Abstract
IntroductionGonorrhoea and chlamydia cases have been rising among gay, bisexual and other men who have sex with men (MSM) over the last decade. The majority of cases are extragenital and occur at the oropharynx and anorectum. The aim of this narrative review was to review the risk factors and mode of transmission for gonorrhoea and chlamydia at the oropharynx and anorectum among MSM.Results and discussionNew evidence suggests that oropharyngeal gonorrhoea can be transmitted by kissing in addition to through the established route of condomless oral sex; and anorectal gonorrhoea can be acquired when saliva is used as a lubricant for anal sex and rimming in addition to the established route of condomless penile‐anal sex in MSM. In contrast, condomless penile‐anal sex remains the major route for chlamydia transmission.ConclusionsSubstantial transmission of gonorrhoea may occur with practices other than the established routes of condomless oral and/or anal sex and hence condoms may not be effective in preventing gonorrhoea transmission to extragenital sites. In contrast, condoms are effective for chlamydia control because it is mainly transmitted through condomless penile‐anal sex. Novel interventions for gonorrhoea that reduce the risk of transmission at extragenital site are required.
Highlights
Gonorrhoea and chlamydia cases have been rising among gay, bisexual and other men who have sex with men (MSM) over the last decade
A US study reported that HIV-positive MSM had a higher prevalence of anorectal gonorrhoea (8.2% vs. 3.3%) and anorectal chlamydia (9.0% vs. 6.6%) than HIV-negative MSM; the prevalence was similar in both groups for oropharyngeal infection [15]
These findings are consistent with another study conducted in Melbourne, Australia, showing that the prevalence of anorectal gonorrhoea was higher in HIV-positive MSM (15.4%) than in HIVnegative MSM (7.3%) but the prevalence of oropharyngeal gonorrhoea was similar in both in HIV-positive MSM (9.9%) and HIV-negative MSM (8.1%) [36]
Summary
Gonorrhoea and chlamydia cases have been rising among gay, bisexual and other men who have sex with men (MSM) over the last decade. This is consistent with the observation by Passaro (2018) who reported the prevalence of oropharyngeal gonorrhoea did not differ between MSM who had receptive oral-penile sex (10.3%) and those who did not (9.8%) [20]. Consistent with Templeton et al.’s study, Cornelisse et al.’s study identified that both insertive rimming and receptive fellatio are risk factors for oropharyngeal gonorrhoea in MSM in the univariable analysis [41].
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