Associations Between Anorectal Chlamydia and Oroanal Sex or Saliva Use as a Lubricant for Anal Sex: A Cross-sectional Survey

Cornelisse, Vincent J; Fairley, Christopher K.; Read, Tim; Lee, David; Walker, Sandra; Hocking, Jane S; Chen, Marcus Y; Bradshaw, Catriona; Chow, Eric P F

doi:10.1097/olq.0000000000000800

Cited by 21 publications

(27 citation statements)

References 14 publications

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“…However, the role of saliva in chlamydia transmission is less clear (19,20). Unlike with gonorrhea, saliva as a lubricant for anal sex is not associated with anorectal chlamydia after adjusting for condom use and other activities such as rimming (9). Our study showed that C. trachomatis can be detected in saliva and supports the possibility of C. trachomatis transmission via saliva; however, more research into the load of viable and therefore potentially infectious C. trachomatis is needed in order to better understand the implication of the load of DNA detected in saliva reported here.…”

Section: Discussionmentioning

confidence: 99%

“…Past studies have shown that Neisseria gonorrhoeae can be isolated from the tonsillar fossae, the posterior oropharynx, and the saliva (7,8), suggesting that saliva exchange in sexual activities may be associated with gonorrhea acquisition. Epidemiological studies have found that using saliva as a lubricant for anal sex and rimming are strong risk factors for anorectal gonorrhea but not for anorectal chlamydia (9)(10)(11). There has been increased evidence showing that tongue kissing may be a risk factor for oropharyngeal gonorrhea (12); however, the evidence of the risk factors for oropharyngeal chlamydia is limited (11).…”

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confidence: 99%

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Bacterial Load of Chlamydia trachomatis in the Posterior Oropharynx, Tonsillar Fossae, and Saliva among Men Who Have Sex with Men with Untreated Oropharyngeal Chlamydia

et al. 2019

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The aim of this study was to determine whether Chlamydia trachomatis could be detected in saliva and if infection is specific to an anatomical site in the oropharynx. Men who have sex with men (MSM) who were diagnosed with oropharyngeal chlamydia at the Melbourne Sexual Health Centre in 2017-2018 were invited to participate upon returning for treatment. Swabs at the tonsillar fossae and posterior oropharynx and a saliva sample were collected. Throat samples were tested for C. trachomatis by the Aptima Combo 2 assay. The bacterial loads of C. trachomatis in all samples were assessed by quantitative PCR (qPCR) detecting the ompA gene. We calculated the positivity and bacterial load of C. trachomatis for all samples. Forty-two MSM were included. The median age was 28 years (interquartile range [IQR], 24 to 33 years). Thirty-two participants (76.2%; 95% confidence interval [CI], 60.5% to 87.9%) had C. trachomatis detected by qPCR at both the tonsillar fossae and the posterior oropharynx, followed by 9.5% (n = 4; 95% CI, 2.7% to 22.6%) positive at the posterior oropharynx only and 4.8% (n = 2; 95% CI, 0.58% to 16.2%) positive at the tonsillar fossae only. Twenty-nine MSM had C. trachomatis detected in saliva (69.0%; 95% CI, 52.9% to 82.3%). The median C. trachomatis load in saliva was 446 copies/ml (IQR, 204 to 1,390 copies/ml), that in the tonsillar fossae was 893 copies/swab (IQR, 390 to 13,224 copies/ml), and that in the posterior oropharynx was 1,204 copies/swab (IQR, 330 to 16,211). There was no significant difference in C. trachomatis load between the tonsillar fossae and the posterior oropharynx (P = 0.119). Among MSM with oropharyngeal chlamydia, nearly three-quarters had chlamydia DNA detected in saliva, although the viability and implications for transmission are unknown.

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Bacterial Load of Chlamydia trachomatis in the Posterior Oropharynx, Tonsillar Fossae, and Saliva among Men Who Have Sex with Men with Untreated Oropharyngeal Chlamydia

et al. 2019

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“…practices that may transmit it. Indeed recent epidemiological studies have assessed some potential routes such as kissing, rimming (oral-anal sex) and the use of saliva as a lubricant for anal sex among MSM [9][10][11]. However, studying the potential contribution of these sexual practices to transmission using epidemiological studies is difficult because of the great number of questions that would be required for potentially many sexual partners.…”

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confidence: 99%

Chlamydia trachomatis transmission between the oropharynx, urethra and anorectum in men who have sex with men: a mathematical model

Chow

Ong

et al. 2020

BMC Med

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Background It has been presumed that Chlamydia trachomatis is transmitted between men only through anal or oral sex, but no mathematical models have tested this presumption. Methods To test this presumption, we created 20 compartmental mathematical models of different sexual practices that included both oral and anal sex and calibrated these models to the observed rates of Chlamydia trachomatis infection at three anatomical sites from 4888 men who have sex with men (MSM) in Melbourne Sexual Health Centre during 2018–2019. Results A model that included only oral and anal sex could replicate the observed rates of single-site infection at the oropharynx, urethra and rectum alone, but could not replicate infection at more than one of these sites (multisite). However, if we included transmission from sexual practices that followed one another in the same sexual episode (e.g. saliva contamination of the penis from oral sex transmitting chlamydia to the rectum by anal sex), we significantly improved the calibration of multisite infection rates substantially. Conclusions Our modelling study suggests that transmission routes other than just oral and anal sex are necessary to explain the high rate of Chlamydia trachomatis infection at more than one site.

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“…Unlike anorectal gonorrhoea, a Melbourne study by Cornelisse et al . showed that the use of saliva as a lubricant for anal sex is not a risk factor for anorectal chlamydia in MSM .…”

Section: Resultsmentioning

confidence: 99%

The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission

Chow

Fairley

2019

J Intern AIDS Soc

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Introduction Gonorrhoea 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 discussion New 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. Conclusions Substantial 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.

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Associations Between Anorectal Chlamydia and Oroanal Sex or Saliva Use as a Lubricant for Anal Sex: A Cross-sectional Survey

Cited by 21 publications

References 14 publications

Bacterial Load of Chlamydia trachomatis in the Posterior Oropharynx, Tonsillar Fossae, and Saliva among Men Who Have Sex with Men with Untreated Oropharyngeal Chlamydia

Bacterial Load of Chlamydia trachomatis in the Posterior Oropharynx, Tonsillar Fossae, and Saliva among Men Who Have Sex with Men with Untreated Oropharyngeal Chlamydia

Chlamydia trachomatis transmission between the oropharynx, urethra and anorectum in men who have sex with men: a mathematical model

The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission

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