Pharyngeal Gonorrhoea: The Willingness of Australian Men Who Have Sex with Men to Change Current Sexual Practices to Reduce Their Risk of Transmission—A Qualitative Study

Abstract

BackgroundThe pharynx is a common site of gonorrhoea among men who have sex with men (MSM) and may serve as a reservoir for infection, with saliva implicated in transmission possibly through oral sex, kissing, and rimming. Reducing sexual activities involving saliva may reduce pharyngeal gonorrhoea. This study aimed to explore MSM’s views and knowledge of pharyngeal gonorrhoea and their willingness to change saliva transmitting sexual practices. MSM were also asked their views on using alcohol-containing mouthwash to potentially reduce transmission.MethodsUsing a qualitative descriptive approach, 30 MSM who were part of a larger study (GONE) conducted at the Melbourne Sexual Health Centre agreed to take part in semi-structured interviews between 14th May and 8th September 2015. The 10 interviews conducted face to face and 20 by telephone, lasted between 20–45 minutes. Data were analysed using qualitative content analysis.ResultsMost men considered pharyngeal gonorrhoea to be a non-serious sexually transmitted infection and attributed transmission primarily to oral sex. Almost all men reported they would not stop kissing, oral sex, or consider using condoms for oral sex to reduce their risk of pharyngeal gonorrhoea. Kissing and oral sex were commonly practised and considered enjoyable low risk sexual activities. Men were more likely to consider stopping sexual activities they did not enjoy or practice often, in particular insertive rimming. If proven effective, the majority of men reported they would use alcohol-containing mouthwash to reduce or prevent their risk of pharyngeal gonorrhoea.ConclusionFindings from this study suggest MSM are unlikely to stop saliva transmitting sexual practices they enjoy and consider low risk. Men would, however, consider using alcohol-containing mouthwash if found to be effective, highlighting the importance of exploring innovative strategies to reduce pharyngeal gonorrhoea.

Getting the terminology right in sexual health research: the importance of accurately classifying fuck buddies among men who have sex with men

“…However, these terms are often poorly defined worldwide, highly subjective and vary between studies 1–3. In research focusing on men who have sex with men (MSM), regular partners are commonly assumed to refer to romantic relationships, such as ‘boyfriends’, ‘husbands’ or ‘life partners’;4 5 while casual partners are commonly thought to include relationships without emotional attachments, such as ‘one-night stands’ or anonymous sex 6 7. The term ‘fuck buddy’ is very commonly used to refer to sexual partners in the MSM population, but this term is not common in sexual health research.…”

Willingness to change behaviours to reduce the risk of pharyngeal gonorrhoea transmission and acquisition in men who have sex with men: a cross-sectional survey

“…We show that tongue kissing is the practice that MSM are least willing to stop to reduce the risk of both gonorrhoea transmission and also acquisition. Kissing has been reported as the most common activity among MSM,10 and it has been considered an important component of an intimate relationship 3. Oral sex is another common practice that MSM would not be willing to stop nor use condoms for, presumably because MSM consider condomless oral sex to be of negligible risk compared with condomless anal sex 3.…”

“…Kissing has been reported as the most common activity among MSM,10 and it has been considered an important component of an intimate relationship 3. Oral sex is another common practice that MSM would not be willing to stop nor use condoms for, presumably because MSM consider condomless oral sex to be of negligible risk compared with condomless anal sex 3. The majority of men do not enjoy performing rimming,3   and this may possibly explain why more men were willing to stop performing rimming as a preventive intervention.…”

“…Oral sex is another common practice that MSM would not be willing to stop nor use condoms for, presumably because MSM consider condomless oral sex to be of negligible risk compared with condomless anal sex 3. The majority of men do not enjoy performing rimming,3   and this may possibly explain why more men were willing to stop performing rimming as a preventive intervention. Similarly MSM may be more willing to stop using saliva as a lubricant during anal sex as they may prefer to use commercial lubricants.…”

“…However, the majority of MSM would not use condoms during oral sex,3 and it is even more unlikely that MSM will start using condoms during oral sex in the era of HIV pre-exposure prophylaxis. A mathematical model has further demonstrated that the prevalence of gonorrhoea at all sites cannot be eliminated even if there were 100% condom use for anal sex,2 suggesting there are factors other than condomless anal sex that cater for the burden of gonorrhoea among MSM 4.…”