeal gonorrhoea. Their median age was 30 (IQR 25–37) and 6.2% (n=229) had oropharyngeal gonorrhoea. Men had a mean number of 4.3 kissing-only, 1.4 sex-only, and 5.0 kissing-with-sex partners in the last 3 months. Kissing-only and kissing-with-sex were associated with oropharyngeal gonorrhoea, but sex-only was not. The adjusted odds for having oropharyngeal gonorrhoea were 1.46-fold (95% CI 1.04 to 2.06) for men with ≥4 kissing-only partners and 1.81-fold (95% CI 1.17 to 2.79) for men with ≥4 kissing-with-sex partners.

Conclusions These data suggest that kissing may be associated with transmission of oropharyngeal gonorrhoea in MSM, irrespective of whether sex also occurs.

  • gonorrhoea
  • men who have sex with men
  • sexual behaviour
  • kissing
  • transmission
  • saliva
  • sexually transmitted infection
  • sexually transmitted diseases
  • acquisition
  • oropharynx

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Supplementary materials


  • Handling editor Khalil G Ghanem

  • Twitter Follow Eric Chow @EricPFChow

  • Contributors CKF proposed the idea to examine the role of kissing in gonorrhoea transmission. EPFC and CKF conceived the study and designed the questions for the ‘Kissing’ survey. EPFC and DP conducted the statistical analysis. EPFC wrote the first draft of the manuscript. All authors assisted with data interpretation and critically revised it for important intellectual content and read and approved the final version of the manuscript.

  • Funding EPFC, DAW and TRHR are supported by the Early Career Fellowships from the Australian National Health and Medical Research Council (NHMRC) (1091226, 1123854 and 1091536 respectively) and NHMRC ProgramProgramme grant (568971). BPH is supported by an NHMRC Practitioner Fellowship (1105905). VJC is supported by a Research Training Scheme Scholarship from the Australian Government’s Department of Education and Training.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the Alfred Hospital Ethics Committee, Melbourne, Australia (project number 69/16).

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