Abstract
Abstract Masturbation is a common sexual practice in men, and saliva is often used as a lubricant during masturbation by men who have sex with men. However, the role of saliva use during masturbation in the transmission of chlamydia is still unclear. We developed population-level, susceptible-infected-susceptible compartmental models to explore the role of saliva use during masturbation on the transmission of chlamydia at multiple anatomical sites. In this study, we simulated both solo masturbation and mutual masturbation. Our baseline model did not include masturbation but included transmission routes (anal sex, oral-penile sex, rimming, kissing and sequential sexual practices) we have previously validated (model 1). We added masturbation to model 1 to develop the second model (model 2). We calibrated the model to five clinical datasets separately to assess the effects of masturbation on the prevalence of site-specific infection. The inclusion of masturbation (model 2) significantly worsened the ability of the models to replicate the prevalence of C. trachomatis. Using model 2 and the five data sets, we estimated that saliva use during masturbation was responsible for between 3.9% [95% confidence interval (CI) 2.0–6.8] and 6.2% (95% CI 3.8–10.5) of incident chlamydia cases at all sites. Our models suggest that saliva use during masturbation is unlikely to play a major role in chlamydia transmission between men, and even if it does have a role, about one in seven cases of urethral chlamydia might arise from masturbation.
Highlights
Chlamydia trachomatis (C. trachomatis) is a common sexually transmitted infection in men who have sex with men (MSM) [1,2,3] that is considered to be primarily transmitted between men by condomless penile-anal sex [4, 5]
Our models suggest that saliva use during masturbation is unlikely to play a major role in chlamydia transmission between men
We found that model 3 could replicate the prevalence of chlamydia at single anatomical sites but overestimated the clinical multisite infection data at the oropharynx and urethra together across five datasets and underestimated the clinical multisite infection data at the urethra and anorectum together across three datasets
Summary
Chlamydia trachomatis (C. trachomatis) is a common sexually transmitted infection in men who have sex with men (MSM) [1,2,3] that is considered to be primarily transmitted between men by condomless penile-anal sex [4, 5]. Incident anal chlamydia was associated with frequent receptive rimming [6] Another cross-sectional study among MSM in Peru showed that receptive oral-penile sex was not significantly associated with oropharyngeal chlamydia infection [7]. A further mathematical modelling study explored the transmission of C. trachomatis in MSM and found that sexual practices involving the oropharynx or saliva (e.g. oral sex or rimming) improved the calibration of the model [8]
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