At first glance, it seems entirely reasonable that the penis is the key transmitting organ- it secrets large organism load and is inserted into mouth and anus. But ask yourself- how many men who one has sex with have gonorrhoea in their penis at the time? Is it enough to generate an incidence of about 20% in the throat and anus per year? The penis develops symptoms within days, has an incidence of only 5–10% per year so only 1 in 200 men at any one time are infectious. To generate a throat incidence of 20% would require about 100 partners a year assuming a high per partner transmission efficiency of 50%. However at any point in time about 5–10% of men have throat gonorrhoea; most kiss and exchange saliva. To generate a 20% incidence in the throat would require 2 partners per year (50% transmission). So why have we not considered this route of transmission seriously before? Some suggestions; culture was very insensitive at the throat and suggested infection was rare, kissing is highly correlated with other risks, some countries have longer duration urethral gonorrhoea from poor access to treatment and in these situations the penis does play a major role, and kissing has not been measured virtually at all until now. So what then is the evidence for kissing (and saliva) playing a role in transmission? Saliva is often culture positive when a throat is positive, people kiss often, kissing independently predicts the presence of throat gonorrhoea, saliva use during anal sex predicts anal gonorrhoea, positivity in partner studies don’t fit just penile transmission, and recently outbreak of throat gonorrhoea could only be explained by kissing. You make your minds up. Is it time to re think gonorrhoea transmission with an open mind(or mouth).

Disclosure No significant relationships.