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Disentangling the tangled web of Neisseria gonorrhoeae transmission: how important are oropharyngeal infections?
  1. David A Lewis1,2,3
  1. 1Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia
  2. 2Westmead Clinical School & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
  3. 3Division of Medical Virology, University of Cape Town, Cape Town, Western Cape, South Africa
  1. Correspondence to Professor David A Lewis, Western Sydney Sexual Health Centre, Parramatta, New South Wales 2150, Australia; david.lewis2{at}sydney.edu.au

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The prevalence of gonorrhoea within populations is sustained by continued transmission from asymptomatically infected persons, particularly core group transmitters within sexual networks associated with high gonococcal transmission frequencies.1 It is believed that core group transmitters typically maintain a longer period of infectivity through repeat infections.2 Disentangling the relative importance of the various combinations of oral, genital, anal and other forms of sexual contact as drivers of gonococcal transmission in core group transmitters and their communities has proven a major challenge to researchers.

One critical research question still to be addressed relates to quantification of the relative importance of oropharyngeal infections, and in particular kissing, in driving the upward trajectory of Neisseriagonorrhoeae infections observed in many parts of the world today. Recent modelling data have suggested that kissing, in particularly deeper ‘tongue kissing’, may be the major route of gonococcal transmission between men-who-have-sex-with-men (MSM).3 In this issue, Cornelisse et al provide clinical support for this hypothesis through a cross-sectional analysis of gonorrhoea in 60 MSM couples attending Melbourne Sexual Health Centre.4 The authors describe a new paradigm which proposes that most N. gonorrhoeae transmission is unidirectional from either the oropharynx or the anus to the urethra; this is in contrast to the conventional paradigm which emphasises the central role of urethral infections in the dissemination of gonorrhoea.

In their paper, Cornelisse et al highlight their belief that saliva from those MSM with oropharyngeal N. gonorrhoeae infections was responsible for most of the oropharyngeal, penile and anorectal gonococcal infections detected …

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