The Impact of Mouthwash on the Oropharyngeal Microbiota of Men Who Have Sex with Men: a Substudy of the OMEGA Trial

Plummer, Erica L; Maddaford, Kate; Murray, Gerald L; Fairley, Christopher K; Pasricha, Shivani; Mu, Andre; Bradshaw, Catriona S; Williamson, Deborah A.; Chow, Eric P F

doi:10.1128/spectrum.01757-21

Cited by 10 publications

(8 citation statements)

References 61 publications

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“…A previous study examining the incidence of syphilis among 96 men who have sex with men in Indonesia (2019) found that using antibacterial mouthwash containing chlorhexidine increased the odds of syphilis acquisition, and it was similarly suggested that this could be due in part to changes in the oral microbiome [ 45 ]. An Australian clinical trial has shown that daily use of Listerine or Biotene for 12 weeks had no significant effect on the oral microbiome [ 46 ]; however, no study to our knowledge has examined the effect of Betadine and Cepacol used in combination on the oral microbiome. In any event, it is clear from our interviews that, for some sex workers, mouthwash use gives the feeling of protecting against bacteria and viruses and is thus used as a safety precaution (in addition to being widely used for hygiene purposes), therefore establishing that the role of mouthwash use with regard to gonorrhea prevention is important to inform best practice.…”

Section: Discussionmentioning

confidence: 99%

Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study

Phillips,

Fairley,

Maddaford

et al. 2024

JMIR Public Health Surveill

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Background The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection. Objective This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients. Methods This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted. Results In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30% of sex workers (192/664, 28.9%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients’ lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam. Conclusions Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention.

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Section: Discussionmentioning

confidence: 99%

Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study

Phillips,

Fairley,

Maddaford

et al. 2024

JMIR Public Health Surveill

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“…Microbiome analysis will be undertaken as previously described 25. DNA will be extracted from tonsillar samples using the QIASymphony PowerFecal Pro kit (Qiagen).…”

Section: Discussionmentioning

confidence: 99%

“…Open access Microbiome analysis will be undertaken as previously described. 25 DNA will be extracted from tonsillar samples using the QIASymphony PowerFecal Pro kit (Qiagen). Extracted DNA will be used to generate an amplicon-based library using primers that amplify the V4 region of the 16S rRNA gene: 515F (59-GTGYCAGCMGCCGCGGTAA-39) and 806R (59-GGACTACNVGGGTWTCTAAT-39).…”

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confidence: 99%

Optimisation of treatments for oralNeisseria gonorrhoeaeinfection: Pharmacokinetics Study (STI-PK project) – study protocol for non-randomised clinical trial

et al. 2022

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IntroductionNeisseria gonorrhoeaeinfections are common and incidence increasing. Oropharyngeal infections are associated with greater treatment failure compared with other sites and drive transmission to anogenital sites through saliva. Gonococcal resistance is increasing and new treatments are scarce, therefore, clinicians must optimise currently available and emerging treatments in order to have efficacious therapeutic options. This requires pharmacokinetic data from the oral cavity/oropharynx, however, availability of such information is currently limited.Methods and analysisHealthy male volunteers (participants) recruited into the study will receive single doses of either ceftriaxone 1 g, cefixime 400 mg or ceftriaxone 500 mg plus 2 g azithromycin. Participants will provide samples at 6-8 time points (treatment regimen dependent) from four oral sites, two oral fluids, one anorectal swab and blood. Participants will complete online questionnaires about their medical history, sexual practices and any side effects experienced up to days 5–7. Saliva/oral mucosal pH and oral microbiome analysis will be undertaken. Bioanalysis will be conducted by liquid chromatography-mass spectrometry. Drug concentrations over time will be used to develop mathematical models for optimisation of drug dosing regimens and to estimate pharmacodynamic targets of efficacy.Ethics and disseminationThis study was approved by Royal Melbourne Hospital Human Research Ethics Committee (60370/MH-2021). The study results will be submitted for publication in peer-reviewed journals and reported at conferences. Summary results will be sent to participants requesting them. All data relevant to the study will be included in the article or uploaded as supplementary information.Trial registration numberACTRN12621000339853.

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“…After gargling the mouthwash for a week, several bacterial genera, including Prevotella , Antinomyces , and Fusobacterium , were reduced, while the genera Neisseria , Streptococcus , etc., were increased. To our best knowledge, the effects of LIS on salivary microbiome using a 16S approach have not been reported, although the long term (12 weeks) effects of LIS on oropharyngeal microbiome was recently described ( Plummer et al., 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Short-term effects of Chlorhexidine mouthwash and Listerine on oral microbiome in hospitalized patients

Liu

Chen²,

Jeng³

et al. 2023

Front. Cell. Infect. Microbiol.

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IntroductionChlorhexidine (CHX) and essential oil containing mouthwashes like Listerine® can improve oral hygiene via suppressing oral microbes. In hospitalized patients, CHX mouthwash reduces the incidence of ventilator-associated pneumonia. However, CHX use was also associated with increased mortality, which might be related to nitrate-reducing bacteria. Currently, no study determines oral bacteria targeted by essential oils mouthwash in hospitalized patients using a metagenomic approach.MethodsWe recruited 87 hospitalized patients from a previous randomized control study, and assigned them to three mouthwash groups: CHX, Listerine, and normal saline (control). Before and after gargling the mouthwash twice a day for 5-7 days, oral bacteria were examined using a 16S rDNA approach.ResultsAlpha diversities at the genus level decreased significantly only for the CHX and Listerine groups. Only for the two groups, oral microbiota before and after gargling were significantly different, but not clearly distinct. Paired analysis eliminated the substantial individual differences and revealed eight bacterial genera (including Prevotella, Fusobacterium, and Selenomonas) with a decreased relative abundance, while Rothia increased after gargling the CHX mouthwash. After gargling Listerine, seven genera (including Parvimonas, Eubacterium, and Selenomonas) showed a decreased relative abundance, and the magnitudes were smaller compared to the CHX group. Fewer bacteria targeted by Listerine were reported to be nitrate-reducing compared to the CHX mouthwash.DiscussionIn conclusion, short-term gargling of the CHX mouthwash and Listerine altered oral microbiota in our hospitalized patients. The bacterial genera targeted by the CHX mouthwash and Listerine were largely different and the magnitudes of changes were smaller using Listerine. Functional alterations of gargling CHX and Listerine were also different. These findings can be considered for managing oral hygiene of hospitalized patients.

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The Impact of Mouthwash on the Oropharyngeal Microbiota of Men Who Have Sex with Men: a Substudy of the OMEGA Trial

Cited by 10 publications

References 61 publications

Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study

Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study

Optimisation of treatments for oralNeisseria gonorrhoeaeinfection: Pharmacokinetics Study (STI-PK project) – study protocol for non-randomised clinical trial

Short-term effects of Chlorhexidine mouthwash and Listerine on oral microbiome in hospitalized patients

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